Diffuse infiltrative lymphocytosis syndrome in children and adults infected with HIV-1: a model of rheumatic illness caused by acquired viral infection. Certain maternal/infant pairs, as well as other high-risk adults, develop a host-response HIV-1 infection characterized by circulating and tissue infiltrative CD8 T-cell lymphocytosis, termed Diffuse Infiltrative Lymphocytosis Syndrome (DILS). DILS primarily occurs in the salivary glands, lungs, renal interstitium, and gastrointestinal tract. DILS differs from Sjogren's syndrome in the degree of salivary gland enlargement, high frequency of extraglandular manifestations, paucity of autoantibodies, and distinct immunogenetic associations. Salivary gland B-cell lymphoma is a complication common to both conditions. The circulating CD8 T cells in DILS have a memory phenotype. Egress into target tissues involves adhesion molecule receptor-ligand interactions, apparently in response to the local presence of HIV-1. Immunogenetic predisposition involves interaction between both MHC classes I and II loci. This disease appears to reflect a specific host response that leads to persistence of monocyte-tropic, rather than T-cell-tropic, HIV-1 strains, in an analogous fashion to Visna Maedi virus disease in sheep. The development of DILS in children appears to be regulated in a dominant fashion by maternally or paternally inherited MHC class II alleles in response to transplacentally or perinatally acquired maternal HIV-1 strains.


Nocturnal low back pain in pregnancy: polysomnographic correlates. Thirteen women in late stages of pregnancy underwent a polysomnographic study. Eight women (61%) complained of mild nocturnal back pain or back discomfort. Five women (39%) did not complain of nocturnal back pain. The two groups did not differ in total bed time, total sleep time, sleep latency, and wake after sleep onset (WASO). A significant decrease in rapid eye movement (REM) sleep and an increase in stage 2 were observed in the pain group. The same group had a statistically significant decrease in the basal O2 saturation level. The pain group also spent a longer time sleeping in the supine position. We hypothesize that a prolonged stay in the supine position leads to obstruction of the vena cava. In the presence of inadequate collateral circulation, increased pressure and venostasis in combination with a decrease in basal oxygen saturation may lead to hypoxemia, compromise the metabolic supply of the neural structures, and result in pain. It appears, therefore, that the vascular system plays an important role in the pathogenesis of pain. The role played by the disturbed sleep architecture in the production of pain remains to be established. It is possible that the changes observed in sleep architecture result from pain rather than contribute to pain production.


Problem areas of the rheumatic mother.

Problem areas of the rheumatic mother. The extent to which women with rheumatic diseases are disabled in caring for their children is unknown. Fifty-seven women with rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus, all of whom had children under 6 years of age born during the disease, were interviewed. Patients with different diseases differed in their disabilities, but lifting, carrying, transporting, and bathing the child were difficult for most patients. Attention to these problem areas is necessary in the care of young mothers with rheumatic illness.


Target antigens of the SSA/Ro and SSB/La system. The SSA/Ro and SSB/La antigens are polypeptides which serve as autoantigens in systemic lupus erythematosus and Sjogren's syndrome. The SSA/Ro contains two major isoforms of 60 kD and 52 kD. The former is the main native antigen while the latter is a major autoantigen in its denatured form. The SSB/La is a single phosphorylated protein of 48 kD. Recently a new protein of 46 kD, termed calregulin, was suggested as an additional component of the SSA/Ro antigens. However, extensive investigations failed to confirm its relation to the SSA/Ro system. Based on molecular techniques and cDNA cloning of these antigens, it was demonstrated that the 60 kD protein is capable of binding RNA and DNA molecules, suggesting a regulatory role in transcription for this antigen. The 52 kD polypeptide contains multiple zinc finger motifs and its sequence is homologous to the mouse rptl protein, which is a T-cell regulating peptide. The SSB/La is associated with precursors of 5S RNA and tRNA, implying that it has a role in the synthesis and maturation of RNA polymerase III transcripts. The 60 kD and 52 kD SSA/Ro components may be associated within the cell. The SSA/Ro and SSB/La may also be in complex in some points of the cell cycle.


Neonatal lupus syndromes.

Neonatal lupus syndromes. Neonatal lupus is a model of passively acquired autoimmunity in that immune abnormalities in the mother lead to the production of antibodies that cross the placenta and injure the developing fetus. Congenital complete heart block (CCHB), a permanent manifestation of neonatal lupus, is detectable after 18 wk gestation. Transient manifestations include cutaneous, hepatic, and hematologic abnormalities that occur at variable frequency. To date, there is a universal association of CCHB with maternal antibodies to SSA/Ro-SSB/La ribonucleoproteins, detectable by high ratio monomer:crosslinker SDS-immunoblot. Intriguingly, cardiac disease and often other manifestations are not present in the mother, raising the hypothesis that there is differential expression and/or accessibility of SSA/Ro-SSB/La antigens in fetal vs. adult tissues. CCHB may be a final consequence of a more widespread inflammatory response in the heart, including the existence of an associated myocarditis. In contrast to the in utero onset of CCHB, skin lesions generally become apparent after birth. Ultraviolet exposure may be an initiating factor and exacerbate an existing rash. Several studies have documented the predominance of DR3 alleles in mothers of affected offspring, frequently associated with the extended haplotype A1,B8. Available evidence suggests that fetal genetic differences in the major histocompatibility complex (MHC) do not influence susceptibility. The recommended clinical approach includes obstetric and rheumatologic management of both the fetus identified with CCHB and the fetus with a normal heart beat but at high risk of developing CCHB. Fetal echocardiogram is essential in diagnosing and following disease and may suggest the presence of an associated myocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)


Neonatal lupus erythematosus in offspring of mothers with experimental systemic lupus erythematosus. Neonatal lupus erythematosus (NLE) syndrome is a result of the transfer of autoantibodies produced by the mother, across the placenta, to the fetus. NLE is characterized by a transient dermatitis, a variety of systemic and hematological abnormalities, and isolated cases of congenital heart block. The latter has been reported to be due to the presence of autoantibodies specific to La (SS-B) and/or Ro (SS-A). As female mice with experimental SLE, induced by immunization with the monoclonal anti-DNA 16/6 Id, produce a variety of autoantibodies including anti-Ro and anti-La antibodies, we examined the relevance of NLE in the murine system. Offspring of SLE-afflicted BALB/c mothers possessed antibody titers to the 16/6 Id, ssDNA, and nuclear extract, which gradually declined until reduced to normal levels by day 60 after delivery. Antibody titers in the sera of the mothers remained elevated throughout this period. Electrocardiograms were recorded from groups of neonates from mothers with experimental SLE. The results indicated that a high percentage of the offspring had defects in their conduction system including first, second, and third degree heart block; significant bradycardia; and wide QRS complex. Normal patterns were observed in offspring of healthy mothers. Experiments done with mice that were exposed to SLE-related autoantibodies early in their development indicated that offspring to mothers with experimental SLE were neither protected nor more susceptible to disease induction by the 16/6 Id.


Autoantibodies in normal and abnormal pregnancy. Abnormal autoimmune function has been associated with reproductive failure for decades. In fact, all medical conditions historically associated with pregnancy loss (and on occasion infertility) are now recognized to have an autoimmune etiology. It is therefore quite surprising that only less than a decade ago a correlation between the presence of abnormal autoantibodies and pregnancy loss was reported for the first time. Since reproductive failure, similar to other abnormal autoimmune states, is not a monoclonal event, we have established that affected patients demonstrate polyclonal autoantibody abnormalities including a variety of nonorganospecific as well as organspecific autoantibody groupings. For example, patients with repeated pregnancy loss will exhibit abnormal levels of anti-phospholipid antibodies (PA). In normal pregnancy natural autoantibodies do not follow the standard immunoglobulin (Ig) pattern, characterized by a decrease in levels despite a probably mild increase in production, which is excessively compensated by the vasodilatation of pregnancy. PA, especially, demonstrate a mild increase during pregnancy, though levels only in the peripartal period may reach abnormally high titers (in comparison to nonpregnant controls). This dichotomy between total Ig and natural autoantibodies is interesting since it suggests that autoantibodies may be under distinct control. In fact, we have suggested that this observed elevation of autoantibodies may be the result of an antigenic stimulus by self-like antigen, represented by the maternal growth of the parasitic fetus. In abnormal pregnancies, especially those associated with maternal hypertension and fetal growth retardation (IUGR), autoantibody levels do reach highly abnormal levels.(ABSTRACT TRUNCATED AT 250 WORDS)


Immune reproductive failure: effect of nonspecific immunostimulation in mouse model. There is much evidence that pregnancy loss may be immunologically mediated. Failure of the maternal immune system to actively support the pregnancy may be responsible for its demise. Potentiation of immune functions has been attempted in humans; however, the success of immunotherapy is still not clear. Thus immunotherapy experiments in mouse models are important. Nonspecific immuno-stimulation with complete Freund adjuvant (CFA) was shown in our laboratory to reverse the tendency to fetal loss in the CBA/J X DBA/2J mouse combination. CFA elevates the non-T lymphocyte population, decreases T-cell secreted lymphokines, and enhances macrophage-secreted monokines. However, a relationship between these changes and a beneficial effect of CFA on reproductive performance has to be proved. Information obtained from nonspecific immunopotentiation in the CBA/J-DBA/2J model may contribute the assessment of nonspecific immunotherapy in humans.


Immune features in complete Freund adjuvant-treated CBA/J mouse model. Immunostimulation with complete Freund adjuvant (CFA) reverses the tendency to fetal loss in the CBA/J x DBA/2J mouse. First attempts to understand the mechanisms underlying this effect were to evaluate phenotypic and functional changes in the lymphocytic cell population after immunopotentiation. We demonstrated that treatment with CFA leads to diminished responses of maternal splenocytes towards paternal alloantigens and this low response cannot be improved with exogenous interleukin-2. Lymphocytes derived from spleen, para-aortic draining lymph nodes and placenta significantly suppress maternal response to paternal antigens. The effect of low fetal resorption rate is followed by marked elevation of asialo GM-1 and HNK-1-positive cells but not followed by any change of the L3T4 or Lyt-2-positive lymphocyte population in either the spleen or in draining lymph nodes. L3T4 and Lyt-2-positive cells have not been found in the placenta. An important feature was marked elevation of Mac-1-positive cells in the placentas of CFA-treated animals. The relevance of these findings to CFA-induced fetal protection is still under investigation.


Immunotherapy of habitual abortion.

Immunotherapy of habitual abortion. Many cases of habitual abortion have been assumed to be due to hyporesponsiveness to the spouse's antigens encountered in pregnancy. Immunization by paternal leukocytes has been used to potentiate the immune response and prevent further miscarriages. This treatment has been highly controversial in terms of efficacy, mode of action, and side effects. More recently immunoglobulin has been used as passive immunization for similar indications. In our experience immunotherapy is effective; 80% of patients have subsequent live births. The most significant results are seen in patients with five or more abortions, in whom 66% of subsequent pregnancies develop normally compared to 20% in a control group. We have used antipaternal complement-dependent antibody (APCA) production after immunization as a marker of immune response. APCA correlates with beneficial outcome in the next pregnancy. APCA may also be associated with cytokines, which may enhance embryonic and trophoblast development. Immunoglobulin may similarly provide the relevant antibodies or cytokines. At present a large scale meta-analysis is being performed to confirm or refute the efficacy of this treatment. This meta-analysis may resolve the controversy.


The ontogeny of hippocampal local circuits and focal epileptogenesis. Our understanding of the pathophysiological mechanisms underlying the childhood epilepsies is rudimentary at this time. However, results of recent studies in animal models have lead to a number of important hypotheses concerning age-dependent alterations in seizure susceptibility. In area CA3 of hippocampus it appears that during a critical period when this brain area is particularly prone to electrographic seizures, an overabundance of recurrent excitatory synapses may exist. At the same time the synapses themselves appear to be functionally different than their mature counterpart. Age-dependent differences in the properties of postsynaptic NMDA receptors seem to contribute to enhanced seizure susceptibility. In recent years significant progress has been made in unravelling the fundamental processes that underlie the formation of connections between developing neurons. Over-production of early-formed axon collaterals appears to be common-place in the CNS. Moreover, the selection of appropriate patterns of connectivity appear to be dependent in large part on the patterning of neurophysiologic activity. In this regard the NMDA receptor seems to play a pivotal role in synapse consolidation. Based on these observations and the central role recurrent excitation appears to play in hippocampal seizures, it seems entirely plausible that excessive abnormal neuronal discharging that occurs during seizures early in life could result in the consolidation of abnormal numbers of recurrent excitatory synapses. This miswiring of hippocampal networks might be responsible for the marked seizure susceptibility into adulthood and might even contribute to complex partial epilepsy in individuals with a history of childhood seizures.


Immunological factors in infertility.

Immunological factors in infertility. Immune infertility can result from destruction of gametes by antisperm antibodies (ASA) or anti-ovary antibodies, by inhibition of sperm-zona pellucida binding by ASA, or by prevention of embryo cleavage and early development. Condoms, immunosuppressive therapy, sperm processing, and intrauterine insemination have been widely applied, but with controversial results.


Transcription of class II MHC gene by interferon-gamma in FRTL-5 cells. The intracellular mechanism by which interferon-gamma induces the expression of class II major histocompatibility complex (MHC) antigen in nonlymphoid cells is not clear. The effect of recombinant rat interferon-gamma (IFN-gamma), and cycloheximide on the expression of class II MHC gene was studied using the techniques of immunocytochemical staining and northern blot analysis. IFN-gamma induced de novo transcription of class II MHC gene and class II MHC antigen expression on the cell surface. Cycloheximide did not inhibit IFN-gamma-induced class II MHC antigen expression in a dose-dependent manner indicating translational blockade. These results suggest that IFN-gamma induces class II MHC antigen expression via de novo transcription of class II MHC gene leading to synthesis of new class II MHC molecule.


Clinicopathologic and immunophenotypic study of non-Hodgkin's lymphoma in Korea. Lymphoreticular Study Group of the Korean Society of Pathologists. This study sponsored by the Lymphoreticular Study Group of the Korean Society of Pathologists was carried out to provide nationwide data about the histopathologic-immunophenotypic features of malignant lymphomas in Korea. Two hundred and ninety Non-Hodgkin's lymphoma (NHL) among 312 malignant lymphomas collected from three representative areas in Korea were histologically reclassified. Two hundred and fifty three cases were immunohistochemically studied. T-cell lymphoma comprised 35.2% of NHL in this study and showed a quite comparable incidence to that of Japan and China, but it was much higher than in Western countries. A very low prevalence rate of the follicular variety (4.0%) and a higher propensity of primary extranodal involvement (60%) are additional characteristics of NHL in Korea. The most common histologic subtype of B cell lymphoma was diffuse large cell type, whereas the most common subtype of T cell lymphoma was diffuse mixed small and large cell type.


A clinicopathologic study on the diffuse malignant lymphoma--a morphologic and immunophenotypic analysis in 62 patients at Harbor-UCLA Medical Center. In order to compare the prognoses of patients with diffuse malignant lymphomas on the basis of histology and immunophenotypes, we retrospectively studied 62 cases of diffuse lymphoma arising in lymph nodes. We also evaluated the reactivity patterns of monoclonal antibodies (MoAb) LN1, LN2 and LN3 to determine the criteria for making a differential diagnosis in B cell lymphomas. The immunologic phenotypes were determined by the avidin biotin peroxidase complex method, using frozen or paraffin fixed tissues. The majority (66.3%) were B cell with the remaining 20.9% being T cell and 12.9% were non-B, non-T cell lineage. Immunological heterogeneity was found especially in the mixed small and large cell and the immunoblastic lymphomas. There was no significant difference between B- and T-cell lymphomas with respect to survival and death (P > 0.05). Histologically 79% (49/62) of the lymphoma was large cell and 21% (13/62), small cell lymphoma. There was a difference in prognosis between low, intermediate and high-grade of lymphomas. However there were no significant differences among the subtypes of the diffuse aggressive lymphomas. Factors associated with poor prognosis were advanced stages (P < 0.025) and histology of the malignant lymphomas. MoAb LN1, LN2 and LN3 gave positive staining in 83.3%, 91.7% and 60% of B cell lymphomas, respectively. The most common phenotypic pattern in B cell lymphomas was LN1+, LN2+, LN3+/-, suggestive of follicular center cell origin. As a panel, phenotypic patterns of MoAb LN1, LN2 and LN3 may be useful in differentiation of follicular center cell lymphoma from others.


Nonoperative management of persistent sciatic artery aneurysm--a case report. A patient with a sciatic artery aneurysm, which is so rare that only 31 cases have been reported in the literature to date, was treated successfully with transcatheter arterial embolization (TAE) alone. Potentially risky and difficult surgery was avoided. This was the first trial with a good result. TAE alone is simple, safe and effective method for the treatment of sciatic artery aneurysm either in incomplete type or in complete type with adequate collateralization.


Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation. This paper reviews our five years' clinical experience (1987 to 1991) of 22 patients with inflammatory bowel disease (IBD). There were 12 patients with Crohn's disease and 10 patients with ulcerative colitis. The mean age at diagnosis was 8.7 years (2 to 14 years). Clinical impressions before referral were chronic diarrhea in 11, irritable bowel syndrome in 5, colon polyp in 4, lymphoma in 3, intestinal tuberculosis in 2, amoebic colitis in 2, ulcerative colitis in 2 children and other diseases. The mean interval from the onset of symptoms to the diagnosis of IBD was 18 months. Diagnosis of Crohn's disease was delayed for more than 13 months in 8 (67%), whereas that of ulcerative colitis was delayed for more than 13 months in 4 (40%). Diarrhea (50%), abdominal pain (36%) and rectal bleeding (36%) were the three most frequent presenting complaints of IBD. Moderately severe abdominal pain was a more common chief complaint in Crohn's disease (58%) than in ulcerative colitis (10%). Hematochezia (90% vs 17%) and moderately severe diarrhea (90% vs 75%) were more common gastrointestinal manifestations in ulcerative colitis than in Crohn's disease. The associated extraintestinal manifestations were oral ulcer in 7, arthralgia in 11 and arthritis in 4, skin lesions in 2, eye lesions in 2 and growth failure in 9 patients. Of 12 children with Crohn's disease, granuloma was found in 5, aphthous ulcerations in 8, cobble stone appearance in 8, skip area or asymmetric lesions in 6, transmural involvement in 7, and perianal fistula in 3. Among 10 children with ulcerative Colitis, there were crypt abscess in 8, granularity or friability in 10 and rectosigmoid ulcerations with purulent exudate in 8 children. The main sites of involvement in children with Crohn's disease were both the small and large bowels in 7 (58%), small bowel only in 2 (16%), and colon only in 3 (25%). Terminal ileum involvement was seen in 75% of Crohn's disease cases. The main sites of involvement in children with ulcerative colitis were total colon in 4 (40%), up to the splenic flexure in 2 (20%), rectosigmoid in 3 (30%) and rectum only in one (10%). Medical treatment including sulfasalazine, and systemic or topical steroid was administered initially in most patients. Seven of 12 patients with Crohn's disease and 2 of 10 patients with ulcerative colitis were operated on.(ABSTRACT TRUNCATED AT 400 WORDS)


Modification of adriamycin-induced cytotoxicity by recombinant human interferon-gamma and/or verapamil in human stomach cancer cells. Recombinant human-interferon-gamma (rH-IFN-gamma) and verapamil (VRP), either alone or in combination, were evaluated in MTT assay for their modification effects on adriamycin-induced cytotoxicity against MKN-45, human stomach adenocarcinoma cells. VRP as a single agent did not inhibit the survival of MKN-45 at doses of up to 5.0 micrograms/ml. The survival of MKN-45 was inhibited by rH-IFN-gamma dose-dependently and further inhibited by the addition of VRP. However, the maximum growth inhibition of MKN-45 in any combination treatment with rH-IFN-gamma and VRP was less than 50% except in the highest concentration combinations (% survival: 47.9% at 10(4) U/ml of rH-IFN-gamma and 3.0 micrograms/ml of VRP). Adriamycin caused a concentration-dependent cytotoxicity and its cytotoxicity was significantly enhanced by the addition of rH-IFN-gamma and further enhanced by the combined use of rH-IFN-gamma and VRP. The modification effects of rH-IFN-gamma and VRP on adriamycin-induced cytotoxicity were evaluated in terms of modification index (MI), demonstrating that rH-IFN-gamma significantly increased in adriamycin-induced cytotoxicity and that the combined use of rH-IFN-gamma and VRP enhanced the adriamycin-induced cytotoxicity to a greater extent than did rH-IFN-gamma alone: MI values at 10(2) U/ml and 10(3) U/ml of rH-IFN-gamma were 1.7 and 3.1, respectively; those at 1.5 micrograms/ml and 3.0 micrograms/ml of VRP in the presence of 10(3) U/ml of rH-IFN-gamma were 4.4 and 6.0, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Nosocomial pneumonia in medico-surgical intensive care unit. Cases of hospital acquired pneumonia occurring during the 1st 12 months of Medico-Surgical ICU (Intensive care unit, MSICU) in operation were evaluated retrospectively to determine its incidence, common causative pathogens, outcome and radiological patterns with the new hospital setting providing a unique relatively aseptic environment. Among the 920 admitted patients, 73 episodes of nosocomial pneumonia on 63 patients were identified and the incidence rate was 7%. The most common pathogens were Pseudomonas. Staphylococcus, Serratia, and Enterobacter in the order of frequency of occurrence, and the gram-negative pathogens comprised 70%. Nosocomial pneumonia was more common after use of antibiotics due to such pathogens as Enterobacter, Acinetobacter, and Candida which caused poor outcome. Enterobacter had the greatest tendency to be related with poor outcome and Serratia the least. Overall mortality was 25%. Bronchopneumonia was the most common type of pneumonia caused by any pathogen except Acinetobacter which caused a mixed type of nosocomial pneumonia.


MR imaging of the internal carotid artery in ischemic cerebrovascular disorders--clinical and angiographic correlation. This study was intended to correlate the appearance of the cavernous segment of the carotid artery on MR images with the presence of significant stenosis or occlusion of the cervical carotid artery as seen on angiograms in 37 patients with cerebrovascular disorders who had brain MRI and arteriography. Three patients demonstrated an isointense signal within the carotid artery's cavernous segment, correlating with complete carotid occlusion as seen angiographically. Ten patients had variable signal intensity and/or luminal narrowing in the carotid siphon; seven of these findings correlated with angiographic evidence of carotid occlusion, while carotid branch occlusion was seen angiographically in the other three. The demonstration of normal signal void within a normal-appearing cavernous segment of the internal carotid artery in the remaining 24 patients correlated with an absence of significant stenosis within the cervical segment in 21 patients. In the remaining three, significant disease of the internal carotid artery was found. Isointensity or luminal irregularity within the intracranial carotid artery can indicate complete occlusion or slow flow. The presence of normal flow void in the intracranial segment does not exclude significant abnormality of the cervical segment of the carotid artery.


Pediatric gastric volvulus--experience with 7 cases. Gastric volvulus, organoaxial or mesenterioaxial, is a rare condition in infancy and childhood. We experienced 7 cases of pediatric gastric volvulus, consisting of 3 cases of secondary gastric volvulus due to left diaphragmatic eventration or paraesophageal hernia and 4 cases of idiopathic gastric volvulus. Of 7 cases, five were organoaxial in type and two were mesenterioaxial. The main symptoms of secondary gastric volvulus were vomiting and respiratory difficulty whereas those of idiopathic gastric volvulus were abdominal distension and weight loss with or without failure to thrive. It may be suspected on plain abdominal radiographs and usually confirmed by upper gastrointestinal series. Upper gastrointestinal series in organaxial volvulus demonstrated characteristic findings such as reversal of the greater and lesser curvatures and two air-fluid levels. In mesenterioaxial volvulus, the stomach was rotated into inverted position with pyloroantral obstruction showing a beak appearance. The three patients with secondary volvulus underwent repair of associated defect with or without gastropexy and the 3 patients with idiopathic volvulus underwent anterior gastropexy or gastrostomy. In those with idiopathic gastric volvulus, there was no obvious cause such as laxity of the perigastric ligaments. The operative results were satisfactory except for the three patients with idiopathic gastric volvulus whose abdomen remained distended regardless of weight gain.


'Pauci-immune' rapidly progressive glomerulonephritis associated with systemic vasculitis. 'Pauci-immune' glomerulonephritis has been recognized as an important cause of rapidly progressive glomerulonephritis. The paucity of immune deposits can be separated from the other two major immunohistologic variants of crescentic glomerulonephritis, ie, antiglomerular basement membrane (GBM) antibody-mediated and immune complex-mediated glomerulonephritis. Here we describe the case of a 42-year-old woman with pauci-immune' glomerulonephritis and vasculitis presenting as rapidly progressive renal failure with characteristic pathologic and immunohistologic findings. And in this case, despite oliguria and rapid deterioration of renal function, the renal function recovered partially and continued to be stabilized with a favourable response to hemodialysis and combined system immunosuppressive therapy.


Primary non-Hodgkin's malignant lymphoma of the vulva--a case report. A case of primary non-Hodgkin's malignant lymphoma of the vulva which occurred in a 68-year-old woman is presented. Non-Hodgkin's malignant lymphoma is infrequently involved in the female genital tract. Moreover, primary vulvar involvement of this tumor is very rare. To date only 6 cases have been reported in the literature. To our knowledge this is the first reported case of a non-Hodgkin's malignant lymphoma of the vulva in Korea.


Swimming headache followed by exertional and coital headaches. Seven patients who developed a similar headache syndrome are described. They first developed severe, exploding headaches while swimming, and subsequently experienced less severe headaches during physical exertion. They also developed headaches during sexual activity, which were similar to the previous headaches brought on by swimming. Majority of them were women in their thirties or forties. These symptoms were gradually subsided with or without medication after several weeks or months. The possible pathogenesis of this headache syndrome is discussed.


Microphthalmos with cyst--case presentation. The author has experienced a case of microphthalmos with large orbital cyst in a 4 months old female, that was found at the time of birth. To facilitate fitting a cosmetic prosthesis, the microphthalmos with cyst was removed surgically. On serial section I could find an area of discontinuation of the sclera that was suspected to be the defective closure of the embryonic cleft. Some aberrant retinal tissue was found in the wall of the cyst, and markedly disorganized ocular tissue forming a tumor-like mass filled the microphthalmic eyeball. In view of these histopathologic findings I could draw the conclusion that developmental failure of the embryonic eyeball and consequential proliferation of the embryonic neuroepithelial cells occurred at an early developmental stage causing the formation of microphthalmos with cyst.


Autoimmune oophoritis--a case report.

Autoimmune oophoritis--a case report. A case is described of an autoimmune oophoritis that was diagnosed unexpectedly after a hysterectomy and bilateral salpingo-oophorectomy had been performed on the suspicion of ovarian cysts. The patient was a 43-year-old multiparous woman who presented with vaginal bleeding and lower abdominal pain which she had had for one month. Grossly, the ovaries were enlarged and multicystic. The cysts measured up to 3.0 cm. The major histological change was a lymphoplasmacytic infiltrate in close relation to the theca interna of developing, cystic and atretic follicles, but sparing the primordial follicles. The infiltrate increased in density with the follicular maturation and culminated against the corpus luteum. With involution of the developing follicles, the inflammatory infiltrate subsided to some extent. The proportion of the plasma cells increased with the density of the infiltrates. Immunohistochemical study of the ovarian mononuclear cell infiltrate revealed a mixture of B- and T-lymphocytes. The plasma cells were polyclonal. These histological features of the present case are typical of autoimmune oophoritis although the presence of autoantibodies and hormonal level in the patient's serum were unknown. This case may be identified as in the early active stage of autoimmune oophoritis.


Spinal epidural granulocytic sarcoma preceding acute myelogenous leukemia. A rare case of spinal epidural granulocytic sarcoma (GS) preceding acute myelogenous leukemia is described. A 10-year-old boy presented with lower leg weakness. The initial diagnosis was a histiocytic lymphoma, and he was treated accordingly. No evidence of bone marrow involvement was found at that time. The correct diagnosis of epidural GS was made possible in retrospect by using immunoperoxidase staining for lysozyme fourteen months later when the patient showed the full-blown features of leukemia. This rare tumor should be considered in the differential diagnosis of an epidural mass with cord compression in patients with or even without acute leukemia, because early diagnosis followed by appropriate combined chemotherapy and radiation may obviate surgical intervention and eventually prevent leukemic transformation.


Antibodies as molecular probes in neurobiology. Identification of chemically defined neurons and synapses in tissues and tissue cultures. Immunocytochemical localization of 5-hydroxytryptamine (5-HT) in the nervous system and aggregate tissue cultures was performed employing an antibody to 6-OH-1,2,3,4-tetrahydro-beta-carboline. A number of immunochemical and biochemical tests with the antigen and the antibody and some procedural changes in the methodology applied for immunolocalization revealed the anti-5-HT-like affinity of the antibody, if applied in paraformaldehyde-fixed tissues. Studies in the hypothalamus, striatum, brainstem, spinal cord, and pineal gland show the complexities of the serotoninergic system. Ultrastructural immunocytochemistry with the preembedding technique reveals that 5-HT synapses are of the asymmetric type. The presynaptic element contains clear, round, small vesicles, with some large dense-core vesicles. The contacts are made with the somata and primary, secondary dendrites or with spines of non-5-HT neurons. Presynaptic dendrites are found in the n. raphe dorsalis, contacting non-5-HT dendrites. Double immunocytochemical methods demonstrated contacts of 5-HT fibers on enkephalin containing neurons of the spinal trigeminal nucleus and on somatostatin containing neurons of the medullary reticular formation. In vitro studies of cultured mesencephalic neurons were performed with the method of aggregating cultures. Such development of a miniature organized nerve tissue was followed up to 35 d in culture. Organization of the neuropil and synaptogenesis was studied using standard electron microscopy. The differentiation of neurons and astrocytes was studied using antibodies to 5-HT and GFAP. Serotonin immunoreactivity could be observed in neuronal bodies and processes at light microscope level as early as the fourth day of culture.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparative biochemical pharmacology of central nervous system dopamine D1 and D2 receptors. The biochemical properties of central nervous system (CNS) dopamine (DA) D1 and D2 receptors were examined using the specific antagonists [3H]SCH23390 and [3H]raclopride, respectively. There is a different participation of sulfhydryl (-SH) and disulfide (-SS-) groups in the binding site and/or coupling to second messenger systems of D1 and D2 receptors. The ionic studies with [3H]SCH23390 showed slight agonist and antagonist affinity shifts for the D1 receptor. On the other hand, the D2 receptor is very sensitive to cations; even if lithium and sodium influence specific [3H]raclopride binding in a similar manner, there appear to be quantitative differences between these two ions that cannot be explained by surface charge mechanisms. The distribution of D1 and D2 receptors was heterogenous in both species, with the greatest densities in the neostriatum, where the highest concentrations of DA and metabolites were measured. Regions with low endogenous DA content (cerebral cortex and hippocampus) had lower densities of DA receptors. Furthermore, these binding sites were differentially localized within the various regions, and there were substantially more D1 than D2 receptors. The functional significance and heterogeneities in the distribution of D1 and D2 receptors can be related to dopaminergic innervation and turnover.


Trophic factor effects on cholinergic innervation in the cerebral cortex of the adult rat brain. The cholinergic pathway ascending from the nucleus basalis magnocellularis (NBM) to the cortex has been implicated in several important higher brain functions such as learning and memory. Following infarction of the frontoparietal cortical area in the rat, a retrograde atrophy of cholinergic cell bodies and fiber networks occurs in the basalocortical cholinergic system. We have observed that neuronal atrophy in the NBM induced by this lesion can be prevented by intracerebroventricular administration of exogenous nerve growth factor (NGF) or the monosialoganglioside GM1. In addition, these agents can upregulate levels of cortical choline acetyltransferase (ChAT) activity in the remaining cortex adjacent to the lesion site. Furthermore, an enhancement in cortical high-affinity 3H-choline uptake and a sustained in vivo release of cortical acetylcholine (ACh) after K+ stimulation are also observed after the application of neurotrophic agents. Moreover, these biochemical changes in the cortex are accompanied by an anatomical remodeling of cortical ChAT-immunoreactive fibers and their synaptic boutons.


Structural and functional crosstalk between acetylcholine receptor and its membrane environment. Nicotinic acetylcholine receptor (AChR) is a transmembrane protein belonging to the superfamily of rapid, ligand-operated channels. Theoretical models based on thermodynamic criteria assign portions of the polypeptide chains to the lipid bilayer region. From an experimental point of view, however, the relationship between the two moieties remains largely unexplored. Current studies from our laboratory are aimed at defining the structural, dynamic, and functional relationship between membrane lipids and AChR. We are particularly interested in establishing the characteristics of and differences between the lipids in each leaflet of the bilayer and the belt or "annular" lipids immediately surrounding AChR and the bulk bilayer lipids. We are also interested in determining the possible implications of lipid modifications on AChR channel properties. Toward these ends, fluorescence and other spectroscopic techniques, together with biochemical analyses and patch-clamp studies, are currently being undertaken. Correlations can be established between structural aspects of phospholipid packing in the immediate perimeter of AChR and other properties of these annular lipids revealed by dynamic spectroscopic and molecular modeling techniques. Lipid compositional analyses of the clonal muscle cell line BC3H-1 and chemical modification studies have been carried out by incubation of intact cells in culture and of membrane patches excised therefrom with liposomes of different lipid composition. These studies have been combined with electrophysiological measurements using the patch-clamp technique, with the aim of determining the possible effects of lipids on the channel properties of muscle-type AChR. A variety of experimental conditions, involving polar head and fatty acyl chain substitution of phospholipids and cholesterol incorporation, are being assayed in the BC3H-1 cells.


Comparative effects of nitrendipine and hydrochlorothiazide on calciotropic hormones and bone density in hypertensive patients. The effects of the calcium antagonist nitrendipine and the diuretic hydrochlorothiazide on plasma calciotropic hormone concentrations and lumbar bone density were compared during the treatment of hypertension in a randomized, double-blind, 8 week parallel study, followed by a 52 week open label study. There were 32 subjects with stable essential hypertension (sitting diastolic blood pressure > or = 95 mm Hg and < or = 115 mm Hg without medication) without evidence of renal insufficiency or active heart disease. They were randomly assigned to receive either 10 mg nitrendipine twice daily or 50 mg hydrochlorothiazide daily. In order to reach and maintain target blood pressure (diastolic blood pressure < or = 95 mm Hg) during the open label period, the nitrendipine dose was titrated up to 30 mg twice daily, and additional antihypertensive drugs, of differing classes, were added as necessary. Blood samples were analyzed for concentrations of calcium, parathyroid hormone, and calcitonin, and lumbar bone density was determined by dual photon absorptiometry, at the baseline and at 24 and 52 weeks of antihypertensive drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of ambulatory and clinic blood pressure and heart rate in older persons with isolated systolic hypertension. We compared the blood pressure (BP) measurements obtained with a random-zero sphygmomanometer and an ambulatory BP monitor in older persons with isolated systolic hypertension at one site of the multicenter, randomized, double-blind clinical trial, the Systolic Hypertension in the Elderly Program (SHEP) randomized clinical trial. The subjects were community-dwelling elderly participants with isolated systolic hypertension enrolled in the SHEP study and already receiving stable doses of double-blind medication (n = 35 for active treatment group; n = 32 for placebo group). We measured seated (clinic) BP obtained with a random-zero sphygmomamanometer, pulse rate, and BP and heart rate measurements obtained with an ambulatory BP monitor (average 24 h, daytime, and nighttime BP and heart rate). Across treatment groups clinic and ambulatory systolic BPs were not significantly different, but the placebo group had higher ambulatory, but not clinic, diastolic BPs. Within each treatment group (active treatment and placebo) there were no significant differences between clinic and average 24 h, daytime, or nighttime ambulatory systolic BPs. There were also no significant differences between clinic diastolic BP and average 24 h, daytime, or nighttime ambulatory diastolic BPs in the active treatment group, but in the placebo group average 24 h diastolic BP obtained by the ambulatory monitor was 4.6 mm Hg higher than clinic diastolic BP (P = .001). The average 24 h heart rate was 6 to 7 beats/min higher as measured by the ambulatory monitor compared to clinic pulse (P < .01). In the placebo group of this study, average 24 h ambulatory diastolic BPs were consistently higher than clinic diastolic BPs.(ABSTRACT TRUNCATED AT 250 WORDS)


In vivo and in vitro effects of isradipine on cytosolic Ca2+ concentration in erythrocytes from spontaneously hypertensive rats. Cytosolic Ca2+ concentration ([Ca2+]i) was investigated in erythrocytes from spontaneously hypertensive rats (SHR) and their normotensive controls (WKY), after an acute treatment with the Ca2+ antagonist isradipine. Blood samples were obtained from conscious rats and [Ca2+]i measured with fura-2. The [Ca2+]i was higher in SHR than in WKY erythrocytes (P < .05). Isradipine administration had no effect on WKY [Ca2+]i, but reduced that of SHR to WKY levels after 1 h. In vitro, isradipine dose-dependently decreased [Ca2+]i only in SHR (P = .006). The reduction by isradipine of the elevated [Ca2+]i in SHR suggests the presence of a greater dihydropyridine-sensitive Ca2+ influx in the SHR erythrocyte.


Decreased insulin-sensitive Ca2+ transport in cultured vascular smooth muscle cells from spontaneously hypertensive rats. To investigate the role of insulin on Ca2+ regulation of vascular smooth muscle cells (VSMC) in hypertension, the effect of insulin on Ca2+ transport and intracellular free calcium concentration ([Ca2+]i) was measured in cultured VSMC from spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). Insulin produced a substantial increase in 45Ca uptake as well as [Ca2+]i in quiescent cultured VSMC. The stimulatory effects of insulin were completely inhibited by diltiazem, and partially by H-7, TMB-8, and 5-N,N(hexamethylene)amiloride (HMA), but not by W-7 or trifluoroperazine. Insulin-sensitive 45Ca uptake of SHR VSMC was significantly smaller than that of WKY VSMC. Insulin-sensitive increase in [Ca2+]i of SHR VSMC was also smaller than that of WKY VSMC. It is concluded that insulin increases 45Ca uptake, leading to an increase in [Ca2+]i, presumably through the voltage-dependent Ca2+ channel, intracellular Ca2+ release, or protein kinase C mediated mechanisms in cultured VSMC. A blunted response of insulin-sensitive Ca2+ uptake and [Ca2+]i in SHR VSMC suggests the differential regulation of Ca2+ transport in response to insulin in primary hypertension.


Effect of amlodipine on mesangial cell proliferation and protein synthesis. Mesangial cells in the glomerulus have several important physiological functions, as has been demonstrated by past research. Platelet derived growth factor, thrombin, endothelin, and angiotensin II have all been shown to affect mesangial cell growth and protein synthesis. First generation Ca channel blockers also have a definite effect on mesangial cell proliferation. We investigated whether the effects of a second generation Ca channel blocker, amlodipine, were similar. Amlodipine was found to inhibit hyperplasia and hypertrophy in mesangial cells.


Leisure time physical activity and insulin resistance in young obese students with hypertension. To investigate the hypothesis that insulin resistance plays a role in the etiology of hypertension and hyperlipidemia, we measured serum lipid levels, the fasting glucose/insulin ratio, and the insulin response to oral glucose (GTT) in a group of young obese subjects (n = 21) with hypertension and normal glucose tolerance and in normotensive subjects (n = 36) with normal glucose tolerance, matched for age and body mass index. Leisure time physical activity was evaluated by a questionnaire outlining three levels of physical activities during leisure time. Subjects with hypertension had higher fasting serum insulin (19 +/- 2 v 13 +/- 1 microU/mL, P < .01) and lower fasting glucose/insulin ratio (5.3 +/- 0.2 v 7.1 +/- 0.5 mg/dL/microU/mL, P < .01) than normotensive subjects. Subjects with hypertension had higher peak serum insulin and lower plasma glucose area/insulin area ratio in response to glucose (1.8 +/- 0.2 v 2.4 +/- 0.2 mg/dL/microU/mL, P < .05) than normotensive subjects. Serum total cholesterol, low-density cholesterol, and triglycerides were higher in the obese hypertensive subjects than in obese normotensive ones. Blood pressure correlated with either fasting serum insulin, fasting glucose/insulin ratio, or glucose area/insulin area ratio during GTT. The level of leisure time physical activities was lower in obese hypertensive subjects than in obese normotensive ones. There were significant correlations between the levels of physical activity and the fasting plasma glucose/insulin ratio (r = 0.371, P < .01) or the fasting serum insulin concentration (r = -0.282, P < .05). The study provided evidence that a low level of leisure time physical activity is associated with insulin resistance and resultant hyperinsulinemia, which are the key metabolic abnormalities that link hypertension, obesity, and hyperlipidemia in young subjects.


Sustained hypertension in the rat induced by chronic blockade of nitric oxide production. It is well established that acute systemic blockage of L-arginine conversion to nitric oxide by NW-nitro-L-arginine methyl ester (L-NAME) and other substituted analogs of L-arginine produces vasoconstriction and elevates the blood pressure. The present study in rats reports that chronic L-NAME injections (185 mumol/L/kg body weight, intraperitoneally; every 12 h) for 4 days produces sustained arterial hypertension which is fully and rapidly reversed by acute administration of excess L-arginine. The magnitude of the hypertension is not different between L-NAME treated rats fed normal or high sodium diets. The results from this simple experimental model suggest that chronic blockade of nitric oxide synthesis results in sustained arterial hypertension that is not enhanced by sodium loading.


Opposite effects of rough and gentle handling with repeated saline administration on c-fos mRNA expression in the rat brain. The rough handling with repeated saline administration (1.2 ml/kg s.c. for 7 days) enhanced cortical c-fos mRNA expression in the rat brain after a single saline stimulation (1.2 ml/kg s.c.) due to increasing baseline c-fos mRNA levels, whereas the gentle handling with repeated saline administration declined c-fos mRNA expression after a single injection due to decreasing the baseline of c-fos mRNA levels. These two types of handling with the repeated injection led to diametrically opposite results on c-fos mRNA expression after a single stimulation. Neither two types of handling with repeated saline injections affected the net increment of c-fos mRNA induction after a single stimulation, therefore, the effects of handling with repeated treatment on c-fos mRNA expression might be independent of the effects of a single saline stimulation. The present study suggests that c-fos mRNA induction after a single stimulation might be affected by the types or intensities of handling and that care must be taken to estimate c-fos mRNA induction.


Muscarinic cholinergic receptor-mediated modulation on striatal c-fos mRNA expression induced by levodopa in rat brain. To clarify the interactions between dopamine receptors and muscarinic cholinergic receptors by which neurotransmitters may affect genetic responses, we studied the effects of the muscarinic cholinergic agonist, carbachol, and the muscarinic cholinergic antagonist, trihexyphenidyl, on levodopa-induced c-fos messenger RNA (mRNA) expression in rat striatum. Animals were administered levodopa (levodopa with one-tenth dosage of carbidopa), carbachol or thrihexyphenidyl alone or administered in combination as levodopa (100 mg/kg) + carbachol, or levodopa+trihexyphenidyl given as a single bolus. Levodopa given alone increase the expression of c-fos mRNA. Although carbachol or trihexyphenidyl alone was ineffective in inducing c-fos mRNA, the combination of levodopa and carbachol (> or = to 0.1 mg/kg) significantly suppressed the induction of c-fos mRNA as compared with levodopa given alone. The combined administration of levodopa and trihexyphenidyl showed a trend toward an additive effect on the induction of c-fos mRNA vs levodopa alone. These findings suggest that the muscarinic cholinergic system may modulate the levodopa-induced c-fos mRNA expression which then regulates the expression of other mRNAs.


MK-801 induced stereotypies in rats are decreased by haloperidol and increased by diazepam. The effects of haloperidol and diazepam were investigated on stereotypies (wall contacts and turn rounds) induced by the non-competitive NMDA antagonist MK-801 in rats. Haloperidol (0.03, 0.10, 0.25 and 0.40 mg/kg body weight) caused a dose-dependent antagonism whereas diazepam (3.0 and 5.0 mg/kg) caused a dose-dependent agonism of the stereotypies induced by 0.30 mg/kg MK-801 (all drugs given intraperitoneal). Conversely, diazepam (5.0 mg/kg) given alone reduced significantly the number of spontaneous wall contacts and turn rounds. The paradoxial stimulation of MK-801 induced stereotypies by diazepam could be explained by a shift between positive and negative corticostriatothalamic feedback loops envolving GABAergic neurons in favour of the former.


Gamma-aminobutyrate aminotransferase activity in brains of schizophrenic patients. The activity of gamma-aminobutyrate aminotransferase (GABA-T) was estimated in twelve regions of brains from 22 control subjects and 6 cases with schizophrenia. In the controls, no significant correlation was found between the enzyme activity and age or postmortem interval (PMI) in any of the brain regions studied. In experiments on rat brains, the enzyme activity decreased about 20% during the first 2 hours of storage at room temperature and at 4 degrees C but remained steady thereafter. A similar initial decline in activity in the human brain material cannot be excluded. In the human brains, a slightly lower activity was found in the group below 75 years (n = 8) when compared with the group above 75 years (n = 8). A tendency to higher activities was found in female brains (n = 10) compared with male brains (n = 12). No significant difference in the enzyme activity was found between schizophrenic brains, in any of the regions studied, when compared to controls, matched for age, sex and PMI.


Coronariographic significance of heart rate variation related to ischemic episodes in patients undergoing peripheral vascular surgery. To evaluate the characteristics of myocardial ischemia during daily life and their coronariographic significance in a group of patients with proven coronary artery disease undergoing peripheral vascular surgery. Department of Cardiology--Central Hospital--Lisbon. In 14 patients undergoing peripheral vascular surgery and in whom coronariography revealed coronary significative lesions, Holter monitoring was performed during a 24-hour period. Two groups of ischemic episodes were considered: Group A constituted by 44 episodes detected in patients with left main or three vessel disease and group B by 12 episodes detected in patients with one ot two vessel disease. In each group the ischemic parameters were studied. The incidence of myocardial ischemia was 64%. Statistically significant differences were observed between group A and B concerning the mean heart rate variation from two minutes before the onset of ST-segment depression to its onset (2.39 bpm vs 8.75 bpm; p < 0.05), from the onset of ST-segment depression to its maximal depression (4.43 bpm vs 16.67 bpm; p < 0.001) and from two minutes before St-segment depression to its maximal depression (6.82 bpm vs 25.4 bpm; p < 0.00001). No differences were found in duration and maximal ST-segment depression. Particular characteristics of heart rate variation related to the ischemic episodes seem to have a relation with the severity of coronary artery disease in patients undergoing peripheral vascular surgery.


Late arrhythmic events and patency of the infarct-related coronary artery in survivors of acute myocardial infarction. In the present study we evaluated the influence of intravenous thrombolysis and patency of the infarct-related coronary artery on both markers of ventricular electrical instability and incidence of late arrhythmic events after acute myocardial infarction (AMI). Ninety one patients surviving a first AMI who consecutively performed coronary angiography were enrolled in the present study; 44 patients (48%) received thrombolysis, 47 patients (52%) were treated conventionally. Of 91 patients, 90 (99%) had signal-averaged electrocardiogram (SAECG), and 40 (44%) programmed ventricular stimulation. No significant difference was observed between thrombolytic-treated and control group in late potential rate, SAECG determinants and ventricular arrhythmia inducibility. Of 91 patients, 40 (44%) had occlusion of the infarct-related artery: of these, 15 (37%) had late potentials compared with 5 of 51 patients (9%) with a patent artery (p < 0.01). Mean left ventricular ejection fraction was not significantly different between the two groups (0.50 +/- 0.15 vs 0.55 +/- 0.12; p = NS). No significant difference was present between the two groups of patients with regard to inducibility of sustained ventricular tachyarrhythmias, however an odds ratio of 3.5 was observed in the group with a closed vessel.(ABSTRACT TRUNCATED AT 250 WORDS)


[The use of diuretics in heart insufficiency in the elderly]. The kidney function alterations with age and on congestive heart failure, are reviewed as the pharmacocynetic and pharmacodynamic of the diuretics on old patients with this syndrome. The therapeutic importance of hiposodic diet was considered. The reasons for the susceptibility of old people to diuretics and the criteria for the choice of the diuretic on this age, are reviewed. So are the most important adverse effect of diuretics on old people and the contra-indication for the use of these drugs on elderly. The importance of hypocalaemia on old people and how to prevent or correct it are considered. The haemodynamic risks of an excessive diureses are reviewed. Finally, we propose some recommendations about the use of diuretics on the elderly.


[Two cases of endomyocardial fibrosis in Mozambique]. This essay describes two cases of Endomiocardial Fibrosis with right ventricular dominance studied in Mozambique. The clinical, radiological, echocardiographic and patological findings are in accordance with other descriptions of same disease, seen in others countries.


[A surgical technique for high aortic occlusions]. The authors analyze the technical aspects of aortic prosthesis in 37 patients with atherosclerotic, high occlusions of the aorta. The upper occlusion limit in this abnormality is shown to have two X-ray variants. Thoracophrenolumbotomy is considered to be the best access for proximal anastomosis in aortic prosthesis. The traditional operation technique for this abnormality has some disadvantages, the main limit of which is the necessity of shifting a patient from place to place for proximal and distal anastomoses. This makes the operation in these severe patients longer. The authors have proposed a novel procedure for aortic prosthesis by employing a special roller. The latter eliminates the necessity of shifting the patient from place to place during surgery, cuts surgical time by more than 2 hours, allows one to follow asepsis more carefully.


[The use of polytetrafluoroethylene vascular prostheses (Gore-Tex) for subclavian-pulmonary anastomosis in children with tetralogy of Fallot]. The paper provides the results of a modified subclavian pulmonary anastomosis by employing Gore-Tex vascular prostheses in 91 babies with Fallot's tetrad whose age was 10 days to 32 months and weight was 3.6 to 15 kg. In 89 patients, the operation was performed by using a prosthesis, 4-6 mm in diameter, without crossing the subclavian artery, whereas in 2 patients, this was done by lengthening the crossed short subclavian artery. In the early postoperative period, 2 (2.2%) patients died, anastomosis thrombosis requiring a reoperation, occurred in 3 (3.3%) patients; other non-fatal complications were observed in 8 (8.8%) patients. A clear-cut effect of the operation was seen in all patients. SaO2 rose from 54 +/- 18 to 80.0 +/- 8%. In the long-term (6-60 months) postoperative periods, a total of 77 patients were examined: anastomosis function proved to be impaired in 4 (5.2%), all the vascular prostheses, 6 mm in diameter, were patent up to 60 months of surgery. The thrombosis probability for anastomosis, 5 mm in diameter, was 5% during 12 months of operation and 16% during 24-60 months. Three patients needed therapeutical management of heart failure. Other serious complications, including deformity of the pulmonary artery or upper extremity, were not found in the examinees. In the palliative treatment of Fallot's tetrad, subclavian pulmonary anastomosis via the Gore-Tex vascular prosthesis can be the method of choice in the first-year-old infants and has some substantial advantages over the classical Blelock-Taussig anastomosis.


[Methods of plastic surgery of the renal arteries in children with vasorenal hypertension]. The work deals with the management of vasorenal hypertension in children and adolescents. The Bakulev Institute of Cardiovascular Surgery had 185 children with arterial hypertension from 1965 to 1990. Their ages ranged from 12 months to 17 years. The vasorenal genesis of hypertension was caused by fibromuscular dysplasia (FMD) of the renal arteries in 61 patients, unspecific aortoarteritis (UAA) in 39, hypoplasia of the abdominal aorta, kidneys, and renal arteries in 22 patients, supernumerary renal arteries were found in 7 patients. A total of 119 operations were carried out on 106 patients. Operations and one-stage revascularization of the kidneys and alimentary organs were performed on 22 patients, isolated reconstruction of the renal arteries on 51 patients. Among 99 patients with stenoses and aneurysms of the renal arteries 13 were treated by nephrectomy (11.3%). The postoperative mortality was 0.9%. A hypotensive effect was not produced in the immediate postoperative period in 5 patients with UAA (4.6%) and in one patient with, FMD (0.9%). Six operations were performed in late-term periods after the first operative interventions: 2 for aneurysm of autovenous grafts, 2 for restenosis of the renal arteries, and 2 for stenosis of the aorta distal to the primary site of reconstruction in UAA. Three patients died in the late-term periods. The stability of good operative results was highest in congenital hypoplasia of the aorta--100%. A favorable effect of the operation persists in 89.6% of patients with FMD of the renal arteries. The stability of the effect is lowest (75%) in UAA.


[The treatment of critical valvular stenosis of the pulmonary artery by the balloon valvuloplasty method in patients in the first 3 years of life]. The work generalizes the experience of the Bakulev Institute of Cardiovascular Surgery in balloon valvuloplasty of valvular pulmonary stenosis in 58 children of the first 3 years of life: 8 were 1 to 6 months of age, 10 were 7 to 12 months of age, 18 were 13 to 24 months old, and 22 were 25 to 36 months old. Cyanosis was found in 27 of them. As the result of balloon valvuloplasty, the systolic pressure gradient between the right ventricle and the pulmonary artery reduced from 114.7 +/- 12.6 to 31.4 +/- 7.2 mm Hg in children under 1 year of age, from 143 +/- 12.6 to 40.1 +/- 8.3 mm Hg in children aged from 1 to 3 years. In patients with cyanosis, saturation of arterial blood with oxygen increased to 92%. The late-term results were studied in follow-up periods of 6 to 36 months in 35 patients, by means of catheterization and angiocardiography in 15 of them. Analysis showed balloon valvuloplasty to be effective. Balloon valvuloplasty was repeated in 5 patients with critical stenosis because a hemodynamic effect was not achieved by the first dilatation.


[Cardiac abscesses].

[Cardiac abscesses]. The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived.


[Characteristics of the blood flow in the vertebral artery before and after the surgical treatment of the proximal segment of the subclavian artery]. The features of the blood flow in the vertebral artery were studied by ultrasonic dopplerography with functional test for reactive hyperemia in 52 patients. The authors claim this to be an objective screening method allowing the sequelae of occlusion of the vertebrosubclavian segment to be studied and providing information for establishing the diagnosis and appraising the efficacy of reconstructive operations.


[Schemes for implanting shovel pumps for assisted circulation]. The authors propose a design of an axial shovel pump for extracorporeal circulation. They show how to introduce it into various cardiovascular segments and make a comparative assessment of its efficacy in relation to the type and severity of heart failure, surgical access, and treatment policy.


[Age and dyslipidemia as risk factors in transcutaneous transluminal angioplasty]. The paper outlines the analysis of immediate and late outcomes of transcutaneous transluminal angioplasty (TTA) in 147 patients with atherosclerosis obliterans of the lower extremities. The study has revealed that age and dyslipidemia as TTA risk factors fail to affect the immediate outcomes in the early postoperative period. There is a positive correlation of the reocclusion time after TTA and the age and lipid metabolic disturbances in patients with atherosclerosis obliterans of the lower extremities in long-term periods. The paper provides strong evidence for that it is essential to correct dyslipidemias in order to make TTA results better in these patients.


[A comparative evaluation of myocardial protection based on criteria not associated with the quality of myocardial conservation]. Based on the rich clinical material (405 patients), the authors have assessed the most common blood and crystalloid cardioplegic techniques by applying the criteria which do not apply to those of myocardial protection adequacy. Differences have been found between the methods in the volumes of blood loss, the number of patients operated on without utilizing donor blood, terms of aortic occlusion at one-stage operative interventions, recovery of cardiac performance after aortic occlusion. The differences found are essential in choosing the type of cardioplegia by taking into account the individual traits of each surgical intervention and an operating surgeon's opinions.


[Surgical tactics in pleural empyema with regard to the use of a carbon dioxide laser and argon plasma]. The authors analyze the experience gained in treating 30 patients with acute and 23 with chronic pleural empyema. The management policy identified the following points. Laser thoracoscopic necrectomy and empyemic cavity sanitation are indicated in acute destructive pulmonitis. A combination of temporary bronchial occlusion and laser treatment of the empyemic cavity and bronchopleural fistula should be performed after debridement of a destructive pulmonitis area from necrotic tissues. Radical treatment of chronic pleural empyema should be better conducted in the early periods by employing a plasma scalpel at all the stages of surgical intervention for hemostasis, aerostasis and sterilization of the operation field.


[Parasternal mediastino-pleuroscopy in the diagnosis of diffuse lesions of the lungs]. A procedure for parasternal mediastinopleuroscopy (PMS) has been proposed for biopsy of pulmonary tissue and intrasternal lymph nodes. A surgical technique of intervention is described in the paper. PMS was performed in 81 patients with diffuse lesions of the lungs and the disease was morphologically verified. The clinical and X-ray diagnosis was found to be incoincident with their final morphological diagnosis after PMS had been performed in 48 out of 81 patients. To obtain an informative biopsy specimen needed for a morphological diagnosis, biopsies of the lung and lymph nodes should be taken in all cases. Complications occurred in 2 patients. These included bleedings from the intercostal arteries, which required vascular ligation.


[Diagnosis and treatment of complex closed chest injuries]. The results of treatment of 256 patients with complicated closed chest injury are discussed. Multiple fractures of the ribs were found in 178, closed pneumothorax in 127, pneumohemothorax in 71, isolated hemothorax in 55, and rupture of the diaphragm in 3 patients. Most patients received nonoperative treatment, 5 patients (6.1%) needed emergency thoracotomy. Early drainage of the pleural cavity, endoscopic (thoracoscopy, bronchoscopy) methods of treatment, mechanical stabilization of floating rib fractures made it possible to improve the results and reduce the terms of treatment. Two (0.8%) persons died from shock and cardiopulmonary insufficiency.


[Emergency repeated operations for lung cancer]. A total of 43 patients with surgical complications developed after planned surgeries for cancer of the lung were followed up in the Thoracal Oncological Clinic, Cancer. Research Center, Russian Academy of Medical Sciences, in 1981-1990. Emergency repeated operations for complications were performed in 23 (53.4%) of them. Bronchial suture insufficiency after various pulmonary resections occurs in 2.4% of cases in 25 out of 1030 patients). Intrapleural hemorrhages after resection of the lung result from technical errors of a surgeon during mobilization of the lung or lymphadenectomy (in 10 out of 14) and they are infrequent during treatment of pulmonary or lobal blood vessels (in 4 out of 14). Impaired seal of lung parenchymal sutures, which needs active surgical policy, was seen in 2 out of 1030 patients with lung resection. Our clinical material shows that chylothorax as a complication of pulmonectomy is associated with a rare left-sided location of the thoracic lymph duct. In pulmonary cancer, active surgical policy has advantages over conservative therapy: the mortality was 8.0% (2 out of 25) and 25.9% (7 out of 27), respectively. Conservative therapy of patients with bronchial suture insufficiency is preferable after pulmonectomy. Emergency repeated operations in the early period are preferable in these complication after pulmonectomy.


[The invasion of a tumor into the bronchial wall in central cancer of the lung]. The paper analyzes histological findings of a number of bronchial sections made proximal the visible margins of a tumor in 54 patients operated on for central cancer of the lung. In coincidence of micro- and macroscopic limits of the extension of tumor cells was revealed in 29 (53.7%) patients. Statistical analysis revealed that the extension of tumor invasion obeys the exponential law of distribution. Probability of detecting tumor cells at various distances from the visible margin of the tumor was found. The findings suggest that one may predict that tumor cells can remain in the bronchial stump depending on the level of its elimination.


[Buchwald's operation in the surgery of atherosclerosis obliterans]. Analyzing the world's experience in the surgical management of hyperlipidemias and their own results, the authors make an assessment of Buchwald's operation used in the surgery for atherosclerosis obliterans. The major disadvantage of partial ileac bypass is that there is no prognosis of the operation and its complication. Based on the pathophysiological mechanisms of implementation of Buchwald's operation, the authors have developed a mode of pharmacological simulation of a partial bypass which allows one to predict the effect of the impending intervention and to avoid unjustified operations. The unique procedure also enables the indications for simultaneous interventions to be defined. Ten partial ileac bypass surgeries made by the authors are comprehensively analyzed. Taking into account, the authors propose to choose a treatment of patients with hyperlipidemia and atherosclerosis on an individual basis and to do away with the routine indications for partial ileac bypass surgery.


[Annuloplasty of the tricuspid valve with a controllable semi-ring under the control of transesophageal echocardiography]. The paper analyzes the first clinical experience with a novel procedure of tricuspid annuloplasty with a controllable semiring under the control of transesophageal echocardiography in 6 patients with tricuspid dysfunction and those with mitral and tricuspid valvular diseases. The application of intraoperative transesophageal echocardiography makes it possible to control both the degree of mitral regurgitation and the severity of right atrioventricular stenosis. This echocardiography may serve a method for plastic correction of the tricuspid valve.


[Benign brainstem encephalopathy with truncal ataxia--a clinical study of 3 cases]. Three cases (case 1, female, aged 30; case 2, male, aged 32; case 3, male, aged 34) of benign brainstem encephalopathy with truncal ataxia were reported. Two patients had prodromal symptoms Neurological examination revealed truncal ataxia in all cases. As additional neurological signs, anisocoria, mydriasis, nystagmus, ptosis, transient opsoclonus, and facial palsy were seen. There was neither drowsiness nor myoclonus in the three cases. On laboratory examinations, cold agglutination test revealed significant elevation in two cases. The examination of cerebrospinal fluid showed a moderate rise of proteins in one case, but did not revealed pleocytosis in any of the cases. Magnetic resonance imaging of one patient revealed an area of high intensity in the left pontine tegmentum by T2-weighed imaging. The prognosis for all these cases was good, and the reappearance of neurological signs was not present until now. Our cases were different from brainstem encephalitis (Bickerstaff's encephalitis) because of an absence of disturbed consciousness and no pleocytosis in the cerebrospinal fluid. Our cases were also different from "myoclonus-opsoclonus syndrome" because of an absence of myoclonus. We discussed a possibility of a new clinical syndrome which we call "benign brainstem encephalopathy with truncal ataxia".


[High-field-strength magnetic resonance imaging and SPECT of multiple system atrophy]. Two cases of multiple system atrophy (MSA) showing similar abnormalities by magnetic resonance (MR) imaging and SPECT are reported. The clinical diagnoses of the two cases were striatonigral degeneration (SND) and sporadic olivopontocerebellar atrophy (OPCA). In addition, one case of sporadic OPCA without parkinsonism was used for comparison. The MR images were obtained using a 1.5-T MR system and included spin-echo transverse sections with T1-weighted images (TR = 450 ms and TE = 15 ms) and T2-weighted images (TR = 2500 ms and TE = 90 ms). The T1-weighted images demonstrated atrophy of cerebellum and pons, with increased signal intensity in the bilateral putamen. The T2-weighted images demonstrated decreased signal intensity in the putamen, as reported recently. SPECT demonstrated reduced uptake in the celleberum, basal ganglia and frontal lobe cortex. The putaminal changes evident on T1-weighted images may have resulted from deposition of pigments such as neuromelanin and lipofuscin, related to parkinsonism. Both T1- and T2-weighted MRI seem to be useful clinical diagnosis of MSA.


[Pathogenesis of hyponatremia observed in the treatment of acute subarachnoid hemorrhage]. The cause of hyponatremia following subarachnoid hemorrhage (SAH) has been understood as an inappropriate secretion of antidiuretic hormone (SIADH). Whereas, water restriction for the management of this condition sometimes induces a severe dehydration, resulting in vasospasm. To clarify the pathogenesis of hyponatremia following SAH, we measured the daily sodium and water balance with the plasma concentration of atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), and plasma renin activity (PRA) in seventeen cases after subarachnoid hemorrhage. Although the patients received an adequate amount of fluid (more than 4080ml/day; daily average in seventeen cases) and sodium (more than 277 mEq/day; daily average in seventeen cases), eight out of the seventeen cases showed transient hyponatremia of a slight degree beginning on 8.8 days after SAH. ANP values were elevated markedly in fifteen out of the seventeen cases, remaining high during the first two weeks following SAH. ADH values were elevated remarkably in eight out of the seventeen cases. However, these values declined immediately to a normal range within two days following SAH. PRA were increased or came within the normal range, suggesting the lack of water retention. Overall sodium balance and water balance did not differ significantly between hyponatremia cases and normonatremia ones, whereas, sodium balance in acute phase was significantly negative, associated with marked natriuresis in patients with hyponatremia. These correlations suggested that hyponatremia after SAH is the result of natriuresis by an increased ANP rather than ADH. In conclusion, a greater replenishment of water and sodium is required to avoid hyponatremia with dehydration. This technique may be helpful for the prevention of vasospasms following SAH.


[A case of steroid psychosis associated with betamethasone]. Psychotic side effects of steroids have been observed at relatively high frequency if mild cases, such as euphoria, are included, while it has been said that incidences differ among kinds of steroids. We reported a case developing severe schizophrenia-like symptoms following the treatment with betamethasone although this drug is believed to be rarely involved in steroid-induced psychosis, and its psychotic side effects have been rarely reported. When betamethasone was administered for progressive peripheral facial paralysis at a mean daily dose of 7mg, psychotic symptoms appeared from the 15th treatment day. Psychosis began with interrupted appearance of excitation, autism, and misanthropia. Although the steroid was gradually decreased in dose because of abatement of facial paralysis, not only psychotic symptoms were aggravated, but also appeared hallucination. Thus the steroid was withdrawn before the scheduled date while its dose was gradually decreased, and haloperidol was administered. Psychotic symptoms were gradually eliminated and completely disappeared about 40 days after onset.


[Acoustic neurinoma associated with facial neurinoma--a case report]. A 38-year-old man developing slowly progressive left facial paresis was admitted to our hospital. The clinical diagnosis of "adhesive arachnoiditis was made. The first operation was performed in December 1987, and his symptom disappeared postoperatively. Three years later, left facial paresis recurred together with trunkal ataxia. A computed tomography and magnetic resonance image revealed two tumors located at the left cerebellopontine angle region and in the left middle cerebral fossa. These two tumors were thought to arise in the different cranial nerve. Under the clinical diagnosis of acoustic neurinoma associated with facial nerve neurinoma, the two step-operation was designed for total removal of the tumor in December 1990 and January 1991. Intraoperative finding confirmed that these two tumors had the different origin. Pathologic diagnosis was compatible with neurinoma. This patient had no family history of "Neurofibromatosis".


[A case of Castleman's disease with a variable neuropsychiatric symptomatology]. A case of 44-year-old woman who had shown psychiatric symptoms before and during the course of Castlemans' disease was presented. For four years, she first suffered from a paranoid-hallucinatory state and then a depressive one episodically. In the course of the latter, severe anemia developed. She was diagnosed as Castleman's disease, because the increased serum level of gamma-globulin and interleukin-6 (IL-6), and multiple lymphomata were evidenced. A paranoid-hallucinatory state relapsed about one year later from this episode. At last, some bulbar and cerebellar symptoms, and a delirium suddenly occurred. The ischemic changes at the level of the pons and midbrain were revealed by the magnetic resonance imaging (MRI) examination. It is certainly that both neurological and psychiatric symptoms were related to the lesions. This ischemic lesions may have resulted from the anoxia secondary to the severe anemia and/or hyperviscosity syndrome in the disease. On the other hand, the increased serum level of IL-6 as well as the ischemic lesions might have caused psychiatric symptoms in this case, as the interferone which is one of the analogues of IL-6, is known to induce emotional and behavioral symptoms.


[A case of malignant melanoma with orbital metastasis which caused the first symptoms]. A thirty-four-year-old man was admitted to our hospital because of the disturbed visual acuity and pain on the eye movement of the right eye. He had prominent right eye and CT-scan and MRI of the brain disclosed a tumor which could be obviously distinguished from the extraocular muscles, optic nerve and the bulb of eye in the retrobulbar region. On operation we identified dark-red solid tumor which was 3.0cm in diameter, and diagnosed it malignant melanoma pathologically. Because postoperative study detected amelanotic melanoma in the white patch on the right upper extremity, this right orbital tumor was considered to be the metastasis of it from the right upper extremity. Metastatic malignant melanoma of the skin to the orbit is very rare, while most of the eye-associated malignant melanoma originates from uveal tract, special choroid, and conjunctiva. This case was the 26th case of these in the world and the first case in Japan, furthermore the 4th case in the world whose first symptoms were caused by the orbital metastasis.


[Brainstem glioma with supratentorial meningeal dissemination--a case report]. We present a very rare case of 7 year-old-girl who had a pontine glioma with supratentorial meningeal involvement. She complained severe headache with meningeal irritation. She showed fluctuating cranial nerve impairment of the both abducens and glosopharyngeal nerves but no signs of weakness or facial paresis. She also reported two episodes of generalized convulsion with unconsciousness during admission. MRI disclosed a hypointensity intrinsic brainstem mass with an enhancing exophytic component in the prepontine cistern and a sharp contrast uptake is disclosed in the left-meninges of the supratentrial structures. An open biopsy was performed and diagnosed as a high grade astrocytoma.


Dermatology Nursing Standards of Clinical Nursing Practice: ensuring a level of competency. Nursing can take charge of its professional practice by setting standards of clinical practice based on nursing expertise. Standards of Dermatology Clinical Nursing Practice can ensure competency and improve the quality of clinical care and consumer decision making.


Dermatology Nursing Standards of Clinical Nursing Practice: what does it mean to our professional practice? Standards of care and professional performance are the backbone of dermatology nursing practice as well as the basis for professional growth and development. The goal of developing Dermatology Nursing Standards of Clinical Nursing Practice is to gain formal recognition for the practice of dermatology nursing.


Management of rosacea.

Management of rosacea. Rosacea is a skin dysfunction affecting a large number of individuals. The cause is unknown and there is no known cure. Once the condition is recognized, however, much can be done to reduce the extent and impact of this disease.


The drug research process.

The drug research process. The Department of Dermatology at the Washington Hospital Center conducts research on drugs and products for various drug companies prior to their approval by the Food and Drug Administration. The purpose of this article is to describe this interesting and rewarding process which can give dermatology nurses the opportunity to assist patients who might not have found effective or affordable treatment for their condition.


Centriole modification in human aortic endothelial cells. The structure of centrioles in endothelial cells of embryonic (22-24 weeks old) and definitive (2, 14-17, and 30-40 years) human aorta in situ and also in aortic endothelial cells dividing in organ and cell cultures (donor age 30-40 years) was studied. It was found that in the endothelial cells from definitive aorta the lengths of mother centrioles vary from 0.5 to 2 microns, whereas the length of daughter centrioles remains constant (0.4-0.5 microns). The distal part of the cylinder of long mother centrioles consists of microtubule doublets. In aorta of donors 30-40 years old in multinucleated cells and in one of 30 single-nucleated cells analyzed, C-shaped long centrioles were seen. These centrioles exhibit a doublet organization along all their length. Mitotic cells in organ and cell culture had a nonequal structure of spindle poles: at one pole, the long mother centriole was seen, while at the other a mother centriole of standard size was found. In such cells of organ culture long centrioles make contact with the remnant of primary cilia until the end of anaphase. In cell culture mitotic cells are also observed containing C-shaped centrioles. In these cells the number of mother centrioles is odd and their number is not equal to the number of daughter centrioles. The possible mechanism for transformation of endothelial centrioles and its role in the control of cell-cycle progression are discussed.


Hydrogen bonding of iron-coordinated histidine in heme proteins. The hydrogen-bonding motifs of the proton on the N delta atom of iron-coordinated histidine residues in heme proteins have been classified into three categories: (1) Those in which the hydrogen-bond acceptor is either an amino acid residue (serine) directly adjacent to the histidine or a carbonyl group of the polypeptide chain less than five residues away from the histidine; (2) those in which the hydrogen-bonding acceptor is a carbonyl group of the polypeptide backbone associated with an amino acid residue 8 to 17 residues away from the histidine; and (3) those in which the hydrogen-bonding acceptor is an exogenous water molecule or an amino acid residue located far from the histidine in the amino acid sequence. Some biological functions are defined by this classification, whereas others span all classes.


The rigidity of bacterial flagellar filaments and its relation to filament polymorphism. We determined and correlated the rigidity of Salmonella typhimurium, Escherichia coli, and Rhizobium lupini flagellar filaments representing various structural and polymorphic states (plain, complex, straight, superhelical, and right- and left-handed). Persistence length, from which the filament's rigidity and other parameters (Young's modulus, bending force constant, buckling persistence length, flexural deformation, and flexural time) were derived, was determined from electron micrographs of isolated, negatively stained filaments. Outer diameters and radii of strong intersubunit connectivity were determined from three-dimensional image reconstructions and radial mass density profiles from scanning transmission electron microscopy. All filaments appear to be highly rigid with no evident correlation with their helical sense or superhelicity. The complex filament of R. lupini is rigid to the extent that it becomes brittle. The overall flexibility of the flagellum seems to stem mainly from the hook and not from the filament. Polymorphism is probably related to the propelling properties and hydrodynamic shape of the filament rather than to its rigidity.


X-ray solution scattering studies on vinblastine-induced polymers of microtubule protein: structural characterisation and effects of temperature. We report here on X-ray solution scattering and electron microscopy studies of microtubule protein in the presence of the antimitotic drug, vinblastine. In buffer conditions used for microtubule assembly, vinblastine caused the formation of coil-like structures. The coils appeared to be made up of two protofilaments. Details of the structure and behaviour of coils in solution were obtained from interpretation of their solution scattering patterns. Upon increasing temperature from 4 to 37 degrees C the pitch of the coils increased from 25.92 to 26.96 nm. However, little change was observed in their mean diameters (38.46 and 38.45 nm, respectively). Increasing the temperature also favoured increased formation and/or elongation of the coils. The effect of temperature on the pitch was fully reversible. Vinblastine-induced assembly of pure tubulin also showed the formation of coils. However, these coils appeared to consist of only one protofilament. Their mean diameters (38.35 nm) were similar to those of the coils formed from microtubule protein.


Cyclical breast pain--some observations and the difficulties in treatment. This paper describes a retrospective study of the clinical aspects and treatment of 566 women with cyclical breast pain over a seven-year period. Figures for the effectiveness of simple treatments including some homeopathic drugs are reported. The article concludes that reassurance is the fundamental treatment. Good responses are obtained from simple and safe drugs (oil of evening primrose, vitamin B6) with minimal side-effects. The use of stronger hormone drugs such as tamoxifen and danazol was only necessary in a small proportion of patients and resulted in a higher incidence of side-effects.


Peripheral arterial thrombosis related to commercial airline flights: another manifestation of the economy class syndrome. Venous thromboembolism is a well recognised complication of air travel, particularly on long haul flights. This has been attributed to relative immobility in cramped surroundings and to dehydration secondary to alcohol consumption and low cabin humidity. Under these conditions thrombosis at other sites would be expected, and indeed myocardial ischaemia is the commonest emergency in commercial flights. Peripheral arterial thrombosis, however, is not reported, even in comprehensive reviews of flying related medical emergencies. We report on three patients who developed acute lower limb ischaemia following long haul air flights.


Configuration of interdomain linkers in pyruvate dehydrogenase complex of Escherichia coli as determined by cryoelectron microscopy. The dihydrolipoyl transacetylase (E2p) component of the pyruvate dehydrogenase complex (PDC) of Escherichia coli is a multidomain polypeptide comprising a catalytic domain, a domain that binds dihydrolipoyl dehydrogenase (E3-binding domain), and three domains containing lipoic acid (lipoyl domains). In PDC 24 subunits of E2p associate by means of interactions involving the catalytic domains to form the structural core of PDC. From cryoelectron microscopy and computer image analysis of frozen-hydrated isolated E2p cores it appears that the lipoyl domains are located peripherally about the core complex and do not assume fixed positions. To further test this interpretation the visibility of the lipoyl domains in electron micrographs was enhanced by specifically biotinylating the lipoic acids and labeling them with streptavidin. In agreement with the studies of native, unlabeled E2p cores, cryoelectron microscopy of the streptavidin-labeled E2p cores showed that the lipoic acid moieties are capable of extending approximately 13 nm from the surface of the core. Localization of the E3-binding domains was accomplished by cryoelectron microscopy of E2p-E3 subcomplexes prepared by reconstitution in vitro. Frequently an apparent gap of several nanometers separated the bound E3 from the surface of the core. The third component of PDC, pyruvate dehydrogenase (E1p), appeared to bind to the E2p core in a manner similar to that observed for E3. These results support a structural model of the E2p core in which the catalytic, E3-binding, and three lipoyl domains are interconnected by linker sequences that assume extended and flexible conformations.


Use of the Hickman catheter for central venous access in patients with haematological disorders. Hickman catheters were inserted for access in the management of 70 patients with haematological disorders. Twelve patients received a second and one patient a third catheter. The resultant 16,283 catheter-day experience is reviewed. The complication rate was 0.28 per 100 catheter days. Sepsis in the form of catheter-related septicaemia (CRS) and exit site infection was responsible for 72% of complications. Staphylococcus epidermidis was the commonest organism isolated from cases of CRS. Patients receiving broad spectrum antibiotics on the day of catheter insertion were significantly less prone to catheter failure due to CRS or exit site infection (P = 0.008). The Hickman catheter is a useful and reliable method of maintaining central venous access, but prospective randomised trials are required to evaluate the role of prophylactic antibiotics in reducing the incidence of CRS.


The incidence of delayed pneumothorax as a complication of subclavian vein catheterisation. Delayed pneumothorax after subclavian vein catheterisation is a poorly recognised complication which can result hours or days after the catheter placement. We present our experience, during a three-year prospective study of 318 patients with 343 catheter placements in the subclavian vein. Seven patients (2.2%) developed pneumothorax immediately after the subclavian vein catheterisation. Two patients (0.6%) developed delayed asymptomatic pneumothorax that was recognised 48 and 72 hours after the catheter placement. The importance of recognition and treatment of this complication is obvious in patients with a central venous catheter, especially when they are to be operated under general anaesthesia and/or mechanical respiratory support.


The selective use of fine catheter peritoneal cytology and laparoscopy reduces the unnecessary appendicectomy rate. The effect of a management protocol incorporating the selective use of fine catheter peritoneal cytology (FCPC) and laparoscopy on the unnecessary appendicectomy rate was studied in adult patients (> or = 16 years) treated at one district general hospital over an 11-month period. Appendicectomy was performed on 62 adult patients managed according to this protocol, six (10%) of whom had a histologically normal appendix and no other acute condition requiring surgery. A further 57 patients underwent appendicectomy after standard clinical assessment and investigation without the use of FCPC or laparoscopy. Nineteen (33%) of these patients had a histologically normal appendix removed, with no other acute condition requiring surgical treatment. The selective use of FCPC and laparoscopy significantly reduced the unnecessary appendicectomy rate from 33% to 10% (chi 2 = 10.0, P < 0.005). The more widespread use of these techniques in patients with suspected appendicitis is therefore recommended.


Nicotinamide treatment in subjects at high risk of developing IDDM improves insulin secretion. Nicotinamide (NCT) has been shown to be effective in preventing the onset of type 1 diabetes mellitus (IDDM) in mice with non-obese diabetic (NOD) and beta cell damage, mediated by the diabetogenic agents including streptozotocin. NCT therapy in man has been shown to have a beneficial effect on the remission phase of IDDM, and its use is safe. In this open pilot trial we therefore studied the effect of oral NCT administration on insulin secretion rate and islet-cell antibody (ICA) titres in IDDM high risk subjects. NCT (25 mg/10 kg bw) was administered in 6/13 high risk patients identified by a family screening programme. Those subjects tested after eight months without treatment showed a decreasing secretion in comparison to onset baseline (56,1 +/- 37.8 versus 35,5 +/- 12.2), whereas the treated subjects showed an increasing insulin secretion after treatment (26 +/- 10 versus 50.2 +/- 26.6), in spite of ICA persistence. Statistical analysis shows an increased insulin secretion in the treated group versus the untreated group (chi 2 = 3.899, P = 0.048). No side-effects were observed. We conclude that NCT may repair beta-cell function in high risk subjects too if damage is not too severe; furthermore, the effect seems not to be mediated by an immune mechanism.


Acute gastroenteritis: effect on nutritional status. Anthropometric measurements were performed on admission and at four weeks post discharge on 25 adults referred to hospital with acute gastroenteritis. There was a significant change in weight (P < 0.001) and mid-arm circumference (P < 0.05), but no change in skinfold thickness, arm muscle area or arm fat area. The results suggest that weight change during acute gastroenteritis is more a consequence of dehydration than of malnutrition.


Patient satisfaction in an urban accident and emergency department. The aim of this study was to assess patients' opinions about their experience of attending an urban Accident and Emergency department. They were given a questionnaire designed to demonstrate any shortcomings in the delivery of care which required corrective actions. Just over half (50.8%) the patients responded, 411 (95%) of whom recorded satisfaction with the outcome of their visit (P = 0.0001). There was significant correlation between patient satisfaction and waiting time to see the doctor (P = 0.003), the doctor's explanation about management (P = 0.02), and total time spent in the department (P = 0.01). A total of 120 patients (27.8%) did not receive any explanation from the nurse about what was going to happen, and 267 (61.6%) received no information about possible delay. These factors did not significantly influence patients' satisfaction with the outcome, but they need to be addressed as they will obviously lead to an improved service.


Too many rectal examinations? A survey of nursing management of constipation in elderly patients. A survey of nursing practices for the diagnosis and management of constipation in elderly patients in a Department of Medicine for the Elderly showed that up to 100 patients each week were subjected to unsupervised digital rectal examination. This procedure may be distressing to the patients and is probably unnecessary. We question whether this is acceptable or desirable practice.


Fine needle aspiration cytology of palpable breast lesions. Fine needle aspiration cytology is a safe diagnostic technique for breast cancer and can identify certain benign lesions, which can be excised without affecting surrounding tissue. The combination of experienced operator and cytologist can yield high sensitivity and specificity, together with important prognostic information.


Prophylactic drainage of cholecystectomy: analysis of current views. Despite extensive literature on the merits of prophylactic drainage of cholecystectomy this issue remains extremely controversial. According to tradition most surgeons feel safer placing a drain either routinely or selectively in the gallbladder fossa. On the other hand, some surgeons do not employ drainage at all and even advise against it. If the data in the literature is carefully and critically analysed, no superiority of a particular practice can be concluded with certainty; however, conclusions are often misleading as they usually reflect opinions rather than facts based on data. This article does not attempt to condemn drainage or non-drainage, but rather draws attention to the fact that opinions in this respect have been largely based on equivocal data or invalid conclusions.