[Health status and care of the urban elderly]. In order to investigate the health and care of the urban elderly, self-administered anonymous questionnaires were sent to a sample randomly selected from the elderly 70 to 89 years of age, in 3 different areas (central, residential and suburban) in Wakabayashi-Ward in Sendai. Responses from 1,248 were returned by mail (response rate = 76.4%) and results were compared to the expected values estimated from the results of investigations conducted by the Ministry of Health and Welfare. 1) As for present addresses of the elderly, 94.2% were at home, 3.8% in hospitals, 0.7% in nursing homes, and 1.3% in other facilities. 2) Responses showed that 28.4% were suffering from hypertension, 5.6% from diabetes mellitus, 2.2% from strokes and liver diseases, with all of these percentages similar to the respective expected values. However, 12.7% were suffering from heart disease which was over twice the expected value. 3) Analysis of health habits showed that the percentages of the elderly who had "good sleep and rest", "nutritious meal", and "moderate exercise" were higher than expected. Only 2.3% did not practice good health habits, which was one sixth of the expected value. 4) As for meal habits of the elderly, 88.3% had three meals a day, and 33.7% made efforts to take less salty foods. 5) Dietary habits of the elderly indicated that 83.8% were frequent consumers of meat, fish and soybeans products, 62.3% vegetables, 51.0% sweet confectionery (significantly higher), 49.2% milk (significantly higher), 22.3% fried foods like tempura (significantly higher), and 22.3% salty vegetables (significantly lower).(ABSTRACT TRUNCATED AT 250 WORDS)


[A study of falls experienced by institutionalized elderly]. This study was conducted to determine what factors are related to falls, conditions contributing to falls and the associated injuries. Subjects who had lived in 3 institutions for the elderly in the western region of Shizuoka Prefecture were chosen. Subjects (n = 181) had an average age of 76.4 +/- 7.8 years, and all were interviewed regardless of their history of falls. For those who had experienced falls further interviews were conducted. The following results were obtained: 1) There were 64 subjects (35.4% of the subjects) who had experienced falls, some having experienced multiple falls (for a total count of 89 falls). 2) The frequency of falls of differed by sex or age was significantly. The frequency of females was significantly higher than that of males. The frequency for those in their 70's was lower than in other age groups. 3) At the time of experiencing falls the majority of subjects had hypertension, eye symptoms, insomnia, paralysis, functional restrictions, were going up or down stairs, working, and had difficulty reading characters in newspapers, had experiences of stumbling or need of medical attention within for the past 2 years. Results of this study showed that, while the use of tranquilizers or hypnotics were not statistically significant, they were closely connected to and increase in falls among the aged. 4) In the causes of falls, intrinsic factors figured in 34 (34.0%) cases, and the extrinsic factors in 66 (66.0%). 5) Both falls and fall-caused external injuries were higher among females than males. Furthermore, female subjects mainly suffered contusions and fractures while male subjects mainly suffered abrasions.


[Prevention of cerebro-cardiovascular diseases by early intervention in youth]. A significant number of youth have obesity, hypertension, hypercholesterolemia and diabetes mellitus which are major risk factors for C.V.D and I.H.D. and which frequently occur after maturity. Analysis of lifestyle factors show a strong relationship between a series of these factors, and life style practices as typified by time-saving, dietary practice such as convenience foods, insufficient exercises, as well as family history of C.V.D. Prompt establish next of a system for screening high risk children with these factors and a corresponding support system for guiding and instructing them, is indicated. Studies should be performed from the viewpoint of life-cycle health management for establishing an integrated examination system for circulatory diseases for screening to follow-up.


[Factors associated with the improvement of lifestyle among a middle and advanced aged male population]. Factors associated with improvement of lifestyle (diet, smoking, drinking, exercise and health check-up) were studied among 3,503 males aged 40 or more, based on data obtained by two questionnaire surveys which were conducted at about a five year interval in a mountainous area of Aichi Prefecture. Age was positively associated with the improvement of every habit except for health check-up. Developing diseases was associated with the improvement of every habit except for exercise, with strong associations existing between liver diseases and improvement in drinking habits and between diabetes and improved nutritional balance. Improved dietary habits was inversely associated with frequent use of instant foods and irregular eating habits. Moderation in eating was associated with a balanced diet, frequent intake of yellow/green vegetables, fats & oils, and non-smoking at the time of the initial survey. Cessation of smoking was positively associated with fruit intake and inversely associated with irregular meal times, number of cigarettes per day and alcohol intake at baseline. An increase in frequency of exercise was positively associated with consumptions of fruits and dairy products and inversely associated with frequent use of instant foods at time of the initial survey, while an increase in frequency of health check-up was observed among men who had a balanced diet. The improvement of each habit was associated with the improvement of one or more other habits. These results suggest that likelihood for improving lifestyle is higher among men who have a health consciousness and that improvements in these habits are independent.


[A case-control study on factors relating to discontinuation of domiciliary care for the bedridden elderly in a metropolitan area]. A case-control study was conducted to examine factors relating to discontinuation of domiciliary care for the bedridden elderly in Shinagawa-ku, Tokyo. Cases were bedridden residents aged 65 years and over who had abandoned home care and applied for admission to live in a special nursing home for the aged between April and September in 1990 after being recipients of welfare allowances for disabled elderly. Controls were bedridden residents who continued to be given home care and matched to cases by sex, age and beginning month of the receiving of allowances. Among 50 cases and 94 controls interviewed, we obtained responses from 31 cases (62%) and 60 controls (64%). The main results were as follows: 1. During the home-care period, ADL (activities of daily living) of cases, especially walking ability, deteriorated more severely than in controls. Night delirium also appeared more frequently in cases. 2. The primary caregivers of cases were older than those of controls. Remarkable differences between cases and controls were observed in the family structure, the number of family members and the number of sub-caregivers. Cases tended to live alone or live with a spouse only, and with smaller number of family members and caregivers. 3. Case lived more frequently in houses with small numbers of rooms and without rooms of their own. 4. As regards utilization of domiciliary care services, cases used dispatch of home helpers more frequently and used day services less frequently.


[Study on the relationship between toddler temperament and development (first report)--the correlation among toddler temperament, maternal perception and rearing environment]. The purpose of this study is to clarify how a child's temperament and maternal perception influences the rearing environment. As the conceptual framework, we used A.J. Sameroff's transactional model and Miyake's conceptual model of mother and child. The following process was hypothesized: toddler temperament influences maternal perception, which in turn influences rearing environment under which children are developing. Questionnaires concerning toddler temperament, maternal perception and rearing environment were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and results from 306 mothers and children who answered the questionnaires were analyzed. The results were as follows: (1) Child temperament showed a tendency to accord with maternal perception of how easy it is to handle him/her. (2) Maternal perception was related to rearing environment. (3) Temperamental characteristics were related to rearing environment. (4) While the influence of child temperament and maternal perception on the rearing environment was not shown to be strong, the hypothesized process of this study was supported to a certain degree. From these results, it appears that it is important to pay attention to a child's temperament as a contributing factor in the health practice of mother and child.


[An outbreak of food poisoning suspected due to Aeromonas and characteristics of the isolated strains]. On June 7, 1990, food poisoning with main symptoms of abdominal pain and diarrhea occurred in Inuyama City, Aichi Prefecture. From results of bacteriological examination, three kinds of mesophilic Aeromonas spp. were detected from patients, leftover foods, well water, and cookers, one of which was A. hydrophila which was shown to produce haemolysin thought to be the cause of the food poisoning. On the other hand, A. sobria and A. caviae isolated from various materials did not produce haemolysin. The latter two strains of mesophilic Aeromonas spp. did not produce any other enterotoxins. Therefore, it appears that the well water containing A. hydrophila, A. sobria and A. caviae polluted the foods, which then had caused the food poisoning. Of nine strains of A. hydrophila, five do not dissolve sucrose, and these are typed as serogroup O:22 or O:23. The other four strains dissolve sucrose, and these are typed as serogroup O:16. According to the drug sensitivity test, all of these nine strains of A. hydrophila were resistant to Ampicillin, Erythromycin and Cephaloridine.


[Occupational skin hazards in hairdressers and their etiologic factors--results of mass health examination at health centers]. From 1986 to '88, mass health examinations for skin disorders among hairdressers were performed in 4 Health Centers in Osaka Prefecture. Among 306 female hairdressers examined, the prevalence of skin lesions was 49.0%, consisting of skin lesions of hands and arms alone 22.9%, nail lesion alone 13.7%, and both 12.4%. Characteristic features of the skin lesions were dryness, roughness, thickening of epidermis, redness, hyperkeratinization, scales, desquamation, etc. In the case of nails, thinning, onycholysis, onychoschisis, pitting, transverse grooves and onychorexis were characteristic. The relationship between prevalence of skin disorders and site of lesions to history or category of work was studied. For the prevention of these skin hazards, improved chemicals, equipment, and hygienic education are necessary. Periodical health-checks including participation by a dermatologist, and health supervision should be continued with cooperation between Health Centers and beauty salons, because these businesses are principally small-size enterprises.


[A study on the distortion of distributions of delays in detecting pulmonary tuberculosis]. It is reported that a cumulated percentage of the interval between the onset of symptoms and the first visit to a doctor (patient delay) and that between the first visit and diagnosis (doctor's delay) among pulmonary tuberculosis (TB) patients demonstrate a straight line on the log-normal probability paper. Factors influencing the straight line nature of these delays were analyzed. The samples consist of 454 patients who were diagnosed between 1986 and 1988, from the area served by the Kochi Chuo Health Center. They were divided into two groups; 125 patients detected due to the manifestation of additional symptoms related to TB while being treated for other diseases (group A), and 329 patients detected only after the onset of TB symptoms (group B). Results are as follows. 1) When considering all patients (group A+B), patient delay among cases found through positive examination of tubercle bacillus and the doctor's delay among cases whose bacillus examination was negative demonstrated a straight line. However patient delay among bacillus negative cases demonstrated a downward tendency and the doctor's delay among bacillus positive cases demonstrated a upward tendency on the log-normal probability paper. 2) In the B group, both the patient's and doctor's delay demonstrated virtually straight lines among both bacillus positive and negative cases. However, in the A group, a straight line among bacillus positive cases was demonstrated, while a downward tendency was revealed among the bacillus negative cases.(ABSTRACT TRUNCATED AT 250 WORDS)


Uterine fibronectin mRNA content and localization are modulated during implantation. Fibronectin mRNA and protein content were examined during embryonic implantation in the rat uterus. Content of total fibronectin mRNA at day 6 of pregnancy increased relative to the non-pregnant uterus. In contrast, fibronectin protein content of the subepithelial stroma was relatively decreased except in the region directly surrounding the lumen, and this fibronectin immunoreactivity was sensitive to hyaluronidase treatment. These changes are likely to reflect the degradation and subsequent remodeling of the previously stable uterine extracellular matrix in preparation for embryonic implantation. A+, B-, V + fibronectin mRNAs were present in both the non-pregnant and day 6 pregnant uterus with increased content of A+ and V+ fibronectin mRNAs in the latter. A + fibronectin mRNA was distributed throughout the endometrial stroma of the non-pregnant uterus and content of the subepithelial stroma increased by day 4 of pregnancy, coincident with progesterone action on the endometrium. On day 6 of pregnancy, fibronectin mRNAs encoding the V95 and A regions were preferentially localized to the mesometrial zone of the subepithelial stroma. Accumulation of these mRNA splicing variants at the mesometrial zone was dependent upon decidualization, but the embryo was not required. Thus, there are two major changes in uterine fibronectin gene expression as a result of pregnancy: increased fibronectin mRNA content and mesometrial localization. These changes suggest a key function for fibronectin in implantation and imply the operation of a regulatory program of fibronectin gene expression which depends on hormonal sensitization and a nidatory stimulus.


Expression of Hox 2.1 protein in restricted populations of neural crest cells and pharyngeal ectoderm. A polyclonal antibody, alpha Hox 2.1a, was used to localize Hox 2.1 protein in presumptive neural crest cells and nodose ganglion of 8.5-10.0 day p.c. mouse embryos. The following results were obtained: (1) The nodose placode, in its epithelial state, first expresses Hox 2.1 protein at 9.0 d.p.c. By 9.5 d.p.c. presumptive migrating neuroblasts between the nodose placode and ganglion primordium also express Hox 2.1 protein. (2) At 9.5 d.p.c., presumptive crest cells lateral to the cephalic cardinal vein and within pharyngeal arches 4 and 6 are immunoreactive for alpha Hox 2.1a. In the arch 6 region, positive cells extend medially to a mesenchymal cell population on the lateral aspect of the foregut wall. (3) At 10.0 d.p.c., Hox 2.1 protein expression in putative crest cells is restricted to the arch 6 cell population. A similar staining pattern is seen using alpha Hox 2.1a with chick embryos. Comparison with the chicken embryo suggests that the Hox 2.1 positive cells in the pharyngeal arch and those on the lateral aspect of the foregut in the mouse embryo correspond to the caudalmost subpopulation of the circumpharyngeal crest (Kuratani and Kirby: Am. J. Anat. 191:215-227, 1991; Anat. Rec. 234:263-280, 1992). These results are consistent with a role for Hox 2.1 in pattern formation in the caudalmost region of the vertebrate head.


Segregation and early dispersal of neural crest cells in the embryonic zebrafish. We have exploited our ability to visualize and follow individual cells in situ, in the living embryo, to study the development of trunk neural crest in the embryonic zebrafish. In most respects, the development of zebrafish trunk neural crest is similar to the development of trunk neural crest in other species: zebrafish trunk neural crest cells segregate from the dorsal neural keel in a rostrocaudal sequence, migrate ventrally along two pathways, and give rise to neurons of the peripheral nervous system, Schwann cells, and pigment cells. However, some aspects of the development of zebrafish trunk neural crest differ from those of other vertebrates: zebrafish trunk neural crest cells are significantly larger and fewer in number than those in avian embryos and the locations of their migratory pathways are slightly different. This initial description of neural crest development in the zebrafish embryo provides the foundation for future experimental studies.


Laminin expression in the mouse lung increases with development and stimulates spontaneous organotypic rearrangement of mixed lung cells. The recent establishment of a role for laminin in mouse lung organogenesis (Schuger et al. 1990a,b, 1991) prompted us to study its expression in the developing lung. Laminin A and B chains were detected in the murine lung from the first hours of development onward. In situ hybridization of mRNA as well as SDS-PAGE studies of lung cells in monoculture indicated that both epithelium and mesenchyme produce complete laminin molecules. Quantitative analysis of the in situ hybridization studies showed a gradual increase in laminin expression during development which was further supported by immunohistochemistry and ELISA. The overall pattern of expression suggested that the effects of laminin in morphogenesis were not restricted to a particular stage of development. Furthermore, the increase in expression during late development supported a role for the molecule in the fetal lung, which was not previously established. We next determined whether the increase in laminin production modulated the behavior of fetal lung cells as compared with their embryonic counterparts. We previously showed that organotypic pattern formation does not occur in cultures of mixed embryonic lung cells unless exogenous laminin is added (Schuger et al., 1990b). Organotypic pattern formation is the result of cell sorting into epithelial and mesenchymal compartments and further rearrangement in a pattern resembling the tissue of origin. In the present study, we demonstrated that organotypic pattern formation occurs spontaneously in cultures of mixed fetal lung cells, which express high laminin levels. Pattern formation was abolished by antibodies to laminin. These studies suggest a correlation between laminin expression and the ability of lung cells in culture to reproduce normal tissue patterns. We conclude that laminin is critical for epithelial-mesenchymal recognition and further morphogenic interaction during both the embryonic and fetal stages of lung development.


Coordinate expression of IGF-I and its receptor during limb outgrowth. The morphogenetic mechanisms involved in shaping the embyro are largely unknown. Previous studies from this laboratory suggest that the mesonephros promotes limb outgrowth in ovo in the chicken embryo and might be involved in early limb morphogenesis, since damage to the mesonephros results in truncated limbs. In limb bud organ cultures, the presence of the mesonephros promotes cartilage formation. This effect can be reproduced by exogenous IGF-I or prevented by blocking antibody to IGF-I. In order to examine the hypothesis that mesonephros-derived IGF-I is involved in the early morphogenesis of the limb, we examined the spatial and temporal expression of IGF-I and type I receptor for IGF by in situ hybridization at stages when the onset of limb development occurs. The results show that neither transcript is detected at stage 13, prior to the appearance of the limb bud; but both transcripts are detected in the mesonephros at stage 14, an early stage in limb outgrowth. The hybridization signal in the mesonephros for both transcripts increases with development and signal was codistributed as well. At stage 18 the level of receptor transcripts detected in the flank relative to the limb decreased. Thus, the temporal and spatial patterns of expression of IGF-I and its receptor are consistent with their involvement in the initiation of limb outgrowth and support the model that localized expression of a growth factor and its receptor can be involved in shaping the embryo.


Paracrine/autocrine growth mechanisms in tumor metastasis. The successful growth of metastatic tumor cells is due to their responses to local paracrine growth factors and inhibitors and their production and responses to autocrine growth factors. At early stages of metastatic progression, there is a tendency for many common malignancies to metastasize and grow preferentially at particular sites, suggesting that paracrine growth mechanisms may dominate the growth signals affecting metastatic cells. At later stages of metastatic progression, where widespread dissemination to various tissues and organs occurs, autocrine growth mechanisms may dominate the growth signals affecting metastatic cells. The progression of malignant cells to completely autonomous (acrine) states can ultimately occur, and at this stage of metastatic progression cell growth can be completely independent of growth factors or inhibitors. Various strategies have been developed to treat cancer that are based on the responses of malignant cells to growth factor or inhibitor analogs, anti-receptor antibodies, or antibody- or growth factor-toxin conjugates. Since the responses and expression of growth factor receptors can change during malignant progression, the development of cancer treatments using analogs of specific growth inhibitors or antagonists of growth factors, such as monoclonal antibodies or other agents, to block growth signaling mechanisms may only be useful at the early stages of malignant cancer progression before widespread metastasis of acrine cells occurs.


Synergistic antiproliferative effects of the combination of interleukin-1 alpha and doxorubicin against human melanoma cells. We have investigated the antiproliferative effects of recombinant human interleukin-1 alpha (IL-1) combined with the cytotoxic antitumor drug doxorubicin against A375 human melanoma IL-1-sensitive (C6) and IL-1-resistant (C5) clonal cell lines. Growth inhibition was assessed by the MTT assay, and C5 cells were 10-fold less sensitive to IL-1 than the C6 cells, but both cell lines were equally sensitive to doxorubicin. Synergistic antitumor activity between the two agents was evaluated by median effects/combination index analysis, and IL-1 and doxorubicin were strongly synergistic over a broad range of drug concentrations. The strongest synergism occurred when C6 cells were exposed to IL-1 prior to doxorubicin, and when C5 cells were pretreated with doxorubicin for 6 hr prior to IL-1 additions. An examination of various ratios of the two agents revealed a maximum 20-fold potentiation of doxorubicin, and a 30-fold potentiation of IL-1 median dose values in the combination compared to the median dose values obtained with doxorubicin or IL-1 alone. Doxorubicin treatment enhanced the binding and internalization of [125I]IL-1 after 24 and 48 hr at 37 degrees C, but IL-1 binding to cells incubated on ice was increased only marginally by doxorubicin pretreatment. Treatment of C6 cells with IL-1 for 24 hr did not alter the cellular accumulation of doxorubicin. A recombinant protein IL-1 receptor antagonist that binds to both the 80 kDa type I and the 65 kDa type II IL-1 receptors, blocked the cytostatic effects of IL-1 and abrogated the synergism with doxorubicin. In cells synchronized following release from aphidicolin block, doxorubicin caused a G2 + M accumulation, IL-1 alone had no effect, and the combination of both agents resulted in a G2 + M block similar in magnitude to that caused by doxorubicin alone. These results provide preclinical evidence that doxorubicin combined with IL-1 may be beneficial in the clinical treatment of malignant melanoma and possibly other types of solid tumors.


Sequential therapy with chemotherapeutic drugs and liposome-encapsulated muramyl tripeptide: determination of potential interactions between these agents. Three syngeneic murine tumor models were used to determine potential interactions between chemotherapeutic drugs and the synthetic liposome-encapsulated macrophage activator, muramyl tripeptide phosphatidylethanolamine (MLV-19835). Experiments were designed to maximize any additive toxicity of the simultaneous administration of MLV-19835 on the known myelosuppressive effects of doxorubicin, ifosfamide, and cisplatin. Treatment with these drugs resulted in diminished blood leukocyte counts, altered leukocyte differentials, and decreased hematocrits, but the systemic administration of MLV-19835 produced no additional deleterious effects. Myelosuppression normally observed at 2 weeks following treatment of mice with doxorubicin was prevented by combination treatment with MLV-19835. In addition, there was no interference of the antitumor activity of ifosfamide or doxorubicin against subcutaneous, kidney, and spleen tumors. These studies and the recent demonstration of the biological activity of MLV-19835 in phase II trials of osteosarcoma recommend clinical testing of these combined modalities.


Expression of glial fibrillary acidic protein in human medulloblastoma cells treated with recombinant glia maturation factor-beta. Medulloblastoma, a common pediatric brain tumor, is a primitive neuroectodermal tumor which often displays neuronal and/or glial characteristics. We have investigated the consequences of treating cell lines derived from a human medulloblastoma with glia maturation factor-beta (GMF-beta), a protein found in mammalian brain. GMF-beta promotes growth arrest and morphological alteration of cultured glioma and neuroblastoma cells. The proliferation of medulloblastoma cells was arrested 24-48 hr after exposure to human recombinant GMF-beta. During the same period, treated cells acquired a morphology similar to that of mature astrocytes. By 72 hr, all treated cells bound an antibody against glial fibrillary acidic protein (GFAP), a distinguishing biochemical feature of mature astrocytes. Immunoreactivity was accompanied by de novo expression of GFAP mRNA. Our observations are the first demonstration of the induction of morphological and biochemical characteristics of mature astrocytes in cultured medulloblastoma-derived cells by an exogenous factor.


[Tumor necrosis factor: pleiotropic cytokine]. Originally described for its capacity to induce hemorrhagic necrosis of transplantable tumors in mice, TNF-alpha also exerts cytotoxic effects against some tumor cell lines in vitro. It is now known that TNF is an essential mediator of cellular immunity and a wide variety of biological activities of TNF in vitro and in vivo has been reported. TNF is an important mediator of inflammation and is involved during the pathogenesis of several auto-immune, infectious or cancer diseases. While some immunomodulatory properties of TNF have at least been partially elucidated, the biochemical basis of TNF cytotoxic action remains largely unknown. Furthermore, the molecular mechanisms of TNF susceptibility have yet to be clarified. Clinical studies with recombinant TNF as an anticancer agent are encouraging. Multiple phase I and phase II trials have been carried out without major therapeutic effect. In fact, TNF resistance and TNF-induced systemic toxicity are two major limitations for the use of TNF as an antineoplastic agent. The clinical application of human TNF remains an area of active research and innovative approaches such as gene therapy need to be elaborated. The elucidation of the process of lysis and the modulation of TNF resistance are crucial to the future development of TNF and its use in antitumor therapy.


[Retinoids and carotenoids in cancer chemoprevention trials]. At the present time, cancer chemoprevention trials, especially non-randomised studies, constitute a large part of the scientific literature. Our purpose was to perform a critical analysis of the few randomised trials comparing a group treated with retinoids or carotenoids to an untreated control group or a placebo control group. Only one trial gave convincing results in favor of such chemoprevention, especially concerning the incidence of secondary cancer, at the cost of severe toxicity. Moreover, we have attempted to list the ongoing intervention trials which could provide details on the indications involved for such treatments.


[Chemotherapy of malignant ovarian Brenner tumors. Review of the literature apropos of 2 histological complete remissions after polychemotherapy]. The authors report two cases of malignant ovarian Brenner tumor treated by polychemotherapy, that had a complete histological response confirmed by a second look laparotomy. The review of the literature shows that complete responses are exceptional, either after mono- or polychemotherapy.


[Adjuvant therapy of breast cancer with tamoxifen and endometrial carcinoma]. Twenty cases of endometrial carcinoma are reported, observed in women who had received long term tamoxifen treatment as adjuvant therapy for breast cancer. Furthermore, a specific study was carried out on an homogeneous group of 790 women with an operable breast cancer, 318 receiving tamoxifen as adjuvant treatment. Five endometrium carcinoma were observed in the group under tamoxifen versus none in the other group. From an analysis of these cases, authors will carry out a case control study to evaluate the relative risk of endometrial carcinoma for patients under tamoxifen. They underline the importance of gynecologic follow up procedures for all women receiving this endocrine therapy.


[Epidemiology of breast cancer in men].

[Epidemiology of breast cancer in men]. Incidence data for male breast cancer from 34 selected cancer registries in different parts of the world are presented. The geographic variation in incidence is similar to that observed for female breast cancer, resulting in a strong correlation between their respective rates, although certain populations have higher rates for male breast cancer than expected from the female incidence, notably Israeli Jews and blacks in the United States. It seems that both environmental factors (acting by the intermediary of endogenous oestrogens excess) and genetic predisposition play a role in determining the epidemiological profile of male breast cancer, as they do for cancer of the female breast.


[Departmental compilation of histoprognostic data in senology. Apropos of campaign screening in Bouches-du-Rhône]. In January 1990 a registry for cases of breast cancer occurring in the Bouches-du-Rhone area was set up in conjunction with a screening programme for women over 50 years of age. The aim of this study was to compare histoprognostic findings of unscreened patients (A) with a palpable lesion, screened patients (B) with or without a palpable lesion and self screened patients (C) registered for clinically occult mammary carcinoma. The histoprognostic criteria studied were: histological type, tumor size, prognostic grade and axillary lymph node involvement. Of the 2,478 surgical procedures registered, 1,125 involved women over 50 years of age including 47% with malignant disease. Only 3.7% of screened patients presented intraductal carcinoma compared with 1.17% to 18.2% of unscreened A or self-screened C patients. The incidence of minimal infiltrating breast cancer smaller than 10 mm varied widely from 17.3% in A patients to 33.7% in B patients and 51.4% in C patients (P < 0.001). The incidence of histoprognostic grade III tumors ranged from 17.9% in A patients to 10% in B patients and 4.3% in C patients (P < 0.007). Lymph node involvement decreases from 41% in A to 28% in B patients and 23% in C patients (P = 0.01). Based on our data, 41.9% of screened patients were in the most favorable prognostic category, ie intraductal carcinoma or infiltrating carcinoma less than 10 mm or grade I and no lymph node involvement, versus only 26.1% of A patients and 60.9% of C patients (P < 0.0001). Information of the incidence, pathology of interval tumors in previously screened women will be evaluated in the future. This first study underscores the necessity for this kind of registry to evaluate the histoprognostic profile year by year of a breast cancer screening campaign.


[Acute cholecystitis: percutaneous transhepatic drainage]. Despite emerging endoscopic techniques for treatment of gallbladder diseases the operative cholecystectomy is the treatment of choice in acute cholecystitis. Percutaneous cholecystostomy is an alternative treatment modality in poor surgical risk patients. In 19 out of 36 patients with percutaneous cholecystostomy no subsequent cholecystectomy was performed. A long-term observation of these 19 patients showed normal function of the gallbladder in ultrasound studies, thus percutaneous drainage can be a definitive treatment for acute cholecystitis in selected cases.


[Percutaneous removal of residual calculi of the bile ducts by T-drainage tract]. Percutaneous instrumentation under fluoroscopic control via the T tube tract is a minimally invasive technique to remove retained bile duct stones after cholecystectomy. 23 of 25 patients were treated successfully with this method. Two patients needed either percutaneous transhepatic stone-removal or repeat surgery because his residual calculus could neither be removed percutaneously nor endoscopically. In standard situations, the calculi were removed quickly and easily under outpatient conditions. Impacted and large calculi had to be mobilized and fragmented prior to their removal. One patient developed fever, another a mild, transient pancreatitis, no serious complications were observed. In large series, the success rate is 86-95%, the complication rate 3-5%, and the mortality rate 0-0.1%. A relative drawback of the percutaneous technique is the waiting period of approximately 4 weeks which is required for tract maturation. However, this inconvenience is acceptable if we consider that the risk of the percutaneous procedure is less than with endoscopic retrograde sphincterotomy. Therefore, we still favour a primary percutaneous radiologic approach to remove retained bile duct stones.


[Roentgen findings in T-drainage--results of 311 patients]. Postoperative T Tube cholangiographies of 311 patients from 1980 to February 1992 were evaluated by studying the patient histories and x-ray examinations. Most frequent questions concerned residual stones and papillary occlusion. Most frequent pathological findings were dilatation of the choledochus and of the bile ducts, residual stones and paravasations. Fistulas, abscesses and signs of cholangitis rarely occurred. Dilatation of the choledochus alone did not lead to further treatment. Papillary occlusion was treated by leaving the T drain in situ, patients with occlusion and residual stones were treated by papillotomy, litholysis or lithotripsy. Only 5 patients with necrotizing pancreatitis and abscess had to be reoperated. T tube cholangiography, which at the beginning of the study was a routine postoperative control with minor complications, will surely be applied less frequently in the future due to advances in endoscopy.


[Sonography and biliary extracorporeal shockwave lithotripsy]. Ultrasound is an indispensable tool for preliminary diagnosis ('filter function'), during treatment ('monitoring function') and in the followup examinations ('follow-up function') after shock wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which experience to date has shown to be rare.


[Magnetic resonance tomography of the hepatobiliary system: indications, limitations and outlook]. In a prospective study we examined the diagnostic value of MRI and MR cholangiography (MRC) in patients suffering from hepatobiliary disease. By using hepatobiliary contrast media (Mn-DPDP, Gd-BOPTA), sensitivity and specificity of MRI were significantly increased. In 65 patients we comparatively analyzed the diagnostic results of MRI and MRC versus ultrasound, CT and invasive techniques such as ERCP. We conclude that the use of MRI and MRC improves the diagnostic evaluation of patients with hepatobiliary disease.


[Renal arteriovenous fistula after kidney biopsy: color Doppler ultrasound and angiography diagnosis with embolization using the same procedures]. Arteriovenous (AV) fistulas are an uncommon but well-known complication of percutaneous renal biopsies. Recent studies suggest that Color Doppler Sonography is useful in the identification of post-biopsy renal AV fistulas. AV fistulas may cause persistent hematuria, hypertension, or high-output cardiac failure. In these cases surgical ligation or angiographic embolization is necessary. In this study we report a case of post-biopsy renal AV fistula identified with Color Doppler Sonography and Angiography. The renal AV fistula also was embolized with a platinum microcoil under angiographic and ultrasonographic guidance.


Urinary extravasation from the kidney of recurrent renal cell carcinoma. A man presented with recurrent renal cell carcinoma, complicated with acute pyelonephritis, 3 months status post partial nephrectomy. He underwent cystourethroscopy and a bilateral retrograde pyelogram, then was referred for a Tc-99m DTPA renal study; the images showed an initial photon-deficient area of the right kidney being gradually filled-in by radiotracer with further extension laterally, indicating urinary extravasation. 16 days later this area was aspirated, yielding 5 ml of yellowish fluid with clots consistent with necrotic tumor and pus.


Deriving a 67-nucleotide trans-cleaving ribozyme from the hepatitis delta virus antigenomic RNA. RNAs derived from the genomic and antigenomic hepatitis delta virus are capable of self-cleavage, and thus have the potential for serving as ribozymes in a trans-cleaving reaction. Because the catalytic core of such an enzymatic RNA was not evident from phylogenetic data, we took a step-wise approach to identifying the core, reducing the RNA in size, and characterizing various properties for each size class. Thus, a 186-nucleotide antigenomic RNA (termed Ag180) was found to be capable of cleaving well in 20 M formamide (Smith and Dinter-Gottlieb, 1991), and this unusual stability in formamide was lost by reducing the 3' end of the molecule, leaving a 140-nucleotide RNA (Ag 140). Both RNAs showed only intramolecular cleavage at a wide range of concentrations, and a number of conformers could be seen in the Ag140 RNA, some of which were resistant to cleavage at 37 degrees C. Since Ag140 could not cleave in 20 M formamide, the 5' and 3' termini of Ag180 were truncated and produced Ag5-84, which cleaved to 100% at 37 degrees C in less than 0.25 min. Internal deletions of the Stem IV region resulted in Ag5-73, still capable of efficient cleavage, although with a lessened stability in formamide. A trans-cleaving enzyme-substrate pair was finally derived from this RNA, and it consisted of a 67-nucleotide enzyme that cleaved a 13-nucleotide RNA substrate.


9-Aminoellipticine-derivatized alpha- and beta-oligodeoxyribonucleotides targeted to the cap of beta-globin mRNA: hybridization to natural and engineered mRNA, inhibition of translation, and improved effect of tandem chains. We studied the duplex stability and the antimessenger activity of 9-aminoellipticine-5'-functionalized alpha- and beta-anomeric DNA sequences complementary to the first 14 nucleotides of the rabbit beta-globin mRNA. The duplex formed by the beta-conjugate with the natural mRNA target possessed a marginally better stability to that of the duplex formed by the unfunctionalized compound, as measured by the thermal elution. The alpha-conjugate did not anneal to native mRNA, possibly due to the interference of the 9-aminoellipticine with the cap structure and, unlike the beta-adduct, was practically inactive as inhibitor of translation in a cell-free system. However, it did hybridize to an RNA construction containing the beta-globin mRNA plus an additional 50 bases in 5'. Surprisingly, translation from this construction was inhibited by the alpha-species in spite of the nonvicinity of the target to the cap. Both alpha and beta conjugates hybridized to a DNA 14-mer of the same sequence as that targeted onto the mRNA. Thermal denaturation and fluorescence spectroscopy showed that the drug brought no considerable stabilization to the duplex, the linker presumably being unfavorable to intercalation. An increased stability of the complex and a higher inhibitory effect on cell-free beta-globin translation were obtained with two contiguous beta-oligomers of which one was functionalized.


Characterization and minimization of cellular autofluorescence in the study of oligonucleotide uptake using confocal microscopy. Intrinsic autofluorescent signals can interfere with extrinsic fluorophore signals when living cells are viewed under a confocal laser scanning microscope. The general pattern of this endogenous fluorescence is initially diffuse and cytoplasmic, but it can redistribute and intensify to become punctate and perinuclear as cells age. To reduce the contribution of autofluorescence when tracking the location of an extrinsic fluorophore, such as a fluorescently-labeled oligonucleotide, laser power settings, aperture settings, laser scanning rates, pH buffering environments, and excitatory wavelengths can be modulated. Decreasing laser power settings and aperture sizes, increasing laser scanning rates and excitatory wavelengths, and surrounding cells in a pH buffer all act to delay the signal transformation. In addition, the presence of an exogenous fluorophore can hasten the autofluorescent redistribution and intensification when compared to similar untreated cells.


Inhibition of murine leukemia viruses by nuclease-resistant alpha-oligonucleotides. We studied the antiviral activity of nuclease-resistant alpha-anomeric oligonucleotides. An alpha-oligonucleotide (20-mer) targeted to the primer binding site (PBS) of murine retroviruses inhibited viral spreading. The inhibition only occurred when the cells had been electropermeabilized in the presence of the oligonucleotide. The PBS sequence is involved in reverse transcription and in translation. The data suggest that the oligonucleotide could perturb reverse transcription activity. Thus, either the oligonucleotide induced a decrease in initiation or it inhibited the extension of the minus or plus strands DNA during reverse transcription. These results show that reverse transcription may be an interesting target for antisense oligonucleotides.


Nonspecific suppression of [3H]thymidine incorporation by "control" oligonucleotides. Phosphodiester oligonucleotides are rapidly degraded in spleen cell cultures. The present studies were conducted to determine whether thymidine released from degradation of such oligonucleotides could be reutilized and compete with [3H]thymidine incorporation, thereby causing nonspecific inhibition of "proliferation" assays. Our studies in mitogen-stimulated mouse spleen cells demonstrate that "control" oligonucleotides that contain thymidine can cause more than 90% inhibition of [3H]thymidine incorporation. This inhibitory effect was generally dependent on the location of the thymidine within the oligonucleotide: oligonucleotides that had 3'-terminal thymidine(s) caused more suppression than those in which thymidines were at the 5' end. All oligonucleotides caused a modest but variable inhibition of [3H]uridine incorporation. Furthermore, [3H]thymidine incorporation was partially inhibited even by oligonucleotides that did not contain thymidine. We propose that investigators who use [3H]thymidine incorporation assays to assess antisense effects do so with caution. It may be prudent to use control oligonucleotides with the same number and location of thymidine bases and to confirm [3H]thymidine incorporation assays with other measures of cell proliferation.


Cytotoxicity of a selected series of substituted phenols towards cultured melanoma cells. Substituted phenolic compounds were previously shown to exhibit cytotoxicity towards epithelial cells in the presence of the enzyme tyrosinase as a result of the formation of their quinone products. Seventeen of these compounds were tested for cytotoxic properties towards three different melanoma cell lines. The compounds were split into four groups of phenol derivatives, A; alkoxyethers, including 4-hydroxyanisole (4HA), B; oxyethers derivatized at the acyl side chain, C; oxyethers derivatized at the phenol, and D; acyl thioethers. Toxicity was determined by total cell counts after 3 days exposure to the compounds. Large reductions in cell numbers were observed with 4HA (the methoxy-), ethoxy-, propoxy and iso-butoxyethers of group A and the methyl- and propyl thioethers of phenol of group D. Derivatization of the ethoxy- and propoxy side chains (group B) did not seem to increase the cytotoxic effects, as determined by cell counts. Compounds of group C, which need intracellular esterase activity to release the phenols, showed moderate toxicities. Toxicity of certain compounds was confirmed by LDH release into the culture medium and by increased trypan blue uptake of cells exposed to the compounds. Flow cytometric investigations of cells after exposure for 24 h revealed that most compounds caused an increase in the proportion of cells in G1 phase. A complete accumulation of cells in S-phase was observed after exposure to 4-ethoxyphenol. Inhibition of DNA synthesis was also shown by inhibition of bromodeoxyuridine incorporation. The results presented show that phenolic compounds exhibit cytotoxic properties towards melanoma cells some of which may be mediated by tyrosinase activity. Toxicity of the compounds was shown to be exerted during DNA replication but their toxic action may also be due to membrane damage and inhibition of cell metabolism.


Purification and analysis of growth regulating proteins secreted by a human melanoma cell line. Supernatants of a human malignant cell line established from a CNS metastasis, contained several proteins with putative growth regulating functions. BioGel P-10 gel filtration chromatography, reverse phase HPLC purification, and amino-terminal sequencing of purified peptides resulted in characterization of beta 2-microglobulin (beta 2M, 10 kD), ubiquitin (6 kD), and tissue inhibitor of metalloproteinases 2 (TIMP-2, 21 kD). In addition, CNBr cleavage and purification of resulting peptides revealed diazepam binding inhibitor (DBI, 8 kD) and melanoma inhibiting activity (MIA, 11 kD). The secretion of beta 2M as part of the HLA-class I complex may be related to impaired autologous anti-tumour immune function; ubiquitin may play a role in activation or deactivation of extracellular proteins or cell-cell interactions. As HTZ-19 cells respond in a dose-dependent manner to midozolam, DBI may interfere with growth regulation mediated by diazepam receptor sites. In a collagenolytic assay, TIMP-2 interfered with metalloproteinase functions, which are required for degradation of collagen type IV and organotopic metastasis. MIA is clearly associated with a proliferation inhibiting effect on HTZ-19 cells. In conclusion, although this tumour shows a degree of progression, several proteins with putative functions at different cellular levels were identified, related to proliferation as well as to the type of metastasis.


Treatment with high dose mouse monoclonal (anti-GD3) antibody R24 in patients with metastatic melanoma. R24 is a mouse IgG3 monoclonal antibody that reacts with the ganglioside GD3 expressed by melanoma cells and other cells of neuroectodermal origin (e.g. adrenal medulla). Antitumour activity of R24 was demonstrated in initial phase I and pilot trials, but treatment was limited by urticaria at cumulative doses of 400 mg/m2. A trial exploring intensification of the dose of R24 was conducted in eight patients. Planned doses of R24 antibody were 800 and 1200 mg/m2 over 6-8 days by continuous i.v. infusion. All patients received concomitant therapy with hydroxyzine hydrochloride and cimetidine to minimize urticaria. One patient developed anaphylaxis, after which no further therapy was given. All patients developed peripheral blood lymphopenia and marked decreases in serum complement values during treatment, suggesting depletion of two possible effector mechanisms of the antitumour effects of R24. A vascular leak syndrome, manifested by weight gain, oedema and hypotension, was evident in seven patients during the initial 24-36 h of treatment. Serum sickness syndrome was observed in six of seven evaluable patients between days 5 and 8, coincident with the onset of the human anti-globulin response to R24. One patient given 1200 mg/m2 had a minor response (38% reduction in pelvic nodes) lasting 12 months. There was no detectable increase (by immunohistochemical staining) in deposition of R24 within tumour sites at doses used in this trial compared to that observed at doses of 240 and 400 mg/m2. The maximum tolerated dose was 800 mg/m2. Dose-limiting toxicity was manifest as reversible hypertension with end-organ symptoms (chest pain or visual field defects) in patients treated with a dose of 1200 mg/m2.(ABSTRACT TRUNCATED AT 250 WORDS)


Identification of a 66 kD heat shock protein (HSP) induced in M-14 human melanoma cells by severe hyperthermic treatment. Following severe hyperthermic treatment M-14 cells synthesize at high rate a new protein of about 66 kD, in addition to the three well known major HSPs (HSP 28, HSP 70 and HSP 90). This 66 kD protein is constitutively expressed at low levels and its rate of synthesis is not enhanced by mild hyperthermic exposures (40 degrees C for 2-4 h; 42 degrees C for 1-3 h), sufficient to induce the three major HSPs. The 66 kD protein is induced whenever the thermal dose administered to cells attains a threshold, roughly corresponding to a 50% reduction in survival. The 66 kDa protein is not induced by a variety of compounds (disulfiram, arsenate, cadmium) able to elicit a stress response in M-14 cells, as indicated by enhanced synthesis of the three major HSPs. Once induced by a treatment at 45 degrees C for 15 min, the rate of synthesis of the 66 kD protein remains above the control level for 16-20 h during recovery from the stress, while the synthesis of HSP 70 is shut off between 8 and 12 h. Immunoblotting and immunoprecipitation studies showed that the 66 kD protein shares immunological determinant(s) with HSP 70. Pulse-chase experiments demonstrated that the 66 kD protein is not a degradation product or a late post-transcriptional modification of HSP 70. It is proposed that the 66 kD protein is a previously unrecognized heat shock protein (HSP 66), characterized by an unusually high threshold for its induction.


Cerebral metastatic melanoma: correlation between clinical and CT findings. Thirty patients with malignant melanoma and cerebral metastases confirmed by CT were studied. Metastases were classified according to their size: < or = 1 cm (group A), 1.1-4 cm (group B), and > 4 cm (group C), in order to assess the clinical course of the disease and predict the response to treatment with fotemustine. Group B lesions were the most common, independent of the site of the primary tumour, except for patients with rectal melanoma. Group C metastases were least common and were usually solitary. Asymptomatic patients usually had group A metastases, whereas those with non-specific complaints, hemisyndrome or neurobehavioural changes usually had group B metastases. The time from diagnosis of the primary tumour to discovery of disease in the CNS was significantly longer for those who had group A lesions, compared with those who had groups B or C lesions (P < 0.0001). Solitary lesions usually belonged to groups B or C, whereas multiple lesions belonged mainly to groups A or B. All the responders to fotemustine has mainly cortical, group A or group B lesions. Patients with group C lesions or leptomeningeal spread did not respond to fotemustine. Our findings suggest an association between the size of the cerebral metastatic lesion from malignant melanoma and clinical parameters characteristic of tumour behaviour.


Fotemustine--an advance in the treatment of metastatic malignant melanoma. Although chemotherapy has been generally of limited clinical benefit in the treatment of metastatic malignant melanoma (MMM), fotemustine (FM) is a newly developed drug which is active against this disease. Twenty-four patients with histologically proven MMM were treated with fotemustine, with or without dacarbazine (DITC) according to different phase II trials. In the first schedule, three patients received FM alone on days 1, 8, 15 followed by a 5-week rest period. The second schedule consisted of FM administered on days 1 and 8 alternating with DTIC on days 15 and 16, followed by a 5-week rest period (19 patients). The third schedule, given to two patients, consisted of DTIC followed 4 h later by FM. The overall response rate was 8.3%. Response in those who were treated with alternating drugs, included one partial response (PR) in the brain which lasted 4 months, and one PR in brain metastases with complete response (CR) in lymph nodes for 4 months. Clinical and radiological evidence of regression was observed mainly in brain metastases (22.2%), reflecting the intracerebral activity of the drug. It seems that fotemustine is superior to any other drug currently available in the treatment of these metastases.


The role of regional isolated perfusion in the eradication of melanoma micrometastases in the inguinal nodes: a comparison between an iliac and femoral perfusion procedure. Regional perfusion therapy of melanoma is followed by an apparent decrease in lymph node metastases. When regional isolated perfusion is performed by cannulating the blood vessels at the iliac level, at least the middle and distal parts of the inguinal nodal zone are included. This is not the case with femoral perfusion. These two types of perfusion were therefore compared to determine whether iliac perfusion eradicates micrometastases present in the inguinal nodes. The regional node recurrence rate and time to regional node relapse of 97 patients treated with iliac perfusion were compared with those of 20 patients who received femoral perfusion. Prognostic factors such as sex, MD Anderson stage of disease, Breslow thickness and Clark level of the primary melanoma, and number of nodules of those with recurrent melanoma were equivalent in both groups. All patients were perfused with melphalan under normothermic conditions during the period 1978-1990. Five of 20 patients (25%) receiving femoral perfusion and 31 of 97 patients (32%) receiving iliac perfusion (P = 0.7, chi 2 test) developed inguinal node metastases after a median period of 25 (8-40) and 19 (2-71) months, respectively (Mann-Whitney U test, P = 0.9). There was no statistically significant difference in the 5-year survival rate (55% versus 62%, respectively; log rank test P = 0.5). Since no advantage could be seen in terms of reduction of inguinal node relapse for iliac perfusion, it is concluded that perfusion of the distal nodes is not the major cause of reduction of regional node metastases.(ABSTRACT TRUNCATED AT 250 WORDS)


[Hepatitis B in Wallis: results of a seroepidemiological survey]. A sero-epidemiological survey was conducted on Wallis Island, in the South Pacific, from July 1988 to May 1989. A random sample from the general population was examined. 672 sera were tested for HBs antigen and anti-HBc antibody. Analysis of the data showed that there was little, if any, transmission from mother to newborn; serological markers seemed to be acquired during the first years of life, before the age of 15 years. After 15 years, seropositivity rate is stabilized at 85% for one and/or the other of the two markers. The seropositivity rate is 39% for the HBs antigen alone. A protocol to vaccinate infants less than one year is proposed.


[Analysis of new criteria for increasing the specificity of commercial Western blots]. We examined the frequency of serum cross-reactivity on Western blot for HIV1 and HIV2. 661 patients with tuberculosis in Abidjan, and 4,899 asymptomatic persons for HIV1 and HIV2 infections were tested. All specimens positive on ELISA for HIV1 or HIV2 were further characterized by synthetic peptide based tests. Confirmed positive samples were tested by HIV1 and HIV2 specific Western blot criteres utilisis. Dual serologic reactivity on synthetic peptide tests was significantly more frequent in HIV positive patients with tuberculosis than asymptomatic subjects. Positive HIV1 Western blots were seen in 61%-86% of specimens positive for HIV2 only on synthetic peptide tests. [Cross-reactivity, to HIV2 Western blots by HIV1 positive specimens was significantly more frequent in patients with tuberculosis than in asymptomatic subjects.] Using recently recommended criteria for HIV1 and HIV2 Western blot interpretation (presence of 2 env bands) reduced the overall proportion of HIV1 positive specimens having a positive HIV2 Western blot from 39% to 14% and HIV2 positive specimens having a positive HIV1 Western blot from 31% to 8%.


[Resurgence of yaws in Central African Republic. Role of the Pygmy population as a reservoir of the virus]. The authors present the results of a clinical (framboesia) and serological (TPHA and VDRL) investigation aimed at defining the reservoir of virus of yaws in the Lobaye area (southwest of CAR) out of which the disease spreads in spite of previous mass treatment campaigns. The Lobaye focus is still active because we found among the pediatric population under the age of 15 years, 5.6% contagious skin lesion and 19.6% VDRL+. In this area with contact between nomadic Pygmies and sedentary ethnic groups, the observed level of clinical and serological attacks suggested that the pygmie population, as previously described, makes up the principal focus of yaws. For every 1 case found through clinical examination, 3.5 cases VDRL+ and 4.8 cases TPHA+ are found through serological examination. This proportion indicates that clinical screening alone is not sufficient to evaluate the endemic yaws level in a population.


[Neurosyphilis in Guinea. Retrospective study of 82 cases hospitalized at the CHU of Conakry]. The authors report the semeiology of 82 (61 male, 21 females) neurosyphilis cases in patients, admitted into hospital at the CHU of Conakry, in the service of neurology and psychiatry. These cases were confirmed by serological reactions in the sweat and the neurolymph-spinal fluid.


[Trachoma in the Sabou area (Burkina Faso). An epidemiological investigation]. Little is known about the epidemiology of trachoma in the Mossi plateau of Burkina Faso and the recent drought could have modified the transmission of the disease. A study population of 82,187 was surveyed using a cluster sample technique. A total of 1,841 people in 108 compounds were included in 18 villages. Data concerning trachoma were collected during six weeks of fieldwork in July 1991, during which local health workers were trained in trachoma and primary health care in ophthalmology. Active trachoma prevalence rises in infancy to reach a peak of about 13% (95% CI 3-23) in the 2 to 5 years old age groups, and then falls to less than 2% prevalence in 30 to 49 age group. Trachoma scarring is almost non-existent and trichiasis was not seen. Active disease was significantly more prevalent in female (prevalence ratio = 1.97, 95% CI: 1.34-2.90) and this difference was present from the age of 3 years. Active trachoma above the age of 30 was more likely to be intense than follicular (p < 0.001, Fisher's exact test). Because of a low prevalence of active disease and because trichiasis is absent, trachoma is not a major health problem in the Sabou area, Burkina Faso. Girls are more affected by active disease than boys and inflammatory trachoma in adults are usually intense in this setting.


[Current status of knowledge on the epidemiology of rickettsiosis in Africa]. Rickettsioses have been reported all over Africa. Serologic investigations have been driven using non specific methods as Giroud microagglutination and Weil-Felix test which led to numerous false positive. This explains the difficulties encountered in the evaluation of the prevalence of such diseases in Africa. However, three recent studies made in Tunisia, Central Africa and Zimbabwe show that seroprevalence of spotted fever group rickettsiae infections is close to 45% using MIF as reference method. New technics as Western and Line immunoblotting and RFLP PCR should allowed to new studies and revision of epidemiologic data on rickettsioses in Africa.


[Imported malaria in Brest hospitals from 1981 to 1990]. From 1981 to 1990, 96 confirmed hospital cases of imported malaria occurred in Brest. An important increasing of the annual number was observed in 1986. A high proportion of infection was due to Plasmodium falciparum, mainly from black Africa. Most of the patients was French young men, without or with inadequate chemoprophylaxis. Every case of malaria due to P. falciparum appeared during the 2 months following their return from an endemic area. Two patients had a clinical profile of visceral evolutive malaria and 5 a cerebral malaria. Three patients died.


[Toxoplasmosis in Gabon. Results of a seroepidemiological investigation]. A toxoplasmosis sero-epidemiological inquiry was effected with 2,324 sera collected from Libreville, Lébamba, Makokou, Lastourville and Woleu-Ntem. All the sera were first screened through Pastorex toxo (Diagnostics Pasteur). Those with more 8 IU/ml and 267 sera with less 8 IU/ml were then assayed by ISAGA (bioMerieux) for IgM. The results of ISAGA must be interpreted with carefulness for natural agglutinins are frequent in this population. The acquisition of immunity is precoce and more of 60% have a serology positive from ten years old. There was no difference between sex.


[Cysticercosis in the province of Kayanza (Burundi)]. Prompted by the diagnosis of two cases of cysticercosis in patients from the same province of Burundi, we conducted a study in this area to determine the cysticercosis incidence rate in this area of Burundi. Patients having presented with more than two convulsive seizures were studied. All of them usually eat pork. Diagnosis was established with the 3 following criteria: positive ELISA reaction in blood and/or CSF; presence of cystercus in subcutaneous node. Cysticercosis was diagnosed in 40 of the 98 investigated patients, 25 presenting a neurocysticercosis.


[Electroencephalographic study of trypanosomes in meningoencephalitic stage of human African trypanosomiasis from Trypanosoma brucei gambiense before and after treatment with DL-alphadifluoromethyl- ornithine hydrochloride monohydrate (DFMO)]. The aim of the study was to assess effects of DFMO (an inhibitor of polyamine biosynthesis) on waking electroencephalogram (EEG) of 25 patients at meningoencephalitic stage of human african gambiense trypanosomiasis (HAT), six of whom having been previously treated with and considered refractory to Melarsoprol. DFMO was administered intravenously at dose of 400 mg/kg/day for 14 days, followed by oral treatment at dose of 300 mg/kg/day for 21 days. EEG data were performed before, then 15 days after the end of the therapy. Initially tracings presented diversified abnormalities which have been classified into four groups: intermittent delta waves/generalised delta waves/low voltage background/paroxistic activities. Control recordings showed an improvement, but as for Melarsoprol tracings not returned completely to normal patterns. In most of the patients therapy was associated with clinical disorders improvement and in all but one with disappearance of trypanosomes. Marked amelioration in recordings of the patient who presented trypanosomes in LCR samples, suggest he was responsive to the treatment and perhaps therapy did necessitate continuation? The use of EEG investigation during treatments as a supervision way of patients with trypanosomiasis is discussed.


[Phlebotomus perniciosus Newstead, 1911 naturally infected by promastigotes in the region of Nice (France)]. The authors report the results of investigations in Nice from July, 16 to August, 3, 1991. The 2,098 phlebotomes captured represent three species: Phlebotomus perniciosus, Phlebotomus ariasi and Sergentomyia minuta. Two species: P. perniciosus and P. ariasi are infected with promastigotes. About 4% of dissected females are parasited. This is the first description in France of P. perniciosus infected.


[Anopheles paludis: important vector of malaria in Zaire]. An entomological study was carried out on the transmission of malaria in the Bandundu region, Zaïre, during the dry season (July and August 1991). Five Anopheles species were recorded: Anopheles paludis, A. gambiae, A. funestus, A. moucheti and A. nili. A paludis was the dominant species and represents 55.1% of the total; the average number of A. paludis bites per man/day was 4.2. The sporozoite index was 6.2%; the inoculation rate due to A. paludis was h = 0.26, 1 infective bite each 4 days. A. paludis plays an important role with A. gambiae and is considered as one of the main vectors of malaria in this region.


[Application of a new transport and storage material for improving the quality of drinking water in rural African areas]. Although boreholes in rural african areas deliver safe drinking water, there is a daily consumption of water polluted by fecal bacteria. Contamination occurs during transport, storage and domestic allocation of water. This is directly attributable to ignorance of the rules of hygiene, and the use of traditional jars ineffective in maintaining water quality. Their replacement with more modern recipients and the initiation of sanitary education markedly decrease bacterial water contamination, however, WHO standards which define portable water are rarely attained. In fact, it seems that established WHO conditions can only be achieved with piped water or after chemical disinfection.


[Epidemiology of Tinea capitis in Bangui (Central African Republic)]. In Bangui (Central African Republic) an epidemiological survey making use of cluster sampling has been performed. Prevalence rate is not very high in Bangui (3.4%). Boys are more infected than girls. Both in rural and urban area prevalence rates are decreasing with age. Microsporum langeronii has been identified in 98% of case.


[Epidemiologic aspects of whooping cough in a village of the central district of Kolokani in Mali]. Epidemiologic aspects of a whooping cough outbreak are studied in a village of a rural precinct of Kolokani in Mali. The survey shows that the village as been contaminated by two children coming from Bamako, an urban center. Spreading of the epidemic is due to the lack of suitable therapy and vaccination. Seventeen cases are noticed within 83 children aged 0 to 13 years (20.5%) from October 12th, 1988, to January 22nd, 1989. The attack rate is the same in males and females. Knowledge, attitudes and practices of the population to face whooping cough are noted. Measures are proposed for therapy and prevention.


[The effect of the alkylating carcinogen dipin on the proliferation, the level of polyploidy development and on micronucleus formation in a population of parent and newly formed hepatocytes]. In the process of hepatocarcinogenesis induced by dipin and partial hepatectomy in mice, initial hepatocytes are gradually replaced with a population of newly formed hepatocytes which originate from oval cells (Radaeva, Factor, 1990). It has been shown that the increase in hepatocarcinogenesis duration (2-11 weeks) along with the intensification of oval-cell reaction are accompanied by a progressive injury of cell genome in the initial hepatocyte population. This injury manifests itself by an accumulation of cells with micronuclei as well as by the development of high levels of polyploidy and aneuploidy. In the initial parenchyma, clastogenic and aneuploidizing effects of dipin are maximally pronounced at the stage of appearing hepatocyte nodules which consist of newly formed hepatocytes (8-11 weeks). By this time the proliferative pool comprises 83-92%, the amount of aberrant cells increases in average from 7 to 50%, and the indices of average nuclear ploidy in population enhance 6-8 times as compared with the average level of polyploidy in normal parenchyma. The quota of binuclear cells without micronuclei abruptly falls while the quota of binuclear cells with micronuclei and nuclear bridges increases reaching 3/4 of the total amount of binuclear cells. Binuclear cells with nuclear bridges comprise about one third of binuclear cells with micronuclei. At the stage of hepatocytic nodules (8-11 weeks after induction), the population of newly formed hepatocytes is characterized by the absence of morphologically damaged cells and of cells with micronuclei, a low incidence of binuclear cells (1-3%), and a high value of proliferative pool (83-96%).


[The peroxisomes of eosinophilic leukocytes]. Functional properties of peroxidase-containing granules (peroxidasosomes) of eosinophiles are discussed. Findings are reported on the activities of peroxidase systems and of non-enzymic cationic proteins which occur in the eosinophilic peroxidasosomes in normal state and in various pathological states as well as their antimicrobial and antiparasitic activities.


[The antimicrobial proteins and peptides of neutrophilic leukocytes]. Findings suggesting a vast variety of non-enzymic cationic proteins and peptides in human and animal leucocytes are reported. These cationic proteins and peptides demonstrate their antimicrobial and cytotoxic properties due to their detergent characteristics and their capacity to change the permeability of cellular wall and membrane by electrostatic interactions. Information on their homology with some serine proteases is presented.


[Saprotrophic microflora as a producer of biologically active substances for the purpose of microbial saprotrophic pharmacotherapy]. A problem of utilizing the microflora producing biologically active substances with a view to elaborating a microbial pharmacotherapy is discussed. The principle of this kind of therapy is to arrest pathological processes and to correct biochemical processes in the organism by means of "beating up" the strains-producers of biologically active substances. Substances secreted by strains-producers, are capable to suppress the growth of pathogenic microflora and malignant tumors as well as to correct physiological and pathological processes, may be utilized in future for a microbial saprotrophic pharmacotherapy depending on indications.


[An experimental study of the mechanisms of precopulatory isolation between 3 genetic forms of the house mouse in the genus Mus]. Under experimental conditions, possible mechanisms of precopulatory isolation were studied in house mice of there forms: Mus musculus musculus, sympatric M. spicilegus, and allopatric hybrid population of M. m. domesticus x M. m. musculus. In these experiments, the animals were placed in pairs (a male and a female in state of estrus) on a neutral territory. Nine combinations of matching were used. No pronounced mechanisms were found to prevent the copulation of partners of different forms. The factor analysis has revealed the dependence of different forms of social interactions between potential sexual partners upon three factors: taxonomic position of female, taxonomic position of male, and variant of matching. It was shown that the behaviour of female was one principal determinant of the development of events during the experiment.


[An electron microscopic study of retinal development and pathogenesis in mutant CBA/J mice with hereditary retinal degeneration]. Electron microscopic study of the neural retina pathogenesis was carried out on mice CBA/J in comparison with corresponding process in substrain CBA/Ki (Caley et al., 1972). A difference in terms of the pathology development was found between substrains CBA/J and CBA/Ki. It was shown that, in CBA/J, the retinal degeneration begins later than in CBA/Ki. As distinct from the latter, CBA/J proceeds to increase the thickness of outer nuclear and plexiform layers as well as the number of membranous discs of rod outer segments (ROS) between P10 and P12. In the retina of mouse CBA/J, pathologic alterations of the outer nuclear layer and the inner segments of photoreceptors precede the ROS destruction. It was found that the pigment epithelium is capable to phagocytize membranous discs of ROS in mouse CBA/J at P10 and P12. In CBA/J, the mitochondria in inner segments of photoreceptors begin to decay at P10; by P12, the amount of such segments reach 40%. At P12, the number of pycnotic nuclei (6%) in the outer nuclear layer coincides with the number of inner segments with dense degenerative cytoplasm. At P15, the state of retina as evaluated by the extent of far advanced degeneration of the outer nuclear layer is equalized in mice of both substrains. From P10 to P15, macrophages which phagocytize membranous discs of ROS are present in the interphotoreceptor space of CBA/J. The administration of PABA solution (7.5 x 10(-3) mg/g) daily from P1 to P9 or from P1 to P11 and with subsequent fixation at P10 and P12 respectively exerted no effect on the rate of retinal pathogenesis in mouse CBA/J. The causes of revealed differences in the development of retinal pathology between CBA/Ki and CBA/J are discussed as well as the causes of the absence of PABA effect on the retina of mutant mouse CBA/J.


Why patients choose to purchase a hearing aid privately. A questionnaire survey was undertaken of patients who had recently purchased a private hearing aid. They were asked their reasons for choosing a private aid in preference to an NHS aid. Cosmetic considerations and the failings of Health Service provisions were the most commonly cited reasons.


[A trial of the enzyme nuclease S1 for the recognition of defects in the secondary structure of DNA]. In order to develop an adequate method for quantitative determination of age-related defects of DNA secondary structure in somatic cells, the testing of enzyme nuclease S1 ("Sigma") was carried out. The conditions have been selected under which this enzyme revealed all single-stranded breaks and did not induce nonspecific breaks in DNA. It was shown that homopurine-homopyridine blocks of DNA capable of changing to H-form hypersensitive to S1, were not detected with the enzyme in the selected conditions.


[Defects in the secondary structure of DNA recognizable by nuclease S1 and their possible role in the aging of mammalian somatic cells]. The amount of defects in DNA secondary structure recognized by nuclease S1 and their localization by sequences of various nucleotide composition were studied in relation to the age factor. It was established that a significant twofold increase in defects of DNA secondary structure was observed in hepatic cells of very old (30 months and older) intact mice only, as well as in radiation-induced acceleration of aging at the age 19 months. The prevailing localization of the defects of DNA secondary structure has been demonstrated in those sequences which were enriched with AT pairs by 3% (as compared with the average level). It was concluded that the mentioned defects of DNA secondary structure are not the cause of aging. Nevertheless they can play an essential role in the process of irreversible destruction of genome in the terminal phase of aging.


[Changes in the count of large granular lymphocytes in the blood of virtually healthy persons depending on sex and age]. The maintenance of large granular lymphocytes (LGL) in peripheral blood of 30 healthy donors has been studied. The mean value was 5.5 +/- 0.4% spreading from 2.4% to 10%. Healthy men had a higher level of LGL maintenance than healthy women (5.8 +/- 0.4% vs 3.6 +/- 0.7% respectively). It was found that the amount of LGL in male peripheral blood increased with age while the parameter spread decreased.


Simplified measurement of auditory filter shapes using the notched-noise method. The shape of the auditory filter at a given centre frequency can be estimated by measuring the threshold for detecting a sinusoid presented in a spectral notch in a noise masker, as a function of notch width. Laboratory studies using this method have typically been based on threshold measurements for between 13 and 19 notch widths. In this note, we describe how both the overall sharpness and asymmetry of the auditory filter in hearing-impaired subjects can be estimated with reasonable accuracy using only five notch widths. This considerably reduces the testing time needed, making it possible to apply the method in clinical testing.


The period evoked potential: a rapid technique for acquisition of phase-locked responses to continuous pure-tone stimulation. In view of the current audiological need to obtain rapidly recorded and objective threshold information, particularly for frequencies below 1 kHz, we have developed an evoked potential technique based on the frequency following response. The technique involves the acquisition of a single captured epoch of EEG containing phase-locked responses to 1000 cycles of a continuous pure-tone stimulus. The captured epoch is partitioned into segments representing the responses to single cycles of the stimulus. The segments are then averaged to produce the period evoked potential. The process takes less than five seconds.


The effect of posture on three objective audiological measures. This study examines the effect of posture on click evoked otoacoustic emissions, tympanic membrane displacement, and travelling wave velocity obtained using the auditory brainstem response. Statistically significant changes with posture were observed for each technique. The changes in evoked emission and tympanic membrane displacement measurements were comparable with those reported by previous experiments. Travelling wave velocity measurements were shown to be sensitive to inferred posturally-induced changes in labyrinthine fluid pressure of around 150 mm saline. There was no statistically significant correlation between posturally-induced changes measured by the three techniques. It is suggested that different mechanisms are responsible for the posturally-induced changes observed for the three techniques.


Non-organic hearing loss in young persons: transient episode or indicator of deep-seated difficulty. Depressed auditory thresholds without evidence of organic hearing loss are observed in a small percentage of children and young adults. Several studies suggest that non-organic hearing loss (NOHL) is a manifestation of, or reaction to stress. Proposed treatments range from ignoring the apparent hearing loss through the use of psychotherapy and/or counselling to confronting the individual with evidence to prove that there is no real loss of function. Few studies report on long-term outcome. Thirty-eight subjects who had been diagnosed more than six and up to twenty-seven years ago as having NOHL were identified from records. Efforts were made to determine if there was any evidence of longer term effects. Nine were untraceable. Of those reviewed one was established as a malingerer; five had concurrent speech problems; one was possibly dyslexic; five were or had been under psychiatric care. These findings suggest that NOHL may, in some individuals, indicate underlying problems that merit detailed investigation and treatment.


Syllabic compression: effective compression ratios for signals modulated at different rates. Compression circuits are being used increasingly in hearing aids to reduce the dynamic range of signals. Their performance is usually characterized by: (1) the threshold sound level above which the compression starts to operate; (2) the compression ratio, which is the change in input level (in dB) required to achieve a 1 dB change in output level; and (3) the attack and release times over which the signal is integrated to determine the necessary gain change. In many practical situations, the effective compression ratio obtained with dynamically varying signals such as speech is less than the compression ratio obtained using standard test signals (slow square-wave modulation with large modulation depth). This article describes the effective compression ratios achieved with sinusoidal modulation, as a function of modulation rate, level relative to the compression threshold, compression ratio and time constants. The effects of compression on a typical speech signal are also discussed.


Bias in scoring auditory brainstem responses. ABR waveforms from 50 multi-handicapped children were analysed by nine judges in an investigation of scoring bias. Prior to estimating threshold for each subject, the judges were provided with either true or false ABR thresholds. This preliminary information was true in 25 of the cases and false in the other 25. The same ABR waveforms were evaluated one week later, but true/false biasing thresholds were reversed. Results revealed that while the more experienced judges were more accurate in their assessments, they were not necessarily less biased. The effects of bias were more predominant in those cases where the estimation of threshold was the most difficult.


Effects of the fitting parameters of a two-channel compression system on the intelligibility of speech in quiet and in noise. These experiments were carried out to assess how accurately the gains and compression ratios in a two-channel compression system needed to be set. We used as a research tool a laboratory version of a two-channel full-dynamic-range compression system. The system was initially adjusted to suit each hearing-impaired subject according to the manufacturer's recommendations. Then, further adjustments were made to ensure that speech stimuli were both audible and comfortable over a wide range of sound levels. Finally, the settings of the gains and compression ratios were systematically varied from the adjusted values and the effects of this on the intelligibility of speech in quiet and in noise (12-talker babble, levels of 65 and 75 dB SPL) were measured. The results indicated that speech reception thresholds (SRTs) in quiet were significantly adversely affected by decreases in low-level gain. However, SRTs in noise were relatively unaffected by changes in low-level gain. An exception occurred at the higher noise level used, where increases in the low-level gains (with corresponding increases in compression ratios) had a significant adverse effect on the SRTs. It is concluded that, provided excessive low-level gains (associated with high compression ratios) are avoided, the main criteria for fitting such a system should be listening comfort (i.e. achieving an acceptable tonal balance, and avoiding uncomfortably loud sounds) and an appropriate value of the threshold for detecting speech in quiet (which should be a little below 50 dB SPL).


Diaries of tinnitus sufferers.

Diaries of tinnitus sufferers. Nine tinnitus sufferers kept daily diaries of their tinnitus experiences for up to three months. Levels of the loudest and quietest tinnitus and tinnitus annoyance were moderately highly correlated with each other and weakly correlated with the degree of sleep disturbance. Fluctuations in tinnitus sensation were frequent and associated with higher perceived levels and annoyance. Results were complicated by individual differences in tinnitus and lifestyle.


Estimation of the loudness of tinnitus from matching tests. To correct for the influence of recruitment when the loudness of tinnitus is measured by a balance test in an ear with sensorineural hearing loss, an averaged loudness function was devised, which converts the sensation level (SL) of tinnitus into an estimate of the effective loudness level. This is essentially the same as a phon scale except for the difference in reference level, and is defined as the equivalent SL of the tinnitus as if measured in an ear with a bone-conduction threshold of 0 dB HL at a frequency between 500 Hz and 4000 Hz. Using this function, the median estimated loudness of tinnitus from 301 randomly selected patients was 15 dB 'effective loudness level' with a maximum of more than 60 dB. A nomogram was made for clinical use to determine the effective loudness level easily from the SL of tinnitus and the bone-conduction HTL of the test ear. Although somewhat approximate, the effective loudness level is considered to be an unbiased loudness estimate of tinnitus under the condition that only the SL of tinnitus and the bone-conduction HTL are available, and makes it easier to appreciate the actual loudness compared with a complex loudness unit such as on the sone scale.


[4-year experience of the Warsaw Center for Home Oxygen Therapy]. Long-term oxygen therapy (LTOT) became a routine in the treatment of severe respiratory failure and cor pulmonale. Four years experience of the LTOT in Warsaw is presented. From 237 patients referred 172 were qualified for treatment. Majority--130 (76%) suffered from COPD. The rest of the group presented with pulmonary fibrosis, tb sequelae, bronchiectasis, kyphoscoliosis or chronic pulmonary thromboembolic disease. The mean oxygen breathing time averaged 14.5 H/day. Seventy two patients that is 42% of treated group died. The most frequent (63%) cause of death was respiratory failure. No adverse effects of LTOT were observed.


[Effect of home oxygen therapy on patients with chronic obstructive lung diseases]. Effects of 4 year of long-term oxygen therapy (LTOT) in 130 COPD patients were evaluated. All suffered from severe airways obstruction (FEV1 = 0.84 l), hypoxaemia (PaO2 = 55 mm Hg) and pulmonary hypertension (PAP = 29 mm Hg). The mean oxygen breathing hours averaged 15.2 h/day. Forty seven patients (36%) died during the observation period. LTOT did not prevent the progress of respiratory insufficiency-fall inc C and FEV. However it stabilized pulmonary arterial pressure and haematocrit. It was found that FEV1 < 0.76 l, PaO2 < 52 mm Hg, PAP > 30 mm Hg and oxygen breathing hours < 12/day bear risk of early death despite LTOT. The variables correlated best with survival were FEV1 and PaO2.


[Quality and results of year-long home oxygen therapy in Poland]. Accuracy of qualification to LTOT and the results of one year of treatment were assessed in 12 regional centres in Poland. 390 patients with advances respiratory failure entered the study. There were 305 patients with COPD and 85 patients with other chronic lung diseases. The accuracy of qualification to LTOT in Poland is satisfactory--2/3 of patients were accepted to treatment with severe hypoxaemia (PaO2 55 mm Hg), the remainder with moderate hypoxaemia (PaO2 = 56-65 mm Hg) and signs of tissue hypoxia. After one year of treatment 6.5% of patients did not need LTOT and 13% stopped to fulfill the single entry criterion still needing treatment.


[Effect of short-term home oxygen therapy on pulmonary artery pressure does not predict the survival of patients with chronic obstructive lung disease]. We wanted to verify if the acute effect of oxygen on pulmonary arterial pressure (PPA) is related to survival on LTOT as was suggested recently in the literature. We studied 46 COPD patients qualified for LTOT. The acute effects of O2 on pulmonary haemodynamics were assessed by pressure and flow measurements before and after 30 mins of O2 breathing via 28% Ventimask. Thirty nine patients reacted with a fall of the mean PPA of less than 5 mm Hg. These were termed nonresponders (NR). In seven patients mean PPA fell > 5 mm Hg. They were called responders (R). After the initial investigations patients were followed up on LTOT for 2 years or until death. During two years of LTOT 15 patients died (12 from NR and 3 from R groups). The first two years survival rate was 69% in NR and 57% in R groups respectively. We conclude that survival on LTOT is not related to the acute effect of oxygen on the pulmonary arterial pressure in COPD patients investigated in the steady-state period of the disease.


[Effect of tobacco smoking on pulmonary function in employees of the Institute of Tuberculosis and Lung diseases in Warsaw]. The effects of smoking habit on pulmonary function was studied prospectively (from 1987 to 1991) in a group of the staff in the Institute of Tuberculosis and Lung Diseases in Warsaw. The prevalence of smoking was the lowest among physicians (42% in 1987 and 24% in 1991). Nurses smoked more--51% in 1987 and 41% in 1991. A positive trend in quiting smoking was noted especially among physicians, nurses and technicians. Pulmonary function test were normal in all studied groups. The most pronounced decreases in lung function were noted in smokers.


[Evaluation of the relations between exercise tolerance, dyspnea and pulmonary function in patients with chronic obstructive lung diseases]. We studied 53 patients with severe COPD (FEV1 0.92 +/- 0.40 1, PaO2 61 +/- 9 mm Hg), aged 58 +/- 9 years, to assess the relationship between ability to exercise (6 MWD), dyspnea and baseline lung function parameters. Dyspnea at rest (D1) and during exercise (D2) was evaluated using VAS. During exercise dyspnea increased by 41 +/- 28, and oxygen saturation (StcO2) decreased from 92 +/- 3% to 84 +/- 9%. The fall in the StcO2 of more than 3% was observed in 42 patients (79%). We found that 6 MWD significantly correlated with the FEV1, VC and maximal dyspnea during exercise. There was no correlation between exercise tolerance and resting PaO2, PaCO2, severity of dyspnea at rest and the increase in dyspnea during exercise as well as with the resting and exercise StcO2 and the fall in StcO2 during walk. Dyspnea at rest and during exercise significantly correlated with air flow limitation and StcO2 at rest, during exercise and the exercise decrease in StcO2. There was a significant correlation between the fall in StcO2 during exercise and blood gases at rest. No relationship between the fall in StcO2 and the increase in dyspnea during exercise was found.


[Dyspnea at rest and after exercise and the mental status of patients with chronic obstructive lung diseases]. Thirty two patients with severe COPD were studied. We evaluated relationships between their psychological status, lung function parameters, exercises tolerance (6 MWD test) and dyspnea at rest and exercise (visual analogue scale). Patients demonstrated increased level of anxiety and psychological tension. In nearly half of the patients depression, low self-esteem and disbelief in the efficiency of therapy were observed. The correlations between the psychological status and the exercise tolerance hasn't been found. The correlation between the high level of depression and impairment of the lung function was found. The high increase in dyspnea score during exercises was connected with low self-esteem, although at rest the dyspnea level in those patients was low.


[Regulation of respiration in patients with sleep apnea syndrome]. 20 obese men with OSAS were examined. Polysomnography confirmed this diagnosis. In the daytime pattern of breathing, mouth occlusion pressure (P0.2) and ventilatory responses during CO2 rebreathing test were evaluated. Lung function indices were within normal limits except decreased value of MEF 25 and slight hypoxaemia (Pa0.2 -67 +/- 6 mm Hg). In comparison to control subjects the patients with OSAS when awake had increased ventilation, Vt/Ti ratio and P0.2. This suggests increased inspiratory neuromuscular output in daytime. During CO2 rebreathing test the whole ventilatory and P0.2 response lines were shifted to the left but the slopes of these lines were within normal limits. We conclude that the control of breathing in OSAS patients is changed in comparison to healthy subjects with normal weight.


[Test of nonspecific bronchial hyperreactivity to water mist in patients with atopic bronchial asthma]. 22 males with atopic asthma in clinical remission and 22 healthy males were evaluated. The age of the 44 males ranged from 19 to 23 years. Atopy was diagnosed in patients with a characteristic medical history, positive skin prick tests and elevated serum IgE levels. All patients underwent a bronchial provocation test to distilled water mist. The aerosol was produced in a ultrasonic nebuliser (Thomex) at a speed of 2 ml/min. All spirometric tests were carried out using Pneumoscreen (Jaeger) before and after inhalation of 2, 6, 12, 20 and 30 ml of distilled water. A positive test was defined: as a decrease of FEV1 by/or more 10%, decrease of MEF50 by/or more 25% and increase of Raw by/or more 30%. A positive test was found in 7 patients with atopic asthma after inhalation of 20 ml of distilled water. Sole lowering of FEV1 was seen in 11 asthmatics. In the control bronchial constriction could not be induced.


[Cough-syncope syndrome in tracheobronchomalacia]. A 40-year-old man, referred for treatment of syncope due to cough, was found to have generalized tracheobronchomalacia. The diagnosis was based on an abnormal collapsibility of the trachea and bronchi on bronchoscopic examination. The detailed investigations confirmed the diagnosis of cough-syncope syndrome due to tracheobronchomalacia. Based on this case the causes, symptoms and possible treatment of those clinical entities are discussed.


Repression of the E. coli lactose operon by cooperation between two individually unproductive "half-operator" sites. Two remote and weak lac regressor binding sites can be used jointly to repress the synthesis of beta-galactosidase in E. coli, while they cannot separately. When this result is discussed in reference to the various modes of cooperation between the sites, it supports with a new approach a model implying the simultaneous binding of lac repressor to both sites with the formation of a DNA loop. In connection with this point, we present a new strategy to detect cooperative interactions in vivo, based on the asymmetry of the DNA binding site, formally equivalent here to a half-site, heterodimerization of the protein, and influence of orientation of the sites on repression at short and long distance.


[Biological significance and interpretation of the corpulence index BMI (Body Mass Index)]. A study of the corpulence of young French men between the age of 18 and 20 has proved the existence of a biological constant between the height and the weight, bringing a new significance to the Body Mass Index. The elaboration of a new index BMC (BMI corrected), allows us to know with precision the underweight or overweight of any individual.


[Effect of interleukins and somatomedins on the production of neurotensin by cell line SH-SY5Y derived from human neuroblastoma]. The goal of this study was to investigate the regulation by insulin-like growth factors 1 and 2, and interleukins on the production of neurotensin in the SH-SY5Y cell line derived from a human neuroblastoma. Cultures were performed in RPMI1640 culture medium with heated foetal calf serum 12%. After 24 hrs. of fasting without serum, interleukins-1 alpha, IL-2, IL-4 and insulin-like growth factors 1 and 2 were added. Results showed: 1) A mitogenic effect of ILs (p < 0.001) and of IGFs (p < 0.001). 2) The presence of neurotensin in HCl0.1N cellular extracts (0.06 fmol/micrograms protein). 3) The increase of cellular neurotensin content in the presence of IL-4 (560%), IL-2 (480%), IGF-1 (610%) and IGF-2 (200%). Our results indicate that the human neuroblastoma cell line SH-SY5Y produces neurotensin and that ILs and IGFs act in vitro to modulate this production.


Fair pay and then some: how to retain your staff. It may be stating the obvious, but the bottom line is this: treat staff the way you would like to be treated yourself. Appreciate, respect, recognize and reward them. Behavior that is appreciated gets repeated. The easiest way to find out if your team is happy is to open up the channels of communication. Relieve yourself of the guesswork by asking them what they want. If you can't give them everything at once, you may be able to satisfy at least some of the items on their wish list. And when you address their needs and wants, you'll be rewarded with more loyalty and commitment than you'd ever have expected. You will be that "greener pasture" that the best and the brightest gravitate toward.


Stress factors and coping strategies in the dental profession. Stress is inherent in dental practice. Identifying stressful factors is the first step toward coping with the insidious nature of stress, as preventive measures can then be efficiently established. While numerous studies have been conducted, none of them has identified a specific stress factor that is common to all practitioners, which demonstrates the multifactorial and multidimensional aspects of dental stress.