[Hemodynamic effects of enalapril in patients with non-complicated acute myocardial infarct]. To evaluate the hemodynamic effects of the first oral administration of enalapril maleate, a long-acting ACE-inhibitor, in the early phase of an acute uncomplicated myocardial infarction, we studied 15 patients, in Killip class I or II, within 72 hours from the onset of symptoms. Hemodynamic measurements were obtained by a triple lumen 7 F Swan-Ganz catheter, inserted into the pulmonary artery, under control conditions and 2, 4, 6, 8 and 12 hours after 10 mg (15 patients) and 20 mg (11 patients) of the drug. Ten milligrams of enalapril reduced systolic and mean arterial blood pressure (from 118 +/- 17 to 111 +/- 18 mmHg, p < .05, and from 92 +/- 12 to 83 +/- 12 mmHg, p < .01, respectively), with a maximum effect after 4 hours from administration. Heart rate and vascular resistances showed an insignificant trend toward reduction, and no changes were observed in left ventricular systolic work index, right and left ventricular filling pressures or cardiac index. Hemodynamic changes induced by 20 mg of the drug, in a smaller group of patients, had a similar trend, which did not reach a statistical significance. In conclusion, in patients with acute uncomplicated myocardial infarction, a single oral dose of enalapril maleate is safe and well tolerated, does not induce severe hypotension, and produces potentially beneficial changes in hemodynamics.


[Atrial natriuretic peptide, left ventricular mass and renin-angiotensin-aldosterone system in essential arterial hypertension of a mild or moderate degree]. The relationship between plasma atrial natriuretic peptide (ANP), renin-angiotensin-aldosterone system and left ventricular mass in essential hypertension was assessed. Immunoreactive ANP in 10 normal subjects and 20 untreated patients with mild to moderate essential hypertension was compared with echocardiographic measurement of cardiac size, function and blood pressure. Venous plasma concentrations of ANP were also studied in relation to urinary sodium and potassium excretion, as well as the renin-angiotensin-aldosterone system. Plasma ANP was higher in hypertensive patients (25.3 +/- 13.3 pg/ml; p = 0.003) than normotensive subjects (11.1 +/- 2.7 pg/ml). In hypertensive patients, plasma ANP was inversely related to plasma renin activity (PRA) (r = -0.6; p = 0.009). No relationship was found between ANP and blood pressure, nor between the indices of left ventricular mass and function or urinary electrolytes. This study showed that circulating ANP is, in average, significantly increased in hypertensive patients, consistent with previous reports. Our data do not support a direct link between left ventricular mass and increased plasma ANP levels in hypertensive patients. Whether the inverse relationship between ANP and PRA in this pathologic state is a direct one or merely a secondary association has not been clearly established.


[Controversies in the selection of donors in heart transplants]. The shortage of ideal donor hearts has led to an increasing number of would-be heart transplant recipients who die while on the waiting list: an extension of the classical donor criteria seems necessary to expand the donor pool. In this paper, the major controversies on donor selection are presented, along with the clinical results obtained in cardiac transplantation with donor grafts not complying with standard criteria. The extension of donor age over 35 years is supported by the decreased incidence of coronary artery disease (CAD) in the Western world. In our experience, the number of donors over 40 years has increased steadily, without concomitant significant increase in postoperative short- and medium-term mortality after cardiac transplantation. The relative importance of CAD risk factors in the older heart donor is to be weighed out on a case-by-case basis. The performance of coronary angiography in 90% of the donor grafts over 50 years has led to more accurate selection. ECG minor alterations and ECHO diagnosed dyskynesias are of uncertain significance. Localized infection, transitory hypotension, brief cardiac arrest and thoracic trauma do not necessarily contraindicate heart donation. The importance of donor/recipient weight mismatch over 20% is critical only in face of high pulmonary vascular resistance. Prolonged dopamine infusion above 10 micrograms/kg/min may predict poorer function outcome. From our data, severe donor dysionemia may be very hazardous. In conclusion, our experience demonstrates that extended donor criteria do not compromise short- and medium-term clinical results of cardiac transplantation. Nevertheless, several controversial aspects of donor graft selection remain open.


[Rare anatomic coronary variant. Description of a case]. A case of a patient with post-infarction angina and peculiar abnormalities of the coronary arteries is reported. We describe the anatomic findings as well as the possible therapeutical options.


[Fatal aortic dissection in a young woman at the 32nd week of pregnancy]. Aortic dissection in young women without Marfan disease is unusual. When it occurs it is often related to pregnancy. We report a fatal case of aortic dissection in a 29-year-old woman at the end of her first pregnancy. A prompt diagnosis and surgical treatment usually permits the physician to save both mother and fetus. In this case the delay in the diagnosis was fatal for both. We retain that knowledge of this rare complication of pregnancy is useful in order to refer patients early for surgical treatment.


[HELLP syndrome--metamorphosis of pre-eclampsia]. During an eight year period, 100 patients with the diagnosis of pre-eclampsia and HELLP syndrome were treated at the Departments of Obstetrics and Gynaecology of 2 University Hospitals (Technische Universität München and Universität Göttingen). The clinical treatment concepts, which were used in common at the two hospitals, are presented and differ from the common clinical management of pre-eclampsia. The results and therapy concepts are compared and critically reviewed. In recent years, the number of diagnoses and cases of HELLP syndrome has been increasing. Case reports, epidemiological statistics and maternal and perinatal mortality rates indicate a change of the "Gestalt" of preeclampsia due to the HELLP syndrome and its complications.


[Prenatal diagnosis and therapy of adrenogenital syndrome with 21-hydroxylase deficiency]. Genetic counselling of the parents is prerequisite before prenatal diagnosis and prenatal therapy of CAH. Today, chorionic villous biopsy with DNA probe is the method of choice to identify homozygous CAH-fetuses. The aim of prenatal therapy is to prevent intrauterine virilization of the external genitalia in affected female fetuses. Therefore, dexamethasone (3 x 0.5 mg/d p.o.) is given to the mother immediately when pregnancy is confirmed, before prenatal diagnosis and karyotyping is possible. After the result of prenatal diagnosis, treatment is continued until term only when the fetus is affected and female. Prenatal diagnosis and effective treatment of female CAH fetuses greatly reduces the need for corrective surgery and thus helps to alleviate anxieties of prospective parents and therefore encourages further pregnancies. However, prenatal treatment of CAH to date still is an experimental therapy [corrected].


[Umbilical blood flow relations in patients with gestosis-- gestosis-specific Doppler phenomenon]. A collective of 48 pregnant women, whose pregnancies showed signs of a pregnancy-induced hypertension or gestotic tendencies was examined by Doppler ultrasound. The subject of interest was the resistance along the umbilical cord. Measurements were taken both ends of the umbilical cords. Usually, a decline of the indices is seen, which makes the difference between the two ends (Delta F) turn out positive. Pregnancies with any sign of a gestotic development, showed elevated resistances at the placental end of the cord. The indices of the foetal abdominal insertion were just about the same. Delta F changed significantly in our group of patients. Here, the values of both sides either did not differ from one another or the placental indices even exceeded the foetal ones. We called this special constellation of umbilical indices a Doppler phenomenon characterising gestotic pregnancies.


[Cellular immunity in pregnancy-induced hypertensive diseases]. Cytokines (IL-1, sIL-2R, IL-3, IL-6, TNF-alpha, IFN-gamma, GM-CSF and neopterin) were measured in sera of 37 patients with hypertensive disorders of pregnancy, 10 healthy pregnant and 10 healthy non-pregnant controls. With the exception of neopterin (p = 0.004) there were no statistically significant differences in cytokine concentrations between healthy pregnant and non-pregnant controls. No statistically relevant differences between healthy pregnant women and hypertensive patients could be found in cytokines of T-lymphocytic origin except GM-CSF in patients with HELLP syndrome (p = 0.02). Elevated levels of IL-6, TNF-alpha and neopterin were observed in hypertensive women. Differences to healthy pregnant controls were statistically significant for IL-6 (p = 0.008), TNF-alpha (p = 0.009) and neopterin (p = 0.04) and were more pronounced in severe forms of the disease. These 3 parameters of monocytic origin showed significant positive correlations amongst each other. A participation of cell-mediated immunity (especially monocytes/macrophages) in the pathomechanism of hypertensive disorders of pregnancy can thus be assumed.


[Monitoring daily insulin needs--an important follow-up parameter in late pregnancy in diabetic mothers?]. Pregnancy is a state of natural insulin resistance, which is due to placental production of human placental lactogen (HPL), an insulin antagonising hormone, leading to a remarkable increase of insulin requirement in pregnant diabetics in the 2nd and 3rd trimester. Aim of the prospective study was the quantification of daily insulin requirement during the last 28 days before delivery in pregnant women suffering from insulin-dependent diabetes mellitus (n = 20) with and without evidence of "placental insufficiency syndrome" employing peripheral rheography as indirect parameter for placental haemoperfusion. All diabetic women included controlled carbohydrate metabolism by means of a functional insulin therapy (FIT; HbA1c in normal range < 5.8%), a multiple injection regime with frequent blood glucose self-control at least from the 2nd trimester of pregnancy. According to the results of peripheral rheography in the 34th gestational week, an impedanceplethysmographic method for quantifying peripheral haemoperfusion, patients were subdivided in a group with (B: n = 8) and without (A: n = 12) indirect evidence of placental dysfunction. Groups did not differ in maternal age, duration of diabetes, maternal weight and week of delivery (A: 39.08 +/- 1.44; B: 39.12 +/- 1.46). Mean weight of neonates was lower in group B (3319 +/- 619 g) compared to group A (3613 +/- 437 g). During a comparable state of near-normoglycaemia in both groups, 7 out of 8 women in group B, but only 1 out of 12 women in group A displayed a significant decrease in daily insulin requirement from day -28 to day -3 before delivery (linear regression; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


[Induction of labor with a new intracervically administered prostaglandin E2 gel. Report of initial experience]. We report on our experience with the induction of labour using 0.5 mg of prostaglandin E2 gel (Cerviprost, Organon) intracervically. Out of 43 cases, 27 were primiparae. Indication for induction was: 10 post-term pregnancies, 9 PROM's > 24h, 12 foetal and 11 maternal indications. Mean Bishop score before induction was 3.1 and 9 hours later or at the beginning of regular contractions 6.7. In 9 of the 43 cases induction was unsuccessful. There were 23 spontaneous vaginal deliveries, 6 forceps and 5 Caesarean sections. Uterine hyperstimulation was found in 6 cases, 5 of which occurred during the first 16 inductions, and only one was seen during the following 27. A possible reason may be unrecognised extra-amniotic application of the gel. Intracervical prostaglandin seems to be an appropriate method not only for cervical ripening but also for induction of labour in cases with a low Bishop score. Although side effects are rare, sufficient monitoring and control of mother and foetus are mandatory.


[Occlusion of a vesicovaginal fistula with Latzko-repair]. The Latzko procedure is a well-known method for the closure of small vesico-vaginal fistulas occurring in the vaginal dome after hysterectomy. This method is favoured by gynaecologists. In three Departments of gynaecology, a total of 104 patients were treated. 76% had been referred from other hospitals. 56.7% resulted from gynaecological operations. In 69.2% was a benign and in 28.8% a malignant disease. In only 2 cases, the primary disease remained unknown. In 97 of 104 (= 93.3%) cases, the procedure according to Latzko succeeded at the first attempt. 5 of 7 recurrences were resolved by the second attempt with the same operative technique according to Latzko, signifying a secondary success rate of 98%. There were only 2 notable complications: the one, where a postoperative bladder haemorrhage attributed to anticoagulants, and the second with a bladder stone noticed 11 years after the Latzko procedure. This technique can be performed in 95% of all vesico-vaginal fistulas occurring. The fundamental advantages of its use are: short duration of the procedure, high cure rate and few complications.


[Prognostic and therapeutic significance of steroid receptors in invasive breast cancer]. It is generally accepted that breast cancer with positive steroid receptors has a better prognosis than with negative receptors. The aim of this study was to analyse the influence of the oestrogen (ER) and progesterone (PR) receptors regarding disease-free interval (DFI) and overall (oa) survival of 441 patients operated on in the Department of Gynaecology of the University Hospital of Zürich. Analysis of the subgroups separated according to menopausal status showed the following results: Premenopausal patients (n = 135): Only PR have a significant influence on the oa-survival (p = 0.0370), not the ER. The DFI was independent of ER and PR positive findings. Postmenopausal patients (n = 306): In this group only the ER has a significant influence (p = 0.0296) on the oa-survival, not the PR. Both steroid receptors did not have any influence regarding DFI. Metastases and local recurrence occur pre- and postmenopausaly approximately at the same time, independent of the quality of the steroid receptors. The better oa-survival despite the same DFI can be explained by a better response to the therapy by patients in the premenopause with positive PR status and patients in the postmenopause with positive ER status.


[Use of computer-assisted image analysis for the detection of immunohistochemical receptor status in breast cancer. Immunohistochemical densitometry receptor analysis--IRDA]. A method for the evaluation of the immunohistochemical staining score of steroid receptors in breast cancer using computer-based image analysis is presented. The optical density of tumour cell nuclei was measured using kryostat sections and, using a control section as reference, an objective threshold for specific staining was defined. In intensively stained sections, a good correlation with visual scoring was achieved, but in 9 out of 16 sections, which were regarded as receptor-negative by visual scoring, a specific receptor-positive staining was demonstrated by image analysis. Next to the percentage of positive cells (PP) and the mean staining intensity (SI), a histogram of the receptor concentration in positive nuclei was calculated. The method allows, besides an objective evaluation and documentation, an exact definition of a threshold for specific receptor measurement and furthermore shows the pattern of receptor concentration in the tumour cell nuclei. Hence, the method could contribute towards a more widespread use of immunohistochemical receptor analysis.


[Malaria tropica and pregnancy].

[Malaria tropica and pregnancy]. The authors report on a female patient of 26 years of age suffering from malaria tropica infection in her 36th week of pregnancy with fatal outcome. The newborn (after performance of Caesarean section) was infected connatally. Although infections with malaria are rare in Europe today--especially during pregnancy--there is a probability of rising incidence on account of increasing international tourism. Therapeutic problems are expected to multiply due to the resistance of Plasmodia to antiparasitary medication. Additionally pregnancy involves the risk of a more severe course of the disease in the mother. Pregnant women should be discouraged from travelling to countries with malarial risk because of the likelihood of a high rate of abortion, danger of intrauterine retardation, increased incidence of premature deliveries and risk of connatal infection of the newborn. If such warnings cannot be heeded, the persons concerned must be given all relevant information on conventional preventive measures in accordance with WHO recommendations and drug prophylaxis as recommended by a hospital or institution dealing with tropical diseases according to updated standards. The measures to be taken must be adapted to the individual risk of exposure of the patient.


[Malignant lymphomas of the vulva and vagina]. Primary appearance of a malignant lymphoma in the vulvovaginal region is extremely rare. In this paper, we report on three such cases we observed during the last few years. There was no difference in clinical manifestation compared to cancer of the vulva/vagina. The diagnosis was made using histological and immunohistochemical methods. Choice of the treatment depended upon the stage of malignancy and spreading of the tumourous changes (radiation, chemotherapy). On reviewing the literature of the last 15 years, we could not find any description of primary malignant lymphoma in the vulva and vaginal region.


[Forensic aspects of bladder and ureteral injuries in standard gynecologic operations]. Damage to the efferent urinary passages during abdominal or vaginal hysterectomy cannot always be prevented no matter how carefully one may proceed preoperatively and intraoperatively. However, all possibilities of avoiding complications or at least of recognising and eliminating them before surgery, must be explored. Nevertheless, formation of vesicovaginal or ureterovaginal fistulas or of a congested ureter will be rare. In such cases, one cannot jump to the conclusion of mismanagement or a therapeutic error from the mere occurrence of damage. In each individual case, there must be an expertise and a legal judgment as to whether there has been any infringement of the legal requirement to exercise all possible medical care lege artis. Claims for damages are justified only if the conditions of an individual case show, on close examination, that such care had not been exercised.


[Carl Credé: in memory of the 100th anniversary of his death (14 March 1892)]. Major advances taught by the German gynaecologist and obstetrician Carl Siegmund Franz Credé were the manual expression of the placenta and the prophylaxis of the gonoblennorrhoea. Under his supervision, as head of the obstetrical department of the Berlin Charité, the first exclusively gynaecological unit was founded in Europe. In 1856, he was elected head of the Department of Obstetrics of the University of Leipzig. Credé was the editor of the first 42 volumes of "Archiv für Gynäkologie". He died on March 14th, 1892, from prostatic carcinoma.


[An unusual type of locomotion in mice of line 101/Hy]. An unusual type of locomotion--backward movements--was revealed in the 101/HY mouse strain characterized by a chromosomal instability and the defect in DNA repair. The backward movements were found in 60% of mice belonging to the population under study. The manifestation of the character was found to vary: it was high in 16% of the animals. No age and sex differences were found. The backward movements in the 101/HY mouse strain were somewhat similar to the peculiarity in locomotion of the neurological hot-foot mouse mutants. The latter had mild anatomical alterations in the cerebellum. No obvious brain pathology was revealed in the 101/HY mice.


[Structural heterochromatin and X-chromosome inactivation]. Our previous studies on the expression of the G6PD and alpha-GAL genes from the X chromosome of inter-specific hybrids of voles of the Microtus genus have demonstrated an unusual pattern of X-inactivation in the parents. The observed phenomenon was explained as the presumable result of nonrandom inactivation of the X chromosomes with a heterochromatin block in crosses involving Microtus arvalis whose X lacks a heterochromatin region and also of random X inactivation when both parents had heterochromatin blocks on the Xs. Based on known models, we discuss here the possible mechanisms of the effect of heterochromatin on X-inactivation; we give preference to the model postulating binding of nonhistone protein to the inactivation centre as the key event. The hypothesis we offer suggests change in chromatin conformation in the inactivation centre during packaging of heterochromatic region of a chromosome; the protein molecules diffusing along the chromosome towards the heterochromatin region by the "facilitated diffusion" mechanism may happen to be in the region of the X-inactivation centre, which, being in a favorable state, binds specifically to it; as a consequence, the binding probability of protein to heterochromatin increases as compared to chromosome without heterochromatin block.


[Cloning the trpBA-genes from Pseudomonas mendocina and Pseudomonas marginata]. The trpBA genes of Pseudomonas mendocina and P. marginata were cloned in Escherichia coli using pBR322 as a vector. Transcription of the cloned genes took place from their own promoters, in the following order: trpB-->trpA. The latter genes were not linked to the trpF gene and could not be induced by indole glycerol phosphate. Thus, the trpBA cluster of P. mendocina and P. marginata are distinguished from that of P. putida, P. aeruginosa (trpIBA) and P. acidovorans (trpFBA).


Right-to-die responses from a random sample of 200. Seeking public attitudes toward the right-to-die, 200 telephone interviews were conducted with a random sample of residents in a midwestern city in the summer of 1990. Overall, 90% favored some kind of personal control over death circumstances. With semantics as an independent variable (euthanasia, mercy killing, physician-assisted suicide, or some form of personal control over death) only the group to whom "physician-assisted suicide" had been presented as a choice said "no" or "probably not" to a legalization question (p = < .0001).


Alterations in perceptions of caregiving demands in advanced cancer during and after the experience. Bereaved spouse caregivers (N = 65) studied during the time they were giving care were contacted a minimum of 6 months following the first interview to determine if perceptions of the demands of caregiving had changed over time. Thirty-one participated in the second phase of the study. Although managing the physical care was identified as most difficult during the time of caregiving, reflective thought about the difficulties in caregiving revealed that standing by or observing the slow deterioration of the ill spouse was perceived as most difficult. In addition, over 50% of the caregivers returning the survey at Time 2 reported personal regrets with respect to their ole as caregiver. These people wished they had sought out and utilized more resources to aid them in their caregiving activities. Recommendations for clinical work include: helping the spouses to: (a) recognize their own grief over the losses they incur, and (b) accept assistance from resources outside the home.


Oregon Hospice Association: statewide data set. The Oregon Hospice Association (OHA) has developed a statewide data set on persons who die while receiving hospice services. The work to date is described, including the development and refinement of data collection forms, and selected results from 1989 and 1990. Although the data set is limited, the information generated does provide OHA staff and board members, and hospice programs in the state, baseline information to use with legislators, funding sources, and the media.


Developing a certificate course for hospice nurses: a Delphi survey of subject areas. A Delphi survey of 16 national experts in hospice nursing was conducted to address which subject areas were the most important to include in a certification course for hospice nurses. The three-round survey elicited 70 subject areas which were ranked in order of importance according to the group opinion of the panel of experts. The means, average deviations, standard deviations, and variances for each rank were calculated. The panel showed a high degree of consensus and there was little change in ranking after the second round. The survey produced results that should be of interest to organizations concerned with developing certification courses and examination procedures for hospice nurses.


Organizational factors to consider when developing a certification program for hospice nurses: a Delphi survey. A Delphi survey of 16 national experts in hospice nursing was conducted to address the question of which organizational factors should be considered when developing a certification program for hospice nurses. The three-round survey elicited many factors to consider which were arranged by category and ranked in order of importance according to the group opinion of the panel. The means, average deviations, standard deviations, and variances for each factor were calculated. The panel showed a high degree of consensus and there was little change in ranking after the second round. The survey produced results that should be of interest to organizations concerned with developing a certification program for hospice nurses.


Certification for hospice nurses? Assessment of need. An assessment of need survey questionnaire sent to the hospice nursing community yielded a substantial return (1,550). The respondents overwhelmingly endorsed a certification process. They also emphasized the value of hospice experience and caring personal attitudes over formal educational preparation both for hospice work and for certification purposes. The preferences of these nurses for various elements of a certification process are compared to those revealed in a Delphi study of 16 hospice nursing leaders. Certain of their experimental and demographic characteristics are related to other research findings about the characteristics of hospice nurses.


Production of anti-fibroblast growth factor receptor monoclonal antibodies by in vitro immunization. Monoclonal antibodies against the high affinity tyrosine kinase Fibroblast Growth Factor (FGF) receptor may help define receptor epitopes involved in FGF binding and signal transduction which mediate coronary and tumor angiogenesis (the development of blood vessels). Monoclonal antibodies against the FGF receptor were made by in vitro immunization. Receptor was PAGE-purified and transblotted to nitrocellulose. The nitrocellulose was dissolved with acetonitrile, and the receptor used as antigen in an in vitro immunization system. Screening for FGF receptor positive clones was done using membrane preparations from Coronary Venular Endothelial Cells (CVEC) expressing the FGF receptor, both by Enzyme Linked Immunosorbent Assay (ELISA) and Western blot. Culture supernatants of several clones tested positive for IgM or IgG monoclonal antibodies against the FGF receptor. Antibodies were affinity purified. Ascites fluid was produced in Balb/c mice primed with Incomplete Freund's adjuvant (IFA). The monoclonal antibodies were also found to be suitable for receptor immunoprecipitation. Immunocytochemistry was done on sections from a variety of species. Further characterization of these antibodies, as well as the production of the remainder of a panel of anti-FGF receptor monoclonal antibodies, is underway.


An erythroid species-specific antigen of swine detected by a monoclonal antibody. A monoclonal antibody (1AC11) has been produced which recognized the glycophorin of swine red blood cells. 1AC11 was specific for swine membrane erythrocytes. No other swine cells (leukocytes, macrophages, kidney and testis cells) nor red blood cells from all the tested mammalian species (goat, human, sheep, cattle, horse, rabbit, cat and guinea pig) were recognized. There was no blood group activity detected. Immunocytochemical analysis of blood vessel in the swine pituitary tissue showed that besides membrane erythrocytes, cytoplasmic molecules were recognized in some cells. Immunoblot analysis of both membrane and aqueous phase of chloroform/methanol fractions from swine erythrocytes showed that the monoclonal antibody 1AC11 reacts with the major sialoglycoprotein of apparent molecular weight 45,000 daltons.


Preparation and binding specificity of a monoclonal antibody recognizing 3-deoxy-D-manno-2-octulosonic acid (Kdo) in lipopolysaccharides of Re chemotype. A mouse monoclonal antibody (MAb E1) was raised against the lipopolysaccharide (LPS) of the Re mutant R595 of Salmonella minnesota. This IgG3 antibody (MAb E1), unstable at low pH and low ionic strength, was purified by chromatography on QAE Sepharose A50. The binding specificity of MAb E1 was characterized by direct and inhibition enzyme immunoassays, using natural LPSs from different strains and chemotypes, and synthetic analogs of LPS substructure of the 3-deoxy-D-manno-2-octulosonic acid (Kdo) and Lipid A regions. Among various LPSs, MAb E1 reacted exclusively with those of Re-chemotype. It recognized alpha-Kdo- monosaccharide and disaccharide structures present as non-reducing side chains in various Re-type LPSs and synthetic antigens. The antibody did not react with Lipid A or various lipids, and the presence of the lipid region was not necessary for the reaction. The recognition of the epitope was not reduced by the presence of a substituent at O-8 of one of the two Kdo units present in the Re LPS from Proteus mirabilis, but the reaction was inhibited by phosphorylation of O-4 of Kdo, by the proximity of core (heptose) or Lipid A (acylated glucosamine) residues, or by certain LPS-LPS interactions.


Monoclonal antibodies to somatostatin receptor of rat brain. Murine Monoclonal antibodies (MAbs) to the rat brain somatostatin (SRIF) receptor were produced. Sp 2/0 myeloma cells were fused with splenocytes of Balb/c mice immunized with the soluble rat brain SRIF receptor which was partially purified by gel-filtration chromatography. Screening by radioligand ([125I-Tyr11]SRIF-14) binding inhibition assay yielded three stable cell lines producing IgG1, IgM, or IgA antibody. Autoradiographic study of the polyacrylamide gel electrophoresed under nondenaturing conditions revealed that these MAbs inhibited the ligand binding to the receptor, regardless of their incubation with the receptor prior to the ligand binding. The results suggest that the MAbs produced are the antibodies to the ligand binding site of the receptor, and bind to the receptor in competition with the ligand.


Production and characterization of two monoclonal antibodies to human glutathione peroxidase. Glutathione peroxidase (GSH-Px) is an important selenium-containing enzyme which protects cells from oxidative damage. Two hybridoma clones (GPX-121 and GPX-347), producing mouse IgG1 monoclonal antibodies specific for GSH-Px, were established. Immunoblot analysis revealed that GPX-347 was specific for human GSH-Px, while GPX-121 cross-reacted with human, rat, mouse and rabbit GSH-Px. Correlation between GSH-Px content and its enzymatic activity was investigated in erythrocytes of 76 humans and in human lung adenocarcinoma PC-9 cells by using a sandwich type ELISA. The results indicated that GSH-Px activity was expressed higher than expected from GSH-Px content especially in the range of low GSH-Px concentration. PC-9 cells selenium depleted medium did not stain but the cytoplasm of PC-9 cells grown in medium supplemented with selenium stained strongly.


Generation of murine triomas secreting bi-specific monoclonal antibodies that recognize HBsAG ad and ay subtypes. We report the generation of murine triomas by fusing splenocytes from mice previously immunized with HBsAg ay-subtype and a hybridoma, secreting anti-HBsAg ad-subtype monoclonal antibody, which was rendered HGPRT- by induced mutagenesis with N-methyl-N'nitro-N-nitrosoguanidine. The fusion yielded a 83.8% of hybrids showing the antigen specificity of the parental hybridoma and a 16.1% of bi-specific monoclonal antibodies. One of them, coded as 1C8A5, showing a heavy chain isotype (IgG1/IgG2b) was used as capture reagent in an ultramicro-ELISA. As little as 0.78 I.U. of both HBsAg ad- and ay-subtypes could be realiably detected.


A MAb-based ELISA for detecting circulating antigen in CSF of patients with neurocysticercosis. A monoclonal antibody (MAb)-based enzyme-linked immunosorbent assay (ELISA) was evaluated for detecting circulating antigen (CAg) in the cerebrospinal fluid (CSF) of patients with neurocysticercosis. CAg of Cysticercus Cellulosae was detected in 95 out of 116 patients with neurocysticercosis. Of the 21 neurocysticercosis patients in whom CAg was not detected, 14 had only higher density spots, 3 had one or two lower density spots and 4 had no obvious damage in their brain Computed Tomography (CT) scans. CAg was also not detected in CSF samples of patients with other diseases of the central nervous system. These included cerebral tumor, encephalopyosis, brain trauma, viral meningitis and cerebral hemorrhage. Detecting CAg with MAb-based ELISA is better than any previously available methods for the diagnosis of active neurocysticercosis.


Conformational transitions and specific heat anomaly in poly(dG-dC) and its methylated analogue. The Zimm and Bragg theory of the helix<-->coil transition has been modified to explain order<-->order transitions in polynucleotides, in particular B<-->Z<-->psi(-)<-->coil transitions in poly(dG-dC) and poly(dG-me5dC). Lambda anomalies in specific heat measurements around the transition point have also been explained by a further modification of the same theory. Theoretical results are found to be in good agreement with the experimental data. The nucleation parameter is consistent with the stabilization/destabilization of the ordered states (Z helix) under various environmental conditions, e.g. methylation of cytosine residue at C5 position or change in the cationic concentration of the solvent.


Solution conformation of a model hexapeptide containing RGD sequence. The solution conformation of a model hexapeptide Asp-Arg-Gly-Asp-Ser-Gly (DRGDSG) containing the RGD sequence has been studied in DMSO-d6 as well as in aqueous solution (H2O:D2O/90:10%) by 1H NMR spectroscopy. The unambiguous identification of spin systems of various amino acid residues and sequence specific assignment of all proton resonances was achieved by a combination of two dimensional COSY and NOESY experiments. The temperature coefficient data of the amide proton chemical shifts in conjunction with the vicinal coupling constants, i.e. 3JNH-C alpha H, NOESY and ROESY results indicate that the peptide in both the solvents exists in a blend of conformers with beta-sheet like extended backbone structure and folded conformations. The folded conformers do not appear to be stabilised by intramolecular hydrogen bonding. Our results are consistent with the flexibility of RGD segment observed in the NMR studies on the protein echistatin containing the RGD motif (references 23-25).


Positron annihilation studies in lysozyme and catalase. Positron annihilation studies have been carried out in two enzymes, lysozyme and catalase. Temperature dependence of the positron lifetimes in these two enzymes has been investigated. The results explained in terms of the free volume model and fluctuations between different conformational microstates of enzyme structures provide a new insight into the mechanism of bio-activity of these enzymes.


Effect of coenzymes on the quaternary structure conformation of glyceraldehyde-3-phosphate dehydrogenases of mung beans and rabbit muscle. Kinetics of thermal inactivation of glyceraldehyde-3-phosphate dehydrogenases of mung beans and rabbit muscle have been studied under different pH conditions in the absence and presence of various concentrations of NAD+ and NADH. The data have been discussed with respect to the effect of the coenzymes on the quaternary structure symmetry of the two enzymes and their binding isotherms. Both the (homo-tetrameric) apo-enzymes exhibit biphasic kinetics of thermal inactivation, characteristic of C2 symmetry, at lower pH values and a single exponential decay of enzyme activity, characteristic of D2 symmetry, at higher pHs. In each case, NAD+ has no effect on the biphasic kinetic pattern of thermal inactivation at lower pH values, but NADH brings about a change to single exponential decay. At higher pH values, NADH does not affect the kinetic pattern (single exponential decay) of any enzyme, but NAD+ alters it to biphasic kinetics in each case. The data suggest that NAD+ and NADH have higher affinity for the C2 and D2 symmetry conformation, respectively. With mung beans enzyme, the effect of NAD+ on the two rate constants of biphasic inactivation at pH 7.3 is consistent with a Kdiss equal to 110 microM. The NAD(+)-dependent changes in the kinetic pattern of thermal inactivation of this enzyme at pH 8.6 suggest a positive cooperativity in the coenzyme binding (nH = 3.0). In the binding of NADH to the mung beans enzyme, a weak positive cooperativity is observed at pH 7.3.(ABSTRACT TRUNCATED AT 250 WORDS)


Role of serine esterase in hydrogen peroxide-mediated activation of phospholipase A2 in rabbit pulmonary arterial smooth muscle cells. Exposure of rabbit pulmonary arterial smooth muscle cells to hydrogen peroxide cause dose-dependent stimulation of [14C] arachidonic acid (AA) release and enhancement of the cell membrane-associated phospholipase A2 activity as well as of the cell membrane-bound serine esterase activity tested against synthetic substrate p-tosyl-L-arginine methyl ester. While pretreatment of cells with serine protease inhibitors, viz. phenyl methyl sulphonyl fluoride, diisopropyl fluorophosphate and alpha-1-proteinase inhibitor, and antioxidant vitamin E prevents H2O2 stimulation of AA release and the cell membrane-bound serine esterase and PLA2 activities, that with actinomycin D and cycloheximide is devoid of any effect on H2O2 caused stimulation of AA release and the smooth muscle cell membrane associated serine esterase and PLA2 activities. Treatment of the smooth muscle cell membrane suspension with the serine protease trypsin markedly stimulates PLA2 activity. These results suggest that on exposure to H2O2 the smooth muscle cell membrane-bound serine esterase plays an important role in stimulating the cell membrane associated PLA2 activity thereby resulting in an increase in AA release.


Inactivation and reactivation of horseradish peroxidase immobilized by various procedures. Horseradish peroxidase (HRP) immobilized by coupling the amino acid side chain amino groups or carbohydrate spikes to the matrix has been studied for its resistance to heat, urea-induced inactivation and ability to regain activity after denaturation in order to understand the influence of the nature of immobilization procedure on these processes. The various immobilized preparations were obtained and their properties studied: Sp-HRP was obtained by direct coupling of HRP to cyanogen bromide-activated Sepharose, Sp-NHHRP by coupling periodate oxidized and diamine-treated enzyme to the cyanogen bromide activated Sepharose, SpNH-COHRP by coupling periodate-treated enzyme to amino-Sepharose and SpCon A-HRP by binding of the enzyme on Con A-Sepharose. All the immobilized preparations exhibited higher stability against heat-induced inactivation as compared to the native HRP. Sp-NHHRP was most stable followed by Sp-HRP, SpNH-COHRP and SpCon A-HRP. Sp-NHHRP was also superior in its ability to regain enzyme activity after thermal denaturation, although Sp-HRP regained maximum activity after urea denaturation. Inclusion of Ca2+ was essential for the reactivation of all preparations subsequent to denaturation by urea.


Spectral evidence for the oxidation of beta-hydroxybutyrate to acetoacetate: diminution of spectra by glucose and chloride. Chemical oxidation of beta-hydroxybutyrate (beta-OHB) to acetoacetate (AcAc) has been carried out by a simple and new method employing potassium persulphate as an oxidising agent. Under the conditions of assay, beta-OHB (0.079-0.395 microM) was instantaneously oxidised to AcAc and the authenticity of the oxidised product was proved by absorption spectroscopy. A common absorption maxima at about 446 nm was observed in all the spectra recorded for the product (AcAc-complex) obtained after the oxidation of beta-OHB (0.079-0.395 microM) to AcAc followed by coupling with diazotized p-nitroaniline. This absorption maxima was almost equal to that obtained for AcAc-complex using AcAc as reference standard. It implies that AcAc formed by the chemical oxidation of beta-OHB is identically similar to the AcAc used as reference standard for the study. This fact was further strengthened when absorption spectra, recorded either individually or in combination (mixed-type), exhibited a single peak with a common absorption maxima at about 446 nm. Absorption spectra was found to be partially diminished by glucose (1.77 microM) and chloride (17.1 microM), while almost complete diminution of absorption spectra was observed at higher concentration of glucose (8.88 microM) and chloride (51.3 microM).


Characterization of aliphatic amine 1,4-diazobicyclo (2,2,2) octane-induced stimulation of beet spinach thylakoid electron transport. Electron transport activity of beet spinach thylakoids was enhanced in the presence of aliphatic amine, DABCO (1,4-diazobicyclo (2,2,2) octane), a hydrophilic proton trapping agent. The extent of stimulation was pH-dependent and similar to the effect of the uncoupler ammonium chloride on electron transport. The stimulation of whole-chain (H2O-->MV) electron transport activity was observed only at high (rate-saturating) light intensity. The light-induced proton uptake coupled to electron transport of thylakoid was also arrested by DABCO, suggesting that DABCO uncouples thylakoid phosphorylation by proton trapping.


Identification and characterization of mutations in 'X' region of a hepatitis B virus carrier. A defective form of Hepatitis B virus (HBV) was identified in an apparently healthy voluntary blood donor, who was positive for the presence of HBV by dot blot hybridization, but did not have any serological markers of HBV infection. Two regions, part of X and part of surface antigen genes, were amplified by polymerase chain reaction, cloned and sequenced by Sanger's dideoxy chain termination method. The base sequence analysis revealed that the HBV mutant belonged to ayw serotype and showed three point mutations, in the form of deletions at nucleotides number 1402, 1438 and 1450. Such mutations in the 'X' region, and their likely presence elsewhere, could explain altered antigenic expression.


Physicochemical characterization and phylogenetic comparison of fish lens proteins. The composition of soluble eye lens proteins from four chondropterygiian and fourteen teleostean fishes were analyzed for heterogeneity in MW and pI. Lens proteins from all the fish species studies are distributed in the pI range 4.3-9.0 with polypeptides in the range 17,500-31,000 Da. Phylogenetic trees are constructed based on the observations.


Purification of C-reactive protein from Channa punctatus (Bloch). C-reactive protein (CRP) is found to be a normal component of serum of freshwater air-breathing murrel Channa punctatus. Based on the property of binding with C-polysaccharide (CPS) of pneumococcus bacteria in presence of Ca2+, CRP was purified by phosphorylcholine-Sepharose affinity column chromatography. Molecular weight of the intact protein molecule was estimated to be approximately 141,000 by gel filtration. In non-reduced and reduced conditions the molecule showed molecular weight approximately 28,000 and 14,000 respectively in SDS-PAGE. Monospecific antisera was raised against the affinity purified CRP and used as a tool to detect CRP in the hepatic cytosol and egg extract. The level of CRP in the normal serum was estimated to be 220 micrograms/ml.


Reconstitution of denatured E. coli alkaline phosphatase with E. coli ribosome. E. coli alkaline phosphatase was denatured by physical/chemical means. In vitro reconstitution of this denatured enzyme was assisted by 70S E. coli ribosome, as shown by the recovery of its catalytic competence. Almost total recovery of activity of the totally inactivated enzyme was obtained in presence of equimolar concentration of 70S ribosome at 50 degrees C.


Purification of erythrocyte cytochrome P-450 from goat and chick. Cytochrome P-450 has been purified from goat and chick erythrocytes and characterized. Goat erythrocyte cytochrome P-450 content was higher than that of chick erythrocytes cytochrome P-450. Elution profile of purified protein from DEAE-cellulose column showed a single peak. The catalytic activities of aminopyrine-N-demethylase and acetanilide hydroxylase were found to be higher in purified proteins. Molecular weight was determined by SDS-polyacrylamide gel electrophoresis.


Effect of vanadate on tryptophan metabolism in streptozotocin diabetic rats. Administration of sodium orthovanadate (0.3 mg/ml) through drinking water for 20 days to streptozotocin-induced diabetic rats resulted in reversal of markedly elevated activities of some of the key enzymes of tryptophan-niacin pathway, viz. hepatic and renal aminocarboxymuconate semialdehyde decarboxylase and hepatic tryptophan oxygenase, to normal levels without restoring the elevated blood sugar level to normal state. However vanadate administration to normal rats did not cause any significant change.


Effect of amiodarone, an antiarrhythmic drug, on serum and liver lipids and serum marker enzymes in rats. Administration of amiodarone (AD) to rats leads to marked damage to liver, as evidenced by pathological changes and significant increases in activities of serum marker enzymes and levels of lipids like cholesterol and phospholipids with no alteration in the triglyceride levels. The risk factor, that is the total cholesterol/HDL cholesterol ratio, exhibited increase in the experimental animals, indicating that amiodarone treatment may lead to the development of coronary heart disease.


CDRI-85/287: studies on competition to estrogen binding sites in the immature rat uterus. Ability of compound CDRI-85/287, a new nonsteroidal antiestrogen with negligible inherent estrogenicity, to inhibit uptake of 3H-estradiol (3H-E2) by the immature rat uterus in vivo was investigated. Different doses of 85/287 were administered either intraperitoneally 30 min before 3H-E2 or orally 1 and 6 hr before 3H-E2. A dose dependent inhibition in 3H-E2 uptake was observed after administration of the compound by either route and was 69% at 50 micrograms/rat ip dose and 80% at 2.5 mg/kg po dose. In in vitro competitive binding assay, however, the compound showed poor affinity (RBA 0.42% of estradiol-17 beta) for cytosolic estrogen receptors. Considering the potent anti-estrogenic as well as anti-implantation efficacy of the compound, its action in vivo appears to be mediated via its active metabolite(s).


Effect of depot medroxyprogesterone acetate and testosterone ananthate on the testis of albino rats: ultrastructural and biochemical studies. Male albino rats were treated with depot medroxyprogesterone acetate (1 mg/animal/day) + testosterone ananthate (100 micrograms/100 g body weight/day) for 30 and 60 days. After 30 days of treatment, all the testicular enzymes like beta-glucuronidase, hyaluronidase, sorbitol dehydrogenase, lactate dehydrogenase, acid and alkaline phosphatase, registered non-significant decrease in their values. Fifty percent of the treated animals achieved sterility after 30 days of treatment. After 60 days of treatment the testis showed degenerative changes in Golgi phase and late spermatids. Changes in the Golgi phase spermatids were related with degeneration of the nuclear membrane. Changes in the late phase spermatids included mitochondrial hypertrophy of the midpieces, membrane lysis, absence of cristae and degeneration of annulus leading to detachment of tail. Cytoplasm of luminal area displayed hypertrophied mitochondria devoid of cristae, prominent appearance of Golgi bodies, intense lysosomal activity and ample vacuolation. Tail fragments of degenerated spermatids prevailed in luminal cytoplasm. Except for beta-glucuronidase which registered a significant decrease, levels of all the other testicular enzymes, viz. hyaluronidase, lactate dehydrogenase, sorbitol dehydrogenase, acid phosphatase and alkaline phosphatase were within their control limits. The ultrastructural and biochemical changes are correlated.


Ultrastructural specialization of intestinal epithelium over Peyer's patches in the bonnet monkey, Macaca radiata. The follicle associated epithelium (FAE) which separates the lymphoid follicle of Peyer's patch from the gut lumen is known to have specialized cells called M cells or "microfold" cells in man and certain animals. These cells are considered to be involved in antigen uptake and transport. Our light microscopic study of the small intestine of bonnet monkeys suggested the presence of such specialised cells in FAE. We have confirmed the presence of M cells in bonnet monkey FAE having ultrastructural features very similar to those of human M cells.


Evaluation of the modulatory influence of food additive-garam masala on hepatic detoxication system. Potential chemopreventive role of an Indian food additive-garam masala has been assessed through its impact on the hepatic levels of detoxication enzymes like glutathione S-transferase (GST), cytochrome b5 (cyt. b5) and cytochrome P-450 (cyt. P-450), and acid soluble sulfhydryl (-SH) content in 8-9 weeks old Swiss albino mice of either sex fed on the 0.5%, 1.0% and 1.5% (w/w) garam masala in the diet for 10 days. The data from this short term study revealed the significant but dose-independent alteration in the levels of detoxication system enzymes. The results suggest the possible chemopreventive potency of this widely used food additive by being a bifunctional inducer of detoxication system.


Toxicities, LD50 prediction and in vivo neutralisation of some elapid and viperid venoms. Toxicity levels of elapid (Naja naja and Naja oxiana) viperid (Vipera lebetina and Vipera russelli) venoms for mice and rat for intraperitoneal intravenous and intramuscular routes have been determined. The data have been analysed using a mathematical expression to calculate lethal venom concentrations in human snake bite cases. Further, in vivo neutralisation of snake venom potency (after experimental injection) using high voltage-low current electric shock treatment has been attempted. This treatment postponed the death further by 60-90 min in mice in case of elapid envenomation. In case of viperid envenomation such a postponement of death time was not noticed. The death postponement induced by the shock treatment probably refers to structural impairments that occur at molecular level in venom components and their consequent altered interactions with the target tissue or system.


Curative effect of methionine on certain enzymes of chick kidney cortex under lanthanum toxicity situation. Acute single dose administration of lanthanum chloride (250 mg/kg body wt, ip) to chicks have been found to alter the levels of enzymes of the antioxidant defence system of chick renal cortex fractions. Such changes involved significant decrease in activities of glucose-6-phosphate dehydrogenase, glutathione reductase, glutathione peroxidase and catalase of kidney epithelial cells. However glutathione-S-transferase activity was not altered. Glutathione and total thiol contents were decreased while lipoperoxidative reactions in kidney-cortex was significantly enhanced. The data indicate that amelioration of lanthanum toxicity condition by methionine supplementation may be due to the methionine serving as a precursor of glutathione.


Effects of Azadirachta indica A Juss on some biochemical, immunological and visceral parameters in normal and stressed rats. Effects of A. indica (AI) were evaluated on some biochemical, immunological and visceral parameters in normal and stress rats. AI (100 mg/kg) lowered blood glucose, triglyceride and SGOT levels in normal rats, and attenuated stress-induced elevations of cholesterol and urea levels. In rats immunized with SRBC, AI enhanced the humoral antibody response to the antigen. Further, AI facilitated the footpad thickness response to SRBC in sensitized mice and also enhanced leucocyte migration in immunized rats. In stressed rats, AI significantly attenuated the stress-induced (a) suppression of humoral immune response and (b) gastric ulcerogenesis. These results are discussed in light of the possible mechanisms involved in the effects of AI in normal and stressful situations.


Biopharmaceutical studies of spirobishexahydropyrimidine. Oral administration of spirobishexahydropyrimidine showed an increase in the activity of serum transaminases, lactate dehydrogenase and alkaline phosphatase. Biological half life and other pharmacokinetic parameters showed rapid absorption and slow elimination of the drug.


Metal uptake by mycelia during submerged growth and by sporocarps of an edible fungus Volvariella volvacea. Uptake of a few metals by V. volvacea was determined during submerged growth of the organism in sublethal concentration of each metal salt. The uptake of Pb2+ and Hg2+ was 5 and 5.23 micrograms g-1 respectively while that of Cu2+ was 500 micrograms g-1 under experimental conditions. Treatment of spawned substrate separately with different metal salts showed maximum and minimum uptake of Pb2+ (100 micrograms g-1) and Cd2+ (2.93 micrograms g-1) respectively by sporocarps. All metal salts at test concentrations reduced biological efficiency of sporocarp production but markedly by Co2+. Cd2+ and Co2+ were highly toxic to mycelia and sporocarps respectively. The uptake of Cu2+ by mycelia and Pb2+ by sporocarps were highest among the five metals tested. Metal toxicity, tolerance and uptake capacity of V. volvacea differ considerably with concentration of metal ions.


Role of free radicals in Plasmodium berghei infected Mastomys natalensis brain. Lipid peroxide, lipid hydroperoxide, reduced glutathione, oxidised glutathione, lipofuscin contents and the activity of the enzyme superoxide dismutase were assessed in P. berghei infected M. natalensis brain. The results showed significant increase in the levels of lipid peroxides, lipid hydroperoxides and lipofuscin in brain subcellular fractions of P. berghei infected M. natalensis. Furthermore, a depressed superoxide dismutase activity was observed along with regulation in glutathione content. An elevated level of lipid peroxidation products along with depressed activity of scavengers in brain during malaria highlights the role of free radicals in malarial pathology.


Phaseolus vulgaris L. var. HUR 15--a potential indigenous source for commercial PHA preparation. Mitogenic potential of the partially purified lectin from P. vulgaris isolated by ammonium sulphate precipitation was assessed by lymphocyte transformation test (LTT) and was compared with three commercially available phytohemagglutinins (PHA). The blast inducing capacity and mitotic index analysis revealed that this preparation has potential to be used in the indigenous commercial production of PHA which is routinely used for human chromosomal studies from the peripheral blood culture at, at present, is imported.


Reasons for partial/non-immunization with oral polio vaccine/triple antigen among children under five years. To identify the reasons for non-immunization/postponing immunization, parents of 615 poliomyelitis (APM) children and 908 children attending the Outpatient Department (OPD) for other ailments were interviewed. A total of 165 (26.9%), 185 (30.1%) and 264 (43%) among APM and 645 (71%), 183 (20.2%) and 80 (8.8%) among OPD children were immunized, partially immunized and unimmunized, respectively. Forty two per cent and 21% among parents of APM and OPD children, respectively in the unimmunized group were unaware of the need for immunization. The other reasons are minor illnesses, lack of interest, fear of side reaction, non-availability of vaccine or vaccinator. The decision to withhold immunization was mostly by parents when the child had some minor illnesses, mostly respiratory infections. It is recommended to educate the health personnel-clinicians and para-clinical workers by seminar and training and the public through mass media and group contact on the need for and completion of the immunizations.


Prophylactic theophylline infusion for prevention of apnea of prematurity. To assess if there was any advantage in the prophylactic use of theophylline to prevent apnea in preterms, we treated 56 preterms (Group A) < 34 weeks gestation with theophylline infusion and compared these with 25 age and weight matched preterms (Group B) who received no therapy. Aminophylline (25 mg/ml) was infused from admission in all neonates (group A) at rates ranging 0.2 to 0.38 mg/kg/h and blood levels estimated on an Abbots TDX analyser by Fluorescence Polarization Immunoassay, after 5 days infusion. All neonates (Groups A + B) were monitored on a Corometric 505 neonatal monitor. In Group A, 1/48 developed primary apnea while in Group B, 4-21 had primary apnea (p < 0.05). Serum theophylline ranged from 2.3 to 39.5 micrograms/ml with a mean of 12.7 micrograms/ml. The mean serum level of theophylline in 4 cases who exhibited clinical evidences of toxicity was 30.1 micrograms/ml. A statistically significant difference (p < 0.05) was noted in birth weight and serum level inspite of similar infusion rates of theophylline. A linear correlation r = 0.65 was noted between serum level and infusion rate. Multivariate regression analysis, between birth weight and gestational age to serum level, showed a linear correlationship only between birth weight and serum level (r = 0.45).


Prevention of hypoglycemia: a controlled evaluation of sugar fortified milk feeding in small-for-gestational age infants. The study population included 110 term healthy small-for-gestational age (SGA) infants having a blood sugar of > 30 mg/dl at the age of < 30 minutes. They were randomized into two groups; (a) Group I (study group) received sugar-fortified milk formula and (b) Group II (control group) received standard milk formula. A minimum of 80 ml/kg/24 hour of milk was given. The first feeding was given within 45 minutes of birth and subsequently at 2 hours of age and then every 2 hourly till the age of 24 hours. The blood sugar (initial within 30 minutes of birth) was monitored at the age of 2, 4, 12 and 24 hours by dextrostix. The babies on fortified feeds received significantly (p < 0.001) higher amount of carbohydrate (8.1 mg/kg/min) as compared to those on standard milk (5.1 mg/kg/min). The incidence of hypoglycemia was reduced significantly (p < 0.01) by the sugar-fortified feeds. The mean blood sugar level in babies receiving fortified feeds was significantly higher at all the ages as compared to those receiving standard feeds. Nearly all the babies who subsequently developed hypoglycemia had a preceding blood sugar value of less than 60 mg/dl. The study highlights that sugar-fortified milk feeds are useful in preventing hypoglycemia in SGA infants and should be routinely recommended along with breast feeding in developing countries especially when facilities for monitoring of blood sugar are unsatisfactory or not available.


Sleep pattern and night awakening in healthy infants. Sleep pattern and night-awakening were studied in 500 healthy infants by a semistructured interview method. A total of 92.2% infants shared bed with their mothers, 6.8% with grand parents and 1% with fathers. Paternal participation at bedtime was observed to be insignificant. Infants of non-working mothers and families with vegetarian habits slept significantly more as compared to the working mothers and families with non-vegetarian habits. Night-time awakening was reported in 96% of the infants. If a child is functioning well in other areas of life, parents can be assured that the problem is not of serious concern and unnecessary medication of infants should be avoided.


Infant mortality in Pondicherry--an analysis of a cohort of 8185 births. Infant mortality rate is one of the 12 global indicators for monitoring Health for All. Reliable data on infant mortality are not available for the majority of developing countries including India. To plan strategies for bringing down the rate and, later, to evaluate them, 'Cause Specific Rates' would be necessary. Pondicherry has achieved low rates of infant mortality. A study was conducted in the Anganwadis of Pondicherry to determine the causes of infant deaths. The 8185 children born between 1-4-1987 and 31-3-1988 in Pondicherry formed the study group. The Anganwadi workers collected information on the cause of death for the 222 children dying within the first year. The infant mortality rate was 27.1 per 1000 live births. Acute respiratory infections and diarrheal diseases accounted for 45% of the deaths.


Renal parameters during infancy.

Renal parameters during infancy. In a prospective study we estimated common renal parameters in 48 full term normal neonates, of which 15 were also tested at 6 months and 12 months of age. The mean levels of serum creatinine, were high at birth (0.73 mg/dl) but normal for age at 6 and 12 months; uric acid followed a similar trend. The blood pH and bicarbonate were low at birth (7.28 and 20.36 mEq/L, respectively) reached normal adult values by 12 months; chloride levels were high at birth (110 +/- 5 mEq/L) and normal at 6 months. The plasma renin activity was higher than normal all throughout the first year (27.1, 416.8, 64.8 ng/ml/hr by RIA). Plasma aldosterone values were high at birth (1387.5 pg/ml) and reached normal level (301.6) at 12 months. Renal length and volume as assessed by ultrasonography compared well with American standards. Urinary constituents were variable due to breast feeding up to 6 months and varied diet during the weaning period. This study shows that mild metabolic acidosis and hyperchloremia due to immaturity of renal acidification mechanism and high renin and aldosterone levels due to partial nonresponsiveness of distal tubules are normal variables in babies from birth to 6 months. The levels of serum creatinine and uric acid are high at birth and in assessing renal functions this should be borne in mind.


Commercial oral rehydration solutions--pitfalls, knowledge, attitude and practices. Locally available commercial preparations of oral rehydration solutions (ORS) were analyzed for their composition, package instructions and availability. A survey from 50 chemist stores, revealed that ORS packets available belonged to 28 different pharmaceutical companies. None of the shops stored more than five different brands and alternate preparations were handed over the counter freely. Only 48% of the available ORS formulations had the WHO recommended composition. In about one-fourth preparations, the sodium concentration was 30 mEq or less per litre. Forty-one per cent solutions had glucose concentrations more than 2%. The glucose and sodium ration of 1:1 was maintained in only 48% of the formulae. Bicarbonate and citrate both were used with almost equal frequency in these preparations. Cost, flavor, additional ingredients and package instructions varied widely in different packets. ORS formulations most commonly found in the drug stores had low sodium and high glucose concentration. The attitude of doctors and nurses of Pediatric Department and Chemists towards commercial ORS was also studied. While 92% doctors were aware about WHO-ORS, none of the chemists and only 4% nurses had this awareness. All the respondents could remember only up to 3 or 4 brand names and except 30% doctors, none were aware about the composition of those brands of ORS. Regarding importance of composition, preparations and precautions, practically nobody was up to the mark, but doctors were definitely better as compared to nurses and chemists.


Urinary tract infections in the 90s: pathogenesis and management. Urinary tract infections are one of the most common types of infection encountered in the practice of medicine. Recent discussions have focused on our current knowledge of natural host defenses that function during normal physiologic conditions in an attempt to prevent urinary infections. However, increased susceptibility to these infections may result from intrinsic risk factors that alter host defenses, or from extrinsic risk factors. Advances in the treatment of urinary infections have focused on short course therapy for women with uncomplicated lower tract infections, and on oral therapy in women with mild acute uncomplicated pyelonephritis. Also, in the area of prevention, reasonable candidates for antimicrobial prophylaxis have been identified. Even so, further studies are needed to define more clearly our understanding of the pathogenesis, treatment, and prevention of infections of the urinary tract.


Criteria for diagnosis of urinary tract infection and evaluation of therapy. Patients with urinary tract infections are commonly used to study the efficacy of new antibiotics. Some criteria, for example the presence of more than 100,000 organisms of a single species per ml as an indicator of infections, have been accepted for many years but all rules have exceptions. Other criteria such as relapse, re-infection are less clearly agreed. Furthermore, timing of collection of specimens during and after treatment shows great variation in protocols and in definition. These criteria and the methodology of collecting, transportation and examination of urine are discussed.


Urinary tract infection in the elderly. How to treat and when? The prevalence of urinary infection increases with increasing age for both men and women, reaching over 50% for both sexes amongst institutionalized patients. Bacteriuria is, generally, asymptomatic, and asymptomatic bacteriuria is not an indication for therapy, except prior to invasive genitourinary procedures. Treatment has not been shown to prevent subsequent symptomatic episodes, is associated with antimicrobial adverse effects, and promotes the emergence of resistant organisms. In addition, early recurrence is the rule following therapy in the institutionalized elderly and prolonged periods free of bacteriuria are seldom achieved. Symptomatic infection may manifest as invasive infection or irritative symptoms. Antimicrobial therapy is selected on the basis of organism susceptibility and patient tolerance. Therapy of 7-14 days is suggested, as short course therapy is not as effective in older women. For men, initial courses of therapy of 7-14 days are likely to be appropriate. As prostatic localization is frequent, recurrent symptomatic infection may require more prolonged therapy of six or 12 weeks. Bacteriuria in the elderly is a large and complex problem. Overuse of antimicrobials should be avoided, but further investigations to characterize the optimal use of antimicrobials are still required.


Optimal characteristics of agents to treat uncomplicated urinary tract infections. The optimal characteristics of agents to treat uncomplicated urinary tract infection must include activity against the major pathogens involved in these infections as well as a low potential for development of bacterial resistance. High urinary levels should be present for an adequate period to eliminate the organisms. Side effects should be minimal with minimal effect on the bacterial flora of the community. Treatment programs of single-dose, three days, or five days can be developed depending upon the agent.


Single dose treatment failure in women with acute cystitis. Single dose treatment regimens (SDT) are effective, inexpensive alternatives to longer courses of therapy for adult females with acute cystitis or asymptomatic bacteriuria. A number of SDT regimens consistently cure 85 to 100% of women with acute cystitis and 50 to 80% of women with asymptomatic bacteriuria. However, SDT is inherently less effective than longer regimens because many upper tract infections are not cured. Initial SDT studies suggested that most patients with significant renal invasive disease or underlying urological abnormalities fail therapy. As a result, SDT has been proposed as an efficient strategy to diagnose significant upper tract infections with accompanying pathology that merit additional investigation or treatment. Few studies have refuted or supported this hypothesis. Single-dose treatment studies show an association between the site of infection as determined by the antibody-coated bacteria (ACB) test and treatment outcome. Patients with ACB-negative tests have a cure rate of over 90% in almost all studies in which the organism is susceptible to the agent chosen. Patients with positive ACB tests tend to have treatment failure rates of 30 to 50%. However, imaging studies have not been carried out in parallel with these studies and the validity of using single-dose treatment failure to screen women for significant upper tract pathology has still not been established.


Management of urinary tract infections in pregnancy: a review with comments on single dose therapy. Most investigators agree that the adverse effects of urinary tract infections in pregnancy can be abrogated by effective early detection and treatment. However, the optimal methods for screening and treatment remain controversial. Although single-dose therapy has not been applied to pregnant women with acute pyelonephritis, most but not all studies which have compared single-dose with longer courses of beta-lactam or other antibiotics in pregnant asymptomatic bacteriuric women have shown no differences in outcome. This paper reviews recent trials of single-dose treatment of bacteriuria in pregnant women.


Short-term treatment of urinary tract infections: the French concept. The indications for short-term treatment to cure urinary tract infections (UTIs) have been recently clarified in France by a "Consensus Conference". Short-term treatment essentially concerns young, non-pregnant women with symptomatic uncomplicated lower UTI of less than three days duration, with no other underlying severe illness or previous uro-nephrological history, and who accept the idea of clinical and possibly bacteriological control after treatment. Only antibiotics with prolonged urinary excretion are recommended, i.e. co-trimoxazole, fluoroquinolones or fosfomycin-trometamol. In pregnancy, in children, or in the elderly, indications for short-term treatment still remain controversial. As compared with conventional therapeutic strategies using urine cultures, the use of test strips for nitrite and leukocyte esterase for deciding on treatment and assessing its efficacy should allow considerable financial savings.


Susceptibility of frequent urinary pathogens to fosfomycin trometamol and eight other antibiotics: results of an Italian multicenter survey. In order to assess the resistance profile for fosfomycin trometamol after several years of clinical use in Italy, this study has explored the susceptibility to fosfomycin and eight other antibacterial drugs of 6,021 strains isolated from 23,816 urines during 1990 in three teaching hospitals located in Genoa, Parma and Catania. Gram-negative strains, notably Escherichia coli (41.6%), were primarily involved. Amoxicillin was the least active compound with resistance in 41.4% of the isolates. Fosfomycin showed the lowest rate of resistance in both gram-negative (2.8%) and gram-positive (2.1%) pathogens. This was followed by norfloxacin with a resistance rate of 11.8% and netilmicin with 12.2%. These results indicate that fosfomycin-trometamol may continue to be used in single-dose treatment of urinary tract infections even in the absence of microbiological data since the prevalence of resistance to the drug is, at present, so low that therapeutic failure is highly improbable.


Spectrum and susceptibility of pathogens causing acute uncomplicated lower UTI in females and its correlation to bacteriologic outcome after single dose therapy with fosfomycin trometamol versus ofloxacin/co-trimoxazole. In a multicentric study comparing oral single-dose therapy of fosfomycin trometamol (3 g as fosfomycin) versus co-trimoxazole (1.92 g) or ofloxacin (200 mg) as many as possible of the pathogens were sent to and analysed in a central laboratory. The pathogens were identified and minimal inhibitory concentrations (MIC) of fosfomycin, trimethoprim alone and in combination with sulfamethoxazole, ofloxacin, ampicillin, amoxicillin combined with clavulanic acid, and cephadroxil were determined. The eradication of pathogens (cfu < 10(3)/ml at one week after single-dose therapy) was analysed according to species and MIC of the antibiotic used. Urine cultures of 349 patients were analysed. Escherichia coli was the predominating species followed by staphylococci and Proteus mirabilis. Enterococci were mostly found in mixed culture. Baseline pathogens of monoinfections were eradicated in 87.1%, in 88.9% and in 86.4% of 284 patients treated with fosfomycin trometamol, co-trimoxazole and ofloxacin, respectively. The MICs of the five antibacterial agents and the two antibiotic combinations for 253 baseline pathogens showed that of the E. coli strains none was resistant to ofloxacin, three (MIC = 128 mg/l) were resistant to fosfomycin, 3.6% to co-trimoxazole, 6.2% to trimethoprim, 8.8% to ampicillin, and 5.7% to amoxicillin/clavulanic acid. The eradication rates according to the MICs of the corresponding drugs showed equally good eradication rates for fosfomycin up to an MIC of 64 mg/l. Above this level two out of three strains were also eradicated by fosfomycin trometamol. For co-trimoxazole and ofloxacin no intermediately sensitive or resistant strains were found. Within the range of MICs found there were equally good eradication rates for both antibacterial agents.(ABSTRACT TRUNCATED AT 250 WORDS)


The comparative activity of fosfomycin trometamol against organisms isolated from infected urines. Five hundred urinary pathogens, collected from patients of general practitioners and hospital in-patients, were identified and tested for susceptibility to fosfomycin, ampicillin, cephalexin, nalidixic acid, nitrofurantoin, trimethoprim and sulfamethoxazole. Overall, 83% of the isolates were sensitive to fosfomycin, comprising 89% of the out-patient strains and 77% of the in-patient isolates. This degree of sensitivity was similar to that of cephalexin, nalidixic acid and trimethoprim, but higher than that observed with ampicillin, nitrofurantoin and sulfamethoxazole. Fosfomycin generally showed a broad spectrum of activity, but was less active than some other compounds against Klebsiella spp. and streptococci. More than 70% of strains resistant to ampicillin, sulfamethoxazole or trimethoprim were sensitive to fosfomycin indicating that cross resistance is not presently a problem.


The influence of anaerobiosis on the activity of fosfomycin trometamol. MICs of fosfomycin trometamol were estimated for 40 strains of bacteria (20 gram-positive cocci, 20 gram-negative bacilli) by the agar incorporation method (Iso-Sensitest agar) in the presence of the potentiating agent, glucose-6-phosphate (25 mg/l). Titrations were carried out in duplicate under aerobic and anaerobic conditions. For 22 strains (12 gram-negative bacilli), a fourfold or greater reduction in MIC was observed in tests conducted under anaerobic conditions. The effect was particularly marked with Klebsiella spp., four of five strains of which showed a 16- to 32-fold reduction in MIC in anaerobic conditions. To investigate the reasons for the effect of anaerobiosis, selected strains were examined in an opacity monitoring device in which cultures can be grown in aerobic or anaerobic atmosphere. Surprisingly, the effect of anaerobiosis observed by continuous turbidimetric monitoring was much less than that seen in agar incorporation MIC titrations: under anaerobic conditions, there was little or no reduction in the concentration of fosfomycin trometamol required to cause a lytic effect on dense bacterial cultures, and a small, but variable effect on the emergence of resistant variants.


Treatment of bacteriuria in pregnancy with single dose fosfomycin trometamol: a review. Bacteriuria in pregnancy occurs in about one in 20 pregnant women and is usually initially asymptomatic. It is an important marker for acute symptomatic infection (often pyelonephritis) later in pregnancy, which occurs in about one in four bacteriurics. Several considerations surround the antibiotic treatment of the asymptomatic infection; these include a low frequency of in vitro resistance to the agent used, lack of toxicity to the foetus, a low incidence of gastrointestinal side effects, good compliance and proven efficacy. Fosfomycin trometamol seems to fit these requirements. In three controlled studies (two multicentric) 250 patients were treated with fosfomycin trometamol in a 3 g (as fosfomycin) single dose; 197 patients were given one of three other agents. Cure rates for fosfomycin trometamol were 77-94% (68-94% for other agents), which was satisfactory in an infection which is sometimes difficult to eradicate. Further studies are needed in this important but accessible group of patients. Opportunities should be taken to study more foetal outcomes and provide more data on gastro-intestinal tolerability.


The role of fosfomycin trometamol in the management of urinary tract infections in pediatrics. Single-dose therapy has been documented in defined groups of adults. For children, this type of treatment requires further investigation. Children to be studied should have uncomplicated UTI and the drugs should optimally have a broad antibacterial spectrum, a low tendency to select for resistant bacteria, and pharmacokinetic properties allowing maintenance of inhibitory antibiotic levels in urine for at least two to three days. Fosfomycin trometamol, trimethoprim and co-trimoxazole are oral antibacterials that may prove effective for single-dose therapy in children, as has been suggested in some studies.


Oral prophylaxis with fosfomycin trometamol in transurethral prostatectomy and urological maneuvers: literature review and personal experience. In the literature there are three comparative and two open studies in which 1,395 patients received 3 g of fosfomycin trometamol per os 12 or three hours before and 24 hours after surgery: 625 patients received control substances or placebo. In the comparative studies the incidence of postoperative bacteriuria in patients treated with fosfomycin trometamol ranged from 2.9 to 7.6% at one week and from 1.2 to 3.2% at two to four weeks follow-up, and was lower than in patients treated with reference drugs or placebo. In the open study, postoperative bacteriuria ranged from 2.9 to 6.0% at one week follow-up. In our open study, 70 patients were evaluable. Four out of 70 (5.7%) developed fever > or = 38 degrees C, with positive urine culture, during the first three postoperative days. At two weeks follow-up another 5.7% showed a symptomatic urinary tract infection with a cumulative infection rate of 11.4%. In all cases, the bacteria were resistant to fosfomycin trometamol. A low incidence, 4.2%, of side effects, mainly related to the gastrointestinal tract, was observed. Fosfomycin trometamol proved to be effective with the advantage of no risk of cross resistance, practical pharmaceutical formulation with good patient compliance, good safety profile with few side effects and a satisfactory cost/benefit ratio.


Induction of an invasive phenotype in benign tumor cells with a laminin A-chain synthetic peptide. K-1735 clones 10 and M2 are cell lines cloned from a UV-induced murine melanoma. While both lines are highly tumorigenic, only the M2 cells are highly invasive in vitro and metastatic in vivo. Here we have exposed the clone 10 cells to the synthetic peptide PA22-2, which contains the IKVAV sequence from the A chain of laminin and which, like laminin, induces collagenase IV production and enhances metastasis formation by B16F10 cells. Zymogram analysis of conditioned media from clone 10 cells cultured on the peptide demonstrated a dose-dependent increase in collagenase IV activity. When clone 10 cells were cultured on a reconstituted basement membrane (Matrigel), this peptide caused an invasive phenotype comparable to the M2 cells. The invasive clone 10 cells were, however, unable to form lung colonies in vivo in the presence of this peptide. We conclude that this peptide represents an active site on laminin which is able to stimulate the invasiveness of this tumor cell line, but that this activity is not sufficient to confer metastatic potential.


Evaluation of in vitro reconstituted basement membrane assay to assess the invasiveness of tumor cells. The crossing of tumor cells through basement membranes represents a critical step in the metastatic process. We have used a reconstituted basement membrane (matrigel) coated on filter in a Boyden chamber to assess the invasive potential of tumor and normal cells. No correlation was found between chemoinvasion in vitro and the metastatic potential in vivo. Normal human fibroblasts and murine 3T3 fibroblasts penetrated filters coated with matrigel. On the other hand, the tumoral cells (MCF7, MCF7 gpt, MCF7 ras, BeWo, JAR, NUC-1 cells) were unable to cross the matrix. Our results suggest that in our conditions, this widely used model to assess tumoral invasion does not provide a universal assay to test the invasiveness of tumor cells. Penetration of the matrigel appears to be related to chemotactic or haptotactic responses depending upon cell types. Our data emphasize the variability of molecular events associated with basement membrane invasion.


Altered establishment/clearance mechanisms during experimental micrometastasis with live and/or disabled bacterial lacZ-tagged tumor cells. To study micrometastasis at its earliest stages, the bacterial lacZ marker gene was introduced into human EJ Ha-ras-transformed BALB/c 3T3 cells (LZEJ), followed by their intravenous injection into nude mice. Lung micrometastases were easily identified by blue staining of lacZ-tagged cells minutes/hours after injection, permitting effective evaluation of establishment/clearance mechanisms of LZEJ cells. Different treatments were used to disable LZEJ cells (fixation, irradiation, or mitomycin C) to determine modulation of these processes--although unable to divide, these cells stain for lacZ expression for days after treatment. Fixation-killed cells generated large microfoci (> 13-15 cells/focus) with well-rounded morphologies while live, irradiated, or mitomycin-treated cells generated smaller, irregularly shaped foci (3-7 cells/focus). Fixed-cell foci were cleared more slowly from lungs than the other three classes, even when prefiltered to remove large aggregates. All foci of disabled cells were eventually cleared while a basal level of live-cell foci persisted. Co-injection of fixed and live cells (or preinjection of fixed cells, followed by live cells) resulted in complete clearance of live-cell microfoci; in contrast, preinjection of live cells (then injection of fixed cells) led to survival of live-cell micrometastases. Therefore, altered deformability and/or cell surface interactions of tumor cells modulate the effectiveness of host-clearing mechanisms in the lung and in some situations these altered cells facilitate clearance of live tumor cells that are normally tumor-progressing.


MHC class I antigen expression is inversely related with tumor malignancy and ras oncogene product (p21ras) levels in human breast tumors. MHC class I antigens participate in the immune response by presenting peptides to CD8+ cytotoxic T cells. Decreased expression of these antigens in tumor cells may contribute to an evasion of immune system and consequently to enhanced tumor growth. However, not all tumors expressing low levels of HLA antigens show increased malignancy, probably as a result of the differential activity of the oncogenes involved in malignant transformation. The ras family of cellular oncogenes is one of the most frequently detected families of transformation-inducing genes in human solid tumors. The aim of this work is to study the expression of MHC antigens and the ras oncogene product, p21ras, in 60 primary breast tumors in order to define its clinical significance in tumor progression. HLA antigen expression and p21ras levels were measured on breast tumors using immunohistochemistry methods and enzymoimmunoassay, respectively. The results demonstrate that more invasive tumors have both a decreased expression of HLA class I antigens and higher levels of p21ras protein expression than less aggressive tumors. These findings indicate that the capacity of breast cancers to grow and metastasize is related to low levels of MHC class I antigens and enhanced p21ras expression, thus supporting the involvement of MHC and ras oncogenes in breast tumor malignancy.


Polyclonal natural antitumor antibody binding dynamics: preferential release of surface membrane molecules and increased metastasis. Flow cytometry revealed the dynamic nature of polyclonal whole serum naturally occurring IgG and IgM antibody binding to the syngeneic murine T cell lymphomas SL2-5, L5178Y-F9 and the in vitro selected high natural antibody binding variant L5178Y-F9 TPA/NAb+3. This was particularly evident at physiological conditions where the temperature was 37 degrees C and the concentration of reactive serum natural antibodies (NAb) was high. Lower binding was observed at 37 versus 4 degrees C, or after raising the temperature from 4 to 37 degrees C, a procedure which was associated with an augmented loss of 125I-surface-labelled material from cells incubated in NAb compared to cells exposed to growth media. Even at 4 degrees C, NAb binding exhibited biphasic kinetics suggesting a loss of surface-bound NAb and a subsequent cycle of NAb uptake. The increased intravenous liver metastasis potential of the high NAb binding L5178Y-F9 TPA/NAb+3 corresponded with its higher total loss of 125I-surface-labelled material when incubated in NAb at 37 degrees C, and with its extensive loss of NAb binding when the temperature was raised from 4 to 37 degrees C. These observations are consistent with the idea that molecules released from the cell may contribute to the higher metastasis. This thinking was supported by the increased metastasis of tumor cells injected intravenously, either with serum in which they had been preincubated at 37 degrees C or into mice treated with supernatants from tumor cells incubated in NAb.


School nurses immunising without a doctor present. Oxfordshire's school health nurses routinely carry out rubella and tetanus and polio booster immunisations without a doctor present. Kate Saffin describes the preparation for and introduction of the practice and the results of an evaluation study. School nurses surveyed reported only one problem: increased workload because the doctor is no longer there to provide 'an extra pair of hands'.


HIV/AIDS and sexual health.

HIV/AIDS and sexual health. In including HIV/Aids and sexual health as key areas, The health of the nation stresses that 'good personal and sexual relationships can actively promote health and well-being'. This is a central concept, presenting challenges for professionals working in education and health writes Doreen E Massey, director of the Family Planning Association. In the second of our series on the opportunities the white paper offers nurses working in the community, she explores some of these challenges; in particular that promoting sexual health is not simply about disease prevention.


Health care interviews by school nurses. A health care interview (HCI) carried out by school nurses was piloted in Bath health authority for pupils entering secondary school. Tim Williamson reports the results of an evaluation study involving 99 pupils who had previously had a check with the school doctor at the age of ten. The HCI significantly improved the children's knowledge of who the school nurse was and how to contact her, but failed to improve knowledge of what the school nurse did. A total of 39 problems requiring some action were identified.


What's cooking in school meals?

What's cooking in school meals? School meals are a valuable opportunity to provide children with a nutritious meal and to teach children about healthy eating. It is a service on which many children, and parents, still rely. Since 1980, however, school meals have not had to meet any minimum nutritional standards and the service has become increasingly cost-orientated due to budget constraints. Gill Cawdron looks at the school nurse's role in relation to two initiatives in school meals: the School Meals Campaign and the School Meals Assessment Project.


Marketing: Part 4 of 4. Using quality assurance to promote the generic role. Unless customers--purchasers, providers and the public--can identify the benefits of the health visiting service they are unlikely to see it as a priority provision, warns Joy Notter. In the fourth and final article in this series, she examines the role of quality and quality assurance in a marketing strategy to sell health visiting services.


Family and social issues in sickle cell disease. Sickle cell disease (SCD) in Britain affects some 150 babies a year, born mainly to Afro-Caribbean and West African families. Like every chronic illness, it can have major psychosocial and practical consequences. Kenny Midence and Polly Shand describe the condition and the problems facing people with SCD and their families.


Informal care: problem or solution?

Informal care: problem or solution? Government policy stresses that care in the community must mean care by the community. Government policies have increasingly recognised, too, that care by the community means care by families. Yet social support policies have reduced the benefits available to carers. Hilary Graham examines the problems facing those giving and seeking informal care.


Propranolol retards revascularisation and impedes early myogenesis in regenerating skeletal muscle transplants: an autoradiographic and morphometric study in mice. The beta-antagonist (blocker) propranolol was tested for its effects on satellite cell proliferation and the revascularisation and regeneration of transplanted skeletal muscles. Utilising autoradiographic techniques it was found that there was no difference in the actual timing of onset of satellite cell activation between propranolol-treated and control mice. However, the numbers of proliferating myogenic cells were substantially reduced in the propranolol-treated mice until revascularisation of these transplants began, about 24 h later than in the controls; myogenesis was therefore retarded by propranolol. When transplants from propranolol-treated and control mice which had been allowed to regenerate for 14 d were analysed morphometrically it was found that there was no significant difference in the size of the transplants, although propranolol induced the formation of substantial lipid deposition in the central transplant region; this was evidence of inhibited revascularisation in the early stages (up to 4 d) after transplantation.


Hypertrophy of rat extensor digitorum longus muscle injected with bupivacaine. A sequential histochemical, immunohistochemical, histological and morphometric study. Histochemical, immunohistochemical, histological and morphometric properties of bupivacaine-injected rat skeletal muscle were studied at times spanning the complete course of degeneration and regeneration to establish when, if ever, 'normality' is reached. This was achieved in a sequence of measurements made on the same series of rat fast-twitch extensor digitorum longus muscle (EDL), of the fibre type composition, myosin heavy chain content, fibre size, connective tissue content and myofibril size at 1-2 h and 2, 4, 8, 11, 21, 40, 60, 80 and 180 d after treatment. By 2 d after injection 86% of the fibres had undergone necrosis. A rapid restoration of histochemical, immunohistochemical and morphometric properties then occurred, being apparently complete by 21 d after injection. A pattern of ongoing changes recognised when regeneration was essentially 'complete' are reminiscent of changes that occur in muscles following compensatory hypertrophy produced by synergist ablation. These changes included an increase in muscle weight, a decline in normalised peak twitch and tetanic tensions, and normalised force in response to different stimulation frequencies (Rosenblatt, 1992), an increase in the relative number of type I fibres and of fibres reacting with the slow myosin heavy chain antibody, an increase in whole muscle cross-sectional area, an increase in type I and type II fibre cross-sectional area and diameter, an increase in myofibril cross-sectional area, density, number, and area fraction, and an increase in the relative proportion of intramuscular connective tissue collagen. This suggests that the EDL muscle is being made to do more active work and is being influenced by passive forces (stretch) imposed on it. These changes appeared permanent: they stabilised at about 60 d after injection and were maintained for at least the next 120 d.


Cartilage and related tissues in the trunk and fins of teleosts. The structure and distribution of cartilage and related tissues in the dorsal fin, caudal fin and vertebrae of teleosts were studied in 11 species. With the exception of Zellknorpel, all the tissues previously described in teleost heads were present in the trunk and fins, although they were found in smaller quantities. The distribution of the supporting tissues indicates that they serve different functions. Hyaline cartilage was restricted to vertebral and fin bones undergoing endochondral ossification, fibro/cell-rich cartilage acted as an articular tissue, and hyaline-cell cartilage and its subtypes formed flexible and resilient supports in the caudal fin. Mucous connective tissue was packed as a space-filler around neurovascular bundles in fin rays, and chondroid bone was found beneath articular surfaces. The differences between cranial, and trunk and fin supporting tissues may reflect developmental as well as functional differences between the cranial and postcranial skeleton.


Macrophages and other endocytic cells in the mouse uterus during the second half of pregnancy and into the postpartum period. The spatiotemporal distribution of macrophages in the uterine wall of mice in the second half of pregnancy and the early postpartum period has been studied. Macrophages were identified using a combination of morphological criteria, the capacity to endocytose horseradish peroxidase and the expression of the Mac-1 antigen. Macrophages were a consistent feature of the myometrium. Numerous endocytic cells were found in the decidua basalis and metrial gland of pregnant mice and in the 'scar' regions of postpartum mice. However, few of the endocytic cells expressed the Mac-1 antigen. It is concluded that stromal/decidual cells, and not monocyte-derived macrophages, are primarily responsible for the removal of cellular debris in the decidua basalis and metrial gland during the last week of pregnancy and in repair of the uterine wall in the postpartum period.


Lectin histochemical study of the prostate gland of the rhesus monkey (Macaca mulatta). Glycoconjugates in the secretory epithelial cells of the rhesus monkey (Macaca mulatta) prostate gland were investigated using lectin histochemistry. The monkey prostate possesses cranial and caudal lobes. Histochemical staining with a battery of 8 lectins demonstrated differences in lectin binding patterns of the secretory epithelial cells between the 2 lobes. BS-1 bound exclusively to the cranial lobe, and PNA bound exclusively to the caudal lobe. DBA bound exclusively to a number of the secretory epithelial cells of the caudal lobe. In addition, both lobes showed binding with Con-A, RCA-1, WGA and S-WGA, but were negative for binding with SBA. Specific lectin binding patterns suggest a differing carbohydrate composition for each region, and a biological difference between the cranial and caudal lobes of the rhesus monkey prostate.


Mandibulodental allometry in the African wild dog, Lycaon pictus. Mandibulodental relations were evaluated in a sample of 34 adult Lycaon pictus crania (18 males, 16 females). Standard mesiodistal and buccolingual measurements, together with 8 mandibular measurements (intercondylar distance, intercarnassial breadth, mandibular length, arch length, condylar height, canine-condylar length, mandibular width, mandibular height) were allometrically scaled to total skull length. These results were then compared with those of domestic dogs and of 3 smaller southern African canids, Vulpes chama, Canis adustus and C. mesomelas. The results highlighted the differences in mandibulodental relations between males and females and provided support for the theory that females have relatively larger postcanine tooth sizes to match the higher masticatory demands of lactation and pregnancy. The African wild dog is shown to be more closely related dentally to the domestic dog than has previously been supposed.