[Initial results of the Netherlands Cancer Registration. Work group annual report Netherlands Cancer Registration]. Since the early 1980s a new set-up for a nation-wide cancer registry in the Netherlands has been developed. Recently, the 1989 incidence rates were published in the first national report. A total of 55,500 invasive tumours were registered (29,500 in males and 26,000 in females). After correction for age according to the European standard population figures, the incidence rates for all malignancies were 443 per 100,000 males and 309 per 100,000 females (excluding basal cell carcinomas of skin). Over 70% of all patients were 60 years of age or older. The most common cancers were lung cancer in males and breast cancer in females, accounting for 24% and 31% of the total cancer incidence by sex, respectively. The incidence rates of lung cancer and other tobacco related cancers in males were relatively high, as compared to those in other Western European countries. The Netherlands Cancer Registry offers new opportunities for clinical and epidemiological research.


[Individualized hemodilution in acute brain infarct using a 20% albumin solution and physiological saline solution]. To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident. Prospective, randomized clinical trial. St Lucas Hospital, Amsterdam. Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20% solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infarction. All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg (SD 3) and a haematocrit (Ht) of 0.32 l/l (SD 0.02). The control group only received individually dosed rehydration with crystalline infusion fluids. Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning. The results in the total haemodilution group and the control group did not differ significantly. However, in the subgroup with normal Ht (< 0.45 l/l; n = 201) there was a significant reduction (p < 0.05) of the mortality after 3 months (27% and 16%, respectively) and an increase of independence at home (35% and 48%, respectively) due to a reduction of the viscosity by means of haemodilution with albumin (a specific viscosity effect in the normovolaemic group). In the control group with raised Ht (dehydration; Ht > or = 0.45 l/l; n = 50) there was a significant decrease (p < 0.005) of the mortality after 3 months (27% and 8%, respectively) and an increase of independence at home (35% and 59%, respectively) compared with the control group with normal Ht without signs of dehydration (Ht < 0.045 l/l; n = 102), due to rehydration exclusively with crystalline infusion fluids (a specific rehydration effect in the dehydrated group). In cerebrovascular accident patients haemodilution should be adjusted individually; in normovolaemic patients haemodilution should be carried out with an albumin solution; the higher the Ht, the more rehydration with crystalline infusion fluids is to be carried out.


[AIDS in a Zambian district].

[AIDS in a Zambian district]. During the years 1990 and 1991 data were collected of all 231 patients fulfilling the WHO clinical criteria for the diagnosis of AIDS in the three hospitals of Sesheke, a rural Zambian district. The group of 231 consisted of 46.3% male and 53.7% female patients. Mean age for women was significantly lower than for men (25.2 and 31.1 years, p < 0.001). A total of 185 patients could be tested for HIV-1 antibodies. There were 151 (81.6%) positive results, 19 (10.3%) negative results and in 15 (8.1%) cases the results were not clear. Most important signs were weight loss, chronic cough, prolonged fever and chronic diarrhoea. Seroprevalence figures for HIV-1 in the same period were 16% for blood donors and 41% for patients attending the clinic for sexually transmitted diseases. Most patients with AIDS in Sesheke district present with a wasting syndrome. Tuberculosis, the incidence of which has increased dramatically, has to be excluded in those cases. The outlook for the population in Sesheke and Zambia is dim with the current high seroprevalence figures.


[Acute subdural hematoma following minor head injury]. A 73-year-old patient is described who developed tentorial herniation after a minor head trauma. The initial neurological examination was normal and she had no skull fracture. The cause turned out to be a subdural haematoma of arterial origin, without cerebral contusion or oedema. Prompt surgical intervention resulted in a excellent outcome. The authors conclude that a special form of acute subdural haematoma should be distinguished, which after minor head injury and a lucid interval results in sudden neurological deterioration, especially in the elderly. It has to be treated by prompt surgical intervention.


[Loss of taste sensation in terbinafine administration]. Terbinafine is a new antifungal agent for oral treatment of dermatomycosis. Seven patients are reported who developed taste loss after treatment with terbinafine. In four of them, taste loss was complete while one patient was still able to taste sweet products, and a second and third patient no longer tasted salty and sweet products, respectively. In all patients, the onset of the adverse reaction occurred 4-8 weeks after starting treatment. As far as known, taste loss is a transient effect which disappears within 3-6 weeks after discontinuation of terbinafine.


[Menstruation pattern and month of birth]. By using the Nijmegen data base on breast cancer we attempted to determine whether a relationship exists between menstrual pattern and month of birth and if so, if its agreed with the hypothesis of Seasonal Preovulatory Overripening Ovopathy (SPrOO). On the basis of the birth curve of women who participated in the Nijmegen breast cancer screening programme (1975) risk months for SPrOO and reference months were defined. We found that more women born in a risk month had an early menarche (< or = 11 years), a long menstrual cycle (> or = 5 weeks; QI: 20-25 kg/m2), menorrhagia, and an early (35-40 years) or late (> or = 56 years) menopause age. This relationship was in line with the predictions according to the SPrOO hypothesis. In all, a positive (but not always significant) relationship appeared to exist in 12 of the 15 associations studied. We conclude that there is a relationship between menstrual pattern and month of birth, which can be explained by the SPrOO hypothesis.


[Spontaneous regression of cancer; a description of 7 cases]. To trace and describe patients with spontaneous regression of cancer (SRC) in the Netherlands. The Helen Dowling Institute for biopsychosocial medicine. Descriptive. Informal collection and collection by means of calls in two local medical journals. In these calls colleagues were asked to suggest possible candidates to contact the investigator. Upon contact permission was obtained to collect the medical data. When SRC could be established an interview was conducted with the patient and with persons in his environment. Seven patients with spontaneous regression of cancer were traced. These spontaneous regressions concerned adenocarcinoma (2 cases), non-Hodgkin lymphoma (2 cases), mesothelioma, undifferentiated carcinoma or sarcoma (liver) and choriocarcinoma (1 case each). A call for cases in two local medical journals for colleagues proved to be a fast and inexpensive searching method. None of these cases had been published previously. The frequency of SRC in the period of 1980 upto and including 1989 in the Netherlands can be estimated to be at least 1:100,000.


[Pregnancy during residency].

[Pregnancy during residency]. The number of female residents in the Netherlands has steadily increased in recent years. Due to the increased time on waiting lists to enter residency programmes and to the increased duration of training, female residents will be older during their residencies. This will probably result in an increased number of pregnancies during residencies. A questionnaire regarding pregnancy during residency was sent to 191 residents in two university hospitals in the Netherlands. The response rate was 74.3%. Fifty percent of the male and only 19% of the female residents had children. No negative effects of a pregnancy on their training were experienced or anticipated by the residents. However, a negative effect on the functioning of the department was expected. No formal provisions, like replacements were available and many solutions to replace pregnant colleagues depended on the flexibility of the colleagues. The wish to have children was high and equally distributed among male and female residents, 92% and 96%, resp. Given the difficulty to seek a permanent position and to have children after residency, the choice of many female residents will be to have their children during residency. This increase in number of pregnancies requires anticipation of the residency programme directors. They should take the lead in proposing adequate regulations.


[A newborn infant with a tail].

[A newborn infant with a tail]. A case of a male baby with a tail is described. The tail was surgically removed. Histopathological investigation showed that it was covered with hairless skin. It contained adipose and fibrous tissue, arteries, veins and nerves, but no cartilage, bone or muscle. In most cases of these caudal appendages surgical excision is sufficient, although an underlying anomaly should be excluded radiographically.


[The Reformed Church in Aduard: the oldest hospital in The Netherlands]. The present Dutch Reformed Church building in Aduard (near Groningen) is the only remnant of a large Cistercian monastery founded on June 5, 1192. Typological and archaeological investigations indicate that the church building represents originally the hospital facility for the lay brothers of the monastery, which according to the chronicle of the monastery was built in the beginning of the 14th century. This date is confirmed by the architectural style of the building and corresponds to the date of the original tiled floor which showes some sacred patterns. These findings mark this building as the earliest known hospital facility in the Netherlands, ranking among the earliest buildings of its kind in Europe.


[The medal collection of the Tijdschrift]. A short survey is presented of academic and medical medals, with specimens dating from the 17th century onward, in the collection of the Society 'Nederlands Tijdschrift voor Geneeskunde'. With respect to the old medals, the existing clusters of interest (academical and medical medals) are served by selective acquisition rather than by the quest for completeness. The evolution of medical science, medical institutes and practice in and after World War II merits documentation by extending the collection to the present days. The motives to commemorate, to celebrate and to honour facts or persons still stand, and Dutch artists are clearly interested and able to express these sentiments in medals.


[The status of Italian psychiatric reform: the example of Lombardy in comparison with Switzerland]. In Italy, the worldwide reduction in numbers of psychiatric beds since the fifties had led already by 1971 to a much lower per capita rate of beds than in most European countries. In Northern Italy the psychiatric reform of 1979 speeded up the ongoing reduction of beds, ameliorated conditions for hospitalized patients and built up ambulatory care. A comparison with three Swiss cantons shows that, in Lombardy, the largest and economically most developed Italian Region, the rate of patient contacts with outpatient services has probably reached or surpassed the level found in Switzerland. Contacts by home visits are much more frequent than in Switzerland. The number of psychiatric beds per 1,000 inhabitants is 0.7 in Lombardy and thus has been reduced to one third the Swiss bed-ratio. Comparisons of Italian with Dutch and Danish psychiatric register data show that the Italian psychiatric service as a whole reaches a considerably smaller segment of the severely disordered patients. The Region of Lombardy has recently been trying to increase the psychiatric bed-ratio by agreements with private hospitals. The shortage of beds is not compensated by the ambulatory services and is leading to increasing stress for the families of the severely disordered.


[How does the schizophrenic nuclear syndrome arise? Results of the Bonn transition series study and Anglo-American models--a comparison]. The value of neurobiological theories of schizophrenia depends in the long run on their usefulness when the genesis of diagnostically relevant features is to be made plausible. That is why in recent Anglo-American research on schizophrenia more and more subtly differentiated models have been developed to explain even highly complex psychotic changes of experiences in terms of neurobiologically founded cognitive deficits. Empirical testing, however, was hardly possible, since there did not exist any studies dealing with the hypothesized connections between psychosis and psychological deficit. This situation has now changed with the Bonn study of sequences of transition from experiences of deficiency to first rank symptoms. Its overall result permits an empirically based assessment of the genesis of all elements constituting the schizophrenic nuclear syndrome according to the "Present State Examination". In the present contribution the results concerning the genesis of thought insertion, -withdrawal, -broadcasting, and first rank verbal hallucinations are singled out and compared to the corresponding Anglo-American models. The summary results in a sweeping confirmation, yet it also reveals the insufficiency of a simply "rationalistic" view of the symptom genesis.


[Empirical findings with arson offenders]. Forensic, psychological and psychopathological findings on 40 arsonists, who were investigated in our psychiatric department between 1980 and 1990, are presented. The findings indicate that arsonists represent a diagnostically heterogeneous group of offenders. On the other hand, some common psychodynamic patterns can be seen; in particular, a high degree of suicidal and autoaggressive behaviour. As reported by other authors, arsonists appear to suffer from a disorder of impulse control. A historical review illustrates that since the mid-19th century a purely psychopathological model of pyromania has been found unsatisfactory, and suggests that psychodynamic aspects should not be over-emphasized. Analysis of the different motivation and abnormalities of arsonists could render the term pyromania obsolete. This requires however a radical reappraisal of the significance of psychiatric diagnosis within an anthropological framework.


[Somnambulism and pavor nocturnus--review and case report]. A case of night terror with sleepwalking in an adult patient is described. Sleep polygraphic data are presented. The literature related to sleepwalking, night terror and its treatment is reviewed. The psychopathologic patterns of sleepwalking and night terror are illustrated and the differentiations of parasomnias and epileptic seizures discussed. The clinical applications of these findings are described and practical recommendations made for the management of NON-REM parasomnia.


[Successful treatment of seasonal compulsive syndrome with phototherapy]. We report the case of a 40-year-old woman with a seasonal form of obsessive compulsive disorder (OCD) which was usually accompanied by obsessions and occurred only in autumn or winter. Frequently, the OCD symptomatology was accompanied by depression. After a 12-day treatment with full spectrum bright light (3000 lux; 2 hours a day between 9 and 11 am) without changing the long-term antidepressive medication (125 mg amitriptyline/day) there was a complete remission of OCD symptomatology, with no relapse during the next months.


Tubeless tests of exocrine pancreatic function in patients with cystic fibrosis. In order to determine the value of non-invasive tests in the analysis of exocrine pancreatic function in cystic fibrosis, 14 older cystic fibrosis patients were studied by a set of non-invasive tests. The tests comprising trypsin, total amylase, pancreatic isoamylase, lipase and pancreatic polypeptide (PP) in fasting serum, PP in postprandial serum, and p-aminobenzoic acid (PABA) excretion in urine, were compared to faecal fat excretion after discontinuation of pancreatic enzyme supplementation. Eleven of the 14 patients were found to have a faecal fat excretion of more than 7 g per day. Serum levels of trypsin, pancreatic isoamylase and lipase and the urinary excretion of PABA showed significant negative correlations with faecal fat excretion. Although serum trypsin, postprandial PP and urinary PABA excretion were the most sensitive tests for severe exocrine pancreatic insufficiency, the differences in sensitivity were rather modest. Therefore, the type of test to be selected for clinical use is mainly dependent upon factors as accessibility, simplicity, patient's acceptability and costs.


New modalities in the treatment of exocrine pancreatic insufficiency in cystic fibrosis. Pancreatic insufficiency is the second most important pathophysiological expression of cystic fibrosis (CF) and occurs in the majority of patients. It leads to fat malabsorption and high energy losses in the stools and is one of the major causes of malnutrition often seen in CF. Although the development of enteric-coated enzyme preparations offers a dramatic improvement in therapy, it is still difficult to achieve complete correction of fat malabsorption. The cause for this treatment failure is the relative acidic environment in the duodenum induced by a decreased pancreatic bicarbonate output. To improve the efficacy of enteric-coated preparations the dissolution of these preparations in the duodenum must be optimised in order to achieve a high intraduodenal enzyme concentration. With the aim to increase intraduodenal pH, additional therapy with H2-antagonists and oral prostaglandins has been tested without unequivocal success. Omeprazole, a gastric acid inhibitor with more potency and duration of action compared to H2-antagonists, improves the efficacy of enteric-coated capsules of pancreatin dramatically. With a daily dose of 20 mg in addition to Pancrease (3 x 4 capsules) near normalization of faecal fat excretion will be reached in most CF patients with persistent steatorrhoea.


Cystic fibrosis: genetics and intestinal secretion. The identification of the cystic fibrosis (CF) gene and within that gene the most frequent mutation is of major importance. The genotype/phenotype relationships in large study populations give a better insight in the clinical variability of CF. Variability between different CF patients is also detected in the intestinal chloride secretion capacity. Further research might be of value for a better understanding of the pathophysiological basis of the clinical heterogeneity in this disease. Diagnostic difficulties are present now that CF patients are being diagnosed with normal sweat chloride levels and the diagnostic value of mutation analysis fails in most of these atypical patients.


Liver disease in cystic fibrosis.

Liver disease in cystic fibrosis. Liver disease associated with cystic fibrosis (CF) is considered a secondary effect of the basic defect of the disease, leading to obstruction of bile ductules by abnormal mucoid secretions; additional factors have been involved in the pathogenesis, such as abnormalities in bile acid metabolism, nutritional deficiencies, drug hepatotoxicity, stenosis of the common bile duct by the fibrotic pancreas. Clinical presentation of liver disease in CF is rare during the first few years of life, although neonatal cholestasis can be occasionally the first manifestation of the disease. Isolated massive steatosis has been reported in less than 5% of cases as a consequence of malnutrition. Focal biliary cirrhosis is the pathognomonic hepatic lesion and is present in 25-30% of CF patients, most of whom are asymptomatic. The focally distributed lesions can extend leading to multi-lobular biliary cirrhosis with occurrence of signs and symptoms of cirrhosis and portal hypertension. Early diagnosis of CF-associated liver disease is difficult since liver function tests may be normal even in cases of overt cirrhosis: no test has proved to be sufficiently sensitive and specific and even liver biopsy is of questionable relevance due to the focal distribution of hepatic lesions. Clinical examination is of major importance, since the presence of hepatomegaly seems to correlate well with the histologic finding of fibrosis. The rationale for the use of the choleretic non-toxic bile acid ursodeoxycholic acid in CF-associated liver disease is to reduce the viscosity of bile and to replace toxic bile acids which accumulate in the hepatocyte.(ABSTRACT TRUNCATED AT 250 WORDS)


Gallbladder disease in cystic fibrosis.

Gallbladder disease in cystic fibrosis. Among the various gastrointestinal manifestations observed in patients with cystic fibrosis (CF), gallbladder abnormalities occur frequently. These include a high prevalence of nonfunctioning gallbladders (30%), micro-gallbladders (8-30%), and gallstones (4-30%). The underlying pathophysiology for this increased prevalence in patients with CF is not completely understood, due to contradictory findings. These findings concern: (1) abnormalities in bile acid metabolism resulting in bile that is supersaturated with cholesterol, (2) an impaired nucleation time, and (3) biliary stasis, due to bile duct abnormalities and/or impaired gallbladder motility. The diagnosis of gallbladder disease in CF may be obscured by other common gastrointestinal complications, resulting in a long delay between onset of symptoms and the diagnosis. Cholecystectomy in CF is the treatment of choice, provided they are carefully managed in the pre- and perioperative period. The operative morbidity and mortality, even with intensive management of pulmonary disease, amounted to 10% and 5%, respectively. Therefore, alternative options, like laparoscopic cholecystectomy are of interest and require further investigation, especially for CF patients with severe pulmonary disease.


Malnutrition and age-specific nutritional management in cystic fibrosis. Malnutrition is recognised as a major prognostic factor adversely affecting survival in cystic fibrosis (CF) and is the result of an unfavourable energy balance in these patients. A high resting energy expenditure, dependent on the patient's genotype, in addition to pulmonary infection play an important role in producing anorexia and weight loss. Nutritional management with the aim to gain weight and catch up with growth is age-specific. It is important to repair nutritional status as early as possible after diagnosis. In infancy breast feeding is advised with, if necessary, supplemental feeding with predigested formulae such as Pregestimil. In childhood nutritional management must be aimed towards a normal weight gain and growth velocity. The latter is the best guide of nutritional adequacy. If weight gain falters the first principle is to treat any associated respiratory infection, the second is to ensure adequate enzyme therapy and control of steatorrhoea, and only then should dietary energy supplements be introduced. When oral hypernutrition fails, nocturnal naso-gastric tube feeding of a non-elemental formula may be considered. Parenteral nutrition is rarely indicated and should be reserved as a last solution for CF-patients.


Nutritional state and lung disease in cystic fibrosis. The life expectancy of patients with cystic fibrosis (CF) is largely dependent on the severity and progress of the pulmonary involvement associated with the disease. Many data support the view that malnutrition and deterioration of lung function are closely interrelated and interdependent, with each affecting the other, leading to a spiral decline in both. The occurrence of malnutrition appears to be associated with poor lung function and poor survival, and conversely prevention of malnutrition appears to be associated with better lung function and improved survival. Nutritional intervention may lead to an improvement in body weight, lung function and exercise tolerance, provided that the intervention is combined with exercise training in order to increase both respiratory and other muscle mass. These improvements can be preserved when patients have the stamina to continue with a high-energy, high-fat diet and daily exercise training at home.


Effectiveness of low dose cyclosporine in acquired aplastic anaemia with severe neutropenia. Six patients with acquired aplastic anaemia were treated with cyclosporine (5 mg/kg/day) either alone or in combination with corticosteroids. A favourable response was observed in 4, including 2 patients presenting with an absolute granulocyte count of less than 0.2 x 10(9)/l. The 6th patient showed no effect after 6 wk of therapy and was thereafter successfully treated with anti-thymocyte globulin (ATG). Side effects of cyclosporine therapy were minimal (maximum follow-up 20 months). Temporary discontinuation of the drug in 1 patient resulted in a relapse which responded to reinstitution of therapy. Our results indicate that cyclosporine may be an effective, well-tolerated agent in acquired aplastic anaemia even in previously untreated patients with severe neutropenia.


Prevalence of Raynaud's phenomenon.

Prevalence of Raynaud's phenomenon. Studies that present prevalence rates for Raynaud's phenomenon show great variation. Figures range from a few to more than 20%. In this study, 508 patients who attended their general practitioner filled in a questionnaire dealing with symptoms of Raynaud's phenomenon. When strict criteria (cold digits, numbness and at least a biphasic discolouration) were applied, prevalence was 0.5% in males and 2.9% in females. When a monophasic white discolouration was included, prevalence rates increased by 5.4% in males and by 7.5% in females. The respective percentages became 10.4% and 21.2% when subjects with cold digits and at least a monophasic white or blue discolouration were included. Complaints of cold digits were present in 22.7% of the males and in 35% of the females. We conclude that a great deal of the variation in prevalence of Raynaud's phenomenon can be explained by differences in its definition.


Psychogenic periodic fever.

Psychogenic periodic fever. The present report concerns a 35-yr-old Caucasian male who had suffered from episodic fever of unknown origin over a period of 13 yr. Extensive investigation covering all the known causes of fever of unknown origin did not yield a diagnosis. Finally, a psychogenic cause was considered, and treatment with a psychotropic drug and relaxation therapy led to complete disappearance of the febrile periods.


A case of recurrent adrenocortical carcinoma, with observations on long-term o,p'-DDD therapy and complications. This report describes a patient with a recurring, one stemline-aneuploid, adrenocortical carcinoma. The condition showed a number of unusual characteristics over a period of 22 yr. It changed from a biochemically functioning, low-grade malignant tumour into a non-functioning malignancy with pronounced mitotic activity, accompanied by an ovarian carcinosarcoma 1 yr before death. Quality of life was reasonable for many years despite chemotherapy, consisting of a total of almost 10 kg of o,p'-DDD administered over a period of 8 yr, and the subsequent side effects (e.g. low T4; increased bleeding time). A reduced mineralocorticoid activity, induced by o,p'-DDD, was reversed after discontinuation of o,p'-DDD treatment. During o,p'-DDD administration the substitution requirements for both hydrocortisone and fludrocortisone acetate increased, leading to periods of hypoadrenocorticism with prerenal uraemia.


Pathophysiology and therapy of heart failure, new insights and developments. Part I. During the last decades heart failure has become a syndrome of major concern. Despite a decline in the occurrence of coronary artery disease and improved treatment of systemic hypertension, its primary aetiologic factors, the incidence of heart failure has been ever increasing. It is estimated that in the U.S.A. and most of western Europe approximately 1% of the population suffers from congestive heart failure. Its importance is directly related to its very adverse prognosis with an annual mortality rate as high as 50-60% in the advanced stages of failure. Although treatment with certain vasodilators or converting enzyme inhibitors may improve survival to some extent, the remaining mortality rate still remains high. As it is also extremely difficult to improve the clinical well-being of heart failure patients, emphasis is now on the early phase of failure and in particular on the preceding stage of asymptomatic ventricular dysfunction. Recent animal and human data indicate the significance of myocardial hypertrophy as a first step towards progressive myocardial muscle dysfunction superimposed on the initial cardiac event which leads to asymptomatic ventricular dysfunction. Moreover, there is evidence that neurohumoral activation occurs before heart failure has developed. Although available data only relate to circulating neurohormones, early alterations in local paracrine or autocrine acting systems may well be at issue. Also, whereas heart failure is generally considered a cardiac disorder, there is accumulating evidence that peripheral systems such as the skeletal musculature and the kidney are markedly involved. Changes in peripheral tissue function are not necessarily related to a reduction in cardiac pump function and tissue perfusion, but may be intrinsic of nature. Thus, significant abnormalities in skeletal muscle oxidative metabolism occur which are not secondary to regional flow disturbances. The recognition of cardiac and peripheral changes before or during the early phases of heart failure are likely to alter the current strategies in the treatment of this syndrome.


Pathophysiology of the pancreas in cystic fibrosis. Pancreatic insufficiency occurs in the majority of cystic fibrosis (CF) patients. Deficient fluid secretion is apparent at all levels of pancreatic function and leads to pancreatic protein hypersecretion which may in turn result in protein precipitation and ductal plugging. An impaired chloride and bicarbonate secretion appears to account for this fluid secretion deficit. A minority of CF patients have sufficient preservation of pancreatic function to prevent steatorrhoea. These patients are diagnosed at a later age, experience milder symptoms and have a far superior overall prognosis than patients with pancreatic insufficiency (PI). Patients who are homozygous for delta F508 have a high frequency of PI (99%), whereas patients with other genotypes are more often pancreatic sufficient (PS). In 538 patients with CF DNA analysis was performed and related with pancreatic function. The most striking observation was that nearly all given genotypes were associated with either PI or PS and not with both. In addition, we were able to classify mutations as "severe" and "mild" with respect to pancreatic function.


[Disturbances of lipid metabolism during nephrotic syndrome: physiopathology and treatment]. Both increased synthesis and decreased catabolism of lipoproteins may account for the severe hyperlipidemia which frequently occurs in patients with the nephrotic syndrome (NS). Nevertheless the complex relation between hyperlipidemia and proteinuria remains unclear and still debated. Increased levels of serum total cholesterol, of low-density lipoprotein and of apolipoprotein B are the most characteristic reported abnormalities placing these patients at high risks for atherosclerotic vascular disease. Moreover recent experiments have suggested that hyperlipidemia may also play a role in the progression of renal disease. Thus the reasons for using hypolipemic treatment are now growing in number and recent trials with lipid lowering medication have been successful without major side effects.


[Percutaneous transluminal angioplasty for vascular access in hemodialysis. Apropos of 53 operations]. Percutaneous transluminal angioplasty as stenosis treatment in hemodialysis arterio venous fistulae. About 53 cases. Percutaneous transluminal angioplasty was used 53 times to dilate 75 stenoses in 37 hemodialysed patients. Rate success was 85% without vascular access loss. This kind of surgery is atraumatic and permits a future "opened surgery".


[Cyclosporine and idiopathic extramembranous glomerulopathy. Hypothesis, facts and questions in 1992]. The survey of open trials of Cyclosporin (CyA) in membranous nephropathy demonstrates that low dose CyA (4-5 mg/kg/day) given for a long term therapy (more than a year) can induce remission in 60-70% of the patients. Shorter therapy must be avoided because of the high rate of relapse after CyA withdrawal. Antiproteinuric effect of CyA does not seem to be related to an haemodynamic mechanism. Relapse of the nephrotic syndrome after CyA withdrawal after long term therapy can be observed but is far less frequent than in corticodependent nephrosis or in short term therapy with CyA. Further studies are needed to evaluate the risk of long-term nephrotoxicity and to determine what kind of patients should be treated. Controlled trials of CyA in membranous nephropathy against reference treatments are also warranted.


[Should adult nephrotic syndrome secondary to idiopathic extramembranous glomerulonephritis be treated? An approach by decisional analysis]. Treatment of nephrotic syndrome (without renal insufficiency) due to idiopathic membranous glomerulonephritis in adults is not clearly defined. A decisional analysis was done from data published in literature in order to define the best therapeutic choice. Three therapeutic strategies were studied: corticosteroids (either 125 mg/48 h or 30 to 60 mg/24 h), alternate therapy according to Ponticelli protocol (corticosteroids and chlorambucil), abstention of therapy. The data were divided in two groups according to the time of follow-up. The first group allows a decisional analysis for a short period of time (16 to 37 months), the second group allows this analysis for a longer period of time (54 to 65 months). The results differed according to the length of post treatment follow-up. For the shorter follow-up, corticosteroids or the association corticosteroids and chlorambucil appeared to be better than no treatment. For longer follow-up, any treatment shows an advantage in comparison to abstention of therapy. Our tentative conclusion is to propose only symptomatic treatment for this disease.


The aromatic amino acid decarboxylase inhibitor, NSD-1015, increases release of dopamine: response characteristics. Addition of the aromatic amino acid decarboxylase inhibitor, NSD-1015 (10 microM), to Krebs'-Ringer phosphate (KRP) superfusion medium, significantly increased the release of dopamine in vitro from superfused corpus striatum tissue fragments of male rats. A dose-dependent increase in release of dopamine was obtained in response to increasing concentrations of NSD-1015, with 1.0 microM being the minimally effective dose. In addition to the striatum, NSD-1015 also increased the release of dopamine from superfused hypothalamic tissue fragments. This capacity of NSD-1015 to increase release of dopamine was calcium-independent, appeared to be somewhat specific and could apparently increase the release of dopamine in vivo, as indicated by increases in the release of the metabolite of dopamine, DOPAC, under conditions of push-pull perfusion. Although the putative role of NSD-1015 is as an aromatic amino acid decarboxylase inhibitor, the present results demonstrate that, either as a result of this function and/or in addition to this role, NSD-1015 is a potent activator of the release of dopamine.


Abstinence from U-50,488H, a kappa-opiate receptor agonist, decreases the binding of [3H]DPAT to 5-HT1A receptors in the hypothalamus of the rat. The effect of trans-(+/-)-3,4-dichloro-N-methyl-N-[2-(1-pyrrolidinyl) cyclohexyl]-benzene-acetamide methane sulfonate (U-50,488H), a kappa-opiate agonist-induced tolerance and abstinence on 5-HT1A receptors was determined in regions of the brain and spinal cord of the rat. The administration of U-50,488H (25 mg/kg, i.p., twice daily) to male Sprague-Dawley rats for 4 days resulted in the development of almost complete tolerance to its analgesic and hypothermic effects. On day 5, the animals were divided into tolerant and abstinent groups and sacrificed. The brain and spinal cord were excised from all groups of rats and the brain was dissected into 6 regions, namely, amygdala, hypothalamus, striatum, midbrain, pons+medulla and cortex. The 5-HT1A receptors were characterized by using [3H]8-hydroxy-2-(di-n-propylamino)tetralin ([3H]DPAT) as the ligand. The binding constants (Bmax and Kd values) of [3H]DPAT in regions of the brain and spinal cord of rats tolerant to U-50,488H and vehicle did not differ. However, the Bmax value of [3H]DPAT in the hypothalamus of U-50,488H-abstinent rats was decreased but the Kd value did not change. In the other regions of the brain and spinal cord of U-50,488H-abstinent rats, the Bmax and Kd values of [3H]DPAT were unaffected. Subcutaneous administration of DPAT produced hypothermic response in vehicle- and U-50,488H-treated rats. The intensity of this effect was more marked in U-50,488H-abstinent group. It is concluded that 5-HT1A receptors are down-regulated in the hypothalamus of U-50,488H-abstinent rats but the hypothermic response to 5-HT1A agonist is intensified.


The comparison of benzodiazepine derivatives and serotonergic agonists and antagonists in two animal models of anxiety. The present paper compares the effects of different serotonergic agonists and antagonists with benzodiazepine derivatives in two animal models of anxiety; the Vogel's and the open-field tests. In the Vogel's conflict test, both diazepam and midazolam produced an anti-punishment action. The drugs 8-OH-DPAT (0.025 and 0.05 mg/kg), buspirone (0.62 mg/kg), gepirone and ipsapirone (0.3 and 0.62 mg/kg, respectively) increased punished intake of water. Ritanserin disinhibited the behaviour of rats at the doses of 2.5 and 5.0 mg/kg and ICS 205-930 (0.001 and 0.01 mg/kg) exerted a marked increase in punished drinking, while ondansetron was active only after the largest dose (1.5 mg/kg). In the open-field test, all drugs increased the number of entries into the central area, as well as the time spent in the central sector of the open-field. The present data indicate similar but not identical spectra of pharmacological sensitivity of both ethologically-oriented and conflict tests, for various classes of anxiolytic drugs. The 5-HT1A receptor agonists and 5-HT2 receptor antagonist have been shown to have similar anxiolytic-like profile to the benzodiazepines but in a narrower dose-range. The 5-HT3 receptor antagonists appeared to be unique in respect to their very strong anti-emotional activity (ICS 205-930), devoid of any clear-cut general inhibitory properties upon locomotion.


The non-competitive NMDA receptor antagonist (+)MK-801 counteracts the long-lasting attenuation of the hypothermic response induced by acute doses of 8-OH-DPAT in the rat. The effects of acute doses of 8-hydroxy 2-(di-n-dipropylamino)tetralin (8-OH-DPAT) on the hypothermic response, induced by a challenge dose of 8-OH-DPAT, were examined in rats. Acute doses of 8-OH-DPAT (1.0 or 0.5 mg/kg, s.c.) significantly attenuated the hypothermic response induced by 8-OH-DPAT (0.05 mg/kg, s.c.). The response to 8-OH-DPAT was almost abolished between 4 hr and 4 days and the attenuation of the response lasted for 21 days. On day 28 the response had returned to the control level. The non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist, (+)-5-methyl-10,11-dihydro-5H-dibenzo-(a,d)cyclohepten-5,10-imine [(+)MK-801], blocked this long-lasting attenuation of the 8-OH-DPAT-induced hypothermic response. Given on its own, (+)MK-801 did not reduce body temperature, at the doses used in the experiments but the drug did block the acute effects of 8-OH-DPAT, at the same doses which blocked the attenuation of the hypothermic response. The present data suggest that stimulation of glutamate NMDA receptors may underlie the long-lasting effect of acute injections of 8-OH-DPAT.


Antagonism of the toxicity of cocaine by MK-801: differential effects in spontaneously hypertensive and Wistar-Kyoto rats. A putative role for endogenous excitatory amino acid systems in the mediation of the cardiovascular and toxic responses to acute administration of cocaine, was examined in spontaneously hypertensive and normal Wistar-Kyoto rats. Conscious, restrained, male hypertensive and normal rats (12 weeks of age) received either the non-competitive excitatory amino acid receptor antagonist, MK-801 (0.01-10 mg/kg, i.v.) or vehicle, 30 min prior to initiation of infusion of cocaine hydrochloride (1.25 mg/kg min, i.v.). Administration of MK-801 produced increases in mean blood pressure and heart rate in both hypertensive and normal rats. Resting rectal temperature was reduced by MK-801 only at the largest dose tested (10 mg/kg). Infusion of cocaine caused convulsions and death at doses of 27.8 +/- 2.3 and 48.2 +/- 5.7 mg/kg, respectively in the normals, and 21.2 +/- 2.5 (P < 0.05) and 31.1 +/- 3.4 (P < 0.05) in the hypertensive rats. Pretreatment with MK-801 abolished the enhanced sensitivity of the hypertensive rats to the toxicity of cocaine. The doses of cocaine required to cause death were significantly increased, in the hypertensive rats at doses > or = 0.05 mg/kg, an effect which was not evident, at any dose, in the normals. The maximally effective dose of MK-801 (0.5 mg/kg) increased the dose of cocaine required to cause lethality by 272% (P < 0.05) in the hypertensive rats; the increase produced by MK-801 in the normals (163%) was not significant. Cocaine-induced convulsions were abolished in both hypertensive and control rats with doses of MK-801 > 0.1 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)


Antioxidant and free radical scavenging activities of Gastrodia elata Bl. and Uncaria rhynchophylla (Miq.) Jacks. Gastrodia elata Bl. (GE) and Uncaria rhynchophylla (Miq.) Jacks (UR) are two traditional Chinese medicinal herbal drugs, used for the treatment of convulsions and epilepsy. Their antioxidant effects in vivo and their free radical scavenging effects in vitro were investigated. Epileptogenic foci in the lateral brain of the rat were induced by the injection of ferric chloride into the lateral cortex. Both extracts significantly inhibited the increase in levels of lipid peroxide in the ipsilateral cortex, at all times observed. In addition, the two extracts also induced an early increase of activity of superoxide dismutase in the mitochondrial fraction of the ipsilateral cortex. In in vitro experiments, the two extracts exhibited significant dose-dependent scavenging effects on free radicals, using electron spin resonance spectroscopy. These results suggest that the proposed antiepileptic effects of GE and UR may be attributable to the antioxidant activity of the active components in these two medicinal herbs.


Antinociceptive and thermoregulatory actions of vasopressin are sensitive to a V1-receptor antagonist. The involvement of arginine vasopressin (AVP) has been investigated in cold water swim (CWS) stress-induced antinociception (SIA) and CWS-induced hypothermia. The antinociceptive action of AVP (0.5 micrograms, i.c.v.) pre-CWS was antagonized by d(CH2)5Tyr(Me)AVP (0.5 micrograms, i.c.v.) but not by naloxone (5 micrograms, i.c.v.). CWS produced SIA on the hot-plate which was initially naloxone-insensitive. Neither AVP nor its antagonist had any significant effect on CWS SIA. AVP-induced increase in body temperature, during recovery from CWS-induced hypothermia, was significantly (P < 0.001) reduced in the presence of its antagonist. These findings suggest that the antinociceptive and thermoregulatory actions of AVP may be mediated via V1-receptors.


Resistance to insulin-induced hyperphagia in fat-preferring rats. Outbred male Sprague-Dawley rats were screened for their macronutrient (fat, carbohydrate and protein) preference profile and divided into two groups, the low- and high fat-preferring groups each deriving 23% and 72% of its total caloric intake from fat respectively. Subcutaneous administration of bovine insulin (6U/kg) resulted in an increase in total caloric intake in the low, but not the high fat-preferring group. Furthermore, the increased caloric intake in the low fat-preferring group was entirely due to increased carbohydrate consumption. These data suggest a defect in the action of insulin in fat-preferring rats.


Benextramine-neuropeptide Y (NPY) binding site interactions: characterization of 3H-NPY binding site heterogeneity in rat brain. Pre-incubation of rat brain membranes with 200 microM benextramine followed by extensive dilution and washing to remove unbound ligand reduced Bmax for N-[propionyl-3H]-NPY (3H-NPY) specific binding by 61% relative to control membranes treated identically but in the absence of benextramine. When rat brain membranes were co-incubated with 3H-NPY and 57 microM benextramine, there was a significant shift to the right; the apparent Kd for 3H-NPY binding increased two-fold relative to control membranes. These data are consistent with the hypothesis that benextramine is a competitive and irreversible ligand for a population (60-65%) of rat brain NPY binding sites. 'Paired tube' assays were then used to determine the selectivity of these benextramine-sensitive and insensitive 3H-NPY binding site populations. PYY, NPY and NPY13-36 each displaced 100% of 3H-NPY from rat brain membrane binding sites both in the absence and presence of 1 mM benextramine. In contrast, [Leu31,Pro34]NPY displayed the same binding site selectivity as benextramine in displacing 65% of 3H-NPY from specific binding sites on untreated rat brain membranes, and it failed to displace 3H-NPY from membranes treated with 1 mM benextramine. Thus the selectivity of the benextramine-insensitive 3H-NPY binding site population--PYY > = NPY > NPY13-36 >> [Leu31,Pro34]NPY--is characteristic of a Y2-like NPY binding site population, while the benextramine-sensitive 3H-NPY binding sites appear to be a Y1-like binding site population.


Positive inotropic effects of CGRP and isoprenaline: analogies and differences. In guinea-pig isolated left atria, electrically stimulated at 1 Hz, isoprenaline and calcitonin gene-related peptide (CGRP) induced a positive inotropic effect in the same concentration range (0.3-100 nM). The increase in contractile tension induced by both agonists was associated with a reduction in time to peak tension and relaxation time. However CGRP was more active than isoprenaline in reducing the time to peak; this effect was more evident when the bath temperature was reduced from 30 degrees to 24 degrees C. The positive inotropic effects of isoprenaline and CGRP were potentiated by forskolin (30 nM), a direct activator of adenylcyclase; on the other hand, cholera toxin (1 microgram/ml), which irreversibly ribosylates Gs protein, did not modify the effect of CGRP, while antagonizing the concentration-response curve for isoprenaline. It is concluded that the increase in atrial contractile tension produced by isoprenaline and CGRP are linked to the adenylcyclase system in a different manner.


Thyroliberin (TRH) increases thymus cell proliferation in rats. The effects of thyroliberin (TRH), a TRH-like tripeptide colon mitosis inhibitor (CMI), a somatostatin analog SMS 201-995 and metoclopramide (dopamine receptor antagonist enhancing prolactin secretion) on rat thymus cell proliferation were investigated. The incorporation of bromodeoxyuridine (BrDU) into thymic cell nuclei was used as an index of the proliferation. It was found that TRH, but not other compounds investigated herein, increased the thymus cell proliferation 12 hours after the injection.


Meningiomas of Meckel's cave.

Meningiomas of Meckel's cave. A series of 16 patients with meningiomas of Meckel's cave is reported. Trigeminal neuralgia, typical or atypical, was the initial symptom in 10 patients (62.5%). At admission, trigeminal signs and symptoms were present in 15 patients (93.7%); in 7 patients (43.7%), trigeminal dysfunction was combined with the impairment of other cranial nerves. On retrospective analysis, these patients fall into two clinical groups that differ also in prognosis. Group 1 comprises eight patients with trigeminal signs and symptoms only. These patients had small meningiomas strictly affecting Meckel's cave. Total removal of the tumor was achieved in seven of eight patients, without adjunctive postoperative neurological deficits. In this group, there were no tumor recurrences. Group 2 comprises the other eight patients in whom trigeminal dysfunction was combined with impairment of other cranial nerves. These patients had large tumors arising from Meckel's cave and secondarily invading the cavernous sinus (five patients) or extending into the posterior fossa (two patients) or largely growing into the middle fossa (one patient). Total removal was achieved in only one patient, and a worsening of the preoperative neurological status was observed in four patients; there were three cases of tumor progression. A subtemporal intradural approach (used in the past in every case) is still used for the small tumors of Group 1 with good results. Since 1985, for tumors involving the cavernous sinus, we have employed a frontotemporal craniotomy with extradural clinoidectomy and superior and lateral approach to the cavernous sinus. When the tumor extends toward the posterior fossa, we use a combined temporosuboccipital-transpetrosal approach.(ABSTRACT TRUNCATED AT 250 WORDS)


The transsphenoethmoid approach to the sphenoid sinus and clivus. Surgical access to the sphenoid sinus and clivus for the resection of benign and malignant disease is difficult and is often associated with significant morbidity. The transsphenoethmoid approach, an extension of a familiar otolaryngological procedure, with or without a limited medial maxillectomy, allows access to this region with little morbidity and excellent cosmetic results. Since 1988, the transsphenoethmoid approach has been used in 15 patients at our institution for resection of primary and recurrent chordomas, chondrosarcomas, pituitary macroadenomas, repair of cerebrospinal fluid leaks, and drainage of petroclival cysts. In most instances, an ipsilateral approach is most satisfactory. When necessary, a contralateral transsphenoethmoid approach is used when the tumor is posterolateral to the internal carotid artery and as far lateral as the abducens nerve.


Significance of different levels of the Edinburgh 2 coma scale calculated from the outcome of neurosurgical patients. In the management of patients with acute cerebral disturbances, it is essential to determine precisely the degree of impaired consciousness. In order to secure the accuracy of observations, one must use a reliable coma scale. We have evaluated the Edinburgh 2 coma scale (E2CS) and explored the relationship between levels of the E2CS and the final outcome. Case notes and observation charts of the past 7 years were reviewed, covering neurosurgical operations on 406 patients, in each of whom the postoperative course was evaluated periodically by the E2CS and the outcome was determined by the Glasgow outcome scale. By matching the outcome with each level of impaired consciousness, about 22,000 pairs of data were obtained. In order to quantify the morbidity rate, different stages of the Glasgow outcome scale were rated from 100 through 0, arbitrarily. It was proved that levels of the E2CS were arranged in the correct order in respect to both mortality and morbidity rates. It was shown at the same time that each level has different prognostic significance and that the distance between each level is not identical. The recommendation is made to separate the levels on a chart not by an ordinal number but by the distance calculated on the basis of either mortality or morbidity rates. This will make it possible to get a rough estimate of the patients' prognoses by simply looking at a daily clinical chart.


Force, fatigue, and the cross-sectional area of wrist extensor muscles after radial nerve grafting. The force and fatigue of the wrist extensor muscles during maximal voluntary and tetanic contractions were measured and compared in the injured and noninjured extremities of 11 patients with radial nerve gap injury and in 9 normal volunteers. The cross-sectional area (CSA) of the wrist extensor muscles was determined by magnetic resonance imaging and was correlated with force. In the patient group, an average of three (range, 2-4) sural nerve cable grafts, measuring 11.5 +/- 5 cm (range, 5-20 cm) in length, were sutured to the nerve stumps at least 9 years before this study. Differences in the CSA values of the injured and noninjured arms were compared, and a ratio was established (CSAR). The mean CSAR was 82.9% +/- 14.3. These differences were not statistically significant (P > 0.10, paired t-test). Despite very well-recovered muscular mass, the maximal voluntary contraction force was found to be incompletely recovered by up to 62.7% +/- 23, when compared with the noninjured side (P < 0.05, paired t-test). The fraction maximal voluntary contraction force/CSA had decreased by up to 76.4% +/- 25.5 (P < 0.05, paired t-test). An increased fatigability of the affected muscles persisted in all patients. The patients' noninjured extremity behaved in the same way as that of the dominant extremity of normal volunteers with regard to force, lever, and CSA values.(ABSTRACT TRUNCATED AT 250 WORDS)


Selective cooling of brain using profound hemodilution in dogs. A new method of selective cooling of the brain was studied under profound hemodilution in 17 dogs. The carotid and vertebral arteries were bilaterally exposed, and the right vertebral artery was destroyed to provide an infusion route for cold solution for brain cooling. After the other three cerebral arteries were clamped simultaneously in the neck under low-dose heparinization, cold Ringer's lactate solution was immediately perfused into the right vertebral artery. Brain temperatures fell gradually in two dogs, and the experiments were terminated. In 10 dogs, the brain temperature fell to 28 degrees C within 4.4 +/- 1.5 minutes and was maintained at 27.0 +/- 1.0 degrees C for 60 minutes. During this interval, the body temperature was 33.9 +/- 1.6 degrees C, the stump pressure of the vertebral artery was 58 +/- 15 mm Hg, and the hematocrit value of cerebral venous blood was 7.2 +/- 4.2%. Inspection of the brain during infusion revealed paleness of the cortical vessels and no evidence of swelling. All animals survived in good condition until the time of death at 10 weeks. Histological examination of the brain revealed no evidence of ischemic injury. In a control study of five dogs, Ringer's solution at 38 degrees C was infused in the same manner as the cold solution. None of these dogs recovered from anesthesia. It is concluded that selective cooling of the brain under profound hemodilution has a protective effect on cerebral ischemia and provides a relatively bloodless operative field.


The effect of mild hypothermia on permanent focal ischemia in the rat. The effect of mild hypothermia on cerebral injury was evaluated in a rat model of permanent middle cerebral artery (MCA) and ipsilateral carotid artery occlusion. The MCA occlusion was performed in rats at temporalis muscle temperatures of 30 degrees C, 33 degrees C, 34.5 degrees C and 36.5 degrees C (n = 10, 8, 10, and 13, respectively). The animals were kept at the desired temperature for 1 hour and rewarmed to 36.5 degrees C. In a separate group of animals (n = 11), the temperature was decreased to 33 degrees C 1 hour after performing the arterial occlusion at normothermia. These animals were rewarmed to 36.5 degrees C after another hour with side by side controls (n = 9) kept at 36.5 degrees C throughout the experiment. Twenty-four hours after the MCA occlusion, rats were killed and the percentage of infarcted right hemisphere was determined in coronal brain sections with 2,3,5-triphenyltetrazolium chloride. The percentage of infarcted volume at 30 degrees C, 33 degrees C, and 34.5 degrees C (9.3 +/- 2.1%, 8.2 +/- 2.2%, and 8.4 +/- 2.2%) (SEM) was significantly smaller than at 36.5 degrees C (19.6 +/- 1.6%, P < 0.01). There were no significant differences between the hypothermic groups. When rats were cooled to 33 degrees C 1 hour after the arterial occlusion, the percentage of infarcted volume was also significantly smaller than the control group (8.0 +/- 1.8% vs. 17.4 +/- 2.1%) (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


Failure of cerebral blood flow-metabolism coupling after acute subdural hematoma in the rat. We have used a recently introduced cerebral blood flow tracer, technetium-99-DL-hexamethylpropylene amine oxime, to map regional cerebral blood flow simultaneously with measurements of glucose metabolism ([14C]-2-deoxyglucose technique) using autoradiography. The technique was used to compare the acute effects of middle cerebral artery occlusion with the more complex events that occur after induction of an acute subdural hematoma (SDH) in the rat. Previous studies with this SDH model have shown that an infarction is induced in the cortex under the hematoma. In both models, the core of the infarct zone was associated with a reduction in both flow and metabolism to less than 15% of control values. In both models, the infarct core was surrounded by a band of tissue in which glucose metabolism increases by 60 to 70% and blood flow is reduced by the same amount. Global blood flow after the SDH was reduced by 14%, but remained unchanged after middle cerebral artery occlusion. In the hippocampus, a massive increase in metabolism (up to 157%) after SDH was accompanied by a paradoxical decrease in blood flow (32%). This discrepancy between blood flow and metabolism indicates loss of flow-metabolism coupling and provides a mechanism for infarct recruitment and delayed hippocampal damage after SDH.


Gravimetric measurements of cerebral edema in a rabbit brain tumor model. The development of tumor-induced cerebral edema was studied in rabbits to establish a data base for future work using this brain tumor model to correlate the degree of edema with other functional and morphological parameters. The VX-2 carcinoma was implanted into the brains of New Zealand White rabbits. Animals were killed 9 and 13 days later, and gravimetric analysis was used to measure the specific gravity of gray and white matter in both the tumor-bearing implanted and contralateral nonimplanted hemispheres. Studies were conducted in untreated tumor-bearing rabbits as well as in those receiving dexamethasone daily for 4 days before death. Tumor tissue and peritumoral gray and white matter and contralateral gray and white matter were analyzed. In all cases, at both 9 and 13 days after tumor cell implantation, tumor tissue exhibited extremely high specific gravity values exceeding the range detectable by the assay procedure. Compared with controls, specific gravity values in tumor-bearing animals generally increased in gray matter and decreased in white matter as a function of tumor growth. This trend was seen in both peritumoral gray and white matter as well as in contralateral gray and white matter areas. However, in most cases, the changes in specific gravity values as compared with controls were not statistically significantly different. The primary exception to this was in peritumoral white matter, in which mean specific gravity values at both 9 and 13 days after implantation were statistically significantly lower than for the corresponding site in control non-tumor-bearing animals.(ABSTRACT TRUNCATED AT 250 WORDS)


Improvement of cortical morphology in infantile hydrocephalic animals after ventriculoperitoneal shunt placement. As a sequel to our previous descriptions of the pathological changes induced by hydrocephalus in the infantile cerebral cortex, the study presented here has evaluated the effects of surgical decompression on cortical cytology and cytoarchitecture. Hydrocephalus was induced in 14 kittens by the intracisternal injection of kaolin at 4 to 11 days of age. Nine of these hydrocephalic animals received low-pressure ventriculoperitoneal shunts at 9 to 15 days after kaolin injection; these animals were monitored preoperatively and postoperatively by ultrasound and were killed at various postshunt intervals up to 30 days. Five normal or saline-injected animals served as age-matched controls. At the time of shunt placement, the ventricular index confirmed that all recipient animals had attained moderate or severe degrees of ventriculomegaly. Within 3 days after shunt placement, the size of the lateral ventricles had decreased to control levels and was accompanied by rapid and dramatic improvements in behavior and skull ossification. When the animals were killed, gross inspection revealed that about half of the animals exhibited mild to moderate ventriculomegaly, with cortical mantles 50 to 80% their normal thickness. Tissue from frontal (primary motor), parietal (association), and occipital (primary visual) cortical areas was processed for light microscopic analysis. Pyknotic or dark shrunken neurons, which are found typically in hydrocephalic brains, were observed only occasionally in the cortex of shunted animals. Gliosis and mild edema were prevalent, however, in the periventricular white matter. The laminae of the cerebral cortex could be identified in all shunted animals. In those animals with mild residual ventriculomegaly, the entire cortical mantle was somewhat compressed, as evidenced by an increased packing density of neurons. Furthermore, the somata of some neurons were disoriented. Overall, these results indicate that most of the morphological characteristics of the cerebral cortex are preserved after surgical decompression and suggest that ventriculoperitoneal shunts may prevent neuronal damage and/or promote neuronal repair.


Pull-out strength of Caspar cervical screws. Anterior cervical instrumentation as an adjunct to bone fusion has an important role in cervical spine surgery. Posterior vertebral body cortex purchase is strongly recommended in the use of the Caspar system, although few biomechanical data exist to validate this requirement. In this study, Caspar screws were placed in 43 human cadaveric cervical vertebral bodies, either putting them into the posterior vertebral cortex as identified radiographically or penetrating it by 2 mm as recommended in the literature. Pull-out tests were conducted with tension applied to a connected plate at 0.25 mm/s, and force-deformation data were obtained. Failure typically occurred with clean pull-out; in most instances, cancellous bone remained attached to screw threads. Mean load without posterior cortical purchase was 375 +/- 53 N; with penetration it was 411 +/- 70 N. These differences were nonsignificant. Average deformation to failure was 1.41 +/- 0.10 mm in the group without posterior cortical penetration. In the posterior penetration group, mean deformation was 1.56 +/- 0.16 mm. Again, differences were not significant. Posterior cortical penetration does not improve the pull-out strength of Caspar screws in an isolated vertebral body model, but other biomechanical studies need to be done before insertion methods are altered.


Intraorbital ophthalmic artery aneurysm: case report. A rare case is presented of a nonruptured aneurysm of the intraorbital ophthalmic artery in which successful resection of the aneurysm resulted in improvement of preoperative progressive signs caused by the mass effect of the aneurysm. The surgical management of this rare entity is discussed with special attention given to the collateral circulation of the ophthalmic artery from the external carotid artery.


Focal dystonia secondary to cavernous angioma of the basal ganglia: case report and review of the literature. The case of a young woman with focal dystonia of the hand due to a cavernous angioma of the basal ganglia is presented. The lesion involved the anterior third of the lentiform nucleus and a large portion of white matter anterior to this nucleus and lateral to the head of the caudate, as shown by magnetic resonance imaging; it was completely removed through a computed tomography-assisted stereotactic craniotomy by microsurgical technique, resulting in the cure of the patient. These facts support the pathophysiological hypothesis of a disruption of the striatopallidothalamic projection to the premotor cortex as the cause of symptomatic dystonia. A review of the reported cases of cavernous angiomas of the deep cerebral gray nuclei shows that this is the first case of cavernous angioma associated with movement disorder.


Histologically benign recurrent meningioma metastasizing to the parotid gland: case report and review of the literature. This report presents a very rare case of metastatic meningioma of the parotid gland from a recurring intracranial lesion. The primary tumor, intracranial residues, and parotid metastasis were histologically benign. Meningiomas rarely metastasize; even rarer are cases in which both the primary and the secondary tumors have benign histological characteristics. The 11 cases reported in the literature have been critically reviewed. The case we present is noteworthy also for the exceptional localization of the metastasis in the parotid gland.


Reversibility of cerebral atrophy after head injury in children. Reversible cerebral atrophy in humans has been documented by computed tomography in alcoholics and has been described as an incidental finding after head injury in children. Two children were studied who had sustained a severe closed head injury, 1 and 5 years previously, after which cerebral atrophy had developed, according to subacute computed tomography. Reversible cerebral atrophy was seen on magnetic resonance images of both patients. Despite normal appearance on magnetic resonance images more than 1 year after injury, both patients exhibited residual neuropsychological impairment on a broad range of cognitive and memory tests.


Segmental neurofibromatosis of the sciatic nerve: case report. A case of rare segmental neurofibromatosis is presented. Multiple neurofibromas along the right sciatic nerve were found. Other typical manifestations of neurofibromatosis were absent. By microsurgical dissection, it was possible to remove the neurofibromas from the nerve trunks and to preserve all motor and sensory functions. Classification of the different neurofibromatosis types is briefly reviewed. The problems of resection of benign major nerve trunk tumors in neurofibromatosis are discussed.


En bloc resection of an ethmoid carcinoma involving the orbit and medial wall of the cavernous sinus. The involvement of the cavernous sinus by malignant tumors has limited their surgical treatment. We report here a successful en bloc resection of an invasive ethmoid carcinoma involving the cavernous sinus in a 46-year-old man. To prepare for surgery on this patient, a cadaver study was performed to investigate the feasibility of en bloc cavernous sinus resection and reconstruction. The preoperative evaluation, operative approach, and postoperative management are presented.


e-PTFE ventricular shunt catheters.

e-PTFE ventricular shunt catheters. The perfect polymer surface for implantation should resist the adhesion of bacteria while producing no reaction in surrounding tissues. Silicone elastomer is a common material used for medical implantation devices. This material is superior to most available for implantation because of its flexibility and low, but detectable, tissue reaction. We have evaluated a flexible, expanded polytetrafluoroethylene (e-PTFE) ventricular catheter for cerebrospinal fluid shunting and have found that although e-PTFE is safe for cerebral implantation, the porosity of the material allows tissue ingrowth that obstructs the lumen. Our limited clinical evaluation of 5-microns internodal distance e-PTFE revealed that this open-cell structure, allowing tissue ingrowth, apparently is a poor candidate to replace silicone elastomer in cerebrospinal fluid shunting devices. However, further investigation may provide a polymer superior to silicone elastomer to create a cerebrospinal fluid shunt.


Clinical analysis of a series of vertebral aneurysm cases. We reviewed 38 cases of aneurysms of the vertebral artery treated over the last 10 years: 26 (68%) located at the junction of the vertebral and posterior inferior cerebellar arteries, 10 (26%) at the vertebral artery, and 2 (5%) at the vertebrobasilar union. There were three distinct forms of aneurysms: 20 saccular (53%), 10 fusiform (26%), and 8 dissecting (21%). Among these 38 aneurysms, 33 (87%) had ruptured: 18 of the saccular aneurysms (90%), all 10 of the fusiform aneurysms (100%), and 5 of the dissecting aneurysms (63%). Computed tomography of the 28 ruptured aneurysms revealed diffuse subarachnoid hemorrhage in the basal cistern combined with intraventricular hemorrhage in 24 cases (86%). Magnetic resonance imaging was useful for differentiating between fusiform and dissecting aneurysms. Abnormalities such as a double lumen of the vertebral artery were demonstrated in four of the dissecting aneurysms. The overall surgical results were good for 22 of the 27 surgically treated cases (81%). New bleeding was observed in 8 (24%) of the 33 ruptured aneurysms. The rate of new bleeding was high (60%) in the patients with dissecting aneurysms, and occurred mostly in the acute stage. The incidence of vasospasm was 27%, and only two patients suffered permanent neurological deficits. These findings indicate that the rate of new bleeding tends to be high in patients with saccular and dissecting aneurysms, and thus, they should be treated as early as possible. A preoperative balloon occlusion test should be conducted if proximal occlusion of the vertebral artery is necessary, since proximal occlusion is not always safe, despite angiographic evidence of sufficient contralateral arterial flow.


Saccular aneurysms of the distal anterior cerebral artery and its branches. We report a series of 84 consecutive patients (41 women) with 92 distal anterior cerebral artery aneurysms (DACAA). All aneurysms were saccular. Four different locations of DACAAs were found: proximal, 5 aneurysms; frontobasal, 8; genu corporis callosi, 72; and distal, 7. Sixty-five patients presented with subarachnoid hemorrhage (SAH), the rest were incidental findings in patients with multiple aneurysms. Forty-five patients had single DACAAs. Multiple aneurysms (a total of 117) were found in 39 patients (46.4%), and DACAAs were responsible for SAH in 20 patients. Of the 65 patients with SAH, 54 underwent mainly early direct surgery, and 46 (85%) of these had good outcomes 1 year after surgery. Three patients remained severely disabled, and five patients (9%) died. All of the poor surgical results were obtained in patients with severe preoperative deficits. Exact measurements of DACAA sizes and necks were smaller than those of cerebral aneurysms in other locations. Aside from localization, microsurgery of these aneurysms presented no special difficulties, as compared with surgery of aneurysms in other locations.


Personal and extrapersonal space: a case of neglect dissociation. Dissociation between personal and extrapersonal neglect has rarely been observed in man. In this study we present a case of severe personal neglect in the absence of a deficit for extrapersonal space. An extensive neuropsychological assessment demonstrates the absence of cognitive impairments in visuo-spatial processing and confirms the selective presence of a severe representational deficit of the left side of the body.


Inflexibility of mental planning: a characteristic disorder with prefrontal lobe lesions? Inflexibility of mental planning processes has repeatedly been discussed to represent a specific disorder resulting from human frontal lobe lesions. Patient groups suffering from acute or chronic unilateral frontal (medial, lateral) or retrorolandic (temporal, parietal) lesions and nonbrain-damaged controls were requested to mirror and to reverse mentally a maze structure that had been learned by the covered maze presentation technique (KARNATH et al., Neuropsychologia 29, 271-290, 1991). The patients with acute frontal lesions were impaired to adapt the acquired mental plan to the new (but related) problem and made more errors than those with acute temporal or parietal lesions and controls. However, no impaired plan modification was detected in patients with chronic frontal brain lesions. The difference of task performance in the acute and chronic (recovered) stage of frontal brain damage is discussed.


Defensive responses to looming visual stimuli in monkeys with unilateral striate cortex ablation. A number of residual visual functions including detection, localization and discrimination of visual stimuli, have been demonstrated in the "blind" fields of monkeys and human patients following damage to striate cortex. We report here that avoidance movements of the head can also be elicited from monkeys with unilateral striate cortex ablations when a "looming" stimulus is presented within the hemianopic and presumably "blind" field. The possible role of the retinofugal projection to superior colliculus in the mediation of these defensive head movements is discussed.


Dichotic listening: what does it measure? Auditory lateralization was investigated in 26 right-handed and 26 left-handed, normal subjects using seven different dichotic listening tests in each proband (free recall of digit lists, free recall of consonant-vowel (CV) syllables, four different CV syllable monitoring paradigms, and free recall of Morse codes). Reliabilities calculated with the formula of Spearman-Brown were low for digit recall (0.29, corrected for test length: 0.50), but good for CV recall (0.83), CV monitoring (0.75-0.88), and Morse code recall (0.50, corrected for test length: 0.88). Nevertheless, interest correlations were low, both for right- and left-handers (negative correlations ranging from -0.44 to -0.05, positive correlations ranging from 0.01 to 0.51). Only 38-77% of the right-handed and left-handed subjects retained one direction of ear advantage across any combination of two tests. The data suggest that different dichotic tests reveal different results. This may be due to psychometric, procedural, or phonetic properties. We conclude that individual predictions of language dominance are not justified using the dichotic tests evaluated in the present study.


Parallels between asymmetries of Planum temporale and of hand skill. Relationships between the skill of each hand and differences between the hands are described for a sample of 14-15-year-olds representative of the general population. The description is modelled on the account of Galaburda et al. (Neuropsychologia 25, 853-868, 1987) of relationships between asymmetries of the Planum Temporale (PT) and measures of PT area on each side, in order to show parallels between findings for the two types of asymmetry. For both PT and hand skill, the extent of asymmetry appears to depend on the greater variability of the weaker side rather than of the larger or "better" side. The findings are also described as a replication of the study of hand skill in children by Annett and Manning (Br. J. Psychol. 80, 213-226, 1989). As no score transformations were needed in the present sample, the grounds for doubt raised by Bishop (Handedness and Developmental Disorder, Blackwell, Oxford, 1990) about the earlier sample are removed. Repetition of the analyses for right-handed and left-handed writers separately demonstrates very close similarities for findings in the two hand preference groups. Theories about the mechanisms responsible for asymmetries appear to require the presence of factors which reduce brain area and hand skill on one side. For most people the reduction is to the right PT and to the left hand.


Factor analysis and the cerebral hemispheres: temporal, occipital and frontal functions. Three experiments are reported that use a number of lateralized tasks believed to draw on processes localized to the temporal, occipital or frontal lobes. Oblique factor analyses of the resultant asymmetries indicate the existence of nine lateralized functions, characterized as auditory lexical, facial figural, facial motive, spatial attentive, spatial positional, spatial quantitative, tactile figural, visual lexical, and visual phonetic in nature. Most functions are uncorrelated, but as in an earlier report (Boles, Neuropsychologia 29, 59-91, 1991), both positive and negative correlations are observed. These outcomes continue to be consistent with neurodevelopmental theory, and inconsistent with lateralization strength, hemisphericity, and independence views of individual differences in lateralization.


Early rightwards orienting of attention on simple reaction time performance in patients with left-sided neglect. A specific disruption in the ability to automatically disengage attention from its previous focus has been hypothesized to account for the extinction phenomenon often observed in the unilateral spatial neglect syndrome. Recent literature, however, also brings out the role played in neglect by an imbalance in the attentional orienting systems, resulting in an early shift of attention towards the side of space ipsilateral to the brain lesion. In the present study we hypothesized that this attentional bias in orienting of attention might be demonstrated in a paradigm of simple reaction time to lateralized visual stimuli by contrasting the presence vs the absence on the computer screen of the square boxes used to facilitate position expectancy. A main prediction was made that patients with neglect would show a significant increase in reaction time to contralateral visual stimuli in the presence of bilateral reference boxes as compared to conditions in which no boxes were displayed. The right-sided box was in fact expected to exert an early attraction on the patient's attention, thus modifying the pattern of reaction times to the proper targets. This prediction was confirmed in right brain-damaged patients with moderate to severe neglect.


Effect of oat bran consumption on total serum cholesterol levels in healthy adults. The effect of oat bran on total nonfasting serum cholesterol levels in healthy adults was studied. Twenty volunteers whose cholesterol levels were greater than 200 mg/dl consumed 3 ounces of oat bran daily for 93 days in addition to their normal dietary intake. Rescreenings were conducted at days 31, 62, and 93. Repeated measures analysis of variance (ANOVA) revealed no significant difference in total serum cholesterol levels over the four consecutive screenings (a = 0.05, p = 0.054), although ANOVA for polynomial trends revealed a significant difference in total serum cholesterol levels across time (a = 0.05, p = 0.007) (quadratic effect). The interaction of gender with time revealed no significant difference. Thus, it is concluded from this study that daily addition of oat bran to the diet does not significantly lower total cholesterol levels for a sustained period of time.


The costing out of operational expenses between the Veterans Administration and the Air Force at the New Mexico Regional Federal Medical Center. The purpose of this pilot study was to identify the cost of providing care to Veterans Administration (VA) and Department of Defense (DOD) patients eligible for care in the Emergency Department of the New Mexico Regional Federal Medical Center in Albuquerque, New Mexico. Medical records for the Emergency Department (N = 456) were reviewed for individual medical supply item and medication usage. Cost data were then tabulated for each item and each group, respectively. The results indicated that the DOD and VA shared equally in the consumption of expendable medical supply and medication funds in the Emergency Department.


Prodromal signs and precipitating factors in attempted suicide. What characterizes the presuicidal phase of suicide attempters in a military population? And what precipitates their suicidal action? These questions were investigated in a sample of 112 male suicide-attempting conscripts serving in the Norwegian Armed Forces. One-half of the subjects had shown behavioral signs such as isolation or aggression, over 80% displayed psychiatric symptoms. A majority verbally expressed their psychic problems, but few had explicitly stated suicidal ideas. Two major clusters of suicide precipitants were identified. Loss traumas were recorded in one-third of cases, some sort of conflict situation in 40% of cases. Implications for suicide preventive measures are discussed.


Syncope in military formations: a persistent problem. Syncope of personnel standing in ranks during a military ceremony is an all too common occurrence. An episode of syncope can have serious and sometimes long-lasting medical consequences in addition to disrupting the ceremony and causing embarrassment for the individual involved. This article will discuss the pathophysiology and contributing factors, common injuries which can result, immediate on-scene treatment, and recommendations as to how this phenomenon might be prevented.


Seroprevalence of hepatitis A, B, and C in a United States military recruit population. One thousand five hundred thirty-eight U.S. Navy and Marine Corps enlisted recruits were tested for hepatitis A, B, and C serologic markers. The recruit population (mean age, 19 years) was 91% male, 69% white, 17% black, 9% Hispanic, 2% Filipino, and 2% "other" racial/ethnic group. Anti-HAV was found in 129 (8.4%) recruits, anti-HBc in 35 (2.3%), HBsAg in 5 (0.3%), and anti-HCV in 4 (0.3%). For recruits born in the U.S., the prevalence of anti-HAV and anti-HBc was 5.5% and 1.3%, respectively; for the 7% of recruits born outside the U.S., the prevalence was 44.9% and 14.0%, respectively. By logistic regression analysis, seropositivity for hepatitis A and B was independently associated with age, nonwhite racial/ethnic groups, and birth outside of the U.S. This study indicates that there is a relatively low risk of hepatitis A, B, and C infection among Navy and Marine Corps recruits.


Experience with a partnership program for cardiac surgery at a regional military medical center. A Partnership Program between USAF Medical Center, Wright-Patterson (WPAFB) and Miami Valley Hospital (MVH), Dayton, Ohio, was created through CHAMPUS to provide cardiac surgical services for eligible patients. During the first year of this program, 82 patients underwent 89 percutaneous transluminal coronary angioplasty (PTCA) procedures. Sixty-one patients underwent cardiac surgery at WPAFB, 50 were referred to MVH due to ineligibility or other reasons, and five were referred to other military or civilian hospitals. The program has been successful with low morbidity and mortality (3%). Cost savings for PTCAs was $241,853 and for cardiac surgery was $462,046.


An educational report: the mechanics of geriatric assessment in a military community-based family practice residency. Over the past several years, increasing emphasis has been placed on geriatric training in family practice residency programs. Because geriatric assessment is an important educational concept, we elected to start an inpatient geriatric assessment program at our community-based military family practice residency. Our experience is outlined here.


The effect of an increased index of suspicion on the diagnosis of pneumothorax in the critically ill. The impact of specialized training in critical care producing a heightened index of suspicion for the diagnosis of pneumothorax in intensive care unit (ICU) patients was prospectively examined. During a 12-month period, 28 ICU patients were found to have a pneumothorax. Nine of the 28 patients with pneumothorax (32%) were initially misdiagnosed by physicians who neither received specialized training in critical care nor routinely cared for critically ill patients. Six of these nine initially misdiagnosed pneumothoraces (67%) were correctly diagnosed by a physician with specialized training and experience in critical care medicine prior to any clinical deterioration in the condition of the patients. This study suggests that specialized training and experience in the management of critically ill patients can significantly improve upon the diagnosis of pneumothorax in these patients and limit the occurrence of tension pneumothorax in the same patient population.


The content of outpatient family practice care in an Army community hospital: one physician's three-year experience. The purpose of this pilot study was to describe the 3-year experience of ambulatory medical care provided by one family physician in an Army community hospital. Data collected at each outpatient visit included the patient's age, race, gender, problems actively addressed, and procedures. There were 7,895 outpatient visits, representing 3,665 patients and 2,292 families. Of the 13,158 problems recorded, the 10 most frequent were pregnancy care, general medical examination, alcohol and tobacco use, hypertension, depression/anxiety, contraception, otitis media, acute upper respiratory infection, vaginitis, and headache. Further studies should be done to validate this pilot study.


Rapid host nation medical deployment.

Rapid host nation medical deployment. Rapid development of land-based units in Operation Desert Shield/Storm presented critical needs for medical support. Integration of small Navy mobile medical teams in Bahrain and a larger United States Army Hospital unit in Riyadh, Saudi Arabia, at host nation hospitals presented an innovative method of providing this support. The success of these ventures in convenience and quality of care establishes the host nation interaction with military medical professionals as a workable, satisfying, and important adjunct to standard military medical care.


Multi-institutional privileging: a pilot demonstration project of the United States Navy and the Joint Commission on Accreditation of Healthcare Organizations. The U.S. Navy and the Joint Commission on Accreditation of Healthcare Organizations have undertaken a 3-year multi-institutional privileging project. The concept involves granting privileges in one Navy facility that are recognized throughout the system during the staff appointment period. It entails: (1) use of specialty-specific standardized privilege lists, (2) designation of one authority at a time to grant the appointment with privileges, (3) use of a single credentials file during the practitioner's career, and (4) medical staff bylaws applicable to the entire system. The concept is potentially useful in other armed services, the Veterans Administration, and some civilian systems.


Nursing research priorities for the care of the naval hospital patient: a Delphi survey. The purpose of this study was to identify priorities for nursing research in a naval hospital using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program at a regional medical treatment facility. Via a three-round Delphi survey, priority research questions were identified for the nursing department of a naval regional medical treatment facility. A serendipitous result was the identification of nursing research priorities within a deployed naval fleet hospital.


Female health care during Operation Desert Storm: the Eighth Evacuation Hospital experience. Little has been published concerning female soldiers' health care during combat. Therefore, a retrospective review of the Eighth Evacuation Hospital's gynecological records was performed while involved in Operation Desert Shield/Storm. Additionally, a health care survey was distributed to female soldiers. This review revealed that a large part of the hospital's gynecological resources during this conflict were employed treating preventable conditions. These problems could have been avoided if appropriate measures had been taken prior to deployment. It was concluded that all female soldiers should be required to undergo a gynecological health care screen prior to deployments.


Vocal cord dysfunction during wartime.

Vocal cord dysfunction during wartime. Vocal cord dysfunction (VCD) often masquerades as asthma. The diagnosis is rarely suspected, but should be considered in cases of asthma that present atypically or that fail to respond to standard therapy. The frequency of VCD would be expected to increase during times of stress, including periods of war, since it is thought to be a conversion reaction. A high level of suspicion for VCD is essential to make the diagnosis so as to avoid unnecessary, potentially toxic medications and to direct the patient to prompt psychiatric care, which along with speech therapy, is the cornerstone of care.


Gastric Hodgkin's disease: recurrence after autologous bone marrow transplant. Gastric involvement in Hodgkin's disease is rare. A case of gastric Hodgkin's disease occurring after autologous bone marrow transplantation is presented. A retrospective review of 339 cases of Hodgkin's disease in the Tumor Registry at Brooke Army Medical Center revealed six additional cases of documented gastric involvement. These six cases plus the case report are reviewed as well as the available literature on gastric Hodgkin's disease.


Intracerebral hematoma localization and removal using intraoperative ultrasound. Intraoperative ultrasound can be used to localize central nervous system lesions such as hematomas, abscesses, aneurysms, and tumors. High-resolution transducers can differentiate between the echogenic pattern of the normal brain parenchyma and the abnormal pattern of the lesion. When removal of the lesion is necessary, ultrasound can provide an accurate means of localization and immediate evaluation of the surgical site. The following case is presented as an example of the growing use of ultrasound in neurosurgery.


Military operations at moderate altitude: effects on physical performance. The purpose of this study was to examine changes in select anaerobic and aerobic dependent physical performance tasks in U.S. Marines exposured to field operations at moderate altitude. The subjects (N = 16) completed Wingate anaerobic power, submaximal aerobic cycle ergometry, hand grip strength, and push-up tests on three separate occasions. Testing sessions occurred at sea level, at altitude after a 10-day acclimatization period (immediately before field operations), and at altitude immediately after 4.5 days of field operations. Anaerobic power was significantly (p < 0.05) reduced after the field operations at altitude. In contrast, the aerobic cost of doing submaximal exercise was slightly elevated (p < 0.05) after the altitude field operations. No physiologically significant effect was noted for hand grip or push-up results. The findings of this study indicate that field operations at moderate altitude do result in slight, but significant, anaerobic-aerobic performance decrement in U.S. Marines.


Heightened anxiety in Army Reserve nurses anticipating mobilization during Operation Desert Storm. Research was conducted in January 1991 to compare anxiety levels of Army Reserve and civilian registered nurses and to identify factors contributing to high anxiety. It was predicted that anxiety would be greater in reservist nurses who were anticipating mobilization during Operation Desert Storm. This hypothesis was supported through the examination of t test statistical analyses and stepwise multiple regression, which demonstrated that years of military service, gender, and the presence and number of children in nurses' families related to higher anxiety levels. Army Reserve nurses identified separation from loved ones and financial concerns as the largest contributors to anxiety, while significant interventions for alleviating anxiety included detailed and consistent information from Army commands.


Psychiatric hospitalization: treatment or triage? We examined the outcome of active duty psychiatric inpatients (N = 101) 2 years after admission. Most patients were young with minor diagnoses (adjustment disorders), yet only 20% were still on active duty 2 years later. This compared poorly with national retention rates for all lengths of time in service (p < 0.0001). Longer time in service and low severity of diagnosis predicted a better outcome. We discuss implications of these findings.


Tobacco habits, lifestyle, and reactions to smoking restrictions among Norwegian military officers. A 1989 cross-sectional study revealed that Norwegian army and air force officers smoked considerably less than civilian men. The prevalence of smokeless tobacco use, on the other hand, was higher than among civilians and similar to that of conscripted soldiers. Reactions to new smoking restrictions were largely neutral, but smokers were more negative than non-smokers. A majority of the officers reported low compliance with smoking regulations. Smokers generally belonged to the oldest cohorts and had less education, higher alcohol consumption, less physical activity, and more unhealthy dietary habits than the other subjects, whereas snuff use was more common among the youngest and more healthy officers. This indicates that the health hazards of prolonged snuff use are underestimated, and that this habit may gain increased popularity if nothing is done to prevent it. Intervention strategies are suggested.


Comparisons of wartime and peacetime disease and non-battle injury rates aboard ships of the British Royal Navy. Disease and non-battle injury rates were computed for ships of the British Royal Navy which were deployed during wartime and peacetime operations. The wartime sick list admission rates were lower aboard carriers, battleships, and cruisers when compared with their counterparts deployed in peacetime; rate differences for battleships and cruisers were statistically significant (p < 0.05). Several categories of disease also yielded significant differences in the wartime/peacetime contrasts. Infections and parasitic disorders aboard carriers, skin diseases aboard battleships, and skin diseases, injuries, and generative system disorders occurring on cruisers were all lower during wartime than on peacetime deployments. Illness rates also varied by ship type, with the lowest rates evidenced aboard carriers.


Childhood physical and sexual abuse and failure to complete military basic training. Forty percent of a group of 25 military basic trainees discharged from training for mental health reasons admitted histories of childhood physical and/or sexual abuse. In a control group of 25 successful trainees, only 1 gave a history of abuse. Consistent with published studies of childhood abuse in psychiatric patient samples, women in our discharge group were more likely to report abuse histories than men. Perpetrators were usually reported as non-biological male family members of the respective victims. The authors conclude that adult survivors of childhood abuse appear to be less able to tolerate the stresses of military basic training, and discuss the need for identifying and therapeutically assisting these individuals during their training.


Upper respiratory disease in deployed U.S. Navy shipboard personnel. A study was conducted to determine the risk of upper respiratory disease among deployed U.S. Navy shipboard personnel. Between January and June 1989, a Patient Encounter Form was used to collect disease information from 10 U.S. Navy ships. Patients with a diagnosis of upper respiratory infection (URI) on initial sick-call visit were used in this study. Information on time spent in various ports and time at sea for each of the 10 ships was also collected. A classification scheme was developed to permit daily estimates of URI rates and to indicate whether the ship was in port or at sea. Of 967 cases of URI, 64.4% occurred while at sea, with an average daily rate of 0.5/1,000 crew members; 35.4% of the cases occurred while in port, with an average daily rate of 0.4/1,000 crew members. There was an increase in URI rates after 9 days at sea or in port. These data suggest that there are defined periods of increased transmission of upper respiratory infections aboard ships, both at sea and in port.


Color vision testing for the U.S. Naval Academy. Normal color vision is a prerequisite for admission to the United States Naval Academy. The Farnsworth Lantern (FALANT) is the Navy's definitive test for color vision. A FALANT is not available at many locations where candidates are examined, so satisfactory performance on pseudoisochromatic plates has been considered an acceptable alternative. Until recently, the Farnsworth Dichotomous Test Panel D-15 had also been used as an alternative test, but is now considered unacceptable. In the summer of 1991, a large number of candidates reported for induction who were unable to pass the FALANT. Since their screening physical examinations had been reported to show normal color vision, a shadow of doubt was cast upon the ability of the alternative tests to predict performance on the FALANT. Four hundred subjects were then tested on several color vision tests to determine if these tests could predict FALANT success. The results of this study and recommendations are presented.


Training resident surgeons in combat: an experience during the Persian Gulf War. The Persian Gulf War necessitated the activation of many Army Reserve and National Guard physicians, including a number in residency training. No prototype existed for the continued training of resident surgeons in a combat setting. The 159th Mobile Army Surgical Hospital (MASH) deployed in support of the Allied invasion of Iraq. A structured training program for two general surgery residents attached to the 159th MASH was developed and implemented. This program combined supervised operating room experience, perioperative management, morbidity and mortality conferences, and orthopedic grand rounds, all with careful professional documentation. A planned reading program could not be realized, due to the physical setting of wartime. Residents and attending staff interacted positively and the residents were able to continue their formal training as an integral part of the hospital. The model developed by the 159th MASH is a practical method of continuing structured resident training in a combat setting.