[Examination of the effect of chlorfenvinphos on the activity of aminotransferase in plasma and liver in vitro]. In vitro experiments the effect of chlorfenvinphos on aminotransferases activities in rat plasma and liver homogenate cytoplasmic fraction was studied. As amino groups donors in the transamination reactions with plasma enzymes the next eight amino acids were used: alanine, aspartic acid, cysteine, phenylalanine, leucine, lysine, valine and asparagine, and with the liver cytoplasmatic enzymes--the same above mentioned without asparagine. In all these reactions as an amino groups acceptor alfa-ketoglutaric acid was used. To the incubation mixtures were added: 1 cm3 of the plasma or liver homogenate cytoplasmic fraction; 0.05 cm3 of chlorfenvinphos solution in ethyl acetate (0.17 mg/cm3) or 0.05 cm3 ethyl acetate. Aminotransferase activity was expressed as the amount of glutamate developing during 1 h incubation. Glutamic acid was determined spectrophotometrically after chromatographic separation on filter paper. Both in rat plasma and in liver cytoplasmic fraction all used amino acids as amino groups donors in the transamination reactions were shown. In the reactions with the blood plasma enzymes the most active donors were: alanine, aspartic acid and cysteine and with the participation of liver transaminases: alanine, aspartic acid and phenylalanine. As well in plasma, as in liver the greater activity of AlAT than of AspAT was observed. In the reaction with alanine and aspartate there was formed in the case of plasma 1.51 mumol Glu/cm3 and 1.00 mumol Glu/cm3 respectively and in the case of liver -69.07 mumol Glu/g and 53.26 mumol Glu/g respectively. Results of statistical analysis revealed that small plasma and liver aminotransferases inhibition was caused by the solvent, while the insecticide under test had no influence on the efficiency of transamination.


[The effect of n-methylcarbamate insecticides on catecholamines in rat adrenal glands]. The influence of acute (50% LD50), subacute (10% and 20% LD50) and 12-weeks (5% LD50) intoxication with carbaryl and propoxur on the adrenaline (A) and noradrenaline (NA) level in the rat adrenal glands was investigated. The level of A and NA was decreased to very low values after acute intoxication with carbaryl. Probably this effect result from increase of release of accumulated acetylcholine during poisoning. With lower dosages of carbaryl and propoxur (10% and 20% LD50) different biochemical effect in adrenal glands has been observed. There was a significant decrease in the level of A and simultaneously increase in the NA level. Intoxication with 20% LD50 dose of propoxur has caused smaller alterations than the same dose of carbaryl. Carbaryl when given in a dose of 5% LD50 (12 weeks) produced within first six weeks similar changes to that which can be observed during subacute poisoning. Such character of changes (increase of NA level and decrease of A level) indicate that probably N-methylcarbamate insecticides inhibited the last step of biosynthesis of adrenaline. It can be due to inhibition of N-methyltransferase noradrenaline activity.


[Results of testing well water from an area influenced by the chemical plant "Police"]. The subject of this study was the determination of the correlation between the operation of Chemical Plant "Police" and contamination of underground waters. The waters from ten wells in 16 localities were tested in 1982, 1987 and 1990. The indicators of contaminations emitted in different form by Chemical Plant "Police" as fluorides, ammonia and its derivatives nitrites and nitrates, sulphates, phosphates and also chlorides were tested. Bacteriological examinations of water also were performed. Investigations performed in 1987, confronted to 1982, showed development concentration of ammonia and minor as depends fluorides and sulphates. In 1990 lowering of average level of all chemical indicators were obtained. Presumable the introduction of technological changes in Plant determined the reduction of contaminations of underground water in this area.


[Occurrence of aquatic organisms in water pipes and the resulting problems with drinking water disinfection]. The present text is the first part of a paper aimed at specification of the requirements ensuring effective disinfection of drinking water. The discussed health hazards result not only from the presence of pathogenic microorganisms in water, but also from the occurrence of micro- and macroscopic plant and animal organisms. It was shown that while the traditional method for water treatment and disinfection reduces the number of these organisms, it fails to eliminate them completely, particularly in the case of tap water intake from shore intakes of surface waters.


Dentin hypersensitivity treated with a fluoride-containing varnish or a light-cured glass-ionomer liner. Dentin hypersensitivity in 112 teeth was randomly treated with Duraphat or Vitrabond. No patients were included unless they, without being asked, complained about daily pain for a long period of time caused by cold, warm, sweet, sour, touch or any combination of these five variables. Patients were excluded if the dentin hypersensitivity could have been caused by cervical abrasion/erosion lesions deeper than 1 mm, cracked-tooth syndrome, caries lesions, operative caries treatment, and/or periodontal surgery or root scaling within the last 6 months. The pain was registered on a binary scale: 1) pain before the treatment; and 2) pain/no pain after the treatment. With Duraphat, 22% of the treatments failed within 1 wk and the cumulative 1-yr success rate was 41%. With Vitrabond, 2% failed within the first week and the 1-yr success rate was 79%. The difference between the two treatments was highly significant. Patients in whom Duraphat failed were treated with Vitrabond and vice versa; the 1-yr success rate for the retreated teeth was 68% when "Duraphat-failures" were treated with Vitrabond and 42% when "Vitrabond-failures" were treated with Duraphat.


Caries and saliva in 12-18-year-old diabetics and controls. Eighty-five 12-18-yr-old adolescents suffering from insulin-dependent diabetes mellitus (IDDM) and their healthy age- and sex-matched controls were investigated with respect to dental caries, salivary flow rate, pH and buffering capacity of saliva, counts for lactobacilli and mutans streptococci, and salivary glucose content. The diabetics had their disease well controlled according to the HbA1 levels. The results showed no statistically significant difference between diabetics and controls in DMF and DMFS indexes and the number of initial caries lesions. Mean number of initial caries lesions was 3.2 in diabetics, 2.3 in controls. Mean stimulated salivary flow rate was 1.2 ml/min in the patients, 1.4 ml/min in the controls. The pH and buffering capacity values were 7.3 and 4.8 in the patients, 7.4 and 5.1 in the controls, respectively. High counts of mutans streptococci (> 10(6) CFU/ml) and lactobacilli (> 10(5) CFU/ml) were observed more often, but not significantly so, among the patients than in the controls. The mean concentration of glucose in saliva was 10.3 micrograms/ml in the patients, 9.7 1 microgram/ml in the controls. Thus, if the patients' IDDM is well controlled, their salivary and caries data does not differ from that of healthy controls.


Progression of approximal caries in primary molars and the effect of Duraphat treatment. The progression of caries lesions over a 2-yr period was studied in 3-6-yr-olds. All 468 children included in the study lived in an area during 1977-85 (Malmö, Sweden) with a low fluoride concentration (0.2 ppm) in the drinking water. Radiographs were taken with a standardized periodic identical technique. Caries lesions were scored on the distal surface of the first and on the mesial surface of the second primary molars (maximum 8 per child) according to Gröndahl et al. Half of the children were treated semiannually with a fluoride varnish (Duraphat). In all, 421 surfaces with caries at baseline were available at the 1-yr examination and 369 at the 2-yr examination. After 1 yr, 34.1% of the shallow enamel lesions remained unchanged, while a progression was seen in 60.9%. 5.1% had been restored. The corresponding figures after 2 yr were 20.6, 52.1 and 27.3%. Of the deeper enamel lesions at baseline, 28.8% remained unchanged after 1 yr and 13.7% after 2 yr. Of the lesions extending into the dentin, 81.5% had been restored after 1 yr and all after 2 yr. When evaluating the effect of Duraphat, only the percentage of individuals with one or more superficial enamel lesions showing progression was determined. After 1 yr, 51.2% in the Duraphat (n = 41) and 82.8% in the control group (n = 29) showed progression (restored surfaces included). The corresponding figures after 2 yr were 66.7 (n = 42) and 91.2% (n = 34). The differences after both 1 yr and 2 yr were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)


Xylitol 5-P formation by dental plaque after 12 weeks' exposure to a xylitol/sorbitol containing chewing gum. Five subjects used xylitol-containing chewing gum for 12 wk. Dental plaque was collected before and after the exposure to xylitol. The plaque samples were examined for their capacity to form xylitol 5-P by incubation with 14C labeled xylitol, extraction and separation on HPLC. It was found that the capacity of the plaque to form xylitol 5-P was not reduced during the xylitol exposure in any of the subjects. No other xylitol-derived metabolites were observed. The inhibitory capacity of xylitol thus appears to be maintained after 12 wk exposure to xylitol.


Tobacco smoking, a factor in tooth loss in Reykjavík, Iceland. A random sample of 1023 people 52-79 yr of age out of a group participating in a longitudinal study at the Heart Preventive Clinic of the Icelandic Heart Association in Reykjavík, Iceland, was examined. The examination was carried out in 1985-7. The results on the number of remaining teeth and total edentulousness were compared to information regarding smoking habits and social status. Total edentulousness was more common among women. Total and partial edentulousness was more frequent in the lower "employment" classes while no statistical difference was found for smoking in this respect. This, however, did not affect the significance of tobacco smoking as a factor in the loss of teeth. In general smokers had fewer remaining teeth and were more often edentulous than ex-smokers, smoking time not considered, who again suffered more tooth loss than those who had never smoked. Therefore it is concluded that tobacco smoking may be a major single independent risk factor in the loss of teeth.


Sensitivity to a low calcium diet in different bones: an experimental study in the adult rat. Adult male Sprague-Dawley rats weighing an average of 550 g were age matched into one control group and one group given a low calcium diet. The animals were followed for 34 wk. There was a similar loss of cancellous bone tissue in the proximal tibia, the first tail vertebra and the mandible due to calcium deficiency. The bone loss was not related to the initial amount of cancellous bone or to the bone-forming activity, which did not differ between experimental and control animals.


Short term bone healing in calcium deficiency osteopenia and disuse osteopenia: experimental studies in adult rats. Adult male Sprague-Dawley rats (average weight 530-540 g) were studied in two different series. In series I, studying disuse osteopenia, the experimental rats had all maxillary molars extracted on one side. After 16 wk they had their mandibular first molar of the corresponding side extracted and were followed for another 4 wk. In series II, studying calcium deficiency osteopenia, the experimental rats were given a low calcium diet for 16 wk and at this time had their mandibular first molars extracted. Both disuse and calcium deficiency caused osteopenia, which did not seem to impair the healing process after tooth extraction in the short term. One puzzling finding in the disuse series (I) was that the alveolar height at the extraction site was higher in the experimental than in the control group 4 wk after extraction.


Influence of masticatory muscle function on craniofacial growth in hypocalcemic rats. The aim of this study was to investigate the influence of low masticatory function on the craniofacial growth pattern in rats fed a low calcium and vitamin D deficient diet. Male growing rats were divided randomly into three groups: the Normal Hard Diet group, the Deficient Soft Diet group, and the Deficient Hard Diet Group. Lateral cephalograms were taken at days 0, 14 and at the end of the experiment, day 28. The craniofacial growth pattern was altered by an upwards rotation of the viscerocranium (orthocranialization) in the Deficient groups and, the total skull lengths were shorter than in the Normal Hard Diet group. The viscerocranium in the Deficient Soft Diet group was in an even more orthocranial position than in the Deficient Hard Diet group and the antegonial notch was shallower. This indicates that an induced disturbance of craniofacial morphology due to metabolic bone disease during growth is accentuated by a low masticatory function.


Longitudinal study of stimulated whole saliva in an elderly population. The aim of this investigation, which is part of the longitudinal gerontologic population study in Gothenburg (H-70), was to examine the effect of aging on salivary flow. Three 70-yr-old cohorts, born in 1901/02, 1906/07, and 1911/12, were studied both cross-sectionally and longitudinally. Representative subsamples (n = 931) were followed up to 82 yr in the first and up to 75 yr in the second and third cohorts. Whole saliva secretion was stimulated by paraffin wax chewing for 5 min and all sampling was carried out in the morning after an overnight fast. The mean secretion rate was 1.24 for men and 0.94 ml/min for women at the age of 70 (all cohorts pooled). The percentage values for extremely low secretion rate (< 0.2 ml/min) were 2 and 6%, respectively. Neither the cross-sectional nor the longitudinal comparison showed any decrease in secretion rate on a group basis either in the age interval 70-82 yr in the first or between 70 and 75 yr in the other two cohorts. However, an increased prevalence of complaints of mouth dryness was found, especially among women. The main conclusion from this study is that there is no decline on a population basis in paraffin-wax-stimulated salivary flow with increasing age.


Factors influencing mercury evaporation rate from dental amalgam fillings. Factors influencing mercury evaporation from dental amalgam fillings were studied in 11 volunteers. Air was drawn from the oral cavity for 1 min and continuously analyzed with a mercury detector. In six volunteers the median unstimulated evaporation rate was 0.1 ng Hg/s, range 0.09-1.3 ng Hg/s. After chewing gum for 5 min the highest evaporation rate was 2.7 ng Hg/s. Chewing paraffin wax gave only a small increase in evaporation rate. Changes in airflow rates between 1.5 and 2.5 1/min during the 1 min sampling did not change the amount of mercury drawn from the oral cavity. Sampling with different mouthpieces and closed mouth was compared to open mouth sampling with a thin plastic tube. It was found that the latter method could result in lower values for some volunteers due to simultaneous mouth breathing. After placing individual plastic teeth covers in the mouth, the intraoral evaporation of mercury decreased immediately by 89-100% of previous levels. This technique could be used to detect mercury evaporation from separate amalgam fillings or to reduce the intraoral mercury vapor concentration. Rinsing the mouth with heated water for 1 min increased the mean evaporation rate by a factor of 1.7 when the water temperature increased from 35 degrees C to 45 degrees C.


Alveolar ridge augmentation by osteoinductive materials in goats. The purpose of the present study was to determine whether alveolar ridge augmentation could be induced in goats. In 12 male goats allogenic, demineralized, and lyophilized dentin or bone was implanted subperiosteally on the buccal sides of the natural edentulous regions of the alveolar process of the mandible. Light microscopic evaluation revealed fibrous encapsulation, a few multinuclear giant cells, little inflammatory reaction, and no osteoinduction. It was concluded that no osteoinduction took place in goats.


Levels of cyclosporin-A (CsA) in saliva in children after oral administration of the drug in mixture or in capsule form. The cyclosporin-A (CsA) level in human unstimulated whole saliva was studied in 5 children, aged 9-16 yr, receiving the immunosuppressive drug CsA following renal allograft transplantation. The time-concentration relationship of CsA in saliva was determined in the children who were taking the drug orally in mixture form (n = 3) as well as in capsule form (n = 3). For the mixture, the median maximal level of CsA in whole saliva was 2867 ng/ml compared to 5.4 ng/ml for the capsule. The oral mucosal exposure of CsA during the dosage interval was approximately 130 times higher when the drug was administered in mixture form than in capsule form. The study demonstrates that gingival tissue is exposed to a considerable concentration of CsA throughout the dosage interval in patients taking CsA in mixture form. Therefore the vehicle in which the drug is administered should be considered in the pathogenesis of CsA-induced gingival overgrowth.


Effects of food preservatives on growth and metabolism of plaque bacteria in vitro and in vivo. The aims of the present study were to assess the consumption of food preservatives during the last decades, and to study the effect of the preservatives, sorbic and benzoic acid, on growth and glycolysis of oral bacteria in vitro, and on acid formation by dental plaque in vivo. Five consumption reports from the Central Bureau of Statistics of Norway were used to estimate alterations in consumption of staple food containing the two preservatives. A modified broth dilution method was used to determine the MIC values of the preservatives against Streptococcus sobrinus and Streptococcus sanguis. Extracellular 14C-glycolytic metabolites were studied by HPLC analyses. Plaque-pH measurements were used to assess possible effects on acid production. The consumption reports indicated increased consumption of preservatives. The in vitro testing suggested that legal concentrations of preservatives may inhibit the growth of oral streptococci. However, the preservatives did not inhibit in vitro glycolysis at tested concentrations. In vivo testing with similar concentrations (0.4% w/v) showed a significant effect. A higher concentration (2% w/v potassium sorbate) had a tendency to inhibit acid-formation by dental plaque even more.


Nail pigmentation associated with zidovudine: a review and report of a case. Zidovudine has become the standard therapy for patients with AIDS and for asymptomatic HIV infected patients with low helper-T-cell levels. As experience with the drug has grown, knowledge of the range of side effects has increased. We describe progressive pigmentation of finger and toe nails in a white patient due to zidovudine therapy, a phenomenon not often described. Nail pigmentation occurs primarily in black patients. It appears to be reversible and relatively dose dependent. The mechanism responsible for the discoloration is unknown. It is important to alert patients to this side effect and to prevent unnecessary investigations and treatment for other diagnoses, such as cyanosis.


A foodborne outbreak of group A streptococcal disease at a birthday party. A severe foodborne outbreak of group A streptococcal disease (T28) affected 122/169 people (72%) who attended a church party or ate leftovers from the party. The median incubation time was 42 h. Muscular pain or weakness and fatigue usually preceded pharyngeal symptoms. Complications included otitis media with perforation, peritonsillitis requiring tonsillectomy, arthritis and pericarditis. A 45-year-old man died 36 h after he developed an influenza-like illness, and at necropsy there were histological signs of early streptococcal septicaemia. The strain produced erythrogenic exotoxins B and C. Streptococci were probably transmitted by sliced eggs on sandwiches. Laboratory experiments showed that there was an increment in viable count of streptococci with 6 logs after incubation in egg yolk for 24 h at room temperature. The unusually warm climate and flaws in food handling routines contributed to this large foodborne epidemic.


Septic shock induced by group A streptococcal infection: clinical and therapeutic aspects. During 1988 and 1989 > 500 cases of serious group A streptococcal infections were reported in Sweden, many with a fatal outcome. We report here on 11 consecutive patients with septic preshock/shock and multiorgan failure, including acute renal failure. 10 had verified group A streptococci (GAS) serotype T1M1 infections while 1 patient was culture negative but with clinical signs of severe infection and serological evidence of GAS infection. Presenting symptoms were high fever, relative bradycardia, edema and renal failure. In all patients the condition deteriorated despite conventional treatment including volume substitution and antibiotics. Systolic blood pressure was transiently < 80 mmHg in 10 patients and 9 of them needed infusion of inotropic agents to avoid fatal circulatory shock. In 9 patients respiratory aid was instituted and 7 were dialysed. Plasma exchange was performed in 7, while the remaining 4 received transfusions with blood and plasma without plasma exchange. 10 patients improved and were discharged within 8 weeks. One woman died within 2 days after admission to the hospital. Renal function recovered in all survivors, with a follow-up serum creatinine < 80 mumol/l. The complicated clinical picture in these patients with many simultaneous therapeutic events confounds the interpretation of the effect of single actions. The favourable outcome in these severely ill patients suggests that potent inotropic agents, immunoglobulin therapy and plasma exchange might be beneficial in severe streptococcal disease when conventional treatment fails.


Outbreaks of group A beta-hemolytic streptococcal pharyngitis in children: correlation of serotype T4 with scarlet fever. We evaluated the clinical features of 121 children who had group A beta-hemolytic streptococcal (GABHS) pharyngitis during 2 outbreaks in the Chikuhou district, Fukuoka, Japan, with respect to T types. During the first outbreak (November 1989-February 1990), T12 (50%) and T22 (27%) were the dominant T types isolated. During the second outbreak (January-April 1991), 64% of the typable strains were T4. Pus on the tonsils was less common and strawberry tongue more common in patients with eruptions than in those without. Skin eruptions were much more common in the patients infected with T4 than with other T types (p < 0.001). Despite a 10-day regimen of amoxicillin, 12/69 patients (17.4%) had evidence of GABHS on repeat cultures. The results suggest that T4 may be associated with a high incidence of scarlet fever. Serotyping should be performed to identify disease carriers and patterns of GABHS infection.


Kinetics of serum levels of interleukin-6 in Staphylococcus aureus septicemia. The kinetics of Il-6 serum concentrations were analyzed in 17 patients with a culture verified Staphylococcus aureus septicemia. The analyses were performed using an antigen capture immunoassay. All patients had elevated IL-6 serum concentrations on admission. In most cases a subsequent rapid decrease to low levels was registered within 10 days. The IL-6 serum concentrations reflected the clinical course. In sera sampled on admission a relationship was found between IL-6 serum concentrations and levels of C-reactive protein.


Survival and causes of death among patients with Yersinia enterocolitica infection. A Norwegian 10-year follow-up study on 458 hospitalized patients. The aim of the present study was to elucidate the possible influence of the Yersinia enterocolitica infection on long-time survival, and to describe clinical conditions associated with a fatal issue. During the period 1974-83, Y. enterocolitica infection was diagnosed in 458 hospitalized patients by antibody response or isolation of the microorganism. The patients were followed for 4-14 years (until 1987). The observed cumulative survival rates for female patients, and for the whole material, deviated significantly from the expected rates for 10 and 8 years. Two patients died in association with the acute infection, and 2 died from malignant mesothelioma during the first year of observation. 4/42 other patients died during the follow-up period from chronic multiorgan disease, 9 from malignant disease, and 2 died from hematological disorders. A very high mortality (10/22) was observed among patients who had developed chronic liver disease subsequently to the infection. We conclude that chronic conditions associated with the Y. enterocolitica infection may exert a substantial impact on long-time survival.


Delayed antibiotic-induced lysis of Escherichia coli in vitro is correlated with enhancement of LPS release. A kinetic turbidimetric Limulus amebocyte lysate (LAL) assay was used to study the effects of gentamicin, amoxycillin and ciprofloxacin (16 x MIC) upon release of lipopolysaccharide at different stages of a growing Escherichia coli 055:B5:H culture in vitro. In this model a linear correlation was present between the logarithms of colony counts and free LAL activities. Untreated E. coli grew from log values of 4.9 +/- 0.15 (low inoculum) and 6.8 +/- 0.08 cfu/ml (high inoculum) at t = 0 to 8.9 +/- 0.05 and 9.1 +/- 0.13 cfu/ml at t = 6 h, respectively. The log values of basal free LAL activities at low and high inoculum sizes were 1.9 +/- 0.07 and 3.3 +/- 0.14 endotoxin units/ml, increasing 2100- and 69-fold, respectively during a 6-h growth. Amoxycillin-induced lysis was not significantly associated with an increase in free LAL activity. Efficacy of bacterial killing by gentamicin was high, but free LAL activity increased only 3.2- and 7.7-fold at the low and high inoculum experiments, respectively. Ciprofloxacin induced cell filamentation during the experiments. At low and high inoculum conditions exposure to ciprofloxacin induced a 43- and 68-fold increase in free LAL activities, respectively. Our data indicate that (a) LPS is released as long as E. coli remain structurally intact; (b) LPS release is enhanced when bacterial biomass increases; and (c) are taken as evidence against the concept of lysis-correlated LPS release.


Antibody response to a Haemophilus influenzae type b polysaccharide tetanus toxoid conjugate vaccine in splenectomized children and adolescents. 20 children and adolescents 4-18 years old and splenectomized for various reasons (spherocytosis (n = 6), idiopathic thrombocytopenia (n = 8), other (n = 6)) were immunized once with a Haemophilus influenzae type b (Hib) polysaccharide tetanus toxoid conjugate vaccine. Prior to vaccination 10/20 patients had anticapsular antibodies below what could be considered the minimum protective level in splenectomized (0.6 micrograms/ml), whereas all obtained high antibody levels after vaccination. In addition 1 infant with congenital asplenia was vaccinated at 2,4 and 6 months of age, and was shown to respond well after the second and third injection with serum antibody concentrations of 0.84 and 10.7 micrograms/ml respectively. Because asplenic individuals have an increased risk of invasive Hib infection, these data suggest that vaccination of such individuals against Hib may be justified.


Bacteriology of the maxillary sinus in healthy volunteers. In order to investigate the bacteriology of the healthy maxillary sinus, 12 volunteers were subjected to antral puncture with instillation of sterile saline, followed by aspiration. Maximum efforts were used to obtain aspirates without contamination. None of the aspirates showed bacterial growth.


Ciprofloxacin versus a tobramycin/cefuroxime combination in the treatment of serious systemic infections: a prospective, randomized and controlled study of efficacy and safety. Sequential intravenous and oral ciprofloxacin (CF) was compared with a combination of tobramycin and cefuroxime (T/C) in the treatment of serious systemic infections. Altogether 310 patients were randomized, 160 receiving CF and 150 T/C, the 2 groups being reasonably well balanced. 29 patients without infection were excluded from the analysis. Complete clinical resolution was obtained in 75% (107/143) patients receiving CF and in 78% (107/138) receiving T/C; the difference was not statistically significant. The rate of bacterial eradication in septicaemia was 72% (95% confidence interval (95% c.i.): 58-86%) for patients treated with CF and 87% (95% c.i.: 77-96%) when T/C was given, while the eradication rates in urinary tract infection were 72% (95% c.i.: 54-90%) and 45% (95% c.i.: 23-67%) for CF and T/C, respectively. Significant differences in bacteriological response for other diagnoses were not detected. Also for lower respiratory tract infections (LTRI) the clinical and bacteriological responses were quite similar, although relatively more failures occurred in CF treated patients with LRTI caused by pneumococci. The frequencies of adverse reactions were comparable, but the reactions were less serious following CF treatment. Our results indicate that CF may be used for empirical treatment of serious infections. However, if pneumococcal etiology is likely, alternative antibiotics should be used, and if necessary, coverage against anaerobic bacteria should be added.


Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice. Etiology and clinical manifestations have been studied in 153 adult patients with lower respiratory tract infection, and the results are presented according to clinical and radiographic diagnosis. Laboratory investigations revealed that bacterial infection, mycoplasma and chlamydia included, occurred as often in 22 patients whose clinical diagnoses of pneumonia were not evident radiographically, as in 20 patients with radiographic pneumonia. In the latter group significantly higher values of erythrocyte sedimentation rate and C-reactive protein were demonstrated. The most common pathogen was influenzavirus A, followed by respiratory syncytial virus, Streptococcus pneumoniae, and Mycoplasma pneumoniae. Chlamydia pneumoniae infection was found in 3 patients with radiographic pneumonia. The study supports the traditional view that patients with a positive chest radiograph as a rule present more serious manifestations of lower respiratory tract pathology than patients with a normal radiograph. However, as only 1/9 patients with pneumococcal infection and 2/7 with mycoplasmal infection had radiographic evidence of pneumonia, radiography alone did not seem to offer sufficient information for selecting patients for antibacterial therapy.


Reactivation of hepatitis B virus infection with an unusual pattern of serological markers. A 73-year-old man presented with acute hepatitis, judged to be a reactivation of hepatitis B virus infection. His serum samples during a follow-up time of 16 months showed an unusual pattern of serological markers. He was consistently HBeAg positive, HBsAg fluctuated just under the cut-off value and he had a low level of circulating anti-HBs. By electron microscopy numerous aggregates of surface antigen particles, but not complete virions were seen. He was HBV DNA positive by hybridization. The complete precore and core genes and a region of the surface gene were amplified from his serum by PCR. These findings emphasize the need for expanded serological testing in some patients with acute clinical hepatitis.


Streptococcal myositis.

Streptococcal myositis. Streptococcal myositis (SM), is a very serious condition with a high mortality rate. The port of entry of the infection is often unknown. We present here a case report concerning a 68-year-old patient with fulminant SM preceded by symptoms of an upper respiratory tract infection. Haemolytic streptococci of group A were found in the blood, muscle tissue and throat. The patient survived after massive therapeutic interventions including intensive care with intravenous antibiotics, fasciotomy, plasma exchange, controlled respiratory ventilation and exarticulation through the shoulder. The patient's wife fell ill at the same time with a sore throat and the same type of streptococci (T-type 3) was found in both patients.


Disseminated actinomycosis due to Actinomyces meyeri and Actinobacillus actinomycetemcomitans. A 44-year-old man presented with pulmonary lesions and neurological symptoms suggestive of lung carcinoma with cerebral metastases. He had non-specific chest X-ray findings since 6 years and he also suffered from relapsing purulent skin lesions which resolved spontaneously or by short courses of antibiotic treatment. When corticosteroids were given, multiple subcutaneous swellings developed that spontaneously ruptured. The pus contained Actinomyces meyeri and Actinobacillus actinomycetemcomitans. On operation, the intracerebral lesions appeared to be abscesses and the same bacteria were cultured as from the skin lesions. Bronchoscopical examination did not reveal a diagnosis. Amoxicillin was given for 12 months and the patient recovered.


Candida albicans septicemia in a premature infant successfully treated with oral fluconazole. A premature male infant, birth-weight 1460 g, was treated successfully for a Candida albicans septicemia with orally administered fluconazole for 20 days. Dosage was 5 mg/kg/day. No side effects were seen. Fluconazole may present a major progress in treatment of invasive C. albicans infections in neonatology.


Leishmaniasis diagnosed from bronchoalveolar lavage. A 51-year-old renal transplant patient, whose spleen had been removed 11 years ago, was admitted to hospital for elective surgery, which was cancelled as she developed spiking fever and nonproductive cough and her general condition deteriorated. After 2 weeks, leishmaniasis was unexpectedly diagnosed from a bronchoalveolar lavage specimen, which had been subjected to parasitological examination under the suspicion of pneumocystosis. Isoenzyme typing identified the parasite as Leishmania infantum. The patient had visited Malaga, Spain, twice a year, the last trip taking place 1 month before admission. Specific treatment was followed by rapid recovery without relapse during 1.5 years. Splenectomy and immunosuppressive medication obscured the clinical suspicion of leishmaniasis. The case is a reminder of the interstitial pneumonitis in leishmaniasis and emphasizes the value of broad-spectrum methods detecting a variety of parasites.


Antibodies to Borrelia burgdorferi in various population groups in Croatia. The purpose of the present study was to investigate the prevalence of antibody to Borrelia burgdorferi in Croatia in various population groups. The study comprised 263 individuals: 93 healthy subjects (travellers); 100 controls separated into 2 subgroups, 50 from high risk zone (endemic) and 50 from low risk zone (non-endemic); and 70 members of a high risk population (forestry workers). Antibody to B. burgdorferi of IgM and IgG class were analysed by an ELISA technique using mixed antigen made of strain B31 (ATCC 35210). IgG antibodies were detected in 9/93 (9.7%) in general population; 22/50 (44.0%) in the control group from high risk zone and 4/50 (8.0%) from low risk zone; and 30/70 (42.9%) among forestry workers. In all tested groups low numbers of IgM positive were found.


Rapid emergence of quinolone resistance in Campylobacter jejuni in patients treated with norfloxacin. 15/60 subjects from one center, who all took part in a multicenter double-blind, placebo-controlled study to evaluate the effect of norfloxacin on acute enteritis, had norfloxacin sensitive strains of Campylobacter jejuni in pre-study stool specimens. Eight of the 15 subjects received active drug. In 3 of these 8, high-level quinolone resistant Campylobacter strains of the same serotype as in pre-treatment samples were isolated 4-90 days after the initiation of treatment.


[Heart valve substitution: the effect of preoperative findings on long-term outcome]. In a retrospective analysis of 653 consecutive patients who underwent heart valve replacement by one single type of mechanical prosthesis (St. Jude Medical) at three Swiss university medical centers (Basel, Bern, Lausanne), the outcome was judged on the basis of preoperative variables. These variables should facilitate the timing of heart valve replacement. Preoperative evaluation includes NYHA classification of symptoms, chest X-ray, ECG, and LVEF on angiography. Postoperative outcome was assessed clinically at yearly intervals by NYHA classification, documentation of complications and mortality. Five-year-survival rates were 96 and 88%, and complication-free rates were 82 and 76% respectively in patients after isolated aortic and mitral valve replacement. An unsatisfactory outcome with death or persistent severe symptoms was more frequent when preoperative symptoms at rest and atrial fibrillation were present. Heart valve replacement should not be postponed until severe symptoms and functional impairment occur. Clinical criteria are at least as important for the timing of operation as the findings of more complex investigations.


[Bacterial pathogens in diarrhea: demonstration of verotoxin-producing Escherichia coli using the polymerase chain reaction]. In 23% of 576 diarrhea patients we were able to demonstrate putative bacterial pathogens. Not included in this number is Clostridium difficile which was found in 8 of 48 (8.3%) specimens analyzed. In addition to Salmonella (8.2%), Campylobacter (6.0%), Aeromonas (2.7%), Shigella (1.9%) and Yersinia (0.8%) we identified verotoxin-producing Escherichia coli (VTEC) in 10 patients (1.9%). VTEC were found as frequently as Shigella (occurring exclusively in patients returning from the tropics) and we propose that VTEC should be routinely assayed in patients with travel-associated diarrhea as well as in those with diarrhea presumably acquired in Switzerland. Established methods for identification of E. coli O157:H7, which include screening for sorbitol-negative Enterobacteriaceae and agglutination, are laborious and insensitive (only 1 of 10 patients with proven VTEC infection positive). The other 9 patients were identified by means of the polymerase chain reaction (PCR). In 7 of these 9 patients we were able to isolate a verotoxigenic strain following a positive PCR result by screening large numbers of colonies. None of them belonged to the O157:H7 serogroup and, in addition, all were sorbitol-positive. The polymerase chain reaction as performed in this study is easy to use, is applicable to large numbers of specimens, and can be regarded as the method of choice for demonstration of VTEC in the clinical diagnostic laboratory.


[Hyperkalemia during prolonged use of angiotensin II-converting enzyme inhibitors in end-stage renal insufficiency]. Hyperkalemia is a severe complication of end-stage renal failure. To evaluate whether ACE inhibitors may even worsen the propensity to develop hyperkalemia in this condition, we have analyzed retrospectively pre-dialytic blood pressure and serum potassium in 15 patients on chronic hemodialysis before and during long-term ACE inhibition. This treatment induced a significant drop in blood pressure (from 173 +/- 3/90 +/- 2 to 159 +/- 5/85 +/- 2 mm Hg [p < 0.05]), whereas serum potassium increased from 4.9 +/- 0.2 to 5.5 +/- 0.2 mM (p < 0.05), irrespective of the dosage of ACE inhibitor and of the residual diuresis. Hyperkalemia was well tolerated and was corrected in all patients by dialysis; treatment was discontinued in only one case. In conclusion, ACE inhibitors represent effective antihypertensive treatment in end-stage renal failure. However, long-term ACE inhibition may be accompanied by a worsening of hyperkalemia, which could be accounted for by a reduced effect of aldosterone on extrarenal potassium homeostasis.


[Q-DIPS: current approach to prediction of drug interactions]. Interactions are an important cause of adverse drug effects. Because of the large number of substances and the complexity of the mechanisms involved, computers can be of great help in the detection, prediction and management of interactions. We propose a new complementary approach to the prediction of interactions through a key mechanism, hepatic drug biotransformation. The originality of the approach consists in integrating in vitro enzymatic data and pharmacokinetic data to make in vivo predictions. An Inhibition Index (II) is defined to characterize the interaction potential of an inhibitor for a specific isozyme independently of the isozyme's substrates. It is thus possible, even in the absence of prior clinical observations, to make individualized qualitative as well as quantitative predictions of potential in vivo interactions. Q-DIPS is a prototype computer system under development on a Macintosh to manage the large amount of multi-dimensional data and facilitate the investigation and validation of extrapolations. The kinetics of II for two antifungal drugs, fluconazole and ketoconazole, are simulated and compared in order to illustrate the potential of the approach.


[Incidence and clinical aspects of scombroid fish poisoning]. An impressive case of scombroid-fish poisoning in a 34-year-old woman prompted us to investigate the incidence, clinical findings and follow-up of this disease, the syndrome of which resembles histamine intoxication. In 25 years (1966-1991) a total of 76 incidents after intake of tuna fish were reported to Swiss Toxicological Information Centre. 27 reports came from physicians, and of these 18 fulfilled the criteria of scombroid-fish poisoning. Thus, this intoxication occurs rarely in Switzerland. The symptoms in 31 well documented cases are described. Most patients had erythema (87%), half complained of headache and one third had gastrointestinal symptoms. The clinical course was benign in all patients, and the symptoms had disappeared after a mean period of 8 hours.


Groin infection following cardiac catheterization: a case report. A 56 year old female with insulin dependent diabetes mellitus developed a severe wound infection after a cardiac catherization. The clinical features and treatment of progressive bacterial synergistic gangrene and necrotizing fasciitis are discussed.


Arabidopsis and Nicotiana anthocyanin production activated by maize regulators R and C1. Anthocyanin pathway-specific transcriptional activators R and C1 from the monocot maize were expressed in two dicots, Arabidopsis thaliana and Nicotiana tabacum. Expression of R caused augmented anthocyanin pigmentation in both plant species and augmented trichome (hair) production in Arabidopsis. Alone, C1 had no effect. Hybrid transgenic Arabidopsis expressing both C1 and R produced anthocyanins in root, petal, and stamen tissues that normally never express anthrocyanins. When R was expressed in the transparent testa glabrous (without anthocyanins and trichomes) mutant of Arabidopsis, the deficiency was complemented and both anthocyanins and trichomes were restored.


Interaction of U6 snRNA with a sequence required for function of the nematode SL RNA in trans-splicing. Nematode trans-spliced leader (SL) RNAs are composed of two domains, an exon [the 22-nucleotide spliced leader] and a small nuclear RNA (snRNA)-like sequence. Participation in vitro of the spliced leader RNA in trans-splicing reactions is independent of the exon sequence or size and instead depends on features contained in the snRNA-like domain of the molecule. Chemical modification interference analysis has revealed that two short sequence elements in the snRNA-like domain are necessary for SL RNA activity. These elements are sufficient for such activity because when added to a 72-nucleotide fragment of a nematode U1 snRNA, this hybrid RNA could participate in trans-splicing reactions in vitro. One of the critical sequence elements may function by base-pairing with U6 snRNA, an essential U snRNA for both cis- and trans-splicing.


Nucleosome core displacement in vitro via a metastable transcription factor-nucleosome complex. In order to function, transcription factors must compete for DNA binding with structural components of chromatin, including nucleosomes. Mechanisms that could be used in this competition have been characterized with the use of the DNA binding domain of the yeast GAL4 protein. The binding of GAL4 to a nucleosome core resulted in a ternary complex containing GAL4, the core histone proteins, and DNA. This ternary complex was unstable; upon the addition of nonspecific competitor DNA, it dissociated into either the original nucleosome core particle or GAL4 bound to naked DNA. Nucleosome core destabilization by GAL4 did not require a transcriptional activation domain. These data demonstrate the displacement of nucleosome cores as a direct result of binding by a regulatory factor. Similar mechanisms might affect the establishment of factor occupancy of promoters and enhancers in vivo.


Identification of a second pseudoautosomal region near the Xq and Yq telomeres. The telomeres of Xq and Yq have been observed to associate during meiosis, and in rare cases a short synaptonemal complex is present. Molecular cloning of loci from Xqter and Yqter has revealed that their sequence homology extends over 400 kilobases, which suggests the possibility of genetic exchange. This hypothesis was tested by the development of two highly informative microsatellite markers from yeast artificial chromosome clones that carried Xqter sequences and the following of their inheritance in a set of reference pedigrees from the Centre d'Etude du Polymorphisme Humain in Paris, France. From a total of 195 informative male meioses, four recombination events between these loci were observed. In three cases, paternal X alleles were inherited by male offspring, and in one case a female offspring inherited her father's Y allele. These data support the existence of genetic exchange at Xq-Yq, which defines a second pseudoautosomal region between the sex chromosomes.


DNA sequencing by primer walking with strings of contiguous hexamers. When template DNA is saturated with a single-stranded DNA binding protein (SSB), strings of three or four contiguous hexanucleotides (hexamers) can cooperate through base-stacking interactions to prime DNA synthesis specifically from the 3' end of the string. Under the same conditions, priming by individual hexamers is suppressed. Strings of three of four hexamers representing more than 200 of the 4096 possible hexamers primed easily readable sequence ladders at more than 75 different sites in single-stranded or denatured double-stranded templates 6.4 kilobases to 40 kilobase pairs long, with a success rate of 60 to 90 percent. A synthesis of 1 micromole of hexamer supplies enough material for thousands of primings, so multiple libraries of all 4096 hexamers could be distributed at a reasonable cost. Such libraries would allow rapid and economical sequencing. Automating this strategy could increase the speed and efficiency of large-scale DNA sequencing by at least an order of magnitude.


Alterations in signal transduction molecules in T lymphocytes from tumor-bearing mice. Impaired immune responses occur frequently in cancer patients or in tumor-bearing mice, but the mechanisms of the tumor-induced immune defects remain poorly understood. In an in vivo murine colon carcinoma model (MCA-38), animals bearing a tumor longer than 26 days develop CD8+ T cells with impaired cytotoxic function, decreased expression of the tumor necrosis factor-alpha and granzyme B genes, and decreased ability to mediate an antitumor response in vivo. T lymphocytes from tumor-bearing mice expressed T cell antigen receptors that contained low amounts of CD3 gamma and completely lacked CD3 zeta, which was replaced by the Fc epsilon gamma-chain. Expression of the tyrosine kinases p56lck and p59fyn was also reduced. These changes could be the basis of immune defects in tumor-bearing hosts.


Invariant chain peptides in most HLA-DR molecules of an antigen-processing mutant. Class II major histocompatibility complexes bind peptides in an endosome-like compartment. When the class II null cell line 721.174 was transfected with class II DR3 genes, DR molecules were produced in normal amounts. However, the DR molecules were abnormally conformed and unstable because deletion of an antigen-processing gene had impaired intracellular formation of most class II-peptide complexes. Yet, 70 percent of the DR molecules still bore peptides, 80 percent of which were 21- to 24-amino acid fragments of the class II-associated invariant chain. These peptides were rare on DR3 from control cells. Thus, a defect in the main antigen-processing pathway revealed a process in which DR molecules bind long peptides derived from proteins present in the same compartment.


Expression directed from HIV long terminal repeats in the central nervous system of transgenic mice. Infection with the human immunodeficiency virus (HIV) is frequently accompanied by the AIDS (acquired immunodeficiency syndrome) dementia complex. The role of specific HIV genetic elements in the pathogenesis of central nervous system (CNS) disease is not clear. Transgenic mice were constructed that contained the long terminal repeats (LTRs) of two CNS-derived strains and a T cell tropic strain of HIV-1. Only mice generated with CNS-derived LTRs directed expression in the CNS, particularly in neurons. Thus, some strains of HIV-1 have a selective advantage for gene expression in the brain, and neurons can supply the cellular factors necessary for their transcription.


Range of messenger action of calcium ion and inositol 1,4,5-trisphosphate. The range of messenger action of a point source of Ca2+ or inositol 1,4,5-trisphosphate (IP3) was determined from measurements of their diffusion coefficients in a cytosolic extract from Xenopus laevis oocytes. The diffusion coefficient (D) of [3H]IP3 injected into an extract was 283 microns 2/s. D for Ca2+ increased from 13 to 65 microns 2/s when the free calcium concentration was raised from about 90 nM to 1 microM. The slow diffusion of Ca2+ in the physiologic concentration range results from its binding to slowly mobile or immobile buffers. The calculated effective ranges of free Ca2+ before it is buffered, buffered Ca2+, and IP3 determined from their diffusion coefficients and lifetimes were 0.1 micron, 5 microns, and 24 microns, respectively. Thus, for a transient point source of messenger in cells smaller than 20 microns, IP3 is a global messenger, whereas Ca2+ acts in restricted domains.


Hepatic synthesis of lipoproteins and apolipoproteins. We have attempted to review new information concerning the regulation of the secretion of three major apolipoproteins that are synthesized in the liver: apoB, apoA-I, and apoE. ApoB, which is a large protein involved in the transport of triglyceride and cholesterol from the liver to the peripheral tissues, appears not to be regulated on a short-term basis at the transcriptional level. Rather, once synthesized, this protein, which is unique in its intracellular transport in the secretory pathway, is subjected to post-translational regulation, which is dependent on the lipid status of the cell. Assembly of nascent apoB-containing LPs begins in the ER. If core lipids, whether triglyceride or cholesteryl ester, are limiting, then apoB will be rapidly degraded, most likely in the ER compartment. However, if one or both of the core lipids are available in adequate quantities, then apoB will be protected in the ER, and more apoB, in the form of an apoB-containing LP (whether VLDL or a smaller particle) will be secreted by the hepatocyte. Addition of surface lipids, mainly phospholipids or free cholesterol, probably occurs in the Golgi. A further mechanism that regulates the secretion of apoB-containing LPs may involve rapid reuptake of newly secreted particles. The regulation of the secretion of apoA-I by liver is very different from that of apoB. Although apoA-I is also synthesized on attached ribosomes and becomes contranslationally or post-translationally associated with the RER membrane, it is transported to the Golgi much more rapidly than apoB. In the Golgi nascent HDL particles are formed, but it is also likely that apoA-I is secreted by the hepatocyte in a lipid-poor form.(ABSTRACT TRUNCATED AT 250 WORDS)


Hepatic clearance of plasma low density lipoproteins. An elevated plasma LDL concentration is a major risk factor for the development of atherosclerosis and coronary heart disease. The concentration of LDL in plasma is determined, to a large extent, by events in the liver, since this organ is the source of LDL (via VLDL) and is the major site of LDL catabolism. LDL uptake by the liver is mediated largely by receptor-dependent mechanisms and fully 80 to 90% of whole body receptor-dependent LDL catabolism occurs in the liver. The rate of receptor-dependent LDL uptake by the liver is influenced by dietary and genetic factors. Cholesterol and fatty acids are the major dietary factors that alter receptor-dependent LDL uptake by the liver and appear to do so by regulating LDL receptor gene transcription. Regulation of LDL receptor gene transcription by sterols is mediated by sterol regulatory elements within the LDL receptor promoter, but how the nucleus actually senses cellular cholesterol levels and how dietary fatty acids might influence this process remain to be elucidated. Genetic factors may affect the basal rate of receptor-dependent LDL transport or the sensitivity of the LDL receptor pathway to regulation by dietary lipids. An understanding of how dietary lipids regulate hepatic LDL transport and plasma LDL levels, and identification of the major genetic factors that determine responsiveness to dietary lipids is crucial to the development of safe and effective dietary guidelines and to the selection of individuals most likely to benefit from diet modification.


Issues in sterilization and disinfection. Urology nurse managers and practitioners play a key role in minimizing the risk of infection to patients. It is essential that managers understand the processes of sterilization and disinfection, precautions, recommendations, and related issues to establish appropriate policies and procedures. It is equally important for practitioners to understand sterilization and disinfection and the rationale for practice guidelines. This area is dynamic, with new products and technology being introduced into the market each year. Along with these innovations will be additional information, and possibly revisions in recommendations. Therefore, urology nurses must remain current with scientific literature and national standards.


Intravenous access. Part 3. Venous access devices. The nursing care of the whole patient, not just the venous access device, should be the focus of the nurse. Venous access devices provide the nurse with the rare opportunity to have assured venous access for blood sampling as well as the administration of intravenous therapies. The meticulous care of venous access devices is essential if complications are to be avoided and their primary function maintained.


Magnetic resonance imaging of myositis ossificans: analysis of seven cases. Myositis ossificans typically presents as soft tissue swelling with progressive ossification on radiographs. Since magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue masses, we analyzed eight MR examinations in seven patients with myositis ossificans to determine if typical patterns were present. One acute lesion had homogeneous intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. Two subacute lesions had low signal intensity margins with slightly increased signal intensity centers on T1-weighted images and very high signal intensity on T2-weighted images. Five chronic lesions had two different patterns. All five were well-defined with low signal intensity borders. Three had signal intensity patterns characteristic of fat on T1-weighted and T2-weighted images. The other two lesions had intermediate signal intensity on T1-weighted images and slightly increased signal intensity on T2-weighted images. We conclude that typical MR appearances of myositis ossificans do exist. A low signal intensity rim is a common finding. However, these patterns are not unique to myositis ossificans and resemble those that have been reported in other lesions. It is important to be aware of the spectrum of MR findings of myositis ossificans when considering the differential diagnosis of a soft tissue mass.


Epithelioid hemangioendothelioma of bone. A report of two cases and review of the literature. Epithelioid hemangioendothelioma is the prototype of a group of vascular tumors characterized by epithelioid or histiocytoid endothelial cells. Epithelioid hemangioendothelioma of bone is a rare lesion that constitutes fewer than 1% of primary malignant skeletal neoplasms. We describe two cases that illustrate the spectrum of radiographic features seen with this neoplasm, and also present its appearance on magnetic resonance imaging.


Superolateral erosions of the humeral head in chronic inflammatory arthropathies. Erosive lesions on the superolateral aspect of the humeral head were studied in 127 patients with chronic inflammatory arthropathies including rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), ankylosing spondylitis (AS), and psoriatic arthropathy (PA), as well as in a control group of 53 patients with non-inflammatory shoulder joint disease. Superolateral erosions were found in 39 out of 127 patients (31%), comprising 11/56 RA cases (20%), 22/50 JRA cases (44%), 4/9 cases of AS (44%), and 2/12 cases of PA (17%), but were absent in non-inflammatory disorders. Two morphologically distinct types of erosions were observed, an extensive one, present in all of the inflammatory conditions studied, and a circumscribed one occurring predominantly in JRA patients.


The signal intensity of the normal odontoid process (dens) displayed on magnetic resonance images. In order to analyse the normal signal intensity of the medullary space of the odontoid process (dens) relative to age, the craniovertebral junction of 33 asymptomatic volunteers in six age groups was examined by means of magnetic resonance imaging. To avoid partial-volume effects 3-mm slices were used in sagittal and axial planes. The signal intensities relative to cerebral white matter varied from 0.51 to 1.23 in the sagittal plane and 0.56 to 1.51 in the axial plane. The signal intensities relative to muscle varied from 0.76 to 2.40 in the sagittal plane and 0.96 to 2.30 in the axial plane. The signal intensities relative to fat varied from 0.22 to 0.62 in the sagittal plane and 0.23 to 0.68 in the axial plane. No correlation with age of the volunteers was found. The normal medulla of the dens may exhibit a low signal intensity on T1-weighted images irrespective of age.


Selective arterial embolization in the treatment of aneurysmal bone cyst and angioma of bone. Nineteen aneurysmal bone cysts and five angiomas of bone were treated by selective arterial embolization. The median follow-up was 22 months. In 17 patients healing occurred with complete relief of symptoms; in 11 of these almost complete ossification of the lesion resulted. In the remaining cases, little or no ossification was apparent but ossification may take 1 year or more to occur. No recurrence was observed in any of these cases. Recurrence occurred only in two cases. In one, growth of the recurrence stopped after a second embolization, and the X-rays showed no change. Selective arterial embolization represents a treatment of choice in aneurysmal bone cyst and angioma of bone especially of the spine, sacrum, or pelvis. In these sites embolization replaces surgery which might be hazardous due to intraoperative bleeding.


Diminished space in the acromioclavicular joint in forced arm adduction as a radiographic sign of degeneration and osteoarthrosis. The purpose of this study was to examine the acromioclavicular joint by radiography under forced arm adduction to demonstrate diminished joint space as a sign of cartilage degeneration and osteoarthrosis. A total of 192 right and left joints were investigated in 96 healthy working men. There were three main results from the manoeuvre: in 135 of the 192 joints the space was reduced, in 33 joints it was unchanged, and in 24 joints the joint space was increased. In 43 joints (22% of the total) a marked reduction of the joint space to 1 mm or less occurred during the manoeuvre; in the remaining 92 joints with space reduction the reduction was less pronounced. A narrow acromioclavicular joint space during forced adduction of the arm indicates cartilage thinning and may be interpreted as a sign of osteoarthrosis.


[Psychological preparation of disclosing diagnosis and therapy in patients with malignant hematologic diseases]. The article deals with the experience in psychological preparation of patients with haematologic malignant disorders for diagnosis ant therapy. Psychological assessment and preparation of the patients, including members of their families, were carried out in the Institute of Haematology of the University Clinical Centre in Belgrade, from November 1990 to the present day. Over a period of less than 11 months, the psychological preparation was carried out in 146 hospitalized patients in whom leukaemia was diagnosed. The same was done with 292 members of their families. This kind of clinical practice requires a team work which involves: a clinical psychologist, the head of the unit, and medical doctors who treat the patient during hospitalization.


[Electroretinography findings in the other eye in patients with central retinal vein occlusion]. ERG assessment in 32 patients with recent OVCR was done over the period of 6 years. The aim was to check the hypothesis whether ERG values in the affected and "healthy" eye of the same patient are same. The control group consisted of patients of the same age but without eye disease. Scotopic "b" wave and photopic b/a ratio, known as indicators of oxygenation of the retina, were studied. In bs wave and b/a ratio the statistically significant difference between the group with OVCR and the other groups was found. Other groups showed no significant differences. The hypothesis that OVCR associated with a systemic disease is necessarily accompanied with changes in the other eye, has been challenged. However, the safety of the other eye is not absolute.


[Clinical significance of 5'-nucleotidase]. The paper deals with the current data of molecular organization, localization, activity and clinical significance of 5'-nucleotidase in the diagnosis of different illnesses. The paper also deals with the specificity and sensitivity of 5'-nucleotidase comparing to other laboratory tests.


[Incidence and prognostic significance of ventricular arrhythmias in patients after acute myocardial infarct]. Patients after myocardial infarction have a high incidence of both frequent and complex ventricular arrhythmias. Arrhythmias detected by 24-hour electrocardiographic recordings at hospital discharge are predictive of next cardiac mortality. Both left ventricular dysfunction and ventricular arrhythmias have been associated with poor prognosis following acute myocardial infarction. But dysfunction of the left ventricle and ventricular arrhythmias are independently related to mortality. This finding provides a rationale for treating patients with frequent and/or complex ventricular arrhythmias detected at hospital discharge after acute myocardial infarction. Beta-blockers should be considered as antiarrhythmic drugs of choice in the treatment of postinfarction patients with ventricular arrhythmias in order to reduce both ventricular arrhythmias and cardiac mortality.


[Use of the positron emitter in functional and metabolic lung studies]. Positron emission tomography (PET), a new technique, uses positrons which, immediately after emission, combine with electrons and annihilate to produce pairs of 511 KeV photons. Commonly used positron emitters (C-11, N-13, O-15) are important constituents of biologic metabolism. However, because of their short half-life characteristics, the on-side cyclotron facility is required for their use. To date, there is not much experience with PET in lung diseases. In this paper brief information about PET application in pulmonary blood flow measurements, ventilation measurement, central chemical control of ventilation and lung metabolic studies, is presented.


[Orbital lymphomas].

[Orbital lymphomas]. Lymphomas are relatively rare in the orbit: only about 8-11% of all orbital tumours. The most common histological type is diffuse well-differentiated lymphocytic lymphoma (DWDLL--Rappaport's classification)--70%. Orbital lesions are always curable by radiotherapy, but in some 40% of these patients local recurrence or dissemination occur. The authors present two patients with diffuse well-differentiated lymphocytic lymphoma, and one patient with FCC lymphoma of centrocytic type (Kiel classification) localized in the orbit. Two of them were irradiated after an unsuccessful treatment by chemotherapy. In the third patient local radiotherapy is still in the course.


[Cyclosporine in the treatment of glomerular diseases in children]. From June 1987 to June 1991 at the Belgrade University Children's Hospital 10 patients, 5 males and 4 females, aged 2-16 years, with chronic glomerular disease, were treated with CyA. Seven patients had INS, 2 lupus nephritis and one IgA nephritis. Before initiation of CyA, all but one, were treated with classic immunosuppressive therapy, which had no effect (8/10) and/or had serious adverse effects (9/10). CyA dosage was initiated at 4-6 mg/kg/BW, and was subsequently adjusted to achieve CyA concentrations in blood at range 50-100 ng/ml. Treatment duration was 2-17 months. Patient compliance to CyA therapy was observed in 5/7 INSs: 2 cortico-sensitive (1 with FSGS was cortico-dependent and 1 had frequent relapses) and 3 cortico-resistant patients (2 with FSGS and 1 with minimal histologic changes). After drug withdrawal, only one of the patients who responded, had no relapse. One of the two patients with SLE showed improvement during CyA administration, while no response was observed in the patient with IgA nephritis. Adverse experiences with CyA therapy involved decreased renal function (2/10), arterial hypertension (1/10), hyperbilirubinaemia (1/10), transient LDH increase and hyperuricaemia (1/10).


[Metastatic neck tumors of unknown primary localization]. The authors present their experience in the diagnosis and therapy of metastatic neck tumours of unknown primary localization. Over the period from 1975 to 1985 in Otorhinolaryngology Department of the Military Hospital in Sarajevo 200 patients with the so-called secondary deposits in the neck were treated. Of this number 14 (7%) were patients with unknown primary localization. In 64.29% of these patients metastases in the cervical lymph nodes had developed in deep lymph nodes of the upper jugular location. They were predominantly unilateral than bilateral. Morphologically, those were most frequently deposits of planocellular carcinoma (64.29%) which were in 77.45% of cases firmly fixed. Five-year survival-time was registered in 2 cases only (14.28%).


[Duplex-Doppler sonography in the diagnosis of acute rejection in kidney transplantation]. Duplex Doppler sonography can be used in evaluation of renal allografts. Arterial Doppler signals were quantified with a pulsatility index. In this study 114 Duplex Doppler examinations were performed in 75 patients after renal transplantation. The mean PI in patients with acute rejection was statistically compared with the mean PI in normal allografts, and the mean PI in patients with CsA nephrotoxic effects and chronic rejection. The data shaw that there is statistically significant difference between the patients with acute rejection and other examined groups. The results of this study show that the use of quantitative Doppler US scanning may be valuable in differential diagnosis among the various forms of graft disfunction.


[Cavernous hemangioma of the liver].

[Cavernous hemangioma of the liver]. Over the last six years 8 patients with cavernous haemangioma of the liver were operated in our institute, of whom 7 women and 1 man, aged from 32 to 77 years average, 19.6 years. In two patients double haemangiomas of the liver were removed. So the number of resected haemangiomas was 10. The size of these haemangiomas was 2, 2, 3, 3.5, 6, 6, 6, 6, 6.5 and 16 cm respectively, average 5.7 cm. Diagnosis was established by ultrasonography, computed tomography, blood pool 99m-technetium-scintigraphy, laparoscopy and selective angiography. Indications for the operation were: palpable tumour and pain in 2 patients; suspected liver metastases secondary to colon cancer 7 years after right colectomy; suspicion to primary haematoma of the liver and suspicion to secondary liver tumour in a patient with a big tumour of the left ovary. Incidental ultrasonic finding of the liver tumour occurred in a patient with obstructive jaundice. In a female with Bartter's syndrome ultrasonography and explorative surgery were carried out in order to reveal endocrine tumour (reninoma), as well as an occasional finding during cholecystectomy. Various operative techniques were performed in these 5 patients: 3 left lobectomies, 1 segmentectomy of the V and the VI liver segments, and 3 atypical resections. The only postoperative complication in our series was a mild superficial variceal thrombophlebitis of the leg in one female patient which disappeared on conservative treatment. These 5 patients have been followed-up from 1 to 48 months (average 18 months), and were symptom-free, except the patient with Bartter's syndrome who stayed on treatment.


[Circadian variation in complex ventricular arrhythmias in patients with coronary disease]. In a group of 60 patients with coronary artery disease and complex ventricular arrhythmias which were recorded by 24-hour ambulatory electrocardiogram, circadian variation of ventricular arrhythmias was analysed. All patients had multiform ventricular premature beats: 40 (67%) patients had pairs of ventricular premature beats; 26 (43%) patients had episodes of ventricular tachycardia, and 8 (13%) patients had R on T type of ventricular premature beats. The most frequent multiform ventricular premature contraction was recorded between 7 and 10 h. a. m. and between 5 and 8 h. p. m. Similar bimodal distribution in frequency of pairs of ventricular premature beats and episodes of ventricular tachycardia, was recorded. Episodes of both symptomatic and asymptomatic types of myocardial ischaemia showed a circadian rhythm similar to that seen in complex ventricular arrhythmias. The study revealed the existence of significant circadian rhythm of ventricular arrhythmias in coronary patients which may be important for chronopharmacologic approach to antiarrhythmic therapy.


[Significance of the the tumor markers, Ca-125 and tumor-associated trypsin inhibitor in patients with carcinoma of the cervix and uterus]. Quantitative contents of tumour markers in 51 patient suffering from carcinomas of the cervix and corpus uteri, are analysed. CA-125 and tumor-associated-trypsin-inhibitor (TATI) were determined in the serum of these patients before and after surgical treatment. After careful and detailed analysis and statistical testing of the results, we observed insignificant changes of CA-125 in both localisations of carcinoma. The great importance of preoperative determination of TATI markers in carcinomas of the corpus uteri is emphasized. However, the testing of these markers should be performed with great attention and in correlation with other indexes of pathobiological nature of cancers of the cervix and corpus uteri.


[Diurnal changes in the levels of immunoreactive parathyroid hormone and calcitonin in patients with chronic renal insufficiency]. The circadian rhythms of the serum immunoreactive parathyroid hormone (iPTH) and calcitonin concentration were examined in 6 patients with chronic renal failure (CRF) not treated by haemodialysis. In 3 patients on haemodialysis the influence of haemodialysis with cuprophan and polyacrylonitrile membranes (in a.m. and p.m. periods of day) on serum concentration of these was investigated. The results demonstrate that in patients with CRF in predialysis period the circadian rhythm of serum iPTH concentration is at least partially preserved. However, the effect of dialysis on serum C-terminal iPTH concentration showed a sharp progressive fall of the concentration during haemodialysis on polyacrylonitrile membranes. The study of the circadian rhythm of serum calcitonin concentration in CRF patients with the six hours intervals between blood sampling could not reveal changes which favour the opinion of the existence of circadian rhythmicity. In patients on haemodialysis during haemodialysis with cuprophan membranes a rise of serum calcitonin concentration was observed.


[Use of erythropoietin in children with terminal renal insufficiency treated with chronic hemodialysis]. Nine pts, aged 4-20 years (mean 12) with chronic uremic anaemia (mean Hb 5.8 g/dl, range 5.0-7.0 g/dl) on regular thrice-weekly haemodialysis, were treated with human recombinant erythropoietin (rh-uEPO) for a mean of 28.11 weeks (range 4-48). To attain a target Hb concentration (9.6-11.2 g/dl) RH-uEPO (Cilag) was administered i.v. after each dialysis in increasing doses within the range (51-300 U/kg/week). All pts were treated with persantine. Five pts needed iron supplementation. All pts showed increased Hb concentration and none of 6 previously transfusion dependent pts needed further transfusions after the first week of rH-uEPO. Pretreatment long-term dialyzed, polytransfused and iron overloaded pts, even when treated with lower doses of rH-EPO, responded better, reaching target Hb level from the 8th- to the 16th week. Three of 4 highly sensitized pts on rH-EPO treatment had a significant decrease of cytotoxic antibody titre, and 2 were successfully transplanted. rH-EPO also significantly improved the life quality in all pts. No pts developed any serious side affects. There was a transient increase in BP (2 pts) and transaminase with eosinophilia (4 pts).


[Clinical heterogeneity in patients with ocular myopathies]. We present the results of clinical, electrophysiological, and biopsy studies in patients with ocular myopathy. Nine patients (four women and five men) were included in these investigations. According to the biopsy findings the patients were divided into patients with oculocraniosomaltic syndrome (OCSS) and patients with oculopharyngeal muscular dystrophy (OPMD). The presented clinical features, especially in the OCSS groups was more variable. Associated neurological and multisystem disturbances were characteristic of OCSS. Biopsy findings were of essential significance in distinguish these two conditions, especially in cases of the late onset.


[Radiotherapy of primary spinal cord tumors in adults]. Between 1980 and 1985 we treated 21 patients with primary spinal cord tumors. There were two diffuse and ten localized ependymoma, six low grade astrocytoma and three malignant glioma. Surgery consisted of total resection in six patients, subtotal resection in three and biopsy in twelve patients. Radiation doses ranged 45-55 Gy. Median age was 55 years (34-70 years), and median follow-up after therapy was 5 years (1-9 years). For patients with localized ependymoma, overall survival and 5-year recurrence-free survival are 80%. Of two patients with diffuse ependymoma, one is alive with no evidence of disease 6 years after the initial diagnosis, while the other is dead. Overall survival and 5 years recurrence-free survival for patients with low grade astrocytoma are 83% and 67%, respectively. All three patients with malignant glioma died of local recurrence (one had diffuse craniospinal metastases, too) one year after the initial diagnosis. Radiotherapy is therapy of choice after surgery in primary spinal cord tumors in adults, although local recurrences remain the major problem.


[Epidemiologic characteristics of human parvovirus B19. Report of an epidemic of erythema infectiosum in the area of Belgrade]. During the period 29.10.1987-10.5.1988 an outbreak of an illness with rash resembling Erythema Infectiosum occurred among school children in one part of Belgrade-Mladenovac. This is the first outbreak of Erythema Infectiosum reported in Yugoslavia and confirmed in University College of Middlesex School of Medicine, London, in November 1989. Of 720 school children exposed to infection of Human Parvovirus B 19 two hundred and eighty four (39.4%) have had clinical symptoms and 166 (58.4%) of them were in the age group 10-14. The sero-epidemiologic investigations excluded infection of Rubella virus, Cytomegalovirus and Coxsackie viruses A 9 and B 5. To detect the infection Elisa IgM antibody, complement fixation, inhibition of hemagglutination and isolation have been used. Clinical symptoms of illness have been manifested as Rubella like exanthemas on extremities in 92.5%, extremities and body in 26.5% and the phenomenon "slapped Cheek" was discovered in 76.25% of all patients. Reappearance of rash has been observed in 25% of cases.


[Treatment of idiopathic nephrotic syndrome with cyclosporine A]. Cyclosporin-A (Cy-A) is a new drug used in the treatment of idiopathic nephrotic syndrome (INS) over the past few years. The treatment is based on the two postulates; first, that INS is presumably a disorder of T lymphocytes, and second, that Cy-A exerts its immunomodulatory effect on T cell immunity. The paper first gives evidence why in the current nephrology the three histologic variants, i.e. minimal changes, focal glomerular sclerosis and diffuse mesangial hypercellularity are termed idiopathic nephrotic syndrome, and review of immunopathogenesis of INS, which might be a rational use of Cy-A as therapeutic modality. Recent data concerning the treatment of INS with Ca-A have shown that Cy-A might be an alternative drug for corticosteroid sensitive patients, but who are either frequent relapsers or drug-dependent. However, Cy-A maintain remission during administration only. It could be used to overcome side effects of corticosteroid therapy, which is of particular interest in children with growth retardation. Treatment of patients resistant to classic immunomodulatory therapy (corticosteroids, cyclophosphamide, chlorambucil) was beneficial only in 22% of cases. In these patients, especially if their glomerular filtration rate is reduced, Cy-A is potentially nephrotoxic and may lead to rapid deterioration of renal function. Long-term administration of Cy-A requires regular screening for nephrotoxicity by laboratory tests and renal biopsy every 6-12 months.


[Vascular headache and cerebral edema].

[Vascular headache and cerebral edema]. Headache is one of the commonest symptoms in neurology. It can be present among many other somatic illnesses. There are many aetiological factors. Pathogenetic mechanisms are unknown. There is a significant number of patients with headache, especially with vascular headache, (about 15%), and vascular headache associated with cerebrovascular ischaemic stroke. Therefore the new investigations of neurobiochemical and neurophysiological problems are necessary. A group of patients involved in our study with diagnosis of vascular headache was tested. The result of the study (especially neuroradiological results) show that many patients, prevalently young women, had cerebral oedema during the attack of vascular headache.


[Pityriasis versicolor--modern views on etiology, pathogenesis and therapy]. Pityriasis versicolor (Tinea versicolor) is a superficial chronic fungal infection caused by Pityrisporum species which are normal "inhabitants" of the cutaneous flora. The morphologic changes from yeast to mycelial hypha form are important in the development of clinical lesions. The onset and course of the disease are under the influence of genetic factors, age, sex, climate, local environmental factors, malnutrition, pregnancy, oral contraceptives, corticosteroid and immunosuppressive treatment. They favorize transformation of saphrophytic to pathogenic form, and are the cause of recurrences and chronicity of the disease. The ultrastructural and immunologic studies which are carried out today would significantly contribute to a better understanding of pathogenesis of the disease. The disease is limited to seborrheic areas of the skin and commonly has three clinical forms: papulosquamous, follicular and inverse. This can make great problems in differential diagnosis. In the treatment of these patients it should be kept in mind that Pityriasis versicolor is not a primary contagious disease and that conversion of Pityrisporum depends on the predisposing factors. Numerous medicaments with local and systemic effect which are used nowaday in the treatment and prevention of pityriasis are reported. Way of application, doses, duration of therapy, advantages and disadvantages are given in detail.


[Acute lymphoblastic leukemia in refractory anemia with "ringed" sideroblasts]. The paper deals with the progression of idiopathic refractory sideroblastic anaemia (IRSA) and its transformation to acute B lymphoblastic leukaemia (ALL). Attention is paid to haematological changes prior to leukaemia development. Acute leukaemia was best expressed in this patient by severe deterioration of dyserythropoiesis, leukopenia, and by an increase of blasts in the bone marrow over 5%. Our patient is an additional evidence to the hypothesis of the common lymphohematopoietic progenitor.


[Gilles de la Tourette's syndrome].

[Gilles de la Tourette's syndrome]. Gilles de la Tourette's syndrome (GTS) is characterized with motor and vocal tics, initiating before 21 years of age, lasting for over a year and are associated with diverse behavioral disorders. The study analyzes features of 12 our GTS patients with mean age at the onset of the disease of 12.0 years, while the exact diagnosis was established only after 9.5 years (2-33 years). In 11 out of 12 patients the disease started with motor or vocal tics, while in completely developed clinical picture of GTS the permanently present tics were associated with coprolalia (6 patients), echolalia, copropraxia (in 2 patients, respectively), attention deficits (9 patients), obsessive-compulsive disorders (8 patients) etv. The role of neuroleptic therapy was discussed according to our experience and other reported studies. In our study, haloperidol had good therapeutical effect in 64% of the treated patients.


[Pharmacology--new therapy. Calcium channel blockers: new aspects of therapeutic use of diltiazem]. The calcium antagonist, diltiazem is effective in the treatment of patients with various types of angina pectoris, as well as with essential and renovascular arterial hypertension. Sustained-release diltiazem in dose of 180 mg once daily is effective as sustained-release diltiazem in dose of 90 mg twice daily. Besides, in patients with stable angina pectoris and essential arterial hypertension the monotherapy with sustained-release diltiazem in dose of 180 mg is similarly effective as beta blockers and thiazide diuretics. However, monotherapy with sustained-release diltiazem is at least effective as monotherapy with sustained-release verapamil. Comparative clinical investigations showed that diltiazem is more effective than propranolol in decreasing ischemic attacks, whereas the risk of bradycardia is smaller. On the other hand, nifedipine (dihydropyridine calcium antagonist) is more effective than diltiazem in lowering ischemic electrocardiographic changes, incidence of attacks and improving working capability. The efficacy of diltiazem, nifedipine and verapamil is similar in the treatment of patients with spastic angina pectoris, whereas the least effective is propranolol. As far as the arterial hypertension is concerned, clinical investigations showed that the efficacy of diltiazem and nifedipine is similar. Side effects are relatively rare (1.8-9.6% patients) and depend on the dose (nausea, fatigue, dizziness, headache and itching).


[Acute pancreatitis in a patient treated with hemodialysis]. Acute pancreatitis presents about 1% of all acute abdominal diseases. Its mortality is about 20-50%. The main etiological causes are diseases of the biliary tract and alcoholism. In 10-20% of cases the cause is still unknown. Chronic renal failure is also mentioned as a possible cause of acute pancreatitis. The purpose of this article was to show the frequency and course of acute pancreatitis in patients on haemodialysis during the last 15 years with a case report. From 1976, to 1991, in our Centre about 600 patients have been observed. The diagnosis of acute pancreatitis has been posed in 5 patients (0.8%). In 2 of them the course was easy, 2 died and 1 survived despite a number of complications and two surgical operations. Acute pancreatitis is a rare disease in patients on dialysis, but it is more frequent in them than in persons with healthy kidneys. The mortality in those patients is also high. With adequate care and treatment there is a possibility to survive even heavy type of acute pancreatitis.


[Penicillin allergy in children].

[Penicillin allergy in children]. Penicillin allergy in children is overdiagnosed and paediatricians, fearing the possibility of fatal anaphylaxis, seldom question a report that a child is allergic to penicillin. Laboratory tests to predict whether a patient will react to penicillin are unhelpful in routine clinical practice and skin tests themselves carry a significant risk of anaphylaxis and even death. A few simple inquiries can often exclude the diagnosis. However, a history of penicillin therapy associated with an immediate reaction suggests penicillin allergy.


Zocor, the postmarketing experience.

Zocor, the postmarketing experience. The aim of this study was to develop and test a descriptive, intensive drug surveillance methodology in order to examine the effectiveness and safety of new drugs in the immediate postmarketing period. The HMG-CoA reductase inhibitor, simvastatin (Zocor), was chosen as the test drug. Data were collected from 100 randomly chosen cardiologists, specialist physicians and general practitioners practising in the six main centres of South Africa. A 66% doctor response rate was achieved and 438 patients were enrolled in the study. The overall effectiveness expressed as a percentage decrease (from baseline) in total cholesterol levels was 20.5% for the 251 patients who started on a 10 mg daily dose of the drug and 27.6% for the 42 patients who started on 10 mg but changed to 20 mg/d. The safety profile of simvastatin was comparable with the premarketing clinical trial data, and patient non-compliance appeared to be dose-related. The methodology employed was found to be suitable for the collection of safety and effectiveness data in the postmarketing period and simvastatin was shown to be effective with few adverse events reported.


Simvastatin in non-insulin-dependent diabetic patients with hypercholesterolaemia. The objective of this study was to evaluate the lipid-lowering effect of simvastatin in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypercholesterolaemia while possible clinical and biochemical adverse effects were monitored for. Forty-three NIDDM patients with hypercholesterolaemia (total cholesterol > 6.5 mmol/l) used simvastatin after a detailed clinical laboratory evaluation as well as a 4-week wash-out period and a 4-week placebo baseline period. Simvastatin treatment was initiated with a 10 mg dose for 6 weeks; this was increased to 20 mg and 40 mg at 12 and 18 weeks of follow-up respectively if the total cholesterol level had not decreased to below 5.17 mmol/l. Patients were placed on a lipid-lowering diet and continued to take any regular non-lipid-lowering medication throughout the trial; side-effects were monitored at 6-week intervals until patients had taken simvastatin for 24 weeks. The mean total cholesterol level was reduced by 22.2% at the first follow-up visit, and by 24.2%, 23.3%, and 28.5% at the second, third and fourth follow-up visits respectively compared with base-line levels. A dose of 10 mg simvastatin brought about a reduction in total cholesterol similar to those found with higher doses. The mean triglyceride level was reduced by 20.9% with 20 mg simvastatin. The high-density lipoprotein cholesterol level was not altered significantly and neither was the control of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of therapy on renal impairment in essential hypertension. The effect of hydrochlorothiazide 50 mg, amiloride 5 mg (HCTZ-A) (Moduretic; MSD) and its combination with pindolol and nadolol on renal function were compared in patients with mild to moderate essential hypertension (mean untreated supine blood pressure 179 +/- 5.7/108 +/- 2.6 mmHg) with compromised renal function (glomerular filtration rate (GFR) < 85 ml/min). After randomisation to a beta-blocker plus diuretic, the beta-blocker was washed out (diuretic-only period) and the other beta-blocker added. Eleven patients completed the randomised cross-over comparative study, 5 receiving pindolol 15 mg plus 1 dose of HCTZ-A daily for 6 weeks, and 6 nadolol 120 mg plus 1 dose of HCTZ-A daily. The beta-blocker was then withdrawn for 4 weeks, after which each group of patients received 1 dose of HCTZ-A plus the alternative beta-blocker daily for 6 weeks. The GFR was measured using chromium-51-ethylenediamine-tetra-acetic acid at the end of each treatment phase. The mean GFR (+/- SE) fell from 69.6 +/- 5.8 to 60.6 +/- 5.1 ml/min (P < 0.01) during HCTZ-A therapy, whereas the addition of pindolol or nadolol caused no further drop in the GFR. We conclude that mild degrees of renal impairment in essential hypertension may be aggravated by HCTZ-A therapy when given as one tablet of Moduretic daily.


Nutritional status in rheumatoid arthritis. Effects of disease activity, corticosteroid therapy and functional impairment. Sixty-five patients with rheumatoid arthritis (RA) (mean age 37.2 years) were compared with 71 controls (mean age 33.8 years). Anthropometric measurements included body diameters and skin-fold thickness at multiple sites, while biochemical markers of nutritional status included serum albumin, thyroxine-binding pre-albumin and retinol-binding globulin levels. None of the RA subjects was outside the range that extended 2 standard deviations above and below the normal control values for lean body mass. Discriminant analysis showed that corticosteroid therapy did not significantly influence skinfold thickness in RA. A combination of bi-acromial and bi-ankle diameters had a sensitivity of 70% and a specificity of 72% in differentiating the RA group, in whom disease activity had a greater effect on body diameters than corticosteroid therapy did. Differences related to functional impairment were a manifestation of disease activity rather than a direct effect on skinfold thickness or body diameters. According to anthropometric measurements in ambulant patients, RA does not result in malnutrition in young individuals.


A simple 'tally sheet' system for collecting information on the paediatric utilisation of a western Cape day hospital. This paper describes a simple 'tally sheet' system for collecting information on the paediatric utilisation of Bishop Lavis Day Hospital. of 2,053 children seen over a 7-week period in August and September 1988, the details of 1,971 (96%) were entered on the tally sheets; age and weight were documented in 1,915 (97%) cases. Only 19 patients (1%) were neonates, 370 (19%) were aged under 1 year, 1,092 (57%) 1-6 years and 453 (24%) 6-13 years. One hundred and ninety-eight children (10%) had a weight for age less than the 3rd percentile and 646 (34%) a weight between the 3rd and 25th percentiles; 505 (26%) were between the 25th and 50th percentiles and 566 (30%) above the 50th percentile. Nursing personnel alone saw and treated 1,067 (52%) of the children and the commonest conditions treated were upper respiratory tract infections (31%) and infective and non-infective skin conditions (18%). A similar system could be used to evaluate other aspects of health care.


The cost of neonatal care.

The cost of neonatal care. A medical and financial assessment of the Neonatal Unit at Groote Schuur Hospital showed that the emphasis was on high care provided at a cost of R265 per patient per day. Intensive care cost R530 and low care R88 per day. The average was R172 per day. Infants of very low birth weight (< 1,500 g) accounted for 58% of expenditure. Half of this amount was spent on infants of below 1,000 g; the cost was R14 621 per survivor and R344 per quality-adjusted life-year. The cost declined progressively for infants of greater birth weight. There are a paucity of comparable local data, but the cost of the care was very reasonable.


Vaccination coverage in Mhala and Elim in 1990--a health systems approach. This paper assesses the implementation of the 1986 Gazankulu policy on immunisation in 2 of the homeland's 6 health wards, Mhala and Elim. Vaccination coverage was estimated using the cluster sampling technique recommended by the Expanded Programme on Immunisation of the World Health Organisation. Vaccination coverage of children aged 12-23 months who have received eight valid doses (as stipulated in the programme) is estimated at 25% in Mhala and 53% in Elim (P < 0.001). While both figures can be substantially improved, the analysis concentrates on factors that help explain the differences between 2 districts that fall under the same central administration. As well as demographic differences, key factors include the presence of community-based health facilities and availability of staff (including programme leaders). The need for regional planners to have detailed and comprehensive knowledge of the health system at district level, and to make allowance for this, is put forward as vital to effective health planning. The failure of the Gazankulu policy to attain its objectives also reflects the often unrecognised consequences of the fragmentation of health services.


[Factors which may mask a possible safe threshold for asbestos fibre]. Five factors are identified which could mask a possible threshold for asbestos fibre as a cause of asbestosis: (i) the definition of asbestosis; (ii) the influence of dust other than asbestos fibre; (iii) the underestimation of the true exposure to fibres; (iv) the non-allowance for random error in the determination of disease; and (v) the overestimation of early (high) exposures coupled with the underestimation of later (low) exposures. The manner in which each of these factors may tend to mask the existence of a threshold is dealt with. It is concluded that one or more of the factors could have been responsible for some of the unsuccessful past attempts to demonstrate a safe concentration for asbestos fibre. It is recommended that in future, exposure-response studies should take these factors into account.


Does primary Streptococcus viridans pneumonia exist? In 4 adult black patients admitted to an urban general hospital with community-acquired pneumonia, Streptococcus viridans alone was isolated from blood culture (first subculture), in the absence of any other positive microbiological finding. Sputum examination by Gram staining and culture in 3 cases was reported as negative. Echocardiography was performed in 3 cases and was normal, without evidence of endocarditis. The clinical course of illness in the 4 patients is described. The chest radiograph showed a segmental or subsegmental consolidation in all cases; this appeared 'mass-like' in 2 patients. Viridans streptococci may be a more important, if still uncommon, cause of community-acquired pneumonia than previously suspected. The organism should be considered as a possible cause of chest infection, particularly in patients with appropriately positive blood cultures and no other positive microbiological finding.


South African psychiatrists' attitudes to the present implementation of the Abortion and Sterilisation Act of 1975. In 1980 and 1990 reports were published in the SAMJ on the attitudes of South African gynaecologists to the present Abortion and Sterilisation Act of 1975. The proportion of respondents favouring abortion on demand in the first trimester rose from 32% to 40% over this period, while that of respondents requesting a review of the Act increased from 71% to 85%. The Society of Psychiatrists of South Africa decided to conduct a similar survey of its members using the same questionnaire with some additional questions on current psychiatric practice. Of the 50% of psychiatrists who responded, 78% were personally involved in the implementation of the Act. Some 51% of psychiatrists supported termination on request before the 12th week of pregnancy, an equal number felt that the role of psychiatrists in the implementation of the Act should be reduced, and 89% considered that the present Abortion and Sterilisation Act requires review. Thus, many psychiatrists and gynaecologists are seeking a revision of existing legislation on the medical termination of pregnancy.