Cognition and vigilance: differential effects of diazepam and buspirone on memory and psychomotor performance. Effects of a single dose of the anxiolytic buspirone (15 mg) on memory and psychomotor performance were studied in healthy volunteers and compared to those of the classic benzodiazepine anxiolytic diazepam (15 mg). The study was performed in a double-blind, placebo-controlled way. Three groups of 12 subjects were exposed to an extended test battery before and after intake of drug or placebo. Next to this, an evaluation session took place 1 week later. Immediately after intake, diazepam exerted major effects on memory, impaired psychomotor performance and decreased alertness. In particular, long-term memory had deteriorated, which was interpreted as anterograde amnesia. One week later, more items were recalled from the predrug session compared to the number of items from the postdrug session; this was interpreted as retrograde facilitation. After intake of buspirone, there were no effects of alertness and vigilance, on psychomotor performance and on memory. One week later, a small memory decrement was noticed for verbal material, which was considered as a sign of anterograde amnesia. These results indicate that effects of anxiolytics on memory can be more easily demonstrated 1 week later than immediately after drug intake and, furthermore, that the disruptive effects of diazepam outweight the small effects of buspirone. Finally, it was established that the effects of diazepam on cognition might be mediated by its effects on alertness and vigilance and that cognitive effects are not related to the anxiolytic properties of the drug.


Are there EEG correlates of mental states in animals? The thesis of this paper emerges from the fact that mental states are generated by neural processes that also produce an associated electroencephalogram (EEG). Thus, it is logical to expect correlations between mental state and EEG. The corollary is that the EEG can serve as an index of mental state, which can be particularly useful for studies in animals, where mental states are much less accessible for objective study than in humans. Herein, I briefly review the traditional approaches that have informed our attitudes about animal mental states. Virtually all of our conclusions about mental states in animals are drawn by inference from behavioral observation, a process that is highly and unavoidably subject to anthropomorphism. Traditionally, the electroencephalogram (EEG) has been used in a crude way as an objective indication of physical and behavioral state in animals. This, however, has led to substantial controversy, because there are several situations in which EEG patterns and behavior seem to be dissociated. We not only fail to understand these dissociated states, but there are also important humane animal-welfare issues that remain unresolved because we do not fully understand the extent to which the EEG can reflect mental state. At issue is whether EEG-behavioral dissociations, to the extent that they exist, are proof that the EEG is dissociated from mental states. Powerful new EEG methods, such as topographical EEG mapping, wavelet analysis, and testing for nonlinear ('chaotic') dynamical properties and short-term serial dependencies, are now available for studying the extent to which the EEG can index thinking and feeling in humans and, by extrapolation, in animals. Critics who have become disenchanted with the utility of the EEG should at least concede that fresh approaches to old problems are now available and should therefore be thoughtfully considered. If such research does nothing more than improve the rigor of the debate over animal welfare and rights issues, it will be worth the effort.


Intensity dependence of auditory evoked N1/P2 component and personality. The slope of the amplitude/stimulus intensity function (ASF) of sensory evoked potentials was found to be related to 'action-oriented' personality traits like 'sensation seeking', 'extraversion', and 'impulsivity'. We studied the ASF slope of the auditory evoked N1/P2 component as well as short-term ASF slope changes and their relationship to a German personality inventory (Freiburger Persönlichkeits-Inventar) in 33 healthy subjects. The ASF slope correlated negatively with 'life contentment' and positively with 'stress' in the first run. Stronger associations, however, were noted between slope changes within one test session and personality. Subjects scoring high on the second-order factor 'aggressive excitability' were characterized by a slope decrease from the first to the second run, following a 20-min interval. This finding of personality-dependent test-retest changes of the ASF slope stresses the importance of monitoring the duration of the recording when studying ASF slopes and offers an explanation for inconsistencies in the literature concerning cross-modal correlations in visual and auditory ASF slopes. The hypothesis is proposed that the serotonergic system, which has been related to 'action-oriented' personality, is involved in the modulation of the intensity dependence of the auditory evoked N1/P2 component.


[Normovolemic induced hemodilution. Behavior of various hemodynamic indices]. Changes in mixed venous oxygen saturation of hemoglobin (SvO2), heart rate (HR), cardiac index, (SI) were measured in 20 patients undergoing major orthopedic surgery (rachis and pelvis bone resections for tumours: mean-lasting 8 hours), to estimate the safety limits during isovolemic hemodilution. Up to Hb 8 g%, in all patients, a cardiac index improvement (+41%) was found, and this was mainly caused by an increase in stroke index (+31%). For 16 patients at Hb 6 g%, this improvement was present only in 44% and declined during further hemodilution. In all cases, CI was moderately lower than baseline value (-18%) this was caused by an important increase in HR (= 55%) partially compensating for by the fall in SI (-57%). The Authors conclude that, in patients under general anaesthesia, isovolemic hemodilution is safe up to Hb 8 g%. Below this value the left ventricular performance rapidly declines.


[Rationale for anesthesia in non-cardiac surgery on patients with heart transplant]. The introduction of cyclosporine in the prevention of rejection, together with the improvement of surgical and anaesthetic techniques, produced a tangible increase in long term survival time and the life quality of heart-transplanted patients, so that, they have to undergo non-cardiac surgical operation, more and more frequently. The aim of this report is to analyse the essential physio-pathological, clinical, haemodynamic and pharmacological knowledge in order to perform a safe anaesthesia on the above mentioned patients. The Authors are basing this report on experience obtained in deep study of their own cases. In fact they have anaesthetized 190 patients during heart transplantation; later on, 27 of these patients have undergone subsequent major or minor non-cardiac surgical operations.


[Anesthesia and central nervous system in carotid surgery]. The Authors, in the debate concerning the most appropriate anesthesiologic treatment in thromboendarterectomy surgery, relate their experience using three different types of general anaesthesia under electroencephalographic monitoring. The results are commented correlating data with some physiopathologic considerations. Carotid surgery, in particular the operation of thromboendarterectomy (TEA), during the last few years has assumed features and frequency typical of a routine procedure. Nevertheless, if from a surgical point of view the criteria of choice of the patients and the surgical techniques have been well standardized, in the anesthesiologic field the discussion between the supporters of the locoregional anaesthesia on one side and of the general anaesthesia on the other side is still open. By this report we mean to bring a contribution to the debate correlating our anesthesiologic files with some physiopathologic notations on the theme.


[Gastric tonometry. Experience of a polyvalent intensive care unit]. Tonomitor NG tube was positioned in the stomach of 11 critical ill patients during their stay in ICU and 48 measurements of intramucosal pH (pHi) have been performed. In 7 patients haemodynamic measurement were performed in concomitance with each pHi measure. The Authors looked for statistical relations between pHi and SAPS, pHa, HCO3-a, MAP, DO2/BSA, VO2/BSA, SvO2, diuresis and outcome. A good correlation was found between pHi and MAP (r = 0.47). Dividing the considered parameters into 2 groups in agreement with pHi values < or = and > 7.32 significant relations (p < 0.05) results between pHi and SAPS, MAP, pHa. More significant relations were found between pHi and outcome (p = 0.0015) and between the mean of the pHi values obtained from each patient (pHi-m) and outcome (p = 0.0005). The pHi-m of the surviving patients was always > 7.32 while the pHi-m of the deceased patients was always < 7.32. This results confirm the importance of the pHi measured during the stay in ICU as a prognostic index and suggest that the MAP may be the most important haemodynamic parameter which correlate with pHi values.


[Anesthesia and perioperative care in radical cystectomy]. The results of anesthesia and perioperative assistance on a series of 84 patients who underwent since 1982 to 1990 a one-stage radical cystectomy and urinary diversion are reported. Reduction of the high risk of operation is particularly dependent on preoperative preparation, use of a safe anesthesia technique with continuous evaluation of vital signs, control of blood loss and use of low dose of heparin for prevention of venous thromboembolism. The complication rate was low, 7.1% for the early one, 16.6% for late one. General mortality of 5.9% is dependent on the high average age of the patients and on the fact all the cases were deeply invasive cancer.


[Aspiration syndrome in cesarean section. Our experience from 1980 to 1990]. In the last twenty years maternal mortality attributed to anaesthesia has decreased. Inhalation of gastric contents is the commonest cause in patients undergoing cesarean section; in fact pregnant women are considered "high risk" because of gravidic modifications. In this retrospective study of 10017 caesarean sections performed under general anaesthesia in our institution between January 1980 and December 1990, we evaluated the frequency of this syndrome (7 cases = 1:1431). We had no case of maternal and neonatal mortality. All these seven patients were admitted at our recovery room for less than 5 days; aspiration pneumonitis occurred in only three patients. Our results suggested that induction of anaesthesia with high doses of thiopental reduces complications related to light anaesthesia, including vomiting. At a dose of 5-6 mg/kg thiopental didn't produce any significant neonatal depression as documented by Apgar scores.


[Treatment and outcome of prospective organ donors in neurosurgical intensive therapy. Analysis of a 3-year period]. Strict guidelines for selection, monitoring and treatment of Potential Organ Donors (POD) in Neurosurgical Intensive Care Units (ICUs) are mandatory since patients with Acute Brain Injuries (ABI) are more frequently admitted on these specialized ICUs. We report the guidelines accepted in the Neurosurgical ICU of Treviso City Hospital (TVH) and the results obtained in the last three years (1988-1990). All patients with unfavourable neurological outcome were considered POD if absolute or relative contraindications to organ procurement were absent. They were treated with a multisystemic approach, according to standard protocols, including: ECG monitoring, water and electrolyte balance restoration, pharmacological cardiocirculatory support, prophylaxis and treatment of infections, control of hormonal disturbances. Our data demonstrate an increase of POD from TVH due to the centralization of patients with ABI in the Neurosurgical ICU and show an increase of the rate of POD from Neurosurgical ICU vs General ICU of TVH. The increase of POD in the Neurosurgical ICUs involves medical, legal, organizing and psychological problems, related to this clinical condition. The attention to severe protocols, that must be periodically reviewed, makes more easy the management of POD and ameliorates the outcome of these patients.


[Brachial plexus block by the axillary route. Cannulation of the neurovascular sheath with a G22 spinal needle. Our experience with 100 cases]. The aim of this study was to evaluate the utility of the brachial plexus block using an axillary route employing the technique in which the needle is inserted into the sheath at an angle parallel to the neuro-vascular bundle with a sole modification: using a G22 spinal needle and without evoking paresthesia. The results obtained show that this method ensures an improved and more widespread analgesia. The flexibility and small size of the G22 spinal needle allow traumas to the axillary guaina and brachial plexus to be reduced to a minimum. In addition its length enables the anesthetic solution to be diffused around the first rib, including the axillary and musculo-cutaneous nerves, thus ensuring e total sensory and motor block of the upper limb.


[Postoperative pain in shoulder surgery]. Postoperative shoulder pain should be adequately treated not only because of the high severity of the symptomatology often observed, but also because pain and muscle contraction render impossible an early rehabilitation programme. Regional anaesthesia, by virtue of its beneficial effects on the pathophysiology of pain and its influence on the rehabilitative problems of shoulder surgery, is the most adequate technique for the control of postoperative pain.


[Ambulatory anesthesia in arthroscopy of the knee: proposal of an intravenous general anesthesia technique]. The Authors propose a technique completely i.v. for arthroscopy of the knee by means of proposal discontinuous infusion. The advantage underlined are tolerability, efficaciousness, features of awakening and a few collateral effects verified, and this leads to be conclusion that this anaesthesia system must be considered of choice in this type of surgery.


[Brain death and prolonged fetal survival]. The Authors presents in detail a case of a 25-year-old primigravida that had fatal intracranial bleeding at the beginning of the 15th week of gestation, whose vital function are sustained for 49 days. Despite the insuccess to bring the pregnancy to a gestational period favorable to induce the delivery, they analyse the problems connected to the maternal maintenance and to the fetal growth.


[Urapidil and dopamine in severe heart failure. A clinical case]. The Authors report their experience with a new vasodilator drug (Urapidil) employed in the management of serious cardiac failure, in a patient who previously didn't respond in a satisfactory manner to a therapy with Dopamine alone. After several days of continuous treatment, the patient was discharged, without any sign of toxic or metabolic reactions.


[Subarachnoid anesthesia and peridural anesthesia: which are the causes of total failure? A clinical case]. The paper reports the case of patient undergoing cystoscopy and subsequently radical cystectomy suffering from BPCO and pulmonary emphysema who received sub-arachnoid anesthesia during the first operation and peridural anesthesia during the second, with total failure both times. The techniques were correctly performed and on both occasions it was necessary to resort to general anesthesia in order to perform the operation.


[Case report: application of peridural stimulation in a case of intractable coccygodynia]. The Authors report a case of coccygodynia following a car accident and describe the therapeutic approach used. In view of the clinical characteristics of pain and the limited quality and duration of benefits, it was proposed to insert an epidural neurostimulation electrode in an attempt to normalise the threshold of neuronal activity at the level of the spine.


[Chronic exposure to inhalation anesthetics and immunity]. The existence of a professional disease caused by exposure to general anesthetics has been reported by a number of studies, but opinions still differ as to the effective implications of this type of exposure. The aim of the present study was to analyse alterations in cellular and humoral immunity in anesthetists regularly exposed to general anesthetics. Regression analysis showed that IgA and NK lymphocytes were significantly increased whereas total T lymphocytes reduced in parallel with age and length of service. It can therefore be supposed that the increase in IgA might suggest chronic liver disease, while alterations in the lymphocyte populations, even if closely associated to chronic exposure leading to the hypothesis of a cause-and-effect relationship, do not alter immune system functions since they are similar to those that occur with ageing.


[National survey on the action taken at the intensive care units to control hospital infections]. In 1990, a survey of recommended infection control practices in ICUs was carried out in 11 European countries. At the European level, 1005 ICUs returned the questionnaire (response rate = 61.2%), while in Italy only 129 ICUs out of 289 answered (response rate = 45%). The survey showed that the diffusion of recommended infection control practices in Italian ICUs was similar to other European countries, even if infection control resources at the hospital level were scarce: a hospital infection control program was launched ad necessary resources were available in only 14% of the responding Italian ICUs.


[Multicenter study on the treatment and outcome of patients admitted to intensive care units in Italy. Presentation of the research project and the study protocol. GiViTI (Gruppo Italiano per la Valutazione degli interventi in Terapia Intensiva)]. Although Intensive Care Units (ICU) are present in most of the Italian Hospitals for acute patients, the heterogeneity of the patients case-mix and the large variation in structural, organizational and staffing arrangements have limited the feasibility and precision of evaluation studies aimed at assessing the quality of health care delivered and its impact on patients outcomes. To our knowledge there has been no nationwide study aimed at assessing the quality and effectiveness of the delivered care in samples of ICUs and patients that are representative of the source populations. To study the effects of variations in health care practices on the outcome of the patients admitted in ICU, we designed a multicentric observational study involving 120 ICUs within the country. The present study is the first part of a project involving a network of Intensive Care Units gathered under the name of GiViTI-Italian Group for the Evaluation of the Interventions in Intensive Care-that is representative of the national Italian reality in the field. The idea of a large collaborative group acting in the field of Intensive Care stands in line with several quality, effectiveness and resource utilization studies that are ongoing in other European countries and is also the result of a series of smaller-scale experiences carried out by other Italian groups eventually emboied in the GiViTI project. In the framework of the ongoing long term, multisite, and multidisciplinary project, the present study calls for the recruitment of all consecutive patients seen at the participant centers during a two months period.(ABSTRACT TRUNCATED AT 250 WORDS)


[The type of coma as prognostic indicator in severe cranial trauma in childhood]. Various methods are used by neurologists to evaluate posttraumatic brain damage. The most important and reliable are the length of posttraumatic amnesia and coma. In previous papers we have already described the value of the type of coma in the prognosis of serious head injury in childhood (Baracchini-Muratorio et al. 1985; Pruneti et al. 1985). In this study, 30 children (aged 6-12 years) with serious closed head injury and subsequent coma were evaluated. The children were divided into two groups according to the type of coma, using the Plum and Posner coma classification (1966) modified by Pagni et al. (1974). The children were followed up for at least two years (9 for five years) after the trauma by means of neurological, physical, EEG, CT scan and neuropsychological examinations. The neuropsychological test results confirm the hypothesis of a different evolution of sequelae in relation to the type of coma, independently of length of coma and site of brain damage.


[Transcranial Doppler for the monitoring of gas embolism in neurosurgical operations in the sitting position]. The risk of venous air embolism is significant in neurosurgical procedures performed in the sitting position. Monitoring for venous air embolism, therefore, is crucial and can be approached from several aspects. The most sensitive generally applicable clinical method for the detection of intracardiac gas is based on an application of the Doppler principle. The Authors describe the technique used to adapt a transcranial Doppler (TC 2-64 B, EME, Germany), and a probe designed to record the Doppler signal from intracranial arteries (Transcran FP 2, EME, Germany), as precordial Doppler in order to monitor venous air embolism in neurosurgical procedures performed in the sitting position.


[Blood levels of cortisol and prolactin. Are they indices of the degree of protection against surgical stress?]. The paper evaluates the level of analgesic protection by assaying cortisol and prolactin levels in two groups of 20 patients each undergoing general anesthesia using two different techniques: TIVA with propofol and fentanyl, and BPN-nitrous oxide. The results showed that TIVA caused a very slight increase in residue cortisol which was, however, within normal limits. With BPN-nitrous oxide anesthesia there was a greater increase in cortisol, reaching a statistically significant level in blood collected one hour after the end of surgery. With regard to prolactin, there was a marked increase in this hormone using both techniques although in percentage terms this increase was lower in TIVA. These results show that plasma prolactin is a more sensitive test than cortisol assay in evaluating antalgic protection and that, of the two anesthetic techniques used, the most protective appears to be TIVA with propofol and fentanyl.


[Fentanyl prevents the pain at the site of propofol injection]. The effect of fentanyl, administered immediately before propofol, when pain is experienced at the site of propofol injection was studied in 28 children undergoing elective surgery. The intravenous administration of fentanyl (2 micrograms/kg) significantly reduced such pain compared with a control group receiving saline. The results suggest that the administration of fentanyl may be a valid procedure in relieving pain on injection of propofol.


Postoperative pain control by transdermal fentanyl. Preliminary comparison of two dosages to a fixed-interval i.m. morphine regimen. The efficacy of postoperative pain control with two doses of transdermal fentanyl were compared to a fixed-interval intramuscular (i.m.) morphine regimen in 21 patients undergoing orthopedic surgical procedures. The two transdermal fentanyl patches with delivery rates of 70-80 micrograms/hr and 90-100 micrograms/hr, groups one and two, respectively, were compared to an i.m. morphine regimen of 150 micrograms/kg every 6h, group three. Transdermal patches were applied one hour prior to surgery and removed after 24h. Analgesia, safety scores, side effects, and a global postoperative evaluation were recorded by a blinded physician at frequent intervals up to 36h. No significant difference in pain intensity, evaluated by the visual analog scale, were found between the three groups. Group two had the lowest discomfort score. Groups one and two had a significantly lower respiratory rate than group three. Although there were isolated significant differences in peripheral hemoglobin saturations, these differences were not consistent. This is the first study in which transdermal fentanyl was compared to a fixed-interval i.m. morphine protocol without supplementation with other narcotics. The results show that fentanyl by a transdermal route can provide analgesia comparable to i.m. morphine. No clinically important adverse side effects were found in any of the study groups.


[TOSS (time oriented score system): definition of the nurse/patient relations based on the timing of the workload. Validation during the stay. Gruppo Italiano Multicentrico di Ricerche in Terapia Intensiva (GIRTI)]. TOSS, together with severity of illness (SAPS) and intensity of processes (TISS), has been determined in 941 patients on the 9th day of ICU stay, to ascertain the validity of TOSS in the calculation of the nurse/patient ratio, not only at the time of admission to ICU but also during the stay. The mean values of all indexes measured on day 9 proved lower than those measured on day 1. When the patient population were divided into survivors and non survivors, the above finding held true for surviving patients, while only TISS showed such behavior in patients who eventually died. On the contrary, both TOSS and SAPS on day 9 were not significantly different from those on day 1. Moreover, overall TOSS and TISS were linearly correlated on both occasions; however, the slope of regression lines were significantly different for the two measurements. Specifically, TOSS grew less rapidly, as a function of TISS, on day 1 compared to day 9; this yields, at equal TOSS value, a lower TISS value on day 9 compared to day 1. Therefore, TOSS demonstrates to be a suitable index to determine the nurse/patient ratio, more reliable and straightforward to be measured than TISS.


[Systemic poisoning caused by percutaneous absorption of mineral spirit]. Owing to a car accident, the clothes of a injured joiner were permeated with a timber impregnating product containing 51.8% of mineral spirit (a mixture of naphthenes, aromatic and aliphatic hydrocarbons). Despite a short-lasting skin exposure (approximately 40 minutes), dermal contact has caused full thickness burns that, in their turn, have made easier the percutaneous absorption and the storage of organic solvents in subcutaneous tissue depots. Twenty-four hours later, clinical findings of neurologic involvement have arisen, that have got worse when the peripheral tissue perfusion has got better by the adequate replacement of lost blood.


[A rare case of "secondary" drowning].

[A rare case of "secondary" drowning]. The Authors present a case of a young man who drowned in sea water after the shock caused by a lightening that fell close to him as the swam. The Authors discuss and analyze the effects of the two events (drowning and lightening) which developed similar cerebral injuries but with a different origin.


[Post-anesthesia rhabdomyolysis syndrome following muscular stress. 2 case reports]. Effort rhabdomyolysis is a syndrome which takes the form of a pathology with different etiopathogenetic stages. General anesthesia may trigger off acute muscular cytolysis which is probably influenced by the inflammatory surgical pathology itself. The observation of two cases of post-anesthetic rhabdomyolysis following muscular stress suggest that the exhaustion of muscle energy reserves and the consequent alteration of the ATP/ADP ratio may act as a trigger mechanism for this syndrome. Its close relationship with malignant hyperthermia makes a precise anamnesis vitally important, especially in relation to recent intense physical effort in patients undergoing emergency surgery for acute pathologies.


[Processing, targeting and import into the mitochondria and peroxisomes of proteins coded by nuclear genes]. I have herein discussed two gene-enzyme families in maize whose protein products participate to purge toxic oxidants from cells, and are thus of importance to all aerobic organisms. We have demonstrated that plant mitochondria import precursor proteins (i.e., preSOD-3) in a manner analogous to other eukaryotic cells. The "transit peptide" (TP) of preSOD-3 is 31 amino acid long and has similar properties to other reported TPs for mitochondrial and chloroplastic proteins. Import to peroxisomes is uniquely different from that for mitochondria and chloroplasts in that no consensus presequence seems to be involved. Instead, targeting signals seem to be integral parts of peroxisomal proteins.


[A comparative analysis of notochord formation in amphibian embryos]. We studied the origin, structure, and development of the notochord in Pleurodeles waltlii (Urodela) and Xenopus laevis (Anura) embryos. The notochord rudiment is formed in both species at the early gastrula stage as a cluster of polarized chorda-mesoderm cells located along the sagittal plane of the embryo. In Pl. waltlii the notochord rudiment is separated from the gastrocoele roof as a result of contraction of apical cell surfaces. The contraction wave spreads forward and backward along craniocaudal axis, i.e., segregation of the notochord rudiment progresses in two directions simultaneously. Similar process takes place in X. laevis embryos; however, propagation of the contraction wave in the anterior part of the body somewhat differs from that in the posterior part. While the "anterior" contraction wave resembles that in Pl. waltlii embryos, progression of the wave in the posterior part of the body is distinguished by a closer association of the notochord rudiment with ectoderm and the presence of its delamination boundaries with the somite mesoderm.


[Cytological study of the nucleolus organizer regions in the chromosomes of CBA and C57BL mice and their hybrids]. Transcriptionally active NORs of chromosomes visualized by AgNO3 staining were studied in bone marrow and embryos (day 10 of gestation) of CBA and C57BL mice, as well as of (CBA x C57BL)F1 hybrids. These mouse strains were shown to differ by the average number of Ag-positive NORs in marrow cells; in hybrids, the number of NORs is greater than in the parent strains. During embryogenesis, the number of chromosomes carrying silver-stained NORs increases; however, no significant differences by this parameter was detected between hybrid and C57BL embryos. The average number of silver-stained NORs was the smallest in embryos of CBA mice.


[The effect of the micromanipulations used for transgenosis on mouse development]. Non-specific effects of micromanipulation techniques used for producing transgenic mice on processes of embryonic development were studied. Zygotes obtained from C57BL and BALBxDD mice were treated as follows: (1) incubated in culture medium; (2) the male pronucleus punctured with a glass microneedle; (3) microinjected with a buffer solution; and (4) DNA (mouse P-35 oncogene with human insulin gene promoter) injected into the male pronucleus. Then zygotes were transferred into oviducts of syngeneic or allogeneic pseudopregnant females. Such treatment resulted in the intrauterine death of embryos, as well as in birth of the dead or non-viable offspring with numerous defects of development. Zygote pronucleus puncturing is the most damaging manipulation, since its effect exceeds that of the zygote incubation and is comparable with the effect of buffer of DNA injections.


[Oocyte maturation and activation in the common frog and the clawed toad under the action of divalent cations]. Maturation of Rana temporaria and Xenopus laevis oocytes was induced by solutions containing Mn2+ and Co2+ ions. Completion of oocyte maturation was estimated by the following criteria: (1) appearance of the maturation promoting factor (MPF) in the oocyte cytoplasm and (2) oocyte capacity to activation and formation of male pronuclei from the injected sperm nuclei. X. laevis oocytes matured under the effect of Co2+ ions were shown to contain MPF. Oocytes of both species matured under the effect of either ions could not be activated by pricking with a needle and injected sperm nuclei didn't transform into pronuclei. R. temporaria oocytes matured under the effect of ions in late spring, when natural spawning takes place, showed spontaneous activation.


[Parthenogenetic activation of bovine oocytes maturing in vitro]. The effect of hyaluronidase (0.3%) and killed bull spermatozoa on the parthenogenetic activation of cow oocytes matured in vitro until metaphase II was studied. It is shown that hyaluronidase, killed spermatozoa, and both agents in combination activate 3.4, 15.0 and 29.6% oocytes, respectively.


[The centriolar cycle in polykaryons containing prematurely condensed chromosomes or telophase-like nuclei]. In fused interphase-mitotic cells, either interphase nuclei are induced to premature chromosome condensation (PCC) or mitotic chromosomes are induced to telophase-like nuclei (TLN) formation. This study concerns structural and functional changes in centrioles of fused cells in which PCC or TLN are induced. Embryonic pig kidney cells were fused using a modified PEG-DMSO-serum method. Cell cycle period of the nuclei was determined before cell fusion using double-labeling autoradiography. Polykaryons containing desirable type of PCC or interphase nuclear combination in TLN were selected on the basis of isotope labeling after being embedded in epon. Selected cells were cut into serial sections and studied under electron microscope. The data obtained showed that centrioles at every interphase period undergo mitotic activation when their nuclei are induced to PCC. They acquire fibrillar halo and form half-spindles. Daughter centrioles at G1, S and G2 periods are also capable of mitotic activation when separated from their mother centriole. Inert centrioles were found in some cells with G1-PCC. When mitotic nuclei are induced to TLN formation, their centrioles also become inactivated. They lose fibrillar halo and mitotic spindles break down. Some mitotic centrioles develop features characteristic of interphase period such as satellites and vacuoles. Induced nuclear and centriolar changes are simultaneous and may be controlled by the same factor. Mitotic factor of mitotic cell partner which induces PCC may also induce interphase centrioles to mitotic activation. Degradation of the mitotic factor leading to TLN formation may also cause the loss of the mitotic activity of centrioles and disorganization of mitotic spindles.


[Secondary prevention of colon cancer].

[Secondary prevention of colon cancer]. Each year more than 6000 patients in Poland die from cancer of the colon. Morbidity due to colonic cancer increases rapidly in our country. From 1973 to 1982 there was a three-fold increase in the morbidity due to colonic cancer as compared to the years 1952-1955. Five-year relative survival in the same periods did not improve, either being 28% in men and 27% in women. To compare, in the USA with high morbidity rates due to colonic cancer where each year there are 145,000 new cases of cancer, 5-year relative survival is 42% for men and 54% for women. This raises a question whether our strategy of treatment of colonic cancer is correct. This question is even more justified now when secondary prevention of colonic cancer is of practical value. Total mortality due to colonic cancer is 60%. However, diagnosis and treatment of early forms of colonic cancer reduces mortality to 20% and below. Therefore, effective management colonic cancer should include not only the so-called primary prevention (interfering with etiological factors for instance through high fibers diet) but also secondary prevention through monitoring of precancerous changes in the colon, removal of potentially malignant lesions and early forms of colonic cancer [19]. Secondary prevention interfering with the pathogenesis of colonic cancer is the subject of the present paper. We would like to emphasize the need for a better management program for colonic cancer, especially that the data concerning colonic cancer in Poland may be underestimated due to diagnostic neglect and faulty cancer register.(ABSTRACT TRUNCATED AT 250 WORDS)


Colorectal carcinoma as a genetic phenomenon. Carcinogenesis in human large intestine is a result of multiple, heterogeneous and random genetic changes. Deletion of tumor suppressor genes and activation of oncogenes appear to be important molecular events. These compromise the loss of chromosomes 5, 17, 18 or functional inactivation of FAP, p53 and DCC genes. Activation of Ki-ras and c-myc oncogenes seems to be crucial for both cell immortalization and morphology modification. Identification of genes involved in this process enables both a screening and a new classification. Also it is an important step towards a gene therapy.


Colorectal polyps in autopsy material. Part I. Adenomatous polyps. In prospective studies specimens of the large bowel were obtained from 733 autopsy cases. After fixing they were examined under illuminated magnifying lens and all polypous lesions were excised for histological analysis and classified according to Correa's criteria (8). Adenomatous polyps were found in 280 cases (38.2%) and their prevalence increased with age in both sexes. Adenomatous polyps, also multiple were found most frequently in the transverse colon, and then ascending colon, sigmoid, descending colon and rectum. The mean number of adenomatous polyps per positive specimen was 2.33 for men and 2.60 for women. In 6.8% their diameter was > or = 10 mm. The prevalence of polyps with severe degree of dysplasia (III degree) increased from proximal to distal segments of the colon in both sexes and their prevalence is significantly higher in the ascending colon in women. In the whole series there were 6 adenocarcinomas of 5-18 mm in size, all in women over 80 years of age. The results of the present study were compared with the data concerning other populations of the world. In the light of a repeatedly confirmed a generally accepted relationship between adenoma and adenocarcinoma of the large intestine the results of our study seem to underestimate the prevalence of colon adenocarcinoma in the population of Cracow and Cracow district.


Current methods in histopathology.

Current methods in histopathology. The past decade has presented many new methods to histopathology. However, there are important reasons for establishing these methods in every institute for pathology. It is not enough just to exchange old equipment into new systems. It takes a careful judgement what will be the benefits from a new system for the institute, the hospital and the patient. Important factors like institute management, quality assurance, quality control, speed, competitiveness, profitability and environmental safety aspects are high ranking tasks in the modern institute of pathology, next to the specialization in new diagnostic areas like immunohistochemistry, bone-pathology (bone-morphometry/undecalcifield iliac crest biopsy histology), flow cytometry, image analyzing or PCR-techniques etc. The main target of each institute of pathology, weather of private nature or a governmental/state institution, is the establishment of a high quality, safe and reliable diagnosis in the fastest time and for a price based on a standardized, accepted and economical system. Institutions will be more controlled by certain economical departments which have to watch the cost-/profit situation of the hospital and it's individual institutions in comparison to the average country standard and the average European standard. The introduced methods are mostly standard in "Western" institutes. However, it is of utmost importance that the institutes in "Eastern Europe" establish these standards as soon as possible in order to be competitive and to be able to join research-projects with "Western" universities - a necessary source of income.


Mode of action of fibrates.

Mode of action of fibrates. Fibrates are a class of hypolipidaemic drugs that effectively reduce plasma triglyceride and cholesterol levels, but also raise HDL cholesterol. In recent years the attention of pharmacologists and clinicians to fibrates has been renewed also in the light of a multifaceted action on plasma lipids as well as on factors modulating the thrombotic homeostasis in blood. The mechanisms of actions underlying these effects are discussed in this short review.


Vasoactive eicosanoids in the rat heart: clues to a contributory role of cardiac thromboxane to post-ischaemic hyperaemia. To assess the potential role of vasoactive cardiac eicosanoids in the modulation of coronary flow, we measure thromboxane(TX)B2, 6-keto-prostaglandin(PG)F1 alpha, PGE2 and sulphido-peptide leukotrienes (LTC4, D4, E4) in the coronary effluent of isolated perfused rat heart in both baseline and post-ischaemic conditions. Leukotrienes were undetectable. The order of production rate for the other eicosanoids was 6-keto-PGF1 alpha > TXB2 > PGE2. Production of such substances was increased about seven-fold over control after 5 min. global ischaemia; experiments with hypoxia showed that this was due to an actual increase in synthesis and not to a washout effect. A platelet source for TXB2 was excluded by 111In platelet labelling experiments. We assessed relative sensitivity to inhibition of cardiac TX synthesis relative to production of 6-keto-PGF1 alpha to inhibition by aspirin, ibuprofen, diclofenac and the specific thromboxane synthase inhibitor OKY-046. Aspirin, ibuprofen and diclofenac decreased 6-keto-PGF1 alpha production at a concentration always greater than required for a similar extent of TX inhibition. On the other hand a selective inhibition (> 90%) of TX was observed in the presence of OKY-046. Regression analysis of various 6-keto-PGF1 alpha/TXB2 ratios, as obtained in these different conditions, vs coronary flow, showed no correlation in baseline conditions, but a significant positive correlation (r = 0.59, P < 0.01) for post-ischaemic values. These data suggest a role for cardiac eicosanoids, including a non-platelet, cardiac-derived TX, in modulating the hyperaemic response in the isolated rat heart.


Effects of a beta 2-agonist (clenbuterol) on cultured human (CG-5) breast cancer cells. In order to gain further knowledge about the possible oestrogen-like activities of clenbuterol (a beta 2-adrenergic drug illegally used as partitioning agent in food producing animals), we treated a hormone dependent human breast cancer cell line (CG-5) with different concentrations of the drug (10(-3) M to 10(-8) M). The effects of clenbuterol and oestradiol on cell proliferation were compared. Both oestradiol and clenbuterol, at low concentrations (10(-7) M and 10(-8) M) stimulated cell proliferation, but the effects of clenbuterol were less marked and significant. Probably clenbuterol elicited cell proliferation through a different mechanism, since it did not affect the cellular oestrogen receptor concentration. Clenbuterol failed in binding to the high affinity oestrogen receptors present in the CG-5 cells. As the beta-adrenergic receptors and the susceptibility to their stimulation have been recently demonstrated in vivo and in vitro in many tumour and normal cells, it is reasonable to suppose that clenbuterol may induce cell proliferation through beta-adrenergic stimulation.


Effects of sulglycotide on endogenous prostaglandin synthesis in human antral mucosa. The effect of sulglycotide, a polysulphated glycopeptide isolated from pig duodenum, on PGE2, 6-ketoPGF1 alpha and TxB2 production from isolated biopsy specimens of human antral mucosa was investigated in vitro, in comparison with carbenoxolone. In addition to a tendency toward increased PGE2 production just short of statistical significance, both sulglycotide and carbenoxolone significantly increased 6-ketoPGF1 alpha accumulation in the incubation medium. TxB2 levels were not significantly modified by the two drugs. Therefore, changes in the prostanoid production by human antral mucosa could, at least partially account for the cytoprotective effects of sulglycotide in man.


[Recent advances in xenotransplantation]. Interest in xenotransplantation has dramatically increased in the past 4 years, focusing on the potential use as donors of distantly related animals such as pigs (discordant xenografts). The major barrier is hyperacute rejection. The mechanisms responsible for this rejection include: specific reaction of the recipient's natural antibodies with antigens in the donor's organ, direct activation of the recipient's complement system by endothelial cells in the donor's organ, and/or relative failure of complement inhibitory proteins in the donor's organ to impede activation of the recipient's complement system. In case of vascularized xenograft, the temporary depletion of anti-donor antibodies (anti-ABH or anti-HLA class I) from a graft recipient may allow the long term survival of the graft despite a possible return of the antibodies to the circulation. This phenomenon is called accommodation. The mechanisms involved could be: the endothelial cells in a graft develop a resistance to complement mediated injury; the antigens expressed on the blood vessels become modulated or changed; the natural antibody repertoire changes in such a way that there are fewer anti-donor antibodies. The accommodation phenomenon encourages the view that the barrier to xenotransplantation is not immutable.


[Residual lymphocytes after specific depletion. Functional study]. We previously demonstrated that, following a 2-day stimulation of T cells by MHC incompatible cells, a ricin A-chain conjugated to a monoclonal anti-IL2 receptor p55 subunit can kill 1.5 log of the activated alloreactive T cells while non specific killing of alloreactive T cells of a third partner does not exceed 0.5 log. This methodology is of potential use for selective alloreactive T cell depletion in MHC incompatible bone marrow transplantation in order to prevent both graft versus host disease and graft rejection. This study shows that this T cell depletion method does not alter T cell reactivity to microorganism antigens encountered in infection following BMT. It was found that T cell proliferation to cytomegalovirus and to candida antigens is not affected as shown in proliferative assays and by limiting dilution analysis for the latter antigen.


[Discordant heart xenografts. Experimental study in pigs conditioned by total lymphoid irradiation and cyclosporine A]. The use of discordant xenografts may solve some of donor shortage problems. The beneficial effects of treatment with total lymphoid irradiation (TLI) and classical drugs on this discordant model of transplantation rejection was evaluated. Twenty-four lamb hearts were transplanted heterotopically in the abdomen of 24 pigs. Group I received no treatment (control). Group II received continuous intravenous medical treatment cyclosporin A (CyA) (5 mg/kg) and azathioprine (3 mg/kg) 3 days prior to transplantation. Group III received the same medical treatment and simultaneously 12 grays of irradiation in 5 equal fractions with a high rate (100 cGy/min) or a low rate (1.6 cGy/min) prior to transplantation. Group IV also received 12 grays in 5 fractions at a high rate followed by the medical treatment started 5 days after TLI and continued until the day of transplantation. Antibody and serum cyclosporine levels were monitored. Histology specimen were analyzed at the end of the experiment. Mean GST (graft survival time) in group I and II was 140 +/- 35 min and 117 +/- 27.4 min respectively. The histological features of these hearts suggested acute humoral rejection (hemorrhage, thrombosis, and edema) without cellular infiltration. In group III, one heart functioned 4.5 days with pathological features of cellular rejection and a second animal died at 6 hours with a functioning graft with no evidence of an acute rejection. Both had been treated with the low rate TLI protocol (1.6 cGy/min). The mean GST in this group was 1080 +/- 794 min. In Group IV, one graft functioned for 6.5 days and another for 3.25 days. Mean GST was significantly increased in this group to 4800 +/- 2647 min (p < 0.05). A cellular infiltration was seen in this two grafts. The remaining graft was rejected in 6 hours with histological lesions typical of acute humoral rejection. Antibodies levels at the time of transplantation were lowest (40%) in group IV and in the low rate irradiation group. The ability of TLI to induce tolerance and to prolong survival in a discordant xenograft model depends upon cumulative dose, rate of irradiation, delay between TLI and graft placement, and combined treatment with immunosuppressive drugs. A high rate of TLI and graft placement is delayed. Low rates of irradiation may be beneficial when there is a very short period between treatment and transplantation. These findings highlight the potential usefulness of TLI in combination with immunosuppressive drug therapy when antibody-mediated rejection occurs, such as with xenograft and in sensitized patient.


[Superacute xenogenic rejection: attempted treatment with anti-idiotypic antibodies]. Heart xenotransplantation in the guinea-pig to rat model, a highly discordant combination, is invariably followed by a hyperacute rejection of the graft. Preformed IgMs were shown to be responsible for the destruction of the graft by stimulating the complement cascade. We tried to inhibit preformed antibodies, before transplantation, by inducing anti-idiotypic antibodies using autologous Fab' mu specific for guinea-pig endothelial cells. This treatment seems to exert a neutralizing effect on xenogeneic hyperimmunization, against guinea-pig endothelial cells but not against preformed anti-guinea-pig antibodies.


[T clones, a means of exploring minor antigens involved in graft versus host reaction]. During MHC-matched bone marrow transplantation, a graft-versus-host reaction (GVH) mediated by donor T lymphocytes and directed against host minor histocompatibility antigens may be observed. The establishment of T cell clones from GVH mice has enabled us to study minor antigens recognized during the reaction. Most of the T cell clones were Thyl+CD4+CD8-alpha beta+. Four minor, weakly polymorphic antigens, were evidenced; two of those antigens, recognized by CD4+ T cell clones, were implicated in GVH. One CD8+ T cell clone cannot provoke GVH mortality. The two "killer" clones express V beta 18 and V beta 2 TCR gene segments, respectively.


[Synthesis of collagen in culture of endothelial cells of the human umbilical vein. Effects of cyclosporine A]. Interstitial renal fibrosis and gingival hypertrophy are frequent side-effects of cyclosporin A which have been attributed to a dysfunction of extracellular matrix synthesis. Endothelial cells might participate in the matrix accumulation observed. We studied the effects of increasing concentrations of cyclosporin A on protein synthesis by human umbilical vein endothelial cells. Collagen synthesis decreased significantly to 800 ng/ml in both medium and cell layer. The percentage of hydroxylation of its proline residues decreased significantly as from 400 ng/ml. The main proteins, analysed by SDS-PAGE, were thrombospondin, fibronectin and the alpha 1 and alpha 2 chains of type IV collagen. These fractions did not show any change after 24 hours exposure to 200 ng/ml of cyclosporin A. These results demonstrate an inhibitory effect of cyclosporin A on collagen synthesis by human umbilical vein endothelial cells. Consequently, matrix accumulation by increased collagen synthesis in cyclosporin A treated patient may not be directly related to the drug effect on endothelial cells.


[Expression of HLA-DP antigens on normal and leukemic blood cells]. HLA-DP allodeterminant elicit weak cellular and humoral immune responses. This study was undertaken to find out if the low immunogenicity of HLA-DP could be accounted for by a low level of expression on peripheral blood mononuclear cells. Double staining experiments and flow cytometry were performed in 28 healthy individuals, HLA-DP was found to be as expressed as DR and DQ on B lymphocytes. Furthermore, a DP+/DR- lymphocyte sub-population was identified and characterized as freshly activated T lymphocytes.


[Natural killer lymphocytes in kidney transplantation]. We conducted a dual study of phenotype and function of natural killer cells (NK) using flow cytometry, this study being applied to renal transplantation. The CD 16 and CD 56 clusters correlated well with NK cytotoxicity, especially for CD 3 lymphocytes, whereas CD 57 should no longer be considered a NK marker. NK activity was determined on K 562 or Daudi cells, either spontaneously or after in vitro activation with r-interleukin 2 (LAK). Cytotoxicity was analyzed after labeling of target cells by carboxyfluoro-diacetate and measured by flow cytometry. We found that in renal transplant recipients NK cells were deficient in numbers and functions and showed that LAK activity was also diminished. Azathioprine appeared to be the main immunosuppressant impairing NK cells. Viral infections increased the numbers and functions of NK cells, whereas during malignancies they remain as low as in uncomplicated recipients. NK cells deficiency might be involved in the high incidence of de novo malignancies in renal transplant recipients.


[Immunodeficiency caused by graft versus host reaction. Extra-thymic effect of thymus in restoring immunity]. Cell-mediated immunity in lethally irradiated graft-versus-host mice can be restored after repopulation with syngeneic bone marrow cells and thymus grafting. The thymus is not only required for the maturation of T lymphocytes, but also for the inhibition of a radioresistant mechanism resulting in lymphoid cell rejection.


[Routine application of HLA class II oligotyping. Value of automatization]. HLA class II typing by DNA amplification and hybridization with allele-specific oligonucleotides has led to an improvement of the overall typing accuracy. In an attempt to apply this procedure to a large-scale analysis, we sought to implement an automation system using the Biomek 1,000 robotic work-station. This system allows a rapid preparation of many consecutive samples and avoids the risk of human errors. It is now routinely used in several laboratories.


[Interleukin 4 increases lymphocytic adhesion to allogenic endothelium through a dependent protein kinase A]. Interleukin 4 and tumor necrosis factor alpha increase endothelial cell adhesiveness for lymphocytes by promoting adhesion molecules synthesis. We have shown that intracellular mechanisms, which transduce IL 4--but not TNF alpha--signal, involve a protein kinase A.


[In situ production of interferon gamma and interleukin 6 by infiltrating cells from human kidney allografts in irreversible rejection. Modulation by cytokines]. Using ELISPOT assays, we detected a significant number of cells secreting interferon-gamma and interleukin 6 among 8 irreversibly rejected kidney allografts compared with normal kidneys. Interleukin 2 increases the frequency of interferon-gamma producing cells and interleukin 4 decreases the frequency of both interferon-gamma and interleukin 6 producing cells.


[Kidney transplantation in hyperimmunized patients ignoring the cross-match performed with historic sera]. To ignore the positivity of renal pretransplantation cross-match performed with peak sera remains a controversial practice. The present study concerns 11 renal transplantations after positive cross-match with peak sera and negative cross-match with current sera. The clinical results of these transplantations lead to the assumption that peak sera contained HLA antibodies not specific to the graft and non HLA antibodies responsible for the positivity of the cross-match.


[Polycythemia after kidney transplantation]. Between 1971 and 1990, 251 kidney transplanted patients with a well functioning graft were evaluated to determine the frequency of post-transplant erythrocytosis (PTE). Thirty-one patients (13 percent) developed polycythaemia 10.6 +/- 10 months after transplantation. Thromboembolic complications occurred in 22 percent of the cases. The frequency of PTE was higher in males than in females (sex ratio: 7.2 vs 2.1; P < 0.05). Patients with renal dysplasia had a lower incidence of PTE (3 vs 22 percent; P < 0.05) as did those who had been treated with azathioprine (9.4 vs 19 percent; P < 0.05). None of the patients treated with recombinant erythropoietin before transplantation developed PTE during a mean follow-up of 15.1 +/- 4.5 months. The majority of polycythaemic patients had normal erythropoietin levels. These results show that there is an erythropoietin-independent proliferation due to an increased sensitivity of erythroid progenitors or to an erythroid stem cell stimulation by cytokines.


[Kinetics of erythropoietin blood levels from D-1 to D-29 in kidney transplantation]. This study of serum erythropoietin levels and reticulocytes counts in the first month after kidney transplantation shows that the erythropoietin peak is efficient only when serum creatinine level at the time of the peak is under 200 mumol/l.


[Diagnosis of stenoses of the renal artery graft by pulsed echo Doppler velocimetry. Application to the prospective evaluation of the incidence of stenoses of renal graft artery]. The value of pulsed Doppler velocimetry (PDV) to detect renal graft artery stenosis was evaluated in a prospective study of 42 kidney-transplanted adult patients. The results of PDV were compared with those of arteriography which is regarded as a reference examination. With PDV the diagnostic sensitivity was 85 percent and specificity was 82 percent. The low cost and good sensitivity (provided the interpretation problems are known) of this harmless examination make it a good instrument to detect renal graft artery stenosis. In order to obtain an early diagnosis, 148 kidney-transplanted patients were systematically examined by PDV 1, 3, 6 and 12 months after transplantation. The incidence of renal graft artery stenosis was evaluated at 6.8 percent.


[Kidney biopsy puncture, kidney aspiration puncture with fine needle, examination of urine sediment in phase contrast. Comparative study for the diagnosis of acute rejection in kidney transplantation]. The relative importance of renal biopsy and cytological studies (fine needle aspiration biopsy and urine sediment examination by phase contrast) in the diagnosis of acute rejection episode was evaluated in 30 patients who received a kidney transplant. All patients underwent these 3 examinations simultaneously during an acute degradation of graft function. Sensitivity of renal biopsy, fine needle biopsy and urine sediment was 0.86, 0.68, 0.43 respectively. The association of fine needle biopsy and urine sediment examination increased the sensitivity up to 0.73. Renal biopsy is indicated to assess the vascular and glomerular status or in the presence of inconclusive cytological studies.


[Effect of pregnancy on renal function after transplantation]. Between 1968 and 1991, 36 pregnancies were reported in 28 patients who had undergone kidney transplantation at the Necker hospital, Paris. Pregnancies with favourable graft outcome were compared with those accompanied by significant deterioration of graft function and requiring haemolysis. The risk factors for renal function deterioration during pregnancy in kidney-transplanted women were found to be an initial nephropathy induced or aggravated by a previous pregnancy, an alteration, even mild, of graft function, hypertension, even controlled by treatment, an HLA mismatch and several episodes of acute graft rejection soon after kidney transplantation.


[Non anti-HLA antibodies and early irreversible rejection after kidney transplantation in children]. Despite the absence of anti-HLA antibodies (Ab) about 10 to 20 percent of renal transplants are lost during the first months from rejection. The role of humoral rejection seems more likely than cellular rejection since they do not respond to standard anti-rejection therapy. We studied 37 patients who rejected their graft despite negative T and B lymphocytes cross-match during the first eight months (m: 59 days, range: 2-240) following kidney transplantation. These patients were compared with 57 patients who experienced a favorable outcome. The sera were tested for the presence of Ab against epidermis of a panel of 5 normal skins and against an epithelial-endothelial hybrid cell line (EA hy 926, Dr C.J.S. Edgell), expressing both endothelial and epithelial antigens. Among the 37 patients who rejected theirs grafts, 8 had anti-keratinocytes Ab, 11 had Ab against epithelial-endothelial hybrid cell line, 9 were positive for both tests. Among the 8 pts who lost their graft before 25 days, 5 were positive for at least our test. Conversely, 7 among the 57 pts with favorable outcome had Ab: 2 against keratinocytes, 5 against hybrid cell line. These data suggest that non anti-HLA Ab may play a role in graft rejection. Furthermore the detection of such Ab prior to transplantation may predict patients at risk of severe rejection. In such cases, plasma exchanges may be proposed if they develop steroid-resistant rejection.


[Study of CD45 isoforms on T CD8 lymphocytes, in the peripheral blood and the graft in patients after kidney transplantation]. We report characterization of CD45 isoforms expressed by CD8+ lymphocytes in peripheral blood and in the graft of 40 kidney transplanted patients who underwent kidney biopsy on the basis of clinical signs suggesting rejection. Standard histological examination of the biopsy fragments and three-color cytofluorimetric analysis of lymphocytes extracted from the same fragments by mechanical and enzymatic treatment were performed simultaneously and compared to the peripheral blood lymphocytes. In 14/40 biopsies where lymphocyte extraction succeeded, the predominant subset was CD8 (CD4/CD8 mean ratio was 0.53). Almost all CD8+ cells were activated: among these CD8+ cells, 55 percent were HLA-DR+, and 68 percent CD45RO+, i.e. of a memory cell type with cytotoxic activity. This situation resembles the in vitro observation made during mitogenic stimulation of lymphocytes by phytohemagglutinin, OKT3 or CML ("culture mixte lymphocytaire"). Beside their evident interest for the diagnosis, these data could be useful for our understanding of the physiopathology of the rejection crisis.


[Transplantation for primary hyperoxaluria. Role of oxalate crystal deposits in the occurrence of kidney failure]. We analyzed the records of 3 patients transplanted for end-stage renal failure due to primary hyperoxaluria and evaluated on repeat biopsies the role played by oxalate deposits in the constitution of renal failure after isolated kidney graft, or combined liver and kidney transplantation. Early failure of the renal graft is frequent and often interpreted as the consequence of recurrence because of the presence of oxalate deposits on the graft biopsy. In fact, the decrease in oxalate deposits observed in our 2 cases of combined liver and kidney transplantation despite the progressive renal failure, indicates that crystal deposition is not responsible for the renal lesions. However, we cannot exclude that the oxalate molecule toxicity plays a role in the constitution of the diffuse sclerosis which occurred in these two cases after a primary renal non function, aggravating a hemodynamic process by using cyclosporin. On the other hand, as observed in our isolated kidney graft, renal crystal deposition occurring before the onset of renal failure suggests the true mechanism explaining the slow recurrence of renal oxalosis.


["Monobloc" resection in heart and lung transplantation. Technique and advantages of a new procedure]. Hemostasis is a usual problem in surgical heart and lung recipient removal. Since April 1990, we have been using as surgical technique an "en bloc" removal of heart and lungs in order to reduce postoperative bleeding and cardiopulmonary bypass duration.


[Plasma glycosylated residues demonstrated by proton NMR spectroscopy. Value in the detection of heart graft rejection]. In conjunction with biopsy and Doppler studies, we analysed by high resolution proton NMR spectroscopy the blood plasma of 22 heart transplant recipients. There was a significant variation in the glycosylated residues of proteins with the development of acute cardiac rejection. A more extensive study is underway to assess the sensitivity and specificity of this approach for the early diagnosis of acute cardiac rejection.


[Criteria for choice of the donor in heart transplantation in adults]. Among 66 consecutive adult heart transplant recipients operated on from January 1988 to October 1991, 11 experimented early graft dysfunction (4 of them died). Mean donor's age was 37.4 +/- 11 years; 9 patients were older than 50 years; 85 percent of donors received dopamine. Were found without any significant influence on early graft function: donor's age, weight mismatch, duration of donor's intensive care, dose of dopamine administered, external cardiac massage and relative hemodynamic instability, and ischemic time. Conversely, a history of chronic alcoholism in the donor is of pejorative significance, which is not without consequences in view of the current scarcity of donors.


[Towards an integrated protection of heart grafts]. In an attempt to provide a consistent protection of cardiac allografts during the sequence of events inherent in transplantation procedures, we developed two preservation solutions of which one is used for initial arrest, storage and cardioplegia during graft implantation, whereas the other serves as initial reperfusate. The formulations of these solutions are closely interrelated and their design has integrated the basic principles of organ preservation with those of myocardium-specific metabolism. Based upon experimental studies in the isolated rat heart model, this integrated approach has yielded better functional recoveries than conventional preservation protocols.


[Neonatal heart transplantation. First results]. Two 5- and 17-days old neonates with hypoplastic left heart syndrome respectively underwent orthotopic heart transplantation. The donor-recipient weight ratio was +58 percent and +88 percent; ischemic time was 144 and 167 min. The immunosuppressive protocol included thymoglobulin during the induction period and a classical 3-drug therapy, with a rapid tapering off of prednisone over 3 weeks. No infectious complication was observed; each infant experimented one episode of acute rejection, successfully treated with prednisolone. Forty-three months and 10 months later, the 2 children are doing well, with normal renal function and normal growth. No late rejection episode was observed. Heart transplantation in neonates is feasible, the short-term and mid-term results are good. Despite important ethical problems, heart transplantation represents a great hope for neonates with inoperable congenital heart defects.


[Enhancement of the quality of hepatic graft by restoration of hepatic glycogen reserves in the donor]. It has been suggested that depletion of donor hepatic glycogen reserves deleteriously affects the resistance of the hepatic graft to ischemic episodes. In this study, performed in the pig model, we showed that it is possible to enhance the quality of the graft at the time of reperfusion by using a method which rapidly restores the donor hepatic glycogen reserves. With the aid of an isolated liver perfusion model, we compared grafts (n = 24) harvested from pigs fed (group N), fasted for 24h (group J), or fasted with a restoration of glycogen reserves (group P). After the grafts were subjected to 8 hours of cold ischemia, the release of alanine aminotransferase, aspartate aminotransferase and lactic dehydrogenase in the perfusate increased in group J (P < 0.05 vs group N); the increase was corrected in group P (P < 0.05 vs group J). When the grafts were subjected to 15 minutes warm ischemia prior to the liver harvest, the production of bile was reduced in group J (P < 0.05 vs group N); bile production was reestablished in group P (P < 0.05 vs group J). The clinical application of such a method of donor nutritional conditioning, in the hours which precede organ harvesting, may enhance the quality of the hepatic graft at the time of transplantation.


[Double liver-kidney transplantation in the presence of a positive T cross-match]. Kidney transplantation, when performed across a positive T lymphocyte cross-match, is always followed by the occurrence of a hyperacute rejection. On the other hand, successful hepatic allografts have been reported under these same conditions. Furthermore, clinically and experimentally hepatic allograft has been reported to induce tolerance of other organs from the same donor. Thus, combined liver-kidney transplantation constitutes an ideal application of these immunological events. We report here the case of a sequential liver-kidney transplantation in which liver transplantation performed prior to kidney transplantation with an organ from the same donor induced kidney tolerance despite an initial positive T lymphocyte cross-match.


[Transplantation of a segmental small intestine in dogs. Comparison between jejunal graft and ileal graft]. The purpose of this study was to compare heterotopic jejunal and ileal allografts in the dog under cyclosporine A. Fourteen allografts (8 ileal and 6 jejunal) were successfully performed. There was no case of graft-versus-host disease in this series. Six allografts (42.5 percent), 3 jejunal (50 percent) and 3 ileal (37.5 percent), were rejected during the first 3 months (NS). Eight allografts, 5 ileal and 3 jejunal, were tolerated up to 3 months and then removed; 2 ileal and 2 jejunal were normal; 2 ileal and 1 jejunal showed signs of chronic rejection, and 1 ileal signs of advanced rejection. It is concluded that there is no major difference between jejunal and ileal allografts in the dog.


[Incidence and clinical expressions of microvascular complications in patients receiving kidney graft and treated with cyclosporine]. Reported cases of HUS/TTP (hemolytic uremic syndrome/thrombotic thrombopenic purpura) with cyclosporin (CsA) are more and more frequent, which led us to evaluate the incidence of microangiopathic process in kidney graft patients. In our first retrospective study we noted 9.4 percent of HUS/TTP among 117 patients. We tried to detect infraclinical hemolytic events prospectively in 40 new patients by systematic measurement of haptoglobin levels after introduction of CsA. The incidence of falls in haptoglobin levels was 25 percent. The immunological context was always noted: rejection crisis in 5 cases, cytomegalovirus infection in 3 cases, isolated markers of lymphocyte-activity in 2 cases. We never found a clinical or infraclinical form of microangiopathic process without a symptomatic or asymptomatic immunological complication. Monitoring haptoglobin levels make it possible to detect early endothelial injuries which could be linked to the future arteriolopathy described with CsA therapy.


[Protective effect of verapamil and dopamine against cyclosporine-induced vasoconstriction in isolated glomeruli in rats]. Cyclosporin A (CsA)-induced nephrotoxicity is characterized by dramatic changes in glomerular filtration rate and renal plasma flow, largely limiting the clinical use of this drug. The vasoconstrictive response of CsA could explain, in part, these hemodynamic alterations. The present study compares the area changes in rat-isolated glomeruli incubated with CsA alone or after pre-treatment with verapamil and dopamine. In verapamil-pretreated CsA-intoxicated glomeruli, size decrease was reduced (-1.5 percent at T10, -3.1 percent at T20 and -4.8 percent at T30), when compared with CsA alone (-4.7 percent at T10, -10.1 percent at T20 and -12 percent at T30). The results obtained with dopamine were similar. In conclusion, verapamil and dopamine can be regarded as fair protective agents against CsA-induced vasoconstriction in rat-isolated glomeruli.


[Reduction of TNF-alpha release and clinical effects of the first injection of OKT3]. In order to prevent the adverse effects of a first OKT3 injection in renal transplant recipients, we administered polyclonal antilymphocyte globulins (ATG Fresenius, 4 mg/kg/j) for 3 days before OKT3 injection. Compared with a historical group of 5 patients who did not receive ATG pretreatment before OKT3 injection, the patients who were pretreated by ATG had a significantly lower absolute number of circulating lymphocytes before the first OKT3 injection (363 +/- 107 vs 1,230 +/- 80/mm3, P < 0.001), a lower raise in plasma TNF-alpha level 2 hours after OKT3 injection (178 +/- 42 vs 735 +/- 127 pg/ml, P < 0.005) and a significant decrease in frequency and intensity of clinical symptoms, mainly chills, dyspnea, and headaches. However, fever and peak creatinine level were similar in both groups. A 80 percent success rate of crisis treatment was achieved in both groups and there was no increase in infectious complications. In conclusion, pretreatment with ATG induces a lymphocyte depletion, and decreases the amounts of TNF-alpha released as well as the side-effects of a first OKT3 injection.


[Perioperative remote infections in neurosurgery. Role of antibiotic prophylaxis]. We report the results of a randomized, prospective study devised to assess the effectiveness of perioperative cefamandole prophylaxis on the remote infections rate in neurosurgery. Only two kinds of neurosurgical procedures were studied: shunt placement and craniotomy for brain tumour. In the treated patients cefamandole 1.5 g was given one hour before surgery, then repeated twice eight hourly. When the surgical procedure lasted more than three hours cefamandole 1.5 g was administered throughout the operation. No case of local infection was observed in either group, and the percentage of patients with remote infections was the same in both groups. Leucocytosis and temperature were measured during 15 days following the surgical procedure, and there were no differences between the treated and untreated groups in the evolution of these parameters. This study does not suggest that routine perioperative antibiotic prophylaxis is mandatory in neurosurgery.


[Cushing syndrome during pregnancy. New diagnostic methods used in 3 cases of adrenal cortex carcinoma]. Cushing's syndrome during pregnancy is most often caused by an adrenal cortical tumour; it is a rare event which bears poor foetal and maternal prognoses. We report 3 cases of adrenal cortex carcinoma diagnosed during pregnancy (after 24, 27 and 28 weeks respectively of amenorrhea) and revealed by local tumoral signs in 2 cases and by pulmonary embolism in the third. Because hair growth was moderate and weight gain as well as high blood pressure had mistakenly been attributed to the pregnant state, these clinical features of hypercortisolism has only lately been related to tumoral secretion. The hypercortisolic state was firmly established by comparing the patients' urinary cortisol levels (677, 941 and 2,167 micrograms/day) and 20-hour salivary cortisol levels (9.9, 15 and 25.3 micrograms/ml) with values obtained in women at the same stage (88 +/- 11.4 micrograms/day and 2.31 +/- 0.25 micrograms/ml). The aetiological diagnosis was made by the finding of a highly increased salivary testosterone levels (50, 34 and 95 pg/ml; normal = 8.6 +/- 4 pg/ml), and by magnetic resonance imaging which showed unilateral adrenal masses of 3, 8 and 20 cm in diameter respectively. These 3 cases illustrate the difficulty of the clinical diagnosis of hypercortisolism during pregnancy. Assessment of the unbound steroids and magnetic resonance imaging are the most useful methods for an early diagnosis, thus preventing the severe complications which may otherwise reveal this rare pathological condition.


[Colorectal villous tumors. Treatment by electro-resection and laser photocoagulation. 134 cases]. Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of seven patients. Eight patients were lost to follow up. Treatment results could be analysed in 119 patients. A successful treatment was achieved in 108 patients. Tumour destruction was complete in 85.4 percent of the cases with lesions of at least 4 cm in diameter and in 94.3 percent of the cases with smaller lesions. During the average 101 weeks follow up period, 15.7 percent of the patients with total tumour destruction had recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgical treatment. It would appear that endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method for the destruction of colorectal villous adenomas.


[Complications of cervical spine manipulation. A case of "locked-in syndrome"]. The current craze for cervical spine manipulation is due to its rapid and even dramatic results and to the ineffectiveness of many treatments prescribed by physicians. Complications of thoracic or lumbar spine manipulation are very rarely reported, but this is not the case with the cervical spine. We present the case of a woman who suffered a severely disabling complication caused by an "osteopathic" manoeuvre. This technique should be rejected as it is dangerous and as harmless methods can be used with good results in common cervicalgia, even if it is very severe.


[Glucose transporters. Physiology and physiopathology]. Glucose transport is an important step in the regulation of glucose homeostasis. Two types of transport systems are described: active transport accumulates glucose in specific cells, whereas facilitative transport equilibrates blood glucose and intracellular glucose inside all mammalian cells. At the present time, different levels of facilitative transport regulation are known. Facilitative transport is achieved by 5 different isoforms; each isoform has its own characteristics and is subjected to tissue-specific regulation. Alteration of glucose transporters expression may be involved in a physiopathological situation such as diabetes which is characterized by insulin resistance of peripheral tissues and impaired insulin secretion by beta pancreatic cells. Thus, Glut 2 expression is reduced in the beta cells of diabetic rats. The reduction of Glut 2 expression correlates with, and may contribute to the loss of glucose-stimulated insulin secretion. However, Glut 2 expression in liver remains unaltered. The insulin resistance of peripheral tissues may be explained in adipose tissue by a decrease in Glut 4 expression. In skeletal muscle, Glut 4 expression remains constant whatever the physiological or physiopathological situation.


[The low-birth-weight newborn. The training of mothers for care at home]. In March 1989 the sub-program for reducing low birth-weight was put into practice. As a response to the application of this subsystem a plan was started at the Northern Maternal Hospital in Santiago de Cuba aimed at training these children's mothers in relation to techniques for caring babies. By means of the sources used some aspects regarding these newborn children were assessed, as well as the achievements of the mothers in the course during their hospitalization. The results showed the effectiveness of this plan, the advantages of its being adopted by nurses and its great social significance.


[Urinary sepsis in children and nursing care]. A study was carried out with children who had been hospitalized due to urinary sepsis at the Ciro Redondo General Hospital in Artemisa, during the first quarter of 1990. Nursing cares are pointed out. Of the 149 children admitted during that period, 13 (8.64%) had urinary infection. The most affected age group was that under 1 year. The germ most often found was Escherichia coli. Vesicoureteric reflux was found in 2 infants and the most common manifestation was fever.


[The use of the direct method for the diagnosis of Gardnerella vaginalis vaginitis]. A study was carried out on 200 patients divided in two groups of 100, labeled 1 and 2. They underwent vaginal secretion tests by the direct method in order to assess its appropriateness for Gardnerella vaginalis presumptive diagnosis. This study was related with patients' symptoms, such as leukorrhea and fetidity prevailing in Group 1 and lower abdomen pain prevailing in Group 2, as well as the proportions of germs isolated and the association with this symptom for defining the microorganism role in the occurrence of so-called unspecific vaginitis; Group 1 had 100% of positive plates and Group 2 had 55%, who were given adequate treatment for the couple with further confirmation of the results which were effective in 96.7% of the cases. No relation could be seen between IUD and the presence of germ, since it is likely that its existence was not taken into account on inserting IUD.


[Nursing care in psychiatric emergencies]. The emergency psychiatric services implantation in general hospitals, at São Paulo City, motivated the authors to write this article. They present some considerations about psychiatric emergencies and the main points in nursing care of the client in a crisis intervention setting.


[The estimate of nursing personnel: a study of 2 methods]. This study aimed at analysing two methods for the calculation of nursing personnel (traditional formula and nursing progressive care), from statistics information on the atendly of the University Hospital of UFPB, in order to choose the most adequate method. The obtained results showed the nursing progressive care method as being the most viable one, provided is made a study in terms of hospital beds occupation, nursing hours per type of care and personnel performance.


[The policy of human biological reproduction in Brazil]. The author presents some of the historical determinations of the policies of human reproduction in Brazil, placing them among other social policies. She argues that reproductive profile of the social classes depends upon not only the biological reproduction, but also upon the work power.


[Pulmonary hemosiderosis: a case report]. A case of pulmonary hemosiderosis was reported at the Eliseo Noel Caamaño Pediatric Teaching Hospital in Matanzas City. It was a three-year-old patient, with clinical picture and complementary investigations. A review was made of the literature regarding the disease, which is unusual in children, especially with such a clear cause. Because of its high morbidity and frequent mortality, it will be imperative to carry out early examination and adequate therapy. Emphasis is placed on specific nursing procedures for the management of this disease.


[The feelings and suggestions expressed by colostomy patients who self-irrigate]. The analysis of feelings and suggestions presented by a group of colostomy patients which use a specific method of colostomy self-irrigation showed that it's well accepted by these patients. After the positive results using this method, we obtained 88.14% of the positive feelings answers specially wellbeing, safety and normality and an average of 0.35 suggestions per client.


[Pregnancy in adolescence].

[Pregnancy in adolescence]. The goal of this paper is to provide information about pregnancy in adolescents and to influence those people who have to do with the situation of pregnant adolescents and the family and social consequences. The research was carried out at the Dr. Carlos Diez del Ciervo Hospital from 1989 to 1990. It included 1,500 cases and the variables considered were mothers' age, marital status, number of gestations, number of childbirth, residence and initiation of sexual life. The main findings are stated in detail.


[The mass communication media in diffusing the ideology of human reproduction]. This study was conducted with women assisted at public health units of one municipality of São Paulo's metropolitan region. Its objectives were: to verify the mass-media to which they have access and to correlate these findings to these women's social class. It also intended to analysis the permeability of these subjects to the mass-media messages about human reproduction, correlating it to the biological profile presented by such women.


[Playing and learning nurse-patient communication]. The author present an educative game to teach nurse-patient communication. The game was tested by graduate students and utilized by the undergraduate students. Those students, judges and the Author considered this game efficient and adequate to the teaching of the topic under study.


[Spiritual holism as a theoretical reference for the nurse]. This paper pretend to talk about spiritual holism as a theoretical referential in nursing research includes some aspects of the occidental thinking on health and sickness concepts. Its shows man as having a very complex nature.


[The indirect measurement of arterial pressure as a function of cuff width in patients in the immediate preoperative phase, the phase of entry into the operating room and in the postanesthesia phase]. The goal of this study was to compare blood pressure measures using two sizes of cuffs: one standard width (12 cm) and other with correct width that is 0.38 of arm circumference as recommended by American Heart Association. The comparisons were done among surgical patients in mediate perioperative phase, reception area of operation room and postoperative phase during the staying of the patient in the recovery room. The results demonstrated that the arterial blood pressure was hypoestimated by the use of the standard width cuff, reaching values up 30 mmHg in the systolic arterial pressure and 30 mmHg in the diastolic ones.


Administration of narcotics in cancer pain. Cancer pain can be successfully managed with oral or parenteral narcotics in 80% of patients, if those factors that magnify pain perception are also controlled. Pain from any source can be made worse and pain tolerance impaired by depression, regression, intolerance to stress, and/or recurrent withdrawal, all of which require attention and management. Those patients whose cancer pain is still intractable may benefit from a procedure to interrupt pain pathways. Such procedures have become far less common since the introduction of chronic administration of intraspinal narcotics. The subarachnoid route is preferable to the epidural route because it is less likely to result in catheter failure and because much smaller doses can be used, with less systemic effect. In addition, tolerance can be managed more readily by readjustment of dose with the subarachnoid route, and there is no greater incidence of complications. Intraventricular narcotics can be considered in patients whose spinal canal does not allow catheter placement, at approximately 1/10th the spinal dose requirement.


Computer-assisted stereotactic biopsy and volumetric resection of thalamic pilocytic astrocytomas. Report of 23 cases. Twenty-three cases of pathologically verified thalamic pilocytic astrocytomas diagnosed at computer-assisted stereotactic biopsy and/or volumetric resection at the Mayo Clinic between January 1985 and October 1990 were reviewed. Computer-assisted stereotactic volumetric resection was performed in 19 patients. Postoperative imaging demonstrated no residual contrast-enhancing tumor in 14 patients and a small amount of contrast-enhancing tumor (less than 5% of the original tumor volume) in 5 patients. Biopsy only was performed in 4 patients: 2 with primarily cystic tumors successfully treated with stereotactic instillation of 32P, and 2 patients with stable (nonprogressive) deficits. There was 1 operative death; a patient with tumor extending into the midbrain became comatose and died 10 days after surgery. The remaining 22 patients are alive and well. Computer-assisted stereotactic volumetric resection of thalamic pilocytic astrocytomas can be performed with low morbidity and a favorable long-term prognosis.


Computer-assisted stereotactic third ventriculostomy in the management of noncommunicating hydrocephalus. Between January, 1984, and December, 1990, a total of 85 patients have undergone stereotactic third ventriculostomy (TV) at the Mayo Clinic. Sixty-one patients (74%) presented with mass lesions in the region of the posterior third ventricle, aqueduct of Sylvius or fourth ventricle. Twenty-four patients (26%) presented with non-tumoral, adult/adolescent-onset aqueductal stenosis. Follow-up was available for all 85 patients and ranged from 1 to 66 months (mean 25 months). Follow-up revealed initial patency in 84 patients. Eleven patients (13%) ultimately required extracranial shunting for persistent symptomatic hydrocephalus. Two patients underwent revision of their TV. Twenty-seven patients had been previously shunted. Of these, 23 (85%) have remained asymptomatic after TV without the need for further shunting. Stereotactic TV is a safe and effective way of re-establishing normal cerebrospinal fluid flow dynamics in selected cases of obstructive hydrocephalus.


Infratentorial stereotactic biopsy. A review of 11 cases. A review of the stereotactic cases performed at the University of Iowa between February, 1985, and December, 1990, yielded 12 infratentorial stereotactic biopsies in 11 patients. A definitive diagnosis was obtained in 9 of 11 patients. One patient required a second biopsy to obtain a diagnosis and 1 yielded cystic fluid only. The pathological diagnosis obtained included 4 high-grade gliomas, 2 undifferentiated adenocarcinomas, 2 low-grade astrocytomas, 1 malignant ependymoma, 1 pontine hematoma and 1 cyst. None of the patients experienced increased neurological deficit following biopsy and there was no mortality. One patient developed postoperative meningitis. We conclude that stereotactic biopsy of infratentorial lesions can be performed safely with a high probability of obtaining a diagnosis. Adequate tissue diagnosis is necessary to direct further therapy.


Computer-assisted neurosurgery: simulation and automation. Instrumentation has been developed to automate, accurately guide, and integrate microsurgery laser resection equipment that is used in stereotactic brain surgery. The instrument is a computer-controlled laser-guiding system. The improvement in the accuracy comes from relying on a certain well-referenced three-dimensional surgical orientation, and computer-preplanned tumor contours, rather than only the surgeons hand-eye orientation in the operating room.


Interstitial hyperthermia of malignant brain tumors by an implant heating system using stereotactic techniques. Interstitial hyperthermia of malignant brain tumors has been produced by a heated ferromagnetic implant with a low Curie point. Induction heating of the implant, which is stereotactically implanted in a tumor, is obtained by eddy currents in a high-frequency magnetic field. Safe, repeated and long-term treatment of 35 cases of malignant brain tumors has been done using this system. The overall response rate was 31.4%, but the rate for metastatic brain tumors, deep-seated gliomas and others were 50.0, 36.8 and 33.3%, respectively. Deep-seated gliomas were more effectively treated than superficial gliomas by combination with radiation therapy. The common pathological finding was a clearly demarcated coagulative necrosis of ellipsoid shape around the implant.


Stereotactic microsurgical resection of intracranial tumors using the electromagnetic field focusing system. The intense heat produced at the tip of the electromagnetic field focusing (EFF) probe at its point of contact with tissue can cut and vaporize tissue and coagulate blood vessels. As the probe is shaped like a bayonet and has a diameter of 0.3 mm at its tip, it can be used on deep structures through narrow openings, making it ideal for stereotactic craniotomy. Thirteen stereotactic craniotomy procedures using the EFF system were performed. Locations of the lesions were deep in the cerebrum, cerebellum and in the lateral ventricle. The system proved efficient with reduced blood loss and unobstructed view of deep structures. No complications resulted from the use of the system.


Factors predicting successful stereotactic aspiration of colloid cysts. Stereotactic aspiration is a valuable surgical alternative for colloid cysts, but due to cyst heterogeneity, it is not uniformly successful as the sole treatment in all patients. Since 1981, we performed CT-guided stereotactic aspiration as the initial procedure in 25 patients with colloid cysts. We retrospectively reviewed our experience in the first 22 patients and found that preoperative CT imaging studies accurately determined size and predicted cyst viscosity. The preoperative CT appearance of a hypodense or isodense cyst correlated favorably with successful aspiration. Preoperative MRI provided excellent anatomic definition of the cyst and its relationship to other structures, but failed to correlate successful aspiration. Unsuccessful aspiration was related to the high viscosity of the intracystic material or deviation of the cyst away from the aspiration probe. These factors were used prospectively in 3 additional patients to accurately predict success of cyst aspiration.


Stereotactic management of midline brain lesions. Eighty-seven patients, aged 10 months to 92 years, with midline brain lesions were treated using stereotactic techniques at our institution between January 1987 and June 1990. A total of 119 stereotactic procedures were performed with no operative mortality. Procedures included 53 biopsies only, 22 endoscopic laser decompressions, 8 stereotactic microsurgical resections, 9 permanent implants of 125I, 12 temporary implants of 125I, 11 cyst aspirations, 2 cystoperitoneal shunts and 2 intracavitary 32P. The morbidity rate was 4.21%. Local anesthesia was used in 106 of the procedures (89%). Accurate diagnosis was achieved in all cases. Image guidance and stereotactic techniques open new frontiers in the diagnostic and therapeutic management of deep-seated midline intraparenchymal lesions.


Comparison of the neurochemistry of the endogenous opioid systems in two brainstem pain-processing centers. SCH-32615 is a new enkephalinase inhibitor whose analgesic effects were examined following its stereotactic microinjection into the periaqueductal gray (PAG) and the ventromedial medulla (VMM) regions of the brainstem of the rat. SCH-32615 produced a strong, dose-dependent, naloxone-reversible analgesia to thermal noxious stimuli as measured by the hot plate test (HP; supraspinal analgesia) and the tail flick test (TF; spinal analgesia). The peak analgesic effect was seen within 10 min and remained for 45-60 min. ED50 were for PAG, HP = 10.7 micrograms and TF = 17.3 micrograms, and for VMM, HP = 5.7 micrograms and TF = 7.2 micrograms. Using the irreversible mu receptor antagonist, beta-funaltrexamine, it was found that the endogenous enkephalins in the PAG produce their analgesic effects by acting at only one receptor subtype (the mu receptor) while in the VMM both mu and delta opioid receptors are involved (not through the delta alone as previously believed).


Current spectrum of stereotactic irradiation techniques. Our 10-year experience with stereotactic irradiation techniques was evaluated in a series of 709 patients. Stereotactic intracavitary radiation of cystic neoplasms, brachytherapy of malignant glial neoplasms and radiosurgery represent effective and contemporary primary adjuvant or alternative methods to treat a wide variety of brain tumors and vascular malformations.


Distribution of [32P]-chromic phosphate colloid in cystic brain tumors. To suppress cyst formation in 42 brain tumors, 32P has been stereotactically instilled in doses calculated to deliver 20,000-40,000 rad to the cyst wall, assuming uniform dispersal of the radioisotope. However, samples of cyst fluid obtained at varying intervals after injection showed lower than expected activity levels, suggesting early 'plating' of 32P. To accommodate this phenomenon, a surface-area-dependent dosimetric calculation is compared with a volume-dependent calculation which assumes uniform dispersal. These two approaches represent lower and upper extremes. It appears that in small cysts there is less difference in the required administered dose, but in larger cysts potentially very large differences exist and caution should be exercised if uniform suspension is assumed.


CT-guided stereotactic injection of radionuclide for treatment of brain tumors. The authors report on 40 brain tumor patients treated with CT-guided stereotactic injection of 198Au and 32P. Among the 40 cases were astrocytoma in 23 cases, craniopharyngioma in 9, meningioma in 4, pituitary adenoma in 2, and pinealoma and metastatic carcinoma each in 1 case. The tumors were all located in deep or important areas of the brain which were difficult to deal with by conventional operation. 62 injections of colloidal isotopes were performed, and all were successful. No major adverse effects or complications occurred on follow-up of 6-12 months, 28 patients were improved in their clinical symptoms, and CT scanning showed that the tumor sizes were diminished. The effective rate is 70%.


Three-dimensional imaging for brachytherapy planning. A computerized 3-D brachytherapy treatment planning program has been developed which simulates catheter trajectories, radioisotope seed positioning and percentage dosimetry zones about a catheter/seed array in relationship to CT or MRI images. The high activity 125I seed is used in this program. A visual and a non-linear mathematical optimization program will also be described.