Critical evaluation of the 'heated-hand-technique' for obtaining 'arterialized' venous blood: incomplete arterialization and alterations in glucagon responses. In order to test the degree of 'arterialization' and the occurrence of arterio- (or capillary-) venous differences in glucose concentrations for commonly used blood sampling sites (including the retrogradely cannulated dorsal hand vein with application of dry heat to this hand/arm--the 'heated-hand-technique'), oxygen partial pressure (oxygen saturation) and plasma glucose was determined in blood drawn from different venous sites before and after an oral glucose load (75 g). Experiments with and without heating (hot air 68 degrees C) were compared in nine healthy volunteers. Basal pO2 (and oxygen saturation) increased in the order cubital fossa vein less than superficial forearm vein less than dorsal hand vein. Heating raised pO2 by approximately 20 mmHg; P = 0.008) and oxygen saturation (P = 0.008-0.02) at all sites, including those on the contralateral arm. Capillary-venous glucose differences after the glucose challenge were significantly related to the sampling site (P less than 0.0001). They were reduced by approximately 50% in response to heat exposure (P = 0.008-0.011) and could be correlated to pO2-values (r = 0.92; P = 0.01). The lowest capillary-venous glucose concentration difference was measured with the 'heated-hand-technique' (0.4 +/- 0.1 mmol l-1). Heating did not alter integrated incremental glucose (capillary values), insulin, and C-peptide-responses and late, counter-regulatory responses (120-240 min after glucose) of cortisol, growth hormone, and adrenalin. However, the late glucagon response was enhanced (P = 0.011) by heating, concomitant with a significantly reduced 'reactive' decrement in glucose concentrations. In conclusion, the 'heated-hand-technique' provides blood more similar to arterial blood that can be obtained from other venous sampling sites. However, significant residual differences in pO2 and glucose concentrations remain. In addition, altered counter-regulatory hormone responses may occur with heating.


Exercise echocardiography: a methodological study comparing peak-exercise and post-exercise image information. It is unclear whether echocardiography at peak bicycle exercise adds information to registrations obtained recumbent immediately after the test and what factors influence image quality. Therefore, exercise echocardiography was performed consecutively and prospectively in 66 men, unselected with regard to echocardiography, one month after an episode of unstable coronary artery disease. Of 594 segments (9 x 66), 569 (96%) were adequately visualized recumbent at rest. The corresponding figures recumbent directly after exercise, seated before exercise, and seated at peak exercise were 544 (92%), 474 (80%), and 428 (72%), respectively. In the majority of our patients, acceptable images at peak exercise were obtained for the septal region, while for the anterior, lateral, and inferior segments the success rate varied from 50 to 70%. Recumbent after exercise, the success rate was acceptable for most segments, possibly with the exception of the apical and lateral segments. Fifty-five patients developed new wall motion abnormalities or worsening of wall motion in connection with exercise. Echocardiography at peak exercise provided more information than afterwards in patients with images of good quality. However, in patients with inferior image quality, the registrations obtained recumbent after the test revealed wall motion abnormalities which were not obtained seated at peak exercise. Patients with worse image quality had significantly higher respiratory rate and weight, and rated a higher degree of dyspnoea at peak exercise than those with good quality. We conclude that in middle aged men with coronary artery disease, image acquisition at peak bicycle exercise and immediately after exercise are of complementary value.


Dependence of maximum performance time on work intensity in patients with a hereditary myopathy with succinate dehydrogenase deficiency. Patients with a hereditary mitochondrial myopathy with succinate dehydrogenase (SDH) deficiency and abnormal lactacidosis during physical exercise have a low work capacity when exercising for about 10-15 min. Their maximum voluntary muscular strength is fairly normal. The relationship between the time (t) and a constant workload (N) that a healthy subject can maximally sustain can be expressed as: log t = beta + alpha log N. For normal subjects the constant alpha is approximately -5 and the constant beta has a large interindividual variation. Of four myopathy patients alpha was determined from two or three maximum bicycle exercise tests of different duration (including ramp- and steady-state tests using a new application of the method of adding submaximal loads to the final maximum workload). The value of alpha varied between -1.0 and -1.81 and beta had low values, both significantly different from those of healthy subjects. The alpha values explain the divergent results that may be obtained with different types of exercise tests in some of these patients, i.e. a normal or moderately reduced capacity in exercise tests of short duration (for example a short Tornvall or a ramp type of test) and a very low exercise capacity in tests of longer duration (for example a steady state type of test with workloads chosen to allow at least two loads). The low absolute value of alpha may be related to the abnormally increased anaerobic metabolism of these patients during exercise, caused by the SDH deficiency.


Distribution of radioactive aerosol in the airways of children and adolescents with bronchial hyper-responsiveness. The purpose of this study was to examine the relationship between the pulmonary distribution of inhaled radioaerosol, bronchial responsiveness, and lung function in children and adolescents. The participating subjects (n = 39) were divided into three groups: (1) 14 asthmatics with bronchial hyper-responsiveness (BHR), (2) five non-asthmatic subjects with BHR, and (3) 20 controls without BHR. Pulmonary distribution of [99Tcm) albumin radioaerosol, maximal expiratory flow when 25% of forced vital capacity remain to be exhaled (MEF25), and bronchial responsiveness to inhaled histamine were measured. Twenty subjects (52%) had irregular central distribution and 19 subjects (48%) had regular distribution of radioaerosol in their lungs. No difference in distribution of radioaerosol was found between the three groups of children. The median MEF25 among non-asthmatic subjects (80% predicted) was lower than that found in controls (92% predicted) but higher than that found in asthmatic subjects (55% predicted). A relationship was found between reduced flow at the peripheral airways, as indicated by MEF25 and the degree of central distribution of radioaerosol. Furthermore, subjects with irregular central distribution of radioaerosol had an increased degree of bronchial responsiveness. In conclusion, children and adolescents who have flow rates in the peripheral airways or increased degree of bronchial responsiveness tend to have abnormal distribution of radioaerosols.


Pulmonary clearance of 99mTc--DTPA and 99mTc-albumin in rabbits with surfactant dysfunction and lung injury. We measured the pulmonary clearance of inhaled 99mTc-DTPA and 99mTc-albumin in rabbits with surfactant dysfunction induced by dioctyl sodium sulphosuccinate and in rabbits with lung injury induced by oleic acid. The animals were tracheotomized and mechanically ventilated. After inhalation of 99mTc-albumin in ten animals, clearance of the tracer from the lungs was monitored for 90 min. The first 30 min was a control period. Dioctyl sodium sulphosuccinate was then administered in aerosol and after another 30 min oleic acid was injected intravenously. Ten other rabbits were given 99mTc-DTPA, and clearance was externally recorded for 60 min. Five animals inhaled detergent aerosol and five animals were given oleic acid intravenously after 30 min. Airway pressures, tidal volume, and arterial blood gases were measured before and after each intervention. The half-life of 99mTc-albumin in the lung was 442 +/- 123 min during the control period, 363 +/- 52 min after detergent administration, and 134 +/- 18 min after oleic acid administration (P less than 0.05 compared to control and P less than 0.01 compared to the period after detergent). The half-life of 99mTc-DTPA was 94 +/- 16 min before and 10 +/- 0.6 min (P less than 0.01) after detergent administration and 75 +/- 12 min before and 18 +/- 1.8 min (P less than 0.01) after oleic acid administration. Gas exchange was not affected by administration of dioctyl sodium sulphosuccinate but markedly impaired after injection of oleic acid. Compliance of the respiratory system remained unaffected by detergent but decreased after injection of oleic acid.(ABSTRACT TRUNCATED AT 250 WORDS)


Miniature silicon diode matrix-detector for in vivo measurement of 133xenon disappearance in the canine myocardium following local tissue injection. After local tissue depositioning of 133Xenon (133Xe) the regional washout is usually registered by a NaI(Tl) detector. The residual radioactivity of 133Xe is usually measured at its 81 keV photopeak. However, using small Silicon (Si) photodiodes it is feasible to measure only the low-energy activity in the X-ray energy range. In the myocardium of open chest dogs 133Xe washout measurements by a matrix of Si diodes composed in a 4 x 4 array and a conventional NaI(Tl) detector were carried out simultaneously. Fourteen separate pairs of measurements were performed in 3 dogs. When the Si-diodes in the matrix were selected individually in accordance to the position with reference to the diode with maximum count rate or pooled, comparisons could be made between the corresponding washout rate constants measured by the reference detector. In the correlation between the rate constants the intercepts with the y axis were not significantly different from zero allowing the correlation lines to be fitted through (0.0). The slope of the correlation line was close to unity. The registration of the low-X-ray energy of 133Xe by the Si-detectors is an alternative to the conventional high energy activity recording appearing from the gamma-energy of the photopeak. The detector matrix concept allows elimination of motion artefacts and indicator distribution in the myocardial tissue. Due to the uniformity and low cost of Si-diodes the perspective may be the introduction as a disposable transducer useful during cardiac surgery for example.


[The effect of the use of sinusoidal modulated currents on the recovery of athletes]. Modular sinusoidal currents were used to optimize the recovery process of the force of athletes' muscles. 113 elite athletes were analyzed. They were participants in rowing, cycling, tennis and Greco-Roman wrestling. In all cases the modular sinusoidal currents were applied to the dorso-cervical and lumbar regions. It was found that applications to the dorso-cervical regions normalize the altered parameters of the cardiovascular system and increase the capacity of the humeral muscles to contract. Furthermore they stabilize the adrenergic sympathetic zone and stimulate the immune system.


High density lipoprotein cholesterol low serum level as the only risk factor in male patients with coronary heart disease. Forty-three male patients with myocardial infarction, severe angiographic coronary lesions, high or normal low density lipoprotein (LDL) cholesterol serum levels, and without other risk factors for coronary heart disease were selected. In all patients high density lipoprotein (HDL) cholesterol and HDL-cholesterol/total cholesterol ratio were significantly lower than in the control group; in particular, the ratio was below 0.240 which was the median value of normal subjects. Six patients with total cholesterol and LDL-cholesterol below 5.16 and 3.35 mmol/l respectively, had low serum levels of HDL-cholesterol; in 4 of them the value of this risk factor was below 0.9 mmol/l; 2 of 6 patients had a lipoprotein (a) serum concentration above 0.3 g/l but not a premature myocardial infarction or a clinical history of coronary heart disease. Our data confirm that HDL-cholesterol/total cholesterol ratio could be a better marker of coronary heart disease than HDL-cholesterol, total cholesterol or LDL-cholesterol and suggest the importance to check HDL-cholesterol serum levels also in subjects without risk factors for atherosclerotic disease.


[The otilonium bromide-benzodiazepine combination in the therapy of the irritable colon syndrome]. The irritable bowel syndrome is classified ad "disturbance of intestinal motility without an identifiable anatomic substrate". However, the clear etiopathogenetic implications of a psychosomatic nature complicate the search for an adequate therapeutic strategy. Based on this clinical experience, we set out to check the importance of a spasmolytic with a benzodiazepine and the tolerability of this type of combination. We therefore compared the results in 60 patients with irritable bowel syndrome of 8 weeks' treatment with tablets containing octylonium bromide (OB) 20 mg plus diazepam (DZ) 2 mg or OB 40 mg + 2 mg DZ. The doubling of the spasmolytic without increasing the daily dose of anxiolytic appeared to be useful for reducing the symptoms typical for the irritable bowel syndrome. In addition, the combination was found to be perfectly tolerated.


[Otilonium bromide-diazepam in the treatment of the irritable colon. A controlled study versus otilonium bromide]. Octylonium bromide (OB) is a drug with spasmolytic properties acting selectively on the smooth muscle of the gastrointestinal tract by interfering with calcium mobilization from extra- and intra-cellular deposits. The etiopathogenetic implications of a psychosomatic nature of the irritable bowel syndrome amply justify the use of a spasmolytic (OB) with a benzodiazepine. In our study, we compared the combination OB + DZ (20 mg + 2 mg) T.I.D. versus OB alone (20 mg) in 30 patients suffering from irritable bowel syndrome. The double-blind study lasting 3 weeks was aimed at evaluating gastrointestinal symptoms (bowel motions, aspect of faeces, abdominal pain, pre-evacuation pain, bloating) during the three days preceding the study and during the last five days of treatment, as well as the anxiogenic situation as assessed by the STAI scale (State Tract Anxiety Inventory) before and at the end of the treatment period. The results obtained showed that both treatments considerably reduced gastrointestinal symptoms even though OB alone did not appear to be equally effective and the anxiety component was significantly reduced only by treatment with the combination. The absence of side effects and the perfect tolerability of both treatments showed the OB + D combination T.I.D. to be the treatment of choice for patients suffering from irritable bowel syndrome.


[The prevalence of rhinopharyngeal staphylococcal carriers among those employed in the communal food services of the province of Rome]. Microbial food contamination is at present less frequent than in the past. Nevertheless, Staphylococcus aureus food poisoning is still among the most frequent ones in Italy. The authors screened nasal swabs of 112 person working in five communal feeding services in Rome province; of these, 53 were found to be positive. This percentage (48.3%) does not differ substantially from those found by other researchers in various Italian cites.


[A comparison between computed tomography and magnetic resonance in the verification of prolactinomas]. First, computer tomography and subsequently magnetic resonance have profoundly changed the diagnostic protocol for the study pituitary pathology. Conventional X-ray and examination with the use of contrast media are being employed less and less. Tomographic techniques (CT and RM) permit direct identification of anomalies as well as precise evaluation of their relationship with surrounding structures.


[Consumer behaviors in obesity due to overeating. The usefulness and limits of diet therapy]. Appropriate dietary prescription has still a useful place in a weight reducing program, but no such program must be prescribed before careful evaluation of the risk for psychological derangement that may be the consequence. A rational interdisciplinary approach is essential. The importance of correcting a sedentary life style must not be overlooked.


Parity, ethnic group and the prevalence of type 2 diabetes: the Coventry Diabetes Study. The prevalence of Type 2 (non-insulin-dependent diabetes) in relation to parity was compared among South Asian (Asian) and European women during a cross-sectional house-to-house screening programme for diabetes in Foleshill, Coventry, UK. The parity of female residents was ascertained in 8 of the 12 areas visited. These areas contained 2096 European (68 with diabetes diagnosed) and 1148 Asian women (95 with diabetes diagnosed). Crude prevalence of Type 2 diabetes was 3.2% and 14.7% in Europeans aged 30-64 years and > or = 65 years, respectively, and 10.9% and 36.5% in similarly aged Asians, respectively. In those aged 30-64 years, the age and body mass index adjusted prevalence of Type 2 diabetes was highest among nulliparous (Europeans 4.4%, Asians 16.3%) and grand multiparous (parity > or = 5: Europeans 6.3%, Asians 16.5%) women when compared with women who had had 1 or 2 deliveries (Europeans 0.9%, Asians 3.3%, p < 0.001, both ethnic groups). However, parity had no effect among women aged > or = 65 years.


The prevalence, detection, and epidemiological correlates of peripheral vascular disease: a comparison of diabetic and non-diabetic subjects in an English community. A cross-sectional study was performed to investigate the distribution, methods of detection, and potential risk factors for peripheral vascular disease in a diabetic population with comparison to an age and sex matched non-diabetic group. The population came from a geographically defined area consisting of 10 general practices (total list size 97,034) and covered rural and urban districts of East Dorset. Peripheral vascular disease was defined as an ankle/brachial Doppler pressure ratio of 0.9 or less. Of the diabetic subjects reviewed, 864 were classified as having Type 2 diabetes and 213 Type 1 diabetes. The prevalence of peripheral vascular disease in Type 1 diabetes was 8.7% (95% CI 4.9-12.5) and in Type 2 diabetes 23.5% (95% CI 20.5-26.5), which after adjusting for age was not significantly different (odds ratio 1.5, 95% CI 0.8-2.7, p = 0.18). There was no difference in the frequency of symptomatic peripheral vascular disease or the site of occlusion between diabetic and non-diabetic subjects with peripheral vascular disease. Age, cerebrovascular disease, coronary artery disease, glucose, body mass index, and cholesterol in Type 2 diabetes and age and proteinuria in Type 1 diabetes were significant predictors of peripheral vascular disease. In the non-diabetic group, age and cigarettes smoked were significant variables. These findings suggest that clinical features of peripheral vascular disease in diabetic and non-diabetic subjects are similar but risk determinants may be different.


Clinical examination versus neurophysiological examination in the diagnosis of diabetic polyneuropathy. Several methods have been used to diagnose diabetic polyneuropathy and to quantitate the degree of affection of peripheral nerves. Using a newly developed scoring system we compared bedside clinical examination with neurophysiological examination in a group of 78 diabetic patients. Individual scores for clinical examination were significantly correlated with scores for neurophysiological examination (r = 0.7, p < 0.0005). All 78 patients had at least one clinical symptom or sign of polyneuropathy. Clinical examination indicated polyneuropathy in three patients with neuropathic complaints, while neurophysiological examination in these patients showed no abnormalities. In 12 out of 14 patients with normal neurophysiological sensory nerve function, clinical examination showed at least one abnormal sensory modality. Comparing the four different sensory modalities, light touch sense and pinprick sense indicated polyneuropathy better than vibration or position senses. An abnormal Hoffmann reflex of the soleus muscle was always associated with a decreased or absent ankle jerk. The scoring system for the clinical examination proved useful for diagnosing and quantitating the severity of diabetic polyneuropathy. Clinical sensory deficits could not be inferred from the results of neurophysiological testing of sensory nerve function. Pinprick sense, light touch sense, and ankle jerks were the most important parameters in the clinical diagnosis of diabetic polyneuropathy.


The effect of weight-bearing pressure on the plantar circulation in diabetes mellitus. Patients with diabetic neuropathy are prone to ulceration on the sole of the foot, especially in areas with high weight-bearing pressure. The relationship between weight-bearing pressure and nutritive skin circulation in the plantar region was studied. Gait analysis was performed with the EMED Gait Analysis System and the skin circulation was measured by fluorescein flowmetry in ten neuropathic diabetic patients and in eight healthy controls. The critical plantar foot pressure above which nutritional blood flow in the skin was arrested was 3 N cm-2 or more in both diabetic and control subjects. Below 3 N cm-2 the blood flow was independent of weight-bearing pressure both in diabetic and control subjects (correlation coefficient r = -0.01 and -0.19, respectively). Thus, our results indicate that the nutritional blood flow in the plantar region is not decreased in patients with diabetic neuropathy.


Prevalence of haemochromatosis amongst patients with diabetes mellitus. Four hundred and six white caucasian patients with diabetes mellitus (243 male, mean age 54 +/- 16 (SD) years) were screened for haemochromatosis. Four patients had a fasting transferrin saturation > 62% and all were HLA A3 positive. Two were probable homozygotes for haemochromatosis and two heterozygotes. Homozygote haemochromatosis prevalence in this diabetic population was therefore 2/406 (0.0049) which is identical to that reported in the general population. These findings do not support a genetic relationship between the two conditions.


Effect of chronic ACE inhibition on glucose tolerance and insulin sensitivity in hypertensive type 2 diabetic patients. The question, of whether long-term treatment of essential hypertension with angiotensin-converting enzyme (ACE) inhibitors is capable of modifying glucose tolerance or insulin sensitivity in Type 2 (non-insulin dependent) diabetes, is still unsolved. We studied 14 moderately overweight Type 2 diabetic patients with essential hypertension in stable metabolic control after a run-in period and again after 3 months of antihypertensive treatment with the ACE inhibitor, captopril. Glucose tolerance was tested with a 75-g oral glucose load and insulin sensitivity was measured by the insulin suppression test, while dietary and drug treatment of the diabetes remained constant. In the whole group, mean blood pressure (MBP) fell progressively over 3 months from a baseline value of 123 +/- 3 mmHg to a final value of 115 +/- 2 mmHg (p < 0.005); in six patients, the change in MBP was < 5 mmHg (non-responders), thus giving a clinical response rate of approximately 60%. After treatment, fasting plasma glucose, insulin, free fatty acid (FFA), potassium, and glycated haemoglobin concentrations were unchanged from baseline. During the oral glucose tolerance test, the incremental glucose area-under-curve was 0.75 +/- 0.05 mol 120 min l-1 before and 0.76 +/- 0.06 mol 120 min l-1 after treatment (p = ns). Endogenous insulin response and suppression of plasma FFA levels were superimposable on the two occasions. During the insulin suppression test, steady-state plasma glucose levels were 14.4 +/- 1.3 vs 14.2 +/- 1.1 mmol l-1 before and after chronic ACE inhibition, respectively, at comparable hyperinsulinaemic plateaux (291 +/- 21 vs 287 +/- 14 pmol l-1).(ABSTRACT TRUNCATED AT 250 WORDS)


Influence of ripeness of banana on the blood glucose and insulin response in type 2 diabetic subjects. Banana is a popular and tasty fruit which often is restricted in the diet prescribed for diabetic patients owing to the high content of free sugars. However, in under-ripe bananas starch constitutes 80-90% of the carbohydrate content, which as the banana ripens changes into free sugars. To study the effect of ripening on the postprandial blood glucose and insulin responses to banana, 10 type 2 (non-insulin-dependent) diabetic subjects consumed three meals, consisting of 120 g under-ripe banana, 120 g over-ripe banana or 40 g white bread on separate days. The mean postprandial blood glucose response area to white bread (181 +/- 45 mmol l-1 x 240 min) was significantly higher compared with under-ripe banana (62 +/- 17 mmol l-1 x 240 min: p < 0.01) and over-ripe banana (106 +/- 17 mmol l-1 x 240 min: p < 0.01). Glycaemic indices of the under-ripe and over-ripe bananas differed (43 +/- 10 and 74 +/- 9: p < 0.01). The mean insulin response areas to the three meals were similar: 6618 +/- 1398 pmol l-1 x 240 min (white bread), 7464 +/- 1800 pmol l-1 x 240 min (under-ripe banana) and 8292 +/- 2406 pmol l-1 x 240 min (over-ripe banana). The low glycaemic response of under-ripe compared with over-ripe bananas may be ascribed to the high starch content, which has previously been found to be only hydrolysed slowly by alfa-amylase in humans.(ABSTRACT TRUNCATED AT 250 WORDS)


Distinguishing between persistent and transient impaired glucose tolerance using a prediction model. Screening for impaired glucose tolerance (IGT) and Type 2 (non-insulin dependent) diabetes was carried out in 777 people and those with high blood glucose levels completed three 2-h oral glucose tolerance tests (OGTT). Blood lipid levels, fasting and 2-h insulin levels, body mass index, and blood pressure were also measured and family history of Type 2 diabetes recorded. Fifty people were identified with IGT and of these 21 were found to have persistent IGT and 29 transient IGT. A model including the variables body mass index, fasting and 2-h insulin levels, fasting triglycerides and family history of Type 2 diabetes was developed using the Speigelhalter-Knill-Jones weighting method to predict subjects with persistent IGT. This model could be useful in identifying people with persistent IGT and therefore eliminate the need for repeat OGTTs which are time consuming and expensive.


Foot infections in diabetes are rarely due to a single microorganism. The purpose of this study was to investigate the frequency with which multiple organisms can be isolated from severe foot infections in diabetic patients with carefully planned techniques of collection and processing of specimens. One hundred and seventy-seven organisms were isolated from 52 patient admissions (mean 3.4 per infection) at a district hospital. This was compared to a mean of 2.1 organisms per lesion at a local university hospital and 2.3 at a smaller community hospital. Staphylococcus aureus was isolated in about half of all lesions at the three hospitals, while anaerobic organisms were isolated from 30 at the district hospital, 10 at the university hospital, and 4 at the community hospital. This study concludes that, firstly, proper techniques for collection, transportation and examination of culture specimens are important in the isolation of multiple organisms from foot infections in diabetes, and secondly, Staphylococcus aureus is often absent while anaerobic organisms are common.


An audit of the management and outcome of hospital inpatients with diabetes: resource planning implications for the diabetes care team. In order to assess the outcome of hospitalized diabetic patients in an urban health district the notes of a cohort identified from a survey of all inpatients on a single day in spring 1990 were reviewed. One hundred and ten cases were reviewed (8.4% of all inpatients); median age 73 years (range 26-99), 59 female. Fifty-five percent were medical patients (general or geriatric) and 16% were general surgical. Six remained inpatients after 6 months. Sixteen died, of whom 10 had macrovascular disease. Median length of stay was 22 days (2-300), significantly above the district average in all specialties (< 10 days). Of 15 patients with foot problems, 5 died and 3 had major amputations. Only 23% of all patients had documented evidence of screening for diabetic complications. The discharge diagnoses failed to acknowledge diabetes in 54 cases (including 10 deaths). Only 10% had formal advice from the diabetes team and subsequent audit revealed that metabolic management was commonly suboptimal in non-physician units. These data suggest that inpatient diabetes is costly and carries a high mortality. The incidence is substantially underestimated by conventional episode statistics. The evidence from this cohort of diabetic inpatients suggests that improved communication and recognition of the importance of diabetes could usefully contribute to the quality of care achieved.


The effect of a city-wide mass media campaign on the public awareness of diabetes. The aim of this study was to determine whether a mass media campaign about diabetes would increase public awareness and knowledge of diabetes, leading to an increased rate of detection of previously undiagnosed cases. A telephone questionnaire was administered to two groups of randomly selected members of the public before and after a 1-week mass media campaign. Cases of newly diagnosed diabetes were monitored by general practitioners. The median knowledge score rose from 5 (range 0-10) before the campaign to 6 (0-10) afterwards, p < 0.001. The knowledge score for a control group, questioned post-campaign only, was also 6 (1-10). The increase in the median knowledge score was mainly as a result of more people being able to define diabetes and give two presenting symptoms. This increased awareness did not however result in an increase in detection of new cases.


A proposal for continuing audit of diabetes services. Home and Members of a Working Group of the Research Unit of the Royal College of Physicians and British Diabetic Association. A working group was established in order to suggest the process and outcome variables most appropriate for the continuing audit of diabetes services. The proposed audit is being piloted in hospitals in selected United Kingdom Health Districts. The main process and outcome measures suggested are: waiting and consultation times; missed or cancelled appointments; information given to patients and the primary care team; knowledge of diabetes and risks of smoking; recording of key examinations and investigations, i.e. levels of glycosylated haemoglobin (or equivalent), serum cholesterol, body mass index, blood pressure, albumin excretion rate, presence and extent of retinopathy, history of coronary artery, cerebrovascular or peripheral vascular disease; history of severe hypoglycaemia; presence of foot problems; psychological well-being; patient satisfaction; admission rates and hospital bed days for hyperglycaemic and other diabetes related emergencies.


Evidence for reversibility of defective counterregulation in a patient with insulinoma. To investigate her unheralded neuroglycopenia, a 45-year-old woman was studied before and 3 months after removal of her insulinoma. Hypoglycaemia was induced and reversed by glucose infusion during 4-h insulin infusions (1.5 mU kg-1 min-1). Postoperatively, the low preoperative adrenaline, noradrenaline, growth hormone, and cortisol responses increased by 490, 152, 64, and 178%, respectively, and started at higher glucose levels (2.7 vs 1.9 mmol l-1 for adrenaline), with a four-fold increase in autonomic symptoms and more profound psychomotor dysfunction. We conclude that the syndrome of recurrent severe hypoglycaemia with defective warning symptoms and hormonal responses, in this case induced by an insulin-secreting tumour, is reversible, perhaps by the removal of the hypoglycaemia, a finding which may be relevant to other patients with recurrent severe hypoglycaemia.


Description of a diabetes support group: lessons for diabetes caregivers. A weekly psychotherapy group has been established with 21 diabetic patients (mean sessions attended per patient 12.0 +/- 8.9). In this non-structured group, the topics spontaneously chosen most often for discussion included complications and fears regarding complications, diet, and relationships with physicians. Other topics included difficulties achieving diabetes control, relationships with families, devices for day to day management, pregnancy and parenting, depression and eating disorders, and occupational concerns including driving and diabetes. The presence of a physician co-therapist was found to be valuable. Examples are provided of the patients' concerns. It is felt that understanding patients' needs for information and communication with physicians and allied health professionals will enrich the caregiver-patient relationship.


Super-elasticity and thermal behavior of Ni-Ti alloy orthodontic arch wires. Bending properties and thermal behavior of twenty commercial Ni-Ti alloy orthodontic arch wires were investigated quantitatively to characterize their suitability for clinical use. There was substantial difference among the load-deflection curves obtained by a three-point bending test. Some wires exhibited super-elasticity; load decreased little with decreasing deflection. Others showed good spring-back properties only; load was nearly proportional to deflection. Thermal behavior due to phase transformation of the alloy was examined by differential scanning calorimetry (DSC). Some of the wires did not have the correct transformation temperatures to exhibit super-elasticity at body temperature. Moreover, thermal behavior was closely related to super-elasticity. There were clear thermal peaks in the DSC curves of the super-elastic wires. However, wires without super-elasticity had no peak in the DSC curves.


Hemolytic activity of a dental adhesive monomer (N-methacryloyloxy-5-aminosalicylic acid, MASA) and its interaction with phospholipid liposomes as studied by NMR and DSC. N-methacryloyloxy-5-aminosalicylic acid (MASA) has recently been used as an adhesive primer in restorative resin systems. To monitor the biological activity of MASA, we studied changes in NMR-chemical shifts (delta H) and the differential scanning calorimetry (DSC) phase transition temperature (Tm) of dipalmitoylphosphatidylcholine (DPPC)/MASA liposomes with or without the presence of albumin and collagen. The delta H and the Tm did not alter significantly and the interaction of MASA with DPPC was found to be small. Hemolytic activity of MASA was markedly smaller than that of the phosphate monomer (MDP) in bonding agents widely used. These findings suggest that using a MASA primer in resin systems has an acceptable biocompatibility for dentin-pulp, involving its adsorption and adhesion to hard tooth tissues.


The effects of various clinical factors on marginal enamel micro-cracks produced around composite restoration. In this study, enamel micro-cracks produced around composite restorations were observed on surfaces and vertical sections, using a stereomicroscope and a scanning electron microscope (SEM). The effects of various clinical factors, i.e. the curing system, the marginal form and the polishing period after filling, on the incidence of marginal enamel micro-cracks were examined. Enamel micro-cracks were observed on all of the class 1 and 5 composite restorations when the cavity had no marginal bevel and the restorations were polished immediately after filling. Enamel micro-cracks distributed approximately parallel to the cavity margin and located 0.01-0.3 mm from the restored cavity margin. The occurrence of enamel micro-cracks was higher in light-cured composite resin restorations than in chemical-cured ones, for non-beveled cavities when polished 10 min or 24 hours after filling. The occurrence of micro-cracks was reduced by marginal beveling and delayed polishing.


Three dimensional shape measurement of teeth (2). CAD to produce crown considering occlusion. Use of a CAD program to design the shape of a crown, restoration of 6 molar was studied. Stone models of 5 to 7 molars with 6 prepared die for crown and a complete 6 crown which was applied for restoration were measured. The 6 crown data were adapted on the 6 die, and adjusted with 5 and 7 proximal teeth. The coordinates of the data of 6 were then transferred to that of the 6 die. The ends of the adapted crown data were linked with the margin of 6 die. Further the occlusal condition with antagonistic tooth was adjusted by applying the FGP (functionally generated path) technique. FGP was recorded on bite wax and measured. Comparing FGP record and adapted crown, modulation of the occlusal surface was accomplished.


Semi-quantitative analysis of early microleakage around amalgam restorations by fluorescent spectrum method: a laboratory study. Rhodamine B, a fluorescent substance, was used as a tracer to investigate in vitro early microleakage from around amalgam restorations in machinable mica glass-ceramic after thermal stress. Five types of amalgam, i.e., low-copper spherical, low-copper lathe-cut, high-copper admixture, high-copper lathe-cut, and high-copper spherical, were examined in the present study. The results indicated that early microleakage from alloys of lathe-cut particles was lower than that from alloys of spherical particles in both low-copper and high-copper amalgam restorations. A high-copper amalgam with a mixture of lathe-cut and spherical particles tended to exhibit the lowest early microleakage.


Laser-Raman spectroscopic study of the adhesive interface; analysis between 4-META/MMA-TBB resin and bovine or human dentin. A study of the adhesive interface between 4-MET/MMA-TBB resin and hydroxyapatite or bovine enamel was reported. The present report is a continuation of that study. The possible chemical interaction between 4-methacryloxyethyl trimellitic acid (4-MET) and bovine or human dentin was examined by laser Raman spectroscopy. A 4-MET monomer solution was prepared by evaporating two thirds of the methyl methacrylate (MMA) in a commercial dentin adhesive. The solution was then applied to a dentin surface after treating the surface with an aqueous solution of 10% citric acid containing 3% ferric chloride. A salt formed on both bovine and human dentin surfaces. This salt was formed by the process we previously reported in which 4-MET formed a salt on the hydroxyapatite and bovine enamel. No evidence was observed of chemical reaction between 4-MET and any organic component in the dentin.


Possibility of allergic reaction to dentin primer--application on the skin of guinea pigs. We studied the allergic reaction of guinea pigs to glyceryl methacrylate (GM), hydroxyethyl methacrylate (HEMA) and meso-erythritol methacrylate (EM), which are used as dentin primers. On the 18th day of the application test, when macroscopic investigation revealed an inflammatory reaction, the methacrylic acid-treated group showed marked eschar formation in comparison with the control group. In each of the dentin primer groups, a slight degree of skin redness was noted, but there were no serious symptoms. On the 25th day, the applications were resumed macroscopic inspection on the 32nd day found eschar in the methacrylic acid group only. Therefore, this experiment with dentin primers suggests a delayed allergic reaction. Local irritability test showed a more severe reaction than the application test. In this test, all experimental dentin primers and methacrylic solution promptly showed inflammation, and the chemical compound, methacrylic acid was a factor in inflammation.


Developments of the new instruments for TMJ arthroscopic surgery. A large and clearly visible operating area is essential for successful arthroscopic surgery of the temporomandibular joint. The keys to a successful operation are the safe and accurate positioning of a large scope and multiple cannulations, overcoming blind areas. We developed some instruments to resolve these problems; i.e., scopes with a large diameter for high resolution, a triangulation instrument for multiple cannulations, a needle set-up jig for disk traction suture, a step cannulation system and a two-channel cannula for operating in the narrow lower joint space and a fixing jig for cannulas in the upper and lower joint space to observe the same portion of the discal tissue from both joint space during disk suturing. From our experience in applying systematic procedures using these instruments in 37 arthroscopic surgeries, it is possible for this procedure to be done under a visual field and the surgical time considerably shortened.


Perception of conspecific faces by budgerigars (Melopsittacus undulatus): I. Natural faces. Perception of faces by 4 budgerigars (Melopsittacus undulatus), a species of small parrot, was studied with a same-different discrimination task. Reaction times were taken as a measure of the similarity between pairs of faces and analyzed with multidimensional scaling to reveal patterns of similarity among the faces. The perception of natural faces was tested to determine which characteristics were perceptually salient. Color, patterns of markings, darkness of the iris, and size of the pupil corresponded to the observed patterns of similarity among the faces. Differences among budgerigar faces were more salient than differences among zebra finch faces, and budgerigar faces were perceptually distinct from the faces of other avian species. The results from these experiments provide a basis for understanding the ways in which these signals function in the coordination of social behaviors.


Age and sex as factors influencing spontaneous exploration and object investigation by preadult rats (Rattus norvegicus). This study examined developmental and sex differences in the exploratory and investigatory behaviors of Long-Evans rats (Rattus norvegicus). Littermate sextuplets were divided into sex-matched groups (at 30, 60, and 90 days of age) and were individually videotaped on 2 consecutive nights in an arena that contained stimulus objects. Multiple measures of locomotor exploration and object investigation increased significantly with age but were not influenced by sex. Older rats entered more quickly, were more active, spent more time in the arena, and spent more time investigating inanimate stimulus objects than did younger rats. Sex did not significantly affect most measures of open-field behavior; however, the data suggest that the sexes may begin to diverge by 90 days. These results suggest that preadult rats of both sexes are equipped early in development with similar strategies and repertoires for exploration and investigation.


Young children's (Homo sapiens) understanding of knowledge formation in themselves and others. Three- and 4-year-old children (Homo sapiens) were tested for comprehension of knowledge formation. In Experiment 1, 34 subjects watched as a surprise was hidden under 1 of 4 obscured cups. The experimenter then pointed to the cup. All children searched under the correct cup, but no 3-year-olds (in contrast to most 4-year-olds) could explain how they knew where to look. Subjects then discriminated between simultaneous pointing by 2 adults, one who had hidden a surprise and one who had left the room before the surprise was hidden. Most 4-year-olds (but no 3-year-olds) showed clear discrimination between the adults. In Experiment 2, 16 subjects were tested with procedures designed to make the source of their own knowledge more obvious, but this had no effect on performance. We conclude that studies using very similar procedures with chimpanzees and rhesus macaques were measuring an ability (or inability) to understand how knowledge states form.


Perception of cliff swallow calls by birds (Hirundo pyrrhonota and Sturnus vulgaris) and humans (Homo sapiens). We tested for species differences in the perception of the cliff swallow chick begging call. One cliff swallow (Hirundo pyrrhonota), 3 European starling (Sturnus vulgaris), and 3 human (Homo sapiens) subjects were trained on go-no-go or repeating background tasks to discriminate between all possible stimulus pairs, measured by percentage of correct response and latency. We used multidimensional scaling to convert the similarity measures into a 2-dimensional map for each subject. Most of the maps were significantly correlated in Dimension 1 but not in Dimension 2. A cluster analysis separated bird and human maps. To identify the most important acoustic cues for each subject, we regressed the coordinates of each dimension on acoustic variables measured from the stimuli. For all subjects, center frequency was Dimension 1. Different acoustic cues were associated with Dimension 2, with agreement only on bandwidth, by the cliff swallow and 1 starling.


Conditioned taste and taste-potentiated odor aversions in the Syracuse high- and low-avoidance (SHA/Bru and SLA/Bru) strains of rats (Rattus norvegicus). Syracuse high- and low-avoidance Long-Evans rats (Rattus norvegicus; SHA/Bru and SLA/Bru) were selectively bred for good and poor active-avoidance learning. However, SLA/Bru animals are superior to SHA/Bru rats in conditioned suppression and passive avoidance learning. In this experiment, saccharin taste and almond odor were the components of a compound conditioned stimulus (flavor) in an illness-induced aversive conditioning paradigm. SLA/Bru rats (n = 17) showed stronger conditioned flavor, taste, and odor aversion than did SHA/Bru animals (n = 18). Unselected Long-Evans rats (n = 18) were intermediate between the selected strains. SLA/Bru and Long-Evans rats showed taste-potentiated odor aversions in this experiment, whereas SHA/Bru animals did not. The results provide evidence that genetic factors, as exemplified by the different strains, are importantly involved in the mechanisms underlying interoceptive and exteroceptive aversive conditioning.


Affiliative vocalizations in infant rhesus macaques (Macaca mulatta). In Experiment 1, infant rhesus monkeys (Macaca mulatta) were separated and then reunited with mothers, united with a male, or placed in an empty cage. Infants girned more when with mothers or the male than when alone. Girns declined over time when infants were united with the male. Coo rates were high when the infant was alone or with the male. Shrieks, barks, and fear-related behavior were higher with the male. In Experiment 2 the vocalizations of infants were examined during separation when alone or when mothers or a male were in the same room. Infants cooed more when mothers or a male were present. Cooing increased over time, with a greater increase in the mothers' presence. Girns were given to both mothers and males, but more were given to mothers. Coos and girns are both affiliative vocalizations but are differentially modulated as infants cease cooing when they receive contact comfort.


Sex differences in the incidence and sonographic characteristics of antipredator ultrasonic cries in the laboratory rat (Rattus norvegicus). Long-Evans rats (Rattus norvegicus; ns = 10 males and 10 females) in a burrow system responded to a cat in the open area by retreating to a burrow and emitting ultrasounds of 18-27 kHz. Females made more frequent ultrasonic cries, with longer durations of ultrasounds. In a 2nd study (ns = 19 males and 19 females), sonographic analyses confirmed the more frequent vocalizations of females and indicated that the sound pulses of females were reliably shorter in duration and of higher base frequency than those of males. Also, females emitted more pulses per pulse train with shorter within-train interpulse intervals. Six basic pulse forms were determined, and males emitted more (70%) pulses with negatively accelerated descending frequencies than females (25%). The findings indicate that female rats show qualitatively different antipredator vocalizations than do males and add to previous findings of higher levels of female antipredator defensiveness.


Syllable chunking in zebra finch (Taeniopygia guttata) song. We examined how 61 young zebra finch (Taeniopygia guttata) males copied song from 5 adult tutors. Zebra finch song consists of a string of 5-15 distinct syllables, and these syllables were copied as chunks, or strings of consecutive syllables (modal length = 3). The silent interval between 2 syllables was copied as part of the syllable after the silence. Copied chunks had boundaries that fell at consistent locations within the tutor's song, marked by a relatively long intersyllable silent period, a transition between call-like and noncall-like syllables, and a tendency for the tutor male to stop his song short. Young males also tended to break their songs off at the boundaries of the chunks they had copied. Chunks appear to be an intermediate level of hierarchy in song organization and to have both perceptual (syllables were learned as part of a chunk) and motor (song delivery was broken almost exclusively at chunk boundaries) aspects.


Proficient performance of a conjunctive, recursive task by an African gray parrot (Psittacus erithacus). The comprehension skills of an African gray parrot (Psittacus erithacus), Alex, were tested on a taks that included a conjunctive condition. For each trial, Alex was shown different collections of 7 items, each collection chosen from among 100 objects of various combinations of shapes, colors, and materials, and he was asked to provide (vocally) information about the specific instance of one category of an item that was uniquely defined by the conjunction of two other categories (e.g., "What color is the [object defined by shape and material]?"). Other objects exemplified one, but not both, of these defining categories. Alex responded with an accuracy of 76.5%, which indicated that he understood all the elements in the question, including the conjunctive condition, and that he used these elements to guide his search for the one object in the collection that provided the requested information.


Learning to find the opponent: an ethological analysis of the behavior of paradise fish (Macropodus opercularis) in intra- and interspecific encounters. In Experiment 1, 15 behavior patterns of male paradise fish (Macropodus opercularis; n = 72) toward a male conspecific, a male of another species, or no stimulus were recorded, both in home and novel situations. In Experiment 2, the same behaviors were recorded in a runway, and the same stimuli were used as reinforcers in the goal box (n = 18). A typical learning curve was seen when the subject found a male paradise fish in the goal box, learning was followed by apparent extinction when another species was found in the goal box, and few signs of learning were seen when the goal box was empty. Performance of the fish in both experiments can be accounted for by a strong aggressive motivation, a less strong but clear general curiosity, and habituation to the experimental procedure. In contrast to recent assertions in the literature, we conclude that aggressive behavior clearly can serve as a reinforcer in an instrumental learning situation.


The inference of evolutionary trees from molecular data. 1. Procedures for multiple alignment of sequence data, subsequent phylogenetic inference, and testing of the trees derived are presented. 2. The assumptions underlying different approaches and the extent to which they are valid are discussed.


Lactate dehydrogenase in teleosts. The role of LDH-C4 isozyme. 1. Lactate dehydrogenase (LDH) occupies an important position in cell metabolism. 2. Teleosts possess at least three genetic loci coding for lactate dehydrogenase subunits, Ldh-A, Ldh-B and Ldh-c. LDH exists in most tissues in several isozymic forms. 3. The isozyme LDH-C4 is synthesized predominantly in regions of the nervous system concerned with the eye.


Sperm-activating peptide type-V (SAP-V), a fifth member of the sperm-activating peptide family, purified from the egg-conditioned media of the heart urchin Brissus agassizii. 1. A novel type of sperm-activating peptide named sperm-activating peptide type-V (SAP-V) was isolated from the egg-conditioned media (egg jelly) of the heart urchin Brissus agassizii and the primary structure of the peptide was determined by fast atom bombardment mass spectrometry as follows: Gly-Cys-Glu-Gly-Leu-Phe-His-Gly-Met-Gly-Asn-Cys. 2. SAP-V and [Met(O)9]SAP-V stimulated the respiration of B. agassizii spermatozoa with half-maximal concentrations of 0.5 and 0.3 nM, respectively. However, half-maximal stimulation of the sperm respiration required 40 nM of S-carboxymethylated SAP-V. 3. SAP-V induced significant increases in the cyclic AMP and cyclic GMP levels in B. agassizii spermatozoa in a concentration-dependent manner. 4. The addition of SAP-V to B. agassizii spermatozoa resulted in a mobility shift of a major sperm protein (mol. wt from 133,000 to 129,000) on sodium dodecyl sulfate-polyacrylamide gels.


Constitutive protein secretion by guinea-pig seminal vesicle epithelial cells. 1. Secretion of pulse-labelled protein by the isolated epithelium of guinea-pig seminal vesicle epithelium was rapid, unaffected by cholinergic and adrenergic drugs, cyclic nucleotides or changes in the sodium, potassium and calcium concentrations of the "chase" medium. 2. Low temperature, NH4Cl, hyper- and hypo-osmolarity and membrane-stabilizing agents inhibited secretion which was also dependent on aerobic metabolism. 3. Monensin reduced secretion of the six labelled, relatively low molecular weight proteins recovered from the medium in a concentration-dependent, apparently non-specific manner.


Unsaturated fatty acids inhibit glucocorticoid receptor binding of trout hepatic cytosol. 1. The effect of free fatty acids [FFAs (saturated (S) and unsaturated (U))] on dexamethasone binding in vitro using liver cytosol from rainbow trout was examined. 2. All UFFAs but none of the SFFAs tested suppressed binding. This suppression is dose-dependent and correlated roughly with the degree of unsaturation of the FFAs. 3. Scatchard analysis indicated that the addition of linoleic C18:2 (150 microM) increased the dissociation constant (Kd = 5.1 +/- 0.4 x 10(-8) M vs control of 1.7 +/- 0.3 x 10(-8) M) but minimally affected the binding capacity (Bmax = 68 +/- 6.2 vs control of 88 +/- 15.2 fmol/mg protein) suggesting C18:2 caused a conformational change of the receptor. 4. Lineweaver-Burk plot revealed a mixed non-competitive type of inhibition by C18:2. 5. Free acid appeared to be required for inhibition as esterification or derivatization of the acid greatly diminished its potency. 6.C18:2 also promotes the dissociation of bound [3H]-dexamethasone from the steroid-receptor complex but slower in rate and lesser in magnitude compared to that caused by dexamethasone or the glucocorticoid antagonist RU 38486. 7. UFFAs and some of their derivatives can thus modulate glucocorticoid receptor function in vitro and might play essential roles in regulating glucocorticoid action in fish as well. 8. These fatty acids presumably acts at a site different from that of the glucocorticoid binding site.


Detection of a sperm-coating antigen in the semen of Bubalus bubalis. 1. Surface antigens of B. bubalis spermatozoa were solubilized by Triton X-100 and EDTA; the sperm extract was used to raise antibodies in rabbits. 2. Two major polypeptides, immunoprecipitated from the seminal plasma by the antibodies against the sperm extract, exhibited the same electrophoretic mobilities of two immunorelated sperm surface antigens. 3. The two polypeptides were isolated from the seminal plasma, by a multi-step chromatographic procedure, and found subunits of a single protein (MW 30,000), called SP 30. 4. The SP 30 protein bound in vitro to the postacrosomal region of homologous spermatozoa from cauda epididymis. 5. The localization of the sperm-coating antigen on the cell surface is compatible with a role in the fertilization process.


Microsomal ethanol-oxidizing system in Euglena gracilis. Similarities between Euglena and mammalian cell systems. 1. ADH activity of Euglena grown with 50 mM ethanol decreased, but MEOS activity increased with a corresponding increase in the total amount of cytochrome P-450. 2. Phenobarbital treatment increased the total amount of cytochrome P-450. 3. CO and KCN, cytochrome P-450 ligands, diminished acetaldehyde formed from ethanol oxidation by MEOS. 4. The amounts of NAD(P)H cytochrome c reductases and cytochrome b5 type, components of microsomal monooxygenase reaction, have been spectrophotometrically measured. 5. NAD(P)H cytochrome c reductases activities were induced by phenobarbital. 6. DMSO, an inhibitor of rabbit MEOS, inhibited O2 consumption (11-20%) by Euglena grown with an ethanol, but not a lactate medium. 7. These studies indicate the presence of cytochrome P-450-dependent MEOS in Euglena similar to that in the mammalian hepatic cell.


Serine proteinase inhibitor profiles in the hemolymph of a wide range of insect species. 1. The inhibition of trypsin, chymotrypsin, neutrophil elastase and cathepsin G, and pancreatic elastase by the hemolymph of 14 insect species in six orders has been investigated. 2. All samples showed great diversity in terms of both total proteinase inhibitory capacity and specificity. 3. The highest total inhibitory capacity was found in the larval hemolymph of species in the beetle family Tenebrionidae and the lowest in that of an adult coreid bug, Acanthocephala femorata.


A comparison of methods for sample clean-up prior to quantification of metal-binding proteins. 1. The recovery of rabbit metallothionein and metallothionein-like proteins has been examined under different conditions. 2. After heat or ethanol denaturation, recovery of rabbit MT-II was quantitative. 3. Recovery of rabbit MT was not affected by the presence or absence of dithiothreitol (DTT) after heat treatment. However, recovery from ethanolic solution decreased in buffers that did not contain the antioxidant. 4. Acetone precipitation of rabbit MT resulted in lower yields which approached 90% only in the presence of DTT. 5. Recovery of metallothionein-like proteins from cytosols of the hepatopancreas of the tanner crab, Chionoecetes bairdi, were examined using pulse polarography and HPLC. Relative to heat denaturation, ethanol and acetone yielded recoveries of 66 and 28%, respectively, in the presence of DTT. However, acetone did yield a solution which contained less extraneous protein of molecular mass greater than 43 kDa than heat denaturation. 6. We concluded that heat denaturation is the preferred treatment for quantitative recovery of metal-binding proteins. Acetone precipitation is useful for the purification of MT.


Human liver glutamic gamma-semialdehyde dehydrogenase: structural relationship to the yeast enzyme. The amino acid sequences of nine tryptic peptides (containing altogether 105 amino acids) from human liver glutamic gamma-semialdehyde of dehydrogenase (hitherto designated as ALDH4) were found to correspond, at 33-66% identity, to segments from the yeast 1-proline-5-carboxylate (P5C) dehydrogenase encoded by the PUT2 gene.


Characterization of a G-protein from the mandibular organ of the lobster Homarus americanus (Nephropidae, Decapoda). 1. GTP-binding activity was found in both calf brain and male lobster mandibular organ (MO). There was approximately two to three times as much binding in the calf brain. 2. The GTP-binding activity could be extracted from the calf brain with sodium cholate, but not from the MOs. 3. Using ADP-ribosylation catalyzed by pertussis toxin, GTP-binding was shown to be the result of the presence of G-protein. In the lobster MO the G-protein alpha subunit has a molecular weight of about 42 kDa and may be of the Go or Gi varieties.


Glutathione mixed disulfides and heterogeneity of chicken hemoglobins. 1. Adult chicken hemoglobins Hb A and Hb D interact with glutathione disulfide, GSSG. The major hemoglobin, Hb A, forms at least two new components, termed GHb AI and GHb AII, and Hb D forms at least one, GHb DI. 2. At pH 8.0 and 5 degrees C, glutathione disulfide (GSSG) in a molar excess of 50 x took 6 days to complete the reaction, although at pH 8.6 and 41 degrees C only 1 hr was needed, where the hemoglobins Hb A and Hb D were converted to their most mobile forms GHb AII and GHb DI. 3. Slight molar excess (2.7 GSSG/Hb, pH 7.4, 41 degrees C), reacting for 1 hr, showed extensive formation of GHb AI and some GHb AII. 4. Electrophoretic patterns, from the reaction products of 54 GSSG/Hb excess at different times, showed a marked pH dependence. 5. Titration with pCMB (p-chloromercuribezoic acid) of DTE (dithioerythrytol)-reduced samples showed 8.0 +/- 0.4 (N = 5) -SH (sulfhydryl) per tetramer. In hemolysates not reacted with DTE, 6.0 +/- 0.4 (N = 3) -SH were detected. 6. DTE-reduced and GSSG-reacted hemoglobins showed 4.6 +/- 0.5 (N = 7) -SH and 1.5 +/- 0.4 (N = 6) -SH, respectively, as titrated by DTNB, pH 8.0. DTE-reduced hemoglobins showed four fast-reacting -SH groups, no longer present in GSSG-reacted hemoglobins. 7. Our data indicate that chicken GHb AI and GHb DI probably have two glutathionyl residues per tetramer whereas GHb AII has four.(ABSTRACT TRUNCATED AT 250 WORDS)


Induction of cystatin S in rat submandibular glands by papain. 1. Papain (a cysteine proteinase) were administered into the oral cavity of rats twice daily for 5 days. This treatment caused a dramatic increase in the level of cystatin S (a cysteine proteinase inhibitor belonging to family 2 of cystatin superfamily) in enlarged submandibular glands. 2. Immunochemical analysis using antibody against rat cystatin S and electrophoretic analysis confirmed that the protein induced by papain was identical to that induced by isoproterenol. 3. Induction of the cystatin S in the submandibular glands by oral administration of papain suggested a biological response which plays a role in preventing injury exogenous proteinase.


D-glyceraldehyde-3-phosphate dehydrogenase from HeLa cells--1. Purification and properties of the enzyme. 1. D-GPDH from HeLa cells was isolated and purified. 2. Some basic kinetic constants are reported. 3. Sodium dodecyl polyacrylamide gel electrophoresis gave a single band with a molecular weight of approximately 36 K. 4. ATP and NADH inhibit competitively enzyme activity. 5. Comparative catalytic properties of GPDH from normal and tumor cells were effectuated.


Genetic differences in steroid-induced protein synthesis in vivo of the liver and magnum in immature chicks (Gallus domesticus). 1. The present study was conducted to investigate whether or not the rate of steroid-induced protein synthesis measured in vivo in the liver and magnum was different between chicks from different genetic backgrounds. 2. Both protein deposition and synthesis in the liver were enhanced after the administration of beta-estradiol with or without testosterone. In the magnum, the combined administration of beta-estradiol and testosterone resulted in significantly higher protein deposition and synthesis than did beta-estradiol alone. 3. After the administration of beta-estradiol and testosterone, protein deposition in the liver and magnum was lower in broiler than in layer and dual-purpose chicks. Protein synthesis in the magnum tended to be highest, though not significantly, in layer, followed by dual-purpose and broiler chicks in decreasing order. 4. Steroid-induced protein deposition in the liver was not changed between chicks genetically selected for low and high albumen contents. In contrast, steroid-induced protein synthesis in the magnum was significantly higher in high-albumen birds than low-albumen chicks. 5. It was concluded that genetic traits for high egg production were well reflected in increased protein deposition and synthesis in the liver and especially in the magnum of immature female chicks stimulated by steroid hormone treatment.


Isolation and partial characterization of serine- and threonine-rich porcine gastric mucus glycopeptides. 1. Two subfractions from purified porcine gastric mucus glycopeptide were found to separate from each other by cesium chloride equilibrium centrifugation. The highest density fraction and two lower density fractions separated were designated VHD, HD and LD, respectively. A comparative study of these components was made. 2. The high and low density fractions, HD and LD, appeared almost the same or identical, while VHD differed completely from either of them in the following respects: (1) VHD exhibited strong alcian blue binding activity. (2) 57% of VHD bound to the DEAE-Toyopearl column equilibrated with 0.2 M NaCl. (3) VHD eluted from the Sephacryl S-400 column as a lower molecular subunit. (4) One third of the sialic acid as a minor component in VHD was constituted by N-glycolylneuraminic acid. (5) Carbohydrate composition showed typical mucus glycoprotein with slightly higher fucose content. (6) Amino acid compositions of the anionic components prepared from VHD showed the highest Ser/Thr ratio, 1.92 compared to 0.46 for LD and 0.62 for HD. (7) Oligosaccharide released from VHD by alkaline-sodium borohydride treatment was larger than that from HD or LD. 3. The above results indicate the minor component, VHD, separated from the major components, to be a quite similar but not identical component to the so-called sulfated mucus glycoprotein reported previously [Slomiany et al. (1972) J. biol. Chem. 247, 5062-5070].


The amino acid sequence of the single hemoglobin of the high-antarctic fish Bathydraco marri Norman. 1. Bathydraco marri Norman is a cold-adapted Antarctic teleost (Family: Bathydraconidae), living preferably at depths between 400 and 1200 m. 2. The blood of this species contains a single hemoglobin, in which oxygen binding is pH-regulated (Bohr and Root effects). 3. The complete amino acid sequence of the alpha and beta chains of the hemoglobin of B. marri has been elucidated.


Further studies on semicarbazide-sensitive amine oxidase activities (SSAO) of white adipose tissue. 1. White adipose tissue (WAT) from mice, rabbits, pigs and human subjects was investigated for the characterization of the tissue-bound semicarbazide-sensitive benzylamine oxidase activities (SSAO) present in each species. 2. Enzymes from mice, rabbits and pigs shared similar biochemical characteristics: they exerted histaminase activity, oxidized methylamine and acetylputrescine and were completely blocked by carbonyl reagents and by 3,5-ethoxy-4-aminomethylpyridyne (B24), in a dose-dependent fashion. 3. SSAO activity from human WAT had a lower affinity for benzylamine compared with enzymes in the other species and did not show any histaminase activity. 4. These results show that SSAO from human tissues might have different properties from SSAO of other species.


System identification for the ECG using CZT. A new approach for extraction of clinically useful parameters from the ECG signal is presented using the system identification technique of CZT on the DCT-transformed signal. A one to one relationship between the model singularities and the significant points in the time signal is arrived at. The method allows the determination of R-R interval needed in rhythm analysis. The complex cepstrum is used for identifying and removing the effect of zeros outside the unit circle. A significant data compression of 1 in 10 is achieved. A large number of continuous strips of ECG data are analyzed and the results are presented.


An approach to the generalized nurse scheduling problem--generation of a declarative program to represent institution-specific knowledge. An approach to the nurse scheduling problem is presented. The critical problem in nurse scheduling in a hospital is how to determine the day-to-day shift assignments of each nurse for a specified period in a way that satisfies the given requirements as much as possible, where the requirements differ greatly depending on the hospital. We present a method for constructing an agency-independent core procedure which can be tailored to the peculiar requirements of an individual hospital. As a basis, a formal analysis of the problem was performed, and a general scheduling procedure was established. Based on the method, a software system which produces a scheduling program for a given institution was developed. A declarative program that represents institution-specific information is generated through an interview with the user and incorporated into the general procedure. Some of the programming technicalities and an application of the system are also presented.


Dimensions of knowledge sharing and reuse. Many workers in medical informatics are seeking to reuse knowledge in new applications and to share encoded knowledge across software environments. Knowledge reuse involves many dimensions, including the reapplication of lexicons, ontologies, inference syntax, tasks, and problem-solving methods. Principal obstacles to all current work in knowledge sharing involve the difficulties of achieving consensus regarding what knowledge representations mean, of enumerating the context features and background knowledge required to ascribe meaning to a particular knowledge representation, and of describing knowledge independent of specific interpreters or inference engines. Progress in the area of knowledge sharing will necessitate more practical experience with attempts to interchange knowledge as well as better tools for viewing and editing knowledge representations at appropriate levels of abstraction. The PROTEGE-II project is one attempt to provide a knowledge-base authoring environment in which developers can experiment with the reuse of knowledge-level problem-solving methods, task models, and domain ontologies.


Computer probability estimates of angiographic coronary artery disease: transportability and comparison with cardiologists' estimates. A computer algorithm for estimating probabilities of any significant coronary obstruction and triple vessel/left main obstructions was derived, validated, and compared with the assessments of cardiac clinician angiographers. The algorithm performed at least as well as the clinicians when the latter knew the identity of the patients whose angiograms they had decided to perform. The clinicians were more accurate when they did not know the identity of the subjects but worked from tabulated objective data. Referral and value induced bias may affect physician judgment in assessing disease probability. Application of computer aids or consultation with cardiologists not directly involved with patient management may assist in more rational assessments and decision making.


Tolerating spelling errors during patient validation. Misspellings, typographical errors, and variant name forms present a considerable problem for a Clinical Information System when validating patient data. Algorithms to correct these types of errors are being used, but they are based either on a study of frequent types of errors associated with general words in an English text rather than types of errors associated with the spelling of names, or on errors that are phonologically based. This paper investigates the types of errors that are specifically associated with the spelling of patient names, and proposes an algorithm that effectively handles such types of errors. This paper also studies the effectiveness of several relaxation techniques and compares them with the one that is being proposed.


User and manufacturer's requirements for IMAC standardization in Japan. Many radiologists and radiological technologists understand that Picture Archiving and Communication Systems (PACS) are useful not only for image management but also for improving the quality of patient care. However, such systems have not yet been widely installed in hospitals. In order to determine why radiologists have not installed a PACS in their hospitals, we carried out a written survey of 400 Japanese hospitals asking them to describe the current image management activities, the problems inherent in PACS and the problems related to standardization. 216 hospitals responded, and the following suggestions were compiled concerning possible improvements to PACS. (1) PACS benefit needs to be improved with respect to patient care. (2) The cost of PACS should be reduced. (3) The system should be easier to operate and should save time. (4) Standardization is needed to allow simplified, cost-effective networking. We also carried out a written survey of 25 PACS and related equipment manufacturers asking them to describe the opinions inherent in current PACs and the problems related to standardization. Ten manufacturers responded, and the various suggestions were compiled concerning possible improvements to the PAC system.


Influence of CRT workstation on observer's performance. The effects of the operability of the prototype CRT workstation and room illumination upon observer's performance were studied. In the experiment of reading CT images as a routine daily work at the CRT workstation, the average time required to analyse one CT image under a room illuminance of 100 lux was longer than that on the film viewbox. Prolongation occurred due mainly to the longer time required to retrieve and to arrange images as observers desired, and the limitation to the number of images simultaneously displayed on two CRT monitors. In the ROC studies to detect small pulmonary nodules on CRT images of computed radiography with imaging plate, illuminance around 170 lux showed the best result and a statistically significant difference (P less than 0.05) as compared with that of 480 lux. In addition to the radiologist's visual performance, room illumination must also be taken into consideration as it influences the observer's performance and diagnostic efficiency.


The use of multimedia in patient care.

The use of multimedia in patient care. A personal computer based system was constructed to assess the use of various forms of information (multimedia) in patient record keeping. A patient's file with his records kept in a multimedia fashion was made by using the system. We describe the hardware and software construction of the system together with the results and the memory requirements of each type of media. Potential usage of the system in the future is discussed especially in connection with the Picture Archiving and Communications Systems (PACS).


Nordic teleradiology development.

Nordic teleradiology development. In the Nordic countries there are several reasons why teleradiology has been an interesting topic of research during the last years. The distances in rural areas are long, and radiology expert service is not available in every health centre which is able to provide X-rays. Also, the telecommunication network is on a very advanced level in the Nordic countries. The staff is well educated and they are used to operating with computers. This all means that the infrastructure to develop and use systems like teleradiology exists. This paper describes two separate systems developed in Norway and Finland. Their development has been in many respects the same. The common hardware and software features, as well as the differences and the clinical experiences, are discussed in this paper.


PACS in the new Skejby Hospital.

PACS in the new Skejby Hospital. A radiology department with digital imaging equipment and a decentralized PACS has been planned, and is under installation in the new university hospital--Skejby Sygehus--in Arhus, Denmark. The background for the decision, the planning procedure and details of the plan are described.


Experience of a small PACS in Tottori University Hospital. Picture archiving and communications systems (PACS) are expected to become feasible as the way of total radiologic image management. As the first step towards computerized image management, we installed an experimental small PACS with a digital optical archive for magnetic resonance and digitized radiographic film images. During the first 10 months of operation, problems were caused by the frequent mechanical troubles on the acquisition devices, impractical schemes for transmission, and troublesome retrieval and display of images. Although some of them have been solved by the improvements of both hardware and software, the mechanical instability of the digitizer and the inadequate operating procedure of the workstation still remain. As to the characteristics of PACS, the capability of access to every achieved radiologic image is the great advantage for us because the image integration has been impossible in the form of radiographic films for the traditional image management system of our hospital. However, the complicated image display procedure with high overheads is far from ideal for radiologists. The efficiency of image display must be increased to the level of a conventional film viewing system. Furthermore, research is needed on the small PACS to get consensus for the acceptance of a more widely implemented system.


Digital/analog hybrid system for filing of endoscopic images. A new system was developed for filing all the endoscopic images generated in our hospital. The system is composed of an on-line network for analog images supplied from the endoscopy stations and stored on 300 mm optical disks, on the one hand, and an off-line PACS for digital images recorded on a 130 mm magneto-optical disk (MOD) at each endoscopy station, on the other. For close examination of the images digital images are displayed from the MOD on a high-resolution computer graphic monitor, and for quick review of a large number of images, analog images are retrieved from the 300-mm optical disks. This system has been in clinical use at our university hospital for the past year and has proven useful for education of endoscopy, for the quality control of the endoscopy practice, and for the management of the patients.


Information compression in dynamic radiological studies. The large volumes of digital image data from radiological examinations demand further research and practical solutions in image compression before PACS solutions in large radiological departments are plausible. But another type of compression of image information is also possible, which has, in fact, been somewhat utilized already in analog form, but which has far better possibilities in the digital world. The number of essential images in dynamic X-ray, nuclear medicine, examinations etc. can be greatly reduced. These examinations producing image series are reviewed in terms of compression of information. 3-D displays are very useful in slice imaging, because they provide a means to see easier inside the human body than a number of slice images side by side. We also provide a new method, dynamic pulmonary imaging with digital fluoroscopy, as an example of the digital possibilities to compress a number of images into parametric images, numbers, histograms and curves. These processes also have other positive consequences information is transformed into a more easily perceptible form.


Review of the American College of Radiology--National Electrical Manufacturers' Association standards activity. The American College of Radiology and the National Electrical Manufacturers' Association published the ACR-NEMA Digital Imaging and Communications Standard in 1985. Implementations are just now becoming available. During this time, working groups of the committee responsible for the standard have been very active. An expanded version of the standard was published in 1988 and a third version, to be known as Digital Imaging and Communications in Medicine (DICOM), is being prepared for publication in 1992. This paper briefly reviews the history of the standard, describes recent activities, outlines the extensions planned for the DICOM standard, and describes the participation of the committee in international radiological imaging standards activities.


Standardization of network addressing in picture archiving and communications systems utilizing the ISO OSI protocols. The establishment of a communications network requires the definition of addressing schemes to identify systems attached to the network. When it is anticipated that such a network will interconnect to, or communicate with, other similar networks it is beneficial to define standardized addressing schemes. This paper discusses the need for the standardization of network service access point (NSAP) addresses in picture archiving and communications systems (PACS) which use the open systems interconnect (OSI) communications protocols. Possible methods for establishing the necessary hierarchy of address registration authorities are discussed, along with the corresponding address formats.


Current status of Image Save and Carry (IS&C) standardization. Image Save And Carry (IS&C) was planned to be an off-line information system for transmission and exchange of medical images and information between a medical facility's different divisions as well as between other hospitals. The IS&C committee defines file format for magneto-optical disk, the data format and representation, media compatibility and data security and technological assessment. A 'zone management method' which contributes to a rapid access of data in the recording media is used for IS&C file management. The IS&C standard holds as much conformation as possible in order to coordinate with ACR-NEMA (American College of Radiology-National Electrical Manufacturers' Association) and MIPS (Medical Information Processing Systems) standards. The IS&C data format is based upon the ACR-NEMA/MIPS standard. A major difference between the ACR-NEMA/MIPS standard and IS&C standard is that the IS&C standard is expected to serve for recording all kinds of medical information (e.g., diagnostic reports, endoscopic images and electrocardiograms), including X-ray images. Applications to PACS, teaching files, personal electronic health and medical records are promising. The booklet of IS&C standard will be published in the spring of 1992 by the IS&C committee.


Oral diagnostic reporting and synchronized image filing using magneto-optical disks. An experimental radiologic reporting system has been developed and tested. The rewritable and compact magneto-optical disk (MOD) is applied to storing medical images with oral diagnostic reports of these radiologic images. The disk is 5.25 inches in diameter, has 600 MB memory capacity, is erasable, light and compact. Advantages are simultaneous recording of radiologic images and their oral reports by radiologists, and application to circulation of media inside the hospital as well as to filing of medical images. The MOD has a multimedia function of communication and filing. When medical images are taken and stored, oral interpretation by radiologists can be simultaneously added. Physicians can get information of the images and their reports by oral speech at the same time in front of computer workstation. Furthermore, integration of a voice recognition capability is now being undertaken.


The European Community: standardization in medical informatics and imaging. The use of informatics and telecommunications in health care and medicine has reached a stage where the application of standards is an absolute requirement. The AIM Programme of the CEC DGXIII stimulated the study of the subject, and has supported the set up of an official European platform for standardization in this field, the CEN TC251. The needs for standardization in one of the subareas, medical imaging, are described in detail. The future solutions of the problems concerned are regarded prerequisites for the general and practical use of PACS and IMACS.


JPEG compression for PACS.

JPEG compression for PACS. In the medical field, especially in diagnostic radiology, there still remains controversy over how and whether or not to compress X-ray images for storage and transmission. The joint Photographic Expert Group (JPEG) standard which has recently been agreed upon is the very attractive technique to archive and to transport images in medical fields. This technique is based on 'lossy' compression of images, which can handle not only X-ray images but also full-colored images, and is suitable for introduction into picture archiving and communicating systems (PACS). The images can be handled after compression as quite small clusters of data. For example, a single 2000 x 2000 x 12 bits chest X-ray image which is an 8 Mbyte image compressed at a 10:1 ratio could retain virtually all the visible quality of the original version, and would take 100 s to transmit at 64 kbits/s using the Integrated Services Digital Network (ISDN, 800 kbytes compressed file, 8 kbytes/s transmission theoretically). An important factor in the design of this technique is that this format relies on no specific hardware or software if using JFIF (JPEG File interchange Format). Soon this algorithm will be able to run on any workstation or on any PC in the world. Highly compressed images may be unsuitable for diagnostic purposes. However, they may be sufficient for reference images which will be needed in clinical fields.


Mixed neurologic and psychiatric disorders: pharmacological issues. The number of patients with mixed neurologic and psychiatric disturbances is large. The psychiatric disturbances are often atypical in presentation and fit poorly into standard psychiatric nomenclature. They can be difficult to treat using standard psychopharmacologic approaches. This report reviews the impact of brain dysfunction on the use of conventional and nonconventional psychotropic agents in this mixed population.


Neuropsychological screening in the psychiatric emergency room. In a pilot study, a neuropsychological minibattery of tests consisting of Trail-Making Test A (TMA), Trail-Making Test B (TMB), and the Visual Reproduction subtest (VR) of the Wechsler Memory Scale was administered to patients with common psychiatric diagnoses in a psychiatric emergency room (ER). Patients with adjustment disorders were not distinguishable from normal controls, while patients with affective disorders and schizophrenia were more impaired than both of these samples. It is suggested that this or a similar minibattery of tests can be of use as an adjunct screening device for differential diagnosis of adjustment disorder versus more serious psychopathology in psychiatric ERs.


Personality and treatment response in agoraphobia with panic attacks. The present study investigated the association of specific personality characteristics with agoraphobia, and whether they predicted long-term outcome following a group cognitive behavior therapy program. Thirty-three patients with agoraphobia with panic attacks, 18 with social phobia, and 26 "normals" were used in the study. Personality factors were measured with the Maudsley Personality Inventory (MPI), the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Fundamental Interpersonal Relations Orientation-Behavior Scale (FIRO-B). The results showed that (1) agoraphobics are more extroverted and more likely to include others in their activities than are social phobics; however, they are less extroverted, more neurotic, more hostile and intropunitive, and less likely to include others in their activities than are normals; (2) social phobics are similarly less extroverted, more neurotic, and more hostile and intropunitive than normals, but, in addition, are less likely to exert control over others, more likely to want to be controlled, and less expressive of affection than normals; and (3) personality characteristics did not predict treatment outcome.


Bilateral transfer deficit in schizophrenia. Right-handed chronic schizophrenics, left-handed normals, and right-handed normals were tested on a measure of bilateral transfer of motor skill in contralateral hands. Schizophrenics compared with normals showed significantly poor bilateral transfer of skill in terms of errors committed; the group difference was nonsignificant in terms of response time. Results suggested a breakdown in perceptual-motor coordination in schizophrenia.


Patch testing with frullania during a 10-year period: hazards and complications. Contact dermatitis from frullania mainly affects people living in the country. The 2 most frequent species in Europe, Frullania dilatata and Frullania tamarisci, do not cross-react: both species must be patch tested when frullania intolerance is suspected. Yet patch testing with frullania may be hazardous: 9 out of 37 cases recorded in Strasbourg correspond to active sensitization by the tests. Since routine testing is risky, only aimed testing can be recommended.


Development, use, and factor analysis of a self-report inventory for mania. This report describes the development and initial psychometric evaluation of a 47-item self-report inventory for mania developed by the authors. Twenty-five subjects with a diagnosis of mania and 82 subjects with other diagnoses were tested during a hospital admission. The manic group scored significantly higher than the nonmanic group. The questionnaire correctly classified 71% of subjects. Manic patients who lacked insight endorsed as many items as manic patients with insight. A reliability analysis indicated that the items comprising the questionnaire are homogeneous. Test-retest reliability was high. A rotated factor analysis produced two factors, energized dysphoria and hedonistic euphoria. The authors discuss diagnostic, research, and clinical implications and applications of the Self-Report Manic Inventory.


Reactive changes in human epidermis following simple occlusion with water. Reactive changes produced in human epidermis by occlusion with water for 24 or 48 h were studied. A focally widened intercellular space was common. Several, often pronounced, reactive events were observed in the Langerhans cell system, whereas the keratinocytes and the melanocytes seemed unaffected. The reactive events showed a scattered distribution and were revealed only by electron microscopic analysis of extensive section series. It seems that, among epidermal cells, the Langerhans cells are the most susceptible and most easily alerted by an exogenous challenge.


Allergic contact dermatitis in shiitake (Lentinus edodes (Berk) Sing) growers. A 42-year-old female shiitake grower was investigated to clarify the etiology of skin lesions which developed during the planting of shiitake hyphae into bed logs. She complained of repeated eczematous skin lesions during the planting season, from March to July, for 10 years. She handled 7,000 pieces of small conic blocks made of beech, with shiitake hyphae attached to their surface, per day, and 300,000 pieces altogether per season. She was positive on patch testing with extracts of shiitake hyphae. In contrast, female shiitake growers with skin lesions associated with work other than planting, and without skin lesions, were negative on patch testing to the hyphae. Moderate allergenicity was observed to extracts of shiitake hyphae in a guinea pig maximization test. These findings indicated the etiology of skin lesions in shiitake growers to be allergic contact dermatitis induced by shiitake hyphae.


The relationship between social alienation and disorganized thinking in normal subjects and localized cerebral glucose metabolic rates assessed by positron emission tomography. This study investigated the relationships between the relatively mild manifestations in verbal behavior of social alienation and disorganized thinking in normal subjects and cerebral glucose metabolic rates measured by positron emission tomography (PET). Three groups of 10 young normal male subjects were injected with D-[18F]deoxyglucose (FDG) during either wakefulness, rapid eye movement (REM), or non-REM (NONREM) sleep, and 32 to 45 minutes later they were asked to report their thoughts, emotions, or dreams and free-associations to these mental events. Nonparametric correlations were obtained between measures of interpersonal social alienation, intrapsychic conflicts, and thought disorder derived from the typescripts of these reports by content analysis--using the Gottschalk-Gleser Social Alienation-Personal Disorganization Scale--and regional cerebral glucose metabolic rates obtained from PET scans. Total social alienation-personal disorganization scores obtained from the reports of wakeful, silent mentations showed significant positive correlations with glucose metabolic rates in the left temporal lobe. The patterns of significant correlations involving these verbal behavior measures derived from the content analysis of verbal reports of dreams or other mental events occurring during REM and non-REM sleep were in different cerebral locations from those found with these variables during silent, waking mentation. Previous observations suggesting that increased left temporal lobe glucose may typify chronic schizophrenia may instead be indicative of a wide range of thought disorder and/or social alienation manifestations occurring, at times transiently and minimally, in normal people.


Patch test reactions in atopic patients. Patch testing was carried out in 851 atopic patients; 181 atopic dermatitis (AD) patients were additionally tested with 50% dilutions of the test substances. The occurrence of allergic and irritant reactions was frequent, being 57% and 33% for AD patients aged 28-41 years and 19-27 years, respectively. Among age-matched allergic rhinitis (AR)/allergic conjunctivitis (AC) or asthma (A) patients, the number of allergic reactions varied from 25 to 30%, and for irritant reactions was 24%. In all groups, nickel, fragrance-mix, balsam of Peru and neomycin were the commonest allergens. Contact allergy to ingredients of topical medicaments was common among AD patients and patients with severe and long-lasting dermatitis were most frequently sensitized. However, sensitivity to multiple substances was not common among those patients. The number of irritant reactions was considerable, but 50% dilution of the test substances did not solve the problem.


Shoplifting in bulimia nervosa.

Shoplifting in bulimia nervosa. This study compared the shoplifting patterns of 27 bulimic and 25 nonbulimic shoplifters. Bulimic shoplifters often stole food, but usually also stole other items. Nonbulimic shoplifters reported starting to steal at an earlier age, weighed more than bulimic shoplifters, and were more likely to endorse antisocial reasons for shoplifting.


The influence of topical dermatological treatment modalities on epidermal Langerhans cells and contact sensitization in mice. The influence of the widely used topical dermatological treatment modalities anthralin, coal tar and pyrogallol on surface markers of epidermal Langerhans cells and contact sensitization was studied and compared with that of a PUVA treatment. A common effect of all dermatological therapies tested was inhibition of Langerhans cell ATPase, whereas an effect on MHC class II antigens was found only after PUVA or tar treatment. The induction of contact hypersensitivity was inhibited only by PUVA, and not by the other treatments. These results show that various forms of topical therapy influence surface markers and immunological function of epidermal Langerhans cells differently.


Assessing need for extended psychiatric hospitalization. The authors developed a set of rating scales to assess a wide range of variables believed by clinicians to influence the optimal length of hospital stay. They report the results of interrater reliability studies, a factor analysis of the scales, and a correlational study of the factors with actual length of stay. They describe the potential applications of the scales to clinical practice and research.


Diaper dermatitis: a study of contributing factors. A 44-week clinical study was carried out on a large sample of the Italian infant population to measure the incidence of diaper (napkin) dermatitis and to identify the factors related to the development of diaper dermatitis. Factors such as age, sex, the presence of atopic dermatitis, the general state of health of the child, the use of drugs and the type of diaper used were recorded. At the end of the test, 2169 clinical dermatological examinations were performed. The frequency of episodes of diaper dermatitis was 15.2%. Statistical correlations between diaper dermatitis and age, presence of atopic dermatitis, and health conditions were found.


A case of monthly unipolar psychotic depression with suicide attempt by self-burning: selective response to bupropion treatment. A second case of monthly, unipolar, psychotic depression is presented, involving a 26-year-old woman whose illness had a postpartum onset, recurred premenstrually for 33 consecutive months, and involved a suicide attempt by self-burning. Whereas various antidepressant, antipsychotic, and hormonal treatments were ineffective, bupropion (together with low-dose trifluoperazine) induced an immediate and complete remission that was maintained at a 16-month evaluation.


The sensitizing capacity of the antioxidants propyl, octyl, and dodecyl gallate and some related gallic acid esters. 8 alkyl gallates, including the widely used antioxidants propyl, octyl, and dodecyl (= lauryl) gallate, have been subjected to experimental sensitization in guinea pigs. Using a modern sensitization procedure, the results showed that all gallates are moderate to strong contact sensitizers: dodecyl (= lauryl) gallate was found to be the strongest. A characteristic correlation between side chain length and mean response was observed, giving a maximum of sensitization at a length of 12 carbon atoms (dodecyl gallate). A literature review revealed that the frequency of reports of allergic contact dermatitis from antioxidants of the gallate type has increased in the last 4 years. In most cases, the moderate sensitizer propyl gallate was the source of sensitization.


Prick and use tests with 6 glove brands in patients with immediate allergy to rubber proteins. 20 patients with contact urticaria from rubber gloves were prick tested using eluates from 4 latex (Triflex, Ansell Gammex, Exona, Armi) and 2 non-latex (Tactylon, Elastyren) glove brands. All patients showed a positive prick test reaction to at least 2 latex glove eluates. A hypoallergenic glove (Ansell Gammex) gave a positive prick test reaction in 1 patient, but non-latex gloves were negative in all cases. All patients showed a positive result in the use test with a latex surgical glove (Triflex), whereas none did with a non-latex glove (Tactylon). Non-latex gloves and, in some cases, also hypoallergenic latex gloves, are a good alternative to rubber gloves for patients with immediate latex allergy.