[Vestibular evoked potentials. Diagnostic trends]. The contribution of short-latency evoked potentials to the exploration of auditory, visual and somatosensory neurosensory pathways is capital. The determination of short-latency vestibular evoked potentials has encountered many difficulties, mainly due to the necessity to find a specific, very short stimulation in order to select and synchronize the vestibular nerve fibers. Recent studies in animals have demonstrated short-latency potentials evoked by angular accelerations, linear accelerations or electric shocks on the round window. The generators of these potentials seem to be located in the vestibular nerve and nuclei. Electric stimulations of the internal ear have the advantage of providing a study of the peripheral vestibular pathways separately on both sides, while accelerations involve both vestibula, which probably makes the interpretation of data very difficult.


[Acoustic distorsion products. A systematic analysis of technical parameters. How to explain the results?]. The aim of this study was to define the most interesting parameters useful for a clinical application of acoustic distortion products (mainly, F1 and F2 primaries frequencies and levels). The most interesting F1 and F2 primaries level in order to separate subjects with a normally-hearing function and patients with a sensorineural hearing loss is 50 dBHL. This result can be explained by some physiological properties of cochlear mechanisms.


[Use of cultures of human thyroid cells in physiopathology and pharmacotoxicology]. We reconstituted functional follicles from isolated cells, after embedding in a collagen matrix. Therefore we could carry out many investigations. We showed that the cells embedded in collagen reorganized into functional follicles secreting thyroglobulin (Tg) visualised in the intra-follicular compartment, and triiodothyronine (T3) after TSH stimulation. We used these reconstituted follicles for testing several drugs, amiodarone, propranolol and some anaesthetic drugs (thiopental, midazolam and ketamine). We observed that all these drugs inhibited partially or totally, according to the dose administered, the follicular production of Tg and T3. We also found that the follicles reconstituted from thyroid Grave's tissues gave an abnormal secretion of Tg and T3. Finally we created in Rennes a human thyroid model that permits the exploration of pathologic tissues and that may be used in pharmacotoxicology.


[Place of partial nephrectomy in surgery of tumors of the kidney]. Partial nephrectomy for a small renal tumor is usually technically possible, especially in the case of polar tumors, but it does not ensure the same degree of therapeutic safety as radical nephrectomy. At the present time, it is preferable to restrict this technique to tumors in a solitary kidney, when possible, and to benign tumors and tumors less than 3 cm in subjects over the age of 50 years, when the contralateral kidney is healthy.


[Why and how to grade renal carcinomas?]. The prognosis of renal cell carcinomas has been a controversial subject for pathologists for a long time. At the present time, in addition to stage, the nuclear grade defined by Führman represents an essential element in the prognostic assessment. A renal cell carcinoma can be easily characterized by its stage and its grade, defining a precise prognosis. Specific entities such as tubulopapillary tumors, oncocytomas and chromophobe cell carcinomas must also be graded until the results of complementary studies become available allowing a better assessment of their autonomy among renal cell carcinomas.


[Oncocytomas of the kidney. Analysis of current knowledge and creation of a study group]. Typical oncocytomas are easily recognized. Nevertheless, in recent years, some cases of atypical oncocytomas much more difficult to identify, have been published in French and English medical literature. To further complicate the matter, the tumors are sometimes described as benign and sometimes as malignant. To try to clarify such discrepancies, this article will first set forth the current knowledge, and second provide the basis for a subsequent study designed to simultaneously resolve the histologic and prognostic dilemma.


[Is it useful to isolate a chromophobe cell variant among carcinomas of the kidney?]. Chromophobe cell carcinoma is a little known variety of renal cell carcinoma representing 7 to 9% of all renal tumors. This tumor is confused with either clear cell carcinoma (clear subvariety) or oncocytoma (eosinophilic subvariety). Until ultrastructural and prospective studies of the prognosis of this tumor become available, it already seems important to perform colloidal iron staining to establish the differential diagnosis between oncocytoma and chromophobe cell carcinoma.


[Cystic clear cell tumors of the kidney]. Renal clear cell carcinoma can sometimes present as: unilocular cyst; necrotic pseudocyst; multilocular cyst, resembling cystic nephroma. Diagnosis by cytology and on frozen sections is often difficult, or even impossible.


[Tubulo-papillary tumors of the kidney. A distinct entity with a discussed prognosis]. Tubulopapillary tumors of the kidney represent a group of peculiar interest with specific histological and cytogenetic features. These tumors are distinguished from other renal tumors by their more favorable prognosis.


[Urothelial tumors of the kidney].

[Urothelial tumors of the kidney]. Urothelial tumors of the kidney arise from the urothelium of the renal pelvis. Most of them are transitional cell carcinomas histologically similar to bladder carcinomas. The new staging system emphasizes the role of kidney parenchyma in the spread of the tumor. Homolateral multifocal lesions are frequent, along with bladder lesions, preceding, simultaneous with or subsequent to upper tract tumor.


[Primary epidermoid carcinoma of the kidney pelvis. Characteristics in relation to urothelial carcinomas and review of the literature apropos of a case]. Primary renal squamous cell carcinoma is rare. Its histological is not very difficult, but this case report emphasizes the most important diagnostic criteria and defines the frequency clinical course and clinical findings of these tumors.


[Bellini duct carcinoma or kidney collecting duct carcinoma]. The authors report a case of renal collecting duct carcinoma or Bellini duct carcinoma. This rare variety of renal carcinoma, which usually has a poor prognosis, is situated in the renal medulla and pyramid. It is composed of large cells similar to collecting duct cells and can be seen at a distance from the tumor. These cells are arranged in highly suggestive tubular, microcystic and papillary structures. These morphological data are compared with those reported in the literature.


[Primary carcinoid tumor of the kidney. Apropos of a case with immunohistochemical study]. The authors report a case of primary renal carcinoid in a 57-year-old woman in whom the diagnosis, established by histological findings, was confirmed by argyrophilia and immunohistochemical studies using anti-neuron-specific enolase, chromogranin A, serotonin and somatostatin antibodies. The clinical and pathological features of this rare renal tumor are discussed.


[Genetic aspects of renal tumors in adults]. The aetiopathogenesis of adult renal tumors is poorly understood. The specific chromosomal changes detected by the study of tumor karyotypes suggest a cascade of oncogene activation and tumor suppressor gene inactivation in the course of renal carcinogenesis. These cytogenetic studies have isolated two entities: non-papillary carcinomas (clear cell and/or eosinophil carcinomas) and tubulopapillary tumors (cortical adenoma, basophil papillary carcinoma). Specific changes of the short arm of chromosome 3 are observed in 70 to 85% of cases of clear cell carcinomas, while trisomy 17 is detected in 70% of cases of tubulopapillary tumors. Cytogenetics is also able to distinguish low and high grade malignant tubulopapillary carcinomas. Limited data are available at the present time concerning oncocytomas.


[Analysis of DNA of renal cell carcinomas by flow cytometry]. Flow cytometry DNA analysis of fragments of fresh or paraffin-embedded tumor was performed in order to investigate its prognostic value in renal cell carcinoma. As aneuploidy is a frequent cytogenetic finding of these cancers, it is not surprising that the literature reports a high incidence of anomalies of DNA content, affecting 2/3 of cases studied. DNA aneuploidy is more frequent in advanced stages, high grades and spindle-cell carcinomas. Its prognostic value in terms of the survival of nephrectomized patients has been demonstrated by unifactorial studies. Several studies using Cox's model have demonstrated its independence of stage and grade, but they are too limited for DNA ploidy to be considered to be an element of the therapeutic decision. In contrast with other sites, the prognostic influence of the proliferation evaluated by S% does not appear to be as important as DNA ploidy. Prospective studies comparing these results should take into account the tumor heterogeneity observed in this type of cancer by analysing, for example, several fragments of the same tumor.


[Rhabdoid tumor of the kidney].

[Rhabdoid tumor of the kidney]. The clinical and pathological features of a rhabdoid tumor of the kidney in a 4 month boy are presented. The precise diagnostic criteria (light and electron microscopy, immunohistochemistry) of this rare and usually unresponsive and rapidly fatal tumor are underlined.


[Production of griseoviridin and etamycin by the new culture, Streptomyces albolongus]. An actinomycete strain designated as 4297 was isolated from a soil sample collected near Moscow. The strain produced a complex of two antibiotics. One of them had a broad antibacterial spectrum and, in terms of its physicochemical properties and X-ray structural evidence, was identified with griseoviridin. The other was active against gram-positive bacteria and, by its chromatographic comparison with an authentic sample, mass spectroscopic determination of the molecular weight and UV spectra, was identified with etamycin. The strain 4297 differed from the described cultures producing griseoviridin and etamycin. By the taxonomic features it was classified as belonging to Streptomyces albolongus.


[Resistance of the strain Streptomyces hygroscopicus 155 to autogenous and other antibiotics]. Streptomyces hygroscopicus 155, a strain producing pandavir (nigericin) and azalomycin, was studied with respect to resistance to its own and some other antibiotics i.e. tetracycline, gentamicin, streptomycin, erythromycin, tylosin, thiostreptone, benzylpenicillin, monensin and salinomycin. An inactive variant of the culture was used in the control.


[Preparation and regeneration of protoplasts of the strain Streptomyces hygroscopicus 155]. Protoplasts of Streptomyces hygroscopicus 155 producing nigericin, a polyether antibiotic, were prepared. Conditions for protoplasting and optimal concentrations of lysozyme and glycine, and the age of mycelium were studied. With the method of the experiment design, concentrations of four components: CaCl2, MgCl2, KH2PO4 and TES buffer in the regeneration medium were determined. The levels of CaCl2 and TES buffer proved to be the most important parameters.


[Selection of Penicillium chrysogenum--producer of penicillin with several valuable technologic features]. The efficiency of the routine methods for improvement of P. chrysogenum providing specific selection by several features with testing one of them was studied. A new highly potent strain of P. chrysogenum producing phenoxymethylpenicillin was isolated. The strain is characterized by a shorter fermentation cycle, lower viscosity of the fermentation broth and capacity for synthesizing 32,600 units/ml of phenoxymethylpenicillin under industrial conditions (in a lactose medium) by the 97th hour of the cultivation in fermenters with energy consumption of 1.3 kW. The increased amylolytic activity of the strain and the decreased viscosity of the fermentation broth provided using of the fermentation media containing 3.5 per cent of corn meal.


[Immunomodulating action of peptidoglycan of microbial origin]. The action of a high molecular weight peptidoglycan produced by Agrobacter radiobacter sp. on the functional activity parameters in leukocytes and macrophages i. e. chemotaxis and adhesion was studied. It was shown that the peptidoglycan had a stimulating action on the chemotaxis of cells of the peritoneal exudate. A marked stimulating action of the drug on the primary immune response to the tissue antigen of sheep erythrocytes was observed. The peptidoglycan stimulated the antibody titers and delayed hypersensitivity when administered in various periods after an antigenic stimulus. Multifactorial experiments on the protective action of the peptidoglycan in experimental infections were carried out. Second-order polynomial statistic models characterizing the animal survival rate were constructed and the dose-time parameters of the drug use were optimized.


[Inactivating action of bacteria on the lipolytic activity of solizyme and its prevention by antibacterial drugs]. Bacteria capable of producing exoproteases were isolated from intermediate products of microbial lipase. The proteolytic enzymes produced by the bacteria were able to inactivate 20 to 80 per cent of the lipase depending on the time of incubation, protease production by the contaminating microbe and the experimental conditions. Antibiotics and antiseptics inhibiting growth of bacteria prevented or limited their inactivating action on lipase. Except catamine, the tested antimicrobial drugs as such had no effect on lipase activity.


[Sensitivity of microflora isolated in the process of preparing solizyme to antimicrobial drugs]. Microorganisms isolated from intermediate products of microbial lipase (solysime) and auxiliary raw materials, reagents and water used in the production of the enzyme belonged to diverse taxonomic groups. They were mainly susceptible to antibiotics (aminoglycosides, rifampicin, chloramphenicol and others) as well as to antiseptics and chemotherapeutics. However, certain isolates were moderately resistant to some of the antimicrobial agents (they were more frequent among Pseudomonas spp.). The bacteriostatic action of many of the drugs was more pronounced than the bactericidal one. It was especially evident after increasing of the microbial load (from 10(5) to 10(8) CFU/ml). At a temperature of 10 degrees C against 37 degrees C the susceptibility of the cultures to the bactericidal action of the drugs usually decreased.


[Resistance of hospital strains of microorganisms to antibiotics and antiseptics]. The development of resistance of collection and freshly isolated S. aureus and C. albicans strains to the antiseptic decamethoxim and an original diarylcyclohexane derivative was studied comparatively in vitro. It was shown that the rate of the resistance development was low. After 20 subcultures in the presence of increasing concentrations of decamethoxin, its sensitivity of S. aureus and C. albicans decreased 16-32 and 16-fold respectively. After 20 subcultures in the presence of increasing doses of the diarylcyclohexane derivative, its sensitivity S. aureus and C. albicans decreased 4- and 4-8-fold, respectively. It was found that in the hospital strains of S. aureus and C. albicans, the antibiotic resistance and sensitivity to decamethoxin and the diarylcyclohexane remained high, which indicated that there was no cross resistance to these compounds in the strains studied.


[Conjugative R plasmids isolated from hospital strains of Pseudomonas aeruginosa]. It was shown that Pseudomonas aeruginosa hospital strains isolated from patients and environment in the Republican Centre of Burns in Tbilisi contained conjugative R plasmids. The plasmids were marked pM15 and pM19, respectively. The plasmid pM15 determined resistance to carbenicillin, kanamycin and tetracycline and plasmid pM19 determined resistance to carbenicillin, kanamycin, tetracycline, chloramphenicol, gentamicin and streptomycin. Plasmid pM15 had a molecular weight of 45.8 MD and seven sites for EcoRI, six sites for HindIII and five sites for Hpa-I-restrictase. This plasmid, as others, belongs to the Inc-P1 incompatibility group.


[Immunomodulating properties of various microbes--representatives of normal intestinal microflora]. The impact of oral administration of heat-killed bifidobacteria, lactobacteria, enterococci and bacteroides on mouse resistance to experimental salmonellosis and content of immunoglobulin-synthesizing cells in the proper plate of the small intestine was studied. It was shown that the administration of the killed bifidobacteria, lactobacteria and enterococci increased the animal resistance to experimental salmonellosis infection and induced an increase in the content of immunoglobulin-synthesizing cells in the proper plate of the small intestine. The administration of the killed bacteroides had no such effect. Possible development of bacterial preparations with immunomodulating properties based on killed bifidobacteria, lactobacteria or enterococci is discussed.


[Combined action of doxycycline and mytilan on the immune response to tularemia antigen]. Combined action of doxycycline and mytilan, a natural polysaccharide, on the primary immune response to the antigen of the tularemia vaccinal strain in CBA mice was studied. The polysaccharide was used to compensate the immunosuppressive effect of doxycycline high doses on the humoral immune response. The maximum stimulation of the antibody titers as compared to the controls (more than 250 per cent) was observed when mytilan was administered simultaneously with or prophylactically 3 days prior to the antibiotic in doses of 2.5 and 25 mg/kg. The use of mytilan in combination with doxycycline high doses made it possible to compensate the antibiotic-induced decrease of DTH and even to stimulate it as compared to the controls. The highest levels of DTH (150 per cent against the control) were observed when mytilan was administered prophylactically in doses of 2.5 and 11.25 mg/kg 3 days prior to immunization. Mytilan had the highest stimulating effect on antibody production. The combined use of doxycycline and mytilan was characterized by significant stimulation of antibody production and DTH when the dose/time regimens were rational.


[Ciprofloxacin and other antimicrobial drugs in the treatment of disseminated peritonitis]. Forty two patients with general peritonitis were treated with ciprofloxacin and combinations of various antimicrobial drugs. Ciprofloxacin had the highest effect on aerobic and anaerobic microbes in the peritoneal cavity which defined the favourable clinical results in all the patients. Moreover, there were observed no disorders in the composition of the normal intestinal microflora which in the end promoted a decrease in the number of the patients with suppuration of the surgical wound.


[Comparative effectiveness of antimicrobial action of antiseptics against pathogens of chronic purulent otitis media]. Comparable antimicrobial and disinfecting action of decamethoxine and silver preparations on pathogens of chronic purulent otitis media (CPOM) was studied. The clinical isolates of staphylococci proved to be most sensitive to decamethoxine whose MBcC conformed to 16.5 micrograms/ml. The antimicrobial action on Proteus spp. and Pseudomonas aeruginosa was less pronounced. The required concentrations for bactericidal action on these pathogens were 69 and 93.5 micrograms/ml, respectively. The antimicrobial activity of the silver preparations such as poviargol, collargol and protargol was low. Depending on the microbial species, the bactericidal effect of the silver preparations was 12-235 times lower than that of decamethoxin. It was also shown that decamethoxin had a high disinfecting action on CPOM pathogens. It was noted that decamethoxin had a marked ability to increase the bactericidal action of poviargol (by 2-14 times) and its disinfecting action (by 2 times) on Proteus spp., E. coli and Ps. aeruginosa.


[Effect of antibiotics on the absorption of basic nutrients]. The impact of tetracycline, gentamicin, streptomycin, erythromycin, oxacillin, benzylpenicillin and sulfanilamides on the absorption function of the small intestine was studied in 79 patients with chronic bronchitis. The drugs were shown to mainly inhibit fat absorption: on the average, by 87 per cent in all the patients treated with tetracycline, on the average, by 89 and 36 per cent in 80-70 per cent of the patients treated with gentamicin and streptomycin, respectively, and, on the average by 26 and 16 per cent in 20-25 per cent of the patients treated with erythromycin and oxacillin, respectively. The absorption of protein decreased, on the average, by 23-74 per cent in all the patients treated with tetracycline, gentamicin and streptomycin. As for the other drugs, they had, on the average no significant effect on protein absorption. The absorption of carbohydrates (d-xylose) significantly decreased under the effect of these three drugs (by 21, 34 and 36 per cent, respectively). The analysis revealed a relation of absorption function to the presence and degree of intestinal dysbacteriosis.


[Indications for coronarography and coronary angioplasty during the 1st week after myocardial infarction]. There is little data available on the precise indications of coronary angiography and myocardial revascularisation during the first week after myocardial infarction. Mechanical complications (subacute rupture, ventricular septal defect, ruptured mitral chordae), usually require emergency surgery: when the patient's haemodynamic status permits, preoperative coronary angiography is desirable. Recurrent ischaemia may be treated by urgent coronary angiography--dilatation; nevertheless, the results of this type of procedure are associated with high mortality and morbidity and it would seem better practice to start with repeat intravenous thrombolytic therapy: coronary angiography can then be performed in a less acute situation with a view to angioplasty. Finally, in most cases of uncomplicated infarctions, functional investigations such as exercise stress testing coupled with radioisotopic methods, may be usefully performed before coronary angiography to demonstrate any residual ischaemia justifying a myocardial revascularisation procedure: under these conditions, it seems more realistic to envisage coronary angiography 8 to 10 days after the initial coronary event.


[How to and why evaluate the ischemic risk after myocardial infarction?]. After uncomplicated myocardial infarction, clinical and ergometric data before hospital discharge allow identification of patients at high risk of further cardiac events. These relate to the necrosed myocardium (left ventricular dysfunction, sometimes latent, and arrhythmia risk), and also to the jeopardized myocardium: the moderate sensitivity and specificity of classical exercise stress testing for the detection of this often silent ischaemia are much improved by stress radionuclide and echocardiographic techniques (exercise, dipyridamole, dobutamine. . .), the large scale indications of which remain to be validated.


[How to evaluate the hemodynamic risk after myocardial infarction?]. The hemodynamic prognosis of myocardial infarction is determined, at medium and long term, by the function of the left ventricle. This is related to the infarct size, the dilatation and geometry of the ventricle secondary to left ventricular remodeling which often follows infarction. In addition to clinical criteria, the hemodynamic parameters which are essential for patient evaluation are the ejection fraction (by radionuclide or conventional ventriculography), rapidly progressive ventricular dilatation (by repeated echocardiography) and circulatory reserve from the exercise stress test data.


[How to evaluate the arrhythmogenic risk after myocardial infarction?]. The risk of sudden arrhythmic death after myocardial infarction is high, especially during the first months. The evaluation of this risk should be performed before hospital discharge in the same way as residual ischaemia and left ventricular function, which are independent risk factors for arrhythmia, are assessed. Holter monitoring provides information not only about ventricular hyperexcitability (especially the detection of unsustained ventricular tachycardia) but also about the activity of the autonomic nervous system by analysis of variations of the sinus rhythm, the decrease of which carries a poor prognosis. The search for an arrhythmogenic substrate requires signal averaged electrocardiography, but although the absence of late potentials carries a good prognosis, the positive predictive value of this investigation is very low. The association of non-invasive indices of poor prognosis greatly increases the probability of a major arrhythmic event; this may require consideration of programmed ventricular pacing, another method of substrate and risk assessment, which has the added advantage of sometimes indicating the most appropriate therapy.


[Rehabilitation centers: for whom? Why and how long?]. The clinical profile of coronary patients admitted to cardiac rehabilitation centres after myocardial infarction has changed considerably in the last 15 years. Complementary investigations (coronary angiography, studies of left ventricular function) provide accurate information which improves the process of rehabilitation. Global management of the coronary patient requires and justifies, especially in young adults, taking into consideration the physical, psychological and socio-professional consequences of a myocardial infarction. The indications of rehabilitation are much more comprehensive nowadays. Even patients with significant haemodynamic impairment can benefit from a stay in a specialised centre. Contraindications are usually only temporary. Finally, an enquiry performed in 33 French cardiac rehabilitation centres shows large variations in methods, personnel and organisation. However, as a general rule, a 3 week stay seems to be adequate but it is logical to continue rehabilitation when the patients goes home to pursue and maintain at long term the results obtained on discharge from a specialised centre.


[Treatment of risk factors of coronary atherosclerosis]. The treatment of coronary atherosclerosis risk factors is an essential part of secondary prevention of myocardial infarction. This should be started during the acute phase. Hypercholesterolemia is the principal causal factor and the occurrence of an infarct does not change the relative cardiovascular risk attributable to this factor. The absolute risk, positively correlated to total and LDL cholesterol and negatively to HDL cholesterol, is increased after myocardial infarction because of the higher prevalence of lethal or non-lethal ischemic cardiac events. The benefits of cholesterol reduction on cardiovascular mortality have been clearly established. They are greater with cholesterol-lowering drugs than with diet alone, and all the more significant when the initial cholesterol levels are high, but they are present at every value. A 1% reduction in total cholesterol is associated with a 2.5% reduction in coronary mortality both in secondary and primary prevention. After infarction, the cardiovascular benefits greatly exceed the risk of overmortality from other causes. Therapeutic effects may also be demonstrated by non-progression or regression of stenotic coronary lesions. The benefits of hypertension control are not as evident. Diastolic blood pressures inferior to 85 mmHg are associated with an increased coronary risk. While waiting for the results of specific therapeutic trials, reduction of high blood pressure without excessive lowering of the diastolic pressure is recommended. Stopping smoking is a measure of primary prevention which reduces the number of acute coronary events and of sudden deaths. However, the correlation with atherosclerosis is not remarkable. Treating diabetes, sedentarity and psychological behaviour seems to be useful. An evaluation of a personalized multifactorial approach to individual risk should be performed.


[Role of antithrombotic agents after myocardial infarction]. Thrombosis is the causal mechanism of myocardial infarction: severe atherosclerotic narrowing, ulceration of the atherosclerotic plaque and disequilibrium between pro and antithrombotic factors, predispose to this complication. Recurrent myocardial infarction is a common complication in the year following an initial event: the risk is higher when the diseased artery has been recanalized in the acute phase. Reocclusion of the recanalized artery without signs of infarction is also a common occurrence. It was therefore logical to have striven over the years to prevent reinfarction and/or rethrombosis after reperfusion. Mechanical methods have not been crowned with resounding success and antithrombotic drugs are the only products associated with real benefits in this prevention. In this article, the authors review the efficacy of aspirin and vitamin K antagonists in the prevention of recurrent myocardial infarction; the data in favour of an efficacy of aspirin in preventing early reinfarction is also analysed; finally, results suggesting a benefit of platelet antiaggregant therapy (Flurbiprofen or aspirin) on the risk of reocclusion after therapeutic recanalisation are also assessed.


[Prevention of postinfarction cardiac insufficiency: role of angiotensin converting enzyme inhibitors]. Cardiac failure remains a serious complication of myocardial infarction. In addition to therapeutic interventions to limit the infarct size, it would seem possible to influence the progressive changes in geometry and size of the left ventricle, known as remodeling. Experimental and clinical studies have shown beneficial effects of angiotensin converting enzyme inhibitors and the SAVE trial evaluated the prognostic consequences of this therapy, reporting a significant reduction in mortality after 10 months' treatment. Many questions remain which require further research in this field, mainly concerning the optimal time of introduction the treatment, the importance of the chemical molecule used, the most appropriate dosage and the influence of associated drug therapy. ACE inhibitors are now part of the therapeutic arsenal of myocardial infarction but their prescription should be strictly reserved for the population concerned by these trials, that is to say patients with a recent, extensive infarct with left ventricular dysfunction but without clinical signs of cardiac failure.


[Myocardial infarction beyond the 48 first hours: treatment with calcium channel antagonists]. Calcium channel blocking agents prevent calcium entering cardiac and smooth muscle cells. With reduction of the blood pressure, heart rate and myocardial contractility, they reduce myocardial oxygen demand. By relieving spasm and coronary constriction, and dilating the collateral coronary vessels, they improve perfusion of the ischemic zones. The results in experimental infarction are contradictory: the reduction in the infarct size and ischaemia is not constant. In the Myocardial Infarction Study, a trial of lidoflazine in 1792 subjects followed up for an average of 5 years, there was no significant difference between the mortality rates of the two groups. In the Danish Verapamil Infarction Trial I, which included 436 subjects receiving 360 mg/day of verapamil or placebo, the 6 months mortality was less (NS) in the verapamil group (12.8%) than in the placebo group (13.9%) as was the reinfarction rate (7.8% versus 9.2%; NS). In the DAVIT II trial of 1775 subjects, treatment was introduced 9 +/- 2.7 days after admission. Mortality was lower (NS) in the verapamil group (11.1%) than in the placebo group (13.8%) and the recurrences were less common (p = 0.04) in the treatment group (11.0%) than with placebo (13.2%). The Secondary Prevention Reinfarction Israeli Nifedipine Trial is a comparison of Nifedipine 30 mg/day and placebo introduced 7-21 days after infarction in 2276 subjects. After 10 months, the mortality and reinfarction rate were similar in both groups, as in the SPRINT II trial (60 mg/day of nifedipine or placebo) at 6 months. In the Multicenter Diltiazem Postinfarction Trial of 2466 patients, Diltiazem 240 mg/day or placebo was administered 3 to 15 days after infarction.(ABSTRACT TRUNCATED AT 250 WORDS)


[Psychological aspects of short-term follow-up in myocardial infarction]. The author analyses the outcome and emotional repercussions of myocardial infarction in the patient, his or her partner, and of the medical team who manages the infarct (coronary care and cardiac rehabilitation). The adaptive value of certain psychological attitudes is emphasised, for example the denial of illness, and the poor prognosis associated not so much with "type A" behaviour reputed to cause coronary disease but more with post-infarction depression or even with a more stable tendency to hostility in the emotional control. Some of these psychological characteristics may explain the difficulties encountered in designing educative programmes or in poor therapeutic observance by patients despite being aware of the risks they run. These considerations led to therapeutic implication ranging from the strategy of communication with the coronary patient to specific relaxation techniques or with help, to the gestion of stress, to the judicious prescription of psychotropic agents.


[Return to work after myocardial infarction: evaluation and decision]. Working capacity after myocardial infarction depends on the physical and cardiovascular status, psychological repercussions and conditions of work. The latter two are much more important than the first two factors. Cardiovascular functional status is readily assessed by the large number of available investigations which leave little unknown. Exercise stress testing during the second week is the most cost-efficient investigation, providing reliable and sufficiently quantifiable data about the possible sequellae of cardiac failure on effort, ischemia and arrhythmias: an idea of the patient's functional capacity and circulatory responses (athletic, hyperkinetic) may also be obtained allowing adjustment of treatment to improve exercise capacity which goes much further than the statistical hope of prolonging survival. However, it would be naive to think that a satisfactory exercise stress test guarantees the patients' capacity to return to work. Psychological and sociological factors are more important by far. The dominant trait of the post-infarction psychological syndrome must be identified (anxiety, depression, negation): the positive and negative influences of the family, social and professional environment must be evaluated. A good knowledge of the patient's working conditions is essential to go against a number of taboos hindering the return to work (stress, stairs, restaurant meals, etc...). Finally, the medico-legal relationship between the infarct and work should not be neglected: the management of myocardial infarction when an occupational disease must respect the legislative and judicial texts which do not always correspond with everyday clinical practice. There is a lack of structures for cardiac function testing for assessing physical aptitude: we suggest that in the context of the proposed hospital reforms, departmental heads should consider setting up such units which would have a specific task respecting the spirit of these reforms. Nevertheless, cardiologists should pay more attention to the convalescent phase of infarction. This is the time when many social catastrophes can be avoided.


[Immunity to and incidence of measles in a population of Parisian children]. Measles remains prevalent in France despite the development of nationwide vaccination program. This study evaluates measles immunity and correlates it with active immunization. A total of 250 (131 boys and 119 girls) French children, aged 2 to 15 years, seen as outpatients in our hospital, were studied from 1.01.90 to 1.06.91; 133 had received live measles vaccine during the 2nd year of life, the 117 others were not vaccine-protected. Evaluation included medical records, specially those concerning past-history of measles or measles-like diseases and immunizations. Measles IgG and IgM antibodies (ELISA) were looked for in all 250 children. 102 of the 117 children who were not vaccine-protected had a detectable antibody titer. 42 of these 102 had a history of measles, before the age of 5 years in 30, between 5 and 10 years in 9 and after the age of 10 years in 3. Only 4 of the 70 children aged over 10 years and not vaccine-protected had no detectable antibodies. 131 of the 133 actively immunized children had detectable antibodies. Measles is probably more frequently subclinical than was believed until now. Its relative frequency in France in children who had not received the live vaccine explains the high percentage of those aged over 10 years who had detectable antibodies and the relatively low incidence of the disease in teenagers and young adults.


[Enteropathy in premature newborn infants. Prospective study over one year]. In neonatal units, there is a tendency to assume that any acutely sick infant with gastro-intestinal symptoms has necrotizing enterocolitis (NEC). This prospective study was conducted to find a better definition of enteropathy in preterm neonates and their risk factors. All the 351 preterm neonates admitted to a neonatal unit from 1 August 1988 to 31 July 1989 were included in the study. A chart including 45 items was established for each infant, with special attention to data on the pregnancy, delivery, any early ischemic and/or infectious problem, nutrition and any gastro-intestinal (GI) problem. All the neonates were fed similarly, depending their maturation, gestational age and GI status. Each infant was assigned to one of 5 categories: 1) no GI problem; 2) transient obstruction; 3) NEC with pneumatosis; 4) hemorrhagic colitis without obstruction or pneumatosis; 5) other GI disease. 267 infants had no GI problem during their stay in the neonatal unit. 53 developed GI symptoms: 23 transient obstructions, 6 NEC, and 24 hemorrhagic colitis. The mean age at onset of symptoms in these last 3 categories was 7 days, 14 days and 23 days, respectively. Ten risk factors were found to be significantly correlated with GI disturbances: umbilical venous catheter, benzodiazepines, birth weight < 1,500 g, patent ductus arteriosus, ventilatory assistance, abnormal amniotic fluid, gestational age < 32 weeks, early antibiotic treatment, passage of meconium > 48 hours, episodes of apnoea and/or bradycardia. This follow-up shows that the GI disturbances of preterm neonates admitted to a neonatal unit, specially those having one or more risk factors, can be separated into 3 groups: 1) isolated intestinal obstruction, seen in the most immature babies during the first week of life with the risk of developing NEC; 2) frank blood in the stool, indicating colitis and possibly minor forms of NEC; 3) combined obstructive and hemorrhagic symptoms, typical of NEC.


[Comparison of measurements of cholesterol, glucose and uric acid taken at 5-year intervals in children and adolescents]. There are several reports on cardiovascular disease risk factors but, except for lipids and lipoproteins, there have been few studies tracking blood uric acid and glucose in healthy school children. Blood specimens were collected from 4,299 children and adolescents for determination of cholesterol, uric acid and glucose. The first samples were collected between 1977 and 1979 from subjects aged 4 to 17 years. The second samples were collected 5 years later. The blood glucose concentrations increased before the age of 10 years; those of uric acid increased during the second decade and those of cholesterol decreased during puberty, to a greater degree in boys. Hypercholesterolemia (cholesterol > 5.9 mmol/l) was found in about 6% of boys and 10% of girls. Eight boys and 3 girls had blood glucose concentrations higher than 6.7 mmol/l at the first collection. 5 years later, the correlation coefficients by sex and by cross section of age were greater than 0.5 for cholesterol and uric acid and were about 0.3 for glucose. Successive blood values of glucose and uric acid are highly correlated; those of cholesterol are more highly correlated. However, the probability of remaining in the same percentile distribution remains below 50% for subjects whose initial values were above the 80th percentile.


[Regressive myelodysplastic syndromes in children. Committee on Childhood Myelodysplasia of the Society of Pediatric Hematology and Immunology]. As in adults, myelodysplastic syndromes in children are often preleukemic and their spontaneous remission is exceptional. Case 1. A girl, aged 8 years, developed pancytopenia with macrocytic anemia. The myelogram and bone marrow biopsy showed dyserythropoiesis with macroblastosis, but without sideroblasts. The chromosome configuration was normal and the negative results of other investigations led to the diagnosis of refractory anemia without any known cause. Bone marrow transplantation was considered, but a spontaneous remission intervened and has persisted for 3 years. Case 2. A girl, aged 5 years, was investigated for worsening of a macrocytic anemia that had been present for 3 years, without changes of granulocytes and platelets. The myelogram showed dyserythropoiesis with megaloblastosis and sideroblasts. No known cause could be identified. As for the preceding patient, a spontaneous remission occurred, and has persisted for 3 years. Case 3. A girl, aged 5 months, developed pancytopenia. The myelogram showed dys-megakaryocytopoiesis. All hematologic data spontaneously normalized after 1 year, and have remained so 1 year later. The spontaneous remission, that has occurred in our 3 patients, has been reported in one only adult. This possibility precludes considering all the myelodysplastic syndrome in children as preleukemic, and suggests that bone marrow transplantation is not urgent in these situations.


[Infantile spasms associated with a brain tumor]. Infantile spasms are exceptionally associated with a focal cerebral lesion such as a brain tumor. A 15 month-old girl was treated with hydrocortisone and valproic acid for infantile spasms that had appeared a few days earlier. Her psychomotor development was considered normal and the CT scan was normal. Clinical symptoms disappeared within 10 days and the EEG became normal except for a few epileptiform discharges in the frontal areas. The girl developed partial seizures at the age of 5 years. Imaging techniques showed a brain tumor in the right frontal lobe. Surgical excision was followed by radiation therapy. Analysis of the tumor showed an astrocytoma. The girl is normal 18 months after intervention. It is difficult to determine a relationship between the infantile spasms and the brain tumor in this case. The moderately asymmetrical pattern of the EEG after infantile spasms, the fact that these spasms appeared relatively late and the persistence of discharges, lead to repeated specialized investigations.


[Neonatal gastric necrosis].

[Neonatal gastric necrosis]. Neonatal necrotizing gastritis is rare. It is usually a complication of acute anoxia or shock and its diagnosis is essentially radiological. Case no. 1: a boy was born at the 36th week of a pregnancy complicated by preeclampsia. Perinatal asphyxia necessitated delivery by cesarean section. He presented with neonatal respiratory distress which was complicated by pneumothorax. On the 5th day of life, the abdomen was distended and the newborn had still not been fed. On the 6th day, X-rays showed pneumatosis of the gastric wall associated with pneumoperitoneum. Surgery showed an area of necrosis on the posterior surface of the stomach with a small perforation, which was stitched. The child was fed 5 days later and was in good condition at the age of 6 months. Case no. 2: a girl was born at the 35th week of a pregnancy complicated by asthma during the second trimester. Perinatal asphyxia and abnormal fetal rhythm led to delivery by cesarean section. At 24 hour of life, she vomited blood and fibroscopy confirmed the presence of blood in the stomach. On the 3rd day, blood vomiting appeared again, associated with abdominal distension. X-rays showed pneumatosis of the gastric wall; fibroscopy showed necrosis of the lower 2/3 of the stomach. Feeding was stopped and the child was given cimetidine. Refeeding was possible when the girl was 10 days old, and she was in good condition at the age of 6 months. Neonatal gastric necroses and necrotizing enterocolitis have many similar features. Medical therapy is often effective, but surgery is mandatory when necrotizing gastritis is complicated by perforation.


[Antenatal bilateral sylvian infarction and congenital syphilis]. The classical symptoms of congenital neurosyphilis include meningovascular lesions that are responsible for CSF abnormalities. Lesions of larger vessels are very unusual. A boy was born from a neglected pregnancy, weighing 2.7 kg. He was abandoned by his parents and was admitted to hospital at 40 days of age (weight: 2,220 g; height: 47 cm; head circumference: 22 cm) with axial hypotonia, peripheral spasticity and shock syndrome. The TORCH screen was negative but the Treponema Pallidium Hemagglutination Assay (TPHA) was positive. The infant died 4 days later. Brain pathological studies revealed meningoencephalitis and bilateral sylvian infarction. Local arteritis due to syphilis usually concerns small arteries, such as the meningeal and cortical vessels. The occlusion of the two middle cerebral arteries seen in this patient, which were responsible for atrophy of the parietal lobes, is uncommon in congenital syphilis.


[Severe form of neonatal hemolytic disease by anti-Vel allo-immunization]. Routine detection of maternal sensitization during pregnancy sometimes reveals alloimmunization by exceptional antigens. A first pregnancy was complicated by a severe post-partum anemia in the mother, that required a blood transfusion. Irregular agglutinins were detected during the first trimester of a second pregnancy, for which the father was different from the first. The specific antibody was not identified at that time. The newborn, born at a gestational age of 39 weeks, developed severe jaundice at 3 hours of life, with hemolytic disease, anemia and hepatomegaly. Therapy included two transfusions of packed, washed red cells obtained from the mother on days 7 and 25. Immunologic tests showed that the hemolytic disease of this newborn was due to an anti-Vel alloimmunization. Antibodies detected during the pregnancy must be identified in order to manage properly any perinatal problems due to rare antibodies.


[Cerebral embolism revealing aneurysm of the interauricular septum]. Aneurysm of the interatrial septum is a potential cause of systemic embolism, but it is rarely responsible for a cerebral embolism in childhood. A girl, aged 14 years, presented with a sudden right hemiplegia. The coagulation factors were normal, as was the CSF. The CT scan was normal and the EEG showed some theta waves (3-4/s) on the left temporal lobe. MRI, performed 6 days later, showed ischemic lesions leading to a search for the origin of the embolism. One-dimensional echocardiography revealed no abnormality, but two-dimensional echocardiography showed an aneurysm of the interatrial septum bulging into the right atrium. The child was treated with low doses of acetylsalicylic acid, but still had a moderate degree of spastic hemiplegia one year later. Cardiopathies can be among the causes of cerebral embolism in children. An aneurysm of the interatrial septum requires treatment throughout patient's life.


(R)-(-)- and (S)-(+)-adenallene: synthesis, absolute configuration, enantioselectivity of antiretroviral effect, and enzymic deamination. Synthesis of optically pure (-)- and (+)-adenallene 2 and 3 is described. Racemic adenallene (1a) was subjected to deamination with adenosine deaminase monitored by HPLC using a Chiralcel CA-1 column to give (-)-adenallene (2) and (+)-hypoxallene (4). The latter compound was converted to acetate 5. The reaction of 5 with trifluoromethanesulfonic anhydride and pyridine followed by ammonolysis furnished acetate 6 or (+)-adenallene (3) depending on the solvent used in the last step. Acetate 5 was smoothly transformed to the 6-chloro derivative 7, but an attempted ammonolysis led only to racemization and decomposition. Single crystal X-ray diffraction established the R-configuration of (-)-enantiomer 2. The latter forms a pseudosymmetric dimer in the lattice with the adenine moiety in an anti-like conformation. The torsional angles of the allenic bonds show departures from 90 degrees (91 and 97 degrees, respectively) and rotameric preference of the hydroxymethyl groups is different in both molecules of the dimer. The R-enantiomer 2 inhibited the replication and cytopathic effect of human immunodeficiency virus (HIV-1) in ATH8 cell culture with an IC50 of 5.8 microM, whereas the S-enantiomer 3 was less active (IC50 > 200 microM). The enantioselectivity of the anti-HIV effect is significantly lower than that of 2',3'-dideoxyadenosine. Kinetics of deamination of R- and S-enantiomers 2 and 3 catalyzed by adenosine deaminase gave the following parameters: Km values of S-form 3 and R-form 2 were 0.41 and 0.52 mM with Vmax being 530 and 18.5 mumol/min, respectively [corrected]. Again,, a much lower level of enantioselectivity of deamination was observed than that of D- and L-adenosine. These results indicate (i) different enantioselectivity of enantiomers 2 and 3 as HIV inhibitors and adenosine deaminase substrates and (ii) both R- and S-enantiomers 2 and 3 can function as nucleoside analogues with varied enantioselectivity for different enzymes or receptors.


Intra-individual variability of caffeine elimination in healthy subjects. Caffeine is a popular test substance for assessing the activity of hepatic drug metabolizing enzymes in vivo and in vitro. A correct estimation of the relative magnitudes of intra-individual and inter-individual variations in caffeine elimination is significant for the use of the elimination parameter of caffeine to characterize the biotransformation capacity of a specific form of cytochrome P-450 (1AII) in vivo. The purpose of this study is to demonstrate the magnitudes of fluctuation of caffeine-clearance and half-life as well as inter- and intra-individual comparison in 12 healthy male subjects. Compared to the high reproducibility of caffeine decay curves in each healthy male, caffeine elimination varied more extensively between subjects. The distribution of variance amounted to: intra-individual 21.4%, inter-individual 78.6%. The knowledge of variance provided precise evidence of the sample size, which is necessary to prove previously defined differences.


High frequencies in African and non-African populations of independent mutations in the mannose binding protein gene. We have previously identified, in three British families having an index child with frequent infections, a point mutation (GGC-->GAC) in codon 54 of exon 1 of the gene for the human lectin mannose binding protein (MBP). This was associated with low serum levels of this complement activating protein and would be anticipated to impair opsonization of mannose rich microorganisms. We now report a second point mutation (GGA-->GAA) in Gambians from West Africa, involving codon 57 of exon 1. By substituting carboxylic acids for axial glycines in the translated proteins both mutations would be expected to disrupt the secondary structure of the collagenous triple helix of the 96 kDa MBP subunits. In the Gambians the codon 57 mutation was studied by PCR, sequence analysis and restriction analysis and found to be remarkably common (frequency of the mutant gene 0.29 in adults and 0.23 in newborns) whereas the codon 54 mutation was very rare (frequency 0.003). However, the codon 54 mutation was frequent in both a British Caucasian and a Hong Kong Chinese population (frequency of the mutant gene 0.17 and 0.11 respectively). It was predicted that both homozygous and heterozygous individuals would have profoundly reduced serum levels of the protein and this was confirmed by immunoassay as was the reduced capacity of such sera to activate complement through the MBP initiated classical pathway. Our data indicate that the two mutations have arisen independently since the divergence of African and non African populations and both have attained high frequencies.


Microleakage of amalgam restorations using Amalgambond and Copalite. This study compared the effect of using either Amalgambond as a cavity liner or Copalite in the reduction of microleakage in amalgam Class V restorations. Both retentive traditional and non-retentive cavity preparations were compared with gingival cavosurface margin locations both in enamel and in dentin. Cavity preparations were restored with their appropriate liner, thermocycled, and stored in erythrosin red stain for 10 days. The samples were then sectioned and degrees of microleakage determined. Statistical interpretation with the Wilcoxon test showed that microleakage was significantly greater (alpha = 0.05) with the non-traditional cavity design and with cavity margins located in dentin. The results also showed that Amalgambond as a cavity liner significantly reduced microleakage when compared to Copalite.


Effect of a fluoride solution on dentinal hypersensitivity. This two-phase experiment assessed the effects over time of a solution containing 1.09% sodium fluoride, .40% stannous fluoride, and .14% hydrogen fluoride (.717% fluoride solution, DentinBloc) on pain associated with dentinal hypersensitivity. During phase I, 30 subjects demonstrating dentinal hypersensitivity to a blast of cool air were divided into three double blind experimental groups. After baseline data were collected for all subjects, one group was instructed to apply the .717% fluoride solution twice a day. A second group was instructed to apply a gel containing .04% stannous fluoride (Gel-Kam) twice a day. A third group was instructed to apply distilled water. Each subject was assessed at 2, 4, 8, and 16 weeks utilizing the "method of limits" with a standardized, repeatable cold thermal stimulus. The results of a two factor repeated ANOVA indicated that those subjects who applied the .717% fluoride solution reported significantly less sensitivity at the 2-week period than the other groups (P < .05). In addition, those subjects whose solution contained the 0.4% stannous fluoride reported significantly less sensitivity at the 4- to 8-week periods (P < .05). Phase II of the study assessed the .717% fluoride solution on a more precise time course. These included: immediately, 15 minute, 1 day, 1 week and 2 weeks. A one factor repeated ANOVA revealed that this effect presented 15-minute post application (P < .05) and continued throughout the testing periods. It was concluded that the fully active 0.717% fluoride solution was an effective agent in the control of dentinal hypersensitivity after two 1-minute applications.


Clinical effectiveness of a dentifrice containing potassium chloride as a desensitizing agent. Sensodyne F, a dentifrice currently marketed in the United Kingdom, containing potassium chloride (KCl) and sodium monofluorophosphate (MFP) was compared to a placebo dentifrice for effectiveness in alleviating dentinal hypersensitivity. This randomized, double-blind, parallel clinical study covered 12 weeks of product use by 41 subjects. Hypersensitivity levels of the affected teeth were assessed by tactile stimulation, cold air stimulation and overall subjective patient response. The results from these three methods of assessment demonstrated that the KCl/MFP dentifrice was significantly more effective than the placebo dentifrice in reducing dentinal hypersensitivity. The therapeutic response to the KCl/MFP dentifrice as measured by air sensitivity and overall subjective evaluation was statistically significant when compared to the placebo dentifrice within 4 weeks of use. Significant improvement was observed for all parameters at the conclusion of the 12-week clinical study period. Plaque reduction was significantly reduced at week 8 and continued to improve by week 12. The results indicate that KCl with sodium MFP significantly reduced dentinal hypersensitivity and improved overall patient comfort.


Superior oblique tuck surgery in the management of superior oblique palsies. Three hundred and twenty-four patients with superior oblique muscle palsies required surgery over a 15-year period. Forty-four patients underwent superior oblique tuck surgery. Fifteen patients had unilateral and six bilateral tucks alone. Seventeen had unilateral tucks and three bilateral tucks in conjunction with other extraocular muscle surgery. Three had unilateral tucks with a contralateral Harada-Ito procedure. The best results were obtained with isolated superior oblique tucks and tucks in conjunction with a contralateral inferior rectus muscle recession or an ipsilateral inferior oblique muscle weakening procedure. The mean vertical correction following isolated, unilateral surgery was 3.6 prism diopters (range, 0 to 11 delta) in primary gaze and 15.3 delta (range, 0 to 40 delta) in the field of maximum deviation. The mean eso correction in downgaze with bilateral superior oblique tucks was 15.2 delta (range, 10 to 21 delta). There was no statistically significant correlation between the size of the tuck and the amount of deviation corrected. Some degree of postoperative Brown syndrome was seen in all patients, but became less marked with time and in no patient was it severe enough to require reversal of the tuck. In only four patients was there a significant lessening of the effect of the procedure with time. The results show that the superior oblique tuck procedure is an effective operation. In patients with unilateral muscle palsies, 64.3% with an abnormal head posture, 37.5% with diplopia, and 100% with both an abnormal head posture and diplopia achieved an excellent result. In patients with bilateral muscle palsies, 50% with an abnormal head posture and 66% with both an abnormal head posture and diplopia achieved an excellent result.


Effect upon plaque formation and gingivitis of a triclosan/copolymer/fluoride dentifrice: a 6-month clinical study. A total of 159 adult male and female subjects between 18 and 63 years of age, were entered into a 6-month, double-blind clinical study to assess the effects of a dentifrice containing 0.3% triclosan and 2% of a copolymer of methoxyethylene and maleic acid on supragingival plaque formation and gingivitis, as compared to a placebo dentifrice. Both the triclosan and placebo dentifrices contained 0.243% sodium fluoride in a silica base. The subjects had to demonstrate at least mild gingivitis (modified Loe-Silness score > or = 1.0), be free of advanced periodontal disease, have a modified Quigley-Hein Plaque Index score of at least 1.5 and have a minimum of 20 natural, uncrowned teeth. The subjects were stratified into two balanced groups according to baseline plaque and gingivitis scores. At zero time or baseline, all subjects received a complete and thorough oral prophylaxis and were assigned to the use of either the placebo dentifrice or the triclosan/copolymer dentifrice for the next 6 months. Subjects were evaluated for gingivitis and supragingival plaque formation after 3 and 6 months product use. After 3 months, when compared to the placebo dentifrice, the triclosan/copolymer dentifrice provided the following statistically significant reductions (at 99% confidence levels): (1) a 10.0% reduction in supragingival plaque formation; (2) a 20.8% reduction in plaque formation on tooth surfaces with highest baseline plaque scores; (3) a 21.9% reduction in gingivitis, and (4) 30.5% less sites with severe gingivitis, i.e. gingival bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)


Triclosan/copolymer/NAF dentifrice prophylaxis, reduced etching time and shear bond strength of a resin composite to enamel. This study evaluated the effect of a prophylaxis with a triclosan/copolymer/NaF dentifrice (Colgate Gum Protection Formula) and a reduced etching time with 37% phosphoric acid gel on the shear bond strength of a resin composite to enamel. 60 human extracted permanent molars were used. A flat enamel surface was obtained with 600 grit SiC paper and cleaned with a rubber cup and a water slurry of fine flour of pumice. The teeth were randomly distributed into 4 groups of 15 teeth each: Group 1: Pumice prophylaxis with a rubber cup, etched for 30 seconds; Group 2: Pumice prophylaxis, etched for 60 seconds; Group 3: Triclosan/copolymer/NaF dentifrice prophylaxis, etched for 30 seconds; Group 4: Triclosan/copolymer/NaF dentifrice prophylaxis, etched for 60 seconds. After etching, rinsing and drying, an unfilled resin (Coe Bond) was thinly applied with a brush and cured for 30 seconds. A nylon ring was placed over the area and filled with a light-cured resin composite (Occlusin). The teeth were thermocycled for 500 cycles and sheared with a knife-edged blade in an Instron running at a crosshead speed of 1 mm/min. The results in MPa were as follows: Group 1: 18.84 +/- 7.08; Group 2: 22.65 +/- 4.37; Group 3: 18.79 +/- 5.77; Group 4: 19.62 +/- 6.13. An ANOVA showed that there was no statistically significant difference among the groups. Enamel fracture occurred in 20% (3/15) in Group 1, 53% (8/15) in Group 2, 20% (3/15) in Group 3, and 47% (7/15) in Group 4.(ABSTRACT TRUNCATED AT 250 WORDS)


Interfacial morphology of resin composite and shiny erosion lesions. Ten shiny erosion lesions were divided horizontally, in vivo such that the gingival half was prepared and the incisal half remained unprepared. Both were etched simultaneously with 32% H3PO4 for 20 seconds, rinsed and restored using the All Bond wet technique and P50 composite. The teeth, which were extracted as part of a treatment plan, were sectioned vertically midway through the restorations. Polyvinyl siloxane impressions of the tooth/resin interface were taken and examined by SEM for the presence of gaps. The teeth were then demineralized and the fitting surfaces of the restorations were examined for resin penetration into the dentin. Results showed that there were no gaps present in any of the interfaces. The most proliferative and deep resin penetration occurred in the prepared/etched halves.


Bond strengths of Scotchbond Multi-Purpose to moist dentin and enamel. This in vitro study tested the shear bond strengths of the Scotchbond Multi-Purpose adhesive system to moist and dry enamel and dentin. After the tooth was etched, the surface was either dried with compressed air or blotted with tissue paper, leaving the surface visibly moist. Primer and adhesive were applied according to the manufacturer's directions. Resin composite posts were applied, and the specimens were thermocycled. Shear bond strengths were determined using an Instron universal testing machine. For both enamel and dentin, mean shear bond strengths were higher when the surface was left visibly moist after etching. Bond strengths to moist and dry dentin were 21.8 and 17.8 MPa, respectively. Enamel bond strengths were slightly lower, with values of 17.0 and 14.2 MPa to moist and dry enamel, respectively.


Effect of matrix systems and polymerization techniques on microleakage of Class II resin composite restorations. This study investigated the effect of different sized light curing tips (2 mm and 11 mm) with curing techniques associated with different matrix systems (Mylar with reflective wedge and metal with wooden wedge) on microleakage of a posterior resin composite material (P-50) placed using a bonding agent (Scotchbond 2). Eighty Class II mesial and distal slot preparations (40 with enamel gingival margins and 40 with dentin gingival margins) were randomly divided into four equal groups: 1) metal matrix, large tip; 2) Mylar matrix, light emitting wedge, large tip; 3) Mylar matrix, light emitting wedge, small tip; 4) metal matrix, small tip. Three-way ANOVA indicated no statistical differences among groups using small and large curing tips. The results showed significantly more leakage (alpha = 0.05) in the dentin gingival cavosurface margin groups than the enamel cavosurface margin groups. The results also showed significantly greater leakage in the polymerization procedures associated with the metal matrix groups (alpha = 0.05) compared to polymerization procedures associated with the Mylar matrix groups.


Effects of aluminum oxalate/glycine pretreatment solutions on dentin permeability. Aluminum oxalate buffered with glycine to pH 0.5-2.5 has been proposed as a dentin pretreatment for the Gluma bonding system. In this experiment, the effects of 1-minute treatments of smear layers with these aluminum oxalates on the permeability of human dentin were determined in vitro. The aluminum oxalate solutions at pH 0.5-1.5 removed most of the original smear layer but occluded the tubules with crystalline deposits which decreased dentin permeability. Those solutions used at pH 2.0 and 2.5 increased dentin permeability. All dentin pretreatments increased dentin permeability when measured after a 24-hour storage period, especially the solutions at pH 2.0 and 2.5. The SEM correlates of these permeability changes indicated that these solutions remove the smear layer but reocclude the tubules with precipitates which are probably different forms of calcium oxalate, aluminum phosphate and calcium phosphates.


Caries-like lesion formation around fluoride-releasing sealant and glass ionomer. Caries-like lesion formation around Class V preparations restored with fluoride-releasing sealant, glass ionomer and conventional sealant materials was evaluated with polarized light microscopy following lesion initiation and progression periods. Significant differences (P < 0.05) were found among the three treatment groups for mean surface lesion depth following lesion initiation and progression and between the conventional sealant and fluoride-containing material groups for incremental increase in surface lesion depth following lesion progression. Surface lesion depths were significantly reduced in both the fluoride-releasing sealant and glass ionomer groups when compared with the conventional sealant group. The glass ionomer material provided the greatest degree of caries protection at the enamel-restorative interface and had the least number of wall lesions (7.5%); in contrast, the conventional sealant group had the greatest number of wall lesions (17.5%). The incorporation of fluoride from a dental material into adjacent tooth structure may provide enhanced resistance to caries initiation and progression.


Chronic osteomyelitis of the mandible: case report. Chronic osteomyelitis is a devastating disease of unknown etiology. The primary cause is usually thought to be microbiological. The diagnosis of osteomyelitis of the mandible is arduous, particularly in the early stages, and this disease is almost always difficult to cure. Clinical symptoms, radiographic changes and histologic findings are characteristic of this disease. Treatment modalities have been directed toward eradicating microbes and improving circulation, in the early stages. In the case presented, surgical debridement and IV antibiotics were the treatment of choice. The bone biopsy histopathology report in this case, revealed normal bone, which was inconsistent with chronic osteomyelitis. This article delves into the literature providing history and current research trends in the diagnosis, treatment and follow up care for chronic osteomyelitis.


Electrolyte and glucose concentration in plasma and cerebrospinal fluid measured parallel in pathologic newborn infants. Cerebrospinal fluid and plasma sodium, potassium, chloride, calcium and glucose concentration were measured parallel in 14 pathological newborn babies of gestational age and birthweight of 36.3 +/- 4.3 wks and 2410 +/- 890 g, respectively, at the age of 37.8 +/- 4.4 wks postconceptionally. Whilst potassium, calcium and glucose level is much lower in the cerebrospinal fluid than in the plasma, similar sodium and higher chloride concentration was found in the cerebrospinal fluid. The significant positive correlation between plasma and cerebrospinal fluid glucose and sodium levels proves the lack of a functioning barrier for these compounds. On the other hand, cerebrospinal potassium level varied within a narrow range, independently of the plasma-concentration and the maturity of the studied babies. Pathophysiological implications of the results are further discussed in short.


Prolactin and dopamine concentrations in the cerebrospinal fluid during the neonatal period. Prolactin (PRL) has been detected in the cerebrospinal fluid (CSF) in humans and the absolute level appears to reflect the serum PRL concentration. Because PRL is thought to be involved in the regulation of brain water and electrolyte content attempt has been made to determine CSF and plasma PRL and dopamine (DA) concentrations, osmolality, and sodium level in 21 newborn infants undergoing lumbar punction because of apneic spells, fever, or perinatal asphyxia. The mean of gestational age was 36.5 weeks (range: 31-41) and birthweight was 2572 g (range: 1140-3550). The lumbar puncture was performed at the 8.3 postnatal day (range: 1-38). The plasma concentration of PRL was 106.52 +/- 14.43 ng/ml, significantly higher than the CSF PRL level (43.24 +/- 7.39 ng/ml, p < 0.01). This elevated level was observed in all individual cases. DA concentration in the plasma was much higher than the value detected in the CSF (64.75 +/- 13.83 vs 8.64 +/- 0.72 ng/ml, p < 0.01). No difference was observed between the sodium content of the CSF and plasma (138.94 +/- 1.28 vs 138.04 +/- 1.03 mmol/l), however, the osmolality of the plasma tended to be higher than the CSF osmolality (286.7 +/- 3.81 vs 276.76 +/- 2.19 mosm/kg, p < 0.05). In the CSF osmolality, PRL, DA, and sodium concentrations did not show any correlation. in the CSF PRL probably does not play a primary role in controlling the osmolality and sodium content. PRL in CSF seems to be independent from CSF DA concentration.


The distribution of lymphocyte subpopulations in an infant with primary intestinal lymphangiectasia. Authors analysed in an infant with primary intestinal lymphangiectasia the number of intraepithelial lymphocytes and the distribution of T lymphocyte subpopulations in the jejunal mucosa with immunohistochemical methods. It was established that the number of intraepithelial lymphocytes and of the cells belonging to the various T lymphocytes markedly decreased in the patient compared to controls, however the decrease of the CD4 cells was less than that of CD8 cells, thus the CD4/CD8 ratio increased. Authors conclude that the increase of CD4/CD8 ratio in the jejunal mucosa may explain the absence of frequent gut infections in intestinal lymphangiectasia.


Serotonin concentration in offspring of parents suffering from premature coronary arterial disease. Thirty-one 3 to 14 years old offspring of parents who had an acute myocardial infarction before age of 45 and 42 healthy children without any family history of cardiovascular disease were investigated. A significant increase in plasma free serotonin concentration was seen in endangered children. From these results it may be supposed that vascular endothelium is dysfunctional in offspring of parents suffering from premature coronary arterial disease.


Insulin resistance in obese boys with acanthosis nigricans. Insulin resistance was investigated in three obese boys with acanthosis nigricans and their results were compared to those obtained in non-acanthotic obese patients. Blood glucose immune reactive serum insulin and C-peptide during oral glucose tolerance test and 125I-insulin binding investigated. Obese patients with acanthosis nigricans were more insulin resistant than simple obese controls. Insulin binding studies performed in two acanthotic patients suggested that one of them had insulin resistance type A, and the second patient had insulin resistance type B. According to the results acanthosis nigricans can serve as a marker for severe insulin resistance in obesity.


The use of human recombinant erythropoietin in children on chronic dialysis. Human recombinant erythropoietin (r-HuEPO, EprexR) was administered to 8 children with chronic renal failure and high transfusion requirement. The hormone was given i.v. 2-3 times per week at the end of the dialysis. The selected initial dose (160 U/kg/week) was gradually raised up to a maximum of 400 U/kg/week. Anaemia normalised by the tenth week. The aimed target haematocrit was 0.33, the average maintenance dose was 250-300 U/kg/week. The absolute reticulocyte count seemed to be a more sensitive indicator of the actual erythropoietin effect than the haematocrit level. No major adverse effects (convulsion, progressive hypertension, thrombosis) were observed during treatment with r-HuEPO. The need for transfusions decreased dramatically, no transfusion was needed following the second week of treatment. The general condition improved substantially. In one hyperimmunized child the cytotoxic antibody titer decreased by 75 per cent.


A behavioural teratologic study on offspring of self-poisoned pregnant women. Ninety-three cases born from women who attempted suicide by taking large doses of chemicals and eight cases who had mothers affected by a chemical poisoning as accident during pregnancy were studied. Data of birth weight and gestational time, congenital anomalies and postnatal disorders were obtained in cases and matched controls (sociological twins). Test examinations were performed in both cases--controls and their mothers in the home of families. The mothers of index children had a lower socioeconomic status and more were unmarried than the Hungarian pregnant population at large. The behaviour of index and control mothers showed some obvious differences. The bivariate analyses indicated some possible teratogenic effect of maternal poisoning, but it was not confirmed by multivariate analysis except lower birth weight. Thus differences between cases and control were explained mainly by the maternal behavioural factors.


Ewing's sarcoma in the occipital bone. Case report. The head is a very rare primary site for Ewing's sarcoma which occurs most often in the long bones of the extremities and in the pelvis. This report describes an unusual case of Ewing's sarcoma arising from the occipital bone in a seven year old girl. The tumour compressed the venous sinuses, thus lowering the intracranial pressure resulted in temporary recovery which made the diagnosis difficult.


[Aspects of physiology, pathology and epidemiology of cataract]. World Health Organization estimates that 23 million people have a visual acuity of 0.05 or less. For 12-15 million people cataract is the cause of poor visual acuity or blindness and the majority of those afflicted live in Third World countries. It is estimated that in the year 2025 around 40 million people will become blind due to cataract. The therapeutic procedure of choice is surgical removal of the lens. The high success rate of this procedure in highly industrialized countries has been achieved by the constant improvement in technology and operative technique. This, however, does not hold true for Third World countries. The etiology and pathogenesis of cataract are not yet completely understood. This paper reports on the clinical findings and epidemiology of cataract and deals with the physiology and pathology of the lens. The aim of the study was to recognize possible cataractogenic risk factors. A decrease in the blindness rate caused by cataract in Third World countries can best be achieved through prevention.


[Reposition and suture fixation of dislocated posterior chamber lenses]. We treated 11 patients with posterior chamber intraocular lenses that were dislocated into the vitreous cavity. Using a pars plana approach, vitrectomy was performed and in order to facilitate manipulation, half of the bulbus volume was filled by perfluorodecaline. The IOL was grasped with forceps and repositioned with a special technique. In this way the first haptic is fixed in the ciliary sulcus. Fixation of the second haptic with 9 x 0 polypropylene suture was performed with a similar procedure. Finally, prophylactic cryotherapy of the retina is indicated.


[Elasticity of capsulorhexis in the animal model]. A special caliper was designed to determine the stretching capacity of a circular capsulorhexis allowing measurements in 0.02 mm increments. A small capsulorhexis 4.5-6.0 mm in diameter could be stretched 2.7 times; a large capsulorhexis 6.5-8.0 mm in diameter was stretched 2.6 times the original diameter. A smooth circular capsulorhexis is very strong and stabile but also has significant stretching capacity. In a small capsulorhexis, there is the danger that zonular fiber defects or posterior capsular rupture may occur during manual expression, of the nucleus. A large capsulorhexis is more suitable for manual nucleus delivery.


[Intraoperative complications in cataract surgery. A prospective study]. In a prospective study the important intraoperative complications encountered by two experienced and eight less experienced surgeons after 1708 cataract operations were analyzed. In 2.3% a lesion of the iris or iris sphincter occurred. The overall incidence of capsular ruptures was 0.94%. Zonular dialysis was found in 0.67%. If a severe intraoperative complication with a large capsular or zonular rupture is defined by the necessity for an anterior vitrectomy or the impossibility of implanting a standard posterior chamber lens, the rate of complications was about 0.4%. For the two experienced surgeons, only two anterior chamber lenses as stand-by lens were implanted out of 1500 operations.


[In vivo autofluorescence. Measurements of human crystalline lenses with cataract and normal findings after excitation with monochromatic light]. In 25 eyes with nuclear cataract, 18 eyes with posterior subcapsular cataract, 25 eyes with cortical cataract, and 23 eyes without any pathological lens changes, the maximal fluorescence intensity was determined after excitation with monochromatic light at 365 nm, 405 nm, 436 nm, and 485 nm. The coefficient of variation was smaller than 5%. All eyes with cataract underwent cataract surgery a few days after the fluorescence measurements. The fluorescence spectrometer, especially constructed for in vivo measurements, consists of a modified slit lamp (Zeiss 75 SL) and an optical multichannel analyser (OMA) for gauging the data. The clinical trial was undertaken to determine whether, considering the influence of age, there is a difference between the fluorescence intensities in eyes with the above named cataracts and noncataractous eyes. The data were analyzed to determine the effect of age upon fluorescence intensity for all excitation wavelengths in both cataractous and noncataractous eyes. Age had an influence on the fluorescence intensities for all four excitation wavelengths. Assuming that the influence of age was not dependent on the state of the lens, it was quantified for all measurements and an "age-corrected" fluorescence intensity was calculated. The statistical analyses of these "age-corrected" fluorescence intensities revealed a significant difference (P < 0.001) for all of the types of cataracts examined and for normal eyes. The cataract types examined and the normal eyes showed differences in their fluorescence feature. To assess the fluorescence intensities obtained after excitation with the wavelengths mentioned above, one must take into consideration the influence of age on the measurements.


[Plasma formation in Nd:YAG laser surgery]. Plasma formation with nanosecond and picosecond Nd:YAG laser pulses was investigated as a function of laser pulse energy to find possibilities for a spatial reduction of the laser effects. The threshold for plasma formation (optical breakdown) in distilled water is 200 microJ for ns pulses and 15 microJ for ps pulses. At a pulse energy of 1 mJ, the plasma length is 80 microns for ns pulses and 250 microns for ps pulses. For the same pulse energy, ps plasmas are on average three times larger than ns plasmas. The plasma length is approximately proportional to the cube root of the laser pulse energy for both ns and ps laser pulses. The decrease in the breakdown threshold achieved by using ps pulses renders photodisruption with a smaller pulse energy (in the microJ range) possible, and therefore a reduction in the side effects. The results are compared with the "moving breakdown" model.


[Transscleral posterior chamber lens fixation. Simplified and time saving technique]. Transscleral suture fixation of posterior chamber lenses is preferred to angle-supported anterior chamber lenses in cases of complicated cataract surgery with loss of the capsule. One of the disadvantages of suture fixation is the time needed to fix the suture to the haptic of the intraocular lens and to the sclera. Up to now it has been necessary for sutures to be tied separately to the haptic of the posterior chamber lens. With a modified one-piece PMMA posterior chamber lens, which has positioning holes at the vertex of the haptic (Morcher G 48), this is no longer necessary. Using a loop technique, it is possible for a specially designed single-arm loop suture (Ethicon X900G/STC-6) to be fixed safely to this new lens without any knots. Fixation of the sutures can thus be performed more easily and quickly, and there is no more danger of the suture slipping off the haptic. For the first time it has become possible to fix the sutures to the haptic without putting the intraocular lens down in the perioperative field. Reducing the manipulation time on the intraocular lens may also reduce the risk of intraoperative contamination.


[Surgical aspiration of secondary cataract. Success quotas and complications]. Cataracta secundaria ("Elschnig pearls") following extracapsular cataract extraction with IOL implantation can be treated by Neodymium-YAG laser capsulotomy or by surgical peeling. The major benefit of the peeling technique is the preservation of an intact posterior capsule. We retrospectively reviewed the peeling procedures (n = 224, mean age: 67 years) performed in our hospital from 1987 to 1990. The results were as follows: (1) In almost all cases (214/224) visual acuity was improved by the operation (mean improvement 0.16-->0.54); (2) major complications were: rupture of the posterior capsule in 9% (20 eyes), mostly (11 cases = 5%) associated with vitreous prolapse; retinal detachment in 1% (2 cases, one with, one without preceding rupture of the posterior capsule); persistnt corneal edema caused by endothelial decompensation in 1 case; (3) recurrence of cataracta secundaria after the first peeling was observed in 26%. Surgical peeling of cataracta secundaria improves visual acuity to about the same extent as Neodymium-YAG laser capsulotomy. It is not without risk, however, and complications occur, including retinal detachment. The possibility that a secondary cataract can reform must be taken into account.


[Clinical aspects, follow-up and results of cataract extraction in uveitis]. Over a 5-year period, a consecutive series of 52 eyes in 46 patients with uveitis underwent extracapsular cataract extraction. Twenty-eight of these cases received a posterior chamber intraocular lens (IOL). During an average follow-up of 25 months (range 7 to 58 months) 71% of eyes receiving an IOL achieved postoperatively a visual acuity of 0.5 or better; 54% of aphakic eyes reached this level. Persistent cystoid macular edema limited the visual improvement to 20/200 in 6 patients; none of the patients developed cystoid macular edema postoperatively on clinical observation. Intraocular hypertension occurred postoperatively in 12 eyes, but was limited to a 4-week postoperative period in 9 cases. YAG laser capsulotomy was performed in 2 eyes with opacification of the posterior lens capsule without any further complications. The results suggest that uveitis patients benefit from cataract extraction and in selected cases can tolerate IOL implantation without major complications.


[Comparison of various capsulectomy techniques in cataract surgery. An experimental study]. Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.


[Early postoperative corneal astigmatism. Comparison of various suture techniques]. We compared two suture techniques after phacoemulsification and implantation of a standard PMMA posterior chamber lens with a 7 mm intrascleral lamellar incision: the cross-stitch (double running) suture closure and the one-stitch technique. Two series with 100 patients each were examined. In the early postoperative period the astigmatism induced was 1.9 +/- 1.4 D in the cross-stitch group and 1.5 +/- 1.0 in the one-stitch group (P = 0.01). In the latter group, 20% more of the patients were found to have a moderate amount of astigmatism. Four weeks after surgery, however, there were no differences between the two groups. The induced astigmatism in both groups was 1.0 D.


[Endothelial cell protective effect of high viscosity substances in cataract surgery]. An experimental setting is presented to evaluate the endothelial protection offered by various viscoelastic materials applied in cataract surgery. The substances used were: hydroxypropylmethylcellulosis, a hyaluronic acid preparation (molecular weight 5.10(6), concentration 10 mg/ml), a hyaluronic acid preparation (molecular weight 800 000, concentration: 35 mg/ml), and balanced salt solution as control. The endothelial surface of pig corneas were covered by test substances and spread with a loop of prolene 4.0 suture material in a mechanically standard way. A total of 40 corneas were examined and the amount of endothelial damage evaluated by photometry using Janus-green wash-out, a substance, which selectively binds to damaged endothelial cells or descement membrane. The damaged surfaces differed significantly in all groups of viscoelastic substances and in the control group. Examination showed that the least damage was in group 3, followed by group 1 and the most damage in group 2. Endothelial protection during cataract surgery can be improved by modifications of the substances presently applied.


[Ascorbic acid. Cytotoxic effect on cultivated bovine lens epithelium cells]. Ascorbic acid is one of the main components (1.16 mM/l) of the aqueous humor. The molarity of this molecule is 25 times higher than in the plasma of the cow, man or horse. Now the question arises as to which function ascorbic acid has in this extremely high concentration referring to the proliferation of the lens epithelial cells. Thus, the effect of ascorbic acid was investigated upon bovine lens epithelial cells (BLEC) in the range of 0-3 mM/l. These cells were cultivated under various culture conditions (serum-free, serum-containing, aqueous-humor-containing medium) and also incubated with such mitogens as retinal extract (RE), crude endothelial cell growth factor (cECGF), basic fibroblast growth factor (bFGF) or with calcium. In each culture condition 1 mM/l ascorbic acid caused remarkable inhibition of the proliferation of BLEC. Higher concentrations (> 1.5 mM/l) revealed cytotoxic effects. These effects were independent of small variations in the pH value caused by ascorbic acid. In addition, the effect of 2 mM/l ascorbic acid in combination with catalase in a concentration of 500 Um/ml and 1000 Um/ml, respectively, was investigated. It could be shown that catalase is capable of preventing the cytotoxic effect of ascorbic acid. These results show the inhibitory effect of ascorbic acid in its physiological concentration in the proliferation of BLEC.


[Effect of heparin on proliferation of cultivated bovine lens epithelial cells]. The treatments proposed to date for the prevention of secondary cataract have shown limited efficacy or have not been satisfactory due to ocular toxicity. Since it has been demonstrated that heparin can inhibit the proliferative activity of smooth muscle cells and fibroblasts in vitro and in vivo, we examined the effect of heparin at concentrations ranging from 20 to 200 micrograms/ml on the proliferation of cultured bovine lens epithelial cells (BLEC) under various culture conditions: (1) serum-free medium (SFM); (2) SFM + aqueous humor 1:1; (3) SFM +1 and 10% fetal calf serum; (4) SFM +1% retinal extract; (5) SFM +50 micrograms/ml endothelial cell growth factor; (6) SFM +10 ng/ml epidermal growth factor; (7) SFM +10 ng/ml basic fibroblast growth factor. Heparin caused no cytotoxic effects in any of the experiments. With medium 2 and 3, heparin caused dose-dependent inhibition of cell proliferation at concentrations ranging from 10 to 50 micrograms/ml. Cells cultivated in medium 4-7 with the addition of 50 micrograms/ml heparin revealed increased proliferative activity when compared with the corresponding controls. The antiproliferative activity on BLEC in medium containing aqueous humor suggests that heparin is a valuable tool for the prevention of secondary cataract in vivo.


[Measuring scattered light with the Opacity Lensmeter 701 in normal eyes and eyes with cataracts. Correlation between scattered light and cataract-induced vision loss]. In 50 eyes with nuclear cataract, posterior subcapsular cataract and cortical cataract and 34 normal eyes, the amount of scattered light was determined using the Opacity Lensmeter 701 to determine its accuracy in distinguishing between clear and cataractous lenses. Taking as a basis the manufacturer's statement that normal lenses show Opacity Lensmeter readings of less than 25 and that cataractous lenses show Opacity Lensmeter readings of more than 30, 94% of the nuclear cataract cases, 62% of the posterior subcapsular cases and 66% of the cortical cataract cases were identified as being pathologically opaque. Of the normal eyes, 88% had an Opacity Lensmeter reading of less than 25. Among the types of cataract examined, a significant linear relationship (P < 0.05) between visual acuity loss due to cataract and scattered light measurements could be found only in eyes with nuclear cataract, with the individual results heavily scattered around the linear regression. In the case of nuclear cataracts, measuring scattered light with the Opacity Lensmeter is suitable for making general statements on visual loss due to cataract for a whole group of patients. However, in individual cases the results can only be used together with other clinical examinations.


[Postoperative astigmatism. 3.5 mm scleral tunnel incision and implantation of a HEMA posterior chamber lens vs 7 mm scleral step incision and implantation of a PMMA posterior chamber lens]. In a prospective study, two groups of 35 patients each were compared following phacoemulsification and posterior lens implantation. Both groups were followed up to evaluate the evolution of the postoperative astigmatism during a minimum of 6 months. In group A, a HEMA posterior chamber lens was implanted through a 3.5 mm scleral tunnel incision. In group B, a PMMA posterior chamber lens was implanted through a 7 mm scleral step incision. The data were analyzed for the whole observation time with reference to preoperative, early postoperative, absolute and induced astigmatism. Different subgroups were formed. Vector analysis was performed in both groups in order to determine surgically induced axial changes, e.g., the intensity and direction of the power working on the cornea. The results were compared. Group A showed lesser early postoperative astigmatism than group B; however, group A also returned to the preoperative values more quickly. Both groups exhibited a shift towards against-the-rule astigmatism.


[Risk of dislocation and cataract formation in 240 IOGEL lenses. 4 years experiences]. Following planned extracapsular cataract extractions we implanted 240 IOGEL lenses into the capsular bag and noticed 5 dislocations into the vitreous cavity, 2 after an Nd-YAG capsulotomy, 4 postoperatively and 1 after surgical repositioning. Postoperatively, one lens was subluxated into the anterior chamber. Thirty-three patients required a 4- to 5-mm Nd-YAG capsulotomy because of a fibrotic or regenerative secondary cataract. Two lenses dislocated 2 and 6 weeks after the YAG capsulotomy into the vitreous cavity; the capsulotomy was performed 5 and 6 months, respectively, after the implantation. In 4 patients the IOGEL lens dislocated 3 times within the first 3 days and once within the first 3 months after implantation. Primary stable placement in the bag could be achieved, however. One patient required repositioning of the lens because of decentration 3 months after implantation. The lens dislocated on the following day. Late dislocation of the flexible and soft IOGEL lens can be due to the fact that the lenses do not adhere to the capsular sheets. Furthermore, postoperative capsular shrinkage enlarging a posterior capsular opening leads to lens dislocation. Eight patients underwent a secondary anterior chamber lens implantation. In three patients the IOGEL lens was explanted, in two of them without and in one of them with serious complications. The other five patients still have their IOGEL lens deep in the vitreous without complications. We suggest that if a YAG capsulotomy is necessary, it should not be performed before the 6th postoperative month. It should also not exceed 4 mm in diameter and no IOGEL lens should be implanted if a capsular rupture occurs intraoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effect of 0.1% dexamethasone and 1.0% prednisolone acetate eyedrops on the blood-aqueous humor barrier]. In a randomized, double-blind clinical trial we studied the protective effect of prednisolone-acetate 1.0% and dexamethasone 0.1% on the blood-aqueous barrier after cataract-extraction and posterior chamber lens implantation. Pre- and postoperative anterior chamber fluorophotometry was performed after i.v. administration of 10% fluorescein-sodium in 20 eyes of 20 patients of whom 16 finished the study (mean age 68.7 +/- 11.0; 13 female, 3 male). The topical application of either drug 5 times daily for 5 days did show a significant difference in surgery mediated disturbance of BAB in each group before and after phacoemulsification. However, when comparing the effect of the two drugs with each other, a difference could not be detected (p = 0.35). To attain a statistical 95% probability that there is no significant difference between the two treatment groups, a number of 690 patients would have had to be investigated. The results can be interpreted as to be due to a better cornea penetration of prednisolone-acetate which compensate the higher glucocorticoid-potency and receptor-affinity of dexamethasone. The untreated fellow-eyes did not reveal a significant difference between the pre- and postoperative anterior chamber fluorescein-concentrations in either treatment group. Anterior chamber fluorophotometry is able to demonstrate the potency and influence of both prednisolone-acetate 1.0% and dexamethasone 0.1% eye-drops on the BAB following phacoemulsification and IOL-implantation. The difference of both drugs does not seem to be of clinical importance in this context.


[Spontaneous fracture of an implanted anterior chamber lens]. This report deals with an 83-year-old patient who presented with visual deterioration. The patient had had an intracapsulary extraction with anterior chamber lens implantation. The break in the anterior chamber lens happened without any history of traumatic accident and led to dislocation of the lens and corneal decompensation. Scanning electron microscopy of the break area after explantation of the fragments revealed changes in the break zone that were characteristic of alternating tensile and compressive stress. Localization of the break at the transition of the optical part and the haptic where there is the greatest stress in the material points to insufficient strengthening in this critical part of the intraocular lens.


[Capsulorhexis using an ultrasound-controlled cannula]. Every cataract surgeon performing phacoemulsification has unintentionally damaged the posterior capsule. Thus he knows that the device is suitable for cutting the lens capsule. In recent years, I have performed various modifications of capsulorhexis with the aid of an ultrasound-guided cannula in all patients undergoing phacoemulsification. The following method proved to be practicable: The ultrasound-guided cannula is pressed on the lens capsule at 12 o'clock, thus opening the anterior capsule; the cannula is consecutively guided in two semicircular movements from 12 o'clock to 6 o'clock, and the anterior capsula is torn and cut open by directing the opening of the cannula toward the center of the pupil and simultaneously on the anterior capsula and away from the iris, thus making it possible to cut directly at the pupillary margin without damaging the iris. The anterior capsular tear has a smooth circular edge at the intersection of the two semicircles of the capsulorhexis, while a triangular flap directed towards the center of the pupil is often formed at 12 o'clock. At the end of phacoemulsification, the flap is aspirated with the suction rinsing device and cut off with a sharp cannula. This procedure simplifies and accelerates phacoemulsification.