[Association of hyperthyroidism and diabetes mellitus. Description of a case with partial recovery of pancreatic beta-islet function]. The coexistence of Graves' disease and insulin-dependent diabetes mellitus is well known among autoimmune polyglandular syndromes and sustained by common underlying immune pathogenic factors. Hyperthyroidism itself may lead to impaired glucose tolerance in subjects with intact beta-cell function through various not well clarified mechanisms and treatment of thyroid hyperfunction, on the other side, generally ameliorates the degree of metabolic control when diabetes is pre- and/or coexisting. We report a case of Graves' disease associated with diabetes mellitus, in which a partial recovery of insulin secretion is documented after euthyroidism was restored.


[Risk stratification in patients with a first myocardial infarct based on simple clinico-instrumental variables]. It is an acknowledged fact that the prognosis for patients with a first myocardial infarction depends mainly on the degree of residual left ventricle function. We wanted to evaluate the importance that certain simple clinical and instrumental variables can have in stratifying post-infarction cardiovascular risk with particular emphasis on chronic obstructive lung disease (COLD). We selected 97 out of the 512 patients treated in the coronary intensive care unit (CICU) from February 1, 1988 to October 31, 1990 according to the following criteria: First myocardial infarction; no cardiogenic shock; no serious concomitant diseases with considered negative prognosis within 6 months. The following variables were considered for all the patients: age; sex; positive family history for ischemic heart disease; history of diabetes mellitus; arterial hypertension; previous cerebrovascular incident; history of obstructive arteriopathy of the lower limbs, of angor and COLD. The following tests were performed on all the patients: echocardiogram prior to discharge form the CICU; angiocardioscintigraphy with Tc-99 between the 20th and 30th day following the acute event; bicycle ergometer stress test on the 30th day. general mortality; cardiac mortality; non-fatal reinfarction; residual angina at 3 months. All the patients were treated with aspirin (325 mg/die) and/or heparin (12,500 units subcutaneously). All 97 patients were monitored for a mean follow-up time of 19.8 months. General mortality was 2.08% (for reinfarction) 24 (24.7%) non-fatal cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS)


[The use of ergonovine in the hemodynamics laboratory]. In our department we have reviewed the use of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography. From January 1978 to December 1991 the test has been performed in 116 patients. According to their symptoms, the patients were divided into 4 groups: (A) patients with exertional angina: 16 patients (13.8%), (B) patients with angina at rest: 64 patients (55.2%), (C) patients with atypical chest pain: 29 patients (25%), and (D) patients with previous myocardial infarct: 7 patients (6%). We have subdivided the patients with angina at rest, according to the electrocardiogram recorded during pain, into: (1) 16 patients with ST-segment elevation; (2) 14 patients with ST-segment depression or T wave inversion; (3) 5 patients with electrocardiogram unchanged during angina; (4) 29 patients with no electrocardiogram recorded during angina. In 67 patients (57.7%) the coronaries were normal, 17 patients (14.6%) had mild irregularities, 26 patients (22.4%) had non critical fixed obstructions (< or = 70%), and in 6 patients (3.5%) there were fixed coronary narrowings > or = 70%. The left ventricle was normal in 85 subjects (73.2%), hypo or akinetic in 31 (26.8%). After routine coronary angiography and ventriculography, ergonovine maleate, 0.05 up to 0.4 mg, was given intravenously. The ergonovine test was considered positive when a focal spasm narrowed a normal coronary artery, or one with a mild fixed obstruction (< or = 50%) to more than 70%, or when a 70% stenosis became occluded. The development of angina and/or electrocardiographic changes were not taken as a criteria of positivity. Thirteen tests (11.2%) were considered positive.(ABSTRACT TRUNCATED AT 250 WORDS)


[Heart surgery complications during diagnostic coronary angiography. The experience of a nondepartmental hemodynamics laboratory]. The records of the Catheter Laboratory at S. Carlo Hospital in Milan (a District General Hospital without Cardiac Surgery Unit) between 1989-1991 were reviewed to determine how often emergency coronary by-pass surgery was performed because of a complication arising during elective coronary arteriography. A total of 1,009 cardiac procedures were performed, 876 (87%) were confined to left ventricular angiography and coronary arteriography in patients with suspected coronary artery disease. Our Catheter Laboratory complications rate was low: death 0.1%, stroke 0, non fatal myocardial infarction 0.8%, arrhythmia 0.5%, femoral haematoma 0.7%, emergency cardiac surgery 0. Case selection, seniority of operators, femoral approach (98% of the cases) with coronary catheters 6 French can explain these good results. In our experience coronary angiography at a District General Hospital is safe, feasible and diagnostic. Besides our main problem is the non emergency access to a Cardiac Surgery Unit after coronary arteriography: our patients have to join a long waiting list at major Regional Centres with an increase in cardiac events.


[The fibroblast, definition of its phenotype by its "programme" of biosynthesis of the extracellular matrix]. This presentation is an introduction to a symposium focusing on the fibroblast, a virtually ubiquitous cell which is cultured in many laboratories. The traditional definition of the fibroblast based solely on morphological criteria, which has satisfied most biologists for years, now needs reappraisal. The papers delivered at this symposium addressed this issue. Investigations ranged from the phylogenetic origin of fibroblasts in sponges, studied by R. Garrone, to the phenotypic modulations leading to the "myofibroblast" reported by G. Gabbiani, whose manuscript was unfortunately received too late for the conference. The present article describes how the fibroblast can be defined on the basis of its programme for producing extracellular matrix macromolecules. This programme includes a qualitative aspect, i.e., the selection of genes to be expressed: collagen types, variations in alternative splicing patterns of matrix proteins--and a quantitative aspect, i.e., the precise spatial and temporal regulation of production of "selected" macromolecules in order to meet the body's needs. This programme can be studied experimentally, and data are accumulating on the mechanisms involved and on its regulation through intrinsic factors (acting on the genome) and extrinsic and epigenetic factors (vitamins, hormones, nutrition...). Several French laboratories have supplied useful contributions to this research. The results of their investigations, which cover part of this field, are reproduced in this issue of this revue.


[Synthesis and supramolecular organization of components of the extracellular matrix by fibroblasts cultured in a collagen lattice]. Fibroblasts cultured in a collagen gel contract and organize the gel into a three-dimensional matrix of collagen fibers. Within this matrix, the fibroblast cell cycle is blocked at the G1 phase but also at the G2 phase. The fibroblasts produce the main extracellular matrix components (collagen, noncollagen proteins, glycosaminoglycans), although in small amounts. Studies using this in vitro model with radiolabeled precursor substances (14C proline, 3H glucosamine) demonstrated production of supermolecular complexes which resisted to proteolysis by pepsin and collagenase and could not be isolated by saline precipitation. Polyclonal antibodies identified type I collagen, type VI collagen and fibronectin in this coherent supermolecular structure. The presence of glycosaminoglycans was also demonstrated by alcian blue precipitation.


[Modulation of the organization of the extracellular matrix and the production of collagen by interferon gamma in three-dimensional cultures of normal and sclerodermic fibroblasts]. Recent studies have shown inhibition of collagen synthesis by interferon gamma (IFN-gamma) in monolayer human fibroblast cultures on a plastic solid phase. However, the existence of this effect in vivo has not yet been demonstrated. Three-dimensional fibroblast cultures in collagen matrices (collagen lattices or dermal equivalents) provide a more physiological model than conventional cultures and fairly closely simulate in vivo conditions. This model was used for studying effects of IFN-gamma on normal and scleroderma fibroblasts. IFN-gamma induced a dose-dependent inhibition of fibroblast-mediated retraction of collagen lattices. IFN-gamma also inhibited total protein and collagen synthesis. Scleroderma fibroblasts were especially susceptible to the inhibitory effects of IFN-gamma. Since fibrotic scleroderma lesions are associated with tissue retraction and increased production of extracellular matrix macromolecules, these data confirm the potential value of IFN-gamma for the treatment of scleroderma and other fibrotic diseases.


[The keratocyte or fibroblast of the cornea: morphological and biochemical characteristics in normal stroma and a few cases of corneal dystrophies]. Keratocytes are differentiated mesenchymal fibroblast which are specialized in the production and maintenance of the transparent corneal stroma. These elongated cells with large nuclei and scant cytoplasm produce the collages, proteoglycans, and glycoproteins which make up the stroma, as well as the enzymes involved in post-translation modifications and catabolism of these macromolecules. The characteristic morphological features and specific metabolic activity of keratocytes undergo significant changes during tissue repair and in several corneal diseases. Alterations in keratocyte biosynthetic activity, regardless of their cause, ultimately lead to fibrillar alterations responsible for a loss of corneal transparency.


[Inhibition of elastase activity in human gingival extracts by elastin peptides]. Effects of elastin peptides on elastase activity of gingival biopsy specimen extracts were studied in vitro and in vivo. All the extracts from biopsy specimens from 15 patients with a variety of periodontal diseases demonstrated fairly marked elastase activity. In vitro, addition of elastin peptides produced a mean inhibition of 54% +/- 14% with a concentration of 0.25 mg/ml and a mean inhibition of 90% +/- 6% with 2.5 mg/ml. In vivo treatment of gums with a paste containing 1% elastin peptides reduced elastase activity by 47% in 7 of 8 patients. These data suggest that elastin peptides are effective inhibitors of periodontal elastase activity and may be useful in preparations used for the preventive or curative treatment of periodontal diseases with tissue lysis.


[Integrins].

[Integrins]. Cells and extracellular matrix components have complex interactions which are involved in many biological processes throughout the life span. These cell-matrix interactions are mediated by receptors, of which some are integral membrane proteins. The aim of this short article is to review the integrin family, the overall structure of integrins, their distribution and their role. These new data will undoubtedly contribute to improved understanding of the physiological and pathological processes involving connective tissues.


Reproducibility of cutaneous electrogastrography in the fasting state in man. Cutaneous electrogastrography (EGGc), the recording of gastric electrical activity from the cutaneous abdominal surface, still presents a series of difficulties connected with the interpretation of signals. In this study, the authors evaluated the reproducibility of electrogastrographic data over a period of time by making recordings on three consecutive days in a group of healthy subjects. The recordings (lasting 1 hour) were made in the morning on fasting subjects. Three sets of bipolar cutaneous electrodes were placed on the abdomen around the pyloric radiological projection and the couple 3-6 corresponded to the antral axis. The spectral analysis of data was computed by fast Fourier transform. Their data confirmed that the 3-6 couple, corresponding to the antral axis, provides the strongest EGG signal. Each subject's mean gastric frequency and power were evaluated on the three consecutive recording days. The mean frequency was 2.83 +/- 0.22, 2.89 +/- 0.23, and 2.86 +/- 0.16 cpm on day I, day II and day III respectively. The mean power was 54.80 +/- 21.34, 46.86 +/- 21.52 and 49.25 +/- 19.55 microV 2 on day I, day II and day III respectively. The analysis of variance showed that the mean gastric frequency and power were not significantly different on the three days (p > 0.05). This shows that the frequency of the EGGc signal remains stable in the course of time and hence that EGGc is a reliable method of studying disorders in gastric electrical rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)


[Soluble interleukin-2 receptor assay is unhelpful in chronic inflammatory rheumatism]. The level of soluble interleukin-2 receptors (SIL2-R), which reflects lymphocyte activation, is often described as a useful parameter for evaluating disease activity and progression in patients with inflammatory conditions. Serum SIL2-R was assayed using a sandwich ELISA method in 98 subjects including 38 controls (C), 36 patients with ankylosing spondylarthropathy (AS) and 24 patients with rheumatoid arthritis (RA). SIL2-R levels were higher in RA patients than in controls and AS patients (p < 10(-4)), whereas the difference between AS patients and controls was small (p = 0.02). In RA patients, SIL2-R levels were not correlated with any of the clinical or biological parameters studied and remained unchanged during clinical improvements. In the AS group, SIL2-R levels showed no correlations with inflammation parameters (CRP, IgA) and was similar in patients with and without HLA B27 or appendicular joint involvement. This study failed to provide any evidence that SIL2-R levels are helpful for monitoring patients with inflammatory joint disease.


[L-carnitine: metabolism, functions and value in pathology]. Although L-carnitine is not considered as an essential nutrient, endogenous synthesis may fail to ensure adequate L-carnitine levels in neonates, especially those born prematurely. Free L-carnitine is found in many foods, mainly those from animal sources. Absorption of free L-carnitine is virtually complete. Lysine and methionine are necessary ingredients for the biosynthesis of L-carnitine. All tissues in the body can produce deoxy-carnitine but, in humans, the enzyme that enables hydroxylation of deoxy-carnitine to carnitine is found only in the liver, brain and kidneys. Complex exchanges of carnitine and its precursors occur between tissues. Muscles take up carnitine from the bloodstream and contain most of the body carnitine stores. L-carnitine and L-carnitine esters are eliminated mainly through the kidneys, which may play a central role in the homeostasis of this compound. Thyroid hormones adrenocorticotrophin (ACTH), and diet all influence urinary excretion of L-carnitine. Free L-carnitine can be assayed in plasma and urine and is occasionally measured in muscle biopsy specimens. Plasma L-carnitine levels may not accurately reflect L-carnitine body stores. L-carnitine ensures transfer of fatty acids to the mitochondria where they undergo oxidation. This process is associated with production of short-chain acylcarnitine which exit from the mitochondria or peroxisomes. L-carnitine ensures regeneration of coenzyme A and is thus involved in energy metabolism. L-carnitine also ensures elimination of xenobiotic substances. Carnitine deficiencies are common. Currently, these deficiencies are classified into two groups. In deficiencies with myopathy, only the muscles are deficient in L-carnitine, perhaps as a result of a primary anomaly of the L-carnitine transport system in muscles. In systemic deficiencies, L-carnitine levels are low in the plasma and in all body tissues. Systemic L-carnitine deficiencies are usually the result of a variety of disease states including deficient intake in premature infants or long-term parenteral nutrition; renal failure; organic acidemias; and Reye's syndrome. Modifications in L-carnitine metabolism have also been reported in patients with diabetes mellitus, malignancies, myocardial ischemia, and alcohol abuse. A large number of supplementation trials have been carried out.


[Gastro-protection in vivo and in vitro]. Experimental evidence coming from Andre Robert studies indicates that prostaglandins (PG) administered exogenously or released endogenously by mild irritants prevent the formation of gross mucosal lesions induced by various ulcerogens such as absolute ethanol, bile salts, hypertonic solution and acidified aspirin. This action appears to be independent of their gastric inhibitory effects. Mild irritants such as 5 mM NaCl, 20% ethanol and 20 mM taurocholate prevent gastric necrosis through adaptive cytoprotection involving an increase in the generation of endogenous PG. In addition, PG have been shown to increase gastric mucosal blood flow and to stimulate mucosal bicarbonate as well as mucus secretion and these effect may contribute to their gastro-protective action. As demonstrated recently, PG prevented the damage of isolated gastric glands in vitro condition, where systemic, neural and hormonal factors are excluded. Gastro-protection is not the unique property of PG, however the mucosal generation of protective PG is essential for gastro-protective effects of solcoseryl. This paper reviews not only protective factors but also the mechanism and possible pathogenic implications of three related compounds thromboxanes, leukotrienes and platelet activating factor (PAF) in acute mucosal injury by topical irritants. The release of these mediators have been thought to be involved in the mechanism of mucosal injury, especially damage to the microvascular endothelium. Whether gastro-protection plays crucial role in the mechanism of ulcer healing remain unknown, however in chronic studies, PG failed to affect the speed of ulcer healing. On the other hand, epidermal growth factor (EGF) exhibits both gastro-protective and ulcer healing properties due to the potent trophic action and to the stimulation of polyamine biosynthesis. The accumulation of EGF in a large quantities in the ulcer area by the antiulcer drugs such as sucralfate and De-Nol may explain their well-known enhancing effects on ulcer healing.


[Is standardization possible in immunohistochemical examination?]. Immunohistochemistry has become an important tool in research and in surgical pathology. Rapid growth of a new methods in immunohistochemistry supplement traditional histochemical and histological light microscopy investigations. Immunohistochemistry has given pathologists a chance to location different antigens on the cell surface as well as in the cell compartments. The expression of antigens are mostly influenced by factors connected with tissue processing; fixation and embedding. The aim of present article is to show the role of these factors and their influence on some immunohistochemical staining results. Not all the problems are discussed here, the main goal which authors would like to obtain is to show the way how to solve problems which can occur during immunohistochemical staining procedure. They want also to delineate the importance of standardization in immunohistochemistry to make the results more reliable between different laboratories.


Some ultrastructural aspects of Helicobacter pylori gastritis. Ultrastructural examinations of biopsy specimens of the gastric mucosa were performed in 20 patients with chronic gastritis proven by endoscopy and microscopy. The presence of the Helicobacter pylori bacteria was found in close contact with epithelial cells of the antrum and corpus of the stomach. The bacteria were not present in the areas of frequently observed intestinal metaplasia. There were ultrastructural changes on the surface and within the cytoplasm of the epithelial mucous cells, which indicated their disturbed metabolism.


Reactivity of bronchoalveolar space cells in lung asbestosis. Preliminary studies to evaluate lymphocyte subsets bronchoalveolar lavage (BAL) and blood were carried out in a group of patients with lung asbestosis. The assessments were made by an indirect immunofluorescent method using monoclonal antibodies as a marker. The results were recorded on a flow cytofluorometer FASC-can. As compared with a control group, the patients with lung asbestosis showed a slight decrease in the total level of T lymphocytes (CD3) in BAL, however with a clearly disturbed proportion between T-helper (CD4) and T-suppressor (CD8) lymphocytes, which led to a decreased CD4/CD8 ratio. The blood level of T lymphocytes and their subsets in these patients approximated that in the controls. Heavy smoking was also found to enhance disorders in their number and proportion. The assessment of B lymphocytes (by using polyclonal antihuman immunoglobulins (sIg/FITC) showed a significantly high level of these lymphocytes in BAL with simultaneously low levels in blood in the same patients with lung asbestosis. We did not find a clear synergic effect of cigarette smoking on the levels of B lymphocytes in the studied group.


Comparison of porphyrin content in the cortex and medulla of the kidneys and adrenals of patients dying from chronic circulatory insufficiency. Taking into account a correlation between the metabolism of porphyrins and hormones, and especially the metabolic interactions between the kidneys and adrenals, preliminary pilot studies were carried out on porphyrins in the kidneys and adrenals, separately in the cortex and in the medulla of these organs. The material was taken from 11 men and 8 women dying from circulatory insufficiency with vasculogenic renal fibrosis, and without changes in the adrenals. In all cases the concentration of porphyrins was much higher in the adrenals than that in the kidneys, while the content of uro-, copro-, and protoporphyrin was always higher in the adrenal medulla then that in the cortex. Discussing the results obtained the author suggest a correlation between disturbances of the reno-adrenal feedback, and an extremely increased concentration of porphyrins in the adrenal medulla which could be caused mainly by connections between the metabolism of catecholamines and porphyrins.


Endometrial stromal neoplasms of the uterus. A clinicopathologic study. A clinicopathologic study of uterine endometrial stromal tumors (EST) has been performed with special emphasis on histologic and immunohistochemical differential criteria and prognostic factors. The material comprised three stromal nodules (SN), twelve low grade stromal sarcomas (LGESS) and five high grade stromal sarcomas (HGESS). Previously unreported endolymphatic growth was found within one SN. EST showed an association of mitotic index (IM) with atypia, degree of stromal differentiation, additional non-stromal differentiation and venous invasion. IM was the best criterion in the differential diagnosis of LGESS and HGESS and the most significant histologic prognosticator. The present study shows that a histologic grade of stromal sarcoma was a more significant prognostic factor than pTNM stage. The results suggested that clinicopathologic classification of EST could be supplemented by including the following subgroups: a) SN--without intravascular growth, and potentially malignant SN--with endolymphatic growth within the tumor; b) LGESS with IM < 2 and no atypia, and LGESS with 2 > IM < 10 and mild atypia; c) HGESS with 10 > IM < 20 and moderate atypia, and HGESS with IM > 20 and marked atypia. Contrary to common view these observations indicate that the distinction of some SN and LGESS from stromal hyperplasia is possible in an endometrial curretage material.


The clinicomorphological correlations in Schoenlein-Henoch nephropathy in children. Clinicomorphological analysis has been performed in Schoenlein-Henoch nephropathy. Various clinical symptoms are accompanied by morphological changes of variable type and severity. Electron microscopy is a major tool for evaluating these changes. It relatively frequently modifies the diagnosis made by light microscopy. It mainly concerns class I and VI changes (according to a grading system of the International Study Group of Kidney Diseases in Childhood). It was shown that late prognosis was largely determined by the type and severity of morphological changes. Varying severity of changes in individual glomeruli in the same specimen requires in each case a comparison of results obtained by electron microscopy with those obtained by light microscopy in semithin sections. In three children biopsy was repeated. Progression of morphological changes was found in one child. He developed renal failure. In one child morphological changes on first biopsy did not differ from those on second biopsy. Repeated biopsy was performed due to the presence of hypertension. In one child with persistent proteinuria repeated biopsy showed marked attenuation of morphological changes.


Thin basement membranes syndrome: a rare cause of erythrocyturia. The results of the studies in five children with the syndrome of thin basement membranes have been discussed. A comparison of clinical data with the morphological ones shows that recognition of erythrocyturia or hematuria necessitates familial examinations and long-term follow-up. Final diagnosis of this syndrome may be made only by means of electron microscopy.


Focal segmental glomerulosclerosis in children. Clinical and morphological examinations in 25 children with the diagnosis of focal segmental glomerulosclerosis (FSG) show that: 1. electron microscopy permits a detection of FSG in its early stage when light microscopy does not reveal any changes, and immunomorphological studies do not show deposits 2. in this stage small focal interstitial changes may be visible 3. ultrastructural studies reveal changes in case of nonspecific light microscopy i.e. suggesting mesangial glomerulonephritis 4. in doubtful cases it is useful to repeat biopsy.


Membrane-bound tumour necrosis factor alpha: immunocytochemical and ultrastructural studies of human monocytes and monocytic cell line and its induction by tumour cells in vitro. Monoclonal antibody against recombinant human tumour necrosis factor alpha (rTNF) was used for the immunochemical detection of TNF in human blood monocytes and monocytic cell line U 937. Cells stimulated with phorbol myristate acetate (PMA) showed strong surface but not cytoplasmic staining. Unstimulated cells demonstrated weak or no staining. At early time after stimulation (1-2h) a spot reaction was seen in the Golgi area of the cytoplasm of stimulated cells. Coculture of tumour cells with monocytes also resulted in the induction of membrane TNF. Ultrastructural studies confirmed TNF localization within the cell membrane. These results indicate that TNF can be detected within the cells by immunocytochemistry which may make feasible studies on TNF appearance in cellular infiltrates in the tissues.


Immunolocalization of epidermal growth factor (EGF) in human salivary glands detected with the new monoclonal antibody. Epidermal growth factor (EGF) is biologically active peptide commonly seen in many human tissues and organs. Its high concentration has been found in the salivary glands. The purpose of the present study was to determine EGF immunolocalization in normal human major salivary glands using a new monoclonal antibody anti-EGF. The results were compared with EGF location determined by using two human antibodies (Oncogene, USA and ICI from dr Gregory, UK). Immunohistochemical studies were performed by the PAP method. All antibodies demonstrated EGF expression in the efferent pathways of the salivary glands, especially in their proximal segments.


TFX-polfa in the treatment of transplantable Morris 5123 hepatoma in buffalo rats. Buffalo rats with Morris 5123 hepatoma implanted into the muscles of a paw were treated with the preparation TFX produced by Polfa and/or amputation of the paw with the tumour. The results of treatment with TFX followed by amputation were significantly better than those of TFX treatment or amputation alone.


Effect of vitamin E on the immunoreactivity of spleen cells in hyperlipidaemic rats. Atherogenic (lipid-rich) diet suppressed mitogen-induced lymphocyte blastogenic responses in rats. Supplementation with vitamin E completely abolished the suppressive effect of the diet. The atherogenic diet also decreased the tumour necrosis factor alpha (TNF-alpha) activity produced by spleen macrophages, however, vitamin E supplementation failed to abolish this effect. Diet or supplementation had no measurable action on interleukin-1 (IL-1) production of macrophages.


The incidence of hepatitis delta virus infection in chronic liver diseases in Hungary. A study of hepatitis B and D virus markers in 118 hepatitis B virus seropositive patients suffering from histologically confirmed chronic liver disease is reported. The prevalence of hepatitis delta infection amounted to 13.6%, whereas active hepatitis delta virus replication was proven in 6 of the cases. On the basis of these findings, conclusions--similar to those published earlier--are drawn about the role of hepatitis delta virus in the progression of chronic liver diseases. It is suggested that HBsAg-IgM complex seropositivity in patients suffering from anti-delta positive chronic liver disease supports active hepatitis delta virus replication.


The distribution of ABO(H) isoantigens in urinary bladder tumours. The distribution of blood group isoantigens (ABH) was studied with the specific red cell adherence test (SRCA); the red blood cells were visualized by the benzidine-peroxidase reaction. The H antigen was detected with Ulex europaeus agglutinin I lectin by direct immunoperoxidase technique. One hundred and seven bladder tumours were tested. It was found that blood group isoantigens diminished with immaturity (grade) and tumour invasiveness (T stadium). Patients with ABH blood group isoantigen deletion should be considered to be belong to a particularly high-risk group. The preservation of blood group antigens in grade II-III carcinomas may be useful in the choice of treatment (conservative or radical). In six cases in the area of squamous metaplasia of invasive carcinomas a strong false SRCA reaction was noticed detecting presumably the blood group determinants of the epidermal growth factor receptors.


The significance of detailed hepatitis B virus serology in chronic liver diseases. Hepatitis B virus (HBV) markers were studied with Sorin RIA kits in serum samples from 390 patients suffering from histologically confirmed chronic liver disease. On the basis of negative HBsAg, anti-HBs, anti-HBc tests, HBV infection was excluded in 235 of the cases. The diagnosis was fatty liver and/or alcoholic hepatitis in 52%, while chronic active hepatitis and/or liver cirrhosis only in 21.7%. Part or present HBV infection was proven in 155. In 53% of these cases the diagnosis was chronic active hepatitis and/or liver cirrhosis, whereas fatty liver and alcoholic hepatitis occurred in 27.7%. Detailed HBV marker analysis was performed in 76 patients. Previous infection without replication (positive anti-HBs and/or anti-HBc and/or anti-HBe) was proven in 48 cases, 12 patients had active HBV infection (positive HBsAg, HBe, IgM anti-HBc), while in 16 cases HBV integration (positive HBsAg, anti-HBc, anti-HBe) was proven. HBsAg-IgM complex seropositivity was shown in every case with active HBV replication. Because of therapeutic, prognostic and epidemiologic reasons, the significance of detailed HBV serology in chronic liver diseases is stressed.


Dipyridamole thallium-201 scintigraphy in patients with arteriosclerosis obliterans. Increased accuracy in identifying cardiac risk. Forty-eight preselected patients (pts) with arteriosclerosis obliterans were investigated by dipyridamole thallium scintigraphy (DTS). No correlation was found between the distribution of positive or negative exercise ECG testing (ExECG) and isotopic risk-scores (P > 0.1 in the chi-square test). We assessed cardiac ischaemia in 12 pts with insufficient ExECG. Although only 2 pts had documented previous myocardial infarction, 20 pts exhibited irreversible perfusion defect. Silent reversible or irreversible ischaemia was identified in 12 pts (25%). Seven pts would not have been diagnosed to have coronary artery disease (CAD) even by ExECG. In conclusion, DTS was found very useful in these cases. We support a stepwise cardiac risk stratification before major vascular surgery.


Clinical utility of quantitative assessment of liver haemodynamics in cirrhosis provided by dynamic hepatoscintigraphy. Interrelationships between quantitative assessment of portal (%Qp) and arterial (%Qa) components of hepatic blood supply obtained by dynamic hepatoscintigraphy, and clinical variables characterizing the severity of liver cirrhosis and portal hypertension were studied in 25 cirrhotic patients. The variables, clinical state, size of oesophageal varices, ascites accumulation, sonographic stigmata of portal hypertension, liver mass and elimination rate of lidocaine and antipyrine were studied. The %Qa rose in proportion to the severity of liver injury estimated from the Child-Turcotte and McCormick grading scores. The mean %Qa for patients with Child A cirrhosis was significantly higher than that for 8 healthy subjects (34.8 +/- 7.9% vs 18.1 +/- 4.0; P < 0.01). The %Qp values showed relationship with the size of esophageal varices, provided discriminatory data with respect to the ascitic fluid accumulation and the development of intraabdominal collateral circulation. The liver mass had no impact on hepatic dual blood supply pattern, but was linked with the rate of antipyrine clearance. Neither antipyrine clearance nor lidocaine elimination rate corresponded to alterations of hepatic dual blood supply. The %Qp showed a negative correlation with the initial half-life of lidocaine, which was referred to lowered hepatic uptake of the drug. It is concluded that the quantitative assessment of %Qp and %Qa reflect the advancement of portal hypertension better than liver function failure does.


Macroethical responsibilities of societies of gynaecologists and obstetricians. The theme of maternal mortality and morbidity is of transcending macroethical importance. High rates of maternal mortality and morbidity can be significantly reduced by cost-effective means that are not dependent on advanced biotechnology. It has been shown that a major cause of maternal mortality comes from women (i) bearing children too early or too late in their reproductive lives, (ii) too frequently or at insufficiently spaced intervals. If women were able to control their fertility in order not to have children at unwanted times in periods of their life when pregnancy is inimical to their health, the incidence of maternal mortality and morbidity would drop. Improved standards of women's education, both in general and in particular regarding women's reproductive health, would reinforce the understanding of how to protect and improve one's reproductive health, and would accelerate the decline of maternal mortality and chronic morbidities. Accordingly, the macroethical demands of respect for autonomy, beneficence and justice would coincide. The value of justice would be served not only regarding women themselves, particularly those who have traditionally been vulnerable by virtue of their growing age, or dependent status in their communities, but also regarding the children dependent on such women, and families also dependent on the services of such women, like mothers, wives, daughters and grand-daughters.


The effect of sulphonylurea therapy on the outcome of coronary heart diseases in diabetic patients. A retrospective study was performed on 1040 diabetic patients. The survival time of those treated with first generation sulphonylureas (n = 227) was considerably (P < 0.001) shorter after the first attack of angina pectoris (5 +/- 1 years, mean +/- S.E.) or acute myocardial infarction (6 +/- 1 years) than of those (9 +/- 1 years) on glibenclamide treatment (n = 144), with regime alone (n = 282) or treated with insulin (n = 387). The systolic blood pressure of patients with first generation sulphonylureas (166 +/- 1/91 +/- 1 mmHg) proved to be higher (P < 0.01) than those treated with glibenclamide (159 +/- 1/91 +/- 1 mmHg) or being on regime alone (155 +/- 1/89 +/- 1 mmHg) or on insulin (156 +/- 1/89 +/- 1 mmHg) treatments. Serum sodium level was found to be lower (P < 0.05) in patients treated with any kind of sulphonylureas (138 +/- 1 mmol/l) than in the other patients (143 +/- 1 mmol/l). During an observation period, 576 of patients died, 412 of them due to cardiovascular or renal failures. Among the diabetic subjects suffering from coronary heart disease no difference could be detected in risk factors except for higher systolic blood pressure. The shorter survival time of patients treated with first-generation sulphonylureas might be explained by the arrhythmogenic activity of first-generation sulphonylureas. Improvement in therapy, metabolic and cardiovascular alterations during the survey can not be responsible for the shorter survival time of patients treated with first generation-sulphonylureas.


A case of multiple myeloma with multilobulated and convoluted plasma cell nuclei. We report a case of multiple myeloma with unusual cytological features. Cytological diagnosis was rendered difficult due to plasma cells with multilobulated and convoluted nuclei and this variant of myeloma seems to indicate poor prognosis.


LDL molecular size as risk factor in coronary artery disease. Sera of 65 fasting human subjects--32 patients with coronary artery disease (CAD) aged 42-80 years and 33 healthy individuals--were tested for determination of nine lipid-related laboratory parameters, including protein-enriched LDL (low density lipoprotein cholesterol (LDL apo B) which is proportional to the amount of cholesterol per LDL particle. Three of the investigated parameters: protein-enriched LDL, HDL cholesterol and apo B level differed significantly in the two groups (corrected P < 0.001, P < 0.009 and P < 0.009, respectively). Discriminant analysis revealed that protein-enriched LDL, LDL cholesterol, apo B and fasting triglyceride levels, but not HDL cholesterol, were the major discriminating factors for CAD in this study. Pearson correlation coefficients were calculated to describe the association between this size-related parameter and those which in both groups seem to be most strongly associated with it: apo B/A-I ratio (i), triglyceride (ii) and LDL/HDL ratio (iii). The analysis was done separately in the two groups. In the patients with CAD the influence of these three parameters were less decisive in the determination of the protein-enriched LDL than in the controls (corr. coeff.: (i) -0.155 vs -0.358; (ii) -0.624 vs -0.791; (iii) -0163 vs -0.471). In healthy volunteers the size-reducing effect of the same parameters was more profound, and at high values of LDL/HDL ratio, apo B/apo A-I ratio and triglyceride no distinction in LDL particle size can be made any longer between CAD patients and controls. Thus the improvement of the atherogenic profile does not seem to result in the reduction of risk for CAD in terms of LDL size and composition.


Experiences with functional insulin substitution: a follow-up study on control and patient compliance. Functional insulin substitution, an insulin regimen made up of two daily injections of intermediate-acting insulin and prandial boluses of regular insulin, was to be introduced in 49 type 1 diabetic patients, as previous regimens consisting of two or three daily injections proved to be inefficient due to the patients lifestyle or inherent metabolic lability. Forty-five patients were treated with human insulin injected by NovoPen. In 38 cases therapy was changed in the frame of a one-week, small-group, inpatient, structured educational course. After a mean 14 months of follow-up metabolic status improved in 33 cases while there was further derangement in 16. Eighteen patients were practising true functional therapy, i.e. doing blood glucose tests before each injection. Further 22 diabetics were trying to achieve better metabolic control through 2-3 daily blood glucose tests and insulin dose corrections. The metabolic status was not affected by the frequency of blood glucose testing, rather by raising of the daily dose of short acting insulin in conjunction with the switch in therapy acting beneficially. All patients insisted on using NovoPen further on.


Genotoxic effects of occupational exposure in the peripheral blood lymphocytes of pesticide preparing workers in Hungary. Venous blood samples of 240 donors including 33 industrial and 60 historical controls were investigated in order to assess the genotoxic risk of pesticide preparing workers manufacturing monochlorinated benzene in Hungary. Mutation frequencies were determined in the hypoxanthine-(guanine)-phosphoribosyl transferase genes located on the X chromosome. DNA repair capacity was estimated following hydroxyurea treatment with subsequent UV irradiation of separated lymphocytes. Smoking as confounding factor of genotoxicity was also taken into consideration. Mutation frequencies were increased among the workers exposed to monochlorinated benzene in correlation with the duration of working time, compared to the controls. Mutation frequencies were lower than expected among non-smoker, long-exposed workers. Smoking itself proved to be an effective confounding factor in the enhancement of point mutations in the case of long-exposed workers. Smoking, however, caused no significant increase in the mutation frequency among the controls, and did not influence the DNA repair capacity of any of the groups.


Burkitt's lymphoma in adults: a retrospective study of 46 cases. The prognosis of Burkitt's lymphoma is generally considered to be poor, particularly in the advanced stages of the disease. Although recent chemotherapy protocols have given high rates of cure in children, there are few such reports concerning adults. We therefore conducted a retrospective analysis of the results for treatment of 46 adults in the Institut Gustave Roussy (IGR) between 1978 and 1987, in order to establish an effective treatment strategy for use in a prospective trial. The median age of the patients was 31 years and the majority were Caucasians of European origin. The clinical symptoms and course of the disease were similar to those in the pediatric situation and corresponded to the so-called non endemic forms observed in Europe and the United States. Presentation was generally extra-nodal, usually with abdominal manifestations. As a rule, the disease progressed rapidly and showed a high affinity for the central nervous system in the absence of specific prophylaxis, despite systemic therapy with highly active agents, particularly in the advanced stages. According to Murphy's classification, there were 6 stage I, 11 stage II, 19 stage III and 10 stage IV patients (3 of whom had CNS involvement). Treatment was heterogenous, although all the patients received polychemotherapy including anthracyclins. The best results were obtained from eleven patients treated according to the French Multicenter Protocols for pediatric Burkitt's lymphoma (LMB-84 and LMB-86). Kaplan-Meier 5-year relapse free survival rate among the 46 patients was 42% (stage I: 83%; stage II: 67%; stage III: 30%; stage IV: 30%). In order to standardize our therapeutic approach, we started a prospective study in 1988 using the unmodified pediatric protocol for our adult patients.


Relationship of serum antihistone antibody level to the patient's age. The serum antihistone antibody (AHA) positivity of patients with various autoimmune diseases was compared with their positive reaction for antinuclear factor, rheumatoid factor, lupus erythematosus factor, cryoglobulin, immunocomplex, C-reactive protein, total protein, gamma globulin, IgG and IgM. In non-drug-induced SLE cases the predictive value of the AHA test was not higher than that of the other tests. It was striking that in 42% of patients with non-autoimmune disease aged over 70 the AHA test was positive. Elevated IgM values were recorded in about 70% of positive AHA samples.


Polycythaemia and portal vein thrombosis. An attempt was made to discover the aetiology of acquired portal vein thrombosis in 12 polycythaemic patients who did not show any obvious local or regional cause. In addition to the diagnostic criteria of polycythaemia vera, erythropoietin was determined and cultures of erythroblast precursors were examined. The patients could be divided into 3 groups, in the first of which the definite diagnosis of polycythaemia vera was made on the basis of the PVSG (Polycythaemia Vera Study Group) criteria and bone marrow biopsy (5 patients). In the second group (5 patients), there was a diagnosis of possible polycythaemia vera based essentially on the finding of a spontaneous growth of medullary CFU-E. Finally, diagnostic criteria for polycythaemia vera were absent in two patients. On the basis of these findings, the physiopathology of the association of portal thrombosis and polycythaemia is discussed, in particular polycythaemia secondary to hepatic ischaemia.


RRR-alpha-tocopheryl succinate modulation of human promyelocytic leukemia (HL-60) cell proliferation and differentiation. HL-60 human promyelocytic leukemia cells can be induced to differentiate to granulocytes by retinoic acid and dimethyl sulfoxide or monocyte-macrophages by phorbol esters and 1,25-dihydroxyvitamin D3. These studies show that RRR-alpha-tocopheryl succinate (TS) inhibits HL-60 cell proliferation and induces the HL-60 cells to differentiate toward a functionally deficient macrophage-like cell. TS at (15 micrograms/ml) was found to suppress HL-60 cell proliferation by 63% and 89% at 24 and 48 hours, respectively. This suppression of proliferation, however, is not permanent and requires the presence of TS. HL-60 cells treated for 48 hours with TS (15 micrograms/ml) were found to be blocked in the G2/M phase of the cell cycle. HL-60 cells blocked in the G2/M cell cycle phase by TS expressed normal levels of the transferrin receptor. TS-treated HL-60 cells exhibited binucleated morphological appearance; however, the cells did not exhibit chemotaxis, phagocytosis, or changes in the expression of the cell surface markers, CD11a and CD18. However, HL-60 cells treated for 48 hours with TS (15 micrograms/ml) could be stimulated to produce superoxide radicals and exhibited nonspecific esterase activity, two characteristics of macrophages. These results suggest a role for TS as an antitumor proliferative agent and as a modifier of human leukemia cell differentiation.


Effect of dietary soybean and licorice on the male F344 rat: an integrated study of some parameters relevant to cancer chemoprevention. The individual and combined effects of dietary toasted soybean meal (3.13-25%) and dietary licorice root extract (0.38-3.0%) on selected liver and intestinal enzyme levels and on clinical chemistry and histopathological parameters were evaluated on male F344 rats. All parameters were measured one and three months after the 50-day-old rats were started on the diets. By use of newly developed high-performance liquid chromatography-based analytic methods, measurable levels of daidzein (2.67 micrograms/ml) and glycyrrhetinic acid (7.87 micrograms/ml) were detected in the sera of rats on the 25% soybean and 3% licorice diets, respectively. Histopathological evaluations of organs and tissues yielded only nonsignificant strain-related changes. At all dosages, there were no significant soybean- or licorice-related anatomic lesions or hematologic changes. In the clinical biochemistry profile, soybean meal caused moderate but significant dose-dependent decreases in serum cholesterol and increases in alkaline phosphatase, blood urea nitrogen, and phosphorus, which remained within the normal range. Liver glutathione transferase, catalase, and protein kinase C showed significant inductions (up to 50%) in response to increasing doses of soybean meal and licorice extract, with evidence for only marginal interaction between the two additives. Their effects on the intestinal mucosa were not significant. Ornithine decarboxylase levels, an indicator of promotional activity, were unchanged or repressed by the additives. The favorable effects of up to 25% toasted soybean meal and 3% licorice root extract on the levels of the four enzymes, without unfavorable changes in clinical parameters, might account in part for the chemopreventive activities of these additives. These effects would be in addition to direct inhibitory effects of known components in these additives on these or other enzymes or modulation of hormone activity that is not evaluated in this study.


Attributable risk for diet, alcohol, and family history in the Melbourne Colorectal Cancer Study. From the data obtained in a large comprehensive population-based case-control study of colorectal cancer (The Melbourne Colorectal Cancer Study), attributable risk was calculated for a family history of colorectal cancer in near relatives for diet (when > or = 5 of the 11 previously determined dietary risk factors were present) and for beer consumption (for rectal cancer only). The attributable risk was 11% in the presence of a family history of colorectal cancer and 46% in the presence of five or more dietary risk factors. The attributable risk for rectal cancer in the presence of beer consumption was 31% in males and 11% in females. These data are relevant in the consideration of primary prevention of colorectal cancer in Australia, but their general application needs to be approached with caution in view of major differences in the genetic background and the dietary practices in various regions of the world and in view of the uncertainty of what is achievable change, especially for dietary practices.


Diet, alcohol, smoking, serum beta-carotene, and vitamin A in male nonmelanocytic skin cancer patients and controls. A case-control study was conducted in Melbourne, Australia of 88 consecutive males admitted for the surgical removal of a nonmelanocytic skin cancer (histologically confirmed basal cell carcinoma and squamous cell carcinoma) and of 88 male control patients admitted for small elective surgical procedures. In both cases and controls, previous diet, alcohol consumption, and smoking habit were investigated and serum beta-carotene and vitamin A levels were measured. A statistically significant inverse relationship was found between the risk of skin cancer and a high intake of fish (p = 0.05); vegetables in general (p < 0.001); beans, lentils, or peas (p < 0.001), carrots, silverbeet (Swiss chard), or pumpkin (p < 0.001); cruciferous vegetables (cabbage, brussel sprouts, or broccoli) (p < 0.001); and beta-carotene- and vitamin C-containing foods (p = 0.004). Cases had a lower mean serum level of beta-carotene (p < 0.001) and vitamin A (p = 0.02) than controls. The incidence of skin cancer in the study was inversely related to the level of serum beta-carotene (p < 0.0001). The correlation coefficient between dietary beta-carotene/vitamin C and serum beta-carotene was 0.22 (p = 0.04). Smoking and alcohol consumption showed no statistically significant association with the risk of nonmelanocytic skin cancer. The results were similar for both cell types. A high intake of vegetables including cruciferous vegetables, beta-carotene- and vitamin C-containing foods, and fish appears to be protective for nonmelanocytic skin cancer, and this deserves further study, as does the possible etiologic relevance of the low serum levels of beta-carotene and vitamin A.


Ethanol calories do not enhance breast cancer in isocalorically fed C3H/Ou mice. Mammary tumorigenesis is augmented when C3H/Ou mice are fed diet ad libitum but delayed when calories are restricted by 40%. Three feeding experiments were done to evaluate the effect of ethanol on mammary tumorigenesis in isocalorically fed C3H/Ou mice: 1) ad libitum feeding of semipurified solid diet, with one group receiving 12% ethanol (15 g/kg/day) in the drinking water while controls received water alone; 2) isocaloric pair feeding of semipurified solid diet, with ethanol (4 g/kg/day) administered by gavage five time per week; and 3) isocaloric pair feeding of Lieber-DeCarli liquid diet, with one group receiving 29% of calories as ethanol (20 g/kg/day) in the diet. Despite administration of ethanol to isocalorically fed C3H/Ou mice for 65 weeks by three different methods, mammary tumor development was not enhanced. In two of the three ethanol-consuming groups, weight gain and mean body weight were less in the ethanol-consuming mice than in the controls, despite equal total calorie consumption. In only one ethanol-consuming group, where mice received ethanol as a 12% solution in the drinking water, was any difference noted in the tendency to develop mammary tumors. In this case, delay in tumorigenesis was apparent in the ethanol-consuming animals (p = 0.03). These findings do not support the hypothesis that ethanol calories augment the risk of breast tumorigenesis among breast cancer-prone mice consuming isocaloric diets. Instead, reductions in weight gain and body weight among ethanol-consuming mice and an apparent reduction in mammary tumorigenesis in one of three experimental groups suggest that ethanol may decrease metabolic utilization of calories and hence contribute to lowered energy availability.(ABSTRACT TRUNCATED AT 250 WORDS)


Diet in the epidemiology of bladder cancer in western New York. We present the dietary epidemiology of bladder cancer while controlling for a number of lifestyle and environmental risk factors in a study of 351 white male cases with histologically confirmed transitional cell carcinoma of the bladder and 855 white male controls selected from Erie, Niagara, and Monroe counties of western New York from 1979 to 1985. Usual diet was estimated by comprehensive interviews with use of a detailed food frequency questionnaire. An increased risk of bladder cancer was associated with higher kilocalorie intake, but only among those under 65 years of age, with the strongest pattern associated with fat intake. Further analyses of fat, carbohydrates, and protein, with adjustment for total kilocalories, resulted in a positive association of risk with fat intake and a decreasing risk with higher protein intake. Of the vitamins, carotenoid consumption appeared to decrease risk with increased consumption for those under 65 years of age. No significant differences between cases and controls were seen for intake of calcium, retinol, thiamin, riboflavin, niacin, vitamin C, vitamin D, and vitamin E. After adjustment for kilocalories and other confounders, higher intake of dietary sodium was associated with increased risk among both age groups, and the trends were statistically significant. The importance of diet in the etiology of bladder cancer is suggested by our findings.


Dietary patterns and colon cancer in western New York. Seven dietary patterns were identified among control subjects in the Western New York Diet Study (1975-1986) by application of principal components analysis to data from a 95-item food frequency interview. The results of case-control analyses of colon cancer risk for these patterns are presented. Cases were matched with neighborhood controls on the bases of age and sex; 205 colon case-control male and 223 female pairs were obtained. The dietary patterns and intakes of energy, total fat, and dietary fiber were examined with logistic regression for their individual contributions to risk. In males, three of these dietary patterns were associated positively with fat and energy consumption; they elevated risk for colon cancer and accounted for more risk than did the specific nutrients. Control for energy and fat intakes allowed the protective influences of additional dietary patterns to be expressed. No patterns elevated risk in women; two patterns were protective for colon cancer. Controlling for energy and fat intake enhanced the protection afforded by one of these patterns but had no influence on that of the other. Measures of foods rather than single nutrients may be more inclusive of dietary exposures to risk as well as being related more directly to underlying health behaviors. Therefore they may be better able to account for risk in diseases with multiple causation.


Diet and prostatic cancer: a case-control study in northern Italy. The relationship between intake of various indicator foods and beverages and risk of prostatic cancer was assessed in 271 cases of prostatic cancer and 685 hospital controls recruited in two areas of northern Italy, the province of Pordenone and the greater Milan area. Increased risks were found for more frequent intake of meat [odds ratio (OR) in the highest vs. lowest consumption tertile = 1.4, 95% confidence interval (CI) 1.0-2.0], milk (OR = 1.6, 95% CI 1.1-2.4), fresh fruit (OR = 1.4, 95% CI 1.0-2.1), and vegetables (OR = 1.4, 95% CI 0.9-2.2). After allowance for the reciprocal confounding effect of various dietary habits, only frequent intake of milk seemed to be a significant independent indicator of prostatic cancer risk. There was also a clue that the unfavorable influence of frequent intake of a few food items (i.e. meat, fish, liver, ham and salami, milk and butter, and retinol) may be greater or restricted to older individuals (i.e., > or = 70 yrs of age). In conclusion, the present study confirms the presence of a moderate adverse effect of high intake of foods of animal origin, chiefly milk, while it suggests that a diet rich in fresh fruit and vegetables does not convey a protection.


Lack of effects of selenium on N-nitrosomethylbenzylamine-induced tumorigenesis, DNA methylation, and oncogene expression in rats and mice. The effects of dietary selenium deficiency and excess on N-nitrosomethylbenzylamine-(NMBA) induced esophageal neoplasia in rats and forestomach tumors in mice and the effects of dietary selenium on DNA adduct formation and on the activities of DNA adduct-repairing enzyme and oncogene expression in rat esophagus were investigated. The esophageal and forestomach tumors were induced by administration of NMBA by gavage with a total dose of 39 mg/kg body wt in rats and 12 mg/kg body wt in mice. Neither selenium dietary deficiency (Se < 0.02 ppm) nor selenium excess (2.0 ppm) showed any significant effect on the incidence of tumors or number of tumors per tumor-bearing animal. For the DNA adduct formation studies, rats were given a dose of NMBA intraperitoneally after six weeks on the different selenium-containing diets. No significant difference in the amount of the DNA adduct O6-methyldeoxyguanosine was found among the different selenium-treated groups. In a parallel group of rats that did not receive NMBA, the levels of esophageal O6-methyldeoxyguanosine DNA methyltransferase were not significantly altered by dietary selenium levels. The c-myc oncogene expression in rat esophagus was induced by the administration of NMBA (3 mg/kg body wt) by gavage once a week for eight weeks. Dietary selenium did not show any effects on its expression. On the basis of the results of these studies, dietary selenium has no effects in the NMBA-induced tumor model.


Lectin histochemistry of the human amnio-chorionic membrane complex. The presence and distribution of glycoconjugates within the human amnion, chorion, and decidual tissues was examined histochemically following incubation with HRP-labelled lectins. Glycoconjugates within the cytoplasm of cells as well as the extracellular matrix of the maternal decidual layer and fetal chorio-amniotic membranes reacted selectively with OFA, LTA, WGA, PSA, UEA-I, GSAI-B4, RCA-I, LFA, VVA, PHA-E, and GSA-II. Conjugated lectins specific for L-fucose-stained components of amnion, chorion laeve, and decidua while other lectins bound glycoconjugates within decidua and at the junction between maternal decidua and fetal chorionic tissue. These observations suggest that the amnio-chorionic membrane complex may include several histochemically distinct and specialized subpopulations of glycoconjugates distributed within cells and the extracellular matrix. Although specific functions for these glycoconjugates have not been elucidated, they may mediate transport of amniotic fluid and/or facilitate maternal recognition of the developing fetus.


Effect of calcium on mitochondria from human term placenta. We describe here the effects of free Ca2+ on several functions of mitochondria from human term placenta. In the presence of 0.1 microM free Ca2+, an inhibitory effect on both ADP-induced respiration and succinate-DCPIP reductase activity was observed. At the same Ca2+ concentration, ATPase activity as well as various segments of the respiratory chain were stimulated. However, a higher free Ca2+ concentration (0.3 microM) was needed to stimulate progesterone synthesis. Our results suggest that Ca2+ plays an important role in the metabolic functions of mitochondria from human term placenta.


Peroxidase: a novel pathway for chemical oxidation in human term placenta. Hydrogen peroxide-dependent oxidation of xenobiotics in a crude fraction of human term placental membranes (nuclei, mitochondria and microsomes) was investigated. Guaiacol was employed as a model substrate. The rate of its oxidation was found to be dependent on the concentration of protein, H2O2 and the substrate as well as the pH of the buffer. Several other classical substrates for peroxidases from different sources viz. pyrogallol, benzidine, p-PDA, DMBD, ABTS, TMPD and TMBD and endogenous chemicals such as bilirubin and epinephrine were also found to undergo oxidation. The xenobiotic oxidizing capacity of the membranes was retained by CaCl2 (0.5 M) extract as well as by the partially purified enzyme obtained by affinity (Con A) chromatography. The H2O2-dependent chemical oxidation by the partially purified peroxidase was inhibited by NaN3 and KCN (IC50 values 41 and 23 microM respectively). These results suggest that peroxidase may be a major enzyme in human term placenta capable of oxidation of endogenous chemicals and xenobiotics.


Immunotitration of the catalase in the blood of Japanese subjects and mice suffering from acatalasemia and hypocatalasemia. Catalase in hemolysates of normal, heterozygous hypocatalasemic and acatalasemic Japanese was immunotitrated with an anti-human blood catalase rabbit serum. Equivalence points were calculated from the regression lines between catalase activity added and catalase activity remaining in the supernatant. Catalase activities at the equivalence points of Japanese normal, hypocatalasemia and acatalasemia were similar. The results indicate that the specific activities of catalase in the normal and of the variant bloods are identical. Catalase in hemolysates of normal and variant mice was immunotitrated with an anti-mouse liver catalase rabbit serum. In contrast to Japanese acatalasemic subject, the equivalence points of catalase in heterozygous hypocatalasemic, homozygous hypocatalasemic, acatalasemic and normal hemolysates were different, and the ratios of specific activity in these variant mice to that in normal were 0.72, 0.46 and 0.21, respectively. The differences in catalase activities at equivalence points were also supported by the statistical analysis on parameters of regression lines of catalase activities remaining in the supernatant on catalase activities added in the immunotitration. These findings suggest that the molecular properties of residual catalase of Japanese acatalasemia and those of mouse acatalasemia are entirely different.


Evidence for inhibition by endothelium-derived relaxing factor of thromboxane A2 receptor-mediated vasoconstriction in the fetal vessels of the human perfused placenta. Three inhibitors of the release or effects of endothelium-derived relaxing factor (EDRF), N-nitro-L-arginine, methylene blue and oxyhemoglobin, caused further increases in perfusion pressure during vascular constriction with submaximal concentrations of the thromboxane A2-mimetic, U46619 in fetal vessels of human placental lobules perfused in vitro. The results suggest the EDRF, released during constriction of fetal placental vessels in response to thromboxane A2 receptor stimulation, attenuates the vasoconstrictor response. Hence, impairment of EDRF release or function could contribute to the reduced placental blood flow observed in various disease states associated with increased thromboxane A2 production such as pre-eclampsia.


Effect of thyroid hormones and their analogues on the mitochondrial calcium transport activity. In this paper the authors studied the effects of thyroid hormones and their structural analogues on the mitochondrial calcium transport activities. The thyroid hormones, 3,5,3' L-triiodothyronine (LT3) and 3,5,3'5' L-tetraiodothyronine (LT4) at physiological intracellular concentrations between 7.2 and 9 nM, decouple total Ca++ transport, as well as inhibit the passive transport of Ca++, either due to oxidation of pyruvate, malate or succinate or after inhibition with rotenone. The optical isomers 3,5,3' D-triiodothyronine (DT3) and 3,5,3',5' D-tetraiodothyronine (DT4) are less effective at all the used concentrations. Furthermore the structural analogues 3,3',5' L-triiodothyronine (LrT3), 3,5-dicloro, 3',5' L-diiodothyronine (LDiClT2) and 3,5 L-diiodothyronine (LT2) furnished even less effects on the same activities. The effect of the thyroid hormones and of their structural analogues has revealed that the mitochondrial calcium transport may be influenced both by a stereospecific interaction between hormones and protein ligands and by a lipophilic chaotropic action on the mitochondrial membranes lipids. In this context it is interesting to consider that both thyroid hormones and Ca++ transport activity are interacting with the energetic metabolism by means of phosphorylation and substrate oxidation mechanism.


Motional characteristics of K+ and Na+ in intact and sucrose-permeabilized rat lymphocytes. Most, if not all, cells maintain an unequal distribution of Na+ and K+ against their environment. These two monovalent ions are in constant exchange between the cell and the extracellular space since both ions have proved to be permeable through the cell membrane. The distribution of Na+ and K+ in intact and "sucrose-permeabilized" rat lymphocytes were studied ("sucrose-permeabilization" means homogenization in isotonic sucrose solution). Both the intact and the permeabilized lymphocytes were incubated in Hanks' solution and then transferred into K+, Na(+)-free isotonic sucrose solution. Alternatively, the cells were incubated only in the sucrose solution or in Hanks' solution. The Na+ and K+ content of the cells were determined at the conclusion of each period of incubation in the same or different medium. We found that K+ did not equilibrate under any conditions in intact lymphocytes but Na+ responded to changes of the incubation media. In the permeabilized cells Na+ freely equilibrated with the extracellular medium while K+ did not, although its concentration decreased compared to that of intact cells.


Non-Newtonian rheology of leukemic blood and plasma: are n and k parameters of power law model diagnostic? When discussing the rheological properties of normal and leukemic blood it must be considered that blood is a suspension of cells in aqueous solution which is also known as plasma. Whole blood viscosity and plasma viscosity were determined by Rheometer LS30 which allows measuring whole blood and plasma viscosity in the middle and low shear rate ranges. The measurements of the viscosity showed that whole blood and plasma behave as non-Newtonian power law fluid. The values of n (non-Newtonian index) and k (consistency index) of power law fluid were calculated for both leukemic blood and plasma samples. The importance of this phenomenon for the micro-circulation is discussed.


Transamination of some sulphur- or selenium-containing amino acids by bovine liver glutamine transaminase. S-(3-aminopropyl)cysteine and Se-(3-aminopropyl)selenocysteine are deaminated by bovine liver glutamine transaminase. The corresponding alpha-keto acids, S-(3-aminopropyl)-thiopyruvic acid and Se-(3-aminopropyl)selenopyruvic acid, are produced which spontaneously cyclize to ketimine derivatives. They have been identified by comparing their UV absorption spectra and some chemical or chromatographic properties with chemically synthesized authentic samples. Also S-(2-aminoethyl)homocysteine is the substrate for the enzyme. Kinetic parameters determined in comparison to thialysine and selenalysine show that neither the presence of a sulphur or a selenium atom nor the relative position of the atom in the carbon chain appreciably affects the substrate specificity of the enzyme. However, the length of the carbon chain has some influence on it.


A study of the suitability of two methods used for describing the occlusal plane. In this study an effort was made to determine which of the two commonly used methods of occlusal plane determination more precisely depicts changes induced by treatment or growth. Longitudinal lateral cephalometric radiographs of 70 individuals, 40 orthodontically treated and 30 with clinically acceptable occlusion, were used. Following an analysis of outcomes obtained through the conventional application of the Downs occlusal plane method and the functional occlusal plane method, there are indications that: 1) the Downs method may provide a better description of what happens to the occlusion following treatment; 2) the notion that the plane reconstructed using the functional method actually represents the location at which the occlusal function takes place is unsubstantiated; and 3) since it is possible that the results of this study could be influenced by the types of malocclusion, skeletal patterns, and methods of orthodontic treatment, further analyses are called for in order to make more conclusive determinations about these methods.


Measurement and interpretation of changes in memory in response to drug treatments. Drug-induced changes in cognitive functions such as memory are generally domain specific rather than general effects, that is, only some components of memory are altered. Changes in memory can be secondary to alterations in other cognitive domains such as attention, or non-cognitive domains (mood and arousal), or the direct result of alterations on those neurobiological systems that determine memory functions. The selective memory impairing effects of benzodiazepines are used to illustrate how cognitive neuroscience methods and theory can be useful in assessing the memory changes produced by psychoactive drugs.


Toward a neuropsychology of memory in schizophrenia. Three brain regions that have been the focus of recent interest in the neuropathology of schizophrenia include the frontal lobes, the basal ganglia, and the temporal lobes. We tested patients with chronic schizophrenia on three memory tasks, the successful performance of which depends on the integrity of each of these three brain regions. Comparisons between chronic schizophrenic patients and normal control subjects yielded the following results: (a) patients were impaired in remembering the temporal order of previously presented events; (b) patients were impaired on a motor task of procedural learning; and (c) patients showed normal priming effects in an implicit memory task despite their recall deficit in an explicit memory task. The significance of these findings lies in their relation to neuropsychological findings in patients with dysfunction in frontal cortical, basal ganglia, and medial temporal lobe structures.


Remediation of neuropsychological deficits in psychiatric populations: rationale and methodological considerations. The authors provide a literature review and methodological description of the emerging field of neuropsychiatric rehabilitation. Part I reviews literature that reveals compelling reasons for considering neuropsychological (NP) rehabilitation methods in patients with mental illness. NP deficits are prevalent in these patients and in contrast to psychopathology are predictive of social and occupational dysfunction, the most costly aspect of mental illness in both human and financial terms. NP deficits may explain the relatively poor outcomes from traditional vocational rehabilitation programs and there is evidence that they may be remediable. Part II summarizes methodological considerations required for research in this field. Methods for selecting optimal neuropsychiatric rehabilitation intervention techniques are reviewed and some suggestions are offered along with a brief theoretical discussion concerning their potential neural basis. Finally, design issues are reviewed, some tools for the measurement of outcome are offered, and methods are suggested for controlling for medications and environmental factors.


Mental status testing in elderly Hispanic populations: special concerns. The rapid growth of the older Hispanic population highlights the importance of accurately assessing the mental status of these individuals. Although several community surveys have reported relatively higher rates of cognitive impairment among older Hispanics, closer analysis has revealed excessive false positives and the underestimation of cognitive functioning. Problems inherent in the mental status testing of this group include the lack of appropriately translated and culturally sensitive instrumentation, the diversity of the population, differences in their educational experiences, and bias in the test-taking situation. Commonly used neuropsychological test batteries have generally been neither translated nor normed for Hispanic subjects. To minimize cultural differences, cross-cultural tests have used nonverbal content; however, nonverbal testing does not, in itself, remove cultural bias. Alternative methods of testing that may reduce bias include performance-based assessment of everyday living skills and measurement of basic psychophysiological responses.


Cognitive deficits in delirium: assessment over time. Delirium is commonly defined as a transient organic brain syndrome characterized by concurrent disorders of attention, perception, thinking, memory, psychomotor behavior, and the sleep-wake cycle. One of the difficulties in studying delirium is that symptoms tend to fluctuate over the course of the day. Pre-existing organic brain disease appears to be a significant risk factor for the development of delirium, and numerous studies have shown a high rate of delirium in patients with cerebrovascular disease, Parkinson's disease, and Alzheimer's disease. The cognitive deficits associated with delirium have not been widely studied in a systematic, quantitative fashion. Following resolution of the frank delirium, documented cognitive deficits can be observed, and may persist in a diluted form for a period of months. Residual cognitive deficits may be due to a minimal and persistent confusion or to an underlying brain disorder.


Pharmacological treatment of the cognitive side effects of ECT: a review. Electroconvulsive therapy (ECT) is an extremely effective treatment for a variety of psychiatric syndromes. However, it is frequently associated with transient cognitive side effects. Recent research has shown that these effects are sensitive to a number of treatment parameters, such as electrode placement and stimulus dosage, that the clinician may manipulate. However there have been relatively few efforts to determine if these cognitive side effects may be reduced or prevented by psychopharmacological intervention. In animals electroconvulsive shock (ECS) has been used frequently to screen for compounds which may improve cognition and memory. This paper reviews basic research studies on such compounds, as well as clinical trials in the treatment of various cognitive disorders. Studies using such compounds to reduce the cognitive side effects of ECT are exhaustively reviewed. The compounds that have been examined include: opioids, vasopressin, adrenocorticotropic hormone, other neuropeptides, cholinergic agents, nootropic agents, ergoloid mesylates, calcium-channel blockers, dexamethasone, thyroid hormone, and stimulants.


Reliability and clinical concepts underlying global judgments in dementia: implications for clinical research. The Clinical Global Impression Scale (CGI) is a recognized rating scale for global clinical judgments comprising scores for disease severity, change of disease conditions, and a so-called "efficacy index." In this report, the authors subject the CGI to a methodological analysis. Thirty-seven physicians working in psychogeriatric wards were interviewed on 12 patients each with a DSM-III diagnosis of a dementia syndrome. After the physicians made global judgments on the patients with the CGI, "personal" assessment criteria were elicited. The CGI data were correlated in the statistical analysis with the physicians' assessments of the patients on their personal criteria and on "recognized" assessment criteria obtained from DSM-III-R diagnostic criteria for dementia syndrome. Interrater reliabilities between physicians and nursing staff as well as retest reliabilities for the CGI criteria were also measured. While the CGI-severity reflects primarily the cognitive aspects of dementia, the CGI global assessment of change of the disease condition was poorly correlated with the assessments based on "personal" or the recognized DSM-III-R criteria. This was also indicated by the result that the reliability scores for CGI-severity were high and did not vary greatly, whereas the reliability scores for CGI change showed wide confidence intervals.


Self-injurious behavior in the developmentally disabled: assessment techniques. Self-injurious behavior (SIB) is a major cause of difficulty for the developmentally disabled person. Causes are varied, but medical, neurological, and psychiatric disorders should be considered before nonspecific approaches to treatment are chosen. A careful assessment should include a thorough medical and psychiatric evaluation as well as laboratory and diagnostic studies. Various assessment instruments are available to aid in the evaluation process and, to some extent, in the evaluation of the effectiveness of treatment for SIB.


Self-injurious behavior in the developmentally disabled: pharmacologic treatment. The current status of pharmacological treatments of self-injurious behavior (SIB) and aggression in persons with mental retardation and autism was reviewed in the literature. Much of the existing literature is derived from anecdotal clinical experience, with a relative lack of well-controlled studies to determine the efficacy of different treatments. Although all psychotropics have been used to manage SIB and aggression, particularly promising are the data on the use of opioid antagonists like naltrexone. Beta-blockers may also have some role, but more controlled, systematic studies are needed. Use of neuroleptics is on the decline because of their adverse effects, such as tardive dyskinesia and possible impairment of cognitive functions. We assert that the behavioral problems of SIB and aggression are at times manifestations of different psychiatric syndromes. They present in a modified, atypical form in the developmentally disabled population because of cognitive limitations. Further understanding and classification of the psychopathology associated with this behavior is essential for its successful treatment.


Rating the severity of trichotillomania: methods and problems. The capacity to measure the severity of trichotillomania is necessary for studies of the efficacy of treatment interventions. To date, researchers have used diverse methods, including: the adaptation of instruments designed for other purposes, counting episodes of hair pulling, counting hairs that have been pulled out, and both physician- and self-administered scales of severity or improvement. In this paper, the authors review the methods that have been employed, discuss problems in the measurement of trichotillomania, explore the potential for objective measures of hair loss and introduce a new instrument, the Psychiatric Institute Trichotillomania Scale.


The role of adenylate cyclase in neuropsychiatric disease. Over the past decade the study of neuropsychiatric diseases has focused on investigating the integrity of various neurotransmitter and second messenger systems. The most extensively studied second messenger system in both human and rodent tissues has been the adenylate cyclase complex. The search for alterations of adenylate cyclase activity in diseased human tissues ranging from postmortem human brain to isolated lymphocytes has been both fruitful and controversial. Discrepancies are apparent between studies investigating alterations in this system in the human brain and peripheral tissues. Animal studies have proved invaluable for the elucidation of the role of the various components of the adenylate cyclase complex (such as the G proteins) in central neurones. Such studies have also contributed to the elucidation of the effects of psychotropic agents on this system. Clearly, alterations in the functioning of the adenylate cyclase complex have been identified in most neuropsychiatric disorders. The significance of such findings in the study of neuropsychiatric disease will be discussed and also the validity of the various tissue systems used in these studies.


Nonsurgical management of gallstones.

Nonsurgical management of gallstones. Nonsurgical management of gallstones has made considerable progress within the past 20 years. More than 95% of all patients with bile duct stones can be treated successfully by peroral endoscopic or percutaneous techniques. In the case of very large or impacted calculi, intracorporeal or extracorporeal lithotripsy is available (Figure 9-10). Mortality from these approaches is low (in the range of 1%) despite the fact that most patients are elderly and frail, and open surgery is rarely required. While nonsurgical management of bile duct stones is commonly accepted, there is disagreement as to whether gallbladder stones should be managed nonsurgically, especially in view of the introduction of laparoscopic cholecystectomy. For patients in good general health who are willing to undergo surgery, removal of the gallbladder is the treatment of choice. However, there are some patients in whom a nonsurgical procedure ought to be considered. These are patients with a patent cystic duct, a functioning gallbladder, and symptomatic, radiolucent stones who can be scheduled for elective treatment. In patients with small floating stones, solitary radiolucent stones or even multiple large stones with a CT density lower than 50 HU, the chance of complete clearance of the gallbladder ranges between 80% and 90% using oral dissolution therapy, direct contact dissolution, or a combination of extracorporeal lithotripsy and dissolution. Each method has its ideal candidates (Table 9-1). The overall percentage of patients with gallstones for these nonsurgical therapeutic options is probably not higher than 20%. Therefore, the impact on surgery is still minor. Controlled clinical comparisons of the different therapies are lacking at the moment. However, these approaches have already stimulated further research into the pathogenesis of gallbladder stone disease and will no doubt undergo further improvement. Drugs that, in addition to ursodeoxycholic acid, further reduce cholesterol saturation in bile such as 3-hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors are already under investigation for oral treatment of gallstones in combination with bile acids. Further studies will also clarify the influence of gallbladder motility and certain bile constituents, such as proteins, on clearance of gallstones and recurrence after successful nonsurgical management. Thus, nonsurgical options, which obviate the necessity for general anesthesia and eliminate the risk of bile duct injury, will certainly continue to play a role in the management of gallbladder stones.


The host immune response may be responsible for selection of envelope and precore/core variants of HBV. The appearance of replication-competent variants of HBV with mutations in the envelope and precore/core proteins emphasizes that these proteins are the focus of immune selection pressure in the human host. The sequence and speed of application of the multiple selection pressures (humoral and possibly cellular) will determine the virological and clinical outcome. When these variant viruses are passed to a new host, in the absence of the immune selection pressures or modified immune pressures which resulted in their selection, a clinical picture different from that seen in the original host may emerge. Although HBV would seem to be highly evolved, it still seems to have the capacity for further diversity. A number of the reported variations have an obvious clinical relevance, but others do not, and further study is required to elucidate their importance. Whether they represent independently transmissible strains of HBV or are all selected during the course of infection, only to be lost in favor of the original strain on infection of another host, also remains to be determined.


Pathogenesis of sodium and water retention in liver disease. The "Peripheral Arterial Vasodilation" hypothesis most completely explains the clinical spectrum of cirrhosis ranging from compensated to decompensated to the hepatorenal syndrome (Figure 15-1). As the systemic peripheral vasodilation increases, the neurohumoral responses to arterial underfilling are stimulated with resultant renal vasoconstriction, sodium and water retention. Hypoalbuminemia and portal hypertension, as well as local effects of vasodilation at the capillary level, also contribute to ascites formation and peripheral edema. The suppressed plasma renin activity and aldosterone concentrations and exaggerated natriuresis, which are observed in some patients with early cirrhosis during HWI and the supine position, probably indicate greater central translocation of splanchnic fluid in these volume expanded cirrhotic patients when compared with normal subjects. This interpretation is supported by the greater increases in ANF during HWI in these patients when compared with controls. The neurohumoral responses to arterial vasodilation in cirrhosis combine to decrease distal sodium and water delivery, an event which impairs escape from the sodium retaining effects of aldosterone and causes resistance to the distal tubular effect of ANF (Figure 15-3). As discussed, the peripheral arterial vasodilation of cirrhosis is no doubt multifactorial in nature and the resultant arterial underfilling may be worsened by events that could impair the cardiac response to afterload reduction, including bile salt accumulation, alcoholic cardiomyopathy, and tense ascites decreasing cardiac preload. This pathogenetic schema of cirrhosis is compatible with the unifying body fluid volume hypothesis (Figure 15-3), which we have recently proposed.


Molecular biology of the 2-oxo-acid dehydrogenase complexes and anti-mitochondrial antibodies. The confluence of molecular biology and clinical medicine has provided new and valuable insights in PBC. Our understanding of the immunobiology of PBC has changed dramatically using this new technology. It is now possible to explicitly define mitochondrial autoantigens and examine recognition sites, by using autoantibodies, at the primary sequence level. In addition, cloned antigens have been developed to reliably assay for presence of autoantibodies; the use of cloned recombinant antigens should replace that of traditional immunofluorescence for AMA assay. It is also now possible to begin the task of defining the role of T cells in the immunopathology of PBC and exploring the issue of whether immunotherapy is possible. Finally, there is increasing evidence that PDC-E2 is located on the cell membrane of biliary epithelial cells. The mechanism for this expression remains to be studied. The explosion of data in PBC is an example of the serendipity and synergy brought about by application of new techniques to investigate old problems.


[Results of liver examination in drug addicts infected with HIV virus]. Investigations included 52 drug-addicts with asymptomatic HIV virus infection. 8 of them suffered some years ago, from virus hepatitis of type B. Physical examinations did not reveal in examined persons any deviations from normal condition except for hepatomegaly. Results of liver biochemical investigations remained within normal limits. In each of them one confirmed presence of serological markers of HBV infection and in 35 of them of HCV and in 5 of them in parallel HDV. In all the examined persons one carried out liver biopsy and routine morphological examinations. In every case one disclosed a liver injury of drug-induced type. Further, in 31 examined persons one detected a coexistence of chronic, active inflammatory process of liver hepatitis minimal--17 hepatitis chronica persistent--12 hepatitis chronica aggressivE--1 cirrhosis hepatis--1 and in four of them changes of the type fibrosis periportal. In HIV infected drug-addicts it comes about to clinically asymptomatic, chronic hepatitis coexisting with morphological changes of drug-induced type liver.


[Gastroduodenal reflux and histological changes in the gastric mucosa in patients with liver cirrhosis caused by HBV]. Endoscopic and histologic examinations of the gastric mucosa were performed in a group of 35 patients with HBV liver cirrhosis and 30 healthy persons. From among the patients 2 groups were singled out according to a liver disease progression: cirrhosis during liver functional compensation (n - 20). Cirrhosis over the period of liver functional unbalance (n - 15). In the two groups of patients examined the authors found pathological changes in the gastric mucosa, those in the group of patients with liver functional unbalance being more frequent and progressed. A statistically significant relationship was found between the duodenal contents in the stomach and the appearance of inflammatory changes in the mucosa.


[Is Aujeszky's disease a zoonosis?].

[Is Aujeszky's disease a zoonosis?]. Several cases of human illness with symptoms suggestive of Aujeszky's Disease (AD) at an outbreak of the disease in cattle and swine were evaluated during this study. Additionally serological studies of people in the group at high risk for illness caused by Aujeszky's Disease Virus (ADV) were carried out. In a herd of 180 bulls sudden clinical disease occurred with symptoms of muscular tremors, salivation, sweating and severe pruritus of the head. The clinical disease lasted two to eight hours and finished in death. In 7 days 10 bulls died and 60 were either killed or culled. A biological test for AD was positive. ADV was identified in the brain of a dead bull. Serological studies for the bulls were negative, however 92.9% on the premises farm were asymptomatically infected. On third to the fifth day of disease in the cattle clinical signs appeared in six of seven workers which had direct contact with diseased cattle. A pruritus of the palms, which spread onto the lower and upper arms, shoulders and back lasted several days.


[Listeriosis--selected aspects of laboratory diagnosis and epidemiology]. This review presents distribution of human listeriosis in the world including the large food-borne outbreaks in USA and Canada with the rising number of cases especially in Europe. Usefulness of food examination for L. monocytogenes is discussed. Methods for differentiation L. monocytogenes from other Listeria species and other genera are presented.


[Trichinellosis focus resulting from consumption of wild boar meat]. The focus of trichinellosis was presented comprising 28 patients and resulting from consumption of the wild boar meat. Early confirmation of trichinellosis diagnosis in the first case (index case) and an accurate epidemiological analysis established that the patients became infected with Trichinella spiralis strain originating from natural environment. A severe clinical course was disclosed in the index case, moderate course of trichinellosis in 11 patients, a mild course in 15 cases and an abortive course in one patient. The most frequent trichinellosis symptoms included muscular pain (92.3% cases), fever above 38 degrees C (62.2% cases), conjunctivitis (53.3%), periorbital and facial oedema (42.9% cases); headaches and excessive sweating were less frequent (35.8%), while diarrhoea, hemorrhages to the fingernail beds and skin rush were noted in single cases only. No leukocytosis was detected in 15 patients (53.5%) and number of acidophilic granulocytes was normal in 8 patients (28.5%) including 5 patients with moderate course of the disease. Also, no full correlation was detected between severity of the clinical course and anti-Trichinella antibody titres. Increased activity of a muscular enzymes creatine kinase (CPK) could be detected in 27 patients and increased activity of lactic acid dehydrogenase (LDH) in 9 patients. The increase in muscle enzyme activity (CPK in particular) in some patients failed to correlate with the severity of the clinical course. In 10 patients parasitological and histological study of muscle tissue biopsies was performed to determine intensity of the invasion and the character of pathomorphological lesions.


[Complications imminent in patients with salmonellosis]. In 1038 patients with salmonellosis treated in the last 20 years in Department of Infectious Diseases, Medical School, Białystok and literature data defined, distribution and type of complications and consequences these diseases. In acute period of salmonellosis complications are: hypovolemic or infectious and toxic shock, metabolic acidosis, circulation collapse and ileus paralytic. As a late complications are mentioned organs changes and anemias. Salmonellosis nowadays may exist as a complications diseases with immunodeficiency (AIDS).


[Qualifying individuals for vaccine against rabies and administration of the vaccine in Poland from 1980-1990]. In Poland are implemented five basic elements necessary for the efficient human rabies control. They are: epidemiological surveillance of rabies; safe and immunogenic vaccine and serum; effective medical care; network of veterinary diagnostic laboratories; rabies legislation. Presented analysis is based on the 35,226 records of antirabies vaccinees in Poland during the period 1980-1990. It evaluates some failures in human antirabies control. The efforts to achieve the improvement in the standard of the performance should focus on the following: the most effective methods of increasing the level of public knowledge about rabies; medical postgraduated training in rabies; rapid methods for virus isolation; virological evidence (virus isolation) of infection in suspected atypical rabies hosts like squirrels, rodents, bats etc; pre-exposure vaccination for persons at risk of exposure.


[Seroconversion after vaccine with trivalent influenza vaccine during the epidemic season 1990/1 in Poland]. Vaccination was performed by influenza virus vaccine, trivalent type A and B. We vaccinated about 50,000 persons in Poland in different groups of age. HI and NI tests were used for testing antibody level for A/Taiwan/1/86 (H1N1), A/Shanghai/16/89 (H3N2) and B/Yamagata/16/89. The rise of antibody level was statistically significant.


[Evaluation of treatment outcome for bacterial meningitis and encephalitis at the provincial hospital of infectious diseases in Wrocław during 1985-1989]. Data about 848 patients treated in the years 1985-1989 in the Province Hospital of Infectious Diseases were analyzed. Among them were 98 patients with bacterial meningitis and encephalitis. The most frequent etiological agents were Neisseria meningitidis and Diplococcus pneumoniae. In none case Haemophilus influenzae was isolated. The average time of hospitalization was limited to 45 days. Treatment introduced at once was based on the results of bacteriological tests. Crystalline penicillin, cephalosporins of the II and the III generation and in some cases metronidazole were antibiotics of choice. Serious complications were observed in 25% of patients. 5% of patients died.


[Encephalitis during the course of measles]. A case of measles encephalitis in a man aged 18 years was described. Attention is called to the relatively rare occurrence of such neurological complications in measles, diagnostic difficulties and good therapeutic results after corticosteroids and antiviral drugs. For reducing the incidence of measles and its neurological complications the author suggests the usefulness of protective re-vaccination against measles.


[Tetanus in the Katowice district in the years 1976-1988]. Analysis of 89 tetanus cases that appeared in Katowice district in years 1976-1988 in comparison with country data has been made. Morbidity rate was lower than country and frequency in younger age groups was lower too. About a half of dead ill persons suffered of injuries that was unusual for tetanus infections circumstances, and about a quarter of dead persons suffered only of slight and superficial trauma. Attention has been paid to frequent mistakes in specific prevention with injured persons.


[Difficulties in diagnosing a case of typhoid fever]. A sporadic case of typhoid fever of 41 years of age male was characterized clinically mainly with long duration of fever and a few enlargement of liver. Diagnosis was made relatively late. In this case an endoscopic picture of upper gastrointestinal tract and ultrasonographic findings of the organs of abdominal cavity was described.