[Protective effect of ranitidine in the stomach and duodenum against piroxicam. An endoscopy controlled double-blind study]. Protective Effects of Ranitidine in Stomach and Duodenum against Piroxicam / An endoscopically controlled double-blind study In a randomized parallel double-blind study the gastroduodenal effects of 20 mg piroxicam (CAS 36322-90-4) daily in the presence and absence of 300 mg ranitidine nocte was evaluated in 28 healthy volunteers undergoing upper gastrointestinal endoscopy. Drugs were taken over a period of 14 days. Endoscopic controls were performed at entry, and repeated after 7 and 14 days of treatment. A damaging score according to Lanza et al. was used. At entry, both groups displayed comparable mucosal damages in the stomach (0.9 +/- 0.1) and in the duodenum (0.4 +/- 0.2). After 14 days the mean lesion score increased in the piroxicam/placebo group to 6.3 +/- 1.6 in the stomach and to 4.0 +/- 1.4 in the duodenum. The corresponding values in the piroxicam/ranitidine group were 3.4 +/- 1.0 (stomach) and 0.4 +/- 0.2 (duodenum). This protection afforded by ranitidine was significant when compared with placebo (p < 0.05). Our data suggest that 300 mg ranitidine at night markedly protect the stomach and the duodenum against piroxicam.


N-substituted 2-isocyanoarylacetamides with antimicrobial activity. In this study, N-substituted 2-formylaminoarylacetamides (3) were obtained by the Ugi four-component reaction between isocyanides (1), aldehydes (2), and ammonium formate. The reaction products (3) were dehydrated with POCl3/NEt3 to give the title compounds (4). The structure of the compounds 3 and 4 was confirmed by spectral data and elemental analysis. Tests of antimicrobial activity showed that compounds 4 were ineffective against E. coli and fairly active against K. pneumoniae and S. aureus. A better activity was shown against B. subtilis, but all the tested compounds showed a very good inhibitory effect against C. albicans.


Metabolic N-hydroxylation of diminazene in vitro. The two N-hydroxylated derivatives (amide oximes) and the corresponding amides of the trypanocidal diamidine diminazene (Berenil, CAS 536-71-0) have been synthesized. These reference compounds made it possible to investigate the in vitro metabolism of the amidine functionalities of diminazene. Diminazene metabolites were detected for the first time, in the form of the corresponding mono- and di(amide oxime), after incubation with 12000 g supernatants from rabbit liver homogenates and careful workup (freeze drying). The identification was based on the behavior in thin-layer chromatography and on comparison of the mass spectral data for the metabolites with those for synthetic material. The N-hydroxylation of diminazene showed the properties typical of a reaction catalyzed by a microsomal monoxygenase. Diminazene amides did not occur as metabolites. The di(amide oxime) of diminazene was tested for its trypanocidal and leishmanicidal activity on various laboratory strains of trypanosomes in mice and on Leishmania donovani in hamsters. The studies showed that the di(amide oxime) has a trypanocidal effect on various strains of trypanosomes (T. brucei, T. vivax, T. congolense and T. evansi), but this is distinctly weaker than that of diminazene. A diminazene-resistant strain of T. rhodesiense is also unaffected by the di(amide oxime). The di(amide oxime) also has a leishmanicidal effect, but this again is distinctly less than that of diminazene.


Isolation and renaturation of bio-active proteins expressed in Escherichia coli as inclusion bodies. Over-expression of recombinant proteins in Escherichia coli often results in the formation of insoluble and inactive material as inclusion bodies. Within the last years specific methods and strategies have been developed to produce bio-active proteins from these inclusion bodies. These methods include (i) isolation and purification of inclusion bodies, (ii) solubilization and reduction of the insoluble material, and (iii) renaturation of the proteins including formation of native disulphide bonds. Inclusion bodies are isolated from E. coli cells after desintegration of cells by mechanic forces. Due to their stability, inclusion bodies may be purified by washing with detergent solutions or low concentrations of denaturant. High concentrations of urea and guanidine hydrochloride are used in combination with reducing reagents such as 2-mercaptoethanol or dithiothreitol to reduce and solubilize proteins from inclusion bodies. After purification of solubilized materials, proteins are renatured and native disulphide bonds are formed by either air oxidation or glutathione reoxidation starting from reduced material, or by disulphide interchange starting from mixed disulphides containing peptides. Final yield of renatured proteins is raised by low concentrations of proteins and by adding low concentrations of denaturant during renaturation.


Comparison of plasma bismuth levels after oral dosing with basic bismuth carbonate or tripotassium dicitrato bismuthate. In 20 healthy subjects plasma bismuth concentration was measured after single oral doses of basic bismuth carbonate or tripotassium dicitrato bismuthate. The drugs were administered in the fasted state or immediately after ingestion of a standard breakfast. After basic bismuth carbonate, plasma bismuth rose to concentrations between 0.7 and 2.6 micrograms/L in the fasted state, while after the meal the maximal level was only 1.3 micrograms/L. In contrast to these very low levels after basic bismuth carbonate, the administration of tripotassium dicitrato bismuthate was paralleled by an increase of plasma bismuth to concentrations between 15 and 232 micrograms/L with a mean peak value of 64 +/- 15.3 (S.E.M.) micrograms/L in the fasted state. Postprandial ingestion of tripotassium dicitrato bismuthate attenuated the peak concentrations to 10.9 +/- 6.3 micrograms/L. One subject, however, had a value of 120 micrograms/L. This study demonstrates that basic bismuth carbonate leads to very low plasma bismuth concentrations, which are far below the critical range that might eventually be associated with bismuth neurotoxicity. Therefore this compound can be considered potentially useful for bismuth therapy of gastrointestinal disorders.


The familial occurrence of Parkinson's disease. Lack of evidence for maternal inheritance. A questionnaire concerning the occurrence of Parkinson's disease in parents was administered for 252 patients with Parkinson's disease. Eleven fathers and five mothers of patients were reported to also have had this disease. These data fail to provide support for the hypothesis that Parkinson's disease is the result of maternal inheritance of an abnormal mitochondrial gene. This conclusion is further supported by a review of similar studies in the literature and an additional unpublished study, which revealed that of 922 patients with this disease, 37 fathers and 19 mothers were reportedly affected.


OSHA's final bloodborne pathogens standard. Part I. The Bloodborne Pathogens Standard is the first standard promulgated by OSHA that addresses a biological hazard in the workplace. This Standard applies to all workers with occupational exposure to blood or other potentially infectious materials. To achieve compliance, the employer must determine and document exposure. Also, a written exposure control plan must be available that stipulates the use of appropriate methods of compliance such as engineering controls, work practice controls, and the use of personal protective equipment.


Hepatitis B vaccine: acceptance among occupational health nurses practicing in hospital employee health settings. Seventy-seven percent of the hospital employee nurses in this study had accepted hepatitis B vaccine, a higher rate than that reported in the literature for other health care workers. The study found a significant relationship between increased perceived susceptibility to HBV and hepatitis B vaccine acceptance. The unvaccinated nurses did not perceive the employee health setting as risky, yet their clientele (health care workers) are five to 10 times more likely than the general population to be hepatitis B carriers. The younger and less experienced nurses were significantly more likely to have been vaccinated. The hepatitis B vaccine should be offered early in the career of employed health care workers, made accessible at the worksite, and offered to student health care workers. Hepatitis B vaccine education and counseling should focus on increasing perceived susceptibility to HBV for all health care workers and stress vaccine safety and effectiveness.


Nurse practitioner sutured wounds: a quality assurance review. This study found a low infection rate (3.1%) in occupationally related lacerations sutured by an on site nurse practitioner in a meat-packing plant where a high infection rate might be expected. This is compared to an overall infection rate of 1% to 30% of all sutured wounds cited in other studies. This review suggests that worksite availability of a nurse practitioner with expertise in suturing and aseptic technique is correlated to a low infection rate. Findings suggest that prophylactic antibiotics do not preclude good wound care, but may still be merited in wounds at high risk of subsequent infection. Infected wounds may cost anywhere from $2,000 to $150,000 per case depending on severity, in addition to other hidden costs. Clearly a decrease in the morbidity of wound care is significant in terms of decreased cost.


Cardiovascular risk factors in textile workers: prevalence and intervention. This study included 1,390 textile workers from a southern state who received a screening for risk factors for heart disease. Occupational health nurses then provided an education/counseling intervention and one or more American Heart Association pamphlets using the results of the screening. Over half of the workers had at least one modifiable risk factor for heart disease. The most common modifiable risk factor was smoking. Most of the participants (60.8%) had a cholesterol level less than 200 mg/dL, but 27.4% were in the borderline high range of 200-239 mg/dL, and 11.8% had a cholesterol of 240 mg/dL or higher. Almost 26% of the participants had a blood pressure of 140/90 or higher. Findings on a subset of 544 workers re-screened at 6 months were: workers with hypertension were able to lower their blood pressure significantly; cholesterol levels increased slightly in all participants except white males; and although some smokers stopped smoking, others began smoking, so the total number of smokers at the second test was actually slightly higher than at the first screening.


[Fluorocarbon emulsions as injectable oxygen carriers. Recent progress and perspectives]. Fluorocarbon emulsions are presently being developed to serve as injectable oxygen carriers (so-called "blood substitutes"). In this approach oxygen is simply dissolved in the liquid carrier and the amount of gas dissolved is proportional to its partial pressure. Increasing the O2-delivering capacity is therefore achieved more easily by increasing the oxygen content of the air breathed by the patient than by increasing the dose of fluorocarbon administered. The absence of a chemical bond between the gas and its carriers allows over 90% of the transported oxygen to be delivered. The fluorocarbon droplets act as oxygen carriers , and also appear to facilitate its diffusion. Chemically and biologically highly inert, fluorocarbons are excreted by exhalation without being metabolized. The first generation of emulsions, exemplified by Fluosol has only limited efficacy due to its low fluorocarbon content, low intravascular persistence and insufficient stability. It has to be stored and distributed frozen, then reconstituted prior to use. Fluosol has nevertheless been licensed by the Food and Drug Administration for use during high risk PTCA. The second generation of injectable fluorocarbon emulsions, exemplified by Oxygent is 4-5 times more concentrated and consequently more efficacious than Fluosol. Considerably more stable, this emulsion can be stored for over one year at 5-8 degrees C and is ready for use. The fluorocarbon used has a significantly shorter organ-retention time. The applications of the present emulsions are still limited by their short intravascular persistence, and are those for which prolonged efficacy is not required, which includes perioperative hemodilution, ischemia, cardioplegia, reperfusion, sensitization of tumors to radio- and chemotherapy, organ preservation and diagnosis. The efficacy of the new emulsions has been established in various animal models. The mild side-effects observed in Phase I clinical trials appear to result from a transient activation of the monocyte/macrophage system and to be suppressed prophylactically by cyclooxygenase inhibitors or corticosteroids. Research is presently oriented towards controlling intravascular persistence better, increasing emulsion stability further, minimizing side-effects and optimizing emulsion characteristics for specific indications.


[Expression of recombinant human hemoglobin]. The well recognized prevalence of infectious agents in products derived from human whole blood and the increasing number of transfusion-transmitted diseases has made urgent the search for a safe alternative to conventional blood transfusion. Sources of hemoglobin (Hb) different from outdated human bank blood are under active scrutiny in several laboratories. Different approaches have been proposed to produce recombinant human Hb in bacteria (E. coli), yeast (S. cerevisiae) and transgenic mammals. These efforts have lead to the synthesis of recombinant human Hb with functional properties similar to those of native human Hb A. Site directed mutagenesis enables one to modify the structure of the recombinant globin chains with the view of lowering the oxygen affinity and increasing the stability of the tetramers. Progress is still necessary to ensure scaling-up and safe purification procedures, and to prolong shelf life of these solutions.


[Molecular engineering of hemoglobin for transfusion]. The search for a safe alternative to conventional blood transfusion has been directed towards either the use of synthetic perfluorochemicals or the biochemical manipulation of highly purified stroma-free Hb solutions prepared from outdated bank blood. However when using human blood, one does not eliminate the risks of viral infections. A novel source of Hb appeared with recent biotechnology techniques enabling one to synthesize recombinant Hb from microorganisms (E coli or S. cerevisiae) whose genome has been modified to contain globin genes. Normal human Hb A in solution, i.e. outside the red cells, is not suited for direct usage as a blood substitute because i) its high oxygen affinity, due to the absence of 2,3 DPG in the plasma, precludes sufficient O2 unloading to the tissues; ii) at low concentration, relative to that in the red cells, tetrameric Hb dissociates into dimers which escape the circulatory system by renal filtration or rapidly oxidize to the non functional metHb form. Expression of alpha- and beta-globins in Escherichia coli and in Saccharomyces cerevisiae enables one to introduce appropriate mutation(s) in the globin genes resulting in the expression of a synthetic Hb with low oxygen affinity, resembling that of normal whole blood; functional Hb has also been produced in a soluble form either in E. coli or in yeast. The coexpression of beta globin chains and alpha globin subunits linked by a peptide bond results in the direct synthesis of stabilized and fully functional Hb tetramers. Lastly, dilute haemoglobin solutions are prone to autooxidize and the rate of oxidation appears to be inversely proportional with the oxygen affinity of the heme groups.(ABSTRACT TRUNCATED AT 250 WORDS)


[Prion encephalopathies].

[Prion encephalopathies]. Spongiform encephalopathies, also called prion encephalopathies, are characterized, in human as well as in animals, by (1) their clinical picture which indicates strict localisation in central nervous system, (2) their histological aspect: spongiform degeneration and neuronal loss, and (3) their transmissibility in the same animal species but also from man to animal. The nature of the pathogenic agent is still debated. This agent could be one isoform of the prion protein which, probably because of a modification of its tertiary structure, is partially resistant to proteolytic enzymes. Recent description of a bovine spongiform encephalopathy caused by meat flour absorption has raised again the question of the transmissibility of these animal diseases to human.


Epidemiology of allergic diseases.

Epidemiology of allergic diseases. At present there is international interest in MA. Different factors are responsible: the severity and prevalent frequency of these diseases; the health cost that they create: more adequate diagnosis and treatment. Understanding of the epidemiology, pathological mechanisms, favouring factors, the start and development of the disease, is essential to establish a diagnosis and appropriate treatment. Several factors trigger MA, with hereditary disposition and allergen exposure the most significant. Without these two associated factors the disease does not appear. However, there are other factors that play an important part in the prevalence of the allergic state and its development. Some are concerned with the individual (age, sex, race), others with the environment (pollution, socio-economic, environment, infections...). The author has devoted this article to analysis of these individual factors.


IgE modification of the specific antidermatophagoides during the first year of specific immunotherapy (SIT). Six subjects (4 female, 2 male), aged from 16 to 25 years, presented with allergic rhinitis to Dermatophagoides mites and received SIT by the sub-cutaneous route with delayed-release alpha fraction Bayropharm at the standard doses. Diagnosis was based on clinical history, skin tests and measurement of specific IgE at 0, 3, 9, and 12 months, by the fluoro-enzymatic technique (FAST). For comparison, in a reference group (n = 20) the IgE varied between 0.32 and 0.11 IU/ml for D1 and 0.31 to 0.09 IU/ml for D2. The eight patients had specific IgE titres of D1 = 0.96, D2 = 0.99. For these authors, the FAST technique used for the measurement of specific IgE, although less sensitive than the RIA technique of RAST, gives a good evaluation of SIT.


Allergic contact dermatitis in Trieste from 1987 to 1991. Between 1987 and 1991, the authors made patch-tests on 1,427 patients, 389 male and 1,038 female, of mean age 36 years (6-70 years) and mostly suffering from eczema. The standard tests of Italian Group for Research into Contact Dermatitis and the Environment (GIRDCA) were used, following the best data of recent years. Nickel sulphate, thiomersal, "Fragrance mix", cobalt sulphate and potassium bichromate were the allergens varied with age: nickel and thiomersal were most frequently positive between 20 and 30 years. In contrast, the highest frequency of positivity to fragrance mix was seen between 40 and 60 years. Positivity to a simple allergen had a tendancy to reduce with age.


Psoriatic arthritis treated with cyclosporin A. Cyclosporin A (CyA) is a very effective immunosuppressor for inhibition of the humoral immune response and especially for cell mediation and was originally indicated for transplantation of organs and autoimmune diseases. More recently, CyA has been used successfully for severe psoriasis. In this study, the authors describe the results obtained from 8 patients who presented with a psoriatic arthropathy, treated with small doses of CyA (3-5 mg/kg/day). There were reactions in five of them, in two patients the Ritchie index decreased moderately and in one patient the arthritic psoriasis was significantly improved.


Perspectives of common breastfeeding situations: a known group comparison. Infant feeding choice is influenced by social and cultural factors, as reflected in sociodemographic correlates of breastfeeding, which show consistently low breastfeeding rates among women from low-income populations. This study examines attitudes and beliefs that are thought to affect feeding choice and breastfeeding behavior among diverse social and cultural groups. A breastfeeding behavior questionnaire asking women to respond to a variety of breastfeeding situations presented as narratives was administered to members of a La Leche League group and to a group of WIC participants. Results support the idea that different social groups of women display divergent attitudes toward and perceptions of breastfeeding. Although small sample size prohibits generalization of results, the findings reinforce the necessity of designing breastfeeding education programs within specific cultural contexts.


Breastfeeding among women in the Alabama WIC Program. Women who participated in the Alabama WIC Program during 1986-88 and ceased breastfeeding during the months of May to August during those years breastfed an average 5.6 months. Slightly fewer than 15 percent of the women who breastfed continued for 12 months or longer; 45 percent continued for six months; 59 percent did so for 4 months; and 21 percent breastfed for one month or less. Breastfeeding duration was related positively and independently to increased maternal age and parity. Younger women were more likely than older women to stop breastfeeding due to perceived insufficient milk, in order to return to work or school, or to use oral contraceptives. Women who ceased breastfeeding at or after one year postpartum tended to be older.


Breastfeeding and migraine headaches.

Breastfeeding and migraine headaches. Migraine headaches affect 19 percent of adult women. A small group of these migraine sufferers also are breastfeeding mothers. Although a correlation has not been documented in the literature, some women have noted that the onset, frequency, or pattern of their migraine headaches changes during lactation. Lactation consultants can provide education and support to breastfeeding women suffering from migraine. They also are in an excellent position to add case studies to the scientific database about this phenomenon.


The Florida breastfeeding promotion project: a coalition effort to improve hospital practices and policies. The Florida Healthy Mothers, Healthy Babies-Coalition initiated a breastfeeding promotion project. The Coalition focused on hospital policies because of their impact on breastfeeding success and because of the potential for working with other state efforts directed at pregnant women or new mothers. The Florida Healthy Mothers, Healthy Babies Coalition developed a three-part program. It consists of model hospital policies concerning breastfeeding, a lecture series which educates hospital nursing staff on the implementation of these model policies and a workshop through which trainers are prepared to present the educational program. Nurses' Association of the American College of Obstetrics and Gynecology (NAACOG), Special Supplemental Food Program for Women, Infants, and Children (WIC), and Florida Lactation Consultant Association (FLCA) all contributed to this project.


Nursing strike: misunderstood feelings.

Nursing strike: misunderstood feelings. The nursing strike often ends almost as suddenly as it began, and the mother and baby resume nursing with the same pattern as previously, but with a new understanding of their relationship and appreciation of each other's feelings. The best aspect of this technique of "loving" the strike away is that everyone feels good about the situation at its resolution.


Overview of contemporary families.

Overview of contemporary families. Perceptions and definitions of the term family have always been varied and complex. Hence, an overview of contemporary families is presented here from several perspectives. First, families as they have been perceived by nursing and social science theorists are reviewed. Demographic changes in the family over the last two decades are then presented, followed by an examination of issues faced by families as they change over time. Finally, families as they exist within varying cultural and social contexts are discussed. Emphasis is placed on the need for health care providers to be flexible in defining and working with individual patients and their families.


Family functioning during a critical illness: a systems theory perspective. In this article the effects of critical illness on family functioning are described within a systems theory framework. As identified in the literature, family vulnerabilities and strengths that impede or support family functioning during the time a member has a critical illness are discussed. Strategies that nurses can use to assist families of critically ill patients are explored. A challenge to expand family-centered care across various settings is extended.


Caring for parents of critically ill infants and children. This article provides an overview of the literature reviewing the stresses and needs of families of critically ill children. These needs and stresses are summarized and organized to provide a framework for the research-based standard of care that is presented for parents of critically ill children.


Needs of children during the critical illness of a parent or sibling. The needs and significance of well children in the family typically have not been considered when addressing family-centered care. Health care providers and overstressed parents may have little awareness of or insight into the needs and concerns of these children. Without informed and sensitive interventions, however, these children may be at risk for significant long-term negative effects. This article discusses some of the needs and responses of well children who have a critically ill parent or sibling. Using a developmental framework, the author suggests interventions that may benefit these often forgotten but very vulnerable family members.


Needs of adult family members after critical illness: prescriptions for interventions. Concerns for family members of critically ill patients are evident in nursing literature; however, assessment parameters and intervention strategies during the critical care experience require further consideration. This article reviews the results of prior published and unpublished nursing research pertaining to needs of adult family members after critical illness. Selected nursing interventions are provided to encourage practitioners and researchers to develop, test, and evaluate those activities that most effectively meet various types of family-member needs.


Needs of the family during critical illness of elderly patients. Persons 65 years of age or older occupy 46% of all intensive-care beds. This number will rise in the next decade as the percentage of persons age 65 or older rises to a projected 13% by the turn of the century. Elderly patients require care that may be different from their younger counterparts. The needs of the families of the elderly may also be different. Nurses should carefully consider the needs and differences of each family, especially the need to participate in care and to be with the elder and the needs for information, reassurance, and comprehensive discharge planning.


Comparison ratings of need importance after critical illness from family members with varied demographic characteristics. This descriptive study compares ratings of importance of selected needs by family members after the first 3 days of critical illness with family member age, gender, relationship to patient, prior intensive care unit experience, and patient medical diagnosis. Family-need importance ratings from 905 subjects, collected by 27 nurse investigators in 15 states over a 10-year period (1980 to 1989) were used as an aggregate data base. Bivariate t tests and analysis of variance procedures were used to compare ratings of importance for support, comfort, information, proximity, and assurance needs with family member demographic characteristics. Results indicated that there were more similarities than differences on the ratings of importance for selected needs from various family members. Focusing on these similarities should be useful for developing and testing nursing interventions to help family members meet their needs after a critical illness event.


Need for information. Interventions for practice. Information is an important need of families of critically ill patients. Meeting this need requires a multidisciplinary approach and an environment that values the delivery of humanistic care. Critical care nurses require special skills in assessment, planning, intervention, and evaluation to effectively meet the information needs of families. Research is available to guide nurses in meeting the family's need for information.


Visiting critically ill adults: strategies for practice. Visitation and proximity needs are consistently rated as very important by families of critically ill patients. This article reviews the literature on the proximity needs of families, presents nursing interventions to meet them, and suggests a plan for future research in this area.


Support and reassurance needs: strategies for practice. Support and personal needs have been empirically validated as two of the most important family need categories during critical illness. Perhaps over-shadowed during the initial critical care phase by a need for relief of initial anxiety and reassurance of quality care and information, support needs emerge as family members recognize the impact of the stressful illness experience on themselves. Critical care nurses can provide social support to family members through family assessment, counseling, and support groups. Although not empirically tested, it is generally believed that such support will influence the ability of family members to provide support to the patient and thereby influence a positive recovery from critical illness.


Needs of families of critically ill patients: state of the science and future directions. This article provides an overview of the needs of families of critically ill patients and offers suggestions for future research. Continuous, systematic study about the needs of families of critically ill patients is necessary for nursing to be responsive to the health care needs of society in the 21st century.


Invasive hemodynamic monitoring in pregnancy. When the pregnant woman develops an acute or critical illness requiring invasive hemodynamic monitoring, it is imperative to consider physiologic changes that occur during pregnancy that impact on assessment parameters. Awareness of both the alterations in these parameters and the changes in arterial blood gas values guide nursing care that continues to support perfusion and oxygenation needs unique to pregnancy. When critical care capabilities are not available in the labor and delivery unit, the obstetric patient is most often transferred to a medical or surgical intensive care unit. In such cases, consultation with obstetric staff is warranted.


Cardiac disease in pregnancy: intrapartum considerations. Impressive changes in the maternal cardiovascular system occur in response to pregnancy. The patient with normal cardiac function complies with these physiologic changes without difficulty. The patient with cardiac disease, however, may be at significant risk for morbidity and mortality when faced with these changes. Knowledge of the disease process is essential, because caring for the pregnancy patient with known cardiac disease presents a unique challenge to the critical care nurse.


Amniotic fluid embolism.

Amniotic fluid embolism. Pulmonary embolism is the leading cause of maternal death in the United States. Amniotic fluid embolism (AFE) represents the least preventable and most lethal of complications with a reported mortality of 86% and an associated fetal demise of 50%. Although it is widely accepted as a clinical entity, AFE is incompletely understood. A combination of clinical presentation, laboratory findings, and exclusion of other pathologies leads to the diagnosis of AFE. The mainstays of treatment are oxygenation, maintenance of cardiac output, and correction of coagulopathy. The prognosis for the patient experiencing AFE remains bleak because it is largely unpredictable and, except for supportive measures, cannot be corrected.


Management of the intrapartum patient in the intensive care unit: preparing for delivery. Caring for a critically ill obstetric patient requires a thorough understanding of both the pathophysiology of the disease and the physiologic changes that accompany pregnancy and childbirth. This article addresses the care of an intrapartum patient in an intensive care unit. Physiologic aspects of the labor and delivery process are reviewed with emphasis on nursing assessments and interventions. Additionally, techniques for delivery of the neonate are presented.


Legal and professional issues in critical care obstetrics. The practice of critical care obstetrics is a challenging specialty that presents unique problems and issues in providing perinatal care. With the emergence of critical care obstetrics comes increased accountability and expanded responsibilities. This article addresses the legal and professional issues related to critical care obstetrics.


Physiologic changes of pregnancy: impact on critical care. Critical care nurses must have knowledge of normal physiologic changes during pregnancy to assess the obstetric patient appropriately. Multiple adaptations occur during pregnancy that place the woman at risk should medical or obstetric complications occur. At no time in a woman's life does she undergo the vast system changes that she experiences during pregnancy and the postpartum period.


Pregnancy-induced hypertension: understanding severe preeclampsia and the HELLP syndrome. Pregnancy-induced hypertension (PIH) is a multisystem disease with life-threatening complications requiring expert nursing and medical management. Nurses caring for critically ill patients with this disease must be knowledgeable about the pathophysiologic occurrences of PIH as well as the protocols for anticonvulsant and antihypertensive therapy. This article presents the hemodynamic alterations of preeclampsia, the pathophysiology of the disease, and principles of acute management.


Fetal surveillance in the intensive care unit: understanding electronic fetal monitoring. Electronic fetal monitoring has become an integral component of current obstetric nursing care. The goals of surveillance are to establish fetal well-being and identify the fetus at risk for asphyxia and death. Fetal heart rate (FHR) responses provide a cardiovascular indication of fetal acid-base status. To evaluate FHR tracings and plan care accordingly, the nurse must understand the physiologic regularity mechanisms of the fetus, baseline patterns, and periodic changes of the fetal heart rate.


Promoting parenting: the obstetric patient in an intensive care unit. The complex process of mastering the new parent role can be inhibited when the mother has a critical illness that produces barriers to parenting. It is important for nurses to recognize and eliminate common barriers to parenting that occur for the mother in the intensive care unit.


Critical hemorrhage during pregnancy.

Critical hemorrhage during pregnancy. The major causes of obstetric hemorrhage are described, and guidelines for nursing assessment and interventions presented. Complications associated with life-threatening blood loss during pregnancy are identified as well as physiologic changes unique to pregnancy that impact on nursing care.


Custom-fitted protective mouthguards.

Custom-fitted protective mouthguards. Custom-fitted protective mouthguards for children and adults during sports activities can prevent or minimize traumatic dental injuries. This article reviews a method for fabrication of custom mouthguards and discusses their use.


Class I composite resin restoration.

Class I composite resin restoration. Composite resin materials and methods for their use have improved to the extent that long lasting Class I carious lesions on stress-bearing surfaces can be restored with predictable results. This article demonstrates a step-by-step clinical technique for placement of a Class I composite resin restoration lined with a light-hardened glass-ionomer dentin replacement foundation. Emphasis is placed on tooth isolation, thoughtful handling of the respective materials, and the importance of final sealing of the resin/enamel margins.


All-porcelain labial margin for ceramometal crowns. The elimination of the labiogingival metal collar of a porcelain-fused-to-metal (PFM) restoration is an attempt to achieve an improved esthetic result. In their expectation of a more cosmetic tooth restoration, patients may influence dentists to use the all-porcelain labial margin to avoid metal showing in the final restoration. Success of this type of restoration depends upon proper tooth preparation. The all-porcelain margin requires a 1.2-mm wide labiogingival shoulder of approximately 70 or 90 degrees wrapping into the interproximal area. Much of the effectiveness of the restoration depends upon the design of the metal substructure. The following change is made in the design of this substructure for this modified PFM crown: the labiogingival portion of the metal is finished back to the gingival-pulpal line angle with the metal against the axial wall being from 0.3 mm to 0.5 mm thick. This allows for 0.2 to 0.3 mm of opaque and 0.7 to 1.0 mm of shoulder porcelain. The direct lift-off technique is a useful method of achieving clinically acceptable all-porcelain margins. Such restorations may give excellent results.


Effects of pH on the dentin surface.

Effects of pH on the dentin surface. A microleakage and scanning electron microscope (SEM) study was conducted in order to investigate the effects of acidic primers on prepared dentin surfaces. The microleakage study revealed that no significant differences were noted between the five materials tested in regard to leakage at enamel and dentin margins. SEM analyses revealed that the smear layers of all specimens were altered in some manner. Further long-term clinical studies should be conducted to evaluate acidic treatment of dentin.


Cluster management.

Cluster management. Cluster management is a management model that fosters decentralization of management, develops leadership potential of staff, and creates ownership of unit-based goals. Unlike shared governance models, there is no formal structure created by committees and it is less threatening for managers. There are two parts to the cluster management model. One is the formation of cluster groups, consisting of all staff and facilitated by a cluster leader. The cluster groups function for communication and problem-solving. The second part of the cluster management model is the creation of task forces. These task forces are designed to work on short-term goals, usually in response to solving one of the unit's goals. Sometimes the task forces are used for quality improvement or system problems. Clusters are groups of not more than five or six staff members, facilitated by a cluster leader. A cluster is made up of individuals who work the same shift. For example, people with job titles who work days would be in a cluster. There would be registered nurses, licensed practical nurses, nursing assistants, and unit clerks in the cluster. The cluster leader is chosen by the manager based on certain criteria and is trained for this specialized role. The concept of cluster management, criteria for choosing leaders, training for leaders, using cluster groups to solve quality improvement issues, and the learning process necessary for manager support are described.


Dentin bond shear strength and microleakage for Syntac/Heliomolar: a comparison between the manufacturer's and total etch technique. Recent improvements in formulation have led to significant improvements in the bond strength and clinical performance of dentin bonding agents. The growing interest in the concept of total etch prompted a comparison between manufacturer-recommended procedure and that of total etch for the product Syntac. An in vitro study to examine shear bond strength to dentin and microleakage and an in vivo component to investigate the micromorphologic relationship between restoration and tissue was conducted. No statistical significance was observed in bond strength values for the nonetched versus the etched group. Significantly, however, a larger number of specimens in the nonetched group exhibited microleakage. In vivo, only the etched group exhibited a zone of hybridization although both nonetched and etched restorations showed no interfacial gaps. It was concluded that total etch does not compromise the shear bond strength of Syntac but it appears to significantly reduce microleakage possibly due to the formation of a hybrid zone and may have merit clinically.


Case management with the nurse manager in the role of case manager in an interventional cardiology unit. Varying external and internal factors are motivating changes in how physicians and nurses deliver patient care within health-care institutions. A care delivery system that has received increasing attention in the literature is case management. This chapter describes how a community hospital implemented case management for patients undergoing percutaneous coronary angioplasty and cardiac catheterization while developing the new role of clinical manager to serve in the role of case manager. The process for planning and implementing such a role change is discussed, and initial evaluative data are presented.


Nurse clinician model of managed care.

Nurse clinician model of managed care. Many different models of delivering nursing care have been proposed, each with specific advantages and disadvantages. One such model, the nurse clinician model, uses the strengths of advanced clinical practice as the cornerstone for improving quality in patient care. The increase in quality simultaneously produces an efficient and cost-effective system, as indicated by the results of a multiyear study at our institution. While other effective models exist, those that emphasize advanced clinical practice, such as the nurse clinician model, are most likely to achieve improved patient outcomes and conserve resource expenditures.


Permeability effects of two dentin adhesive systems. This in vitro study evaluated the effects of two dentin adhesive systems on dentin permeability. The XR-Bonding System modifies the smear layer but does not open dentinal tubules. The Kanca or "total-etch" technique (phosphoric acid, Tenure A and B, Scotchbond 2 Adhesive) removes the smear layer and opens dentinal tubules. Despite these differences, both systems reduced dentin permeability in a similar manner. XR-Bond decreased permeability to 52% of the smear layer value, while total etching reduced permeability to 66% of that value.


Case management in the neonatal intensive care unit. This article will provide the reader with an overview of the concept of case management as it is used by the neonatal nurse practitioner in a neonatal intensive care unit. The role of the neonatal nurse practitioner as a case manager will be compared and contrasted to the roles of the primary nurse and staff nurse. The collaborative role with physicians will be described. Future directions for neonatal case management also will be addressed.


Implementing managed care in a pediatric setting. A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children's hospital.


Three-year clinical evaluation of CAD/CAM restorations. This study dealt with the clinical evaluation of 121 inlays and onlays generated from both Dicor ceramics and Vita porcelains. These two different types of ceramic materials were cemented using three different duo-cured composite resin luting agents, which differed in particle size. At the end of 3 years, no difference could be detected between the clinical performance of the Dicor and Vita restorations. Both exhibited the same degree of color matching characteristics, marginal integrity, and general clinical performance; however, seven of the restorations exhibited fracture through the isthmus, which was shown to be due to insufficient cavity depth. The balance of the restorations exhibited excellent clinical performance when evaluated against the United States Public Health Service System.


Use of patient care extenders in critical care nursing. This article explores the implementation and use of patient care extenders in two critical care units. Experimentation and diversity in changing the care-delivery system were the forces motivating the management team to redesign the existing nursing care-delivery system. The impetuses for the change process were the use of the role of the registered nurse and cost containment. Two case studies will illustrate from a practical perspective how the change occurred. Although the same nurse manager was responsible administratively for the two units, the patient care extender models were implemented differently. This was based on the conviction that each unit is unique with regard to patients and staff needs. The first case study occurred in an 18-bed cardiac telemetry unit in which the patient extender care model was integrated with direct patient care activities of the unit. In the second case study, which occurred in a ten-bed cardiac care unit, the patient care extender was integrated with indirect patient care activities. The approach to this article is practical, and it is intended for units that may be dealing with these issues in these changing times in health care.


On the essential integration of nursing and informatics. This paper asserts that nursing knowledge is fundamentally inseparable from the strategies and structures that represent it. Nursing informatics comprises a new disciplinary focus that results from a blend of nursing and informatics. The technologies of informatics, communications, computer science, decision science, human information processing, and knowledge engineering, provide critical care nurses with the support necessary for contemporary nursing practice. Informatics technologies enable nurses to communicate, process knowledge in new and more efficient ways, and better understand the nature of nursing thinking.


Image analysis of Artemia salina ribosomes by scanning transmission electron microscopy. A dedicated scanning transmission electron microscope (STEM) at Brookhaven National Laboratory was used to visualize unstained freeze-dried ribosomal particles under conditions which considerably reduce the specimen distortion inherent in the heavy metal staining and air-drying preparative steps used in routine transmission electron microscopy (TEM). From high-resolution STEM images it is possible to determine molecular mass and the mass distribution within individual ribosomal particles and perform statistical evaluation of the data. Analysis of digitized STEM images of Artemia salina ribosomes provided evidence that a standard preparation of these eukaryotic ribosomes consists of a population of heterogenous particles. Because of the integrity of rRNAs established by agarose gel electrophoresis, variations in the composition and structure of the 80S monosomes and the large (60S) and small (40S) ribosomal subunits, as monitored by their mass, were attributed to the loss of ribosomal proteins, from the large subunits in particular. These results are relevant not only to the degree of ribosomal biological activity, but should also be taken into consideration for particle selection in the reconstruction of the "native" eukaryotic ribosome 3-D model.


The Staphylococcus aureus alpha-toxin channel complex and the effect of Ca2+ ions on its interaction with lipid layers. Using the techniques of two-dimensional crystallization on supported lipid bilayers together with computer image processing, two distinct two-dimensional crystal types of staphylococcal alpha-toxin complex are formed depending on the presence or absence of Ca2+ ions. Without Ca2+, these are hexagonally packed (in A, a = b = 89.5 +/- 2.5 A; theta = 119.7 degrees) With Ca2+ present, rectangular crystal packing is seen (in A, a = 114.8 +/- 1.6 A, b = 140.2 +/- 0.7 A; theta = 89.1 degrees). A third, banded crystal type is also seen which is interpreted as a side-to-side packing of regular tubules. We use these tubular crystals for cross-correlation searches with top and side-on views of the complex from single particle reconstructions, and with the repeating units from the two-dimensional crystal types. The results lead us to propose a model in which the different two-dimensional crystal types are formed as a result of alpha-toxin hexamers packing in different orientations. In the hexagonal crystals the hexamers lie end-on with a 6-fold axis in projection. On the addition of Ca2+, the hexamers reorient to lie tilted with respect to the support, thus giving rise to a rectangular projection.


Characterization of the conformational change in the M1 and M2 substates of bacteriorhodopsin by the combined use of visible and infrared spectroscopy. A combination of visible and Fourier transform infrared (FTIR) spectroscopies is used to characterize the formation of the M1 and M2 substates of the bacteriorhodopsin photocycle in glucose-embedded, hydrated thin films. Difference FTIR bands in the amide I region verify the previously reported existence of a significant peptide backbone conformational change in the transition from M1 to M2. The visible absorption spectra demonstrate that contamination of the M-intermediate samples by L, N, or other non-M species should contribute negligibly to the observed changes in the amide I region, and this conclusion is supported by comparison of specific carboxyl group peaks with corresponding bands in published L and N FTIR difference spectra. Based upon spectroscopic results, an extension of the C-T Model (Fodor, S., Ames, J., Gebhard, R., van den Berg, E., Stoeckenius, W., Lugtenberg, J., and Mathies, R. (1988) Biochemistry 27, 7097-7101) is presented. The results of this work suggest that protein structural changes should be clearly visible in M-bR, difference Fourier density maps and that these structural changes may in turn elucidate how bacteriorhodopsin actively pumps ions across the purple membrane of Halobacterium halobium.


Projection map of tubulin in zinc-induced sheets at 4 A resolution. Tubulin polymerizes into two-dimensional, crystalline sheets in the presence of zinc ions. These sheets are well suited to structural studies by electron crystallography. We have developed conditions for forming sheets which are large and well ordered enough to provide both electron diffraction and image data to better than 4 A resolution. In projection maps calculated from this data, the alpha and beta monomers can be identified within the protofilaments. These results indicate that we should be able to determine the structure of tubulin in these sheets at atomic resolution.


EM investigation of myoblast origin in regenerating hamster skeletal muscle explants. This study attempted to dispel the confusion that exists in the understanding of the origin of myoblasts during muscle regeneration. Regenerating hamster muscle explants from cultures were studied under the EM on 4 consecutive days, after incubation. Preincubation specimens served as controls. Revelations were that euchromatic myonuclei underwent dense granulation and activation after incubation. Presumptive myoblasts (PM) lying clearly within the myofibre increased in numbers with incubation time. Some myonuclei showed partial transformation towards a PM. This study concluded that myonuclei transformed into myoblasts during the process of muscle regeneration and that the PM, produced from a myonucleus, was a stage in the development of the satellite cell (SC) in regenerating muscle. These SC, myoblasts from myonuclear origin, proliferated, fused, and formed multinucleate myotubes that matured into myofibres which replaced damaged muscle. Findings of this study may have new implications for the proposed myoblast transplant or gene transfer therapy, both of which, whilst being possible answers for muscular dystrophy, depend on a sound knowledge of muscle regeneration mechanisms.


Localization of a sequence motif complementary to the nuclear localization signal in proteasomes from Thermoplasma acidophilum by immunoelectron microscopy. A sequence motif complementary to the nuclear localization signal (NLS) has been localized in proteasomes from Thermoplasma acidophilum by immunoelectron microscopy using sequence-specific antibodies. The antibodies were generated in two different ways: by immunization with a carrier-coupled peptide and by isolation of the sequence-specific antibody from an immune serum against native proteasomes using a peptide-affinity column. The sequence specificity of the isolated antibody was confirmed by a PEPSCAN-ELISA performed on overlapping nonapeptides deduced from the sequence of the alpha-subunit of the Thermoplasma proteasome. Compared to the antibody induced by the carrier-coupled peptide this antibody fraction showed a much higher affinity for native proteasomes. The attachment site of the Fab portion of the antibody to the proteasome was mapped by electron microscopy in conjunction with image processing. The antibody was found to bind to the periphery of the two outer "disks" of the proteasome complex formed by the alpha-subunits.


Electron microscopy of thin-sectioned three-dimensional crystals of SecA protein from Escherichia coli: structure in projection at 40 A resolution. SecA is a single-chain, membrane-associated polypeptide (102 kDa) which functions as an essential component of the protein export machinery of Escherichia coli. SecA has been crystallized from ammonium sulfate as small, three-dimensional bipyramidal crystals (0.1 x 0.1 x 0.05 mm). These crystals did not demonstrate detectable diffraction of X-rays from rotating anode sources. For study by electron microscopy, individual crystals were cross-linked in glutaraldehyde and OsO4 solutions, dehydrated, embedded in epoxy resin, and sectioned normal to crystallographic axial directions inferred from the external morphology of the crystals. Fourier transformation of processed images of untilted thin sections stained with uranyl acetate and lead citrate show reflections extending to 31 A resolution. Diffraction data and reconstructed images of the projected density of the unit cell contents indicate that the bipyramidal SecA crystals belong to orthorhombic space group C222(1) with unit cell dimensions a = 414 A, b = 381 A, and c = 243 A. Filtered images and density maps of mutually orthogonal projections of the unit cell contents are consistent with a three-dimensional model in which the asymmetric unit contains eight SecA monomers. The large unit cell dimensions and packing of protein monomers suggest that SecA is crystallizing as an oligomer of either dimers or tetramers.


[Unconventional culture of the human hepatitis B virus (HBV)]. The investigation of the key stages of the HBV vital cycle was realised recently through an unconventional cultivation technique, using transfection with an adequate DNA, cloned in plasmids. Transfections was achieved in cell lines, differentiated or not. The results showed that expression of some of the HBV genes is under the control of hepatospecific factors.


[The possibility of the vertical intrapartum transmission of the HIV and HB viruses]. A study was performed on 756 serum samples collected from the umbilical cord of newborn infants. HBV markers were found in 4.63% of the tested subjects. Of these samples, 291 were tested for the HIV markers and 0.34% were found positive (versus 0 in the controls, most of them men from the same region). Results confirmed the possibility of vertical transmission of both viruses, HBV and HIV, in Romania.


Approximate formulae (deduced from a mathematical model) for the characteristics of the interepidemic and epidemic periods of some virus diseases. By a qualitative analysis of the solutions of the mathematical model equations (describing the morbidity and susceptibility evolution in a viral epidemics), approximate formulae for the extreme values of the variables and for the duration of the main phases of a multiannual cycle are deduced. These formulae were validated by numerical simulation of the solutions, leading to the exact values of the mentioned essential characteristics of the diseases propagation.


[The demonstration by immunofluorescence of inframicrobial antigens on samples of peripheral blood vessels (artery and vein) from subjects with different vascular diseases]. The presence of fourteen inframicrobial agents was investigated by the immunofluorescence technique using specific antisera on 345 samples of arteries and veins collected during operation from patients with chronic vascular diseases (arteritis, varicosity) and on 50 samples of umbilical cord. Results indicated a positivity rate of 75.45%; most of the cases had associations of two to five antigens. Coxsackie A virus and mycoplasmas were the agents most frequently found.


Complement fixing antibodies against selected viruses in diabetic patients and non-diabetic control subjects in Ibadan, Nigeria. Sera of forty insulin-treated Nigerian diabetics attending the outpatients clinic of the University College Hospital (U.C.H.), Ibadan, and an equal number of non-diabetic control subjects matched for age, sex and social status were tested for presence of complement fixing (CF) antibodies against five viruses: Coxsackie A and B1, mumps rubella and enterovirus group antigen. Antibody levels to Coxsackie B1, mumps, rubella and enterovirus did not show any significant difference between the two groups (P > 0.05). The serum levels of antibody to Coxsackie A virus were significantly higher in non-diabetic controls than in the diabetics (P < 0.05). Previous exposure to these viruses may not be a significant factor in the aetiology of insulin dependent diabetes mellitus in this environment.


The distribution of nucleic acid chromophores at cellulose-water interfaces. 1. Photometric parameters. A computer-assisted calculus of the chromophores distribution in the contiguous layer around the scattering centers of a multiple scattering medium, using bichromate photometric data and an extended Kubelka-Munk expression, was developed. Explanatory examples of nucleic acid impregnated chromatography paper disks show the efficiency of the method proposed for the study of macromolecular structures and the dependence upon the physico-chemical peculiarities of the solutions used.


[The electrophoresis of biotinylated nucleic acids]. A simple and rapid method was worked out to evaluate the biotinylation level of the pBR322 and pSVK1H genetic cloning vectors, using gel electrophoresis. Avidin was used to slow down the migration of biotinylated DNA: the DNA migration speed diminished as the biotinylation level rose, due to DNA complexation. The highest level of biotinylation is characterized by the formation of a biotinylated nucleic acid-avidin complex with no electrophoretical mobility.


Some seroepidemiological data on HIV-antibody and HBs-antigen prevalence in children and infants of Craiova (Romania). By testing 2362 children and infants from Craiova (Romania), for both HIV-antibody and HBs-antigen presence in the blood, a high rate of positivity was noticed in orphanages and in dystrophia units. A rate of "signal" (i.e. about 4% for HIV-antibodies, and 2.5% for HIV-antibody/HBs antigen), in hospitalized patients (pediatric service), was found as well. Four reasons support the horizontal way of virus transmission as the main route: most of seropositive subjects belong to 1-to-3-year age range, suggesting a virtual contamination before introduction of disposable syringes in Romania care units and hospitals; many HIV-seropositive cases have received frequent parenteral treatments, during repeated hospitalizations for acute respiratory disease; only few of the mothers of seropositive infants exhibited HIV-antibody presence; a relatively high rate of "double" seropositivity, i.e. HIV-antibody/HBs antigen, within tested serum samples was noticed.


HIV-antibody detection in children by competitive and direct micro-ELISA techniques. A comparative study was carried out on 110 sera from children or infants, suspected of HIV-antibody presence following several micro-ELISA assays, using four direct micro-ELISA (Wellcozyme HIV 1 + 2, Rapid Elavia Mixt, Ortho Diagnostics, RECVIH) and a competitive system--Wellcozyme-Recombinant. In three of the four direct systems, as well as in the competitive system, significantly higher mean values of sample/cut off, and cut off/sample ratios, respectively, as compared to the direct systems RECVIH, were present. High optimal levels of sensitivity and specificity (%), as related to Western Blot results, were found with Wellcozyme direct and competitive kits, as well as with Rapid Elavia Mixt kit, as compared to lower levels exhibited by the other two direct system kits (Ortho Diagnostics an especially RECVIH). As regards three Western Blot undetermined results, obtained in patients with a severe clinical state and evolution to exitus, by comparing some serological markers of HIV infection in two serum samples belonging to the same case (second sample collected 4 weeks after collection of the first homologous sample), the disappearance of gag-encoded-p24 band in Western Blot, associated with negativation of HIV-p24-antibody and with the presence of free virus antigen in all three second serum samples occurred, that would reflect a probable fall of immune anti-HIV "barriers" during final stages of illness. Although Western Blot confirmation cannot be excluded, it seems to be useful to assay comparatively HIV-antibody presence by means of direct and competitive micro-ELISA systems, in the same serum sample.


The evolution of hepatitis B virus infection in children with symptomatic AIDS. Hepatitis B virus (HBV) markers were determined in 80 children under 5 years of age with HIV symptomatic infection. Because of high carrier rate of hepatitis B virus in Romania we investigated as control a group of age matched 36 HIV negative children offsprings of HBsAg carrier mothers. Serological and epidemiological investigations in families of HIV infected children support horizontal nosocomial and not vertical transmission for HIV in contrast with HBV whose perinatal transmission can not be excluded. Concerning the probable route of HBV infection both groups of children seem to have a comparable risk for parenteral, contact-associated or maternal-neonatal transmission. HBsAg was detected in 76.25% HIV positive subjects and in 13.9% of control (P = 0.05). From all serum samples tested, only 12, all from the control group, did not present any markers of past or current HBV infection. Two serum markers have been used as an index of active HBV replication: HBe antigen detection and HBs antigen quantification in one or paired serum specimens. HBeAg was detectable in 20% of HIV infected children and only in 2.8% controls (P = 0.05). Almost all HBeAg positive patients have higher values for HBs antigenemia. HBsAg concentrations well above the assay cut off value (sample/cut off ratio > 15) were generally representative for HIV infected children (54% versus 5.6% in controls). The prevalence of hepatitis Delta markers and anti-HCV antibodies was not significantly higher in HIV infected children in spite of the fact that they are potentially exposed to a wider range of antigens.(ABSTRACT TRUNCATED AT 250 WORDS)


[The processing of experimental tabulated data with the standardized Multiplan and VU-CALC programs]. The possibilities are investigated of processing data tables issued from immunofluorescence tests for quick virologic diagnosis, from fluorimetric determinations and from spectrophotometric evaluation of electrophoregrams of serum samples from patients with or without hepatitis. Analysis was realised using microcomputer programs facilities.


Biological roles of HIV Nef proteins. A minireview. The nef gene, its protein products and diverse mechanisms by which HIV pathogenicity is nef-mediated in vivo and in vitro explain the huge amount of works on this topic. Until now the following functional roles have been assigned for nef: 1. downregulation of virus replication; 2. GTP binding and GTPase activities; 3. modulation of cytoplasmic signalling; and 4. cellular (CD4 and IL-2) gene regulation. Many reports which demonstrate the possible functions of nef in viral replication and in development of AIDS have been refuted by other scientists who failed to confirm some biological activities. Host immune response against nef proteins has been claimed as an early diagnosis marker or to be involved in disease progression. Also, nef proteins have been involved in blocking of HLA antigens, in superantigen production or in crossreactivity with some cellular antigens. The role of nef is a complex one, important in establishing and maintaining viral latency in vivo and regulating virus replication in vitro.


Assessment of the accuracy of cytology in women referred for colposcopy and biopsy: the results of a 1 year audit. The results of weekly colposcopy review meetings have been audited for 1 year and cases where there was a discrepancy between the referral cervical smear and the initial colposcopy biopsy have been analysed. New referrals (n = 476) for colposcopy were studied. In the final outcome 80% of 326 women referred for moderate or severe dyskaryosis were found to have cervical intraepithelial neoplasia (CIN) grade II or III or invasive carcinoma. Three women found to have invasive carcinoma had been referred for severely dyskaryotic smears. Twenty women were referred for smears with cell changes suggesting glandular neoplasia: five were found to have adenocarcinoma in situ, whereas eight had CIN and seven had negative biopsies. The results justify the referral policy and demonstrate the need for further investigation when initial colposcopic biopsies are negative.


Cost effectiveness of a fine needle aspiration clinic. The resource implications of a Fine Needle Aspiration (FNA) Clinic at Northampton General Hospital have been evaluated over a 12 month period using a patient management questionnaire. A total of 490 cases from which fine needle aspirates were taken from superficial sites have been assessed (breast 381, thyroid 46, lymph node 44, salivary gland 9, soft tissue 10). Total resource savings (135,544 pounds) exceeded the expenses of the FNA clinic (27,290 pounds). Potential cost savings per case were the greatest for thyroid aspirates. The FNA clinic where the pathologist takes, stains and reports optimally prepared specimens, provides a high quality and accurate service on which clinicians can confidently base clinical management decisions. Unnecessary investigations and operations are avoided, allowing scant resources to be released for other procedures.


Inflammatory lesions of the breast: diagnosis by fine needle aspiration. Amongst 1061 breast lesions diagnosed by fine needle aspiration (FNA) over a period of 6 years (1985-1990), 128 were reported to be showing changes consistent with an inflammatory lesion. On review, the cytodiagnosis was found to be inaccurate in 31 cases. The cytological features of the 97 cases that were correctly reported are described in this report. The cytological diagnoses issued in these 97 cases were acute mastitis or breast abscess (57 cases) and tuberculous mastitis (30 cases). Non-specific chronic mastitis and miscellaneous conditions accounted for four and six cases respectively. Acid fast bacilli (AFB) were demonstrated in 28.0% of tuberculous mastitis cases and 10.0% of those diagnosed as acute mastitis or breast abscess. FNA cytology was found to be useful for the diagnosis of inflammatory lesions of breast and their classification, as only five out of 57 cases of acute mastitis/breast abscess and one out of 30 tuberculous mastitis cases were suspected on clinical grounds.


Brush cytology technique in the detection of oesophageal carcinoma in the asymptomatic, high risk subject; a pilot survey. This study assesses the reliability of abrasive brush cytology in the diagnosis of early cancer of the oesophagus among asymptomatic rural Ciskeians. An inexpensive locally manufactured brush biopsy capsule was used to obtain cytological material from 1336 subjects; 59% of them were brushed a second time. The technique appears to have a high sensitivity (90%) and specificity (99.9%). Three of five asymptomatic subjects diagnosed as having early oesophageal cancer refused further treatment, indicating the importance of health education as a prerequisite to the introduction of a screening programme for oesophageal cancer.


Identification of malignant cells in serous effusions using a panel of monoclonal antibodies Ber-EP4, MCA-b-12 and EMA. A panel of three monoclonal antibodies (MoAbs) was tested on 29 benign and 53 malignant effusions with the aim of investigating its usefulness for the discrimination between benign and malignant lesions. The panel consisted of MoAbs directed against epithelial membrane antigen (EMA); MCA-b-12, reacting with a 350 kD glycoprotein with mucin-like characteristics present on human breast cancer cells and various other normal and neoplastic tissues, and Ber-EP4, directed against a 34 and 39 kD glycopeptide on human epithelial cells but not on mesothelium. Fifty-two (98%) of the malignant effusions reacted with EMA, 49 (92%) with MCA-b-12 and 44 (83%) with Ber-EP4. Fourteen per cent of benign effusions reacted with EMA, 17% with MCA-b-12 and 7% with Ber-EP4. All seven effusions obtained from patients with a malignant mesothelioma reacted with EMA, six of the seven cases staining intensively. None of the seven stained with Ber-EP4. MCA-b-12 did not react with the cells in one case of malignant mesothelioma. The results suggest that the combination of EMA and Ber-EP4 may be used to discriminate between benign and malignant cells and possibly also between adenocarcinoma and malignant mesothelioma. MCA-b-12 followed in general the reaction pattern of EMA, although often with a less intense staining reaction, making this antibody unsuitable for inclusion in the panel.


The British Society for Clinical Cytology Certificate of Competence in Cytology Screening: a report of the first 3 years' experience. In 1988 the Department of Health (DOH) recognized the cytology screener grade of laboratory staff. Cytology screeners have a 2 year training period after which they must sit a 'competence examination'. The British Society for Clinical Cytology offers an examination to meet the DOH specification. It consists of a written paper, a practical screening test, a spot test and a short viva voce. The screening test is paramount and candidates who miss a dyskaryotic smear cannot be successful. In the first 3 years there have been 22 examinations, 294 candidates and a pass rate of 76%. The majority of candidates were Cytology Screeners of 2-3 years experience but significant numbers of Medical Laboratory Scientific Officers (MLSOs) and senior MLSOs also chose to sit the examination.


The Lensman microscope: tool or toy?

The Lensman microscope: tool or toy? The experience of using the Lensman microscope for 1 year indicates that this inexpensive, pocket-sized instrument, which can be used at the bedside or in the outpatient department, can assess the quality of needle aspirates although it is not suitable for making definitive cytological diagnoses.


Fine needle aspiration cytodiagnosis of apocrine carcinoma of the breast. The cytopathological appearances of 14 cases of apocrine breast carcinoma diagnosed by fine needle aspiration cytology are described and the features compared to those seen in apocrine cells aspirated from benign cystic and solid lesions. Significant atypia must be observed before a diagnosis of apocrine carcinoma can be entertained.


The evolution of dementia in idiopathic Parkinson's disease: neuropsychological and clinical evidence in support of subtypes. One hundred and seven newly diagnosed, untreated patients with Parkinson's disease (PD) were divided into two groups according to their age at reported onset of symptoms. Of these, 79 patients were under age 70 (early-onset) and 28 patients were age 70 and over (late-onset). The group of 50 control subjects comprised spouses, friends of the PD patients, and community volunteers. The patients were participants in a multicenter drug study of Parkinson's disease. Each had received a detailed neurological and neuropsychological assessment in the baseline placebo phases of the study. Thirty-4 patients with early-onset and 12 patients with late-onset were reassessed 3 years after treatment with low-dose levodopa, with bromocriptine, or with a combination of the two drugs. The results of the baseline phase of the study revealed that 8% of the early-onset group and 32% of the late-onset group were classified as demented. The 3-year follow-up revealed that the prevalence of dementia had increased to 17% in the early-onset group and to 83% in the late-onset group. This study confirms that at least two distinct subtypes of Parkinson's disease exist. The subtypes differ both clinically and neuropsychologically. The age at onset of symptoms is a critical determinant of the rate and type of cognitive decline in Parkinson's disease.


Behavioral syndromes in Alzheimer's disease. The Behavioral Syndromes Scale for Dementia (BSSD) is a new instrument that showed strong internal consistency and interrater reliability in an outpatient sample of 106 patients with probable Alzheimer's disease. Factor analysis provided support for a priori symptom groupings, particularly the syndromes of disinhibition and apathy-indifference. Dependency (87%), denial of illness (63%), and motor agitation (55%) were common, while sexual disinhibition (2.9%) and self-destructive behaviors (2.9%) were rare. Virtually all symptoms were predominantly minimal to mild in severity. Patients with longer illness duration were more apathetic. Disinhibited behaviors and apathy-indifference increased with greater severity of dementia. Catastrophic reactions, aggression, and agitation were associated with greater functional impairment. There was great heterogeneity in symptom presentation. In Alzheimer's disease, several behavioral changes might be direct manifestations of underlying brain pathology, rather than being solely secondary to cognitive impairment.


Cross-cultural variations in depressive symptoms in later life. The purpose of this study is twofold: to estimate the prevalence of depressive symptoms among older adults in four culturally diverse groups (white Americans, black Americans, Japanese, Taiwanese), and to assess whether there are cross-cultural variations in the way depressive symptoms are manifest. Data from three recent nationwide surveys in the United States, Japan, and Taiwan reveal that the lowest overall levels of depressive symptoms are found among Japanese elderly, followed by Taiwanese, white Americans, and black Americans respectively. Based on previous cross-cultural research, it was hypothesized that the Japanese tend to express depressive symptoms as interpersonal complaints, whereas Taiwanese are more likely to manifest somatic symptoms. In contrast, Americans were expected to express depressive symptoms in the form of depressed cognitions. The findings failed to support these hypotheses. Instead, older Americans tended to have higher scores than Orientals on all three depressive symptom clusters.


A new systematic method of measurement and diagnosis of "mild cognitive impairment" and dementia according to ICD-10 and DSM-III-R criteria. Normative data were collected in a study population of 150 randomly selected elderly subjects. Using the SIDAM (Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, multi-infarct dementia, and dementias of other etiology according to DSM-III-R and ICD-10), both the dimensional and the categorical aspects of dementia and "mild cognitive impairment" are considered. With the SIDAM score (SISCO) [range 0 (minimum)-55 (maximum, no cognitive impairment)] and the SIDAM Mini-Mental State Examination (MMSE) (range 0-30), appropriate cutoffs for the category of DSM-III-R and ICD-10 dementia and "mild cognitive impairment" were defined. MMSE scores of 0-22 were found to be indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," MMSE scores ranged from 23-27 according to a DSM-III-R definition (ICD-10: 23-28). An MMSE score of 22 or less was found to differentiate between DSM-III-R/ICD-10 dementia and "mild cognitive impairment," with a specificity of 92% (ICD-10: 95.6) and a sensitivity of 96% (ICD-10: 96%). With the SIDAM-based DSM-III-R/ICD-10 diagnoses of dementia as the criterion, the SISCO was 97.3% specific (ICD-10: 99%) and 94% sensitive (ICD-10: 94%) in detecting dementia. A SISCO of 0-33 was highly indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," a SISCO between 34-47 (ICD-10: 34-51) was found. The SISCO covers a broader range of cognitive functions than the MMSE and is more useful in detecting even very mild cognitive decline. Furthermore, the newly defined category of "mild cognitive impairment" could be validated successfully by means of GDS Stages 2-3 and CDR Stage 0.5. These findings confirm the value of the SIDAM as a short diagnostic instrument for measurement and diagnosis of dementia and "mild cognitive impairment."


Agitation in elderly persons: an integrative report of findings in a nursing home. Agitated behaviors in the nursing home pose a major problem for caregivers. Our data showed that the three syndromes of agitation--aggressive behaviors, physically nonaggressive behaviors, and verbally agitated behaviors--are differentially related to medical and psychosocial variables. Physically nonaggressive behaviors may be adaptive for a resident who presents a deteriorated stage of dementia, since these behaviors offer stimulation and exercise. Verbally agitated behaviors may be a form of help-seeking behavior for residents with physical disease and depressed affect. Aggressive behaviors are those least understood, although these behaviors correlate with advanced stages of dementia and with poor interpersonal relationships. These findings should be a basis for further studies, with the ultimate goal being improved care for agitated elderly persons.


Toward an understanding of cognitive functioning in geriatric depression. This paper addresses the questions of whether depression compromises cognition in the elderly and whether discernable patterns of cognitive performances could be differentiated between patients with severe depression and those with organic dementia. Published data on geriatric depression and cognitive functioning are divided in demonstrating a depression effect. Further examination and external validation by new data show that the depression effect on discrete cognitive tasks is (1) small, and (2) sensitive to the confounding of sampling and task variables. Future research must take these factors into account. Patterns of cognitive functioning in depression and dementia are different and can be differentiated using a variety of measures. This review finds the term pseudodementia inappropriate and misleading and recommends that it be abandoned.


Relationships among an older adult's life review, ego integrity, and death anxiety. The frameworks of Erikson (1963) and Butler (1963) were used to design this descriptive study that investigated the relationships among life review, ego integrity, and death anxiety in older adults. Three hypotheses were proposed: (a) the greater the life review, the higher the ego integrity; (b) the greater the life review, the lower the death anxiety; (c) the higher the ego integrity, the lower the death anxiety. The sample consisted of 115 female and male volunteers between the ages of 65 and 93. The participants filled out the Life Review Questionnaire, Adult Ego Development Scale, Death Anxiety Scale, Death Preparation Scale, and a Personal Information Sheet. Life review, while not positively correlated with ego integrity, was found to have a negative correlation with death anxiety. Also, religious subjects were found to be more prepared for death than those who did not practice. Implications for therapy and future research are discussed, as well.


Examining key variables in selected reminiscing modalities. This study examined the underlying variables of selected reminiscing processes to determine those that contributed to well-being. Two hundred and forty subjects randomly selected from nursing homes and high-rises participated in one of 10 different reminiscing modalities for eight weeks. Measures of life satisfaction (LSI-A), psychological well being (ABS), self-esteem (SES), and depression (BDI) were given pre- and postintervention to determine the most therapeutic treatment modalities. Results showed the most therapeutic way to reminisce was through a structured, evaluative life review performed on an individual basis. Thus, three variables contributed to successful reminiscing: individuality (one-to-one reminiscing), evaluation (a personal valuing of events), and structure (covering the whole life span).


A strategy of "combination chemotherapy" in Alzheimer's disease: rationale and preliminary results with physostigmine plus deprenyl. Although the central cholinergic deficits are still considered to be of primary importance in Alzheimer's disease, there is great need for an expansion of the pharmacological approach in this illness beyond the simple cholinergic replacement hypothesis. This report focuses on the concept of "combination chemotherapy" in Alzheimer's disease as the next generation of therapeutic strategies. Based on earlier positive findings in Alzheimer patients with the monoamine oxidase B inhibitor, 1-deprenyl, the authors speculate that a combination of physostigmine, the short-acting cholinesterase inhibitor, and 1-deprenyl might be more beneficial than either agent alone. The authors outline a sample paradigm for such combination studies, report preliminary data on the first 16 Alzheimer subjects to have received an initial combination of physostigmine and deprenyl, and point to other possible "combination chemotherapy" strategies for future study.


The integrated health-care system: reflection and projection. This paper presents a personal view of the development of integrated, comprehensive health-care systems in the United States. The influence of Federal legislation is described, beginning with the 1950-60s policy objective of Hill-Burton Program administrators to create a number of community-based regional medical centers, each consisting of a range of health services organized by and around community hospitals. Later variations of the concept appeared in such programs as Medicare-Medicaid, Comprehensive Health Planning, the Regional Medical Programs, and the new Agency for Health Care Policy and Research. Based on the cumulative experience of the past, the economic, professional and social climate of the present, with its increasing involvement of the patient/payer/consumer in decisions, and the enhanced inter-organizational coordination emerging from technologies of computers and communication science, the goal of creating comprehensive integrated systems as conceived in the 1950s and 60s may finally be achieved in the 1990s, but in a different form from that envisioned earlier. By judicious exploitation of computer and communication capabilities and the massive knowledge bases evolving from research, the way is eased for patient-centered integration and coordination of services without demanding integration in the sense of ownership or formal control of all the providers within a central organization.


A historical review of the Kaiser Permanente Medical Care Program. The Kaiser Permanente Medical Care Program evolved from a series of major construction projects in the 1930s and from the World War II shipyards in the early 1940s. In the late 1940s, it became a community-based medical care program, and later in the 1970s, the prototype Health Maintenance Organization (HMO). Over the past five decades, Kaiser Permanente has developed its basic principles of prepaid, group practice for comprehensive-care services where physicians control their medical practice in a partnership of responsibility for the Health Plan, the Hospitals, and the Medical Groups. All of this is carried out with autonomy of its 13 regions in the United States.


Health systems education yesterday, today, and tomorrow. This paper traces the history of the application of industrial management engineering techniques to health systems problems. The educational background of early practitioners and the development of specialized health systems educational programs are described. Projections are made about the future of health systems engineering and health systems education.


Systems approaches in emergency medical services: the history, the impact, and the future. Systems approaches have been important in planning and evaluating emergency medical services (EMS) systems. However, maximal use of systems approaches are limited by small political boundaries, the lack of user-friendly systems tools, and the need for EMS planning staffs who are familiar with these systems tools. Developing technology, particularly communications, will continue to have a great impact on EMS delivery. In addition, the need is seen for continuing advances in systems concepts, and in particular, the promotion and incorporation of health and prevention of injury as systems concepts.


Hospital payment based on diagnosis-related groups. The Prospective Payment System (PPS) used by Medicare to pay hospitals is described. As Diagnosis-Related Groups (DRGs) are central to this system, they are described in some detail. While the results achieved by PPS have been impressive, opportunities to both improve and extend the approach are present. Problems with the approach are described, together with alternatives to direct payment.


Clinical information systems: 25-year history and the future. Clinical information Systems have not advanced rapidly enough to meet the growing needs for clinical data. This is due primarily to the industry's past focus on financial information processing. Pressure is increasing for clinical data to support health-care professionals in the delivery of patient care, and in the establishment and monitoring of quality of care indicators. This article summarizes the history of clinical systems, and presents key issues regarding future clinical information systems.


The origins of hospital microcosting.

The origins of hospital microcosting. This paper begins with a definition of microcosting, including the specification of design criteria and a general model framework. The necessity for micro- as opposed to macro-costing is discussed. Examples of microcosting systems are provided. Relative value scale and case-mix alternatives to microcosting are presented.


Nurse staffing and scheduling: past solutions and future directions. Nurse staffing and scheduling systems have been a significant challenge for operations researchers, industrial engineers, and system developers for many decades. The purpose of this paper is to discuss historical approaches to workload measurement, nurse staffing and personnel scheduling, and to predict possible future directions for nurse staffing and scheduling systems.


Patient-scheduling methodologies.

Patient-scheduling methodologies. Inpatient admissions, surgical scheduling, and outpatient scheduling are three of the most important patient-scheduling functions in the hospital. In this paper, the key elements of state-of-the-art scheduling systems are discussed, along with a rationale for their importance. Our purpose is to show how well-designed patient-scheduling systems can contribute to the improvement of hospital operations.


[Sympathetic control of spontaneous cardiac defibrillation]. The parameters of transmembrane potentials of cardiomyocytes and dynamics of fibrillation process have been investigated when altering the level of sympathetic action on the heart by injection of rausedile, katecholamines and by stimulation of the nucleus of hypothalamus. It was shown that the injection of rausedile decreases rest potential and potential activity, meanwhile electrical irritation significantly increases the period of spontaneously reversible fibrillation.


[The adrenergic regulation of cardiomyocyte electrophysiological activity, cardiac biochemical function and coronary blood flow in rats with incorporated 131I]. The study was made of the rat heart isolated according to Langendorf and right auricles. Intraperitoneal injections of 2.5 MBq/kg 131I were performed. Electrophysiological and biomechanical myocardium response to stimulation of alpha and beta-adrenoreceptors with isoprenalin and phenylephrine hydrochloride was analyzed. Postradiation modification of adrenergic control in animals with incorporated 131I appeared as reduced functional response of cardiomyocytes and intact heart to beta-adrenoagonist and enhanced response to alpha-agonist was detected.


[The effect of leucine enkephalin on the development of a convulsive afterdischarge in the sensorimotor cortex of rats]. The application of leucin-enkephalin solution (LEU) (2 micrograms/2 microliters) on stimulated region of sensomotor cortex did not influence threshold of direct and transcallosal cortex responses (DR and TCR). On coupling of repeated electrostimulation train (RET) (duration of impulse--0.1 ms; duration of train--10 s; frequency--10/s) with application of LEU (after every odd train) the changes of DR and TCR in course of even trains and latency of afterdischarge appearance were such as in control ones. Simultaneously LEU effectively depressed short posttetanic potentiation of DR and TCR and potentiation of amplitude and duration AD, evoked by RET. It is suggested that LEU released from neurons in the course of RET does not participate in initiation of seizure in sensomotor cortex. A possible role of LEU in sensomotor cortex is limitation of intensity and duration of seizures and prevention of status epilepticus.


[The mechanism of the action of dalargin in experimental myocardial ischemia]. In acute experiments on cats it has been shown that dalargin possess antiarrhythmic affect in myocardial ischemia. Antiarrythmic effect of dalagrig may be connected both with reflex and with direct action of dalargin on neurons structure, which


[Microfluorimetric research on the erythroblastic islands and macrophages of the bone marrow]. A microfluorimetric system was used to study rat bone marrow erythroblastic islands (EI) and macrophages. Measurement of fluorescence from acridine-orange-treated cells was performed on the microscope LUMAM-E3 (LOMO, Leningrad) at 530-550 and 630-650 nm. The intensity of fluorescence in 530-550 nm range depended on the intensity of proliferative processes in EI, that at 630-650 nm was associated with activity of lysosomal apparatus of EI macrophages. Erythroblast amplification in EI is parallel both to enhancement of fluorescence intensity at 530-550 nm and 630-650 nm. Intensity of fluorescence of different bone marrow macrophages was evaluated. It is suggested that a part of bone marrow macrophages has high affinity to erythroid tissue.


[Sex differences in the cholinergic status of white rats]. Female rats injected with organophosphate inhibitor of acetylcholinesterase chlorophose at doses of 10 mg/kg and 360 mg/kg showed less considerable decrease in blood acetylcholinesterase activity than did male animals. Females compared with males also demonstrated less expressed clinical symptoms of poisoning (salivation, convulsion) after injection of chlorophose at dose of 360 mg/kg. The value of LD50 in female rats was 860 mg/kg, whereas the comparable value in male animals was 700 mg/kg. Following the injection of atropine at doses of 0.1, 0.3, 0.6 mg/100 g female rats showed 2-3 fold increases in basal adrenal and plasma corticosterone levels, but significant decreases in stress-induced corticosterone levels. As for males, the basal and stress-induced values of corticosterone were not significantly affected by atropine administration. These results suggest that functional reserves of cholinergic system and responsiveness of the hypothalamic-pituitary-adrenal axis to cholinergic influence are greater in females than in males. It is concluded that cholinergic status is significantly higher in female rats than in male ones.


[Sex differences in adrenocortical sensitivity and resistance to cerebrovascular damage in rats under strong stress]. Dynamics of changes in adrenal and plasma corticosterone and the development of cerebrovascular lesions were studied in both male and female rats, exposed to strong stress (combined immobilization and intermittent found sound for 2 hours). Plasma corticosterone levels in stressed females were 460% and 660% of the control values when measured on stress minute 10 and 120. The corresponding values in male rats were 220% and 360%. The stress-induced dilatation of brain vessels and the increases in vascular permeability were less pronounced in females than in males, when studied 0.1 and 24 hours after termination of stress. The number of brain perivascular haemorrhages was markedly reduced in females compared with males. It is supposed that higher resistance to stress-induced cerebrovascular lesions in females may be attributed to higher functional reserves of steroidogenesis.


[The reactivity of the skeletal muscle arterioles of rats to noradrenaline after whole-body gamma irradiation at a dose of 1 Gy]. Male Wistar rats were exposed by total gamma-irradiation at 1 Gy, Reactions of skeletal muscle arterioles and mean arterial pressure on intravenous doses of noradrenaline (0.1, 0.3, 1.0 and 3.0 micrograms/kg) was studied by intravital microscopy in acute experiments 1, 3 and 5-6 days after irradiation. The exposure causes arterial hypotension on day 1 after that as well as marked reduction of spontaneous arteriole vasomotions and decrease of arteriole constrictions at any doses and dates under study. There are no differences of arterial pressure reaction amplitudes in per cent between control and exposed animals at any doses and dates under investigation.


[The effect of low-intensity laser radiation on blood metabolic indices in the postresuscitation period]. The effect of He-Ne laser radiation (632.8 nm; 0.3 mW/cm parallel to oxygenation on metabolism indices of blood, taken in early postresuscitation period after discontinuation of hemorrhagic shock was studied in vitro. Compared to oxygenation alone, combined therapy resulted in more marked oxygen consumption of the blood, normalization of plasma antioxidant total activity, superoxydismutase erythrocyte catalase activity, the number of double connections in fatty acid chain of general lipids and membrane viscosity were elevated. Regular dependence of lipid peroxidation on a number of metabolic blood parameters is revealed.


[The mechanism of the steric exclusion of cells brought about by proteoglycans]. The effect of amount of rabbit erythrocytes and concentration of sodium hyaluronate and sodium salt of protein--chondroitin-keratan-sulfate were studied on aggregation of erythrocytes suspended in 0.15 M NaCL, pH 7.4. It was shown that the rate of steric exclusion of erythrocytes depends on relationship between amount of erythrocytes and concentrations of these proteoglycans.


[The antiepileptic effects of sodium valproate and the calcium antagonist riodipine when used jointly in a model of focal penicillin-induced epileptic activity]. In experiments on 52 freely moving Wistar male rats, 200-220 g in weight, on the model of focal penicillin-induced epileptic activity (EpA) in brain cortex the efficacy of combined application of drugs influencing different mechanisms of epileptogenesis: sodium valproate enhancing GABA-ergic processes, and the calcium antagonist ryodipine (1,4-dihydropyridine) have been studied. It was shown that valproate and ryodipine when used in combination at relatively small doses (150 and 0.8 mg/kg l.p., respectively) produced a more marked antiepileptic effect than each of these drugs given alone. These and previously reported results of studies on the model of generalized pentylenetetrazol-induced EpA, suggest that complex pathogenic therapy (CPT) as a combination of the antiepileptic drugs acting on the corresponding basic pathogenic mechanisms of respective form of epilepsy is reasonable to be used. CPT allows to obtain a better curative effect with a lower dose of each drug used and to reduce the risk of side effects of the drugs applied at large doses in case of monotherapy.


[The antidepressive properties of anaprilin]. After chronic administration of propranolol (1 and 5 mg/kg, 14 days) to rats time-course of forced swimming changed with the decrease of rhythmical index of depression. The drug attenuated depressogenic properties of reserpine and clonidine. Propranolol antidepressive activity is attributed to blockade cerebral adrenoreceptors.


[The antiepileptic effects of sodium valproate and the calcium antagonist riodipine when used jointly in a model of generalized korazol-induced epileptic activity]. In experiments on male Wistar rats on the model of generalized pentylenetetrazol-induced epileptic activity the efficacy of the combination of the drugs influencing different mechanisms of epileptogenesis: sodium valproate enhancing GABA-ergic processes and calcium antagonist, ryodipine (1,4-dihydropyridine), have been studied. Sodium valproate and ryodipine when used in combination at relatively small doses (70 and 0.75 mg/kg, respectively) produced more marked antiepileptic effect than each of these drugs given alone. The results obtained suggest that complex pathogenetic therapy (CPT) as a combination of antiepileptic drugs acting on corresponding basic mechanisms of respective form of epilepsy is reasonable to be used. According to our previous results, CPT can reduce the risk of side effects of each drug due to decreased doses. CPT may be of great importance in case of long-term treatment.