[Relation between lipid-bound sialic acid in blood serum and plasma andin human tumors]. Athymic mice with transplanted osteosarcoma and carcinoma of the rectum were found to have increased blood plasma levels of lipid-bound sialic acid (LSA). To verify the applicability of the method of LSA determination, patients with cancer of the mammary gland, rectum, and colon were examined for their LSA level. The serum LSA level was significantly increased in patients with cancer of the mammary gland and rectum, compared to levels determined in the serum of healthy volunteers. The serum LSA level elevation was even more pronounced in patients with carcinoma of the colon. In patients with carcinoma of the colon who were in remission at the time of blood collection the serum LSA level was found to be reduced to control values.


[The effect of extrarenal factors on certain functions of the kidney and urinary tract. A radionuclide study]. The authors present their experiences concerning the effect of extrarenal factors on the results of radionuclide examination. Functional and functional-morphological examinations of the kidneys and urinary tract can be negatively affected particularly by emotional stress, orthostasis, dehydration, increased kidney motility, address administered drugs during examination (diuretics), drug treatment of the primary disease, muscular strain, cold, pain, increased pressure in the vicinity of the kidney, hypertension, hypotension, as well as further conditions. Radionuclide methods can objectify these processes, the given negative effects can however be presumed to occur also at other examination procedures of the kidney and urinary tract. The conditions of examinations have thus to be optimized and standardized. The examining physician has to know which drugs the patient is receiving and he has to know their effect on renal function.


[Reference values of QRS-complex amplitude parameters in computer evaluation of Frank's orthogonal electrocardiogram]. In 123 healthy subjects (54 women and 69 men) in the age range from 7 to 72 years the x, y, z coordinates were determined along with the magnitude of instantaneous spatial QRS vectors of the orthogonal electrocardiogram according to Frank, and that in 10 ms intervals from the beginning of the QRS complex and eighths of the duration of QRS. The values of these parameters were computed by means of Pipberger's VAH program implemented in the computer SM3-20. The results are presented as means, standard error of means, median, interpercentile interval (2 to 98 percentile) and confidence intervals.


[Structural basis of appendiceal function in rabbits]. Enzymo-, immuno- and lactin-histochemical methods were used to study the structure of the rabbit appendix wall. The value of some structural components in the function of this part of the intestine is discussed. Some findings were documented electronmicroscopically. In addition to its resorptive function, the rabbit appendix is equipped with a potent defense mechanism against adverse environmental effects of the appendix content. Individual structures of this defensive barrier are closely characterized with regard to cellular equipment and possibilities of its morphological identification.


[The importance of pulmonary angiography in the surgical treatment of congenital heart defects with a left-right shunt and pulmonary hypertension]. The studied series consisted of 14 patients with ventricular septal defect and pulmonary hypertension aged from 3 months to 15 years. Three examination methods were compared: (1) Invasive hemodynamic examination; (2) Pulmoangiographic examination by means of wedge peripheral pulmoangiography; (3) Histological examination of bioptic samples. Direct correlation was found to exist between mean PA pressure, PAR/m2, TPR/SR and pulmoangiographic records, in which the following parameters were evaluated: (a) length of the narrowing of the peripheral branch of the PA, (b) background opacity, (c) circulation time. The histological findings obtained in the bioptic samples corresponded practically in all cases with the hemodynamic and PAG findings. Only in two patients did the histological picture display a less severe degree of affection than found by PAG and hemodynamic examination. The obtained results suggest that in light of surgical indications, PAG can be considered a suitable and valuable supplementary method in assessing borderline findings of pulmonary hypertension in children with congenital heart defects and left-to-right shunt.


[Vectorcardiographic features of right ventricular dilatation]. Axial McFee-Parungao lead system vectorcardiograms were obtained in 55 patients with type atrial septal defect, aged 3-24 years, prior to and in average 3 years after surgical repair of the defect. Changes of the QRS loop observed after intervention led to the conclusion that the vectorcardiographic signs of right ventricular dilatation consist of a rightward shift of the posteriorly orientated horizontal plane vectors at 50-70 ms of QRS, decrease of the magnitude of vectors around the 40th ms, no changes in the magnitude and orientation of the initial (10-30 ms) QRS vectors as well abnormal departures of the spatial VCG loop from its preferential plane even in the absence of other signs of right ventricular conduction impairment. The above abnormalities vanished after normalization of hemodynamics.


[The accuracy of saccadic eye movements is associated with their horizontal and vertical direction]. Electro-oculagraphic, photo-oculographic, and magnetoelectro-oculographic methods were used to study and to compare the accuracy of 10 degrees saccadic movements of the eyes in dependence on their direction to the right, to the left, upwards and downwards. Leftward saccades in right-handers and rightward saccades in left-handers proved to be more accurate compared to saccades in the opposite direction. This finding may be related to the functional asymmetry of the cerebral hemispheres. Downward saccades are inaccurate in comparison to upward saccades. Their inaccuracy is caused by overshooting the target. In the case of vertical saccades, the existence of different generators in the brain for triggering upward and downward saccades may play a role, along with a potential preprogramming of the change in the downward look into a sequence of two saccades. The obtained results emphasize the requirement of calibrating the electro-oculogram by saccades in that direction in which the analyzed eye movements are recorded.


[The role of short and long latency reflexes in the small muscles of the hand in the diagnosis of movement disorders--an electrophysiology study]. EMG changes of short (SLR) and long latency reflex (LLR) responses to electric stimulation of digital nerves of the index finger were recorded from the interosseous dorsal muscle I during its slight isometric contraction. Abnormalities of SLR and LLR were found at least on one hand in 9 of 11 patients with nosologically different dysfunctions of the nervous system. SLR latency can yield information on lesions of the peripheral motoneuron. LLR latency proved to be a sensitive indicator of spinal and supraspinal lesions, and since it has also an efferent branch and, unlike SEP, it can detect also lesions of the descending corticospinal pathway. Prolonged SLR latency occurred frequently in s. m. Assessment of muscle reflexes is a valuable auxiliary method in identifying lesions of the peripheral and particularly of the central nervous system.


[Comparison of the inhibitory effect of diltiazem on neurogenic contractions in the mesenteric arteries and veins]. The effect of diltiazem on the magnitude of isometric contractions induced by electric stimulation of intramural nerves (4Hz) was studied on isolated rings of the mesenteric artery and vein of the dog and rabbit. Diltiazem in concentrations of 10(-5) mol/l and above inhibited neurogenic contractions of the mesenteric artery and vein of the dog in a dose-dependent manner. Inhibition of contractions of the mesenteric vein was found to be more pronounced than that of contractions of the mesenteric artery. In the mesenteric vessels of the rabbit, diltiazem in concentrations of 10(-6) and above inhibited neurogenic contractions, and again more markedly in the veins than in the arteries. On comparing the inhibition of contractions in the two animal species studied, the contractions of the mesenteric vein of the rabbit were found to be more intensely inhibited than those of the dog vein. Diltiazem inhibited also phentolamine-resistant neurogenic contractions of the mesenteric artery. The established differences in the magnitude of neurogenic contraction inhibition may presumably be accounted for by quantitative differences in adrenergic innervation of mesenteric arteries and veins, as well as by differences in the magnitude of the contraction component dependent on extracellular calcium which is greater in the veins than in the arteries. This may also explain the more pronounced inhibition of neurogenic contractions in the veins compared to arteries.


[Vectorcardiography of variations in localization of specific conduction systems in the left ventricle]. A realistic computer model of propagation of ventricular activation was used to study the effects of varying the position of specific conduction system terminations in the left ventricle and the septum, representing the sites of initial activation, on the resulting simulated spatial heart vectors. Three differently localized foci of initial activation, each of them represented by one model element, were considered: in the central part of the left septal surface, posteriorly at about one third of the distance from the apex to the base, and in the upper part of the anterior free wall. During the model experiments, the positions of the initial activation were shifted +/- 5 model units (ca 5 mm) in the vertical and lateral direction either separately or in different mutual combinations. Small variations of the initial activation site in the basal parts of the left ventricle led to significantly smaller changes of the vectorcardiographic loop than variations of the same extent with the initial activation site located more apically.


[Changes in the parameters of respiratory mechanics after the aspiration reflex and asphyxia]. Parameters of respiration mechanics (dynamic compliance--Cdyn and total lung resistance--RL), ventilation, blood gases, and right-to-left pulmonary shunts were studied after aspiration reflex in experiments on 29 anesthetized cats. Attacks of aspiration reflex were induced without asphyxia (8 cats) and during two-minute asphyxia (9 cats). The control group consisted of 12 animals. A series of aspiration reflex attacks resulted in short-term improvement of the parameters of respiration mechanics with an increase in Cdyn and reduction of RL. A simultaneous elevation of PaO2 and a decrease of PaCO2 were recorded. In combination with asphyxia (hypoxemia and hyperkapnia), the aspiration reflex induced a reversed reaction, i.e. decreased Cdyn lasting till the end of experiment (3 hours) and an increase of functional alveolar right-to-left shunts. The results indicate that in cats impairment of respiration mechanics parameters is brought on only when deep inspiration is combined with asphyxia.


[Orthostatic adaptation of blood pressure and pulse rate in children]. Reactivity of blood pressure (BP) and heart rate (HR) to active orthostasis was studied in 1540 children aged 3-7 years. After changing the position from supine to sitting all cardiovascular parameters studied increased significantly. The recorded mean increases were as follows: systolic BP-3-7 Torr, diastolic BP-2 Torr, HR-5-7 beats min-1, pulse pressure 3-6 Torr, mean BP-2-3 Torr. The change to erect position induced a further increase. The reactive increments were in negative correlation with the initial values (r = -0.3, p < 0.001) in both sexes. The incidence of responses with a higher amplitude was significantly higher in children from the lower quartiles of supinal BP distribution. The incidence of reactive BP drop increased gradually from 7 to 14% of cases.


[Computer analysis of muscle reflex responses to electric stimulation of peripheral nerves]. A computer program is described which allows analysis of reflex muscle responses to electric stimulation of peripheral nerves. Basically, the program is derived from an older methodic approach, yet the process of evaluating the obtained means of reflex muscle responses is in this computer assisted procedure simpler and of a higher quality. The proposed improvement of the original methodic approach provides an important advantage for clinical practice in significantly speeding up the investigation and evaluation of reflex muscle responses on using financially accessible computer technique of Czechoslovak make. The paper points out the possibility of using the program also for analysis of other biological signals and of adjusting it for more efficient types of personal computers.


[The effect of head position and functional status of the cervical spine on body sway in the upright posture]. In 30 subjects (16 men and 14 women) stabilometry was used to investigate the stability of posture with closed eyes and different positions of the head (backward, forward, right and left turn). Cervical spine mobility of the subjects studied was determined by vertebrogenic examination. The maximum backward extension of the head was found to reduce most markedly posture stability. Correlation analysis revealed a relationship between the functional state of the cervical spine and the degree of posture stability impairment induced by backward extension of the head, with the impairment being more pronounced in the forward-backward direction. The obtained results show that changes in the quality of proprioceptive information from the cervical spine region are also involved in determining the stability level of upright posture. The findings imply that posture with backward extension of the head can be used as a loading test for detecting ataxia of cervical origin.


[Protective effect of 7-oxo-prostacyclin on myocardial calcium overload in the isolated rat heart]. The protective effect of a stable derivative of prostacyclin (7-oxo PGI2) was studied on the model of calcium overload (Ca2+ paradox) 48 h after i.m. administration of the drug in the dose of 50 micrograms/kg. In the isolated rat heart perfused at 37 degrees C and a constant perfusion pressure of 75 Torr (Langendorff preparation) Ca2+ paradox was induced by 3 min perfusion with calcium-free Krebs-Henseleit solution and a subsequent 10 min perfusion with a normal calcium-containing solution. The late protective effect of 7-oxo PGI2 was manifested by improved recovery of heart function (increase of contractility by 50%) and by better preservation of the content of macroergic phosphates (70% sigma ADN) during the Ca2+ repletion phase and of myocardial ultrastructure (sarcolemma) already during the Ca2+ depletion phase. The protective effect of 7-oxo PGI2 can be accounted for by stimulation of Na, K-ATPase activity, otherwise decreased during calcium depletion phase, and by the consequent prevention of alterations in sodium and calcium homeostasis. (Tab. 1, Fig. 4, Ref. 41.)


[The effect of postural changes on respiration and blood pressure in premature neonates]. Changes in respiratory rate, heart rate, and blood pressure in supine, orthostatic (45 degrees), and prone position were studied in 23 premature neonates of mean gestational age 34.5 weeks (30-36), mean birth weight 2100 g (1540-2480) and mean postnatal age 52 hours (12-72). The individual positions of the newborn were changed in 5-minute intervals. In the orthostatic position, the respiratory rate decreased, yet heart rate and blood pressure did not change. In pronation, respiration became more regular. In the preceding supine position, the coefficient of variation of the duration of respiratory cycles was 28.2 +/- 3.5%, while in the 1st minute of pronation it was 15.9 +/- 2.4% and in the 5th minute 14.3 +/- 1.9% (p < 0.001). In the 5th minute of pronation systemic blood pressure was increased. (Tab. 1, Fig. 4, Ref. 20).


[Molecular basis of regulation of contraction of skeletal muscle cells and the role of calcium. Mathematical modeling]. The review summarizes recent knowledge concerning regulatory mechanisms of skeletal muscle cell contraction. Calcium ions are the essential mediator of these processes. Their primary function is signal transmission from the sarcoplasmic reticulum to contractile proteins. A large variety of methods is available for the investigation of such complex molecular processes, ranging from physiological through biochemical and morphological to biophysical and mathematical approaches. Mathematical modelling is assessed comprehensively in the last part of the review. (Fig. 3, Ref. 58.)


[The effect of carnitine on the early phase of liver regeneration after partial hepatectomy in rats with experimental diabetes]. The effect of intraperitoneally administered carnitine (10 or 100 mg/kg) on the early stage of liver regeneration after two-third hepatectomy was studied in rats with experimentally induced alloxan diabetes (60 mg/kg IV). The level of regeneration was assessed mainly on the basis of DNA synthesis in the liver. Untreated diabetic rats exhibited significantly lower values of DNA synthesis determined 24 hours after hepatectomy. Administration of carnitine resulted in a significant increase in DNA synthesis over the given time interval. The stimulatory effect of carnitine in diabetic rats was confirmed also by the recorded values of serum lipids, particularly by the decreased concentration of triacylglycerols and the increased concentration of HDL-cholesterol, as determined in carnitine treated diabetic rats 24 hours following partial hepatectomy. (Tab. 2, Fig. 3, Ref. 34.)


[Long-term results in patients with stereotaxic surgery for psychopathologic disorders]. Long-term results (5-20 years) recorded in 304 patients operated on stereotactically for psychopathologic disorders are presented. The largest group of 260 surgically treated subjects represented aggressive patients. This group consisted of 150 patients with mental retardation, 70 with epilepsy, 20 with schizophrenia, and 20 patients with sexual deviations. Amygdalectomy for patients with normal intellect and posterior hypothalamotomy for those with reduced intellect proved to be the most effective procedure. Symmetrical operations were also effective. In some cases a combination of two target was necessary. In epileptics with aggressivity the combination of amygdalectomy and hippocampectomy yielded the best results. In aggressivity with sexual deviations anterior hypothalamotomy was the most effective operation. Favorable results in aggressivity therapy were recorded in 60% of patients. In patients with criminal sexual deviations, in drug addicts, and in alcoholics, anterior hypothalamotomy was found to be most effective, with favorable results in 50% of patients. In patients with depression, thalamotomy or stimulation of the limbic regions of the thalamus decreased the depression, with favorable results recorded in 66% of patients. The results of the surgically treated patients show that target-oriented stereotactic operations remove psychopathologic symptoms, improve the effectiveness of psychoactive drugs and the social adaptability of patients. (Ref. 15.)


[Embolization of the pulmonary artery bed: hemodynamic and respiratory changes]. Hemodynamic and respiratory changes were studied during embolization of the pulmonary arterial bed in 20 rabbits after pentobarbital anesthesia. Air was insufflated into the auricular vein in the amount necessary to induce circulatory and respiratory changes. Circulatory changes were manifested by decreased arterial blood pressure, increased blood pressure in the right atrium, and aortal and pulmonary blood flow reduced to zero. The respiratory rate was diminished. A series of deep inspirations was followed by apnoe and death of the animal. (Fig. 5, Ref. 9.)


[The HLA complex in 1991].

[The HLA complex in 1991]. In November 1990 the Nomenclature Committee of the WHO updated the designation of loci, alleles, and antigens of the HLA complex. Their complete list is presented in our review, along with current knowledge on the complexity of the HLA-D region. Finally, the paper deals with the tertiary structure of HLA antigens discovered in 1987, which has enabled us to understand the biological significance of the HLA complex. (Fig. 5, Tab. 5, Ref. 15.)


[The physician and the personal computer]. Nowadays the personal computer is being used in a broad range of activities. Its user is also its operator, directly controlling the process. The paper describes both hardware and software, the structure of the PC, its input and output equipment, basic principles of work with a PC, programs and programming, as well as computer languages. A classification of personal computers is presented and the most frequently used types are assessed. (Fig. 5, Ref. 15., Tab. 1)


Fear of humans and its relationships with productivity in laying hens at commercial farms. 1. The relationship between the behavioural responses of laying hens to humans and productivity was determined at 16 commercial sheds from 14 farms. 2. A number of behaviour variables were moderately to highly correlated with production variables; for example, the proportion of birds that moved away from an approaching experimenter in an unfamiliar environment ('shute test') was negatively correlated with peak hen day production, (PKHDP). 3. Behavioural responses to humans accounted for between 23 and 63% of the variation in a number of production variables, including PKHDP and the duration of a high level of production. 4. Inclusion of farm factor variables increased the amount of variation accounted for by the behaviour variables. For example, adding the variable 'time/day spent in the shed by stockpeople' to the behaviour variables 'the proportion of birds that moved away from an approaching human' in the shute test and 'the number of times birds in cages adopted an erect posture' in response to an approaching human increased the variation accounted for in PKHDP from 53 to 61%. 5. The results suggest that fear of humans may be a factor that limits the productivity of commercial laying hens.


Responses of broiler chickens to high-frequency and low-frequency fluorescent light. 1. The influence of the flicker frequency on physical activity and energy expenditure of broilers was studied using commercially available high-frequency (HF) and low-frequency (LF) fluorescent lamps in a 23L:1D lighting schedule. 2. Broilers were reared under and adapted to HF. They were alternately subjected to HF and LF during measurement of activity and energy expenditure. 3. In comparison with HF, LF inhibited activity (number and intensity of movements), but did not influence energy expenditure. 4. It was concluded that the 100 Hz flickering of low-frequency light is detected by broilers and has measurable behavioural effects upon them. 5. The results were discussed in relation to current knowledge of human and birds' critical flicker frequency and perception.


Influence of age and body mass on the heating effect of microwave radiation in broilers. 1. A total of 648 broilers was used in a factorial combination of 3 ages x 3 body masses x 4 microwave treatments to examine the possible interaction between bird age and body mass on the heating effect of microwaves. 2. As age or body mass increased, the increase in body temperature following exposure to microwaves decreased curvilinearly. 3. A significant interaction was evident between age and body mass. For the same body mass, microwave radiation exerted a greater heating influence at the younger age. 4. A model for the heating effect of microwaves is presented which takes into account the influence of both bird age and irradiated body mass.


Effects of temperature on the migration of primordial germ cells in the chick embryo. 1. Incubating eggs at reduced temperatures leads to a decline in the rate of embryonic development. 2. All tissues do not respond equally and the migration of primordial germ cells is delayed in time, but occurs at an earlier stage of development than for normally incubated eggs. 3. The results are interpreted in relation to the integrated development of the gonad.


Direct and correlated responses to divergent selection for residual food intake in Rhode Island Red laying hens. 1. Divergent selection was undertaken in a Rhode Island Red population for residual food intake, measured in males and females, using mass selection. 2. In the absence of a control line, selection response during 14 generations was estimated by the within-year divergence between lines. 3. The direct response in residual food intake was found to be significant in both sexes, the divergence reaching almost three phenotypic standard deviations in each sex. 4. Significant correlated responses were obtained for food efficiency; it was improved in the low residual food intake line. Shank length, wattle length and rectal and comb temperature showed higher values in the high line, suggesting an increased heat production or dissipation. Inconsistent changes were observed for other egg production traits.


Effect of faecal extract on the growth of Salmonella enteritidis in artificially contaminated hens' eggs. 1. Salmonella enteritidis PT 4 grew in eggs stored at 25 degrees C, but not at 10 degrees C. 2. The incidence of generalised infection of the egg contents (greater than 10(6) salmonellas/ml) was greater in eggs inoculated with cells suspended in faecal extract compared to those with cells in Ringer's solution. 3. The removal of most of the iron did not decrease the growth-promoting effect of the faecal extract.


Techniques for the isolation of salmonellas from eggs. 1. When the contents of 4 or more naturally-contaminated intact eggs were combined, the isolation rate of Salmonella enteritidis was improved by extending incubation at 37 degrees C from 24 to 48 h before sub-culture. 2. The isolation rate of salmonellas from raw homogenised whole egg was significantly increased by the inclusion of Novobiocin and Cefsulodin in the primary culture media. 3. Rappaport Vassiliadis broth was found to be superior to Selenite as a selective enrichment medium.


Influence of age on the febrile response to E. coli and S. typhimurium endotoxins in growing pullets. 1. The effect of bacterial endotoxin injection was studied in growing pullets of different ages. Commercial chicks were divided into 5 groups according to age. Bacterial endotoxins (E. coli and S. typhimurium) were injected intravenously and rectal temperature was measured over a period of 300 min. 2. The results showed no significant effect of age on the febrile response induced by bacterial endotoxins, but a slight tendency towards a reduced fever peak was observed with increasing age. The response latency also increased with age.


Use of competitive exclusion to protect newly-hatched chicks against intestinal colonisation and invasion by Salmonella enteritidis PT4. 1. The recommended dose of a commercial competitive exclusion (CE) product (BROILACT) was given orally to newly-hatched broiler chicks to protect them against oral challenge by Salmonella enteritidis PT4. 2. In 5 replicate trials, half of the birds thus treated and half from untreated control groups were examined for salmonellas at 5 d and the other half at 12 d after challenge. 3. Caecal contents were examined quantitatively while heart, liver and spleen samples were examined qualitatively by enrichment. 4. The treatment effectively prevented both colonisation of the caeca and invasion of the other organs by S. enteritidis PT4; the average number of salmonellas was less than 10 colony forming units (cfu)/g of caecal contents in the treated birds and more than 10 million cfu/g in the untreated birds. 5. Infection of organs other than the caeca was completely prevented by protective treatment, whereas 38% of the untreated birds were still infected at the end of the trial.


Effects of dietary protein concentration on the response of growing chicks to methionine. 1. Experiments were conducted independently at two stations to measure the requirement for methionine in chick diets with crude protein (CP) varying in 8 steps from 140 to 280 g/kg diet (experiment 1) or from 90 to 300 g/kg (experiment 2). 2. Protein composition was the same at all protein concentrations within a trial. The diet was designed to be first-limiting in methionine and DL-methionine was added to provide 5 ratios of methionine to CP at each protein concentration. 3. Methionine required for maximum growth rate or maximum efficiency of food utilisation was estimated at each protein concentration by fitting a quadratic regression equation to the relevant data. The requirement was also estimated by fitting the Reading model to data for growth rate and methionine intake. 4. In both trials and by all three methods of estimation, the methionine requirement (g/kg diet) for maximum performance increased as a linear function of dietary CP concentration and nearly in direct proportion to CP. 5. It is concluded that diets which contain surplus protein, beyond that needed to maximise growth rate or food efficiency, need supplementation with methionine beyond that required when dietary protein is just adequate. A suitable rule for practical formulation is that methionine concentration in chick diets should be not less than 0.025 times the dietary CP concentration.


Involvement of food intake in the decreased energy retention associated with single deficiencies of lysine and sulphur-containing amino acids in growing chicks. 1. Growth and energy utilisation were determined in growing chicks fed ad libitum on diets deficient either in lysine (5.95 g/kg) or in sulphur-containing amino acids (SAA, 3.5 g/kg). Food intake, body weight gain, energy retained as protein and as fat, and total energy retention were significantly (P less than 0.05) reduced by single deficiencies of either lysine or SAA. 2. Another two experiments were conducted to determine if the decreased total energy retentions in chicks fed on diets deficient in lysine (experiment 3) or SAA (experiment 4) were associated with reduced food intake, by using tube-feeding to control the amount and pattern of food consumption. Chicks fed on diets deficient in lysine or SAA retained less energy as protein and more energy as fat than the control chicks. Neither total energy retention nor heat increment was affected by these deficiencies. Total energy retention was proportional to metabolisable energy (ME) intake alone. 3. It is concluded that the decreased total energy retentions caused by single deficiencies of lysine and SAA were associated with decreased food intake.


Effect of colostomy on the utilisation of dietary nitrogen in the fowl fed on a low protein diet. 1. The effect of the inhibition of urine back-flow into the colon and caeca by colostomy on the utilisation of dietary nitrogen by fowls fed on a low protein diet and receiving free or restricted water supply was investigated. 2. Colostomy caused an increase in water excretion and a resultant increase in water intake to maintain water balance. 3. Colostomy tended to decrease nitrogen balance and nitrogen utilisation (N balance/N intake) to negative values, and these decreases became significant when water was restricted (P less than 0.05). 4. Excretory uric acid, ammonia, urea and total nitrogen were significantly increased after colostomy in water-restricted fowls (P less than 0.05), but such significant effects were not observed, except for ammonia, in fowls given water ad libitum. 5. It is concluded that the back-flow of urine into the caeca plays a significantly useful role in the utilisation of nitrogen in the fowl fed on a low protein diet especially when water intake is restricted.


Anti-nutritive effect of wheat pentosans in broiler chickens: roles of viscosity and gut microflora. 1. The mechanism of the anti-nutritive activity of isolated wheat pentosans was investigated by examining the roles of digesta viscosity and gut microflora in broiler chickens. 2. Wheat pentosans were isolated by alkaline extraction and purified by sequential treatment with pancreatin, alpha-amylase and lichenase, and high-speed centrifugation. Some of the pentosans were depolymerised using a beta-xylanase, which reduced the relative viscosity of the polysaccharides 4 fold. 3. Inclusion of 35 g alkali-extractable pentosans (containing 854 g arabinoxylans/kg DM) per kg diet significantly (P less than 0.05) depressed broiler performance and the viscosity of the digesta of these birds was significantly (P less than 0.05) higher than that of controls. Addition of the same amount of depolymerised pentosans had no significant effect on bird performance and had less effect on digesta viscosity. 4. Supplementation of the diet containing wheat pentosans (30 g/kg) with procaine penicillin (150 mg/kg) did not improve bird performance. 4. It is concluded that the wheat pentosans elicit their anti-nutritive activity predominantly through increasing the viscosity of digesta.


Production, hatchability and fertility of eggs from breeding Japanese quail (Coturnix coturnix japonica) fed diets containing furazolidone. 1. Breeding Japanese quail were allocated to 8 groups, each group consisting of 20 females and males. The birds were fed one of 4 diets for up to 33 d: a control diet or a diet containing 200 mg/kg, 400 mg/kg or 1000 mg/kg furazolidone. Subsequently, quails were fed a furazolidone-free diet for up to 21 d. Egg production, quality, hatchability and fertility of the groups were measured. 2. Significant reduction in egg production occurred in birds fed 400 mg/kg and 1000 mg/kg furazolidone, the effect being more pronounced at the higher concentration. 3. Hatchability was reduced significantly for all groups of birds fed furazolidone and this effect was both dose and time dependent. The reduction in hatchability was attributable to an increase in infertile eggs rather than an increase in embryonic mortality. 4. Egg quality was affected, with more small eggs being produced by birds fed 1000 mg/kg furazolidone. 5. After removal of the experimental diets egg production of the affected groups returned to control values. Hatchability and fertility of affected groups also returned toward control values, but had generally not attained these values 21 d after the cessation of the experimental diets. 6. It was concluded that standard recommendations for the therapeutic dosage of poultry with furazolidone may not be appropriate for breeding Japanese quail.


Induction of ovarian growth and ovulation by administration of a chicken gonadotrophin preparation to Japanese quail kept under a short-day regimen. 1. Chronic administration of a glycoprotein fraction from chicken pituitary using an ALZET osmotic pump at 12.5 micrograms/h for 2 weeks induced growth of ovarian follicles to a mature size in the ovary and deposition of yolk in sexually immature 6-week-old Japanese quail females which were kept under 8L:16D short-day conditions. However, no ovulation was induced in these birds. 2. Injection of 500 micrograms of the glycoprotein into other immature short-day females was performed following the above chronic administration, 12 or 14 and 15 d after implantation of the osmotic pump. About 24 h after injection, 3 of 14 females laid one or two eggs. Ovulation was confirmed in 4 females by autopsy. A total of 5 of 14 females ovulated 6 eggs, and significant development of the oviduct and the cloacal opening were observed in all of the treated females. 3. Thus, complete ovarian function could be induced in sexually immature female Japanese quail by administration of avian gonadotrophin using a combination of an osmotic pump and an injection.


Whole blood and plasma viscosity values in normal and ascitic broiler chickens. 1. Whole blood and plasma viscosity values in normal and ascitic broiler chickens were measured. 2. The mean blood viscosity value in ascitic broilers was greater than that of the controls. There was a small but significant difference in the opposite direction between plasma viscosity values of the respective groups of birds. 3. Although the haematocrit and arterial pressure index values in the ascitic birds were raised, there was a fall in the concentration of total plasma protein. 4. The data suggest that the raised viscosity in the ascitic birds was caused by a polycythemia and not by any influence of plasma protein. 5. The cumulative effect of these factors, such as raised blood viscosity values and larger deformed red cells flowing through constricted lung arterioles, may contribute to the pulmonary hypertension and ascites seen in some young commercial broilers.


Association of (3H) DNA with fowl spermatozoa and their in vitro fertilisation of hamster ova. 1. Fowl spermatozoa incubated with DNA were used for the fertilisation of zona-free hamster oocytes. 2. Two categories of spermatozoa were detected: those which were not labelled and those which showed a very high degree of labelling (19 +/- 2% of the whole population). 3. In the hamster oocytes exposed to treated spermatozoa the labelled sperm heads were identified.


Energy utilisation of medium chain triglyceride in comparison with long chain triglyceride in growing chicks. 1. To evaluate the relative efficiency of energy utilisation of medium chain triglyceride (MCT) compared to long chain triglyceride (LCT), Single Comb White Leghorn 7-d-old male chicks were allocated into 4 experimental groups and one control of 5 birds per group. The chicks in the control group (Group 1) were given 5 g basal diet each day for 10 d. The birds in groups 2 and 3 received 5 g basal diet/d supplemented with MCT to provide 33.5 kJ GE/d and 67.0 kJ GE/d, and those in groups 4 and 5 were supplemented with LCT at 31.9 kJ GE/d and 63.8 kJ GE/d, respectively. Energy retained as protein and fat, and total energy retentions were measured. 2. No significant differences were found in energy retention as protein between the four energy supplemented groups but significant differences in fat and total energy retentions were found between the different dietary energy contents but not between energy source. Net energy of MCT for production was calculated as 16.0 kJ/g which corresponds to about 74% of that of LCT (22.8 kJ/g).


Further studies on the inheritance of the marbled chickdown phenotype of the domestic fowl. 1. An investigation was conducted among the progeny from crosses between Birchen Modern Game and Silver Sebright bantams into the inheritance of the marbled chickdown phenotype of the latter. 2. The marbled chickdown phenotype has been shown to depend upon homozygocity of both the birchen allele ER at the E-locus and the eumelanin restrictor gene Db. However, all stock used to establish this result were also homozygous for the linked eumelanin intensifier melanotic Ml and the pattern gene Pg, therefore yielding no information on the roles of Ml or Pg in the marbled chickdown phenotype. 3. Examination of the F2 generation both of chickdown and of adult plumage demonstrated the marbled chickdown to be homozygous ER (Db-Pg) with Ml dosage having an effect on adult plumage.


Patient-controlled analgesia for cancer pain: a long-term study of inpatient and outpatient use. The safety and efficacy of patient-controlled analgesia for the long-term control of cancer pain was tested prospectively. Respiratory rates, mental status, and pain relief were recorded at baseline and compared with those during the study period. Patients had a lower analgesic demand (i.e., self-administered less morphine during the nighttime); specifically, dosing declined 48% from the daytime level. Respiratory rates did not change appreciably during the study and no cases of significant respiratory depression were encountered. Patients self-administered sufficient morphine to produce adequate but not complete pain relief in almost all trials. Pain relief was safely achieved by both intravenous and subcutaneous routes of administration in both the inpatient and outpatient settings. Mean 24-h morphine use stayed relatively constant even for patients receiving more than 2 weeks of treatment. In conclusion, patient-controlled analgesia is effective and safe therapy for the long-term control of severe cancer pain.


Nonspecific immunostimulation with low doses of cyclophosphamide (LDCY), thymostimulin, and Echinacea purpurea extracts (echinacin) in patients with far advanced colorectal cancers: preliminary results. Outpatients (n = 15) with metastasizing far advanced colorectal cancers received immunotherapy consisting of low-dose cyclophosphamide (LDCY) 300 mg/m2 every 28 days i.v., thymostimulin 30 mg/m2, days 3-10 after low-dose cyclophosphamide i.m. once daily, then twice a week, and echinacin 60 mg/m2 together with thymostimulin i.m. All patients had had previous surgery and/or chemotherapy and had progressive disease upon entering the study. Two months after onset of therapy a partial tumor regression was documented in one and a stable disease in 6 other patients by abdominal ultrasonography, decrease of the tumor markers carcinoembryonic antigen (CEA), CA 19-9, CA 15-3, and/or chest roentgenography, which may also be attributed to the natural course of disease. Mean survival time was 4 months, 2 patients survived for more than 8 months. Immunotherapy was well tolerated by all patients without side effects.


Simultaneous radiotherapy and chemotherapy with carboplatin in inoperable squamous cell carcinoma of the head and neck: a phase II study. Fifty-six untreated patients with inoperable squamous cell carcinoma of the head and neck were treated with carboplatin 70 mg/m2 i.v. daily on days 1-5 and 29-33 in combination with simultaneous conventional radiation up to a target volume dose of 50 Gy. Depending on tumor response and upon recommendation of surgeons, 21 of 56 patients underwent surgery after a radiation dose of 50 Gy and two courses of carboplatin. Patients who showed pCR after surgery received no further radiotherapy. In all other patients radiotherapy was continued using a shrinking field technique up to a target absorbed dose of 70-74 Gy. Combined modality induced 66% complete remission (CR) and an overall response rate of 98%. After completion of the whole treatment program (combined modality +/- surgery) 53 (94%) of the 56 patients were disease free. The median survival for all patients is 25+ months and the percentage of two-year survivors is 53%. Myelosuppression was the most frequent toxicity, but rarely was severe; leukopenia and thrombocytopenia of WHO grade 3 occurred in 21% of the patients. No other toxicities above WHO grade 2 occurred. Nephrotoxicity, neurotoxicity and ototoxicity were not seen. The addition of carboplatin did not increase the rate of surgical complication over that expected for preoperative radiotherapy. Two patients died of pulmonary embolism after surgery. Combined modality with carboplatin and simultaneous radiation is a highly active and well-tolerated regimen for untreated patients with inoperable squamous cell carcinoma of the head and neck.


Molecular biology in the diagnosis and prognosis of solid and lymphoid tumors. The application of molecular biology to the study of human malignancies has led to tremendous gains in our understanding of their pathogenesis. Although their practical applications are still somewhat limited at this point, the use of molecular diagnostic tools is likely to grow at a very rapid rate as newer and more accurate prognostic markers are identified. The availability of reliable prognostic markers should allow earlier intervention in patients with aggressive disease but exhibiting only limited extent of disease at the time of initial diagnosis. Early intervention in such cases could realistically increase the probability of cure, since highly aggressive tumor cells are more likely to be eliminated by early institution of cytotoxic chemotherapy (4). The p53 tumor suppressor gene clearly represents the most promising potential prognostic marker at present, because of both the multiple phenotypic alterations caused by different p53 mutations and the high frequency of p53 mutations which have been observed in a variety of human cancers. Other prognostic markers related to oncogenes and tumor suppressor genes are almost certain to follow. Validation of new prognostic markers requires a knowledge of both histopathologic diagnostic criteria as well as the consequences for the patient of each diagnosis. There is bound to be some "shake-out" in the field of molecular diagnostics just as there was with other recently introduced techniques such as immunohistochemistry and flow cytometry which were found to provide additional useful information for some tumors and not for others. Since the clinical-pathologic studies needed for verification of putative prognostic markers require relatively long periods of follow up, progress in this area will almost certainly lag behind the ability of molecular biologists to identify new and potentially useful prognostic markers. Our collective ability to reap tangible gains in the clinical arena from our heavy investments in molecular biology and biotechnology depends to a large extent on open channels of communication between clinical and basic scientists. As our ever-increasing insights into oncogenic processes spawn new diagnostic and prognostic markers, our priorities should remain focused on those areas which are inadequately addressed by current methods, and we should avoid the technological trap of devising redundant solutions which increase the expense, but not the efficiency of patient care.


Indications for breast conservation in early stage breast cancer. Breast conservation, utilizing limited excisional breast surgery and axillary lymphadenectomy followed by radiation therapy can achieve excellent local/regional control and survival in many breast cancer patients. With average sized tumors, where larger volume resections are performed the results can equal that of the modified radical mastectomy. However, smaller tumors do very well with breast removal so it is a challenge to demonstrate that the long-term results of breast conservation in earlier stage disease are equivalent to mastectomy. Small or occult tumors do not always indicate localized disease and suitability for breast conservation depends on a combination of factors: tumor size and ratio of tumor to breast volume, cell type, location of tumor, obtaining clear margins, the mammographic picture, multicentricity, and the probability of axillary lymph node involvement. It is important to select patients for conservation where an equivalent survival can be expected. Recurrence in the radiated breast usually is diagnosed and treated at a more advanced stage than the disease which was initially treated conservatively. It is difficult to manage and carries a poorer prognosis.


Patient selection for treatment with conservative surgery and radiation therapy. There is now general agreement that treatment with conservative surgery and radiation therapy yields survival equal to mastectomy with the advantage of organ preservation for properly selected patients. When competently performed, such treatment gives highly satisfactory cosmetic results and acceptably low rates of local tumor recurrence. However, there remain numerous controversies concerning patient selection for this treatment option. The factors involved in patient selection may be grouped into three categories: patient factors; clinical factors; and pathologic factors. This article reviews their use. Because breast cancer has a long natural history, long follow up of patients is required for ultimate proof of the relative merits of different selection or treatment policies. However, due to the increasing numbers of patients being treated with conservative surgery and radiotherapy, it appears likely that many of these questions will be answered within the next decade.


Are DNA flow cytometry measurements providing useful information in the management of the node-negative breast cancer patient? The appropriate management of the breast cancer patient with early stage disease is a controversial, frustrating issue. If laboratory tests could accurately predict tumor behavior, however, the clinician and patient would be greatly aided in their treatment decisions. Although imperfect, there are several new and significant factors that can be used to predict patient prognosis; the most promising and well studied of these factors are DNA flow cytometry measurements. There are at least two estimates of tumor aggressiveness that we can obtain from DNA flow cytometry: one is an estimate of the tumor DNA content or ploidy and the other is an estimate of the tumor proliferative capacity. These measurements have their greatest clinical impact in the node negative patient predicting for relapse-free survival and overall survival. Estimates of proliferative capacity are independent predictors of patient prognosis. Estimates of DNA content are at times controversial and yet still are helpful in distinguishing prognostic subgroups of proliferative activity and may have additional clinical relevance. This discussion will summarize the data obtained from DNA flow cytometry measurements supporting their use as clinically important markers of prognosis in the node-negative patient.


The radiologic spectrum of abnormalities of the foot in diabetic patients. Radiologically visible lesions in the feet of patients with long-standing diabetes mellitus are common and varied. They include osteoporosis, osteosclerosis, osteolysis, juxta-articular defects of the cortical bone, ischemic bone necrosis, new bone formation, spontaneous fracture and subluxation, and neuropathic arthropathy. These manifestations result from diabetic angiopathy and neuropathy and usually are complicated by infection. In this review the author describes these protean radiologic features in light of their pathogenesis and discusses the diagnostic problems encountered.


[Cancer of the breast in radiology].

[Cancer of the breast in radiology]. In this extensive review the author discusses the incidence of breast cancer, screening methods, the theoretic radiation risk, the mammographic signs of suspicious lesions and the value of ultrasonography and stereotactic fine-needle biopsy. The emphasis is on the close relation between radiology, the physical examination, surgery and pathological studies. Up-to-date information about controversial topics is provided, and a therapeutic scheme is suggested.


Granulomatous orbital lesions: computed tomographic features. Orbital lesions exhibiting granulomatous inflammation represent a heterogeneous group of diseases characterized by infiltration with epithelioid cells. The authors retrospectively reviewed the orbital computed tomography (CT) scans of 39 patients who had biopsy-proven lesions with granulomatous inflammation and found that diagnosis on the basis of CT was possible in only a few patients, those with a lesion of characteristic location and attenuation (such as a dermoid cyst) or characteristic distribution (such as bilateral enlargement of the lacrimal gland occurring in orbital sarcoidosis). In patients with multicompartmental disease exhibiting bone and extraorbital involvement the site of origin of the mass, the pattern of bone involvement and the clinical findings helped in classifying the cause of the lesion as Wegener's granulomatosis, a foreign body or mucormycosis. CT was crucial in determining the intraorbital and extraorbital extent of the lesion before excision or biopsy.


Ultrasonography-directed native renal biopsy: comparison of an automated biopsy device with a needle system. The authors compared the performance of an automated biopsy device with a large-bore cutting needle system in ultrasonography-guided native renal biopsy. They retrospectively analysed 52 biopsy specimens from 50 adults with diffuse renal parenchymal disease. Twenty-six consecutive biopsy samples had been obtained manually with a 14-gauge needle (Tru-Cut, Travenol Laboratories, Deerfield, Ill.); a second set of 26 samples had been obtained with a biopsy gun (Bard Biopty, Radiplast, Uppsala, Sweden) fitted with a 14-gauge needle of similar design. The systems were compared in terms of the specimens obtained (the adequacy and the quality of tissue, the number of intact glomeruli and the presence of artifacts) and the incidence of biopsy-related complications. Biopsy specimens obtained with the biopsy gun were judged qualitatively as well as quantitatively superior; they contained an average of 17.6 intact glomeruli, whereas only 11.5 intact glomeruli were retrieved with the needle system. Although the incidence of minor complications was lower after biopsy with the automated gun than after use of the needle system (8% and 15% respectively), two major complications were observed after gun biopsy and none after needle biopsy. The results reported here indicate that for native renal biopsy the Biopty gun delivers a higher-quality tissue core with a lower frequency of minor complications, but not of major complications, than the Tru-Cut needle system.


Spondylometaphyseal dysplasia, Sutcliffe type: a rediscovered entity. The authors describe two children with spondylometaphyseal dysplasia, Sutcliffe type. This easily recognizable form of bone dysplasia is characterized by coxa vara, minimal metaphyseal changes, oval vertebral bodies and metaphyseal corner fractures later in life. It is probably the most common type of spondylometaphyseal dysplasia. Early diagnosis is important for proper management.


Are there predictors for future academic radiologists? A Canadian survey. In 1990 the authors surveyed all members of the Canadian Association of Radiologists and all graduates of the radiology residency program at the University of British Columbia in the previous 10 years. They compared radiologists with and those without a university affiliation to determine the influences on career choice. The factors considered included teaching, research and publication experience, as well as educational background. Most respondents had decided on a career path during the second half of the residency or later. The authors found certain predictors and influences associated with a greater probability that a radiologist would pursue an academic career. For example, academic radiologists were more likely to have performed research, published and presented the results of their research activities, and taught before undertaking the residency program in radiology than their counterparts who were not affiliated with a university or a residency program. However, class standing in medical school and prior educational experience were similar for academic and nonacademic radiologists. The influences most often cited as leading toward an academic career were a desire to teach, the inspiration of a role model and an interest in research. Job satisfaction was higher among nonacademic radiologists, as indicated by the number that would consider a career change. Most of the respondents disapproved of a special residency curriculum for academic radiologists.


Pulmonary arterial embolism secondary to hydatid cyst of the liver. Complications may develop after spontaneous or traumatic rupture of hydatid cysts. A rare complication is pulmonary embolism after rupture of such a cyst into the venous system. The authors present the pulmonary radiologic findings for a patient whose pulmonary complaints gradually increased after surgical removal of a hepatic hydatid cyst.


Benign biliary cystadenoma.

Benign biliary cystadenoma. Biliary cystadenomas and cystadenocarcinomas are rare. They arise in the liver or, less frequently, from the bile ducts. The characteristic appearance of these lesions in computed tomography and ultrasonography scans, as observed in a 26-year-old woman, is described. The features are similar to those of hydatid disease, and without travel history and the results of stool cultures and serologic tests differentiation may be impossible. Other considerations in the differential diagnosis are also discussed. Surgery is always indicated, because benign and malignant tumours in this area cannot be differentiated radiologically.


Large renal arteriovenous malformation: scintigraphic evaluation and therapeutic embolization. The authors describe a patient with a rare type of renal arteriovenous malformation, which was successfully treated by therapeutic coil embolization. Embolization did not destroy healthy renal tissue, as was shown by the Cerino technique, which measures the glomerular filtration rate of each kidney by image processing for standard renograms obtained after administration of diethylene-triaminepenta-acetic acid labelled with technetium 99m.


Idiopathic dilatation of the thoracic venous system. Isolated venous aneurysm is a rarely reported cause of a mediastinal mass. The authors describe a patient who demonstrated aneurysmal dilatation of the superior vena cava, the left innominate vein, the azygos and the hemiazygos veins and the left inferior pulmonary vein after blunt chest trauma. This case emphasizes the value of computed tomography in the diagnosis of this complex, presumably congenital entity.


Protecting seriously mistreated children: time delays in a court sample. The study examined the progress through the child protective system of a sample of 206 severely abused and/or neglected children brought before the Boston Juvenile Court (BJC) on Care and Protection (C & P) petitions. Overall, children were in the system an average of 5 years from the filing of the first official report of mistreatment to the resolution of their cases. The families had been known to the state child protective service agency for an average of more than 2.5 years before the current court involvement. Once arraigned in juvenile court on the C & P, the average case took almost 1.5 years to reach a disposition. After disposition, children permanently removed from parental custody required, on average, an additional year and a half in Probate Court to reach a permanent placement. Of the more than twenty variables examined, including severity of mistreatment, protective service history, and parental mental illness, no meaningful pattern emerged which could predict delays. Our findings characterize the delays experienced by many abused and neglected children, and highlight the necessity of closer monitoring of the progress of cases through the protective and court systems.


Child maltreatment as a community problem. This report reviews research on the community dimensions of child maltreatment and presents a study conducted in the United States designed to illuminate further the importance of social environmental effects on family functioning. The study involves 77 community areas within the Chicago, Illinois, metropolitan area. Child maltreatment rates are related to indicators of socioeconomic and demographic well being for these neighborhoods and for the subunits within them. The results reveal a strong influence of socioeconomic and demographic factors on child maltreatment rates. A further analysis involves selecting pairs of neighborhoods for additional study. In this phase of the research the character of socioeconomically similar areas with contrasting patterns of child maltreatment is revealed. The high-risk areas are characterized by social disorganization and lack of social coherence, in contrast to the low-risk areas which evidence a stronger social fabric. These effects extend to differences in child abuse fatalities.


Parental substance abuse and the nature of child maltreatment. The authors reviewed 190 randomly selected records from the case load of a large juvenile court. These records involved cases in which the state took legal custody of the children following a finding of significant child maltreatment, based on a "clear and convincing" standard of evidence. Sixty-seven percent (127/190) of these cases involved parents who were classified as substance abusers. The results of this study revealed specific associations between (a) alcohol abuse and physical maltreatment and (b) cocaine abuse and sexual maltreatment. Logistic analyses, testing for the effects of polysubstance abuse, revealed that additional forms of substance abuse failed to add significantly to the effects of alcohol in predicting physical maltreatment or cocaine in predicting sexual maltreatment.


Families at risk of child maltreatment: entry-level characteristics and growth in family functioning during treatment. Research suggests that perinatal screening and early intervention may reduce the incidence of maltreatment and improve the parenting in at-risk families. The question of whether families with different sets of entry-level characteristics differ in the way that they respond to intervention is asked in this paper. We investigated whether entry-level family functioning and family problems had an impact on length of time in treatment and the improvement or deterioration of family functioning over time. In our analyses, we used entry-level characteristics to classify families into five homogeneous groups--situationally stressed, chronically stressed, emotionally stressed, multirisk, and violent multirisk--and we found that treatment duration and rate of change in family functioning over time differed in clinically important ways across these groups. Our findings suggest that treatment is likely to be successful in stabilizing and slowly improving the family functioning of the majority of families at risk of child maltreatment.


Discovering physical abuse: insights from a follow-up study of delinquents. In a follow-up study of incarcerated Connecticut youth, 66 subjects participated in extensive personal interviews. This paper documents discrepancies between early data regarding abuse and retrospective self-reports of abuse given at the time of follow-up. It describes the development of an interview protocol in which inquiries regarding medical history, the general temperament of caretakers and their behaviors when intoxicated, and instruments and methods of punishment used in the home enabled subjects to describe abusive experiences not disclosed in response to direct questions about maltreatment. The paper also discusses the use of explicitly worded probes to flesh out a clear picture of subjects' experiences. The conflicts that underlie denial or minimization of abuse are discussed, along with interviewing strategies for overcoming them.


What happens after the care and protection petition? Reabuse in a court sample. Of 206 cases of serious child mistreatment brought before a metropolitan juvenile court on Care and Protection Petitions (C & P), 63 (31%) were dismissed (returning the child to the parent(s]. During a 2-year follow-up period, 18 (29%) of these dismissed cases had substantiated reports of further mistreatment, and 10 (16%) subsequently returned to court on another C & P. Families that had previously been to court for a C & P, and those in which the parent was diagnosed psychotic or character disordered, were significantly more likely to return to court. In addition, we were surprised to find that 8 (6%) of the 130 children ordered permanently removed from parental custody also returned to court. This study documents the continuing mistreatment of children, even after the state's most serious interventions. The study also highlights the necessity of incorporating clinical research in the form of ongoing follow-up of individual cases into the court process, and suggests that it may be possible to identify cases with a very high probability of reinjury and return to court.


University-based interdisciplinary training in child abuse and neglect. This article presents an overview of the 10 university-based interdisciplinary training programs in child maltreatment funded in 1987 by the National Center on Child Abuse and Neglect. The organizational structure, student composition, and academic requirements of the program are described. A more detailed description of one of the programs based in a medical school is presented as a model for replication. The specific clinical and didactic components of the program's curriculum are included. Additionally, recommendations for replicating an interdisciplinary graduate training program in child abuse and neglect are discussed.


Child abuse by mothers' boyfriends: why the overrepresentation? This study showed that although mothers' boyfriends perform relatively little child care, they are responsible for substantially more child abuse than other nonparental caregivers. Using data drawn from interviews with single mothers and records of child abuse substantiated through child protection investigation, mothers' boyfriends' overrepresentation in child abuse was traced to five conditions: (a) the location of their child care in single parent families; (b) their gender; (c) the absence of genetic relationship between mothers' boyfriends and their partner's children; (d) mothers' boyfriends' perceived illegitimacy as caregivers and family members; and (e) mothers' boyfriends' rivalry with their partner's children. The limitations of these findings and implications for future research are discussed.


Ego development in women with histories of sexual abuse. As many as a third of the women in this culture experience sexual abuse prior to reaching age 18. Recent literature and research have presented divergent views related to the impact of early abuse on ego development, with arguments supporting both ego fragmentation and ego acceleration. This preliminary study compared the level of ego development, as measured by Loevinger's Washington University Sentence Completion Test (SCT), of 30 women with histories of childhood sexual victimization, and 30 women with no history of abuse. Results indicated no significant difference between the ego levels of the sexually abused and nonabused groups, with a slight trend toward higher ego development in the abused group. Factors contributing to these findings are discussed and recommendations for future research are suggested.


Long-term effects of incest: life events triggering mental disorders in female patients with sexual abuse in childhood. The authors studied several psychosocial, psychosomatic, and psychodynamic factors in 33 female psychiatric patients who had been victims of incest. Abuse was almost exclusively severe and prolonged. Three quarters of the female patients had been abused by their biological fathers or stepfathers. Sexual abuse experiences in childhood are connected with feelings of anxiety, helplessness, and powerlessness. Together with a lack of support on the part of the mother, these experiences lead to ego weakness, an autoplastic mode of coping with aggression and to patterns of objectal relationships which predispose them to object loss. The links between a girl's traumatic experiences in relationships and her vulnerability to separation in later life and their importance for the incidence of mental disorders will be discussed on the basis of Bowlby's attachment theory.


Medical evaluation referral patterns for sexual abuse victims. It has been recommended that all children suspected of being sexually abused should have medical evaluations. To better understand practices and perceptions of child sexual abuse medical evaluations, a survey was conducted of 579 professionals attending educational programs on child sexual abuse; 85.8% (N = 497) responded. Half (50%) of the respondents reported no previous training in child sexual abuse. Of the 336 nonphysician professionals, 194 (57.7%) were in positions where they make referrals of the victims, and 69% of these did not refer all of the children they saw for medical evaluations. The first referral choice for medical evaluation was most often to the victim's primary physician (57%). For those professionals who did not refer all alleged victims for medical evaluation, neither the victims' age, gender, nor accessibility to care were generally considered relevant in determining the decision to refer. However, the type of abuse and presence of physical and psychological symptoms were considered relevant in making the decision. The majority indicated that the findings of the medical exam were very useful in substantiating or refuting the allegation of abuse. Further training for both medical and nonmedical professionals is needed to increase awareness of the need for and implications of the medical evaluation if children are to receive comprehensive assessments. Physicians may play an active role in this process through education of professionals and provision of care.


Network therapy using videotape disclosures for adult sexual abuse survivors. Treatment of childhood sexual abuse survivors may be enhanced by a technique designed to generate a therapeutic constituency for the survivor around the disclosure of childhood abuse experiences. The need for validating relationships is hypothesized as a condition for successful treatment. The videotaped disclosure process proceeds in five stages: (1) Deciding to make a tape, (2) making a videotape following a semistructured interview format, (3) the patient viewing the tape, (4) showing the tape to potential therapeutic team members, and (5) possibly using the tape for a confrontation with the abuser. The technique has been used on 27 cases. Case histories are given to illustrate the procedure. Discussion includes potential mechanisms of action and issues in treatment that arise with the use of the method described.


Fatality after report to a child abuse registry in Washington State, 1973-1986. Between 1973 and 1986, 11,085 children born in Washington State were reported to the state child abuse registry. We analyzed the fatality rate subsequent to reported abuse for this cohort of children compared to a population of nonabused children matched on sex, county of birth, and year of birth. Children reported to the child abuse registry had an almost threefold greater risk of death than the comparison population. A report of physical abuse carried the greatest risk of subsequent death. However, the relative risks were also elevated for children who suffered neglect or sexual abuse. Children reported to the registry were almost 20 times more likely than the comparison population to die from homicide. Children less than 1 year of age at time of reported abuse had the highest fatality rate subsequent to abuse, but adolescents had the highest relative risk for fatality after abuse, compared to the population of nonabused children. Rates of fatality subsequent to abuse were equal for males and females. Although this study could not measure the extent to which any given intervention reduced the risk of subsequent fatality in abused children, registries can serve a valuable function in identifying subpopulations at risk and quantifying that risk relative to the general population.


Countertransference in the family therapy of survivors of sexual abuse. As family therapy of sexual abuse survivors has become more common, theoretical and technical issues have received considerable attention. Less attention has been devoted to the countertransference experience of the therapist. Unexamined therapist countertransference is a critical element in the treatment of these families, which markedly influences the nature and direction of treatment. Particular types of countertransference are presented here. In addition, the contention is made that countertransference is not only evoked by the particular presentation of the family members, but also by the therapist's unexplored political and moral beliefs.


Evaluating risk assessment implementation in child protection: issues for consideration. The use of systematic risk assessment models by Child Protective Services is a rapidly growing phenomenon. Despite their popularity, we know little about the effect of implementation on casework practice. This article examines some issues that agencies might consider when evaluating the impact of risk assessment implementation on service delivery. The authors recommend an approach that includes the use of qualitative and quantitative measures in a process and an outcome evaluation to determine the degree to which the model has been implemented as intended and the impact of implementation on the case work process. Though this approach is likely to provide agencies with detailed information of the impact of risk assessment implementation, caution is recommended when interpreting the results from an evaluation of a risk assessment model in a field setting.


Juror and expert knowledge of child sexual abuse. Mental health professionals with expertise in child sexual abuse (CSA) often testify as expert witnesses in court. There is significant controversy over the admissibility of this type of evidence. To be admissible, the testimony of an expert must be beyond the common knowledge of the jury and based on information generally considered to be reliable within the professional community in which it is used. To date, no empirical data have existed to allow courts to make an informed judgement as to the extent of either juror knowledge or professional acceptance of CSA data. The present study addresses this issue. Jurors and experts completed a questionnaire designed to reveal their understanding of CSA. Results indicate that experts demonstrated strong consensus on 29 of 40 items included in the questionnaire, and that relative to experts, jurors have limited knowledge of these issues. These results suggest that many of the scientific findings concerning CSA are reliable and that the information is often beyond the common knowledge of the jury. These findings argue for the use of expert testimony in select cases of child sexual abuse.


Childhood history of abuse and child abuse screening. Although a childhood history of abuse is related to parental child abuse, many parents with a history of abuse are not abusive. To determine the effects of a childhood history of abuse on adult child abuse potential, a modified Conflict Tactics Scale (CTS) and the Child Abuse Potential (CAP) Inventory were administered to matched groups of physically abusive mothers with a childhood history of abuse, nonabusive comparison mothers with a childhood history of abuse, and nonabusive comparison mothers without a childhood history of abuse. The modified CTS asked about childhood events and was used to confirm a childhood history of abuse. As expected, the CTS verbal and violence scales were higher for the abusive and nonabusive mothers with a childhood history of abuse. None of the CTS scores were different for the abusive and nonabusive mothers with a childhood history of abuse. In contrast, the CAP abuse scores distinguished between all three study groups. However, on the CAP factor scales, only the rigidity and unhappiness factors discriminated between abusive and nonabusive mothers with a childhood history of abuse. Nonabusive mothers with a childhood history of abuse were less rigid in their child expectations and were happier in their interpersonal relationships than abusive mothers with a childhood history of abuse.


Physically abusive parents and the 16-PF: a preliminary psychological typology. A typology of physically abusive parents was developed based upon personality characteristics measured by the 16-PF. Cluster analysis revealed five distinct patterns, accounting for 81 of 82 profiles submitted. Significant differences among the clusters were found on 14 of the 16 factors. The following types were described: (a) Shy, withdrawn, apprehensive, sober, and restrained; tending to have the least education, the greatest number of children. (b) Parents presenting as "normal" in personality features; tending to have relatively more education, fewer children. (c) Compulsive, bold, dominant, and assertive; tending to be highly manipulative in self-presentations, have high educational levels, and be older than other types. (d) Basically passive and submissive; tending to come from families where both parents are abusive. (e) Isolated, withdrawn, suspicious, tense, and apprehensive; tending to be more psychologically disturbed. Significance tests on external variables performed to validate the solution found differences among clusters in age, education, number of children, number of parents involved in abuse, 16-PF Faking Good and Faking Bad scores, and MMPI Scales L, F, K, 4, 5, 6, 7, and 0. Distinguishing personality features and demographic characteristics of the types are discussed with a focus upon possible treatment approaches for each type. Limitations of the study and suggestions for future research are addressed.


Progress and issues in the implementation of the 1984 out-of-home care protection amendment. The purpose of this paper is to assess the status of implementation of out-of-home protection programs since 1984 in the U.S. Data was obtained from a survey of state child protection services (CPS) liaisons in summer, 1989. A framework for viewing protection after placement is presented and the development of policy regarding maltreatment in out-of-home care is traced from its roots in the deinstitutionalization movement. Changes in state statutes and rules, results in out-of-home abuse and neglect reporting, how states operationalize "properly constituted authority" and "independent investigation," the role of licensing in preventing and remediating out-of-home maltreatment, training initiatives and the extent of the use of background checks are reported. A summary evaluation of the status of the implementation of the federal 1984 out-of-home care protection amendments by state agencies is offered.


Mother's age and risk for physical abuse. It is widely believed that young mothers are at greater risk of engaging in physical abuse. However, this relationship is not clearly supported by previous empirical research. This study reexamines the issue using a nationally representative sample of 1,997 mothers. All analyses controlled for family income, race, number of minor children in the home, age of abused child, mother's education, and whether mother was a single parent. Physical abuse was measured with the Conflict Tactics Scales. Using mother's age at time of birth of the abused child, the younger the mother, the greater the rate of child abuse; however, there was not a significant relationship when mother's age was measured at age at time of abuse. Large families and minority group children were also found to be at greater risk of abuse. The paper discusses implications for further research and for prevention of child abuse.


Substantiation of reported child abuse or neglect: predictors and implications. Underreporting and overreporting of suspected child abuse and neglect cases reduce the efficiency of child protection services. We used all the reports in South Australia for 1988-1989 (N = 3,228) to study the determinants of the decision by child protection workers to register a reported incident as being one of child abuse and neglect. Logistic regression showed that registration (substantiation) was predictable from two variables: the age of the alleged victim and the caseworker's estimate of severity. This latter variable needs investigation, as despite its crucial role we have no information on how caseworkers form a judgment about severity.


[Polymorphism of HLA class I loci HLA-A, -B, -C, in the Mandenka population from eastern Senegal]. A sample of 162 Mandenkalu from Eastern Senegal has been typed for three HLA class I loci: HLA-A, -B and -C. The Mandenka population presents a very high genetic variability with 15 alleles for locus A, 24 alleles for locus B, and at least 8 alleles for locus C. The calculated heterozygosities for the three loci A, B, and C are respectively 0.884, 0.944 and 0.829. The Mandenkalu allelic frequencies are close to that found in other sub-Saharan populations. They show, however, some peculiarities like the occurrence of the Bw 56 allele and the high frequencies of both B5 and B35.


[Production of hyaluronan-binding glycoprotein by human monocytes. Its use as marker in myeloid leukemia]. A hyaluronan-binding protein fraction was isolated by affinity chromatography of peripheral human blood mononuclear cell culture medium through immobilized hyaluronan. The presence of a hyaluronan-binding protein similar to human brain hyaluronectin was demonstrated by (i) the ELISA method on hyaluronan-coated plastic plates using anti-hyaluronectin antibodies, (ii) the lowering of the elution volume of the protein on liquid gel chromatography in the presence of hyaluronan, (iii) the extinction of the reaction to human brain hyaluronectin when antibodies were absorbed out with monocyte hyaluronectin, (iv) western blotting with polyclonal and monoclonal anti-hyaluronectin antibodies. The hyaluronectin-producing cells were adherent (10 min., 37 degrees C) to plastic, esterase (+) and CD 14 (+) cells and had the morphology of monocytes. The protein expression was investigated in leukemic cells by means of the immunocytochemical method. Hyaluronectin expression was restricted to 4/12 of M4 and M5 types of acute myeloid leukemias. Other myeloid leukemia and acute lymphoblastic leukemia cells were negative. The results indicate that hyaluronectin can be produced under free form in the absence of hyaluronan, by human peripheral blood monocytes. It supports the hypothesis that the expression of hyaluronectin in tumour stroma could be due, at least in part, to inflammatory cells of the tumour. The expression of the protein by M4 and M5 acute myeloid leukemia cells suggests that hyaluronectin could be synthesized by immature cells of the monocytic lineage as well as by mature monocytes.


[Fragmentation of fibronectin in cystic fibrosis]. Fibronectin (FN) plays an important role in mediating cell-matrix interactions and also as an opsonin in the phagocytosis of some microorganisms. Due to its domain structure FN is easily attacked by proteolytic enzymes and especially by elastases. Some of the fragments possess original properties as potentiation of viral transformation or proteolytic activity absent in the intact molecule. Cystic fibrosis is frequently accompanied by infection with protease generating microorganisms, such as Pseudomonas aeruginosa. Polyacrylamide gel electrophoresis and immunoblotting revealed the presence of FN fragments in the plasma of patients with molecular weight between 30 and 100 kD. Purified plasma FN was rapidly hydrolyzed in fragments by the sputum of patients as well as by purified Pseudomonas elastase. The comparison of fragments detected in patients' plasma with those produced by in vitro proteolysis confirms the probability of in vivo fragmentation of FN in cystic fibrosis and suggests that several proteolytic enzymes, endogenous and of bacterial origin, might be involved.


[Epidemiological observations on iridovirosis of Lymnaea truncatula, host mollusca of Fasciola hepatica]. Epidemiological studies were carried out in 11 populations of Lymnaea truncatula in 1983-1984 and 1987-1989 to determine the prevalence of snail infection by an iridovirus. The virus was found in the different populations and samples, with a frequency ranging from 1.6 to 87%. The virosis would be endemic.


Professionals' standards of "normal" behavior with anatomical dolls and factors that influence these standards. Do professionals have a consistent standard of what constitutes normal behavior with anatomical dolls? To answer this question, 201 professionals who work with child sexual abuse victims were asked to rate the normalcy of various behaviors with the dolls for nonabused children ages 2 to 5.9 years. The majority of respondents agreed that overtly sexual behaviors, such as demonstrating oral-genital contact or vaginal intercourse, were abnormal for nonabused children. For less obvious behaviors, such as touching the sex parts of dolls, there was more disagreement among professionals about what these behaviors mean. The ratings of these ambiguous behaviors varied depending on profession of the respondent, gender of the respondent, and number of years of experience. Law enforcement professionals, women, and those with the least amount of experience were more likely to view ambiguous behaviors as abnormal. These findings are discussed in the context of past research, with suggestions for future studies.


Behavioral problems in alleged sexual abuse victims. This study was conducted to compare the parental assessments of problem behaviors, using the Achenbach Child Behavior Checklist, among alleged sexual abuse victims (n = 81) and an age, race, and gender matched group of nonabused comparison subjects (n = 90). Alleged sexual abuse victims demonstrated significantly higher mean total behavior problem, internalizing and externalizing scores than the comparison sample. Subscale profiles were all in the direction consistent with withdrawal, impairment in social interaction, and sexual problems. Item comparison indicated that sexual abuse victims were more likely to be assessed as having some problem behaviors that have been reported as being indicative of sexual abuse. A significant difference was not obtained on several behaviors that have been previously reported as indicative of sexual abuse. These findings support concerns that sexual abuse victims do exhibit more problem behaviors, but caution must be exercised when interpreting individual behaviors because of their frequency in a nonabused sample.


Protective personality characteristics among adolescent victims of maltreatment. The purpose of this research was to examine whether personality characteristics, locus of control orientation, and self-esteem were protective against depression among female adolescent victims of maltreatment and to examine whether the presence of these characteristics was related to the age of the victim when maltreatment began. Thirty-three maltreated adolescent females and a comparison group of 112 nonmaltreated female adolescents were administered a questionnaire containing scales measuring locus of control orientation, self-esteem, and depression. Results revealed that personality characteristics interacted with maltreatment status in predicting depression, suggesting that they are protective factors. Results also revealed that adolescents who first experienced maltreatment during childhood were significantly less likely than those who first experienced maltreatment during adolescence to have these protective personality characteristics.


Agreement among professionals about a child's sexual abuse status: interviews with sexually anatomically correct dolls as indicators of abuse. This study was designed to define clinicians' ratings of the comments, behaviors, and affects of abused children and compare them with the same clinicians' decisions about the child's abuse status. The authors concluded that sexually anatomically correct dolls used alone are inadequate in providing enough information for professionals to accurately assess the abuse status of young children. Also it is unclear what observations of the child by mental health professionals are best correlated with their determinations of a child's abuse status. Of concern was the finding that the mental health professionals were more likely to be in agreement with the interviewer's determination of abuse than with the actual status of the child, suggesting undue influence of the interviewer, or, alternatively, both observer and interviewer were responding to unidentified child factors.


Nationwide practices for screening and reporting prenatal cocaine abuse: a survey of teaching programs. Questionnaires surveying policies and opinions about prenatal cocaine abuse were sent to training programs nationwide. Eighty-one pediatric and 81 obstetric programs from 42 states responded. Although respondents favored routinely screening all patients by maternal history (81%) and by urine toxicology (36%), only 64% and 8%, respectively, reported these as established policy. Physicians reporting higher regional prenatal cocaine abuse rates more commonly favored universal perinatal screening (p = .009), but established policies were similar regardless of local prevalence (p = .19). Fifty-two percent of respondents were unaware of their state's requirements for reporting prenatal cocaine abuse. While most physicians favored interventions such as voluntary drug rehabilitation (64%) and family support services (64%), some physicians favored foster care placement for the infants (28%) and involuntary drug rehabilitation (31%). Only 3% felt that criminal prosecution of the mother was appropriate. Policies for managing prenatal cocaine abuse often did not reflect physicians' opinions. A multidisciplinary medical, social, and legal approach is needed to develop effective management policies.


Sexual abuse by grandparents.

Sexual abuse by grandparents. Using a sample of 95 case records of sexual abuse substantiated through child protection investigation, this study confirmed several findings from earlier studies of sexually abusive grandparents: (a) virtually all perpetrators are male, (b) the vast majority of victims are female, (c) a disproportionately large share of abusive grandfathers appear to also be sexually abusive fathers, and (d) stepgrandchildren appear to experience greater risk. Additionally, it was noted that stepgrandparent perpetrators were more threatening and physically violent. However, contrary to some earlier studies, evidence was provided that this form of abuse is inappropriately described as "gentle." Explicit threats and overt physical assault were noted in 14 cases. Moreover, the other tactics used to gain children's compliance, such as overpowering them, suddenly grabbing their genitals, and attacking them in their sleep, appeared to seriously compromise children's autonomy and personal integrity.


Endotracheal intubation.

Endotracheal intubation. Endotracheal intubation can be accomplished by several different methods, which are discussed herein. Special considerations such as the obstructed tube, air leakage around the tube, tube replacement, and drug therapy are also reviewed, as are the indications for tracheostomy, the use of double lumen tubes, and fiberoptic laryngoscopy or bronchoscopy.


Central venous catheterization in the critically ill patient. Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.


Temporary transvenous cardiac pacing.

Temporary transvenous cardiac pacing. Temporary cardiac pacing in the critical care setting can be a lifesaving intervention in a number of clinical situations. A variety of catheter types and pulse generators are available. Insertion techniques include the use of fluoroscopic imaging, intracavitary ECG monitoring, and blind advancement with surface ECG monitoring. This article focuses on the indications, equipment, techniques, complications, and troubleshooting of temporary transvenous cardiac pacemakers.


Peritoneal catheterization.

Peritoneal catheterization. Procedures involving invasion of the peritoneal cavity are often performed on critically ill or injured patients. Like any invasive procedure, they require a thorough understanding not only of their techniques and indications, but also of their contraindications and complications. Used appropriately, these procedures may serve as invaluable diagnostic or therapeutic tools in the care of acutely ill patients.


Sengstaken-Blakemore tube placement. Use of balloon tamponade to control bleeding varices. The management of acute variceal bleeding continues to challenge those who care for patients with portal hypertension. Survival depends on rapid institution of an established protocol for resuscitation, diagnosis, and management of the patient. Balloon tamponade plays an important part in the management of this problem along with pharmacologic and endoscopic modalities. It is important in closing, however, to note that guidelines for use cannot compensate for lack of experience and the authors agree with Vlavianos and colleagues in stating that without experience in its use, balloon tamponade is of limited value.


Advances in the screening and treatment of ovarian cancer. Ovarian cancer is the leading cause of death from gynecologic malignancies. This article reviews the newer chemotherapeutic agents and treatment strategies available to the practicing clinician. Also discussed are the benefits and shortfalls of the various options for screening, such as ultrasound and tumor markers, as well as the data supporting oral contraceptives and the controversy surrounding prophylactic oophorectomy.


Colonoscopy.

Colonoscopy. Colonoscopy is an accepted technique for investigation of the colon. No portion of the large bowel is inaccessible to the diagnostic and therapeutic approach by flexible colonoscopy. The technical aspects of instrumentation have yielded to progress, with a small television chip currently incorporated into the tip of endoscopes transmitting an excellent image of the colon. Primary colonoscopy is being performed for selected indications, and, as facility with the technique increases, there will be a greater tendency for the performance of primary colonoscopy. Interruption of the adenoma-carcinoma sequence by techniques of snare-polypectomy may serve to markedly decrease the incidence of colon cancer over the next generation.


Fiberoptic bronchoscopy in the intensive care unit. The primary uses of FFB in the intensive care unit are in the diagnosis of opportunistic infection and for airway management. In addition, use of PTC brush or BAL with quantitative cultures may allow identification of the specific cause of bacterial pneumonia. Determination of the location and cause of pulmonary hemorrhage is possible in the intubated patient without massive hemoptysis. Use of FFB in atelectasis is more controversial and less commonly encountered. Other uses include foreign body retrieval, tamponade of bleeding segments and diagnosis/treatment of BPF. In addition to development of technical skills and knowledge of the indications for FBB, critical care physicians should be aware of contraindications and potential complications, as well as steps to minimize the latter.


Using a population-based cancer reporting system to evaluate a breast cancer detection and awareness program. During May 1987, a total of 10,207 Wisconsin women were screened as part of a statewide Breast Cancer Detection and Awareness program sponsored by the Wisconsin Division of the American Cancer Society. Data from a population-based cancer reporting system were used to predict the number of expected breast cancer cases for that year. After controlling for secular and seasonal trends, we found that, compared with the number of cases that would have been expected, 51 more cases of localized breast cancer were diagnosed in the state during the time of the program. This study demonstrates the public health impact of a statewide screening program and the usefulness of a cancer reporting system in program evaluation.


Pulmonary artery catheterization.

Pulmonary artery catheterization. After two decades, hemodynamic invasive monitoring using a flow-directed, balloon-tipped, pulmonary artery (PA) catheter has established itself as a significant component of acute clinical care. In spite of continued recommendations for limitations, restrictions, moratoria, and even abandonment, growth in catheter use continues. Attempts to replace it by competing technologies for routine clinical practice have not been successful thus far. More than one million PA catheters are inserted in the United States annually. The clinical utility and value of the pulmonary artery catheter depend largely on the interpretation of information obtained. Clinical interpretation of data is influenced by an understanding of cardiopulmonary hemodynamics, technical skills, and professional integrity of the physician using the device. After a brief history, this article focuses on the technical aspects of the insertion procedure, choice of hardware, and acquisition and analysis of information. Indications, contraindications, and clinical utility are briefly described. Major complications from PA catheterization reported in the literature since clinical introduction of the catheter are summarized.


Peripheral vascular cutdown.

Peripheral vascular cutdown. Critically ill patients who are not candidates for percutaneously placed arterial and venous lines require surgical cutdown. Although significant complications may arise from inadvertent injury to the vessel or associated structures during arterial and venous cutdown, these complications can be minimized by meticulous technique. With attention to site selection and catheter care, the useful life of these complex catheters approaches that of percutaneously placed devices. Finally, although the sequelae of placement by these techniques--including wound and catheter infection, distal ischemia, and vessel ligation--are increased, the need for appropriate intravascular access in these patients far outweighs the potential risks.


Percutaneous intra-aortic balloon counterpulsation. Intra-aortic balloon pumping is the mainstay in the management of acute left ventricular dysfunction in the critical care setting. Percutaneous insertion affords rapid initiation of the procedure. Complications are in greatest part vascular and infectious. The advent of new-generation, totally automatic, closed-loop IABP systems offers the prospect of increasing the effectiveness of IABP support under most conditions, and especially during arrhythmias. This and other developments suggest that despite its standing as the most widely used temporary cardiac assist device, IABP has still to realize its full therapeutic potential.