The potential role of Ca2+ for electrical cell-to-cell uncoupling and conduction block in myocardial tissue. Ca2+ ions are often invoked as potential initiators of cardiac arrhythmias in pathophysiological situations which are associated with an increase of free [Ca2+]i. It is well documented that elevated [Ca2+]i may produce SR release of Ca2+ and oscillations of membrane potential, thereby leading to triggered or spontaneous ectopic activity. The relation among elevated free [Ca2+]i, electrical cell-to-cell coupling, conduction slowing, and reentrant arrhythmias is more speculative. If Ca2+ (e.g. in mechanically injured cells) has direct access to the cellular interconnections (gap junctions), rapid uncoupling occurs at [Ca2+]i which is even within the range of a normal contractile cycle. If cellular integrity is preserved and changes of [Ca2+]i are imposed by extracellular interventions, the effect of [Ca2+]i is critically dependent on pHi. At normal pHi, transcellular conductance remains normal even if [Ca2+]i is increased to bring the cells into a hypercontractile state (> 1-2 microM). At decreased pHi, rapid uncoupling develops at low [Ca2+]i. Comparison of the conduction delay between two cells (or conduction velocity in a simulated conducting medium) with the [Ca2+]i-mediated increase in coupling resistance suggests that the transition from normal conduction velocity to conduction block (a key event in re-entrant arrhythmias) occurs within a relatively narrow range of [Ca2+]i or pHi, almost like a threshold phenomenon. Major efforts have been made in recent years to assess the changes of electrical cell-to-cell coupling and [Ca2+]i in myocardial ischemia. Therefore, the discussion of the role of [Ca2+]i as a modulator of electrical coupling is made in this pathophysiological setting. Comparison of several studies indicate that cell-to-cell resistance and [Ca2+]i in ischemia increase at the same time (10-15 min after perfusional arrest). Since other potential uncoupling processes (delta ATP, delta Mg2+, amphiphilic metabolites, delta pHi) show a similar time-course, it is difficult to attribute cell-to-cell uncoupling in ischemia solely to an increase in [Ca2+]i. Both an initial decrease of membrane excitability and subsequent electrical cell-to-cell uncoupling characterize the early phase of ischemia. The first mechanism is assumed to be more important for the generation of conduction block and re-entry. However, Ca(2+)-induced cell-to-cell uncoupling may partially contribute to the second phase of the early ischemic arrhythmias and mark the transition from reversible to irreversible ischemic damage.


Mechanisms of cardiac growth. The role of the renin-angiotensin system. Hypertension is associated with cardiac hypertrophy, which is a structural adaptation of the heart in order to attenuate the systolic stress on the left ventricle. As cardiac myocytes cannot divide, they increase in mass and volume, probably by activating second messengers and proto-oncogenes involved in cellular differentiation and proliferation. Various mechanisms, such as pressure overload and angiotensin II (Ang II), have been proposed to trigger cardiocyte growth and left-ventricular hypertrophy (LVH). In both cases, activation of second messenger routes which increase the intracellular calcium concentration, protooncogene expression, and protein synthesis have been demonstrated. Ang II also facilitates the action of another trophic agent for cardiocytes, which is noradrenaline (NA). In addition, the prevention and reversal of LVH by inhibitors of angiotensin-converting enzyme (ACE) suggests a key role for Ang II. However, no conclusive evidence has demonstrated the role of a single pathophysiologic factor in LVH. Therefore, it is more attractive to suggest a link between high blood pressure, renin-angiotensin and other vasoactive systems, such as the adrenergic system, which might together lead in a synergistic way to cardiac hypertrophy.


Cardiac fibroblasts: function, regulation of gene expression, and phenotypic modulation. Cardiac fibroblasts constitute the majority of the non-myocyte cell population in the ventricular myocardium. These cells are located in the interstitium, in areas between and surrounding cardiac myocytes. Cardiac fibroblasts are responsible for the synthesis of extracellular matrix proteins such as fibrillar collagen types I and III, basement membrane type IV collagen, fibronectin, and laminin. In addition to its role in muscle development and myoblast differentiations, extracellular matrix consisting primarily of fibrillar collagen is an intricate and highly organized structure that serves to support cardiac myocytes and to maintain functional integrity of the myocardium. Balanced synthesis and degradation of this matrix is the key to normal development of cardiac muscle and perfect myocardial function. Collagen remodeling and accumulation has been demonstrated in several experimental models of cardiac hypertrophy. To gain insights into molecular and cellular mechanisms that affect cardiac fibroblast behavior, cardiac fibroblasts from rat and rabbit ventricular myocardium were cultured and the impact of neurotransmitters and growth factors such as norepinephrine and transforming growth factor--beta (TGF-beta 1), to which cardiac fibroblasts are exposed in vivo, was studied. Results of these studies, with regards to gene expression, proliferation and differentiation of cardiac fibroblasts in culture, and their biological implications are discussed.


Signaling mechanisms for the activation of an embryonic gene program during the hypertrophy of cardiac ventricular muscle. To study the signaling mechanisms which mediate ventricular hypertrophy, we utilized the induction of the ANF gene as a marker of the hypertrophic response. The induction of the atrial natriuretic factor gene (ANF) is one of the most conserved features of ventricular hypertrophy, occurring in multiple species (mouse, rat, hamster, canine, and human) in response to diverse stimuli (hormonal, mechanical, pressure/volume overload, genetic, IHSS, hypertension, etc.). The ANF gene is expressed in both the atrial and ventricular compartments during embryonic development, but shortly after birth ANF expression is down-regulated to negligible levels in the adult myocardium. Since the reactivation of ANF gene expression in the hypertrophied ventricle is a hallmark of the activation of an embryonic gene program, it has also become of interest to determine if similar mechanisms activate ANF expression during hypertrophy and the initial stages of cardiogenesis. A combination of cotransfection, microinjection, and transgenic approaches has been coupled to well characterized cultured cell systems and in vivo murine models employing normal and transgenic mice. The microinjection of oncogenic RAS proteins into living myocardial cells does not lead to the activation of cell proliferation, but activates ANF gene expression, as assessed by immunofluorescence. Co-transfection of mutant and wild-type RAS expression vectors with a ANF-luciferase fusion gene supports a direct effect of activated RAS on ANF gene transcription. Co-transfection of a dominant negative RAS vector effectively inhibits the induction of the ANF gene during alpha adrenergic mediated hypertrophy of ventricular muscle cells, thereby establishing that a RAS-mediated pathway is required for ANF induction.(ABSTRACT TRUNCATED AT 250 WORDS)


Endothelial modulation of myocardial contraction: mechanisms and potential relevance in cardiac disease. Recent studies in isolated cardiac preparations and the intact heart demonstrate that the endocardial and coronary vascular endothelium modulate myocardial contractile behaviour and cardiac pump function in a novel manner, mainly by influencing the duration of contraction and the onset of relaxation but without major effect on early systolic contractile characteristics. These effects are mediated by the release of at least two diffusible substances from endothelial cells: a) endothelium-derived relaxing factor (EDRF) which shortens contractile duration by elevating myocardial cyclic GMP, and b) a novel substance, provisionally named "endocardin", which prolongs contractile duration. Under physiological conditions these endothelial influences may be particularly important for relaxation and early diastolic filling events in the heart. It is possible that they could influence myocardial growth, interact with other cardiac hormones, and via EDRF inhibit platelet adhesion to endothelial surfaces. The release of the endothelial factors is regulated by stimuli such as circulating neurohumoral substances, increased flow, products of platelet aggregation, and endogenous peptides stored in endothelial cells. Although experimental evidence is still limited, it seems likely that cardiac endothelium may play an important role in the pathophysiology of cardiac disease, e.g. overload-induced hypertrophy. The endothelium could a) influence the development of phenotype change by modulating and mediating transduction of extrinsic signals, b) contribute to contractile and other abnormalities (especially "diastolic" dysfunction) because of loss or impairment of its normal function, and c) be uniquely amenable to therapeutically useful pharmacological manipulation.


Energetics of calcium cycling in nonfailing and failing human myocardium. Using sensitive antimony-bismuth thermopiles, isometric force and heat output were measured in muscle strips from nonfailing human hearts and from failing dilated cardiomyopathic hearts at a stimulation rate of 60 beats per minute (37 degrees C). This frequency was chosen because analysis of the force-frequency relation showed significant differences in isometric force between failing and nonfailing human myocardium at 60 beats per minute and at higher frequencies, whereas at lower rates of stimulation (30 beats per minute) force of contraction was similar in failing and nonfailing myocardium. The liberated initial heat was partitioned into its two components, tension-dependent heat and tension-independent heat from high-energy phosphate hydrolysis by contractile proteins and excitation-contraction coupling processes, respectively. Tension-dependent heat reflects the total number of crossbridge interactions, and tension-independent heat is an index of the amount of calcium cycling during the contraction-relaxation cycle. In failing compared to nonfailing human myocardium, peak twitch tension, maximum rate of tension rise and maximum rate of tension fall were reduced significantly. Reduced mechanical performance was associated with reduced liberation of both tension-dependent and tension-independent heat in the failing heart. The reduction of tension-dependent heat by 61% and of tension-independent heat by 69% indicate considerable decreases in the number of crossbridge interactions activated and calcium ions cycled during the isometric twitch. In addition, the rate of calcium removal was reduced in the failing human heart as is indicated by a 71% reduction in tension-independent heat rate. The efficiency of excitation-contraction coupling with respect to crossbridge activation was similar in failing and nonfailing myocardium. These data indicate that impaired myocardial performance in dilated cardiomyopathy may result from disturbed excitation-contraction coupling with reduced amount of calcium cycling and reduced rate of calcium removal.


Spontaneous sarcoplasmic reticulum Ca2+ release leads to heterogeneity of contractile and electrical properties of the heart. The cytosolic Ca2+ (Cai) oscillation generated by the sarcoplasmic reticulum (SR) in response to an action potential (AP) occurs relatively synchronously within and among cells. The SR can also generate spontaneous Cai oscillations (S-CaOs), i.e., not triggered by sarcolemmal depolarization. The local increase in Cai due to S-CaOs is equivalent to that induced by an AP. Heterogeneity of diastolic Cai caused by asynchronous S-CaOs among cells within myocardial tissue leads to heterogeneous myofilament activation, the summation of which produces a Ca(2+)-dependent component to diastolic tone. The local increases in Cai due to S-CaOs also cause oscillatory sarcolemmal depolarizations due to Ca2+ modulation of the Na/Ca exchanger and of non-specific cation channels. Thus, inhomogeneous levels of diastolic Cai may lead to heterogeneity in cell coupling and thus may also affect the impulse conduction. The magnitude of the S-CaOs induced diastolic tonus and membrane depolarization varies with the extent to which S-CaOs are synchronized; partially synchronized S-CaOs following an AP induced SR Ca2+ release produce an aftercontraction and after depolarization. When local S-CaOs is sufficiently synchronized within the cell the resultant depolarization summates and can be sufficient to trigger spontaneous AP. Inhomogeneity of diastolic SR Ca2+ loading and sarcomere lengths within individual cardiac cells due to S-CaOs leads to inhomogeneous systolic Cai levels and sarcomere length inhomogeneities in response a subsequent AP; this heterogeneity compromises the systolic contraction amplitude. Heterogeneity of systolic Cai among cells due to diastolic S-CaOs also leads to heterogeneity of AP repolarization times, due, to heterogeneous Cai modulation of the Na/Ca exchanger, the non-specific cation channel and of the L type sarcolemmal Ca2+ channel. S-CaOs occurrence during a long AP plateau may also modulate the removal of voltage inactivation of L type Ca2+ channels and affect the likelihood of the occurrence of "early after depolarizations." Thus, as a single entity, S-CaOs may be implicated in diverse manifestations of heart failure--impaired systolic performance, increased diastolic tonus and an increased probability for the occurrence of arrhythmias.


[Isolation, structure and properties of new endogenous peptides]. Large scale isolation and determination of amino acid sequences of endogenous peptides from various biological sources (bovine brain and red bone marrow, siberian ground squirrel brain) were carried out. A number of earlier unknown peptides were identified, many of them showing distinct activity in vivo and/or in vitro. Analysis of more than 170 isolated peptide structures resulted in the hypothesis suggesting functional proteins, in particular hemoglobin, to serve also as a source of the peptide "background" which has its own biological significance. Further directions of investigating the endogenous peptide material are mapped. Its potential for developing diagnostics for somatic diseases is demonstrated on patients with CNS disorders.


Mapping the functional topography of a receptor. Photoactivatable derivatives of the alpha-neurotoxin II from Naja naja oxiana are useful tools for investigating the three dimensional architecture of the extra-membrane part of the nicotinic acetylcholine receptor from the electric tissue of Torpedo californica. Three derivatives, carrying an azidobenzoyl group in position Lys-15, Lys-26, and Lys-46, respectively, are shown to react differently within the receptor's quaternary structure. Especially the Lys-26 and Lys-46 derivatives can be used for differentiating between the two nonequivalent alpha-subunits. The Lys-26 derivative is applied for probing the receptor subunits next to the alpha-subunit: the gamma-subunit is shown to be located next to the alpha-subunit binding d-tubocurarine with high affinity. The delta-subunit is the neighbor of the low affinity alpha-subunit. We radioiodinated the toxin derivatives and localized the 125I at the His-31 residue of the toxin. Very little label was found in position Tyr-24, the only tyrosine residue of the toxin, or in position His-4, the only other histidine residue. This result is important for the cleavage experiments necessary in attempts to identify the receptor sequence which reacted with the photolabel.


[Cell membranes as a barrier during biological uses of antisense oligonucleotides, their derivatives, and analogs]. Use of oligonucleotides and their derivatives as gene targeted drugs encounter a problem of crossing of lipophilic cell membranes by these hydrophilic compounds. This paper considers the approaches to overcome the arising barrier: 1) penetration by endocytosis in the presence of bivalent cations; 2) use of non-ionic oligonucleotide analogs; 3) attachment of bulky hydrophobic radicals; 4) use of membrane carriers; 5) interaction of oligonucleotides and their derivatives with specific receptors.


N.m.r. study on the formation and geometry of inclusion complexes of 6-O-(alpha-maltosyl)cyclomalto-hexaose and -heptaose with p-nitrophenol in aqueous solution. The formation and molecular geometry of inclusion complexes of some branched cyclomaltaoses with p-nitrophenol in aqueous solution have been investigated by using high-resolution 1H-n.m.r. spectroscopy. 6-O-(alpha-Maltosyl)cyclomalto-hexaose and -heptaose were found to form 1:1 inclusion complexes with p-nitrophenol, and the dissociation constants for their complexes are quite similar to those for corresponding unbranched cyclomaltaose-p-nitrophenol complexes, indicating that formation of these inclusion complexes is not hampered by the maltosyl branch. From measurement of nuclear Overhauser enhancements, it was concluded that the maltosyl branch is not situated over the entrance of the cavity.


[New strategies for DNA sequencing and determining protein location in genomic DNA]. A new technique of DNA sequencing by hybridization with oligonucleotide matrix (SHOM) has been tested in model experiments. The paper also describes a number of new approaches to protein identification and their mapping on any particular region of genomic DNA.


[Gene expression in cell-free systems on a preparative scale]. In vivo expression of foreign or synthetic genes can be subject to certain restrictions such as protein aggregation, degradation and toxicity. Conventional in vitro systems can overcome these problems, but in turn suffer from other limitations, in particular short life-time and low protein yield. In this review, two types of gene expression system are described. Both are based on the novel concept of the enhanced expression from cell-free extracts where incubation is performed in the continuous flow of a feeding solution rather than in a fixed volume of a test-tube. The first type makes use of cell-free translation of mRNA templates in either prokaryotic or eukaryotic cell lysates. The second utilizes the coupled transcription--translation of DNA templates, with genes transcribed by either endogenous or bacteriophage RNA polymerases. In both systems, translation can be carried out over tens or hundreds of hours resulting in high protein yields.


[Some results and prospects of studies in the area of marine biochemistry and biotechnology]. Recent studies on bioactive metabolites from marine macro- and microorganisms are reviewed with 83 refs. Structures of new sulphated and glycosylated secondary metabolites, which have been reported to have antifungal, immunomodulatory, and cytotoxic properties, are given. Some peculiarities of biosynthesis of natural compounds in marine organisms are revealed. It was shown that some natural products, isolated earlier from sponges, are produced by microbial symbionts. Different physiological activities associated with 8000 marine microbial (mainly symbiotic) strains are discussed as well as some prospects of marine biochemistry and biotechnology development.


Ab initio studies of aromatic-aromatic and aromatic-polar interactions in the binding of substrate and inhibitor to dihydrofolate reductase. Aromatic-aromatic and aromatic-polar interactions are investigated by performing ab initio Hartree-Fock calculations. Binding energies and optimum distances between subsystems are obtained. It is found that the binding energy between two benzene rings is of 3.1 kcal/mol when correlation effects are included, while the serine aromatic complexes energies of binding range from 1.9 to 3.1 kcal/mol.


Proteasome subunits encoded by the major histocompatibility complex are not essential for antigen presentation. Major histocompatibility complex (MHC) class I molecules bind and deliver peptides derived from endogenously synthesized proteins to the cell surface for survey by cytotoxic T lymphocytes. It is believed that endogenous antigens are generally degraded in the cytosol, the resulting peptides being translocated into the endoplasmic reticulum where they bind to MHC class I molecules. Transporters containing an ATP-binding cassette encoded by the MHC class II region seem to be responsible for this transport. Genes coding for two subunits of the '20S' proteasome (a multicatalytic proteinase) have been found in the vicinity of the two transporter genes in the MHC class II region, indicating that the proteasome could be the unknown proteolytic entity in the cytosol involved in the generation of MHC class I-binding peptides. By introducing rat genes encoding the MHC-linked transporters into a human cell line lacking both transporter and proteasome subunit genes, we show here that the MHC-encoded proteasome subunit are not essential for stable MHC class I surface expression, or for processing and presentation of antigenic peptides from influenza virus and an intracellular protein.


[Variations in hospitalization rates of non-neonatal hospital admissions to pediatric departments of three district hospitals]. Hospitalization rates of children from three health districts were analyzed. The rates ranged from 30 to 40 admissions per 1000 children. The length of hospital stay, the rates of transfers and deaths were similar. Admission rates were different for certain selected diagnoses: gastroenteritis, pneumonia, bronchiolitis, head trauma and ear, nose and throat procedures. The variations were not related to differences in physician or bed supply, nor to severity or the disease of a delay in getting medical care. The demographic and geographic characteristics and the different patterns of practice can be associated with the observed variations. The health status of these children must be determined before considering which rate is correct.


Ablation of transplanted HTLV-I Tax-transformed tumors in mice by antisense inhibition of NF-kappa B. Mice transgenic for the human T cell leukemia virus (HTLV-I) Tax gene develop fibroblastic tumors that express NF-kappa B-inducible early genes. In vitro inhibition of NF-kappa B expression by antisense oligodeoxynucleotides (ODNs) inhibited growth of these culture-adapted Tax-transformed fibroblasts as well as an HTLV-I-transformed human lymphocyte line. In contrast, antisense inhibition of Tax itself had no apparent effect on cell growth. Mice treated with antisense to NF-kappa B ODNs showed rapid regression of transplanted fibrosarcomas. This suggests that NF-kappa B expression may be necessary for the maintenance of the malignant phenotype and provides a therapeutic approach for HTLV-I-associated disease.


Cirrhotic changes in livers from children undergoing transplantation. Image analysis. The pattern and extent of disorganization of the liver architecture were studied in 25 children undergoing orthotopic liver transplantation for cirrhosis. Image analysis techniques based on mathematical morphology were used to define seven parameters for each case, including fibrosis index (percentage of Sirius-red-stained areas), three categories of regenerative nodules (< 0.8, 0.8-1.6 and > 1.6 mm in diameter) and three categories of fibrous septa (< 0.4, 0.4-1.2 and > 1.2 mm in width). Fibrosis index ranged from 10.2% to 51.9%. Percentage of small nodules of infralobular size (< 0.8 mm in diameter) varied from 31.4% to 98.2%. Percentage of large nodules, > 1.6 mm in diameter, in only four cases was > 15%. Multivariate clustering analysis classified the cases into three main groups. One of them included only cases of cirrhosis secondary to parenchymal disease or to inborn errors of metabolism. In their pattern, tiny nodules predominated, and the percentage of slender septa, < 0.4 mm in diameter, was very high, although the overall fibrosis index was relatively low. Patients with biliary cirrhosis were classified into two groups. In one the fibrosis index was low and the size of the nodules variable, with 12% large nodules. In the other the fibrosis index was high, and small nodules, < 0.8 mm in diameter, predominated. No relationship was found with age at transplantation or previous portoenterostomy. A presumptive explanation for this divergent evolution might be the occurrence of cholangitic episodes. Overall fibrosis that the liver can sustain without failure is apparently limited.(ABSTRACT TRUNCATED AT 250 WORDS)


Colorectal carcinoma. DNA ploidy pattern and prognosis with reference to tumor DNA heterogeneity. Nuclear DNA content was measured in 72 colorectal carcinomas using single-cell microspectrophotometry on Feulgen-stained smears. Four samples were analyzed from each tumor. Patients were followed for 41-65 months (average, 53). DNA heterogeneity (both aneuploid and nonaneuploid patterns) was present in 44% of the cases. Sixty-eight percent of the tumors showed an aneuploid DNA pattern in at least one of the samples. Patients with nonaneuploid tumors tended to have a survival advantage over patients with homogeneously aneuploid tumors and demonstrated a significantly longer disease-free survival. The DNA ploidy pattern is of potential value in conjunction with histopathologic prognostic parameters in colorectal carcinoma. Since colorectal tumors exhibit pronounced DNA heterogeneity, multiple samples are required from each tumor to permit a proper evaluation of its DNA pattern. The DNA heterogeneity may represent tumor progression and can partly explain the conflicting results reported concerning DNA pattern and prognosis in colorectal carcinoma.


Nutritional management of osteoporosis. To slow the advancement of osteoporosis, nurses must encourage their clients to increase their intake of calcium. For geriatric nurses, this may be a challenge. In conclusion, no current effective therapy is available for the restoration of bone mass once osteoporosis has developed. Primary prevention is the best way to fight this problem. However, goals for the management of osteoporosis are (1) to maintain skeletal mass and integrity, (2) to slow bone resorption, and (3) to treat the symptomatic problem and its sequelae. Having a well-balanced diet containing adequate amounts of calcium, use of calcium supplements when necessary, reducing risk factors in life-style, and use of estrogen are therapeutic measures to reduce bone loss. Clients are also encouraged to exercise by walking or swimming and remain as active as possible. It is important to avoid strain on the spine, as occurs in lifting or bending, to prevent compression fractures on the vertebrae. For treating the symptoms of osteoporosis and its sequelae, it is necessary to relieve pain (by the use of analgesics), provide comfortable light mechanical support for the spine, if needed, arrange assistance in activities of daily living, coordinate a rehabilitation program, and provide emotional support and reassurance to the patient and family. This may be an area largely neglected in practice. Gerontologic nurses may be the first to take the time to thoroughly discuss osteoporosis with their elderly clients and help them to develop a comprehensive program. If through their efforts some falls and fractures can be prevented, this is nursing at its best.


Application of morphometric methods to the cytologic study of intradermal nevi. Twenty-one intradermal nevi were studied by morphometric methods in an attempt to morphologically characterize the two types of nevus cell--epithelioids, type A, and fusiforms, type C--and to quantify the differences between them. Morphometric parameters of the intradermal nevi were compared with similar parameters of melanocytes and melanoma cells so that the maturation rates of the nevi cells could be established and to see if the parameters might indicate the degree of malignancy. Superficial nevus cells were differentiated from deep cells by their larger size and larger nuclear area. Nuclear area appeared to have potential for differentiating benign from malignant tumors. Decrease in cellular area appeared to indicate maturation rather than atrophy. Melanoma cells were differentiated by their larger size. Cell nuclear perimeter appeared to have confirmatory value, while cell perimeter was inconclusive.


Elliptic Fourier analysis of megakaryocyte nuclei in chronic myeloproliferative disorders. Elliptic Fourier analysis was applied to megakaryocyte nuclei in bone marrow biopsies from 15 patients with chronic myelocytic leukemia with megakaryocyte predominance and from 15 patients with chronic megakaryocytic granulocytic myelosis. To assess the reliability of this procedure, the biopsies were evaluated also by the semiautomatic measurement of nuclear area and form factor, and both methods were compared with respect to the degree of morphologic differences obtained between these two types of chronic myeloproliferative disorders (CMPDs). Discriminant analysis revealed correct reclassification of all cases both for elliptic Fourier analysis and for semiautomatic planimetry, whereas discriminant scores were much higher for Fourier analysis. Thus, simple planimetric features such as nuclear area and form factor, in contrast to Fourier analysis, are not able to detect the full degree of morphologic differences between megakaryocyte nuclei in different CMPDs. Elliptic Fourier analysis therefore seems to be a useful procedure for the accurate description of such complicated structures as megakaryocyte nuclei in CMPD.


Implementing a regulation-complaint quality improvement program on a commercial laboratory information system. Implementing a quality improvement (QI) program on an automated laboratory information system (LIS) in the current regulatory climate requires first that the QI program be defined and second that the selected LIS be able to capture important events and use flexible vendor-provided or user-defined routines to prepare reports. Reports key on specific monitors and thresholds defined in the QI program. The product of a pathology laboratory is communicated information. The QI program focuses on the accuracy, clarity and timeliness with which the whole information-generating process functions. To support peer review the LIS must be able to select reports for evaluation based on user-defined parameters, such as diagnosis keyed through Systematized Nomenclature of Medicine codes, or by random or pattern selection by accession number. Counting and review of revised reports will focus attention on accuracy and skill in communication since these indicators often reflect client satisfaction with the report. To link services--e.g., cytology with surgical pathology--the LIS must be able to gather cases from the accession lists of both services and to flag diagnostic inconsistencies. LIS transaction logging at every step in the information process allows tracking of work load, productivity and resource utilization by functional areas and by individual, thus meeting regulatory requirements. Transaction logging also provides management information, such as segmented turnaround time audits, pinpointing sources of delay by kind and location of work or individual involved. Critical data must be held on-line for at least five years.


Surgical treatment of periampullary cancer--review of 766 surgical experiences of 8 hospitals. The incidence of periampullary cancer has been steadily rising in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, which were published in the Korean literature from 1984 to 1992. The 6th decade was the most prevalent age group, occupying 38% of the patients. The ratio of male of female was 1.7 to 1. Approximately 60% of lesion located at the head of the pancreas. Computed tomography which had 85% sensitivity was the most commonly employed modality for a diagnosis. The diagnostic sensitivity of percutaneous transhepatic cholangiography was 72%, of endoscopic retrograde cholangiopancreatography was 71%, and of ultrasonography was 54% in order of frequency. Tumor markers such as CA-19, CEA, and CA-125 were also studied in pancreatic cancer. The combinations of these markers recorded a higher positivity than using solely. The resection rate for lesions at the head of the pancreas was 21%, and that of distal common bile duct, ampulla of vater, and duodenum were 37%, 85%, and 50%, respectively. The morbidity and mortality rates after pancreatoduodenectomy were 44% and 12%, respectively. TNM staging revealed 66% of patients were in stage III, 26% in stage I, and 8% in stage II. The actual 5-year survival rates for cancer of the head of the pancreas was 11%, and that of duodenal cancer, distal choledochal cancer, and ampullary cancer were 21%, 18%, and 15%, respectively. In nonresected group, none survived over 18 months after treatment. Relatively high portion of lymph node metastatic patients may explain the poor survival observed in our series.


Internal capsular lesion associated with dizziness. It has been known that the vestibular system is concerned with feelings of dizziness or vertigo. The vestibulo-thalamic pathway has also been described previously. However, there has been no confirmative report so far regarding the pathway through the internal capsule to the cortex. We have experienced 13 patients with symptoms of dizziness and/or vertigo whose lesions are located only around the internal capsule, mainly at the posterior limb and/or the genu. It is suggestive that fibers with dizziness may pass through a part of the internal capsule, probably through some part of the posterior limb and/or the genu.


Polymorphonuclear leukocyte functions enhanced by chemotaxis. Human polymorphonuclear leukocytes (PMN) migrate into tissues in response to chemoattractants, yet it is not known whether this process alters the functional capabilities of the PMN. Using recombinant human interleukin-8 (rHIL-8, 100 ng/ml) as a stimulus, we compared a population of PMN that migrated through a polyvinylpyrrolidone-coated polycarbonate filter containing 8.0 microns diameter pores with PMN stimulated in suspension. PMN were analyzed by flow cytometry according to functional and phenotypic criteria. CD11b/CD16 expression was unaltered by chemotaxis. In contrast, chemotaxis enhanced phagocytosis of E. coli, independent of opsonization with IgG. Similarly, chemotaxis increased baseline hydrogen peroxide production. We conclude that the chemotactic motion of PMN "primes" the cell for increased oxidative burst activity and augments the ability of PMN to ingest bacteria. This increased functional capability is distinct from rHIL-8 stimulation and appears to be independent of complement-and Fc-receptor expression.


Malignant lymphomas of the nasal cavity and Waldeyer's ring--clinicopathologic and immunohistochemical study. The clinicopathologic and immunohistochemical finding of 10 cases of nasal non-Hodgkin's lymphoma (NHL) and 23 cases of Waldeyer's ring NHL were studied. Immunohistochemically, nasal NHL expressed T-cell markers exclusively, whereas the NHL of Waldeyer's ring were of both T-cell (56.5%) and B-cell lineages (43.5%). Angioinvasiveness by tumor cells was exclusively noted in the T-lineage lymphomas. Epithelial hyperplasia, epitheliotropism by tumor cells, and extensive invasion of adjacent normal tissue were more prominent in T-cell lymphomas than in B-cell lymphomas. T-lineage lymphomas showed distant extranodal spread pattern involving the skin, soft tissue, stomach, spleen, and the liver, whereas B-lineage lymphomas tended to localize in the lymph nodes. The survival rate of Nasal NHL was similar to that of Waldeyer's ring NHL. Although not statistically significant because of small sample numbers, immunophenotype, histologic groups of monomorphic lymphoma, and stage had prognostic importance. In general, T-lineage lymphomas presented with a higher stage than B-lineage lymphomas (p < 0.05)-and overall survival was poor. Stage I disease showed a much more favorable prognosis than stage II disease. Monomorphic lymphomas had a shorter survival than polymorphic reticulosis (PR) or lymphomas with features of PR. This result in conjunction with the morphologic transition between them suggested that monomorphic lymphoma may represent the most advanced stage in the spectrum of PR, lymphoma with features of PR, and monomorphic lymphoma.


Percutaneous transhepatic biliary biopsy using gastrofiberscopic biopsy forceps. To obtain a histopathologic diagnosis at the site of a biliary obstruction, we recently have performed 24 cases of biliary biopsy using gastrofiberscopic biopsy forceps (Olympus, Tokyo, Japan) via transhepatic tracts provided in the course of the procedure of percutaneous biliary drainage. Histopathologic diagnosis was successfully made at the first attempt of biopsy procedure but a second trial was made a week later in 6 cases who were negative for malignant cells on the first attempt. The histological results from the biopsy specimens were 18 adenocarcinomas, 5 chronic inflammations and one normal epithelium. Of 6 cases who were negative for malignant cells on forceps biopsy specimen, three cases were confirmed as adenocarcinoma of the ampulla of Vater, adenocarcinoma of the pancreas and chronic pancreatitis by surgical biopsy. The latter was a true negative result, which was diagnosed as chronic inflammation on forceps biopsy and verified as chronic pancreatitis by surgery. The remaining two cases were diagnosed as malignant obstructive jaundice by clinical and radiological follow-up findings. Major complications (bile peritonitis, bleeding, and hemopneumothorax) occurred in 3 patients, which mainly arose in the earlier period of study. This procedure can be performed at the same time as percutaneous transhepatic biliary drainage with low morbidity or mortality, and although the potential for perforation of bile ducts and injury to adjacent blood vessels is considered it is a useful addition to existing biopsy techniques for yielding material sufficient for histologic analysis.


Heterologous corneal endothelial cell transplantation--human corneal endothelial cell transplantation in Lewis rats. A heterologous corneal endothelial transplantation was attempted using human endothelial cells and a Lewis rat penetrating keratoplasty model. Cultured human endothelial cells were seeded to a Lewis rat cornea, which was denuded of its endothelium. When grafted into the syngeneic Lewis rat, the graft remained clear for at least five days, and then became opaque and edematous because of immune rejection reaction. In contrast, corneas denuded of their endothelium became opaque and edematous immediately after transplantation. These results demonstrate that transplanted endothelial cells have enough antigens to induce rejection reaction even though they have the functional capacity to deturge the cornea.


Studies on the role of interleukin-4 and Fc epsilon RII in the pathogenesis of minimal change nephrotic syndrome. Childhood minimal change nephrotic syndrome (MCNS) has often been associated with allergic symptoms such as urticaria, bronchial asthma, atopic dermatitis, allergic rhinitis and elevated IgE levels and referred to involve immune dysfunction. Fc epsilon RII is known to be involved in IgE production and response. Interleukin-4 is being recognized as a major cytokine up-regulating IgE production. Hence the present study is aimed at investigating the role of interleukin-4 and Fc epsilon RII in the pathogenesis of MCNS. IgE was measured by ELISA. Fc epsilon RII was analyzed by fluorescence activated cell scanner (FAC-scan) by double antibody staining with anti Leu16-FITC and anti Leu20-PE. Soluble IgE receptor was measured by ELISA using anti CD23 antibody (3-5-14). Interleukin-4 activities were measured by CD23 expression on purified human tonsillar B cells. Serum IgE levels were significantly higher in MCNS (1,507 +/- 680 IU/dl) than in normal controls (123 +/- 99.2 IU/dl). A significantly higher expression of membrane Fc epsilon RII was noted for MCNS (41 +/- 12%) than that in normal controls (18 +/- 6.2%) (p < 0.001). Soluble CD23 levels were also significantly higher in MCNS (198 +/- 39.3%) than in normal controls (153 +/- 13.4) (p < 0.01). Interleukin-4 activity in sera of MCNS (12U/ml) was also significantly higher than normal controls (4.5U/ml). These results indicate that increased production of Fc epsilon RII and interleukin-4 may play an important role in the pathogenesis of MCNS.


Papillary muscle necrosis in neonates and infants--analysis of 209 autopsies. A total of 209 consecutive neonate and infant autopsies were reviewed with special attention to papillary muscle necrosis (PMN) of the heart. Associated major pathological findings were analysed for the evaluation of significant pathological accompaniments of PMN. PMN was found in 52 cases among 171(30.4%) neonates and major pathological accompaniments were bronchopneumonia, hyaline membrane disease, hypoxic neuronal change, sepsis, subarachnoid hemorrhage, disseminated intravascular coagulation (DIC) and acute tubular necrosis, among which hypoxic neuronal change and ATN had a statistically significant higher incidence when compared with the control group. (p < 0.005). PMN was found in 13 cases among 38(34.2%) infants and accompaniments were congenital heart disease, sepsis, bronchopneumonia, DIC and hypoxic neuronal change, all of which showed no difference from the control group in incidence. The results imply that PMN is a kind of organ damage in stressed subjects regardless of age, that it is not a special form of myocardial injury in any specific age group including the newborn period, and is possibly of different pathogenesis and significance.


Acetylcholinesterase histochemistry of rectal suction biopsies in the diagnosis of Hirschsprung's disease. Rectal suction biopsy with acetylcholinesterase (AChE) histochemistry has gained increased acceptance as the means of definitely diagnosing Hirschsprung's disease (HD) as well as of excluding this diagnosis when evaluating children with low intestinal obstruction or chronic constipation since the report of Meier-Ruge et al. in 1972. But this AChE histochemical study has not been reported yet in Korea. During the 14-month period from April, 1991 through June, 1992, 37 children, aged 3 days to 17 years had rectal suction biopsies for the diagnosis or exclusion of HD. In this study, AChE histochemistry (N = 37) was compared with hematoxylin & eosin (H&E) staining of same suction biopsy specimens (N = 35) for diagnostic accuracy. The histochemical criterion used for the diagnosis of Hirschsprung's disease was that of Chow et al. (1977), i.e., the presence of many coarse discrete cholinergic fibers in the muscularis mucosae and in the immediately subjacent submucosa regardless of an infiltration of cholinergic fibers in the lamina propria. Of 13 biopsies from the patients with Hirschsprung's disease (N = 13), there were 12 positive reactions, and one false negative reaction in a neonate with total colonic aganglionosis. All biopsies from 24 unaffected children demonstrated negative reactions with no false positive reaction. In comparison, of the 35 specimens examined by H&E staining, ganglion cells were present in the submucosal Meissner's plexus only in 15 of these 24 unaffected children. In conclusion, a 97% diagnostic accuracy was achieved with AChE histochemistry compared with a 74% accuracy with H&E staining (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


Differential pattern of perivascular type IV collagen deposits in phyllodes tumors of the breast. Deposition of basement membrane extracellular matrix is influenced by adjacent tumor cells, and in some cases, the pattern of type IV collagen deposit is characteristic in malignant tumors. In this report, we analyzed the difference in type IV collagen deposition patterns between benign and malignant phyllodes tumors (PTs) of the breast. Of the 15 cases of PTs, 8 cases were benign PTs and 7 cases were malignant PTs. Three cases of other primary sarcomas of the breast (stromal sarcoma, angiosarcoma and osteosarcoma) and 2 cases of fibroadenomas were studied for comparison. The malignant PTs were distinguished from benign ones by increased mitotic figures, cellular atypism, and a higher proliferation index of stromal cells. Immunohistochemical staining against type IV collagen in malignant PTs revealed extensive to moderate deposition of type IV collagen around the small blood vessels in duplicate or multilayering pattern, while benign PTs showed minimal deposition in a single linear pattern. All of the three cases of other sarcomas revealed multilayering or meshwork pattern of type IV collagen around the blood vessels. The deposition of type IV collagen around the blood vessels may reflect the malignant behavior of the stromal tumors of the breast.


Spinal meningeal melanocytoma.

Spinal meningeal melanocytoma. A case of spinal meningeal melanocytoma is reported along with clinicopathologic, immunohistochemical and ultrastructural studies. This patient presented clinically with paraparesis, tingling sensation and numbness of both lower extremities of 4 months duration. No mucocutaneous pigmented nevi were found. On operation, scattered coal-black pigmented lesions were found in the meninges between T3 and T4-5 interspace level. Nearly total removal was carried out. The tumor was composed of spindle and epithelioid cells with heavy brown-black pigmentation. There was no pleomorphism, mitosis, hemorrhage, necrosis or invasion to the underlying cord tissue. In Korea, this case appears to be the first example of this disease. Neurologic deficit improved after surgical excision.


Primary choriocarcinoma of the urinary bladder--a case report. We report a primary choriocarcinoma of the urinary bladder in a 63-year-old man who presented with painless hematuria. He was diagnosed as having an invasive carcinoma and underwent a total cystectomy. The tumor was diffusely hemorrhagic and occupied the dome of the bladder. Histologically, it consisted of cyto-and syncytiotrophoblasts with extensive hemorrhage. No coexisting transitional cell carcinoma component was present. By immunohistochemistry, the tumor expressed beta-hCG and low-molecular weight cytokeratin intensely while it was negative for CEA or EMA. The post-cystectomy serum beta-hCG was 237mlU/ml, and decreased later. The pertinent literature is reviewed and diagnostic criteria are discussed.


An unusual combination of trisomy 21 and partial trisomy 5q. The authors describe a male newborn with multiple congenital anomalies; craniofacial dysmorphism, bilateral cleft palate and lip, ambiguous external genitalia with absence of phallus, ventricular septal defect, agenesis of olfactory bulbs, and presence of small round cells simulating migration defect in the cerebellar white matter. Cytogenetic study demonstrated a chromosomal constitution of 47,XY, +21, +5q. Its pathological significance compared with Down's syndrome and hitherto reported partial trisomy 5q is discussed.


Acute leukemias with unusual immunophenotypes. Over a two-year period, immunophenotypic patterns of 266 acute leukemia cases were analyzed using a panel of tests including TdT, SmIg and 9 surface antigens by the immunofluorescence stains for the assessment of the incidence and grade of phenotypic ambiguity (lineage infidelity) and the possible clinical significance of unusual immunophenotypes. Immunophenotypes were classified into four groups according to the degree of ectopic antigen expression. We classified as Group A (91.7%, 244 of 266 cases) those expressing conventional pattern without ectopic antigen. Group B (3.0%, 8 of 266 cases) was defined to have at least two lineage specific markers and single ectopic antigen. Such a "low grade deviation" did not prevent a definite immunodiagnosis. Group C (4.2%, 11 of 266 cases) revealed a promiscuous coexpression of markers related to different lineages, including two cases (0.8%, 2 cases) of biphenotypic leukemia. Group D (1.1%, 3 cases) included unclassifiable immunophenotypes with no antigen or HLA-DR only expression. Both patients with biphenotypic leukemia and one patient with unclassifiable immunophenotypes failed to respond to induction chemotherapy, suggesting a poor prognosis in these patients. The incidence of acute myelogenous leukemia (AML) cases with one or more ectopic surface antigens was 10 (8.1%) of the 124 AML cases. Ectopic antigen expression was seen in 5 (4%) of the 125 B-lineage acute lymphoblastic leukemia (ALL) cases and 3 (25%) of the 12 T-ALL cases. It is concluded that nearly 95% of cases of acute leukemia cases can be diagnosed accurately with immunophenotyping alone including patients with a mild degree of deviation from expected antigenic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)


A family case of beta-thalassemia minor and hemoglobin Queens: alpha 34 (B15) Leu-Arg. We report a Korean family case of beta-thalassemia minor and Hb Queens. This is the first case report of Hb Queens in Korea. A 43-year-old male and his four family members had beta-thalassemia minor which is very rare in Korea. Incidentally, an alpha chain variant with a high isoelectric point was also found in two other family members without clinical problems and was finally identified as alpha 34 (B15) Leu-Arg or Hemoglobin Queens.


Effect of etching time and acid concentration on resin shear bond strength to primary tooth enamel. The present study compared the shear bond strength of two commercially available systems to human primary enamel. Ground and unground enamel was conditioned for 15 seconds with 37% phosphoric acid siliceous gel. A 60-second application was used as a standard reference. Ten percent phosphoric acid in a polymer gel was also evaluated following a 20-second application to ground and unground primary enamel. No statistically significant difference was demonstrated between the mean values determined for each group. Compared with tests on permanent enamel with the same materials and conditions, it was concluded that no statistically significant difference exists between shear bond strengths to the enamel of the two dentitions.


Dentin adhesives and microleakage in cervical resin composites. This paper reports the effect of dentin bonding agents on marginal leakage in cervical cavities without the classical cavity preparation design. Wedge-shaped cervical cavities were cut on extracted teeth with the gingival cavosurface margin of each cavity involving dentin. The specimens were randomly assigned to three groups of 40 each: Group 1 (control), restored with Fuji glass ionomer; Group 2, restored with Scotchbond 2 adhesive and Silux Plus resin and Group 3, restored with Tenure adhesive and Perfection resin. Half of the specimens in each group were thermocycled. All specimens were then stored in basic fuchsin dye after which microleakage of the restorations was assessed by dye penetration. A grading scale of 0 to 3 was used as the scoring criteria. The results showed that differences were more pronounced at the gingival margin. The control group specimens exhibited the least microleakage. There was no significant difference between thermocycled and non-thermocycled specimens for each category of materials used. There was, however, a significant difference between the experimental groups and the control groups. The dentin adhesives tested did not completely eliminate microleakage at the gingival margin of cervical cavities.


Diagnosis of approximal caries: radiographic versus clinical examination using tooth separation. This study compared the accuracy of clinical examination with bitewing radiographs and clinical examination using tooth separation to recognize the carious lesions activity. 336 bitewings were reviewed for approximal caries on the maxillary and mandibular second premolars and first molars of 168 high school students. Three examiners evaluated the radiographs using a megascope, a magnifying glass (x2) and an amplifying image screen. 77 surfaces were identified with approximal radiolucencies. After the radiographic examinations, the three examiners performed a conventional clinical inspection using a No. 4 odontoscope, a No.5 explorer probe and an air-water syringe with artificial light and relative isolation. The variables recorded were: (1) healthy surface; (2) white spot; or (3) carious cavitation. The separation method was performed with elastics. After 24 hours, the elastics were removed and the clinical examination conducted as in the non-separation group.(ABSTRACT TRUNCATED AT 250 WORDS)


Clinical comparison of Class V resin composite and glass ionomer restorations. Three techniques for restoring abrasion/erosion lesions were evaluated over a 2-year period: 1) glass ionomer restoration (Ketac-Fil); 2) composite restoration with a dentin bonding agent (Silux Plus, Scotchbond 2); 3) composite restoration with glass ionomer liner and a dentin bonding agent (Silux Plus, Vitrebond, Scotchbond 2). There were 116 lesions restored and 115 evaluated for color match, cavosurface discoloration, surface texture, caries development, and retention. Most restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development when measured at 2 years. Glass ionomer restorations and composite restorations with a glass ionomer liner and a dentin bonding agent demonstrated better retention rates, 97.4% and 100% respectively, than the composite restorations with a dentin bonding agent only (86.8%) (Cochrane Q test, P = 0.07).


Marginal adaptation of castings made with dual-arch and custom trays. This study compared the marginal fit of castings made with custom acrylic trays and metal or plastic dualarch impression trays. Standard clinical and laboratory procedures were used to make 36 gold castings for a metal tipodont die. Mean marginal openings were between 25 and 28 microns in all test groups.


Microleakage of composite restorations with Syntac Bond and Denthesive. The purpose of this study was to assess, in vitro, the microleakage of Class V restorations using two new dentin bonding agents with light polymerized resin composite. Restorations were placed in cavities prepared in extracted human premolars using either a bulk or incremental packing technique. Dentin bonding agents were applied according to the manufacturer's instructions. The enamel margin of each tooth was etched with 37% orthophosphoric acid. The teeth were stored for 6 weeks at 37 degrees C, thermocycled, and the restorations examined for leakage using methylene blue dye. The teeth were sectioned buccolingually through the restorations and the degree of microleakage assessed visually. All groups of teeth showed some degree of leakage at the gingival margin. There was a significant difference between the cavities restored by bulk packing of the resin composite and those where the resin had been applied incrementally for both materials (P < 0.05). There was no significant difference in leakage between the two dentin bonding agents (P > 0.05).


Clinical evaluation of a heat-treated resin composite inlay: 3-year results. The purpose of this study was to evaluate a resin composite inlay system in clinical trials involving human subjects. A total of 60 restorations were inserted equally in Class I and II preparations and in premolars and molars. A glass ionomer liner was applied to the dentin. Light-cured direct inlays were fabricated in the oral environment. Thirty inlays were heat-treated for 7.5 minutes at 125 degrees C in a dry heat oven. Enamel margins of the preparations were etched with 37% phosphoric acid gel. All inlays were cemented with a light-cured enamel bonding resin. Restorations were evaluated using the USPHS system and M-L indirect scale. Six, 12, 24 and 36-month recalls were compared to baseline. Color, interfacial staining, secondary caries, and wear were unchanged from baseline for all restorations. Marginal integrity and surface texture show a differential change from baseline and with respect to restoration type. Indirect wear was not significantly different between restoration types (P < 0.05). Wear resistance was not significantly improved with heat treatment, but marginal integrity and surface characteristics showed marked improvement in the heat-treated group at 24 and 36-month recalls.


Clinical microleakage evaluation of a cavity varnish. This clinical study evaluated the microleakage effectiveness of a cavity varnish when used in combination with two types of amalgam: a spherical particle and a dispersed phase alloy. Calcium hydroxide was utilized as the microleakage detection agent. Copalite showed a reduction in microleakage when it was employed with the spherical particle alloy used in this study. This study clinically demonstrated that Copalite is not totally effective in eliminating microleakage.


Physical properties of a periodontal dressing material. Further characterization has been undertaken of a visible light cured periodontal dressing material (Barricaid), which has been shown to exhibit superior physical properties to those of the standard (chemically curing) dressing materials. In particular, water sorption and solubility were studied, with a greater solubility found at 37 degrees than at 23 degrees with little further increase at 50 degrees C. Water sorption increased from 23 degrees C to 37 degrees C but decreased at 50 degrees C. Cure depth, determined by a penetrometer method, showed a constant resistance of 5.8 kg to probe penetration to a material thickness of 11 mm but resistance to penetrometer penetration, i.e. the level of cure, decreased sharply at greater thickness. The tensile strength of the material was unchanged when immersed up to 7 days in water at 37 degrees C, indicating a highly coherent material unaffected by water over a period corresponding to average clinical use. Previous studies showed that interlocking into the embrasures was required for adequate adhesion of Barricaid. To overcome this problem, teeth were etched and a bonding agent applied to the etched enamel surface. This chemo-mechanical lock gave an immediate adhesion value of 43.94 MPa, which decreased to 37.17 MPa at 7 days. The immediate adhesion value without etching and bonding was 34.23 MPa which decreased to 19.32 MPa at 7 days. Soaking decreased adhesion to enamel, but the effect was markedly less when the enamel was pretreated by etching and priming.


Salivary pH while dissolving vitamin C-containing tablets. Vitamin C is packaged in numerous forms which allow protracted exposure of the teeth to ascorbic acid. The repeated use of chewable mega dose tablets of vitamin C as a mint can damage the teeth by dissolving the enamel. In the time it takes to dissolve a chewable vitamin C tablet, a salivary pH drop takes place; salivary calcium and phosphorus ion concentration drops, and enamel dissolution may begin. Although sodium ascorbate, a buffering agent, is present in many vitamin C products, it may be added in insufficient quantity to be effective. With no apparent therapeutic value from topical vitamin C, vitamin C-containing products should be swallowed.


Bond strengths of various materials to dentin using Amalgambond. This study evaluated the bond strength of four restorative materials to dentin using Amalgambond. Two high-copper amalgams [Tytin; spherical, (T) and Epoque 80; lathe-cute, (E)], a gallium alloy [Gallium Alloy GF (G) and a resin composite [P-50 (P)] were tested. The polished dentin surface was treated with dentin-enamel activator (10 seconds), washed, dried, and adhesive agent was applied (30 seconds). In group A, the dentin adhesive was placed onto the dentin and while still wet, T, E, or G was condensed in cylinders (4 mm diameter) with condensation forces suggested by the manufacturer for a clinical situation. In group B, the cylindrical specimens of restorative material were allowed to set and then adhered to the treated dentin using the adhesive system. For the composite (control), the adhesive was applied to the treated dentin and while still wet, P was layered into the cylinder and cured for a total of 90 seconds. After storage in water (37 degrees C) for 24 hours, all the specimens were tested for tensile bond strength. This study revealed that the bond strength of P was significantly higher than the other materials tested and also that amalgam allowed to set for 1, 6 or 24 hours before adhesion to dentin had a significantly greater bond strength than freshly condensed amalgam. Although the desired high bond strength did not develop in the bonding of the metallic restorative materials, signs of bonding were found.


Effect of rubber dam isolation on restoration deterioration. The consequence of using either rubber dam or cotton roll isolation on the subsequent clinical deterioration of 546 polished amalgam and 148 anterior enamel-bonded resin composite restorations was evaluated over periods of up to 15 and 10 years, respectively. Double-blind assessments for several clinical factors or parameters of the restorations were made using both direct and indirect observation methods. The transformed rating scores obtained were evaluated using a mixed model analysis of variance. With very few exceptions, all restoration placements were of high quality, and there were relatively few unsatisfactory rating scores given for any of the clinical factors assessed over the study. The low mean deterioration scores for most of the clinical factors assessed were also fairly similar, irrespective of the isolation method used. Therefore, although a statistically significant difference was found between the two isolation methods for marginal fracture of the composites, the clinical relevance of this difference is questionable.


Pit and fissure sealing and mutans streptococci levels in saliva. The effect of preventive pit and fissure sealants with a resin-based material on the number of salivary mutans streptococci was evaluated in 46 healthy 12-year-old school children (F group) with medium or high counts during a 1-year study period. As controls served 33 children of the same age with the same bacterial levels at baseline (C group) and 55 children with low levels (L group). Caries prevalence and incidence were registered clinically and radiographically. Sealing of all accessible pit and fissures was carried out in the F group with a light-cured Bis-GMA sealant. Bacterial levels at baseline and 3, 6, 12 and 52 weeks after treatment were estimated with a chairside method. The results disclosed a significant (P < 0.05) drop in the number of salivary mutans streptococci in the F and C groups at all sampling occasions compared to baseline. There were however no differences between the groups during the study period. Both the caries prevalence and incidence were significantly (P < 0.05) higher in F and C groups when compared to the L group. The results suggest that preventive pit and fissure sealing with a resin based material does not affect salivary mutans streptococci levels.


Dentin surface treatment and shear bond strength of a light-cured glass ionomer. This study evaluated the effect of dentin surface treatment with polyacrylic acid on the shear bond strength of Fuji Lining LC light-cured glass ionomer lining cement (GIC). A total of 40 human, noncarious extracted permanent molars stored in distilled water were used. A flat buccal dentin surface was ground wet on 600-grit silicon carbide paper. The teeth were then randomly distributed into four groups of 10 teeth each: Group 1: dentin rinsed with distilled water, dried with oil-free compressed air, placement of cylindrical GIC samples and sheared at 15 minutes post-curing. Group 2: same as group 1, but sheared 7 days post-curing. Group 3: dentin treated with GC Conditioner for 10 seconds, rinsed with distilled water, dried with oil-free compressed air, placement of the GIC and sheared 15 minutes post-curing. Group 4: same as group 3, but sheared 7 days post-curing. The GIC was mixed in a 1:1 powder-liquid ratio. The samples were stored in distilled water until sheared with an Instron. The results revealed that dentin surface treatment with the polyacrylic acid significantly increased the shear bond strength to dentin when tested at 7 days post-curing.


Efficiency of protective sealants for glass ionomer cements. This study compared the efficiency of protective sealants for glass ionomer cements. Scotchbond 2, Visar Seal, an experimental light activated silicone and Ketac Glaze were evaluated using liquid scintillation spectrometry. The results showed that Ketac Glaze was a very effective sealant for the newly placed glass ionomer cement and the resin component of Scotchbond 2 is in the same range.


Studies on the antibiotic resistance of Bacillus subtilis strains used in oral bacteriotherapy. Bacillus subtilis antibiotic resistant strains used in oral bacteriotherapy were tested for the resistance to new therapeutically useful antibiotics. Chromosomal mutations originally selected in these strains proved to confer resistances also to these antibiotics. To investigate the stability of the antibiotic resistance markers present in B. subtilis O/C, T, N/R, SIN strains, we considered resistances to Chloramphenicol, Tetracycline, Rifampicin and Streptomycin. Resistances to Tetracycline, Rifampicin and Streptomycin were stably maintained for at least 200 generations in the absence of selective pressure. Chloramphenicol resistance proved to be inducible, showing a progressive loss when the resistant strain was grown in the absence of the antibiotic and a return to its original resistance levels after growth in the presence of the antibiotic. By in vitro and in vivo experiments we demonstrated the absence of homologous transfer of resistance markers among the resistant strains.


Determination of alpha-tocopherol in semisolid gelled preparations by reversed phase HPLC. Recently there has been increasing interest in alpha-tocopherol due to the possibility of its acting as a chemoprotective agent for skin cancer since it acts to protect dermic cells from the attack of free radicals caused by ionized radiations or chemical substances. To carry out this study, semisolid preparations were made from this active substance. We demonstrate a rapid, sensitive and reproducible method of extraction and analysis using an HPLC system with ultraviolet detection to carry out routine measurements beginning with hydrophilic gels of alpha-tocopherol.


A novel HPLC method for the determination of mitoxantrone in pharmaceutical formulations. An HPLC method, using reversed phase chromatography, for the quantitative determination of mitoxantrone in pharmaceutical formulations has been developed. Rhein has been used as internal standard.


Cytoplasmic membrane transplants in early Xenopus embryos indicate cell-cycle-specific effects. Fragments of rough endoplasmic reticulum or Golgi complex isolated from normal adult rat liver homogenates were injected into one cell of cleaving two-cell Xenopus laevis embryos and the effects on development were monitored during early cleavage by morphological analysis. Scanning electron microscopy revealed the formation of large cells on the injected side of the embryos. Such large cells were not present in controls and thus were considered to have been formed as a consequence of delayed cleavage. Delay of cleavage was obtained with as little as 1 ng of membrane protein giving a ratio of membrane protein to embryo protein of 1:10(5). Cytological observations of microinjected embryos confirmed the occurrence of delayed cytokinesis and suggested that nuclear division became asynchronous. Since rough microsomes from proliferating tissues (i.e., livers with primary tumors and livers undergoing regeneration) showed little or no effect on cytokinesis after microinjection into early embryos, we conclude that cytoplasmic membranes may exhibit cell-cycle-specific properties important for normal development.


n-3 and n-6 polyunsaturated fatty acids have different effects on acyl-CoA:cholesterol acyltransferase in J774 macrophages. The effects of incubating J774 mouse macrophages with different fatty acids on cholesterol esterification were investigated. In cells incubated with n-3 polyunsaturated fatty acids, the rate of cholesterol esterification was significantly reduced compared with cells incubated with n-6 polyunsaturated fatty acids or with oleic acid. This change in cholesterol esterification appears to be the result of reductions in the activity of acyl-CoA:cholesterol acyltransferase (ACAT) in the endoplasmic reticulum of the macrophages incubated with the n-3 polyunsaturated fatty acids. No differences in microsomal cholesterol were observed among cells incubated with different fatty acids. However, cellular cholesterol levels were lower in cells incubated with n-3 polyunsaturated fatty acids. In microsomes from cells incubated with n-3 polyunsaturated fatty acids, both the Km and the Vmax of ACAT were lower than in microsomes from cells incubated with n-6 fatty acids or oleic acid. These findings may explain some of the reduction in atherosclerotic lesions that are observed with dietary fish oils that contain high levels of n-3 polyunsaturated fatty acids.


Effects of amino acids and ethanolamine on choline uptake and phosphatidylcholine biosynthesis in baby hamster kidney-21 cells. The effects of amino acids and ethanolamine on choline uptake and phosphatidylcholine biosynthesis in baby hamster kidney (BHK-21) cells were investigated. The cells were incubated with labelled choline in the presence of an amino acid or ethanolamine. The uptake of labelled choline was noncompetitively inhibited by amino acids. Glycine, L-alanine, L-serine, L-leucine, L-aspartate, and L-arginine were effective inhibitors and a maximum of 22% inhibition of choline uptake was obtained with 5 mM glycine. Analyses of the labelings in the choline-containing metabolites revealed that the conversion of choline to CDP-choline and subsequently phosphatidylcholine was not affected by the presence of amino acids. The uptake of choline was also inhibited by ethanolamine in a concentration-dependent manner. Kinetic studies on the uptake of choline indicated that the inhibition by ethanolamine was competitive in nature. Although ethanolamine is a potent inhibitor of choline kinase, analyses of the labelings in the choline-containing metabolites indicated that the conversion of choline to phosphocholine was not affected in the cells incubated with ethanolamine. Ethanolamine did not change the pool sizes of phosphocholine and CDP-choline. Based on the specific radioactivity of CDP-choline and the labeling of phosphatidylcholine, the rates of phosphatidylcholine biosynthesis were not significantly different between the control and the ethanolamine-treated cells. In view of the concentrations of amino acids (millimolar) and ethanolamine (micromolar) in most cell culture media, it appeared that only amino acids were important metabolites for the regulation of choline uptake in BHK-21 cells. We conclude that both amino acids and ethanolamine have no direct effect on the biosynthesis of phosphatidylcholine.


New expressions to describe solution nonideal osmotic pressure, freezing point depression, and vapor pressure. New empirical expressions for osmotic pressure, freezing point depression, and vapor pressure are proposed based on the concepts of volume occupancy and (or) hydration force. These expressions are in general inverse relationships in comparison to the standard ideal expressions for the same properties. The slopes of the new equations are determined by the molecular weight of the solute and known constants. The accuracy and precision of the molecular weights calculated from the slope are identical and approximately 1% for the experiments reported here. The nonideality of all three colligative expressions is described by a dimensionless constant called the solute-solvent interaction parameter I. The results on sucrose have the same I = 0.26 for all three solution properties. The nonideality parameter I increased from 0.26 on sucrose to 1.7 on hemoglobin to successfully describe the well-known nonideal response of macromolecules.


Inhibition of mammalian ribonucleotide reductase by cis-diamminedichloroplatinum(II). Ribonucleotide reductase is a highly regulated, rate-limiting activity in the synthesis of DNA. A previous study has shown that the Escherichia coli enzyme is inhibited by the clinically important antitumor agent cis-diamminedichloroplatinum(II) (DDP), and this has led to the hypothesis that ribonucleotide reductase is an important site of action for this chemotherapeutic agent. This hypothesis has been directly tested in this investigation. We observed that DDP inhibits the mammalian ribonucleotide reductase, with 50% inhibition occurring at 0.3 mM. Unlike the E. coli enzyme where only one of the two protein components is targeted by DDP, we observed that both of the mammalian proteins (R1 and R2) were sites for the inhibitory activity of the drug. Colony-forming experiments, enzyme activity studies, and analyses of R1 and R2 message levels in mutant cell lines containing either high levels of ribonucleotide reductase activity or exhibiting resistance to the cytotoxic effects of DDP were used to further investigate the potential role of ribonucleotide reductase in DDP cytotoxic action and drug resistance. These studies did not support a hypothesis formulated in the earlier investigation that inhibition of ribonucleotide reductase is an important component of DDP cytotoxic activity or that it is a major participant in DDP resistance mechanisms. From a biological point of view, DDP is a very active drug, and in addition to its cytotoxic effects it is capable of inducing a variety of cellular changes. Whether or not the inhibition of mammalian ribonucleotide reductase activity that we have described in this study plays a role in mediating any of these other effects remains to be determined.


Induction and intracellular localization of the 80-kilodalton heat-shock protein of Neurospora crassa. The most abundant heat-shock protein of Neurospora crassa is a multimeric glycoprotein of 80-kilodaltons (i.e., HSP80), induced strongly by hyperthermia and at a lower level by sodium arsenite, ethanol, and carbon source depletion. Immunoelectron microscopy, using indirect immunogold labelling demonstrated that HSP80 was undetectable in mycelium cultured at the normal growth temperature of 28 degrees C, but it appeared rapidly following the commencement of heat-shock treatment at 48 degrees C. HSP80, visualized by the gold label, was observed almost exclusively in the cytoplasm, exhibiting a uniform distribution. Association of this protein with cellular membranes and (or) targeting to a particular subcellular compartment or organelle was not apparent.


Overexpression of SPARC in stably transfected F9 cells mediates attachment and spreading in Ca(2+)-deficient medium. The Ca(2+)-binding protein SPARC is one of a group of proteins that function in vitro to promote the rounding of cells. To assess whether the modulation of cell shape by SPARC is affected by extracellular Ca2+, we used F9 cell lines that had been stably transfected with sense or antisense SPARC DNA. Sense-transfected (S) lines that overexpress SPARC are aggregated and rounded, whereas antisense (AS) lines that express low levels of the protein are flat and spread. We tested whether the cell lines would exhibit these altered morphologies in Ca(2+)-deficient media. When cultured under these conditions, S lines attached and spread, whereas AS lines attached but remained round, with no subsequent spreading. Addition of CaCl2 or purified SPARC to the Ca(2+)-deficient medium resulted in spreading of the AS and control lines and a reappearance of the altered morphologies. Expression of the Ca(2+)-binding cadherin uvomorulin by the cell lines correlated with neither their morphology nor their level of SPARC expression. We conclude that the altered phenotypes of the transected lines reflect, in part, the concentration of extracellular Ca2+ and that the spreading exhibited by the S lines under Ca(2+)-deficient conditions is directly related to their enhanced expression of SPARC. SPARC might, therefore, mediate interactions between cells and matrix that are permissive for adhesion when levels of extracellular Ca2+ are diminished.


Soluble endothelin degradation enzyme activities in various rat tissues. From soluble extract of rat kidney we have previously identified an endothelin degradation enzyme that rapidly and specifically cleaves off the C-terminal tryptophan of endothelin-1, resulting in a peptide that is three orders of magnitude weaker in potency than endothelin-1 in causing smooth muscle contraction. The tissue distribution of this enzyme was examined, and the soluble extracts of rat kidney were found to contain the highest enzyme activity, followed by the spleen and the liver. In contrast, no enzyme activity was detected in the soluble extracts of brain, heart, and lung. The biochemical properties of the partially purified enzyme from kidney were further investigated. The optimal pH of the enzyme was between 5 and 7. The endothelin degrading activity was effectively blocked by thiol protease inhibitors such as benzyloxycarbonyl-Phe-Ala-diazomethyl ketone and p-hydroxymercuribenzoic acid, as well as by phenylmethylsulfonyl fluoride, but not by metalloprotease and other serine protease inhibitors. This enzyme displayed a clear difference in substrate specificity when compared with other thiol proteases such as cathepsin B, cathepsin H, and cathepsin L, known to be present in the kidney. These results suggest that a novel protease with endothelin degrading activity is widely distributed in a number of tissues.


[Histotopographic study of the pharyngoesophageal junction in newborns]. In the present work the importance of the cricopharyngeal muscle as the main constituent of the pharyngoesophageal sphincter is showed. Some aspects traditionally admitted by the classic anatomic descriptions and some hypothesis about the function of this part of the aerodigestive pathway are discussed.


[Unusual congenital laryngeal anomalies: a review of 13 cases]. In this study we presents: 6 subglottic stenosis, 2 subglottic hemangiomas, 2 laryngeal webs, 2 laryngeal cysts and 1 laryngoesophageal cleft. Were diagnosed during laryngotracheobronchoscopies performed to 220 newborns and small children that showed as main finding: stridor, voice change or aspiration syndrome. The stenosis, hemangiomas and cleft were resolved spontaneously. In the webs and cysts surgical correction was required. Here we will expound upon clinical, diagnostical and therapeutic aspects of these rare congenital laryngeal anomalies.


[Correlation between audiometric and electronystagmographic results in Menière's disease]. Cochlear and vestibular functions of 30 patients suffering from Méniere's disease have been analyzed through audiometric and electronystagmographic studies. Auditive thresholds in low, medium and high frequencies have been correlated with the results of the caloric and pendular tests. Statistical analysis has demonstrated that there is no significant relationship between caloric and pendular reflectivity and hearing loss in the mentioned frequencies. In conclusion, in Méniere's disease hearing losses and vestibular alterations follow a different pathologic pattern.


[Smell during speleologic isolation].

[Smell during speleologic isolation]. A smell evolution it is done from two isolation experiences, in a cave by a speologyst in Eastern Pyriness. The investigation verified the smell recovery from a person who is used to living in town with big pollution. This work was done with twenty four fragrant essences, twenty of them were oriented to olfactory nerve exploration and four of them to trigeminal response. These tests were done with each nostril separately.


[Comparative study of histology and flow cytometry results obtained in 2 groups of laryngeal tumors, glottic and supraglottic, in T-1 stage]. We studied histophatological parameters and DNA content in 27 supraglottic and 37 glottic T-1 squamous cell carcinoma of the larynx. The DNA content was determined by the Hedley method in paraffin-embedded sections of formalin-fixed blocks in an EPICS Profile flow cytometer. We studied 14 histopathological parameters and only 3 were statistically different in both groups of tumors: Differentiation, infiltrative degree and mitoses. There weren't statistical differences in DNA content (DNA index and proliferation index).


[Epithelioma of the pyriform sinus: retrospective study and survival analysis after 5 years]. We have studied 27 clinical records of patients with piriform sinus epidermoid carcinoma diagnosed and treated in our department during a period of 6 years. All the patients underwent surgery and radiotherapy. We have analyzed the survival and recurrence rates together with other parameters that may have some influence in them. We have tried to show the factors that might be in relation with the prognosis of pyriform sinus carcinoma. The statistical analysis show a survival rate of 29.6% after 5 years follow up, being the node invasion, wither clinical or histological, the main fact to have a prognostic value.


[Oral hairy leukoplakia in human immunodeficiency virus positive patients: clinical and etiopathogenic aspects]. Clinical and etiopathogenetic features of oral hairy leukoplakia in 5 patients positive for Human Immunodeficiency Virus were studied. Oral hairy leukoplakia were located on the lateral borders of the tongue and showed a corrugated/hairy aspect in all the cases. Histological examination showed hyperparakeratosis, acanthosis, hair like projection (n = 4) koilocyte-like-cells and moderate subepidermal inflammation. Immunohistochemistry revealed positive results for Epstein-Barr virus indicating an active replication of this virus within the epithelial cells of the stratum granulosum and upper stratum spinosum.


[Interaction between hypertriglyceridemia and noise in human hearing]. We carry out a cross-sectional study on 1205 workers exposed to industrial noise. After the clinical, analytical and audiological examination, we can't demonstrate any influence of hypertriglyceridemia on noise induced hearing loss. We get a statistically significant relationship between noise and hearing loss only in the group of workers with normotriglyceridemia.


[ORL emergencies at a health center: a study of the incidence during 1990]. We present a retrospective study of 942 ENT emergencies in a Health Center (primary care), during the year 1990, treated by family physicians. They are analysed under different parameters such as date, time, sex, age, diagnosis, drug prescription and dispatch of the patients to the hospital. We carried out an analysis of the quality of the attention given.


[Homotransplants in cervical trachea: clinical and histopathologic results]. An experimental study about homotransplant of cervical trachea in Wistar rats is presented. Surgical approachment consists in excision of 7 or 9 tracheal rings and their posterior end-to-end anastomosis. The animals are divided in two groups. In the first one an homotransplant of cervical trachea is practised and compared with the second one as control group. Clinical and histopathological results are similar in both groups. Our findings are also discussed, comparing with other authors.


[Primary tumors of the external auditory canal]. Primary tumors of the external auditory canal (EAC) are rare, their etiology is uncertain and their prognosis, dim. The most effective therapy combines both surgery and radiotherapy. This study reviews the literature and shows the results from 13 cases, treated between 1981-1991. This series proves a clear prevalence for the epidermoid tumors (10 out of 13) and we call the attention on their poor prognosis even in those tumors confined to EAC. The types of treatment and their complications as well, were reviewed.


[Supraclavicular schwannoma with malignant cytologic appearance]. We present the case of a old woman with a supraclavicular mass and sarcomatous cytologic appearance. The final microscopic appearance was schwannoma. We also review the pertinent literature.


[Follicular adenoma in lingual thyroid: report of a case]. We present a case of follicular adenoma which has its origin in a unique lingual thyroid. The interest lies in the oddity of this pathology and in the unusual clinical form of dysphagia. In spite of the fact that the thyroid ectopy is a congenital anomaly in the development of the thyroid, the history of previous administration of cervical radiotherapy and the diagnosis in an elderly person makes us suppose, in this case, that there is a different etiopathology.


Three composite finishing systems: a multisite in vitro evaluation. Selection of appropriate finishing and polishing devices is critical to the optimal appearance and longevity of composite resin restoratives. This report compares the effectiveness of three specific finishing and polishing systems when used to prepare the surfaces of composite restorative materials provided by the respective manufacturers. Profilometer surface roughness analyses were conducted at two separate laboratories to cross-correlate numerical smoothness data in this study. Statistically significant differences in mean surface roughness were found between various finishing system/composite resin pairings. Surprisingly, a hybrid composite resin finished and polished with its respective finishing/polishing system gave a significantly smoother surface than a microfill composite surface prepared with its corresponding sequentially coated abrasive disc system. This finding was corroborated at a second site using a separate methodology for profilometer analysis.


Bite forming of occlusal composite restoration. The bite-forming technique of posterior composite restoration is presented. Before preparation, the tooth surface is coated with a separating varnish. The occlusal anatomy of self-cured composite is bite formed by bare opposing teeth. Subsequent finishing is considerably simplified by the ability to peel excess composite from the varnished tooth surface. Finishing and detailing are further simplified by use of top-cut and top-safe superfine diamond points. A "free matrix" is used for Class II restorations.


Indirect porcelain veneer technique for restoring intrinsically stained teeth. Indirect porcelain veneers are often the ideal restoration for intrinsically stained teeth. This article details a step-by-step procedure for esthetically restoring discolored teeth. Porcelain laminate veneers are often indicated when teeth bleaching or direct composite bonding procedures cannot provide the desired esthetic result. Veneers are more appealing to many patients than full coverage crowns because of the more conservative tooth preparation required. If technique details are followed meticulously and cases are appropriately selected, porcelain veneers are not only durable but also promote marvelous gingival health and may be the most esthetic anterior dental restoration.


Effect of thermocycling times on dentin bond strength. Thermocycling is widely used in the evaluation of dentin bonding agents. The purpose of this study was to determine the effect of increasing thermocycling times on the shear bond strength of composite resin to dentin using a NTG-GMA/BPDM-type bonding agent. Fifty human molar teeth were ground flat on the buccal surface into dentin (600 grit). Ten specimens were prepared for each thermocycling group of 100, 500, 1000, 2000, and 4000 cycles. The adhesive agent was applied to the dentin according to the manufacturer's instructions. A cyclindrical-shaped matrix was used to form the composite resin that was light cured to the treated dentin surface for 60 seconds. Thermocycling was started after 24 hours of storage in deionized water at 37 degrees C. Shear bond strengths were determined with an Instron universal testing machine at a cross-head speed of 0.5 mm per minute. The bond strengths in megapascals (MPa) were : 100 cycles 18.1 (+/- 5.2) MPa, 500 cycles 19.4 (+/- 4.0)MPa, 1000 cycles 16.5 (+/- 2.9), 2000 cycles 14.6 (+/- 5.1), and 4000 cycles 19.9 (+/- 3.2)MPa. When this data was subjected to an ANOVA, no significant difference was found between the groups.


[Insurance medicine and accident surgery]. A definition of insurance medicine is presented with due consideration for national peculiarities (social insurances) in Switzerland. The historical development from original trauma-directed accident medicine to the present-day insurance medicine with its more comprehensive nature is shown with particular consideration being given to the close connection with traumatology (trauma surgery/orthopaedic surgery). The guarantee of smooth-running and constructive cooperation between traumatologists and welfare organizations is one of the major tasks of doctors employed in insurance companies, whose sphere of influence and qualifications are under discussion.


Bonding amalgam to tooth structure: a scanning electron microscope study. The purpose of this scanning electron microscope study was to observe the interface between dentin and amalgam utilizing various adhesive resin cements. The adhesive resin materials used in this study were Imperva Dual, Geristore, and Panavia. The scanning electron micrographs revealed that bonds were established between amalgam, adhesive resins, and dentin.


[The deltoid flap-plasty. Therapy of choice in large rotator cuff ruptures?]. Rotator cuff tear is an extremely common and important disease. An extensive rotator cuff tear is an incapacitating event and remains a major problem which forces to respect to the management. The late outcome of majors ruptures of such tears are often a defect-arthropathy with a complete destroy of the shoulder and a loss of flexibility caused by pain. The deltoid muscle plasty, as the logical reconstruction method and relatively easy to perform, lead to better results in compare to all the variety of surgical treatments of restoring the anatomical continuity. This article reviews the clinical manifestations, operative technique and the results associated with the treatment by deltoid muscle plasty. Based on the results. Based on the results of flexibility, and postoperative pain in shoulder we conclude that the early results in our group of the first 20 patients are excellent. 84% of the patients were subjectively very satisfied and free of pain.


Two-step provisional technique for onlay preparations. Compared to full crown temporization, direct autocured resin provisional technique for intracoronal onlay preparations is more complicated and less predictable. Clinical concerns include possible pulpal irritation, extra chair time for contouring proximal and marginal excess, and a critically short time constraint to remove the curing resin in the "rubbery stage" to avoid distortion or "locking" into the preparation. A two-step direct technique using two new light-cured provisional resins addresses these problems. First, a light-cured, elastic resin is condensed against the internal preparation walls and confined within a wedged metal matrix band. Then, using a clear template matrix, the elastic foundation is overlaid with a strong and esthetic light-cured provisional resin.


[Results of surgical management of scapula fractures. 78th Annual Meeting of the Swiss Society of Accident Surgery and Occupational Diseases, 4-5 September 1992 in Olten]. The follow-up of 8 patients with scapular fractures showed a high rate of complications with 3 infections and problems with the osteosynthetic material. This did not effect the results in any case, most results were good. The indication for the operation should be proved restrictively, the following operative treatment should be minimal invasive. CPM-devices were used after operation and had a positive effect.


[Post-traumatic impingement syndrome caused by a displaced tuberculum majus fragment]. The posttraumatic impingement-syndrome caused by displacement and retraction of the entire great tuberosity with the bony insertions of the supraspinatus or infraspinatus muscle is often diagnosed with delay. Two types are distinguished: 1. The fracture of great tuberosity with proximal and dorsal dislocation of the fragment impairs motion by impinging under the acromion and against the posterior glenoid wall. 2. The multi-fragment bony fracture at the rotator cuff insertion, usually finish in rotator cuff deficiency. The analysis of the last 22 operated patients demonstrates the important preoperative complaints, commonly during a long time before reconstruction. The excellent postoperative results show the importance of the early and generous management of proximal humeral fractures.


[Experiences with conservative therapy of humerus shaft fractures]. A well proved method for the conservative treatment of fractures of the humeral shaft is clearly shown by words and pictures. A study of 36 own cases during the years 1985 up to 90 informs on the problems of conservative treatment of these fractures. Even if there is a perfect primary reposition, impossibility of proper retention in the plaster cast may lead to post-primary osteosyntheses (2 cases in 36). Despite correct conservative treatment there are always delayed unions in a certain percentage (6 cases in 34), which you can't recognize before 3 months after injury, but then should bring them to operative treatment. There is quite a high number of pseudarthroses (4 cases in 32). It is still unclear, which type of fracture and which type of patient is going to build up a pseudarthrosis. In conservative treatment, the most important thing is--compared to operative treatment--a very closed and carefully observing aftercare.


[Primary closure of traumatically ruptured bursae]. Normally a bursectomy is the choice of therapy when a bursa of a joint is opened through trauma. A primary closure was performed on 10 patients, selected according to certain specific criteria. Nine out of ten cases showed no complications with good short and long-term results.


Effect of hypothermia on focal experimental seizures. The effect of general hypothermia was investigated in 15 unanesthetized cats. The animals were immobilized with Flaxedil and maintained on mechanical respiration. An epileptogenic focus was induced by stereo-tactical injection of penicillin to the right hippocampus. Cooling of the body was followed by a marked decrease of the amplitude and frequency of the penicillin spikes. The antiepileptic effect of general hypothermia was not dependent on brain stem section as suggested by previous investigations. Seizures generated by a hippocampic penicillin focus were more resistant to hypothermia than discharges produced by penicillin applied to the visual cortex.


Habituation of orienting reaction in therapy-resistant generalized epilepsy. A polygraphic study on resistance to habituation of the somatic, autonomic and EEG components of the orienting reaction elicited by a repetitive auditory stimulus was performed in 39 epileptics with therapy-resistant generalized seizures (TRGS) and in 119 matched subjects in two control groups. The study showed a significantly higher resistance to habituation of the orienting reaction in epileptics with TRGS vs. the normal subjects of control group I. A significantly higher resistance to habituation was also noted in epileptics with therapy-controlled generalized seizures of control group II. The correlational analysis of data showed that the severity of these habituation disturbances in epileptics with TRGS depended on the patients' age, type of electroclinical seizures, pretrial seizure frequency, type of resting EEG, administered treatment (no. of administered antiepileptic drugs/patient), daily dose, as well as on the serum level of these drugs. The multivariate regression analysis showed that the most significant predictive variables for the habituation disturbances were the pretrial seizure frequency, type of electroclinical seizures, daily dose of administered antiepileptic drugs and their serum level. The data also evidenced that the antiepileptic treatment improves the interictal habituation disturbances, the effect being the more marked as the treatment was more sustained. The above-mentioned habituation changes in epileptics with TRGS should be ascribed to some disturbances in nervous excitability.


A trial to apply the concept of genomic imprinting to the manic-depressive illness. The phenotypic indicators of genomic imprinting were applied to the familial psychopathology data collected through the family history method about 886 adult relatives of 65 manic-depressive probands directly investigated. The probands and their relatives were diagnosed according to DSM-III/DSM-III-R criteria. A first analysis of the age at onset of the BP illness by affective status of the probands' parents suggested that the BP disorder begins about 8 years earlier in the probands whose father was affectively ill (13.84% cases) than in the probands whose mother was affectively ill (24.6% cases) (t = -3.29, P < .004). When controlling this result for the effect of the probands' sex, its statistical significance decreased. The severity of the BP illness seemed also to be influenced by the affective status of the probands' father but only when assessing the probands' illness severity over a long time period and taking into account their psychosocial functioning; the number of manic and depressive hospitalized and non-hospitalized episodes as a single measure of the BP disorder severity as well as the morbidity risk in the first degree relatives of the probands did not significantly differentiate the patients whose disorder was transmitted by the father/paternal side as compared with the patients who inherited the BP disorder from the mother/maternal side.