Recognition of telegraphy signs at different listening levels and frequencies. The recognition of telegraphy masked by noise at 40 and 80 signs/min telegraphy speed was studied in 10 normal-hearing subjects at different sound pressure levels (25-85 dB SPL in steps of 5 dB) as well as at different test frequencies (2000, 1000, 800, 630, 500 and 250 Hz). The ability to recognize the signs varied with varying SPL. Recognition for most of the subjects was best at an SPL close to 70 dB. All subjects improved their recognition as the frequency was lowered to 500 Hz, some even at 250 Hz. These facts should be taken into consideration when training telegraphy operators as well as in the construction of radio receivers to permit listening at low frequencies. Furthermore, the critical ratio was calculated at the different test frequencies.


Speech perception in noise with BICROS hearing aids. The speech perception in noise abilities of 14 asymmetrically hearing-impaired subjects who had been fitted with Bilateral Contralateral routing of Signal (BICROS) hearing aids was evaluated. Speech tests were administered with subjects wearing both conventional monaural amplification and their own BICROS aids. Test procedures involved the use of sentence lists from the Speech Perception in Noise (SPIN) test and the Synthetic Sentence Identification (SSI) test, presented in a background of recorded four-talker babble. The performance of the subjects was found to be significantly better with the BICROS aids than with monaural amplification alone.


Psychoacoustical performance in children. In order to contribute to knowledge of the elementary auditory functions in infancy, a group of normally hearing children below the age of four years was examined using advanced tests for cochlear (remote masking, brief-tone audiometry, critical ratio) and central auditory functions (masking-level difference). The results showed that both cochlear and central auditory functions were almost the same in three-year-olds as they were in adults, if not better. This behavior is similar to that recorded with electrophysiological methods and leads to the conclusion that at age three years the auditory system has completed its neurofunctional maturation and it is therefore completely efficient in its elementary psychosensorial functions.


Genetic influences on susceptibility of the auditory system to aging and environmental factors. Auditory susceptibility to aging and environmental factors (noise and toluene) was investigated in two genotypes of mice, CBA/Ca (showing a moderate hearing loss with onset late in life) and C57BL/6J (undergoing spontaneous auditory degeneration with onset during young adulthood). Both strains of mice were often used together as a model of human age-related hearing loss, with a primary decline in auditory high-frequency sensitivity. Auditory function was analysed by recording auditory brainstem response (ABR). Morphological alterations of mouse cochleae were studied by light, transmission and scanning electron microscopy. The age-related elevation of ABR thresholds was more precipitous and the individual variability was larger in C57BL mice than that in CBA mice. Degeneration patterns of the organ of Corti were different between the two strains. In the old CBA-mouse cochlea, giant stereocilia on the inner hair cells (IHCs) and elevated pillar heads were evident. Some normal-looking outer hair cells (OHCs) still remained. In C57BL mice, however, early loss of OHCs and extensively damaged stereocilia constituted the primary lesions of the organ of Corti. After exposure to a 2-7 kHz steady noise of 120 dB SPL for 5 min at the age of 1, 2, 3, 6, or 12 (only for CBA) months, compound and permanent threshold shifts (CTS and PTS) at middle frequencies (8-12.5 kHz) reduced with age in CBA mice but remained in C57BL mice. C57BL mice were more severely affected by noise than the age-matched CBA mice. The amount of recovery from CTS to PTS was, however, independent of age and strain. Pathological changes of the organ of Corti were correlated with noise-induced PTS. Possibilities for prediction of susceptible individuals were tested. At 6 months of age, there was only 2% risk of classifying C57BL mice as CBA mice by pre-exposure thresholds at the high frequency (31.5 kHz), but about 40% risk by CTS at the middle frequency (12.5 kHz), or vice versa. With increasing age, the progress of the interaction between noise trauma and aging had two phases for both strains of mice. First an additivity and then, at total threshold shifts of 30-50 dB, a blocking-like interaction were observed. The rate of progression in post-noise hearing loss did not exceed the spontaneous rate of age-related degeneration. The difference between exposed and non-exposed groups decreased with advancing age for both strains of mice.(ABSTRACT TRUNCATED AT 400 WORDS)


Elevated urinary beta-hexosaminidase in patients with stroke. Urinary beta-hexosaminidase is a sensitive indicator of renal damage. The urinary excretion of this enzyme was measured in 31 patients with ischaemic stroke in the acute phase and in 126 patients 21-43 weeks after their stroke. Both immediately and after 21-43 weeks the patients showed a similar and a significantly increased level of urinary beta-hexosaminidase. This indicates the presence of renal injury in the stroke patients, which in turn might reflect a generalized vascular disease.


Quantitative assessment of urinary protein and enzyme excretion--a diagnostic programme for the detection of renal involvement in type I diabetes mellitus. In an effort to establish a reliable programme for the clinical monitoring of renal involvement in patients with type-I diabetes mellitus, we quantified the urinary excretion of immunoglobulin G (IgG), transferrin (Tf), albumin (Alb), alpha 1-microglobulin (alpha 1MG), N-acetyl-beta-D-glucosaminidase (NAG), and total protein in 130 dipstick negative children and young adults with type-I diabetes. Eighty-five sex- and age-matched healthy persons served as a control group for the definition of the upper reference limits (95th centiles; micrograms min-1 1.73 m2): transferrin 1.4; albumin 16.6; total protein 27.1; NAG: 2.0 mU min-1 1.73 m2. Sex-related differences were detected for IgG (men: 3.8; women: 1.7) and alpha 1 MG (men: 6.0; women: 4.0 micrograms min-1 1.73 m2). The urinary excretion of IgG, Tf, alpha 1MG, NAG, and total protein was significantly higher in subjects with diabetes when compared to healthy controls (p < 0.01). Furthermore, 20 patients (15%) showed an elevated excretion of tubular markers (alpha 1MG and NAG), and 3 patients (2%) of at least two glomerular markers (Alb and/or Tf and/or IgG). Additionally, 18 individuals (14%) presented a mixed excretion pattern of both tubular and glomerular markers. These data suggest that the quantitation of both glomerular and tubular proteinuria provides a sensitive and cost-effective instrument for the non-invasive screening for renal involvement in patients with diabetes mellitus.


Abnormal plasma noradrenaline response and exercise induced albuminuria in type 1 (insulin-dependent) diabetes mellitus. Submaximal exercise provokes an abnormal elevation in albuminuria in type 1 (insulin-dependent) diabetes mellitus. Plasma catecholamines might be involved in this phenomenon by a renal vasoconstrictive effect. Twelve healthy subjects (Controls: albuminuria < 10 micrograms min-1), 13 normoalbuminuric type 1 diabetic patients (DNormo: albuminuria < 10 micrograms min-1) and 13 microalbuminuric type 1 diabetic patients (DMicro: albuminuria 10-200 micrograms min-1) performed a fixed bicycle workload (600 kpm for 20 min+urine collection 40 min post exercise). None of the patients suffered from autonomic neuropathy or hypertension. Fractional albumin clearance (FalbCl) rose in DNormo (p = 0.02) and DMicro (p = 0.01) but not in the Controls (p = 0.40). Basal plasma adrenaline and noradrenaline were not different in the three groups. The increments in noradrenaline were more pronounced in DNormo and DMicro than in Control (Controls < DNormo, p < 0.05; Controls < DMicro, p < 0.01). The changes in FalbCl were significantly correlated with the changes in noradrenaline (all subjects r = 0.65, p < 0.001). The increments in adrenaline were not different in the diabetic groups compared to the controls, and were not related to the changes in FalbCl. Multiple regression analysis showed that changes in plasma noradrenaline (p < 0.002) and in mean arterial pressure (p < 0.005) independently contributed to the changes in FalbCl (multiple r = 0.73). It is concluded that the exercise-induced plasma noradrenaline response is increased in normo- and microalbuminuric type-1 diabetic patients. Noradrenaline appears to contribute in the exercise-induced changes in renal protein handling, possibly by its effect on renal haemodynamics.


Microcalorimetric studies on uraemic plasma. The heat production by human plasma in healthy and uraemic subjects has been measured by direct isothermal microcalorimetry. The plasma from uraemic subjects displayed an increased heat production compared to that of normal plasma. The heat production by plasma from healthy subjects, but not by that from uraemic patients, was both proportional to the amount of thiol groups in the plasma and also to the oxidation of the thiol groups. The oxygen consumption of uraemic plasma was proportional to the heat production. The heat production by samples from uraemic patients was significantly correlated to the plasma concentration of creatinine, whereas no such correlation was found between the concentration of urea and heat production of such samples.


Prostanoids and thromboxane production by renal brush border membrane. It has been estimated that proximal tubule are responsible for about 7.5% of total kidney prostaglandin PGE2 production. In the present report we investigated the production of prostanoids and thromboxane by rabbit renal proximal tubule brush border membrane. PGF2 alpha was the major endogenous prostaglandin produced under basal condition. The addition of exogenous arachidonic acid increased only PGE2 production. No PGE2 production was found when vesicles were incubated with indomethacin or at 4 degrees C, suggesting the involvement of the PGH2 synthase and PGE2 isomerase enzymes. Addition of angiotensin II at 10(-6) and 10(-9) mol l-1 did not affect the endogenous PGE2 production by brush border membrane. Thus, results of our study demonstrates that the renal proximal tubule brush border membrane has the capacity to produce prostanoids and thromboxane.


Renal haemodynamics and tubular sodium handling following volume expansion with sodium chloride (NaCl) and glucose in healthy humans. Renal haemodynamics estimated using inulin- and para-aminohippuric acid-(PAH) clearances and segmental tubular handling of sodium as estimated using lithium clearance where studied in fourteen healthy men. Volume expansion was induced by a 2 h (25 ml kg-1) infusion of 0.9% sodium chloride (NaCl) load. Eight of the 14 subjects were rechallenged with a 2 h infusion of 5% glucose (25 ml kg-1). In addition, ten healthy subjects were investigated with inulin and PAH-clearances during water diuresis. When NaCl was infused glomerular filtration rate (GFR) decreased from 115 to 103 ml min-1 (p < 0.002) and fractional sodium excretion increased by 85%. The fall in GFR could be due to tubuloglomerular feedback as a result of inhibition of proximal tubular sodium reabsorption. The fall in GFR raises doubt about the usefulness of NaCl as an inert control infusion in metabolic studies. During glucose infusion blood glucose rose from 4.3 to 10.9 mmol l-1 with no significant change in GFR, but fractional sodium excretion was reduced by almost 40%. The etiology of the acute antinatriuretic effect of volume expansion with glucose infusion in healthy humans is not known but a blunted decrease in plasma renin activity and erythrocyte volume fraction in conjunction with a failure to mobilize renal dopamine and an increase in plasma levels of antinatriuretic factors such as insulin and norepinephrine are all factors that may contribute to the antinatriuretic effect of a glucose infusion.


Semi-quantitative measurement of myoglobinuria in trauma patients with a latex-agglutination test (Rapi-Tex). A semi-quantitative test (Rapi-Tex) for myoglobinuria was tested in trauma patients. All test results were evaluated blindly. Test specimens were obtained from 20 patients consecutively admitted with severe multiple trauma (Injury Severity Score: 29; range 26-41). The myoglobin concentration was measured semi-quantitatively by Rapi-Tex of three independent observers and quantitatively by enzyme-immuno-assay (EIA). Undiluted as well as 1:2, 1:6, 1:11, and 1:22 diluted samples were used. Test readings were done after 3 min and 5 min, respectively. The Rapi-Tex test classified the myoglobin concentrations correctly in 92.8% of the readings after 3 min and in 87.5% (mean, range: 85.5-91.6%) of the readings after 5 min. Rapi-Tex enables immediate bedside diagnosis of myoglobinuria in trauma patients. The test should be performed on both undiluted and 1:6 diluted urine samples with test reading after 5 min.


Contents of apolipoprotein A-I, A-II and B of the human serum fractions for high-density and low-density lipoproteins prepared by common precipitation methods. Two common precipitation methods for the determination of HDL-cholesterol in human serum were used, dextran sulphate/MgCl2 and phosphowolframate/MgCl2. They yield supernatants which contained almost all of the apoA-I and apoA-II lipoproteins but no lipoprotein apoB. The correlations between chol-HDL and apoA-I were about the same with these methods (r = 0.79 and 0.80). The correlation between the precipitation methods and ultracentrifugal analysis for chol-HDL was highly significant (r = > 0.95). Correspondingly, two common precipitation methods for the determination of LDL-cholesterol in human serum, buffered heparin, and polyvinyl sulphate procedures, produced sediments, which contained the major proportion of the apoB and only small amounts of apoA-I and apoA-II. However, yields of only 69.0-80.2% were obtained for apoB from the sediments and of 85.8-89.4% from supernatants calculated as the difference from chylomicron free serum. This difference might be due to alterations of the molecular structure of apoB by the precipitation reagents. Comparison of the results with the precipitation methods to those using the Friedewald formula showed excellent agreements (r = > 0.91). Very comparable results were also obtained in the case of marked hypertriglyceridaemia provided that the serum samples were briefly centrifuged before analysis of chol, chol-HDL, and triglyceride values for the formula of chol-LDL. The precipitation methods for chol-LDL showed very good agreement with the values obtained by ultracentrifugal analysis (r = > 0.93). There were no remarkable differences in the correlation of apoB and chol-LDL values measured by different methods (r = 0.85). According to the present results it was found that highly significant correlations existed between chol/chol-HDL or chol-LDL/chol-HDL and apoB/apoA-I ratios (p < 0.001). It is quite evident that apoB and apoA-I values could be used to replace chol-LDL and chol-HDL values when the risk for the cardiovascular diseases is to be assessed.


Blood glycated haemoglobin, serum fructosamine, serum glycated albumin and serum glycated total protein as measures of glycaemia in diabetes mellitus. Blood glycated haemoglobin (HbAlc), serum fructosamine (FA), serum glycated albumin (GA), and serum glycated total protein (GTP) were determined in 61 subjects (19 pregnant women with gestational diabetes, 24 pregnant women with insulin-dependent diabetes mellitus [IDDM] and 18 nonpregnant subjects with IDDM). FA, GA, and GTP correlated with HbAlc similarly (r = 0.791, 0.816, and 0.794, respectively, p < 0.001). In a subgroup of 22 subjects data on blood glucose home monitoring was recorded and used for calculating mean blood glucose as an index of average glycaemia preceding sampling of the glycation products. Mean blood glucose levels preceding sampling of HbAlc by 2 months and FA, GA, or GTP by three weeks correlated significantly with HbAlc (r = 0.668, p < 0.001) and GA (r = 0.441, p < 0.05) whereas no significant correlation was found between mean blood glucose and FA (r = 0.003) or GTP (r = 0.252). In conclusion, such methods which measure specifically the non-enzymatic glycation of a single species of protein (i.e. FPLC for HbAlc and affinity chromatography for GA) are to be preferred for assessing glycaemia.


Selective increase in the urinary excretion of protein 1 (Clara cell protein) and other low molecular weight proteins during normal pregnancy. The effect of normal pregnancy on the tubular transport of proteins has been studied by measuring four low molecular weight (Mr) proteins in the urine of pregnant women: protein 1 (a recently discovered urinary protein identical to Clara cell protein), beta 2-microglobulin, retinol-binding protein and alpha 1-microglobulin. The urinary excretion of albumin and beta-N-acetylglucosaminidase was also determined. One hundred and fourteen women with uncomplicated pregnancy were examined: 22 in the first trimester, 42 in the second and 50 in the third trimester. They were compared to 40 age-matched non-pregnant women. The urinary excretion of the four low Mr proteins was significantly increased during the second and third trimester of pregnancy. During the last trimester, the mean relative increases in the urinary excretion of these proteins ranged from 2.8 to 15.6 and prevalences of elevated values from 25 to 46%. This rise in low Mr urinary protein excretion was particularly important in some pregnant women, representing (e.g. for protein 1) more than a 100-fold increase above normal. The urinary excretion of beta-N-acetyl-D-glucosaminidase was also increased during pregnancy but the albuminuria remained stable. These changes in low Mr urinary proteins were reversible after delivery and most likely resulted from a transient decrease in the reabsorptive capacity of the proximal tubule associated with an increase of the filtered load. However, some women excreted high amounts of protein 1 which could not be accounted for by a decreased tubular reabsorption and which might originate from a secretion by the urogenital tract.


Comparison of near-infrared light spectroscopy, bioelectrical impedance and tritiated water techniques for the measurement of fat-free mass in humans. Fat-free mass (FFM) was measured with three different methods: near-infrared spectroscopy, bioelectrical impedance and tritiated water technique, in 76 (39 females/37 males) subjects (age 47 +/- 2 [SEM] years, BMI 26.8 +/- 0.6 kg m-2). From bioelectrical impedance measurements FFM was calculated with manufacturers formula and a formula developed by Deurenberg et al [1]. FFM estimated from tritiated water technique (51.9 +/- 1.1 kg) was significantly lower than measured with near-infrared spectroscopy (57.4 +/- 1.4 kg; p < 0.001) and bioelectrical impedance calculated with manufacturers formula (59.6 +/- 1.5 kg; p < 0.001), but did not differ from the estimation made according to Deurenberg (52.1 +/- 1.2 kg). All the methods were highly intercorrelated, although the correlation coefficients were lower in the obese than lean subjects. Obesity seems to influence the bioimpedance method more than the near-infrared spectroscopy method. The results demonstrate that the near-infrared spectroscopy and the bioelectrical impedance method are simple and reproducible techniques to estimate fat-free mass in normal weight man. Both measurements are based partly on the anthropometric measurements. However, it is necessary to use an adjusted formula to obtain reliable measures of fat-free mass with the bioimpedance method in obese subjects.


Macrolides and the immune system.

Macrolides and the immune system. Macrolides achieve much greater in vivo and clinical efficacy than might be expected from standard in vitro testing. There is accumulating evidence to suggest that macrolides act synergistically with the host immune system. In contrast to beta-lactams, macrolides have increased activity in serum. Phagocytes are a key component of the host immune system against intracellular pathogens. Antibiotics can alter bacterial susceptibility to both uptake and intracellular phagocytic killing. Macrolides appear to enhance phagocyte killing of bacteria whereas beta-lactams have a limited or negative effect. Both macrolides and quinolones achieve high intraphagocytic concentrations that are associated with intracellular antibacterial activity. Azithromycin, which is chemically related to the macrolides, achieves particularly high intracellular levels within phagocytes which may be associated with enhanced synergistic activity.


Future trends in antibiotic therapy.

Future trends in antibiotic therapy. The 1990s will probably see fewer new antibiotics being registered than occurred during the 1970s and 1980s. The main reason for this is the excessive costs involved in the development of a new chemical entity. It is probable that more fluoroquinolones will be introduced and some of them will have improved antibacterial activities compared to current derivatives. Another class of antibiotics likely to develop during the next decade is the macrolides, with the emergence of drugs like azithromycin. Among the beta-lactams, new carbapenems and extended spectrum cephalosporins will be developed to meet the problems of increasing numbers of enterobacteria producing class I beta-lactamases, as well as the new broad-spectrum TEM enzymes. These resistance mechanisms against beta-lactams are also likely to give rise to a new era for beta-lactamase inhibitors. A field which presently looks less promising is that of drugs which are active against methicillin-resistant staphylococci; teicoplanin and daptomycin seem to have only minor advantages over vancomycin. Other developments that can be expected are those facilitating the administration of antibiotics, especially once-daily injectable antibiotics for intensive home care.


Antibiotic prescribing practices and patient compliance in the community. Appropriate prescribing of antibiotics should take into account the most likely causal pathogens and severity of the illness. Few laboratory diagnostic aids in community medicine have been available to the clinician. The development of databases on the epidemiology of infectious diseases defining the most probable causal organisms and their sensitivity patterns, and recently developed bedside diagnostics, will provide a level of diagnostic certainty to community medicine. In addition, it should be recognized that the prescribing habits of a community physician are, to some extent perhaps, influenced by patient expectation and belief systems within the medical profession. Patient compliance with antibiotic regimens is poor in the community and this problem has become increasingly relevant as more patients are discharged early from hospital while still on medication. Non-compliance with medication is associated with the negative interaction of four factors: 1. the patient, 2. the physician, 3. the severity of the disease, and 4. therapy (frequency and duration). Careful counselling of the patient by the physician and educational information about therapy are some of the methods successfully employed to improve compliance. Decreasing the frequency and duration of dosing have also improved compliance. The added convenience of new short-course, once-daily therapies such as with azithromycin are expected to improve patient compliance and overall clinical outcome.


[Computer tomography of the brain in children. II]. The second part of the study "Computerized tomography of the brain in children" is a continuation of the first one published in Supplement for the Collection of Scientific Works by Charles University's Medical Faculty in Hradec Králové from 1990. The former is issued from analyzing 1283 pathological CT findings investigated in newborns and children up to 15 years of age. The present study is concerned with not only the precise diagnosis of the lesion site but also with the type diagnosis and observation of further development of either affected or operated on children brain. When investigating ventriculomegalies, altogether with critical approach to the CT possibilities in diagnosing various types of hydrocephaluses and atrophies, which have been the most frequent pathological findings in this set, the authors also proceeded by monitoring reparative capacities of the brain tissue or post-surgery drainage complications. The problems of children CT investigation are similar to those in adults as far as the brain abscesses, empyemas and non-bacterial encephalities are concerned. A possibility of repeated examinations is of importance in selecting therapeutical approaches and observing their effect. A considerable amount of viral inflammations and the toxoplasmosis appear to be specific for children's age with yet intrauterine course of several of them. They result in severs cerebral damage, hydrocephalus and atrophy with frequent both periventricular and parenchyma calcifications. The acute meningitis did not show unambiguously positive CT findings, though they are frequent to result in mainly the obstructive or hyporesorptive types of hydrocephalus as well as atrophic changes. Only the 8 per cent of post-inflammatory intracranial patients showed normal time-delayed CT finding. From neurocutaneous syndromes, those most frequently occurring were cerebral manifestations of tuberous sclerosis. Apart from periventricular calcifications within the hamartomatous node, the three patients showed large pseudotumorous formations responsible of the deformity of lateral ventricles. In the frame of neurofibromatosis, the authors diagnosed the stenosis of aqueducts, conditioned with adjacent gliosis, and the dysplasia of the base of medial cranial fossa which caused the temporal lobe to prolapse into the fossa subtemporalis and the orbit. The exceptional finding in this set of patients was that of angioreticuloma within the ponto-cerebellar angle in a 10 year-old boy. According to literature, this type of hamartoma does not occur in children of prepubertal age. In 37 children of our set, the extra- or intraparenchymal cavities were diagnosed. Those most frequently occurring were arachnoidal cysts at the pole of temporal lobe as well as porencephalic intraparenchymal cysts.(ABSTRACT TRUNCATED AT 400 WORDS)


[Visual evoked potentials. Their use in ophthalmology and other specialties]. The technique of investigating evoked visual potentials (EVP) is resumed within the context of electrophysiological methods as applied in optic neuritis. Several typical courses of the disease are case-reported in this account. In conclusion, authors recommend further on EVP implications due to its objectivity, non-invasiveness and time-sparing with a possible automated evaluation.


[Coronary endarterectomy in the surgical treatment of ischemic heart disease (review)]. The problems are overviewed with performing revascularization of the coronary bed when in diffuse affliction. The unique way how to revascularize a progressive atherosclerotic disorder of the coronary bed consists in elimination of a degenerated portion of the coronary vessel which is endarterectomy (EAE). This method is specially important in ischemic myocardium supplied with so disordered coronary. The EAE of the coronaries is of routine use with some extended working sites. However, they are not rare to take this method with some objections. These are due to a higher risk in performing surgery and scepticism upon the long term patency of the endarterectomized artery. Because of a polymorph character of atherosclerotic process, one should hardly mention some randomized studies able to prove both inconvenience and advantages of the method. Nevertheless, the large sets are known to exist at present which document the benefit of the EAE method from the scope of both immediate and long term results. This method is only efficient under the condition of a perfect technical skill as well as peculiar and total EAE completion. Besides the known "gas EAE" and "manual EAE" techniques, the authors present a new EAE approach developed by their own using the solution which is injected under tension into the separation layer. The EAE method appeared to be valuable on multiple cardio-surgical centres when correctly indicated and performed including the instantaneous recognition and correction of imminent complications. The authors' experience is in accord with the above conditions.


Evaluation of long-term functional status in first-ever stroke patients in a defined population. Medical, social and ADL variables were registered within 48 hours of stroke onset and 6 and 12 months later in 346 first-ever stroke patients. One year after stroke onset 27% of the patients were dead. 78% of the surviving patients were living in their own homes, 10.6% in old people's homes with no medical facilities and 9.5% in nursing homes. A health index was used for ADL evaluation and the quality of life was estimated according to Nottingham Health Profile (NHP). 16% of the patients had domestic social service assistance before stroke onset. The help given by relatives and friends far exceeded that given by the society before as well as after stroke onset. Right hemispheric stroke patients had a worse outcome than left-sided with respect to ADL and life satisfaction.


Psychosocial assessment after traumatic brain injury. Psychosocial outcome has been difficult to define, but nevertheless widely reported. More recent studies have demonstrated not only that the long term emotional costs of head injury are enormous for survivor and family members, but the functional consequences in terms of changes in family life, recreational and vocational activities, are great and prolonged. These consequences have more recently become the focus of rehabilitation, with studies demonstrating dramatic improvements in many aspects of productive living, and consequent lifetime cost savings of an enormous amount. The psychosocial deficits matter, they can be the focus of treatment, and the treatment can be successful and cost effective.


Traumatic brain injury crisis intervention and family therapy--management and outcome. Brain Injury Treatment and Research Group. This article presents a model for crisis intervention and family therapy after traumatic brain injury. Our program, firmly rooted in object-relations theory and transactional analysis, included patients and family members (significant others) living within 100 miles from the University Hospital of Umeå. The effects of the interventions were gauged at one and two years after the trauma are presented in terms of agreement/disagreement between the patient and the significant other concerning inter- and intrapersonal relationships as well as through a short case presentation. As a conclusion of our study a point is made to expand the scope of intervention to include also other segments of the social network of the patient.


Late psychosocial outcome in severe traumatic brain injury. Preliminary results of a third follow-up study after 20 years. More than 20 years after severe head injury the preliminary results of the present study indicate that the very late psychosocial outcome differed much in the individual subjects. The most decisive negative factors were severely disturbed behaviour and lack of insight. Improvement many years after injury was, however, possible. During the years the relationship between parent(s) and severely head injured sons often became strained. After the first posttraumatic year or two the patient with severe behavioural deficits must be helped to adopt some other type of living.


Subacute brain injury rehabilitation: a program description and a study of staff program evaluation. The concept of continuity of care is introduced and briefly discussed. Three aspects of subacute rehabilitation of patients with Traumatic Brain Injury (TBI) are discussed: the need for differentiated treatment programs, for team integration and emphasis on environmental or milieu factors to accomplish treatment success. The so called Wing Team Model at the TBI Unit at Sunnaas Rehabilitation Hospital is described. In our program the patients are divided in three groups: the North Wing Program, for slow to recover patients, the East Wing program for patients with severe sequelae after TBI and the South Wing Program for ambulatory patients mainly with cognitive sequelae. A questionnaire study of how staff members evaluate certain aspects of the program is presented. The study indicates that the staff members have in general a positive attitude towards the treatment model, but they wish an improved team coordination of the individual programs.


Outpatient management and outcome in relation to work in traumatic brain injury patients. This paper reports on a holistic psychosocial rehabilitation program for post-acute brain-injury patients. Methods and rationale are described and follow-up data are reported on a group of patients with regard to return to employment or educational programs. The results generally give grounds for optimism concerning the effectiveness of psychosocial rehabilitation.


Preliminary findings in a study of age, linguistic evolution and quality of life in recovery from aphasia. Age has been reported as both a decisive and weak variable in recovery from aphasia. A middle aged group of aphasic subjects (50-64) are compared with an older group (65-80) on linguistic task performance, functional communication and quality of life measures administered at 3, 6, 9, and 12 months post stroke. Preliminary findings do not suggest any age based recovery discrepancies for middle aged versus older aphasic subjects on these measures in the first post stroke year. An hierarchical pattern of severity across aphasia type emerged, with fluent aphasic subjects being the least and global aphasia subjects the most impaired both at the beginning and end of the first post stroke year. There appear to be differences in the schedule of improvement on different measures, which remain to be confirmed in the final analysis of the data.


Assessment of aphasia in relation to communication and cognitive impairments among stroke patients. Methods for assessing language impairments differ from those needed for communication problems. The article presents results from three previously published studies by the author and co-workers. It is concluded that information about the impairment and training in compensation should be offered the spouse as well as speech therapy to the patient in order to improve reduced communication due to aphasia. Measures of neuropsychological impairments, communication skills and awareness of deficits should be included as well as tests of linguistic competency if a comprehensive aphasia assessment is sought. The methods described are shown to validly differentiate between aphasic subtypes and neuropsychological syndromes.


Aphasia and its relation to language and thinking. Finding alternative ways for communication. A pictorial computerized communication aid for aphasic patients, PicBox, (12) has been developed by a group in Sweden. During the technical and clinical work with the PicBox program we have had the reason and possibility to reflect on the relation between aphasia, language and thinking. From linguistic and neuropsychological research it has been claimed that in aphasia there is often a general cognitive impairment. Preliminary results from three patients' use of PicBox show that aphasic disturbances can, to some extent, be compensated for by pictorial communication, thus indicating an underlying cognitive competence. There are, however, also data indicating a deeper disturbance leading to an inability to fully use alternatives for spoken or written language.


Assessment of stroke.

Assessment of stroke. Assessment involves firstly identification that a problem exists, and secondly quantification. It is needed for both routine purposes and research. The research purposes--assessment tool--should be valid, reliable, repeatable and sensitive. It is also important that the assessment should be comprehensive--not missing out essential elements. In clinical practice, the use of Check-list may be helpful. In research, formal assessment procedures are required. The precise assessment tools to be used will depend very much on the research question being asked.


Evaluating outcome in stroke rehabilitation (quality control and clinical audit). Audit may require information on case-mix, the resources available, the processes undertaken and the outcome. The most important are the first and last. Measures of case-mix relate to severity and prognosis. Measures of outcome relate to disability. Good measures exist. The difficulties are to agree on measures, to collect data routinely and reliably, and to act on the results.


Evaluating young children's cognitive capacities through computer versus hand drawings. Young normal and handicapped children, aged 3 to 6 years, were taught to draw a scene of a house, garden and a sky with a computer drawing program that uses icons and is operated by a mouse. The drawings were rated by a team of experts on a 7-category scale. The children's computer- and hand-produced drawings were compared with one another and with results on cognitive, visual and fine motor tests. The computer drawing program made it possible for the children to accurately draw closed shapes, to get instant feedback on the adequacy of the drawing, and to make corrections with ease. It was hypothesized that these features would compensate for the young children's limitations in such cognitive skills, as memory, concentration, planning and accomplishment, as well as their weak motor skills. In addition, it was hypothesized that traditional cognitive ratings of hand drawings may underestimate young children's intellectual ability, because drawing by hand demands motor skills and memory, concentration and planning skills that are more developed than that actually shown by young children. To test the latter hypothesis, the children completed a training program in using a computer to make drawings. The results show that cognitive processes such as planning, analysis and synthesis can be investigated by means of a computer drawing program in a way not possible using traditional pencil and paper drawings. It can be said that the method used here made it possible to measure cognitive abilities "under the floor" of what is ordinarily possible by means of traditionally hand drawings.


Irrelevant speech and serial recall: implications for theories of attention and working memory. Irrelevant speech markedly impairs serial recall of visually presented lists, even though the person is asked to ignore the speech. In this, the first major review of the phenomenon, we conclude that (i) the effect occurs in memory rather than at encoding; (ii) within memory, the disruption occurs as a result of a confluence of information at the phonological rather than at the articulatory stage of coding; (iii) speech does not have privileged access to memory, since its disruptive effects may be attenuated by habituation; and (iv) disruption occurs as a result of the changing state of the auditory channel, not as had previously been thought the phonological similarity of visual and auditory streams, and is particularly sensitive to pitch changes in both speech and non-speech stimuli. These conclusions are discussed in the light of two complementary theoretical constructs: a cascading filter system responsible for the access of speech to memory and a system of coding within memory sensitive to changing state of the stream responsible for disruption of serial order. Recommendations are made also for empirical work to refine these constructs.


Linear versus normalized T scores as standardized neuropsychological test scores. In this paper we present and discuss standardized T score systems for neuropsychological test data. Both linear and normalized T scores were calculated for 141 normal subjects and a group of 141 patients with diffuse or focal brain damage. Many standard neuropsychological tests have skewed raw score and linear T score distributions, and we argue that normalized T scores have practical advantages because they permit simple descriptions of both patient groups and individual test score distributions. We also argue that skewness can be partially explained by ceiling effects and other test construction artefacts and that skewed raw score distributions do not necessarily reflect skewed distributions of the underlying mental abilities. Consequently, use of normalized T scores seems appropriate in many research and clinical contexts.


Hemispheric asymmetry effects in children studied by dichotic listening and visual half-field testing. Dichotic listening (DL) and visual half-field (VHF) testing were used to study hemisphere asymmetry in a developmental perspective. Five-, 8-, and 11-year-old children were presented lists of fused words using a DL technique in Experiment 1, and 8- and 11-year-old children were presented pictures of common objects using a VHF technique in Experiment 2. In both experiments, measures of identification, free recall, and recognition of the words/pictures were employed. The results revealed effects of ear input (right-ear advantage) and half-field presentation (right visual half-field advantage) for all age groups, although the magnitude of this lateralization effect differed between the three memory measures. The results are discussed in relation to developmental aspects of language laterality, and in relation to the clinical utility of non-invasive lateralization techniques.


On sensation, perception and thought: a reply to Rönnberg. A traditional partition of cognitive phenomena into sensation, perception and thought is reintroduced in response to recent arguments (Rönnberg, 1990) for conditions that must be met in order to distinguish between perception and cognition. The suggested division seems grossly compatible with Rönnberg's basic aim and receives support from several different lines of inquiry, including single cell recordings in the brain, neuropsychology, computational studies of vision and experimental psychology.


What is the optimal dose and duration of treatment with etoposide? I. Maximum tolerated duration of daily treatment with 50, 75, and 100 mg of oral etoposide. Because etoposide is a cell-cycle phase-specific drug, its degree of cytotoxicity likely relies on duration of cell exposure to a specific concentration. We investigated the maximum tolerated duration of oral etoposide treatment at doses of 100, 75, and 50 mg/d in previously treated patients with biopsy-proven, advanced cancer. "Maximum tolerated" was defined as tumor progression or hematologic toxicity (World Health Organization [WHO] grade > or = 2). The maximum tolerated duration in 19 patients given 100 mg/d was > or = 21 days, since this was the predetermined cutoff point; 3 patients discontinued etoposide because of early tumor progression, and 6 others had developed leukopenia or thrombocytopenia (WHO grade > 2) by day 21. The maximum tolerated duration in 13 patients given 75 mg/d was a median of 11 weeks (range, 2 to 19); 6 patients developed tumor progression and 6 others leukopenia (WHO grade > or = 2) requiring discontinuation of treatment. Ten patients given 50 mg/d tolerated therapy for a median of 13 weeks (range, 3 to 26 weeks); treatment was halted in seven patients because of tumor progression, two because of leukopenia (WHO grade > or = 2), and one because of stomatitis. The data from this study and others suggest that above a certain minimal plasma level, etoposide induces concentration-dependent cumulative toxicity. What remains to be determined is the minimal plasma level per tumor type. It will also be interesting to see whether myelopoiesis, thrombocytopoiesis, and erythropoiesis have differential sensitivity to etoposide, since thrombocytopenia did not occur using daily etoposide doses of 50 and 75 mg, whereas at the same doses 10 of 23 patients required erythrocyte transfusion.


Chronic etoposide schedules in the treatment of non-Hodgkin's lymphoma. The importance of schedule in the cytotoxic efficacy of etoposide is supported by an increasing amount of clinical data. We studied the efficacy of oral etoposide (50 mg/m2/d x 21 repeated every 28 to 35 days) in the treatment of refractory lymphoma. Twenty-five patients were treated; all had received previous chemotherapy and were considered incurable. Fifteen patients (60%) had partial responses, including five of nine patients who had received previous intravenous etoposide. Median response duration was 8 months in patients with low-grade lymphoma and 3 months in those with intermediate- or high-grade lymphoma. Two patients responded to chronic oral etoposide immediately after disease progression with intravenous etoposide-containing regimens, demonstrating the improved efficacy of the chronic schedule. Single-agent oral etoposide, administered at 50 mg/m2/d for 21 days, provides an effective and convenient treatment option for patients with indolent lymphoma. Incorporation of this schedule into combination regimens for aggressive lymphoma is currently under investigation. In addition, we are exploring schedule modifications that may further decrease toxicity while maintaining efficacy.


Exploring the use of chronic low-dose oral etoposide in ovarian cancer: is there a role for this "new drug" in the management of platinum-refractory disease? Despite showing high objective response rates (70% to 80%) to cisplatin- or carboplatin-based chemotherapy, most patients with ovarian cancer ultimately die of complications of their disease. Etoposide, given either as a single agent or in combination with the organoplatinum compounds, has produced disappointingly low response rates in the salvage setting. Based on recent data that suggest chronic administration of oral etoposide is superior to single daily dosing every 3 to 4 weeks, and the failure of previous trials to evaluate etoposide's activity in cisplatin-resistant malignancies, we have begun a phase II trial of chronic, low-dose oral etoposide in patients with clinically defined, platinum-resistant ovarian cancer. Thus far, 11 patients have been entered into the study. Neutropenia, the most prevalent toxicity, has precluded several patients from receiving the full 20-day course of 50 mg/d. No responses to treatment have been observed in nine evaluable patients. The study continues to accrue patients. The final results of this study and other trials should help determine the efficacy of chronic low-dose oral etoposide administration in patients with ovarian cancer.


Evaluation of oral etoposide in patients with metastatic gastric carcinoma: a preliminary report. In an ongoing trial of oral etoposide in patients with advanced, measurable, previously untreated gastric carcinoma, 18 patients have been registered. The starting dose is 50 mg/m2/d given for 21 days, followed by a rest period of 7 days. Courses are repeated every 28 days. Among 16 evaluable patients, it is too early for response evaluation in two patients and three others have achieved a partial response. Responses have occurred in liver, lymph node, and lung metastases. Tolerance to therapy has been acceptable, with mild granulocytopenia being the most prominent toxicity. The study continues to accrue patients. Our preliminary data suggest that oral etoposide is active against gastric carcinoma. Future studies combining oral etoposide with other active agents would be of interest.


Etoposide in the treatment of hormone-refractory advanced carcinoma of the prostate. The leading cause of cancer in males in the United States, prostate cancer accounts for 22% of all new cancers, with 132,000 new cases projected to be diagnosed in 1992. While localized prostate cancer can be cured, up to two thirds of patients present with advanced disease. Androgen deprivation remains the mainstay of treatment for advanced prostate carcinoma. Recurrent disease, however, is invariably refractory to further hormone manipulations. The development of hormone-resistant tumor cells may be explained either by a multi-clones theory, by mutation of previously sensitive tumor cell clones, or, most likely, by both mechanisms. Thus, vigorous efforts are needed to develop nonendocrine treatment approaches. Such efforts have been complicated by the difficulty of assessing therapeutic response in patients with prostate cancer, because the typical metastatic bone lesions seen in these patients are difficult to measure accurately and patients seldom have disease in the lung, lymph nodes, or soft tissue. A variety of single chemotherapeutic agents have been tested against recurrent disease, with widely divergent response rates achieved. Trials of chemohormonal therapy have likewise proved disappointing to date. Preliminary results from an ongoing trial of oral etoposide in patients with recurrent prostate cancer are discussed.


Reimbursement for oral anticancer drugs. Current policies regarding reimbursement for oral anticancer drugs are discussed. Several legislative options that might expand such coverage are reviewed.


Etoposide: seeking the best dose and schedule. Etoposide is an important antineoplastic drug. Despite the use of several combination chemotherapy regimens that include etoposide, the best dose and schedule for etoposide remains unknown. The schedule dependency for small cell lung cancer is now known, and it is likely the same for other sensitive neoplasms (ie, lymphoma, germ cell tumors). Recent data suggest that even a more extended schedule of administration (ie, 14 to 21 days) may be more effective than the standard 3- to 5-day schedule. Several studies have assessed plasma levels in reference to dose, schedule, and tumor responsiveness. Preliminary data suggest that high peak levels (ie, > 5 to 10 micrograms/mL) are associated with more severe myelosuppression than lower peak plasma levels (ie, 1 to 3 micrograms/mL). Response rates and survival in small cell lung cancer patients given low daily doses for 14 to 21 days are comparable with results achieved with standard doses given for 3 to 5 days. Preliminary data from several studies suggest that administering low doses for a prolonged schedule is a superior method of etoposide administration. Other studies including randomized comparisons are necessary to confirm these observations.


What is the optimal dose and duration of treatment with etoposide? II. Comparative pharmacokinetic study of three schedules: 1 x 100 mg, 2 x 50 mg, and 4 x 25 mg of oral etoposide daily for 21 days. The large interpatient and intrapatient pharmacokinetic variability of oral etoposide is well known. We investigated whether dose fractionation would result in less variability. Fifteen patients (five in each etoposide schedule) were given either 100 mg once daily, 50 mg twice daily, or 25 mg four times daily for 21 days. On days 1, 8, and 15 blood samples were collected during 24 hours to measure plasma etoposide levels. Hematologic toxicity was determined by weekly leukocyte and platelet counts and expressed as the relative decrease in these parameters. Once-daily administration of etoposide 100 mg correlated with a significantly higher peak concentration than was observed with the other two schedules. The mean area under the concentration versus time curve (AUC) and mean time with a plasma etoposide concentration above 1 microgram/mL were similar with the three schedules. Peak plasma concentrations, AUCs, and times with plasma concentration above 1 micrograms/mL correlated significantly with the relative decrease in leukocyte but not platelet counts. Large interpatient and intrapatient variability of pharmacokinetic parameters was observed with all three schedules. These data do not support fractionating a daily 100-mg etoposide dose. Moreover, it does not appear useful to adjust oral etoposide doses based on pharmacokinetic data obtained once during a prolonged treatment period. Finally, adjusting oral etoposide doses based on hematologic toxicity seems advisable to decrease the interpatient variability of etoposide's pharmacokinetics.


Clotest (rapid urease test) in the diagnosis of Helicobacter pylori infection. Over a period of 3 months, 85 patients who underwent gastroscopy had antral biopsy taken for Clotest, histology and/or culture for Helicobacter pylori (HP). The sensitivity and specificity of Clotest were found to be 77% and 96% respectively with negative predictive value of 63% and positive predictive value of 98%. Ninety-two percent of the positive Clotests were positive within 20 minutes, thus giving rapid result. Therefore, Clotest is a rapid, sensitive and highly specific test for HP infection. A high correlation between HP infection and chronic gastritis was noted and the prevalence of HP infection in patients with duodenal ulcer (90%) was higher than that of gastric ulcer (64%) or non-ulcer group (65%).


Evaluation of therapies in the treatment of Helicobacter pylori associated non-ulcer dyspepsia. This randomised double blind placebo controlled study evaluated the effectiveness of colloidal bismuth subcitrate (CBS), ampicillin and their combination in the treatment of Helicobacter Pylori in non-ulcer dyspepsia (NUD) and assessed if elimination of this organism is associated with improvement of gastritis and the symptoms. Forty-eight NUD patients with H. pylori and histologic gastritis were randomly allocated to one of the three regimens for 28 days. Symptoms were assessed before and after treatment. Forty-three patients completed the trial. Repeat endoscopy within 48 hours of completing treatment showed suppression of H. pylori in 6 of 7 patients (85.7%) on combined therapy and one of 8 patients (12.5%) on CBS therapy (p = 0.0205). There was no suppression of the bacteria in patients treated with ampicillin. Repeat endoscopy performed 2 weeks after completing treatment showed suppression of H. pylori in 3 of 7 patients (42.9%) on combined therapy and none in the other two groups. Patients on combined therapy who had suppression of H. pylori, 48 hours or 2 weeks after completing treatment were noted to have historical improvement of their gastritis (p = 0.0001 and p = 0.05 respectively). This was also associated with improvement of symptoms in these patients.


Evoked response study among Malaysian multiple sclerosis patients. A study of visual evoked potential (VEP), brainstem evoked potential (BAEP) and median nerve somatosensory evoked potential (SSEP) in 26 Malaysian patients with clinically definite Multiple Sclerosis (MS). This study showed an overall high rate of abnormality, with 85% of patients for VEP, 31% for BAEP and 65% for median nerve SSEP. The rate of abnormality was particularly high for patients who were symptomatic, reaching 100% of patients for VEP, 50% of patients in BAEP, 83% of nerves for median nerve SSEP. The rate of abnormality among those who were asymptomatic was lower, varying from 32% of eyes in VEP, 27% of patients in BAEP and 31% of nerves in median nerve SSEP. Three out of 10 patients with optic spinal form of MS have abnormal BAEP. These show the usefulness of the evoked potential studies in confirming the clinical lesions as well as demonstrating subclinical involvement. The rate of abnormal evoked responses for the asymptomatic patients in this study is generally lower than that published elsewhere.


A computerised out-patient medical records programme based on the Summary Time-Oriented Record (STOR) System. Advances in microcomputer hardware and software technology have made computerised outpatient medical records practical. We have developed a programme based on the Summary Time-Oriented Record (STOR) system which complements existing paper-based record keeping. The elements of the Problem Oriented Medical Record (POMR) System are displayed in two windows within one screen, namely, the SOAP (Subjective information, Objective information, Assessments and Plans) elements in the Reason For Encounter (RFE) window and the problem list with outcomes in the Problem List (PL) window. Context sensitive child windows display details of plans of management in the RFE window and clinical notes in the PL window. The benefits of such innovations to clinical decision making and practice based research and its medico-legal implications are discussed.


The prevalence of isolated unconjugated hyperbilirubinaemia (Gilbert's syndrome) in subjects attending a health screening programme in Singapore. We retrospectively studied the prevalence of hyperbilirubinaemia in 1,296 consecutive subjects attending a hospital health screening programme over an eighteen-month period. Sixty-four subjects (5%) had elevated bilirubin levels. Forty-one subjects (3.2%) had isolated unconjugated hyperbilirubinaemia. These subjects probably had Gilbert's syndrome. Recognition of this common benign condition is important to avoid unnecessary investigations.


Choices and preferences in asthma management. We conducted a questionnaire survey of the management of asthma among doctors in Singapore to determine the trend and range of prescribing habits. Standardised questionnaires were sent to 3,153 medical practitioners registered with the Singapore Medical Council. The overall response rate was 25.3% (797 out of 3,153 doctors). The data were grouped and analysed according to one of 4 respondent-defined groups: (1) non-specialist general practitioners (NS-GP); (2) non-specialists (house officers, medical officers and specialist-in-training) who worked in MOH hospitals (NSMOH); (3) chest specialists; (4) non-respiratory specialists. Patients tended to underestimate the severity of their disease. Inhaled or nebulised beta-agonist was the treatment of choice for acute severe asthma in adults and children for all 4 groups of respondents. In the maintenance treatment for chronic asthma, inhaled and oral beta-agonists and oral theophylline were the mainstay of treatment for adults and children. Nocturnal asthma was similarly treated. The use of inhaled steroids was variably conservative and was reserved for situations where bronchodilators proved inadequate.


Resuscitation of the small baby--is there a limit? Innovations in perinatal care in the last decade, in particular delivery room resuscitations and advanced technologies have probably contributed greatly to improved survival of the small newborns. As a result, progressively smaller and less mature infants are being resuscitated; but some survive with severe neurodevelopmental handicap. There should be guidelines about the lower limits of viability below which no resuscitation should be done. It is the view of many that resuscitation of critically ill small babies should be initiated at birth. Further management will be decided depending on the baby's progress and response. Clinicians have to look into the question of withdrawal of life support in small babies who survive with impairment and chronic illnesses.


Streptococcal pharyngitis in a primary care clinic. A study to determine the sensitivity and specificity of the Directogen Group A Streptococcal Test was carried out in a primary care clinic in University Hospital, Kuala Lumpur. The study also looked at the prevalence of streptococcal pharyngitis in the clinic. We found that the rapid test has a sensitivity of 90.9% and a specificity of 90.7%. Viral pharyngitis is the commonest form (63%) of pharyngitis followed by Group A Beta haemolytic streptococcal pharyngitis (14.2%). The presence of exudates, tonsillar enlargement and the presence of tender cervical lymph nodes have a significantly higher association with streptococcal pharyngitis.


Inguinal bubo: problems in diagnosis.

Inguinal bubo: problems in diagnosis. Two of the four patients with tropical venereal diseases underwent incision and drainage of the inguinal bubo resulting in discharging sinus before they were referred to the Skin Clinic. Clinical diagnosis was made in all four but could not be confirmed. With appropriate therapy resolution was achieved without complications. The difficulties in arriving at and establishing the diagnosis are discussed.


Sphenoid mucocele: detection and surgery by intranasal endoscopy. Sphenoid sinus mucoceles are uncommon and difficult to diagnose clinically owing to the inaccessibility of the sphenoid sinus to clinical examination. A case of infected sphenoid mucocele in which the patient complained of chronic sore throat and in which routine intranasal endoscopy contributed significantly to the diagnosis is presented. The pathology of mucocele and endoscopic sinus surgery as the treatment for sphenoid sinus mucocele is discussed.


Ranitidine and sodium citrate as prophylaxis against acid aspiration syndrome in obstetric patients undergoing caesarean section. The efficacy of a single oral dose of 0.3M of sodium citrate alone as a prophylaxis against acid aspiration syndrome in obstetric patients undergoing LSCS (elective and emergency) was compared with that of intravenous ranitidine. One group of patients was given 30 ml of 0.3M sodium citrate orally just before the induction of anaesthesia while the other group was given 50mg of ranitidine intravenously together with the 30ml of 0.3M sodium citrate. This was done for both the elective and the emergency groups of patients. There was no significant difference in the mean pH of the gastric aspirate obtained from those given sodium citrate alone and those given sodium citrate and ranitidine in either the elective or the emergency group. However, in the emergency group, those who were given sodium citrate alone tend to have a larger volume of gastric aspiration when compared with those given ranitidine together with the sodium citrate. There were significantly more patients with gastric aspirates of more than 25ml in the emergency group to which sodium citrate alone was given. It would appear that supplementing an intravenous dose of ranitidine with the oral dose of sodium citrate is useful in emergency LSCS as a prophylaxis against acid aspiration syndrome.


Comminuted intra-articular fracture of the distal radius--results of early open reduction and internal fixation. Comminuted intra-articular fracture of the distal radius remains a challenging problem. This article reviews the results of 15 consecutive cases which were treated with open reduction and internal fixation with T-plate after failing to achieve articular congruency with closed reduction. The follow-up ranges from 20 months to 28 months. In thirteen cases, articular congruency was restored. However, 4 of these 13 cases later lost some of the articular congruency. This suggests the need for supplementary bone grafting. Reduction of the extra-articular portion of distal radius was generally well maintained. There was an average of 2.4 mm loss in styloid height, an increase of 1.2 mm in ulnar variance and loss of 12.5 degrees of volar tilt. Seven patients (46%) were completely pain-free, with the remaining 8 patients (53%) experiencing mild pain associated with forceful activities involving the wrist. All patients achieved a functional range of motion. Grip strength averaged 81% of the uninjured side. Of the 12 patients who were engaged in active employment, 10 returned to their previous job within 4 months of injury (average 8.5 weeks). The only complication in this series was the development of reflex sympathetic dystrophy in a 68-year-old housewife. We recommend open reduction and internal fixation if closed reduction fails to achieve articular congruency in comminuted distal radius fractures.


Submucous resection for deviated nasal septum: a critical appraisal. Submucous resection (SMR) for the deviated nasal septum had been criticised to have a higher complication rate and less patient satisfaction than septoplasty. Seventy-five patients who underwent SMR were studied and followed up at 6 months to 56 months post-operatively. The rates of short and long term complications were relatively low: septal haematoma 1.3%, nasal infection 1.3%, epistaxis 2.6%, external nasal deformity 9.3% and septal perforation 2.7%. While most patients achieved short term relief of nasal obstruction (93.4%), about 30% had persistent/recurrent nasal obstruction on long term follow-up. Similar rates had been quoted for the operation of septoplasty. We postulated that this was due to unfavourable airflow patterns as a result of minor residual septal deviation. Some patients had associated pre-operative symptoms of snoring (57.3%), headache (48.0%), rhinorrhoea (38.7%), sneezing (30.7%), hyposmia (30.7%) and epistaxis (21.3%). Frequencies of cure/improvement of these symptoms after SMR were 34.9%, 33.3%, 24.1%, 30.4%, 60.9% and 43.8% respectively. The overall post-operative long term (average 23.5 months) satisfaction rate was almost 70%. SMR, being relatively easy to perform, and having similar complication and patient satisfaction rates as septoplasty, should be retained in the surgical armamentarium for the deviated nasal septum.


Percutaneous transluminal coronary angioplasty in acute cardiogenic shock: an overview of the current strategy with a case illustration. Cardiogenic shock from severe left ventricular dysfunction remains the most common cause of death in patients with acute myocardial infarction despite the advent of inotropic agents and intra-aortic balloon support. Lytic agents have not convincingly reduced mortality when administered in a shock scenario. Recently, observational studies have demonstrated survival benefit when mechanical revascularisation, particularly balloon angioplasty, is performed early in such patients. In this article, we report a case of an extensive anterior myocardial infarction with cardiogenic shock who underwent successful acute balloon angioplasty and prolonged intracoronary thrombolysis and use it to illustrate the current evolving interventional approach in the treatment of such a complex clinical syndrome.


The mental diseases hospital, Singapore (the first 100 years)--a short history (Part III). This article (in four parts) traces the history of the first four Mental Hospitals built in Singapore, which were occupied in 1840, 1861, 1887 and 1928. The management of the patients is described; also their lives and deaths. Mention is also made of the doctors and others who looked after them.


Treatment strategies in rheumatoid arthritis. Intervention therapies in rheumatoid arthritis (RA) are directed at the immune dysregulation and chronic inflammatory events in the joint. An ideal therapeutic program would rapidly control inflammation, prevent joint damage and preserve function. The various strategies of treatment involve the use of disease-modifying anti-rheumatic agents (DMARDs) either singly or in combination. Gold salts, penicillamine, sulphasalazine, methotrexate and hydroxychloroquine are used when NSAIDs fail to control inflammation. RA not only decreases the functional disability but the life-span of patients. The traditional pyramid strategy which uses single DMARDs consecutively has been found to be inadequate and slow in suppressing joint inflammation. Hence the race to find treatment regimes and strategies that will favourably alter the outcome of RA patients. Both the "step-down bridge" approach and saw-tooth strategy have been advocated in the attempt to break the progression of joint disease. None of the known regimes can be said to be most beneficial and least toxic.


Helping patients to think better: cognitive therapy for individuals and couples. A system of psychotherapy called cognitive therapy, emphasising that mood disorders are affected by distortions in thinking about self, the future and the world, has been found useful in the treatment of diverse neurotic disorders. Helping the patient restructure his thinking by examining such distortions and correcting them would be a vital process in the prevention or recovery of mood disturbances. Applications of cognitive therapy in depression, panic disorder, hypochondriasis and marital distress are described in this article.


Treatment of neurotic disorders.

Treatment of neurotic disorders. Neurotic disorders are commonly encountered in psychiatric outpatient clinics. Treatment of the commoner conditions like the anxiety states, depressive, obsessive-compulsive, hypochondrical and phobic neuroses will be described. This includes general supportive measures, pharmacological, cognitive, behavioural and psychodynamic approaches.


An unusual injury to the mediastinum--case report. A six-year-old boy sustained an accidental penetrating missile injury to his chest. Imaging studies revealed a metallic foreign body lodged between the pulmonary infundibulum and the right atrium of the heart. No cardiovascular compromise was produced. Surgical exploration was not required. The foreign body remained stable and non-migratory over a 16-month follow-up period.


Renal angiomyolipoma--a case report.

Renal angiomyolipoma--a case report. Renal angiomyolipoma is a benign tumour of the kidney which is often mistaken for a renal cell carcinoma resulting in an unnecessary nephrectomy. It can be diagnosed preoperatively and managed conservatively without surgery. Large symptomatic renal angiomyolipomas can often be treated by renal-sparing surgery. We report a case of a large renal angiomyolipoma diagnosed preoperatively and excised completely with preservation of the kidney.


The prevalence of schizophrenia in relatives of schizophrenic patients. This study examines the prevalence of schizophrenia in 871 first-degree relatives of schizophrenic probands (N = 121) and 658 first-degree relatives of age-matched controls. The controls (N = 126) were medical inpatients referred for psychiatric opinion in a general hospital. Diagnoses in the probands fulfilled the ICD criteria for schizophrenic psychoses. Information on the relatives were obtained from enquiry of the family history and the hospital case records. The prevalence of schizophrenia in first-degree relatives of schizophrenic probands was 22 times that of the medical controls (6.8% versus 0.3%) (p < 0.05). The result supports the observation that schizophrenia is a familial disorder.


Clinical trials of mefloquine with tetracycline. A comparative trial of the combination of mefloquine or MSP with tetracycline was carried out in fifty-one adult Thai male patients with acute falciparum malaria. The patients were randomized to receive either the combination of tetracycline (250 mg qid for 7 days) with mefloquine 4 tablets (1,000 mg) or with MSP 4 tablets (one tablet contains 250 mg mefloquine, 500 mg sulfadoxine and 25 mg pyrimethamine). Fifty patients had a complete 28-day follow-up period. Both regimens produced similar efficacy with no difference in adverse effects. In the mefloquine plus tetracycline group, the cure rate was 72% (18/25). One patient had an RIII response, the others showed initial response to the treatment with FCT and PCT of 40.7 +/- 27.4 and 76.2 +/- 34.2 hours (mean +/- SD) respectively. However, 6 patients developed recrudescence between days 17 and 29 (RI), 3 of these had vomiting. In the MSP plus tetracycline group, the cure rate was 76% (19/25). The means (+/- SD) of FCT and PCT were 44.7 +/- 38.0 and 80.6 +/- 25.0 hours, respectively. Six patients had recrudescence between days 17 and 31 (RI), 2 of these had vomiting. Although the addition of tetracycline improved the cure rate of mefloquine when compared with standard dose of mefloquine alone (3 tablets), these combinations seem to be useful in areas where alternative drugs are not available.


Malariometric survey in Keoudom District, Laos: sensitivity of Plasmodium falciparum to anti-malarials and automedication with chloroquine. A malariometric survey was conducted in the Keoudom District, in the northern part of Vientiane Province, Laos, where an artificial dam-lake on the Nam River is located. The parasite rate of the whole cohort representing 1,105 subjects was 2.44% with the predominance of Plasmodium vivax (70%), while P. falciparum represented 30% with the average parasite density index 3. The low spleen rate (2.3%) characterized the study area as a hypoendemic zone. IFAT antibodies were examined in 419 subjects. The seropositivity of 195 persons < 15 years was 13.7% while in > 15 year old subjects seropositivity was 61.6% with a low GMRT in both groups (140:148). Automedication with aminoquinoline was assayed by urinary analysis in 125 outpatients. Of these, 36 (28.8%) were positive, 89 (71.2%) negative. The frequency of positive blood films for P. falciparum was higher in subjects with aminoquinoline in the urine (36.1%) than in those without (10.1%). Chloroquine sensitivity assay of 15 strains of P. falciparum displayed resistance in 39.3%.


Decrease of malaria morbidity with community participation in central Java. Malaria is still a problem in Java-Bali, although the Malaria Eradication Program started in the 1950's. In the First National Five Year Development Plan it was changed to the Malaria Control Program with the aim to reduce the morbidity and mortality rates through surveillance and spraying interventions using the primary health care approach. In 1984 in Central Java there were malaria areas with an average annual parasite incidence (API) between 1 and 7.5 promille covering about six million population, nearly one third of the population of Central Java. In this study an intervention alternative was carried out with weekly chloroquine prophylaxis to children below 10 years of age in 3 malaria areas of central Java, namely the villages Bedono Kluwung and Kalikutes in Purworejo Regency and Pablengan in Karang Anyar Regency. Health education about malaria with a learning module was conducted by key persons as an element of community participation. The activities of the key persons increased the ongoing surveillance. After one and a half years intervention (July 1985-February 1987) the spleen rates, parasite rates and fever cases dropped to nearly zero in the three study villages. From the results of this study it was recommended that in a malaria risk area with an API of more than 1 promille, intervention with collective chloroquine protection to children below 10 years of age could reduce the API to 1 promille or less. This intervention should be carried out if there is an increase of cases in the area to prevent small outbreaks.(ABSTRACT TRUNCATED AT 250 WORDS)


Behavior of people with respect to malaria in endemic areas with different levels of malaria transmission. The present survey was carried out in two villages of the same malaria endemicity but different levels of transmission in Lamae District, Chumphon Province, southern Thailand with the aim to study whether behavior of people to malaria was similar or not. The total populations in low (village 11) and high (village 13) transmission areas were surveyed twice during low (February 1990) and high (June 1990) transmission periods. All subjects were interviewed by trained interviewers using a structured interview form. Among 410 and 614 people in villages 11 and 13, respectively, it was revealed that during the low transmission period behavior related to chemoprophylaxis and use of bed nets was similar in both villages, whereas risk behavior of night work was significantly higher in village 11 than village 13. This was likely due to their different principal occupations: farming of rubber plantation in village 11 and of coffee plantation in village 13. Concerning pattern of seeking malaria treatment, the malaria clinic and the district hospital were the common places attended by people in both villages. During the second survey in high transmission period, a cohort of 277 in village 11 and 430 in village 13 were available for follow up to study changes in their behavior between low and high transmission seasons. There were significant decrements related to night work and significant increments related to bed net use in both villages.


Molecular cloning of Plasmodium falciparum blood stage antigens and application of the recombinant proteins in serodiagnosis. A Plasmodium falciparum genomic DNA library was established in the expression vector lambda gt11, cloned in Escherichia coli. The library was screened with human hyperimmune sera by in situ hybridization. Twenty clones expressing P. falciparum sequences as polypeptides fused to beta-galactosidase were identified. One, CD3A/9025/60, reacted with all immune sera and expressed polypeptides that were larger than beta-galactosidase as well as reacting with antibodies to beta-galactosidase and to P. falciparum. When the fusion proteins were used as target antigens to diagnose malaria antibodies, a result was obtained which correlated well with indirect fluorescence assay.


Practical uses of acridine orange fluorescence microscopy of centrifuged blood (QBC Malaria Test) and the QBCII Hematology System in patients attending malaria clinics in Thailand. We evaluated the detection of malaria parasites using acridine orange fluorescence microscopy of centrifuged blood (AOFM/CB or "QBC Malaria Test") at two government malaria clinics in rural Thailand. In a subgroup of the patients, a QBC Hematology System for the determination of complete blood counts was also utilized. A Giemsa-stained thick smear (GTS) reading of 100 (1,000x) microscopic fields was used as standard. The AOFM/CB sensitivities were 97% overall and 95% for P. falciparum (Pf). Sensitivity was lower for P. vivax (Pv) (76%). Pv sensitivity depended largely on ameboid form density. A threshold for AOFM/CB to consistently detect Pv ameboid forms was estimated to be 10/100 WBC (700/microliters blood). AOFM/CB was capable of detecting Pf gametocytes and schizonts more frequently than GTS. The total Pf rings per microliter blood estimated from GTS was highly correlated with the number of Pf rings per Paralens microscopic field (PMF) suggesting that AOFM/CB could be used quantitatively. From a technical standpoint, the rural tropical settings of Thailand in this study were not an obstacle to the use of QBC Hematology. The system was found to be useful in conjunction with AOFM/CB. However, in patients heavily infected with Pf gametocytes of Pv ameboid forms, their total WBC and lymphocyte counts needed to be appropriately corrected. Overall, AOFM/CB appears to be a promising tool for field diagnosis of malaria if it is affordable to developing countries.


Control study of oral rehydration solution (ORS)/ORS + dioctahedral smectite in hospitalized Thai infants with acute secretory diarrhea. Dioctahedral smectite, a non systemic antidiarrheal agent, is mucoprotective and absorbs enterotoxins and rotavirus as demonstrated in animal models. Smectite has been successfully used in various countries in children and adults with acute diarrhea. This study was to assess the efficiency of smectite associated with rehydration in infants with acute secretory diarrhea. Sixty-two hospitalized Thai infants, aged 1-24 months, with acute secretory diarrhea were randomly divided into 2 groups receiving (1) oral rehydration solution (ORS) (30 cases), (2) ORS and Smectite (3.6 g/day) (32 cases). Both groups were comparable for age, weight, nutritional status and duration of symptoms before treatment. All 62 infants received lactose free formula and chicken rice soup as the standard diet. Stool frequency, weight change and duration of diarrhea were recorded. The mean duration of diarrhea was 84.7 +/- 48.5 hours in group 1, and 43.3 +/- 25.1 hours in group 2 (p = 0.005). The number of infants with diarrhea was significantly lower in group 2 on Day 1 (p < 0.01) and Day 3 (p = 0.001); furthermore 27% of infants in group 1 and 3% in group 2 had still diarrhea on Day 5. The stool frequency and weight changes were not statistically different in the two groups. No major side effects were observed except two cases of vomiting and hardened stools. It is concluded that (1) Smectite shortens the course of acute secretory diarrhea in Thai infants; (2) smectite may reduce the occurrence of prolonged diarrhea; furthermore (3) in our study dioctahedral smectite was found to be safe in children aged 1 to 24 months.


Assessment of the effectiveness of oral rehydration therapy against severe diarrheal dehydration. A hospital based case-control study for assessing the effectiveness of oral rehydration therapy (ORT) preparation against severe dehydration due to diarrhea was conducted at the Infectious Diseases Hospital, Jakarta, Indonesia. A total of 202 children aged 24 months or less who attending the hospital were suffering from acute watery diarrhea were recruited in the study. Those who were severely dehydrated as assessed by WHO criteria were accounted as cases; those who were non-severely dehydrated were accounted as controls. There were 59 cases and 143 controls. A questionnaire was used to interview all study subjects' mothers about ORT usage and various risk factors. Mothers who used ORT were asked to show how they prepared either oral rehydration solution (ORS) or sugar salt solution (SSS). Effectiveness of ORT against severe diarrheal dehydration was based on the formula for assessment of vaccine efficacy by using the odds ratio (OR). With the use of the logistic regression method, an adjusted OR was obtained after controlling various confounders. The effectiveness of ORT against severe diarrheal dehydration was 72.1% for proper ORT preparation and was decreased to 63.2% when ORT was improperly prepared.


Rice-powder salt solution in the treatment of acute diarrhea in young children. Dehydration is the most common cause of death in diarrheal patients. Early oral rehydration therapy (ORT) can prevent or reverse dehydration from diarrhea in almost almost all cases. Shortages of oral rehydration salt (ORS) packets in certain areas remain a major problem of the Diarrheal Diseases Control Program of Thailand. To find an effective solution that can be prepared locally, a randomized trial of oral rehydration solutions was conducted. A rice-powder salt solution containing rice-power 30 g/l and salt 3.5 g/l (RPSS) was evaluated in a group (n = 23) of infants and young children aged between 4 months and 5 years with mild or moderate dehydration from acute watery diarrhea, and the results were compared with those who received WHO recommended glucose electrolyte solution (WHO-ORS) (n = 21), and glycine supplemented WHO-ORS (G-ORS) (n = 20). The efficacies of WHO ORS and G-ORS were found to be similar. The RPSS was found to be more effective than WHO-ORS and G-ORS as shown by a significantly lower stool frequency, lower rate of stool output, a significantly shorter duration of diarrhea, and a smaller intake of rehydration fluid. Promotion of the effective rice-salt solution could increase early implementation of ORT in many rural communities.


Intestinal capillariasis: a cause of chronic diarrhea and hypoalbuminemia. Seventeen cases of intestinal capillariasis in Srinagarind Hospital, Khon Kaen University, Thailand were reviewed. The mean age was 40.41 years with a range from 21 to 69 years. Most cases had intermittent or continuous voluminous watery diarrhea for one month to three years with hypoalbuminemia. Borborygmi, vague abdominal pain, weight loss and pedal edema were significant associated symptoms. Fecal examination was the most useful for diagnosis by finding the Capillaria philippinensis ova in all cases. Mebendazole 400 mg per day for 20 to 28 days is the treatment of choice. Usually, relapse and death are unusual, inadequate treatment is a major factor.


An intervention model for breast feeding in Maharat Nakhon Ratchasima Hospital. To promote breast feeding and/or prevent further decline of adverse infant feeding practices, we developed an integrated comprehensive breast feeding promotion program, and implemented it in Maharat Nakhon Ratchasima Hospital in 1987. The program provided sound knowledge and attitudes toward breast feeding to all mothers at the Antenatal Care Unit, delivery room, the Postnatal Care Unit, and the Outpatient Department. The program activities included early bonding, assistance with initiation of breast feeding, rooming-in, provision of a breast feeding corner in the special care unit, collecting breast milk for sick babies, a lactation clinic and home visits. The impact of the program was evaluated in 1992. Altogether 1,428 mothers were interviewed using structured questionnaires. The results were highly encouraging. A majority of the mothers were of low socioeconomic status, 60 percent of them worked outside the home, and 40 percent were housewives. Compared with baseline data reported in 1986, breast feeding in infants aged 0 to one month increased from 85 to 90 percent, and the practice in the nine- to 12-month old group increased from 39 to 47 percent. However, the acute drop of the practice from 90 percent at birth to 50 percent at the one- to two-month old stage observed was similar in the two studies. The main reasons given by mothers for prematurely stopping breast feeding were the mothers' working outside the home (46%), and insufficient milk (23%). Provision of breast feeding education, along with improved maternal nutrition, extension of maternity leave, and availability of nurseries at the work place, may sustain a longer period of breast feeding.


Detection of filarial antigen using antibodies raised against Wuchereria bancrofti microfilarial SDS soluble antigen. Polyclonal antibodies raised in mouse ascitic fluid against Wuchereria bancrofti microfilarial antigens (Wb Mf SDS S Ag) were studied for their diagnostic use in bancroftian filariasis using a dip stick, enzyme-linked immunosorbent assay. In sandwich ELISA, 100% of microfilaremic sera (30 out of 30) 53% of acute filarial sera (7/13), 40% of subacute filarial sera (6 out of 15), 13% of chronic filarial sera (2/15) and 20% of endemic area normal sera (3/15) showed the presence of filarial antigen. Determination of filarial antigen titer in microfilaremic sera showed an apparent positive correlation between microfilarial density and antigen titer. The antibody raised against Wb Mf SDS S Ag was found to be cross reactive with phosphorylcholine epitopes. The filarial antigen detected by anti Wb Mf SDS S Ag antibodies in sandwich ELISA is possibly associated with the active stage (microfilaremia) of infection.


Determination of insecticide susceptibility in Culex quinquefasciatus Say adults by rapid enzyme microassays. Rapid enzyme microassays for the detection of resistance due to organophosphate and carbamate in individual field-collected strains of Culex quinquefasciatus adults were conducted. These tests allowed accurate differentiation by eye, on the basis of color changes of susceptible and resistant individuals. Two separate tests were conducted for the biochemical assays. In the insensitive acetylcholinesterase (AChE) test, acetylthiocholine iodide (ACTH) and 5,5-dithiobis-(2-nitrobenzoic acid) (DTNB) were used as substrate and coupling agent respectively. The resulting yellow chromophore indicated AChE activity. Test results showed that the color intensity decreased as increasing concentrations of propoxur were added, thereby confirming the susceptibility of the enzyme to inhibitor. Assay of non-specific esterase however, indicated elevated levels which were correlated with degree of malathion resistance. Electrophoretic data revealed the presence of 2 esterase bands in all strains. It was concluded that such a pattern was not contributory to malathion resistance in adults.


Evaluation of EMD vaporizers and bioallethrin vaporizing mats against mosquito vectors. Different Electric-Mat-Device (EMD) vaporizers and bioallethrin impregnated mats were evaluated for the knockdown and mortality in the adults of Culex quinquefasciatus, Anopheles stephensi and Aedes aegypti. Percentage knockdown of 80-100 was recorded throughout the test period of 11 hours. However, the percentage mortality observed was not appreciable in all types of EMD vaporizers. Device "A" was found to be effective only against Ae. aegypti. Devices "C" and "D" showed moderate effects against An. stephensi and Ae. aegypti. Only device "B" was found to give appreciable mortality in all three vector mosquito species compared to other devices which may be attributed to the uniform release rate (2 mg/hour) of bioallethrin.


Anopheline mosquitos of northwest coastal Malaysia. Collections of adult anopheline mosquitos were made from a cow-baited trap in nine coastal villages located along nearly 160km of northwest peninsular Malaysia. Two collections, separated by 1.5 to 6 months, were made at each site. Nearly 6,000 anophelines of 19 species were collected. The dominant species were Anopheles peditaeniatus. An. sinensis, An. subpictus and An. lesteri paraliae. Small numbers of the malaria vectors An. maculatus (at one site) and An. campestris (at four sites) were collected, but no An. sundaicus were recorded.


Identification of bloodmeals of phlebotomine sandflies using the agarose gel diffusion method. The source of blood meal of wild caught Phlebotomid sandflies collected in areas around Pondicherry was identified using an agarose gel diffusion method. A total of 497 blood samples obtained from freshly engorged Phlebotomid sandflies were tested. Of these 66.8% were positive to human antisera, 29.2% to bovine antisera and the remaining 4.0% to avain antisera. The human blood indices of P. papatasi and P. argentipes were 0.91 and 0.04, respectively.


Seroprevalence of Toxocara canis antibodies among Orang Asli (aborigines) in Peninsular Malaysia. An enzyme-linked immunosorbent assay using excretory-secretory antigens of the second stage larvae maintained in vitro was used to determine the seroprevalence of Toxocara antibodies in Orang Asli (aborigines) of Peninsular Malaysia. The mean + 3 SD optical density of 30 healthy subjects was used as the cut-off point. Overall prevalence was found to be 31.9%. No significant relationship was found between positive rates with sex and age groups, though children between 0 to 9 years recorded the highest positive rates. Eosinophil counts were found to be closely related to the proportion of positivity to toxocaral infection and mean optical densities. There was some degree of cross-reaction with Trichuris trichuria positive sera.


Risk factors for severe measles.

Risk factors for severe measles. A retrospective study on measles was carried out in 522 children admitted to the Department of Pediatrics, Sumber Waras Hospital, Jakarta during the period of January 1982-December 1986. Most of the subjects (91.1%) came from lower socio-economic levels, living in unfavorable environmental conditions in crowded housing. The predominant age group was 2-5 years; complications were observed in 82.6% and mortality in 10.3%. The most common complications and cause of deaths were bronchopneumonia (94.4%), encephalopathy (88.9%) and diarrhea (25.9%) or combinations thereof. The outcome of measles infections is determined by the presence of malnutrition and complications which is influenced by the nutritional intake, exposure, susceptibility and constitution of the patients. The household characteristics (socio-economic, socio-cultural and health facilities available) influence the above mentioned interactions through intermediate variables of nutrition (feeding pattern, food supplements), constitution, age) and treatment. Research and intervention on measles can be designed and planned based on this model of interactions.


Hantaanvirus among urban rats from a slum area in Bangkok. A total of 106 rodents sera from slum Wat Phai Ton and slum Klong Toey were examined by immunofluorescent antibody assay during May to August 1990. The positive sera were further tested by plaque reduction neutralization test with the prototype hantaanvirus and the rat-associated hantaan like virus. Isolation attempts were also performed from their tissues. Antibody-positive rats were found in both slum areas, 32.7% in slum Wat Phai Ton and 5.6% in slum Klong Toey. Rattus norvegicus was the major species found positive. Positive plaque reduction neutralization results indicated that the infecting virus was antigenically similar to the strain of rat-associated hantaanvirus. The presence of low titer antibodies (IFA titer 32 to 128) may be an obstacle to isolation of associated virus using tissue culture.


Intracranial complications of chronic suppurative otitis media. Twenty-nine patients with chronic suppurative otitis media with intracranial complications are reviewed. The complications occurred predominantly in young patients with a mean age of 17 years. The most common complication was brain abscess (n = 20). The others were meningitis (n = 3), subdural abscess (n = 3), perisinus abscess (n = 2) and otitic intracranial hypertension (n = 1). The common pathogens were Gram-negative bacilli, especially Proteus and anaerobic organisms, respectively. The mortality rate was 7%.


Clinical evaluation of fleroxacin in the treatment of bone and joint infections. The objective of this open label, non-comparative study was to evaluate the efficacy and safety of fleroxacin 400mg administered orally once daily to patients with acute osteomyelitis and/or acute septic arthritis. Nineteen patients (10 males and 9 females) were evaluable for the analysis of clinical efficacy and safety. Of these, 7 (36.8%) had osteomyelitis and 12 (63.2%) had septic arthritis. Bacteriological cures were reported in 6 of 7 patients (85.7%) with osteomyelitis and in 8 of 11 patients (72.7%) with septic arthritis. The median duration of treatment for the clinical cures in osteomyelitis and septic arthritis were 29.5 days and 46 days respectively. The eradication rate for the most common pathogens, Salmonella enteritidis and Staphylococcus aureus were 77.7% and 80.0%, respectively. The clinical response was cure in 4 of 7 patients (57.1%) evaluable for osteomyelitis, and in 9 of 12 patients (75.0%) evaluable for septic arthritis at the three-month follow-up after treatment. Adverse reactions were minimal. It is concluded that fleroxacin appears to be an effective and safe in the treatment of acute osteomyelitis and acute septic arthritis.


Characteristics of Pasteurella multocida isolated from humans, swine and poultry in Thailand. Pasteurella multocida is a pathogen of animals and humans. Most of the patients have been associated with animals but many cases had not contacted them. The failure to diagnose P. multocida infections is mostly due to misidentification on gram stained smears and inadequate laboratory identification techniques. In order to compile detailed characteristics of the organism we studied the physical and biochemical properties of 70 isolates of P. multocida - 17 human, 23 swine and 30 poultry. All isolates produced catalase, oxydase, indol, nitrate reduction and ornithine decarboxylase. They failed to produce urease, gelatinase, methyl red, acetoin and could not grow on MacConkey agar, SS-agar, in nutrient broth with 0% or 6% NaCl. With respect to fermentable sugars, all isolates consistantly produced acid from glucose, mannitol and mannose. None of the cultures fermented lactose, maltose and dulcitol. Marked variations in the patterns of fermentation of arabinose and xylose were found. The characteristics tested are important to facilitate identification of P. multocida but could not be used to differentiate the host of the bacterium.


Smoking cessation interventions by family physicians in Texas. A survey of 1,292 family physicians in Texas indicates that most of them (99%) ask patients about their smoking behavior. Fewer physicians, however, participate in further activities recommended by the National Cancer Institute: arranging follow-up visits, providing self-help materials, prescribing nicotine gum, engaging patients in discussion, referring patients to a program for smoking cessation, and involving other office personnel in counseling. Almost 80% of the respondents cited such obstacles to their involvement in counseling/advising patients as patient attitudes or patient preferences for smoking. The survey was conducted to acquire baseline data on the involvement of family physicians in Texas in counseling their patients who smoke and the obstacles they meet in their efforts.


Dicyclomine for medical management of persistent anal fissure with associated spasm of the internal sphincter. The case of a 43-year-old woman with persistent anal fissure responsive to dicyclomine is described. Associated spasm of the internal sphincter had precluded fissure healing. The spasm of the internal sphincter relaxed within 24 hours of dicyclomine administration and subsequently allowed healing. Surgery was avoided.


[Family stress for parents of girls with precocious puberty]. This study addresses whether precocious puberty influences the child-rearing practices of parents. Three patients groups, girls with idiopathic precocious puberty, with premature thelarche and with premature pubarche were studied. These groups were compared with each other, and with reference groups of 'normal' school children and children referred for asthma or referred for behavioural problems. The results showed that the parents of the total group of patients did not experience more family stress and did not appraise their child-rearing situation as being more problematic than that of parents of normal school children, and they had significantly fewer problems than the parents of children referred for asthma of for behavioural problems. Within the group results suggested that parents of girls with premature pubarche experienced more family stress than those of the two other groups. Parents reported specific physical and educational concerns about their daughters. Therefore we recommend that specific attention should be given through a programme of relevant information.


[Parents' experiences in a pediatric intensive care unit]. In this paper an account is given of a research on how parents experience and react to their child's treatment in the Intensive Care Unit of the Academic Medical Centre of Amsterdam. The purpose of this research was to gain insight into how this period influenced parents and to make an inventory of the problems parents were being confronted with. Parents play a fundamental role in supporting their child which is not easy on an ICU because of the unknown and frightening environment. One of the reasons why this kind of study has been done into a descriptive/exploring style is because such research is practically new in the Netherlands. The main results will be described and some recommendations will be made how to improve the quality of the guidance of the parents on an ICU.