[Treatment of hemangioma with the neodymium:yttrium-aluminum-garnet laser (Nd:YAG laser)]. Laser therapy and in particular Nd:YAG laser therapy has become of increasing importance amongst the various methods of treating haemangiomas. Nd:YAG laser radiation penetrates deep into the tissue. To avoid undesirable results of treatment, certain treatment guidelines must be observed: to protect the tissue from serious heat damage, the Nd:YAG laser radiation should be applied exclusively with simultaneous tissue cooling. Depending on the location of the haemangioma, this is carried out with ice cubes (if possible, not containing air bubbles) or with an ice-cold Ringer solution. The depth of penetration of the laser radiation can be increased by tissue compression with a piece of ice or with a special glass disc. In very voluminous haemangiomas, the laser light is additionally applied via a bare fibre directly on to the vascular tissue. The laser power densities we use are between 500 and 3,000 watts/cm2. The power chosen depends on the tissue effect of the laser radiation. Blanching of the vascular tissue without carbonisation is aimed at. With consistent observance of the treatment guidelines specified, haemangiomas should be treated as early as possible with the Nd:YAG laser. The treatment principle of "wait and see" is often advocated, but we consider to be obsolete, since cosmetically and functionally unsatisfactory residual scars may remain even after complete haemangioma regression. Moreover, the progressive haemangiomas which often lead to complications cannot be distinguished from regressive haemangiomas. Last but not least, the child and the parents should be spared the (in some cases appreciable) psychological strain of a haemangioma.


[Rhinoplasty: preventable errors in the first 100 interventions and secondary correction]. The most frequent avoidable mistakes which a young rhinosurgeon commits concern the analysis of the patient's desire, the preoperative critical examination of the facial proportions, the choice of the surgical technique and the operative approach, the choice of the implantation material and the method of how to implant it in a form-fitting manner, overreductions or underreductions by osteotomy and mistakes in the course of postoperative change of the dressings. The way of avoiding these errors and the way of their secondary correction are presented. The principle of a secondary operation is a structural reorientation by a few minor surgical steps.


[The acoustics of the open mastoid cavity (so-called "radical cavity) and its modification by surgical measures. I. Physical principles, experimental studies]. Up to now the importance of the outer ear for the sound transmission is nearly neglected in the otosurgical literature. Nevertheless, surgical procedures can cause severe alterations in the anatomy of the outer ear channel. Necessarily variables which take influence on the acoustic behaviour of the outer ear can get changed by these surgical manipulations. By means of in-situ measurements of the sound-pressure-level near the tympanic membrane the influence of the ear channel/mastoid cavity volume as well as of the size of the outer meatus on the resonance frequency is investigated. In a model of variable volume and several sizes of outer meatus there can be found that the course of resonance-caused sound-pressure augmentation depends on two determining factors: due to the physical-acoustical conditions (Helmholtz-resonator) the peak of the resonance-caused augmentation shifts to lower frequencies the smaller the outer meatus and the larger the volume of the channel/mastoid cavity. Viceversa, an augmentation of the external meatus and an obliteration of the cavity causes a higher resonance frequency. Within values for the volume and the meatal size as can be found in radical cavity surgery the resonance frequency varies in a wide range from 1260 up to 3175 Hz. There is no substantial influence on the amplitude of the sound-pressure augmentation. Measurements undertaken in a temporal bone specimen underline these results: as well as in the model alterations of cavity volume and meatal size lead to partial extensive shiftings of the resonance frequency.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effect of decreased and lost high frequency hearing on latency of acoustically evoked brain stem reaction]. The diagnosis of retrocochlear damage is supported by an increased latency difference between peak I and peak V. In case of high frequency hearing loss peak I is often hard to determine, and peak V latency may be shifted not only by neural delay, but also by missing basal hair cells. The amount of cochlear delay can be estimated by a procedure presented here. High frequency decay was simulated by steep high-pass noise masking. Peak V latency turned out to be established by the highest unaffected frequency components of the click stimulus. Thus, in case of a high frequency gap (with normalization towards higher frequencies) latency may be almost normal. In case of prolonged latency the amount ascribable to the cochlea may be rather precisely be estimated. If the whole lag is explained this way, unnecessary further diagnostics can be avoided.


[The ototoxicity of the cytostatic drug carboplatin in patients with head-neck tumors]. The side effects of the anti-cancer drug carboplatin on the cochlea in 65 patients with head and neck cancer were examined in the present study. A possible dependence of ototoxicity on the patient's age, the effect of pre-existing audiometric changes and the carboplatin dose were investigated. A therapy-induced sensory hearing loss was found in 32% of the patients. The average hearing loss was 15 dB and primarily involved the frequency ranges from 4 to 8 kHz. The degree of the hearing defects incurred was not influenced by the patient's age or pre-existing hearing defects but depended on the carboplatin dose used. The severity of carboplatin cochlear ototoxicity was moderate, so that no patient suffered a lack of hearing that was of social significance.


[Voice rehabilitation after laryngectomy with voice prostheses. Results of a prospective follow-up study]. Although the results of surgical rehabilitation by means of voice prostheses are on the average better than rehabilitation via oesophageal speech, the tracheoesophageal puncture (TEP)-technique has so far not been widely used in Germany. The majority of hospitals still prefer the "traditional" method of voice rehabilitation using oesophageal speech. The present prospective study was undertaken to compare the results of postlaryngectomy vocal rehabilitation, if patients were offered the surgical voice rehabilitation via voice prosthesis as an alternative to oesophageal speech. Taking into account all the patients who underwent laryngectomy from 1989 until 1990 in Tübingen, primary surgical voice rehabilitation was performed in 44 out of 54 patients (81.5%). Interestingly enough, 34 patients who underwent laryngectomy were able to perform communication via the telephone on the day of their discharge. Moreover, one-third of the laryngectomised patients showed a significant increase in speech intelligibility within the first six months after laryngectomy. 36 patients with laryngectomy were able to attain proficiency 6 months after surgery. In 12 patients the prosthesis had to be removed, since either phonation was impossible or patients successfully learned and preferred oesophageal speech. In conclusion, independent of the method of voice rehabilitation (prosthesis, electrolarynx, oesophageal speech), our results support the hypothesis that a voice rehabilitation regimen will yield a higher rehabilitation rate of patients if rehabilitation via surgical voice is offered as an alternative to learning the oesophageal voice. Therefore, it seems to be advisable that patients are allowed to have the choice between surgical rehabilitation and oesophageal speech restoration.(ABSTRACT TRUNCATED AT 250 WORDS)


[Malignant oncocytoma of the submandibular gland]. Case report on a malignant oncocytoma of the glandula submandibularis in a 56-year old female patient. Oncocytomas in otorhinolaryngology are very rare, mostly benign tumours appearing mainly in women between 60 and 90 years of age. They comprise oncocytes, which are epithelial cells with abnormally formed cytoplasm. Oncocytes have an acidophilic granular cytoplasm. Electron microscopy reveals a pronounced increase of hypertrophic mitochondria. Besides the benign variants there are also rare cases of malignant forms. Therapy consists of surgical resection.


[The rare case--neurilemmoma of the vocal cord]. We present the case of a neurilemmoma of the vocal cord, which is a very rare tumour at this site. The tumour was completely removed by microlaryngoscopy. The 78-year old female is free of recurrence for 1 year. She does not show any sign of neurofibromatosis. Microscopic features and the literature are reviewed.


[Magnetic resonance tomography in questionable lesions of the ENT area. Examination technique and results of a prospective study of 1,493 patients]. 1493 patients with various lesions in the head and neck region were prospectively evaluated with MR imaging (MRI) and other imaging modalities. The findings of MRI and conventional imaging techniques were correlated with histological findings. All MRI examinations were carried out on a 1.0 and 1.5 Tesla superconducting MR unit employing combined T1 and T2 weighed spin-echo sequences. Dynamic MRI with fast gradient-echo sequences and application of a paramagnetic contrast agent (Gd-DTPA) was additionally performed in 120 patients. 250 patients were examined with non-invasive MR angiography. Appropriate saturation enabled the visualization of either arterial or venous vascular structures. Analysis of metabolic parameters and tumor proliferation was possible through in-vivo spectroscopy in 60 patients. Highest values for specificity and sensitivity of MRI were achieved in the area of the skull base and petrous bone. In comparison to other imaging modalities, the exact differentiation of pathological alterations such as neurinoma, meningioma and glomus tumors succeeded with high accuracy. In the region of the naso- and oropharynx, plain MRI revealed in 77% of the cases adequate diagnostic information, which could be significantly increased with application of the paramagnetic contrast agent Gd-DTPA. Due to multiplanar slice orientation and improved soft tissue differentiation MRI proved to be superior to other imaging techniques in salivary glands and in the region of the neck. As a conclusion, the advantages of MRI are the depiction and visualization of small infiltrations as well as the high sensitivity and specificity of this imaging modality.


[1,000 ear operations--a critical analysis and clinical consequences]. 1028 ear operations which were performed by our department during the last few years are being analysed in the study. 649 of them were carried out to improve hearing, 245 to cure the middle ear; 120 were reoperations, and 14 could not be classified. The patients were diagnosed as follows: 280 with and 279 with other forms of cholesteatoma, 151 with otosclerosis, 20 with deformations, 89 with a trauma, and 20 with a tumour of the middle ear. Of these, only reoperations of cholesteatoma, chronic otitis media and tympanosclerosis were examined in further detail in this research. 54 (of a total of 280) patients diagnosed with cholesteatoma were surgically treated a second time. The reason for reoperation was recurrent cholesteatoma in 70% of the cases, and a planned second-look operation after one year in 30%. In second-look operations, ossicular chain reconstruction was performed in most cases, but in another 11%, recurrent cholesteatoma was found. The majority of recurrencies occurred either 2 to 4 years after primary operation or after 11 years. 44 of a total of 297 patients with chronic mesotympanic otitis media were re-operated on: 57% of them for recurrent inflammation, and 43% for ossicular chain reconstruction as a planned second-step operation. The majority of reoperations occurred within the first year after primary operation, continually decreasing for up to five years afterwards. The following conclusions can be drawn from these results: 1. Often the patients suffer from extended cholesteatoma, so that at first curative surgery is necessary, while the ossicular chain can be reconstructed by a second operation only.(ABSTRACT TRUNCATED AT 250 WORDS)


[Experimental study of airflow in the main nasal cavity of the human using a nose model]. Airflow patterns of nasal cavities in a human nasal fossa model were examined in this study. Our 1:1 model of the whole nose (both nasal fossae were moulded) gives a good insight into all parts of the nasal cavities. Staining of flow paths visualised that the main stream of air flow passes through the inferior nasal duct in inspiration and expiration. All regions of the nasal fossa were reached by fluid movements and could be marked with staining solution. Under static conditions laminar flow without turbulent profiles was seen in all sections of the nasal cavities. This technique of detection of flow characteristics in the nasal cavities provides a good tool for further research on flow and deposition characteristics of aerosols.


[Significance of immune reactions to cartilage tissue in use of cartilage transplants in nose surgery: detection of anti-collagen antibodies]. In a group of patients who showed repeated resorption or rejection of the transplanted cartilage graft, the immune response against a broad spectrum of collagen, namely, types I, II, VI, IX and XI, was investigated. We found a humoral immune reactivity against collagen type IX und XI, and to a lesser degree against collagen type I, demonstrating a specific immune response to these matrix collagens. These data suggest that some of the unsuccessful results obtained with cartilage grafts may be influenced by factors independent of the operative technique, such as immunological reactions.


[History of instrumental measuring of hearing acuity: the first acumeter]. The necessity of measuring the acuity of hearing in a reproducible way arose for the first time when the invention of Volta's pile in 1800 seemed to present the opportunity of curing deafness. For this purpose Chr. H. Wolke in Jever, Northern Germany, in 1802 devised two instruments which he called "acumeter". Details of these instruments were hardly known, and Wolke's publication was believed to be lost. The author has now succeeded in tracing Wolke's publication and another associated paper by J. J. A. Sprenger. Hence, the circumstances of Wolke's and Sprenger's work and details of these first acumeters are now being published together with original figures and the correct dimensions of the instruments. The acumeters had a pendulum-like hammer that would strike against a plate swinging down from varying heights that could be read in degrees of angle from a scale. One of the instruments was made of wood. It was 1.50 m high, with the pendulum raised to the maximal position 2.70 m. The other instrument of similar construction was made of metal and about half the size of the first one, with a height of 0.70 m or 1.30 m respectively. For comparison Itard's acumeter is presented which was published in 1821. It worked on the same principle, and it is likely that Itard had been inspired by Wolke's paper. The development of mechanical acumeters after Wolke's and Itard's instruments is outlined briefly.


[Toxic drug-induced hyposmia with lovastatin]. We present the first case of hyposmia after application of lovastatin. Unclear disorders of smell should prompt a detailed drug anamnesis.


The effect of the Cornwall and Isles of Scilly helicopter ambulance unit on the ambulance services' ability to deliver acutely traumatized patients to hospital. to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly. retrospectively collected ambulance service and hospital records data analysed longitudinally. The ambulance service and the major casualty department in Cornwall. the provision of a helicopter ambulance unit to a county ambulance service. patients with compound lower limb fractures carried as emergencies by an ambulance service. Principle outcome measure: ambulance 'mission times'. the ambulance services' ability to deliver emergency patients to hospital more quickly when the helicopter unit was available was not demonstrated. In some instances availability of the helicopter unit probably delayed the timely delivery of emergency patients to the casualty department. until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur.


The Purley train crash mechanism: injuries and prevention. On the afternoon of Saturday 4th March 1989 two trains, both bound for London Victoria Station, collided. Part of the rear train rolled down a steep railway embankment and jack-knifed against a tree. The mechanism of the crash and the injuries sustained by the 55 victims who were seen in the A&E Department of the Mayday University Hospital are described. Improvements in signalling technology and design of rolling stock which may reduce both the risk of collision and severity of injury in future accidents are discussed.


Complaints against doctors in an accident and emergency department: a 10-year analysis. We carried out an analysis of complaints against doctors in our Accident and Emergency Department received from 1 January 1979 to 31 December 1988. There were 66 complainants in all, comprising 37 relatives, 21 patients and eight persons acting in a professional capacity. The majority of complaints (80 out of 125) were about poor communication and dissatisfaction with diagnosis and treatment. A small number of complainants had unrealistic expectations of the Accident and Emergency service. A total of 83.3% of complaints were against Senior House Officers who saw 61.3% of all patients. We concluded that an improvement in the communicative, diagnostic and therapeutic skills of doctors would minimize justified complaints.


Orbital cellulitis.

Orbital cellulitis. Orbital cellulitis is an emergency. It may cause blindness and progress to life-threatening sequelae such as brain abscess, meningitis and cavernous sinus thrombosis. Successful management is dependent upon urgent referral and immediate treatment. Although isolated eyelid erythema and swelling usually indicate primary infection anterior to the orbital septum, they may also be the first signs of an underlying frontal or ethmoidal sinusitis. The condition always requires emergency referral to both an ophthalmologist and otorhinolaryngologist.


The lateral soft tissue neck X-ray in accident and emergency medicine. Five patients with upper aerodigestive tract pathology seen acutely in the Accident and Emergency department at St Mary's Hospital, London are presented. The value of the lateral soft tissue neck X-ray in their diagnosis is discussed.


Plasma catecholamine responses in acute severe asthma. Twenty patients presenting to an A&E department with acute severe asthma were studied. Despite clinically severe airway obstruction few had raised catecholamine levels. However several patients with impending respiratory arrest had markedly elevated catecholamine levels, and relationships are demonstrated between these levels and other measures of disease severity.


Waiting times and patient satisfaction in the accident and emergency department. A survey of the waiting times and patients' opinions of these times was undertaken in a busy district general hospital A&E department. The various components of the overall waiting time are analysed and specific points of the patients' attendance, where waiting times were prolonged, are identified. Standards are derived which is hoped may result in 75% of patients being satisfied with the duration of their wait. The current levels of achievement are compared with these standards. Suggested and actual improvements to the department to improve our performance are described.


Advanced airway control in trauma resuscitation. Definitive airway control which may require endotracheal intubation with or without an induction agent and muscle relaxant is an essential component of trauma resuscitation. We reviewed the delivery of advanced airway care in the resuscitation room of a regional trauma centre. This prospective survey suggests that in the absence of an experienced anaesthetist, A&E staff with a background of suitable training and experience may undertake the anaesthetic responsibility associated with securing a definitive airway when the situation demands.


Percutaneous ultrasound guided extraction of non-palpable soft tissue foreign bodies. Ultrasound is being increasingly used in the diagnosis of the soft tissue foreign body (FB), in particular for the nonradio-opaque materials which may not be visualized with conventional radiography (Fornage & Schernberg 1986). A simple technique for ultrasound guided FB extraction under local anaesthesia is described, and comment is made upon our preliminary experience and pitfalls.


Occupational accidents presenting to the accident and emergency department. A prospective survey of patients attending the major Accident and Emergency Department in Aberdeen was undertaken. This department serves a population of 500,000 and sees some 50% of all accidents in the region. All work-related injuries were identified and information relating to the circumstances of the accident, injury sustained, and treatment required was sought. Work-related injuries accounted for 16.5% of new patients attending the department. The commonest injury type was a laceration to a finger. Three hundred and eighty diagnostic X-rays were undertaken and a total of 910 treatments were required over a 27-day period. On an annual basis, it is estimated that some 5100 radiographs and 12,300 medical treatments would be required for work-related accidents. It is estimated that 30% of injuries to the hands and feet would have been prevented by the wearing of appropriate personal protective equipment. The majority of workplace accidents were correctly referred to A&E and any efforts to reduce this workload must concentrate on preventive measures in the workplace. This paper suggests that documenting work-related accidents and determining targets for preventive action would reduce the number of attendances at A&E units with a potential significant saving for industry and the National Health Service.


Intracardiac therapy following emergency thoracotomy in the accident and emergency department: an experimental model. For a select group of patients with penetrating chest trauma, immediate thoracotomy in the accident and emergency department offers the only chance of survival. Foley catheters have been used to achieve haemostasis in cardiac wounds but are not widely used for intracardiac fluid and drug administration during resuscitation. In an anatomical model designed to assess this procedure an average flow rate of 275 ml min-1 was achieved. The equipment required is readily available and easily assembled.


Prevalence of human immunodeficiency virus risk factors in patients attending an accident and emergency department. The prevalence of human immunodeficiency virus (HIV) risk factors was evaluated by questionnaire survey in 1565 consecutive patients who attended an adult A&E department in Brisbane over a 2-month period. The survey revealed that a total of 144 (9.2%) patients could be considered at risk of HIV infection (high-risk group) because of known seropositivity, admission to HIV high-risk factors or engaging in high-risk activities. The remaining 1421 patients who did not acknowledge any high-risk behaviour were classified as an 'unknown-risk' group. More than 70% of the HIV high-risk patient group were under the age of 30 years. A total of 275 (17.6%) patients presented with open wounds and/or needed hospitalization (23 [1.5%] high-risk patients). Of the 490 respondents who engaged in short term sexual relationships, 310 (63.3%) practised unprotected coitus, 32 of these including four seropositives were classified in the high-risk group. The patients were asked if they were in favour of an HIV testing service at their local A&E department; 1324 (86.6%) were in agreement 121 of whom were in the high-risk group. There was no significant difference (chi 2 = 0.093: P greater than 0.7) in opinion between the 'unknown risk' and high-risk patient groups on this matter.


Flying squad response to out-of-hospital cardiac arrest--a decade of experience. The Flying Squad (MEDIC I) based at the Royal Infirmary, Edinburgh, commenced operation in 1980. The MEDIC I response to out of hospital non-traumatic cardiac arrest over the past decade is reported. On-scene resuscitation was attempted in 384 patients. A total of 149 (39%) patients were successfully resuscitated and transferred to hospital. Thirty-six (9.4%) patients survived to discharge from hospital. Patients receiving basic life support prior to the arrival of MEDIC I and in ventricular fibrillation had a survival rate of 14.5% (25/174). During 1988-89, 21 patients were initially attended by ambulance crews equipped with semi-automatic external defibrillators and eight (38%) of these patients survived. The response of a hospital-based flying squad to support trained ambulance crews, especially when equipped with a defibrillator may provide an economically and operationally feasible alternative to training all first responders in the full range of paramedic skills.


Management of the moribund carbon monoxide victim. Carbon monoxide (CO) poisoning is the commonest single cause of fatal poisoning in the U.K. (Broome & Pearson, 1988). The clinical features are numerous and include headache, fatigue, dizziness, confusion, memory loss, paraesthesia, chest pain, abdominal pain, nausea, and diarrhoea as well as coma, convulsions and death. Without adequate treatment many patients develop neuropsychiatric sequelae including headaches, irritability, memory loss, confusion and personality changes. The diagnosis of CO poisoning is often suggested only by circumstances surrounding the victim, and remains a challenge to the A&E department. Hyperbaric oxygen therapy (HBO) is internationally accepted as the most powerful form of treatment in severe cases (Drug & Therapeutics Bulletin, 1988; Lowe-Ponsford & Henry, 1989). However, in the U.K. treatment with HBO is often not considered due to lack of hyperbaric facilities (Meredith & Vale, 1988; Anand et al., 1988), and due to inadequate awareness on the part of hospital staff. We report a case of a patient deeply unconscious as a result of CO poisoning, in which serial treatments with HBO over a period of 14 days, produced dramatic results.


Toxicity awareness and unintended suicide in drug overdoses. The objective of this paper is to determine patients awareness of the toxicity of the drugs they overdose with, the source of these drugs, and whether they would have taken them had they been fully aware of their toxicity, and to examine the implications for prevention. A prospective review of one hundred consecutive overdoses admitted through an A&E department was carried out. Awareness was scored by a ranking questionnaire and intent by response to a standard question when toxicity was explained. Paracetamol was most the most frequently taken drug (39 cases). Overall awareness of toxicity was low. Twenty-eight patients (30%) said they would not have overdosed if they had been aware of the toxicity of what they had taken. Forty-nine per cent of patients took someone elses tablets. There is a rise in analgesic poisoning from 1976. Higher toxicity awareness may reduce the incidence of drug overdose. Smaller prescriptions and over the counter preparations especially paracetamol and limited access to toxic drugs, especially in high-risk homes, should reduce both the number and severity of overdoses. It is possible that a number of deaths from deliberate drug overdose may be unintentional as 30% of survivors in this study did not intend the toxic effects of the drug taken.


Exposure of the hands to ionizing radiation in the resuscitation room of an accident & emergency department. Exposure of the hands to ionizing radiation in the resuscitation room of an A&E department was measured in eight health care personnel over 3 consecutive months. The radiation levels did not exceed those limits currently recommended by the International Commission on Radiological Protection 1990. The level recorded in one individual did exceed the level set at the Lothian Health Boards investigation limit. In only five of 85 occasions were lead gloves worn by the doctor during cross table lateral cervical radiographs. Recommendations are made for reducing the radiation exposure to the hands.


Public awareness of home accident risks--some implications for health promotion. Through daily contact with injured people there was a feeling that most people are sufficiently aware of the dangers in specific risk factor activities, but were not fully aware that they could do a lot to prevent harm coming upon themselves. This paper describes the results of a self-administered questionnaire about the accidents people suffered at home, their level of awareness of the risk they were undertaking, whether they had had a similar accident before, what they think the recovery period from their injury is likely to be and knowledge of, and accidents involving, 17 generally known risk activities. The results confirm that most people are indeed aware of dangers yet a large number still have accidents in spite of that. The results also indicate that campaigns advising people how to avoid these dangers could be successful.


Irregular discharge against medical advice from the accident and emergency department--a cause for concern. An irregular discharge (ID) from the A&E department is an undesirable, but relatively common occurrence. A prospective study was undertaken to quantify the size of the problem and by arranging a subsequent review of the patient, to determine the clinical outcome. Over a 3-month period, 139 patients (0.73%) of attendances) took their own discharge against medical advice. A further 566 patients (3.03% of attendances) left prematurely prior to any medical assessment (DNW). Attenders irregularly discharged, often with serious untreated conditions. A high proportion were intoxicated with alcohol (65.5%). Attempted follow up proved difficult and incomplete. Patients with serious conditions appeared to return spontaneously for further care. Methods of minimizing the numbers of patients who take an ID or DNW are discussed. Taken together, the numbers of these attenders leaving prematurely, can be used as a valid performance indicator of the delivery of health care in the A/E department.


[Pyoverdins from Pseudomonas putida].

[Pyoverdins from Pseudomonas putida]. The structures of two pyoverdins (Pp1 and Pp2) and one dihydropyoverdin (dihydro-Pp2) from a strain of Pseudomonas putida have been elucidated by spectroscopic methods and degradation studies. The pyoverdins Pp1 and Pp2 consist of a chromophore which was identified as (1S)-5-amino-2,3-dihydro-8,9-dihydroxy-1 H-pyrimido[1,2-a]quinoline-1- carboxylic acid substituted at the amino group with a 3-carboxypropanoyl or a succinamoyl residue and at the carboxy group with the N-terminus of L-Ser-L-Thr-D-Ser-L-Orn-L-threo-(OH)Asp-[D-Glu + L-Dab]*-L-Ser-D-allo-Thr- L-c(OH)Orn. Dihydro-Pp2 differs from Pp2 only in the chromophore, which is saturated at carbons 5 and 6. All compounds contain a tetrahydropyrimidine moiety ([D-Gln + L-Dab]*) resulting from the condensation of 2,4-diaminobutyric acid and glutamine.


Degradation of pentachlorophenol by Mycena avenacea TA 8480--identification of initial dechlorinated metabolites. Cultures of the basidiomycete Mycena avenacea TA 8480 were shown to metabolize pentachlorophenol (PCP), 2,3,5,6-tetrachloro-p-hydroquinone (TeCHQ), and 2,3,5,6-tetrachloro-p-benzoquinone (TeCBQ). The first metabolite of the PCP degradation pathway was identified as TeCBQ which in a second reaction is reduced to the hydroquinone TeCHQ. Subsequently dechlorination of TeCHQ yielded 3,5,6-trichloro-2-hydroxy-p-benzoquinone (TCOHBQ). The specific degradation rate for PCP was 1.4 mg x g dry mycelia -1 x day-1. The initial dechlorination rate of TeCHQ was 5.9 mg x g dry mycelia-1 x hour-1. None of the compounds supported growth of the fungus.


Enhancing the training of internal medicine residents at Stanford by establishing a model group practice and raising its clinical educators' status. The education of residents is shifting to the ambulatory care setting. In addition, there is a growing trend toward managed care and increasing competition for patients to be served by "real-world" practices. The authors describe the formation and operation of a program that was established in 1981 at the Stanford University School of Medicine to respond to these changes: the Stanford Medical Group (SMG), a model group practice in internal medicine that operates within the academic medical center. Because raising the status of the clinician-educator faculty was a critical issue for the SMG, the authors also describe the Medical Center Professoriate, a separate faculty track created in 1989 to recognize and reward Stanford's clinician-educators. The authors conclude that the SMG has succeeded in its training and patient care goals and has weathered the great changes in the health care environment that have taken place since 1981. They also report that the separate faculty track is serving its purpose well. They hope that educators and program directors at other academic medical centers may find the descriptions of the SMG and the professoriate useful in solving similar problems.


X-ray studies on phospholipid bilayers. XII. Interactions of pentachlorophenol with myelin. Pentachlorophenol (PCP) is a widely used pesticide, particularly for the preservation of wood. Given its high toxicity and resistance to degradation it has become a dangerous environmental pollulant. Due to its high lipophilicity, PCP is able to partition into the lipid bilayer of cell membranes disrupting several vital functions. The present research was concerned with the effects that the chronic administration of PCP could produce in vivo to the sciatic nerve of rats. X-ray diffraction patterns obtained from freshly dissected and dried sciatic nerves of PCP treated rats did not show significant differences in their reflections with respect to those present in the patterns from untreated animals. However, morphological studies performed by optical and electron microscopy showed degenerative changes in about 10% of the A and B type of nerve fibers.


How attending physicians make instructional decisions when conducting teaching rounds. When attending physicians are conducting teaching rounds, they rapidly decide what and how much to teach in response to each case presentation. How do they make these instructional decisions? The author performed a qualitative study of the instructional reasoning and actions of six distinguished clinical teachers in general internal medicine to address this question. Four data sources were used: interviews with teachers and learners, a structured task, transcripts of teaching rounds, and week-long observations of each ward team. The teachers in this study engaged in substantial amounts of planning before rounds and reflected on rounds afterwards. When listening to a case presentation during rounds, they quickly diagnosed the patient's problems and simultaneously diagnosed their learners' levels of understanding. These diagnostic assessments were used to tailor content-specific curriculum scripts for instruction. Throughout the rounds, the teachers also engaged in interactive thinking, decision making, and improvisation. The author's findings allowed him to hypothesize a model of clinical instructional reasoning and action; they contribute new insights into the interplay between reasoning in a discipline and pedagogical reasoning. Instructional reasoning and clinical reasoning were found to be closely linked through the use of scripts. The implications of these and other findings for medical faculty development are discussed.


The effect of resorcinolic lipids on phospholipid hydrolysis by phospholipase A2. The effects of resorcinolic lipids (5-n-alk(en)ylresorcinols) isolated from cereal grains on the phospholipase A2 catalyzed hydrolysis of phospholipid vesicles were examined. Studied compounds inhibited the apparent enzyme activity at the molar fraction in the membrane as low as 0.025, which is equivalent to the concentration of 3 microM. This effect was visualized by dramatic increase (over ten-fold) of the latency period of the reaction progress. This makes resorcinolic lipids one of the most potent inhibitors of phospholipase A2 among already studied compounds. Highest inhibitory activities were shown for dienoic and monoenoic homologs of 17 carbon atoms in the aliphatic chain. Both saturation of the chain and the increase of its length reduced inhibitory properties of resorcinolic lipids. The data suggest that the compounds studied in this paper like other known amphiphilic inhibitors of phospholipase A2 owe most of their effects to the ability to modify the quality of the substrate interface. These are the alteration of the enzyme binding, velocity of the formation and redistribution of the products. However part of the effect seems to be attributed to direct interaction and modification of enzyme properties by alk(en)ylresorcinols.


Amines in the marking fluid and anal sac secretion of the tiger, Panthera tigris. Analysis of the marking fluid of two tigers (one Bengal and one Sumatran) by GC using an amine-specific column and a nitrogen-specific detector has shown the presence of the following amines: ammonia, methylamine, dimethylamine, trimethylamine, triethylamine, propylamine, and butane-1,4-diamine (putrescine). In contrast to previously published reports, we were unable to detect 2-phenylethylamine. The anal sac secretion was found to have a similar amine content.


Resonance effect of microwaves on the genome conformational state of E. coli cells. The effect of low intensity microwaves on the conformational state of the genome of X-irradiated E. coli cells was studied by the method of viscosity anomalous time dependencies. It has been established that within the ranges of 51.62-51.84 GHz and 41.25-41.50 GHz the frequency dependence of the observed effect has a resonance nature with a resonance half-width of the order of 100 MHz. The power dependence of the microwave effect within the range of 0.1-200 microW/cm2 has shown that a power density of 1 microW/cm2 is sufficient to suppress radiation-induced repair of the genome conformational state. The effect of microwave suppression of repair is well reproduced and does not depend on the sequence of cell exposure to X-rays and microwave radiation in the millimeter band. The results obtained indicate the role of the cell genome in the resonant interaction of cells with low intensity millimeter waves.


Dynamics and kinetics of enzymes. Kinetic equilibrium of forces in biochemistry. To explain the high specificity, high reaction rate, and high thermodynamic efficiency in enzymatic processes, cooperation of the enzyme with a molecular transfer unit is assumed. A "kinetic equilibrium of forces" is suggested, which enables high reaction rates to occur under equilibrium conditions and a thorough examination of the substrate to be made without consumption of free energy. In case of ATPases, ion-binding proteins are the most probable transfer units. By analyzing the elementary effect in muscle contraction it is shown that the new theorem may be of substantial value in elucidating biochemical processes.


Specialty selection and success in obtaining choice of residency training among 1987 U.S. medical graduates by race-ethnicity and gender. The authors developed baseline data on specialty selection and success in obtaining residency positions for the medical school graduates of 1987 who participated in the National Resident Matching Program (NRMP), compared by gender and race-ethnicity. They focused on primary care specialties and obstetrics-gynecology versus all other specialties, and sought to identify group differences in (1) patterns of specialty preference, (2) evolution of specialty choice from before to after medical school, (3) success in attaining the first choice of specialty through the NRMP, and (4) patterns in switching from an alternate specialty (ranked second or lower) to the first-choice specialty between the first and second years of residency training. The results showed substantial intergroup and intragroup variations, both before and after medical school, for family practice, internal medicine, and obstetrics-gynecology. Examination of NRMP outcomes revealed that the underrepresented-minority (URM) graduates, particularly men, were less successful both in achieving any match and in matching to their first-choice specialties. Analyses of patterns in switching specialties revealed several important facts about those who were matched to alternate specialties: (1) over half entered their first-choice specialties in the second year; (2) women had more success in switching to their first-choice specialties than did men, particularly among the URMs; (3) among those who received alternate specialties, the URM women were more likely than the URM men to leave graduate medical education by the second year (reversing the trend for the other groups); and (4) individuals whose alternate specialties were in primary care were much less likely to switch to their first-choice specialties.


Self-assessment programs and their implications for health professions training. Although expected of all health professionals, self-assessment skills are seldom addressed directly in training. A previous review by the author identified curricular criteria associated with improved accuracy and validity in self-assessments of knowledge and performance in curriculum studies published between January 1970 and February 1990. The present review analyzed 11 studies that meet those criteria. Eight studies were of implementations of self-assessment components within training programs in the health professions, and three involved other training environments. Most described initial disorientation or opposition on the part of learners, attributed to unfamiliar roles and to learners' distrust. The curricula that successfully negotiated the transition to self-assessment norms reported noncognitive benefits such as improvements in morale, motivation, and communications among learners and faculty. Reported cognitive benefits included improvements in knowledge, performance, and self-analysis of performance. The constellation of effects suggests that effective self-assessment programs may promote more mature, collegial, and productive learning environments, particularly suited to the training of health professionals. Most curricula fostering effective self-assessment did not require extraordinary resources, and none jeopardized traditional standards. No evidence was found to support or challenge the expectation that self-assessment training would transfer to later work settings.


Declining class size and the decline in graduates choosing family medicine. In light of the major concern about the marked decline in the numbers of graduates from U.S. medical schools who are entering family medicine, the authors analyzed the effect of declining class size on the numbers of graduates entering family medicine residencies. Data were analyzed from ten years of graduating classes (1981-1990) from the 81 medical schools graduating the most family physicians. The analysis confirmed that declining class size is related to the decline in the production of family physicians. In particular, the 31 schools with the largest declines in the numbers of graduates overall (from the early 1980s compared with the late 1980s and 1990) demonstrated as a group a large fall (nearly 25%) in the production of family physicians. The authors conclude that the large reductions in class size in many medical schools are associated with even larger reductions in the numbers of future family physicians being graduated from U.S. medical schools.


Rural training tracks in four family practice residencies. The use of rural training tracks (RTTs) in family practice residencies is a new strategy (beginning in the late 1980s) to increase the number of residents selecting rural careers. The authors describe the four residencies (in Washington, Nebraska, New York, and Kentucky) that have established RTTs. The first residency year is completed in an urban tertiary care center, and the second and third years are completed in a distant rural community wherein the primary faculty are the members of a rural family practice group. Inpatient experience for the residents is provided by community hospitals that offer obstetrics, emergency room care, and first-line critical care. The residents' training is supplemented by specialty faculty practicing in the rural communities. The curricula are highly structured and are evaluated to ensure training experiences of high quality. The RTTs' financial support comes from state initiatives, hospital reimbursement, recruitment budgets, and outpatient care revenues. The authors conclude that the RTT concept has the potential to lessen the shortage of rural physicians.


A national model of faculty development in addiction medicine. Increasing the number of faculty with expertise in addiction medicine is one of the challenges facing the medical community in the 1990s. To meet this challenge, the Society of Teachers of Family Medicine created a faculty development course to increase the expertise of family practice faculty involved in teaching residents. The authors describe the development, implementation, and consequences of the five-day intensive course that was taught to 165 participants at ten sites in 1990. The participants' self-reporting before and three months after the course showed significant increases in the numbers of participants who taught addiction medicine in eight of 11 clinical situations. The authors conclude that the course represents a model of faculty development in addiction medicine that is applicable to other specialties and health professions.


Developing students' cognitive skills in a problem-based surgery clerkship. In 1989-90, 57 students in a new program for the third-year surgery clerkship at the University of Kentucky College of Medicine participated either in a control group (22 students) receiving a traditional method of instruction (Socratic instruction, SI) or in an experimental group (35 students) taking part in problem-based learning (PBL) sessions. The two groups' performances on six evaluative instruments designed to test either their factual knowledge or their knowledge application (i.e., clinical problem-solving skills) were compared. The measures of factual knowledge were associated with higher scores for the SI group on two quizzes; scores were not significantly different on another quiz and on a cumulative final examination. The measures of knowledge application (administered at the end of the clerkship) were associated with higher scores for the PBL group: scores were significantly higher on a modified essay examination and approached significance on a standardized-patient examination. The authors conclude that their results (1) have important similarities to those of previous research suggesting that a PBL format is essentially equivalent to a traditional curricular format in improving students' factual knowledge and (2) support the hypothesis that PBL is superior in improving clinical problem-solving skills.


Geriatrics fellows' perceptions of the quality of their research training. In the last quarter of 1987-88, 95 second- and third-year geriatrics fellows were surveyed to examine their perceptions of the quality of research training available through their programs. A three-phase Delphi survey method was used, with the numbers of individuals responding per phase ranging from 58 (61%) to 68 (72%). The responses were clustered in five areas by means of factor analysis using a varimax rotation procedure. The fellows perceived their research training to be inadequate, primarily due to insufficient time for research activities and to inadequate exposure to research-qualified scientists. The authors conclude that although the fellows strongly supported the notion of a research-focused third fellowship year, implementing such a plan may be futile if new resources are not made available.


Help! Is anyone listening? An assessment of learning needs of practicing physicians. We used a theoretical framework of adult learning, physician learning and change, and educational evaluation to assess physician--learner needs. The study emphasized the physician's perspective and the context of expressed needs. The respondents acknowledged ineffective learning patterns and lack of ongoing self-assessment, and identified changing and specific, emerging, learning needs. New roles are suggested for CME providers. We believe our findings support the usefulness of an integrated theoretical perspective to guide needs assessment that will be cognizant of the complexity of ongoing professional learning.


The HOME microscope workstation. A new tool for cervical cancer screening. The Highly Optimized Microscope Environment (HOME) is a computerized microscope design for assisting pathologists and cytotechnologists in routine clinical tasks. The prototype system consists of an IBM PC-compatible computer and a light microscope in which a built-in high-resolution computer display image is super-imposed on the optical image of the specimen. Also, an encoding stage and objective turret encoder are used to provide continuous monitoring of the stage coordinates and microscope magnification to the computer. This allows any position on the stage to be uniquely defined. Software, written in C language and running under the MS-DOS/MS-Windows environment, is controlled by means of a mouse-driven cursor. A specific application has been developed for cervical cancer screening, taking into account the needs and constraints of microscopists performing this task. Informatics tools offered by the HOME system provide them with precise flagging and relocation of objects on the slide, control of the scanning pathway, and ability to write and print the report directly through the microscope. The computer files generated by microscopic examination are stored and contain information available for quality control assessment and laboratory management.


Nuclear protein content and Ki-67 immunoreactivity in nonneoplastic and neoplastic thyroid cells. The nuclear DNA content in thyroid tumor cells has been shown to be closely related to the malignant potential of the neoplasm. Besides DNA, nuclear protein (NP) constitutes the major mass of the nucleus. The NP content may vary significantly in relation to the proliferative stage in growing as compared to growth-arrested cells. The increase in NP content associated with the transition from G0 to G1 occurs before the onset of DNA synthesis and may be used to assess growth activity. The nuclear DNA and NP contents were analyzed in 90 nonneoplastic lesions and 75 benign and 62 malignant thyroid tumors. All nonneoplastic specimens were euploid, and 1 of 90 was growth activated. In the group of benign tumors, 59 were euploid, and 16 were aneuploid. Among these there were 5 (9%) of 59 and 6 (38%) of 16 growth-activated specimens, respectively. In the group of malignant tumors 57 of 62 were classified as euploid, and in this group 12 (21%) showed growth activity according to the NP content. Five of 62 were aneuploid, and 3 (60%) of these 5 tumors were growth activated. Evaluation of the growth activity by means of monoclonal antibody Ki-67 was performed on a subgroup of 32 thyroid specimens, both nonneoplastic and neoplastic lesions. Ki-67 immunoreactivity was observed in 0-1.1% cells of 6 nonneoplastic lesions, in 0-3.1% cells of 14 benign cells and in 0.2-3.9% cells of 12 malignant thyroid tumors. Growth activity, as reflected by the NP/DNA ratio and Ki-67 immunoreactivity, appears to be low both in nonneoplastic thyroid lesions and thyroid tumors.


Comparison of cell proliferation in breast carcinoma using image analysis (Ki-67) and flow cytometric systems. Cellular proliferation has been implicated as an important predictor of biologic behavior in breast cancer. Cellular proliferation of 95 breast carcinomas was evaluated by comparing Ki-67 immunoreactivity in frozen sections quantitated by image analysis with S-phase and S + G2/M phase fraction determined by flow cytometry on nuclei extracted from fixed, paraffin-embedded sections (modified Hedley's technique). These parameters were correlated with traditional morphologic features of histologic grade, including mitotic count. Ki-67 immunoreactivity correlated with S-phase fraction determined by flow cytometry (r = .41, P = .001) and with S + G2/M phase fraction determined by flow cytometry (r = .29, P = .008). There was also a correlation between histologic grade and Ki-67 immunoreactivity (r = .30, P = .004) and between histologic grade and S-phase fraction (r = .42, P = .0001). Mitotic count correlated with Ki-67 immunoreactivity (r = .25, P = .015) and with S-phase fraction (r = .35, P = .001). Image and flow cytometric analysis systems provide comparable measurements of cellular proliferation; their measurements correlate with histologic grade and mitotic count in breast cancer.


Nucleolar organizer region-associated proteins in cancer cells. Quantitative investigations on gliomas, meningiomas, urinary bladder carcinomas and pleural lesions. Using a modified silver staining technique, we investigated nucleolar organizer region-associated proteins (AgNORs) in paraffin sections of 156 neoplastic tissues and other lesions, including gliomas (n = 41), meningiomas (n = 20), urinary bladder carcinomas (n = 58), and neoplastic and reactive lesions of the mesothelium of the pleural cavity (n = 37). We found significant differences in the mean number and area of AgNORs per nucleus between nonanaplastic and anaplastic astrocytomas. In meningiomas AgNOR analysis may be useful to distinguish between mostly benign tumors (grade 1 tumors) and atypical ones. Urinary bladder carcinomas exhibited a statistically significant increase in both AgNOR number and area as the grade of malignancy increased. Diagnostically useful differences in the AgNOR configuration between inflammatory and neoplastic processes were found for mesothelial lesions. In general, a higher grade of malignancy correlated with an increase in the AgNOR number. This was accompanied by an increase in the total AgNOR area per nucleus, irrespective of whether the size of the individual AgNORs had changed.


Morphometry and discriminant analysis of the endometrium. The authors dated 100 normal endometrial biopsies. Only endometrial specimens with histologically confirmed subphases and no evidence of organic disease were accepted for study. The morphometry and stereologic measures of the glands, lumina and endometrial epithelium were assessed. Quantitative assessment of the normal endometrium supported the histologic events that occur in the endometrial cycle (proliferative and secretory phases). There was a progressive increase in morphometric and stereologic values of the glands, epithelium and lumina during the endometrial cycle. Using stepwise discriminant analysis, 94% of the specimens were correctly classified into the categories of proliferative and secretory phase; two quantitative parameters were required, the epithelial volume density and longest luminal diameter. When three subphases within proliferative and secretory endometrium were considered, the overall accuracy was 90% and 78%, respectively.


Measurement of subvisual changes in cervical squamous metaplastic cells for detecting abnormality. Quantitative measures of visually normal squamous metaplastic cells exfoliated from the uterine cervix were obtained to test the hypothesis that these cells, like intermediate squamous and endocervical columnar cells, show subvisual evidence of atypia in cases of bonafide squamous intraepithelial neoplasia. The cells identified as squamous metaplastic were obtained from 14 abnormal (dysplastic) and 9 diagnostically negative cases. Although the cell populations so grouped showed no statistically significant differences in overall cell size, nuclear area or nuclear/cytoplasmic ratios, there were significant differences in nuclear and cytoplasmic densitometric features and in nuclear texture features. A combination of three features (nuclear density, texture and cytoplasmic density) permitted 76% of the cells to be categorized correctly as originating in normal versus abnormal slides. It is concluded that selected quantitative features of exfoliated metaplastic cell populations may contribute to improved diagnostic accuracy in automated screening for cervical abnormalities.


Morphologic scales and relative distances between lesions identified on Papanicolaou smears. We fit a Gaussian-type curve to a nonmonotonic transform of initial arbitrarily given scales (pseudoscalar transform) of a two-way discrete classification table by maximizing the likelihood (entropy) and computing morphologic scales of clusters of objects identified by visual judgments. The scales give the relative distance between pairs of categories or states. Morphologic scales of histologic lesions (states) identified on Papanicolaou smears were computed from a confusion matrix consisting of 3,545 matched pairs of observations on Papanicolaou smears and colposcopically directed biopsies available from the Gynecologic Cytology Laboratory, University of Minnesota, between 1985 and 1987. The original (uncollapsed) confusion matrix consisted of eight cytologic categories and histologic states: normal plus atypical benign, reactive atypia (including condylomatous changes); mild, moderate and severe dysplasia; squamous carcinoma in situ; invasive squamous cell carcinoma; and other malignancies. The morphologic scales are expressed numerically, which reflects a degree of confusion between two diagnostic categories or states. Except for malignancies other than squamous cell carcinoma, morphologic scales of histologic states seen from cytology retained the order of clinical severity. We detected a high degree of confusion between severe dysplasia and carcinoma in situ. Malignancies other than squamous cell carcinoma fell between moderate and severe dysplasia. Such a transposition of the scales in this group containing adenocarcinoma was likely due to frequent association of adenocarcinoma with cervical intraepithelial neoplasia. Morphologic scales of cytologic categories seen from histology showed high degrees of confusion and transpositions between mild and moderate dysplasia and between severe dysplasia and carcinoma in situ.(ABSTRACT TRUNCATED AT 250 WORDS)


Prediction of recurrence in giant cell bone tumors by DNA cytometry. The most interesting therapeutic aspect of giant cell bone tumors is which patients can be cured without a risk of recurrence by intralesional surgery (curettage). To find out the suitability of some DNA cytometric and morphometric parameters for showing differences between this group of patients (n = 9) and those with recurrence (n = 12), the parameters mean ploidy, 2cDI (mean square deviation of the tumor cell DNA content from the normal 2c value), mean nuclear area and its variability were calculated from cytologic specimens prepared by a cell separation technique from formalin-fixed, paraffin-embedded tissues, measuring the values of 100 stromal cells per case by a TV image analysis system. Further measurements were performed on 19 cases of different diseases of the bone and on an additional 17 cases of giant cell tumors without follow-up. The 2cDI allowed us to distinguish the two groups of patients, with and without recurrence, without overlap; even the lowest value for patients with recurrence was higher than the highest value for cured ones. Mean ploidy analysis resulted in a less convincing discrimination of the patients. Mean nuclear area and its variability failed to predict recurrence. Single-cell DNA cytometry provided a parameter, 2cDI, that was able to predict recurrence in patients with giant cell bone tumors with high sensitivity.


The Hough transform for locating cell nuclei. A method of cytologic image segmentation that works purely on the basis of geometric information is described. Cell nuclei are assumed to be circular or elliptical. The latest ellipse-finding Hough transform is then used to locate the nuclei. The results are encouraging.


Nuclear planimetry and DNA flow cytometry of verruga peruana. Verruga peruana is a vascular hyperplasia that is sometimes histologically mistaken for a malignant neoplasm. An infiltrative pattern with nuclear pleomorphism and mitoses is prominent in some lesions. From a series of lesions of verruga peruana, we selected five atypical lesions, two of them closely resembling epithelioid angiosarcoma. We used histologic criteria as well as morphometry and flow cytometry to further characterize the atypical features of the lesions. Histology and morphometry evidenced marked nuclear pleomorphism. Flow cytometry failed to reveal aneuploidy and disclosed about 10% of the cells to be in the S, G2 and M phase.


Wind-induced accidents of road vehicles. This paper describes the results of a project that collected and collated data for wind-induced vehicle accidents that occurred in the United Kingdom during the major storm of 25 January 1990. The results of this data analysis are used to determine which vehicles are most at risk during windy periods, the nature of the accidents that were caused, and the likely values of accident wind speeds. Also the adequacy of a computer program that can predict such wind speeds (the program BLOWOVER) is assessed as far as the available data allows.


The effects of compliance cost and specific consequence information on the use of safety equipment. The effects of compliance cost and warning content on the use of protective eyewear by racquetball players were evaluated. Four-hundred-twenty subjects were observed for use of eye protection in a field setting. Results indicate that proximal placement of eyewear and the inclusion of specific consequence warning information increased safety equipment use. Implications of this research for augmenting warning effectiveness and safety are discussed.


A modeling perspective on the culture of driving. Each driver is influenced by the collective behavior of other drivers. At the same time, each driver is also part of this collective, and thus influences others. Underlying many driver control and traffic safety programs are two implicit and related assumptions: that drivers are sensitive to the "culture of driving" around them and emulate it; and, that a small shift in the behavior of few might be amplified or snowball to a much larger effect resulting in a changed traffic environment or a modified culture of driving. The paper discusses possible mechanisms for the interactions between individuals, collectives, and culture, drawing on literature from social psychology, sociology, economics, communication, epidemiology, and other disciplines. Traffic behavior modeling could benefit from considering concepts developed in other social disciplines while providing challenging research issues and data sources for testing and developing those concepts.


An experimental evaluation of the effects of periodic motor vehicle inspection on accident rates. 204,000 cars were randomly assigned to three different experimental conditions. 46,000 cars were inspected annually during a period of three years; 46,000 cars were inspected once during three years; and 112,000 cars were not inspected. The number of accidents was recorded for a period of four years. No differences in accident rates were found between the groups. The technical condition of inspected vehicles improved compared to those not inspected. The experiment did not have any unintended side-effects. It is concluded that periodic motor vehicle inspection has no preventive effect on the technical condition of cars in a system where roadside inspections also exist.


The importance of lower limb injuries in car crashes when cost and disability are considered. The United Kingdom Cooperative Crash Injury Study (CCIS) database has been used to produce a sample of restrained, front-seat car occupants who survived a frontal impact. The lower limb was found to be the most frequently injured body region in car crashes of all impact types and the second most injured region in frontal impacts. 67% of all lower limb fractures in this sample were found to occur below the knee. 31% of these fractures occurred at the ankle. A review of literature reveals that injury of the lower limb above the knee produces worse disabilities and longer recovery times than injury to below the knee. The costs incurred as a result of above knee injuries are estimated as being greater than those below the knee. A review of European type approval legislation reveals that car design is not regulated sufficiently to prevent lower limb injury. Further work is suggested using the CCIS database in order to get a better understanding of the mechanisms involved with a view to suggesting areas where changes could be made to improve this situation.


A macroscopic impact analysis of the safety efforts case study: pedestrian fatalities. Any time there are reductions in accidents, advocates of any particular position are quick to claim that it is their "effect" that has improved safety performance. The work in this paper focuses on interpreting a traffic system's performance with respect to a specific type of accident by attributing a change in the number of accidents to the relative contribution of three effects: the activity effect, the safety content effect, and the structure effect. A method is developed and applied to the data sets of pedestrian fatalities that occurred in Greece during the period of 1965-1989. The relative contribution of the effects as well as the pattern changes turn out to have a decisive influence. The possible uses and extensions of the method are also discussed.


Rural motor vehicle crash mortality: the role of crash severity and medical resources. We did a retrospective case control study to examine the relationship between the risk of dying for Michigan motor vehicle crash (MVC) drivers and the type of county (rural/nonrural) of crash occurrence, while adjusting for crash characteristics, age, sex, and the medical resources in the county of crash occurrence. The 1987 Michigan Accident Census was used to obtain data regarding all MVC driver nonsurvivors (733) and a random sample of all surviving drivers (2,483). County of crash occurrence was defined as rural or nonrural. The crash characteristics analyzed were vehicle deformity, seat belt use, and drivability of the vehicle from the scene. Age and sex of the driver were also analyzed. Medical resource characteristics for the county of crash occurrence were measured as the number of resources per square mile for each of the following: ambulances, emergency medical technicians (EMT), acute care hospital beds, and operating rooms, surgeons and emergency physicians. Also considered were the number and level of emergency rooms in the county of crash occurrence along with the maximum level of prehospital care available (basic life support versus advanced life support) in a county. Before adjusting, the relative risk (RR) for rural MVC drivers dying, compared to their nonrural counterparts, was 1.96. Adjustment for crash characteristics, age, and sex (using logistic regression) decreased the RR to 1.51. An attempt to add medical resource variables to the model resulted in high correlation with the rural/nonrural variable, as well as with each other. This multi-collinearity prevented us from providing a simple explanation of the role of medical resource variables as predictors of survival.(ABSTRACT TRUNCATED AT 250 WORDS)


The influence of safety belt laws on self-reported safety belt use in the United States. We assessed rates and trends in safety belt use by presence and type of safety belt law using data from states participating in the 1984-1989 Behavioral Risk Factor Surveillance System. State(s) with a safety belt law allowing law enforcement officers to stop vehicles for occupants' failure to use safety belts (primary enforcement law) had greater and more rapid increases in safety belt use rates than did states with laws requiring that vehicles must first be stopped for some other violation before a citation or fine for occupants' failure to use safety belts could be imposed (secondary enforcement law). Larger and sustained increases in safety belt use occurred when safety belt laws became effective or when fines were imposed for violations than when laws were first enacted. These data suggest that primary enforcement laws result in greater and more rapid increases in safety belt use than do secondary enforcement laws, and that initial increases in safety belt use following implementation of laws are sustained.


The influence of flight experience on midair collision risk perception. Although successful collision avoidance is presumed a learned skill, midair collision accidents typically involve highly experienced pilots. It is hypothesized that pilot complacency, arising from a history of incident-free flights, plays a role in the midair collision process. Pilot risk perception is explored using Laplace's Law of Succession, and the resulting perceived collision probability compared to reality. The two converge at around 5,000 hours of flight experience.


Extra enforcement and the use of seat belts by drivers in Illinois. The use of seat belts by drivers was measured in three target and three control cities in Illinois before, during, and after the application of heightened police enforcement of the seat belt law in the target cities. The extra enforcement produced increases in the use of seat belts by drivers during the four months of the heightened enforcement. Observations of seat belt use continued for four months after the end of the enforcement, and a substantial residual effect remained in two of the three target cities. In one target city the use of seat belts had dropped close to the level at the start of the project by the end of the second month after the end of enforcement. Taking account of the percentage of drivers who became aware of the increased enforcement suggested that a sustained program of enforcement may result in 60%-70% of drivers using seat belts.


Macro model prediction of elderly people's injury and death in road traffic accidents in Croatia. The case of elderly people injured and killed in traffic accidents in Croatia is used to illustrate a prediction method. This method consists of several steps. First, the most important variables are selected. Second, to overcome intercorrelation, new variables are constructed that include the old ones. Third, the new variables and its first derivatives are used in a rank correlation method. The results show good predictive capabilities.


The urban setting of juvenile pedestrian injuries: a study of behavioural ecology and social disadvantage. Population-adjusted rates of fatal and serious pedestrian injuries (in 435 Calgary residents age 0 to 17) and some other indicators of behavioural problems (including juvenile delinquency) and social indicators (including poverty and proportions with low birth weight) were compared across 120 neighbourhoods. Two areas with high rates of pedestrian injury, delinquency, and various indicators of disadvantage were identified, one close to the city core and the other in modern, low-income housing on the city periphery. The patterning of injury rates by income levels across neighbourhoods supports earlier Canadian work. Once again, a multivariate, causal model of stress and vulnerability in coping with physically hazardous traffic environments is implied. Social intervention and community development models based on social work research are advocated.


Time vs. distance as measures of exposure in driving surveys. A survey of drivers carried out in Ontario in 1988 has provided data on time spent driving as well as the distances driven for licensed drivers of both sexes in six age groups and three regions. Substantial differences were found in times, distances, and distance/time ratios among these groups. Men drove 50% greater distances, but spent only 30% more time driving than women; speed, averaged over each day's driving, was lower for older drivers than for younger drivers. Differences in speed reflect differences in the driving done in urban or rural areas, and differences in the opportunity for road crashes; such differences, whether based on units of time or distance, will also affect both the comparisons of accident rates and the perceptions of risk among different groups of drivers. A definition of exposure to risk of road crash is required that considers both time and distance appropriately.


Causes of nonfatal injuries in the United States, 1986. During the 1986 National Health Interview Survey (NHIS), data on injuries resulting in a doctor visit or restricted activity for at least a half day were collected and assigned E-codes. Based on 603 injuries, the estimated number of nonfatal injuries for civilian, noninstitutionalized U.S. residents in 1986 was 60,212,000. The most frequent cause of injury was a fall (11,547,000), followed by motor vehicle traffic crashes (4,361,000) and adverse effects of drugs and biologics (3,363,000). While cause-specific detail was limited by small numbers of injuries in the sample, the NHIS can provide a valuable snapshot of the causes of nonfatal injuries.


Establishing relationships between accidents and flows at urban priority road junctions. This papers explores the effects of traffic stream flows on accident potential at urban priority-controlled (i.e. unsignalized), four-arm junctions. Forty-three urban priority junctions were carefully selected so that other than flow parameters expected to influence accident potential have similar values at the junctions considered. Using traffic accident data for five-year time periods and the corresponding 24-hour flows, a new exposure index is proposed consisting of an expression of the flows of the junction's interacting traffic streams. The regression of this exposure index on the expected number of accidents per year at junctions of the type examined yields a quite satisfactory correlation coefficient, better than those achieved when other proposed indices are used.


Synthesis and pharmacological evaluation of 2,3-dialkylindoles, "in vitro" inhibitors of thrombin-induced platelet aggregation. A series of 2,3-dialkylindoles (1-5) have been prepared and tested as antithrombotic agents. The whole class showed in vitro interesting activity in the inhibition of thrombin-induced aggregation. Among these compounds some ones showed activity comparable to standards also in the inhibition of collagen-induced aggregation. Owing to a very fast metabolic degradation through a beta-oxidative mechanism, a drastic decrease of activity in several tests ex vivo or in vivo was observed.


Synthesis and cardiotonic activity of 2-substituted 5-cyano-1,6-dihydro-6-oxo-3-pyridinecarboxylic acids and their methyl or ethyl esters. The synthesis of ethyl or methyl esters of 5-cyano-1,6-dihydro-6-oxo-3- pyridinecarboxylic acids carrying as 2-substituent a polar group such as CO2C2H5, (CH2)2CO2CH3, (CH2)3CO2C2H5, CH2OCH3, or CF3 group is described. Also 2-[5-cyano-1,6-dihydro-2-(1,1-dimethylethyl)-6-oxo-3-pyridyl]-2- oxoacetic acid and 2,5,6,8-tetrahydro-2,5-dioxo-1H-thiopyrano[3,4-b]pyridine-3-carbon itrile were prepared. Nearly all the above esters gave routinely the corresponding carboxylic acids by alkaline hydrolysis followed by acidification. As milrinone analogues, the above compounds were tested on contractile activity and frequency rate of spontaneously beating atria from reserpine-treated guinea-pigs. 5-Cyano-2-trifluoromethyl-1,6- dihydro-6-oxo-3-pyridinecarboxylic acid and, in a lesser degree, the relative ethyl ester showed an appreciable positive inotropic activity, although inferior to that of milrinone.


Synthesis of substituted DL-3(5-benzazolyl)alanines as dopa and alpha-methyldopa analogs and their effects on dopamine beta-hydroxylase, tyrosinase and diphenoloxidase. The influence of bioisosteric replacement of catechol moiety of L-Dopa and alpha-Methyldopa with benzimidazole and benzotriazole ring has been examined on dopamine beta-hydroxylase and tyrosinase, in order to evidentiate an inhibitory activity on the synthesis of catecholamines and a possible antihypertensive action. The preliminary results obtained so far showed that inhibition of dopamine hydroxylase occurs at 5 x 10(-4) M concentration for the most active compounds bearing a trifluoromethyl group in the azole ring (2a,c). An analogous result was observed in the case of tyrosinase inhibition with compound 2c, while other compounds (2a,e) were equiactive (92% inhibition) at higher concentration (1 x 10(-3) M). Compound 2c was also the most active in inhibition of diphenoloxidase (83% at 6 x 10(-5) M concentration).


Synthesis and pharmacological activity of 4-carbamoyl-5-aryl-6-methyl-4,5-dihydropyridazin-3(2H)-ones. A new series of 4-carbamoyl-5-aryl-6-methyl-4,5-dihydropyridazin-3(2H)-ones have been synthesized and tested for their antiinflammatory and analgesic properties. Amongst the test compounds, only 31 showed antiinflammatory activity, though of shorter duration than that of indomethacin, taken as reference drug. On the contrary, many derivatives displayed relevant analgesic activity, 4--the only 4,5-dehydroderivative--being the most potent in the writhing test. In the hot plate test 3b, 3f and 3k were found to possess the most significant analgesic properties.


Synthesis and pharmacological study of some 3-(isoxazol-5-yl)-quinazolin-4(3H)-ones. A number of new 3-(isoxazol-5-yl)-quinazolin-4(3H)-ones was prepared and tested, together a few analogues previously obtained, for their analgesic, antipyretic and antiinflammatory activities, as well as for their acute toxicity and ulcerogenic effects. In the carrageenan rat foot edema model one of the tested compounds showed activity and LD50 comparable to that of ASA, but the ulceration index approximated zero value.


Styryl and azastyryl 1,3-benzazoles with antihelminthic activity. New 2-benzylideneimino- and 2-styryl-1,3-benzimidazole and benzothiazole derivatives have been prepared and tested in vitro against Caenorhabditis elegans, and Heligmosomoides polygyrus, showing some of them, interesting properties as inhibitors, which were not observed in the complementary in vivo tests. In order to rationalize the activity, log P was measured for all compounds, and QSAR models were developed, allowing the optimisation of the in vitro activity.


Benzimidazole condensed ring systems. 8 (1). Synthesis of some substituted 1-oxo-1H,5H-pyrido[1,2-a] benzimidazole-4-carbonitriles with anticipated antimicrobial activity. As a part of research project on the syntheses of a number of pyrido[1,2-a]benzimidazole derivatives with possible antimicrobial activity, some 3-(chloro or morpholino)-acetyloxy (2,3), 3-(N,N-dimethylcarbamoyloxy) (4,5) and 3-tosyloxy-1-oxo-1H,5H-pyrido[1,2a]benzimidazole-4-carbonitrile s (6) were prepared and evaluated for such activity. Many compounds exhibited in vitro antimicrobial activity and structure-activity relationship is discussed.


Studies about the oral bioavailability of mitonafide and 2HCl amonafide, two new cytotoxic molecules. A study was done on the factors which could modify the oral bioavailability of two new cytotoxic molecules (mitonafide and 2HCl amonafide) when administered in solid form. From the values of the ionization constants, we can assume that the absorption of these drugs is produced in the first segments of the small intestine. In the course of both molecules through the digestive tract to the site of absorption, we presume that their chemical stability will not be significantly compromised by the influence of pH of the GI tract. The high aqueous solubility of 2HCl amonafide and the rapid dissolution rate of mitonafide at low pH values lead to assume that the previous dissolution of the drugs will not be an essential factor in the absorption of the oral form.


Bioactive polymers. 70. The kinetics of controlled release of neomycin in an alkaline medium. Neomycin is coupled on xanthan--a polysaccharide of microbial biosynthesis produced by Xanthomona campestris--through ionic complexation. The kinetics of neomycin release, in vitro, at pH = 8.2 is studied. A release of neomycin, following a zero order kinetics, is observed, regardless of the eluent flow-rate. The neomycin-xanthan complex, protected by a cellulosic membrane, behaves like a monolithic-type device. Diffusion coefficients--increasing with increasing the eluent flow-rate--are also calculated.


Antispasmodic activity of tert-aminoalkylderivatives of 3-benzyl-, 3-benzylaza- and 3-benzyldiazaquinoxalinones. Tert-aminoalkylderivatives of quinoxalin-2-ones, aza- and diazaquinoxalin-2-ones bearing in position 3 a benzyl group were assayed to evaluate the antispasmodic activity. The tested compounds exhibited moderate aspecific antispastic properties that do not warrant further investigation.


Synthesis and ADA inhibitory activity of new 2-aryl-8-azaadenosines. VIII. Title compounds were synthesized from the protected beta-D-ribofuranosyl-1-azide, the sodium salt of malononitrile and the suitable aroyl nitrile. The deblocked 8-azaadenosines had shown good activity as inhibitors of adenosine deaminase (ADA) and a non-substrate behaviour toward the hydrolytic deamination promoted by the enzyme.


4-(1,2-Benzisothiazol-3-yl)alkanoic and phenylalkanoic acids: synthesis and anti-inflammatory, analgesic and antipyretic activities. Continuing their studies on benzisothiazolyl derivatives, Authors refer to the preparation and pharmacological properties of 4-(1,2-benzisothiazol-3-yl) alkanoic and phenylalkanoic acids. All substances were tested for anti-inflammatory, analgesic and antipyretic properties. As reference compounds, 1,2-benzisothiazolin-3-one and 4-(3-oxo-1,2-benzisothiazolin-3-yl) phenylacetic acid, as prototypes of benzisothiazolinonic derivation. Ibuprofen, as a prototype of substituted arylalkanoic acids, and Phenylbutazone were used. Analysis of the data leaded to the following conclusions. Introduction of the aryl moiety, passing from benzisothiazolylalkanoic to benzisothiazolyl-phenylalkanoic structures, produced a remarkable increase of activity. 2-[4-(1,2-benzisothiazol-3-yl)phenyl] propionic and 2-[4-(1,2-benzisothiazol-3-yl)phenyl]butyiric acids showed anti-inflammatory, analgesic and antipyretic properties comparable to those of Ibuprofen. Substantial differences in variations in activities were observed comparing the properties of benzisothiazolylphenylalcanoic acids with those of the benzisothiazolinonic series, object of preceding studies.


4-substituted 1-methyl-1H-indazoles with analgesic, antiinflammatory and antipyretic activities. The synthesis of [(1-methyl-1H-indazol-4-yl)oxy]acetic acid 4, 1-methyl-1H-indazole-4-acetic acid 9, 2-(1-methyl-1H-indazol-4-yl)propanoic acid 15 and [[(1,5,6,7-tetrahydro-1-methyl-4H-indazol-4-ylidene)amino]oxy]acet ic acid 16, as well as of amides and esters derived from 4 and 9, starting from 1,5,6,7-tetrahydro-1-methyl-4H-indazol-4-one is described. Some of the above compounds showed weak antiinflammatory, analgesic, antipyretic and hypotensive activities in rats and mice, as well as moderate platelet antiaggregating effects in vitro.


Synthesis of phenothiazine derivatives as potential inhibitors of phospholipase C. In order to study the structure-activity relationships of phenothiazine derivatives inhibiting phosphatidylinositol-specific phospholipase C (PI-PLC), the synthesis of some phenothiazine amide, amine and ester derivatives was performed mainly by reacting 10H-phenothiazine-10-propanoyl chloride with some amines and alcohols; the resulting amides were reduced with borane to yield the corresponding amines. Starting from 2-chloro and 2-trifluoromethyl-10H-phenothiazine-10-propanoyl chloride two amides were synthesized. The inhibiting activity on PI-PLC from human platelets is reported.


Synthesis and antimicrobial activity of some thiazolinyl tetrahydrobenzo[b]thiophenes and thiazolinyl tetrahydrobenzothieno[2,3-d]pyrimidin-4-ones. Two series of novel 3-carbethoxy-2-(3',4'-disubstituted-2',3'- dihydrothiazol-2'-ylidenamino)-4,5,6,7-tetrahydrobenzo[b] thiophenes (3a-o) and 2-methyl-3-(3',4'-disubstituted-2',3'-dihydrothiazol-2'-ylidena mino-5,6,7,8- tetrahydrobenzothieno[2,3-d]pyrimidin-4(3H) ones (8a-o) have been synthesized and tested for antimicrobial activity. All members of the series have been found to exhibit in vitro antibacterial and/or antifungal activities. Activity was optimized by cyclization to the thienopyrimidin-4-ones. In particular, compounds 8e and 8fd were the most active against the 3 tested microorganisms. Their antifungal activity was higher than that exhibited by nystatin while their MIC was found to be nearly equal to that of nystatin.


Antibacterial and antiproliferative activities of vulpinic acids in vitro. The antimicrobial and antiproliferative activities of vulpinic acids (1 a, b, c) have been assayed in vitro. Activity was demonstrated by vulpinic acids on Gram-positive bacteria only. The MIC values of these compounds were found to be ranging from 3.8-31.5 micrograms/ml. The significance of these results is discussed.


An evaluation of structure-penetration relationships in percutaneous absorption. Prediction of chemical transport across skin is important both to the optimization of topical and transdermal drug delivery and to the assessment of risk following dermal exposure. To facilitate estimation of percutaneous absorption, a number of model in vitro experimental systems have been developed. However, the predictive applicability of the different approaches (with respect to human skin penetration), and the quantitative aspects of the structure-permeation behavior revealed, have not been critically evaluated. The objectives of this paper are to collect, from the literature, the more systematic investigations pertaining to chemical transport across the skin, to quantify the dependence of permeation on the lipophilicity of the penetrants studied, and to assess the relative utility of model systems for the prediction of percutaneous absorption. The categories of chemicals addressed in the survey include n-alkanols, para-substituted phenols, steroids and non-steroidal anti-inflammatory drugs. The experimental systems, used in the studies considered, involve, primarily, steady-state transport measurements across excised skin taken from either human cadavers or hairless mice. Favorable comparisons of these data to solute flux across simple organic liquid membranes are possible. Overall, general patterns of behavior emerge from the analysis such that qualitative predictions can be made. From a quantitative standpoint, though, it is clear that additional "structure-activity" work is necessary to provide appropriate equations that can relate penetration between different test systems and between different chemical classes.


Halogenated isoniazid derivatives as possible antitubercular and antineoplastic agents. Note 1. Halogenated arylhydrazones, 2-aryl-4-thiazolidinones and their 1,1-dioxides containing isoniazid (INI) moieties were prepared and explored for antimicrobial (against bacteria, Candida and mycobacteria) and antitumor activities. None of the tested compounds showed any marked antimicrobial effect. Furthermore, among the compounds submitted to NCI in vitro primary antitumor screening, those bearing 3-fluoro or -chlorophenyl substituents were found to possess selective inhibitory effects on the growth of non small cell lung cancer, whereas those with para-phenyl substituents displayed selective effects, sometimes statistically significant, against leukemias.


Fluorocontaining D-cycloserines. Synthesis and in vitro evaluation of antimicrobial and antiviral activities. Some fluoroacylderivatives at the side chain NH2 of D-cycloserine were synthesized and evaluated in vitro for antimicrobial activity against bacteria and tubercular or non-tubercular mycobacteria. Against the used Gram-positive and Gram-negative strains only trifluoroacetamide 1 exhibited comparable MIC values and lower MBC values than those of parent antibiotic. Other fluoroacycloserines, inactive at all on these bacteria, were found to inhibit the growth of mycobacteria when tested in liquid media. The in vitro anti-Herpex Simplex virus type-2 (HSV-2) activity was also investigated on HEp-2 and Vero cells. The obtained results demonstrated an antiviral activity of the compounds 1 and 3 when tested on Vero cell-lines, whereas the same cycloserine is inactive.


Research on heterocyclic compounds, XXIX. Synthesis and antiinflammatory activity of imidazo[1,2-a]pyrazine derivatives. The reaction in anhydrous ethanol of some substituted 2-aminopyrazines with ethyl 2-benzoyl-2-bromoacetate or with ethyl 3-bromo-4-oxopentanoate afforded a group of ethyl 2-phenylimidazo[1,2-a]pyrazine-3-carboxylates and a group of ethyl 2-methylimidazo[1,2-a]pyrazine-3-acetates, respectively. The corresponding acids obtained via alkaline hydrolysis were subjected to pharmacological testing in vivo in order to evaluate their antiinflammatory activity.


Research on heterocyclic compounds. XXX. Synthesis and pharmacological activity of 2-methylimidazo[1,2-b]pyridazine-3-carboxylic acids. A group of ethyl 2-methylimidazo[1,2-b]pyridazine-3-carboxylates were prepared by reaction in anhydrous ethanol of some substituted 3-amino-pyridazines with ethyl 2-chloroacetoacetate. The corresponding carboxylic acids were obtained via alkaline or acid hydrolysis and then tested both in vivo to evaluate their antiinflammatory, analgesic and ulcerogenic actions and in vitro for their ability to inhibit the prostaglandin biosynthesis. The pharmacological results are discussed in terms of both structure-activity relationships and mechanism of action.


Recombinant human basic-fibroblastic growth factor: different medical dressings for clinical application in wound healing. Recombinant human basic-Fibroblastic Growth Factor (rhb-FGF) is a basic single-chain protein showing high activity as mitogenetic and angiogenetic agent. The application of rhb-FGF in wound healing as stimulator of the tissue repair process is strictly connected with the covering of the wound by means of a proper dressing. A wide number of synthetic occlusive or non-occlusive wound dressings has been developed. Owing to the delicate proteic structure of rhb-FGF, and generally of all the Growth Factors, compatibility with the dressings has to be every time tested, to avoid its inactivation and consequent loss of tissue repair properties.


Condensation products of 2-amino-3-cyano-4,6-disubstituted pyridine with carbon disulfide, thiourea, urea & formamide and their antibacterial activity. Some new 5,7-disubstituted pyrido[2,3-d]pyrimidine derivatives have been synthesized by the condensation of 2-amino-3-cyano-4,6-disubstituted pyridine with carbon disulfide, thiourea, urea and formamide. The structure of these products are supported by their IR and 1H-NMR spectra as well as by elemental analysis. The compounds have been tested for their antibacterial activity against E. coli and S. aureus.


Comparative study of virulence and virulence factors of Aeromonas hydrophila strains isolated from water and sediments of a river. Seventy-four strains of Aeromonas hydrophila isolated from water and sediments of the River Porma (León, N.W. Spain) were characterized biochemically and biologically. Fifty-seven strains (77.02%) were virulent for rainbow trout (Salmo gairdneri) by intramuscular challenge but showed differing degree of pathogenicity which could not be associated with the source. A lack of correlation between caseinase, haemolytic and cytotoxic activities of the strains and their isolation source was also observed. Only two surface characters, acriflavine 0.2% agglutination and non-agglutinating SP-/PAB-phenotypes, were significantly associated with water and sediment strains, respectively.


[Description of Salmonella contamination of industrially made pizza products]. Based on a impurity of industrial made pizza products with Salmonella it was checked to what extent the preparation instructions given by the producer are connected with a hygienic risk for the consumers. It can be declared that the producer didn't deal with its duty for exactness and that the made controls were insufficient.


[Experiences with alkaline filter elution for the detection of DNA damage by genotoxic compounds]. In biological effect monitoring the alkaline filter elution is a suitable method to detect DNA strand breakage and cross-linking in peripheral blood lymphocytes. We applied this method to three groups of workers occupationally exposed to carcinogens: n = 39 welders with exposure to chromium and nickel, n = 20 female shoemakers with exposure to benzene and n = 25 disinfectors in hospitals with exposure to ethylene oxide. In comparison to standardised control groups our results must be interpreted as indicating an increased rate of DNA cross-linking in welders and disinfectors whereas the female shoemakers showed an increased rate of DNA strand breakage. The differences between the results of the exposed groups and the stratified control groups were significant in most cases. We could reexamine 6 shoemakers 4 months after cessation of exposure to benzene; at this moment the results were indicating a clear decrease of the DNA strand breakage. Therefore the method of alkaline filter elution seems to be a valuable tool in biological effect monitoring of groups occupationally or environmentally exposed to carcinogens, especially if the exposure is low, but persistent over a long period.


Infectious risk of replacing venous catheters by the guide-wire technique. During the perioperative period cardiac surgical patients are often monitored by pulmonary artery (PA) catheters. This catheter, which is floated through the right heart into the pulmonary artery, enables the intensivist to measure and calculate indices of myocardial performance. After a variable period of time this invasive monitoring can often be abandoned following cardiovascular stabilization in these patients, but patients usually still require a central venous (CV) access for diagnostic and therapeutic purposes. To place this CV catheter either a de novo puncture at a new site or a guide-wire change at the existing exit site through the PA catheter in place can be performed. Each de novo puncture is associated with a risk of traumatising internal vessels or organs. In contrast, guide-wire change avoids this risk but inherits a potential risk of transferring bacteria by manipulation of contaminated lines. Our study included 159 consecutive cardiac surgical patients in whom PA monitoring was established preoperatively and terminated within a period of up to 72 hours postoperatively. At random the PA catheter was replaced by a CV line either by de novo puncture or by guide-wire change. All CV lines were left in place for 7 days according to standard practice in our intensive care unit (ICU). After removal of CV catheters all catheter tips were cultured semiquantitatively by rollplate technique according to Maki (26) and subsequent immersion broth culture. A positive culture was defined as growth of one up to 15 colonies on the agar-plate or any microbial growth in the broth. A significant colonization was assumed in catheters yielding more than 15 colony forming units (cfu) on the blood agar plate (26). Our results show a significant risk of colonization and catheter-related infection associated with the guide-wire technique as opposed to the de novo puncture. The figures for relevant colonization were 33.3% in the guide-wire group as opposed to 10.5% in the de novo group. However, this difference was noted only in the subgroup in which replacement of PA catheters by CV catheters was performed beyond 48 h after initial insertion of PA catheters. Within the time intervals of 24 and 25 to 48 h, respectively, we could not detect any significant difference between groups.