Serological evaluation of Pasteurella multocida antigens associated with protection in buffalo calves. Different antigens of Pasteurella multocida Carter's type 6:B including whole bacterium, antigen heated at 56 degrees C, antigen heated at 100 degrees C, sonicated antigen, capsular antigen, potassium thiocyanate extract, lipopolysaccharide and sodium salicylate extract were evaluated to assess protection in buffalo calves against haemorrhagic septicaemia. Sera from calves with known protection status in experimental challenge were titrated by enzyme-linked immunosorbent assay (ELISA) against all antigens. Capsular antigen extracted with 2.5% sodium chloride was superior to other antigens for assessing protection status of buffalo calves against P. multocida by ELISA. This capsular antigen was able to differentiate clearly between well-protected, protected and unprotected animals.


A computerized system to store and retrieve data on biological and biotechnological veterinary products of the American continent. The Veterinary Biologics Information System is a project the main goal of which is to collect, analyze and manage data concerning registered veterinary biologics and biotechnological products employed to control animal diseases by the countries of the Americas. Data from each country was gathered by cataloguing each biological product on a questionnaire form. The collected data was then fed into an electronic data base system. A retrieval program was subsequently developed, allowing the user quick access to all data stored in the system. The system operates in English and Spanish and includes such information as the product name, registration number, ingredients, species for which the product is approved for use, the disease against which the product is used, names of manufacturers and distributors and other distinguishing characteristics of the product including expiry dates and withdrawal times. This computerized system, with on-line data bases which can be quickly updated, provides a dynamic answer to the question of timely information concerning veterinary biological products.


Report of the Twelfth International Meeting of the OIE Ad hoc Group on Non Tsetse-Transmitted Animal Trypanosomosis. Paris, 15 May 1991. Studies of Trypanosoma evansi strains of widely varied origin (Africa, Asia, South America) have continued, leading to two groups of diagnostic procedures, tested first in the laboratory and then in the field: the card agglutination trypanosomosis test and the enzyme-linked immunosorbent assay to supplement microscopic examination of smears. A microscopy procedure for differentiating Trypanosoma species in smears was proposed. Diagnostic kits have again been made available free of charge to interested and suitably qualified research workers. Several research workers have studied the lymphokines induced by T. evansi, and the question of the potential therapeutic use of these substances was raised. Research workers in Asia were increasingly involved in various problems associated with T. evansi, including fundamental research and potential applications in the field. The epidemiology of T. evansi infections has been the subject of numerous research projects in Asia and South America. Research on trypanocides has confirmed the activity of Cymelarsan, which has since been marketed, the properties of the new derivative T46 (pharmacokinetic studies) and the value of in vitro and in vivo comparisons of currently available trypanocides. The sphere of interest of the Group was extended to cover all forms of animal trypanosomosis not transmitted by tsetse flies.


Measurable deficit of autonomic and sensory nerve function in asymptomatic diabetic patients. In a group of 46 consecutive outpatients attending the diabetic clinic of our Metabolic Department, 30 insulin-dependent and 16 non-insulin-dependent diabetic patients in stable metabolic control, and in 38 age-matched controls, we measured vibration perception threshold with biothesiometer and autonomic function, by means of the five classical cardiovascular tests: R-R interval variations during deep breathing, Valsalva ratio, lying-to-standing, postural hypotension, and sustained handgrip. None of the patients complained of symptoms related to diabetic autonomic neuropathy (DAN) or sensory polyneuropathy. Vibration perception threshold positively correlated with Valsalva ratio (p < 0.05) and deep breathing (p < 0.01), and all of them correlated with age (p < 0.001), but not with duration of diabetes and metabolic control. Patients scored significantly lower than controls in vibration perception threshold and all of the autonomic function tests. According to the outcomes of cardiovascular tests ["Autonomic Score" (AS)] patients were divided into two different groups: presence (DAN+ = AS > or = 3) or absence (DAN- = AS < 3) of autonomic neuropathy. The DAN- group (n = 28, 60.9%) showed no significant differences from the DAN+ group (n = 18, 39.1%) in age, duration of diabetes, glycated hemoglobin, or body mass index. DAN+ patients had vibration perception threshold measured at the first toe tip and at external malleolus significantly higher than DAN- patients (p < 0.01 and p < 0.001, respectively) and controls (p < 0.005), as well as all the other cardiovascular tests except sustained handgrip. No difference in any of these items was observed between DAN- patients and controls.(ABSTRACT TRUNCATED AT 250 WORDS)


The effect of ejaculation on albumin excretion rate. Microalbuminuria predicts the development of diabetic nephropathy. Large daily variations in albumin excretion rates are frequently observed. Because seminal fluid contains protein and albumin, we reasoned that sexual activity, ejaculation, or residual urethral semen could contribute to albumin content in urine and thus effect determination of albumin excretion rate. Our study was designed to determine the effect of ejaculation of albumin excretion rate and to ascertain if patients routinely should be advised to refrain from sexual activity during or before the urine collection period. Ten normotensive, nondiabetic men (age 31.0 +/- 2.3 years) collected 24-h urine specimens on three occasions: after 3 days of abstinence from sexual activity, during a 24-h period which included one ejaculatory episode, and on a day following sexual activity. Results for albumin excretion rate were: abstinence day: 4.8 +/- 0.7 micrograms/min; sex day: 6.3 +/- 1.1 microgram/min; post-sex day: 4.9 +/- 1.0 micrograms/min. There was no significant difference between these values when compared directly or after log transformation. There also were no differences in urinary creatinine excretion or clearance. We conclude that in nondiabetic individuals ejaculation does not influence albumin excretion rate.


Relevance of measuring red blood cell disaggregability in insulin-dependent diabetic patients. A viscometric study of blood from insulin-treated diabetic patients is carried out. Patients are divided into three major groups--group I: without or with minimal retinopathy and recent diabetes (n = 37), group II: without or with minimal retinopathy and at least 20 years of diabetes duration (n = 35), group III: with severe retinopathy (n = 27). Each group is also subdivided according to the glycosylated hemoglobin (HbA1c) level, used to assess long-term glycemic control. Finally, the rheological parameters of six groups are compared: three of which have a HbA1c level less than 7.5% [I1 (n = 15), II1 (n = 9), III1 (n = 9)] and three others have a HbA1c level more than 7.5% [I2 (n = 22), II2 (n = 26), III2 (n = 18)]. The most important result concerns the thixotropy index xi t, which reflects the dynamic property of red blood cell (RBC) disaggregability under shear. Strong correlations between this parameter and HbA1c level are found for groups I (r = -0.53, p < 0.001) and III (r = -0.68, p < 0.001), providing evidence of a RBC disaggregability disorder for a poor glycemic control of diabetes. In contrast, such a correlation is not pointed out for the group II. As the value for xi t is not statistically different for groups II1 and II2 and is close to the normal value in both groups, the existence of a rheological protection against the retinopathy could be involved.(ABSTRACT TRUNCATED AT 250 WORDS)


Medical risk factors in diabetic patients with foot ulcers and severe peripheral vascular disease and their influence on outcome. The association between medical risk factors and the outcome of foot ulcers was evaluated in 208 consecutive diabetic patients with severe peripheral vascular disease (systolic toe blood pressure < or = 45 mm Hg). All patients were treated and followed by the same foot care team. Eighty patients healed primarily, 83 healed after a minor or major amputation, and 45 died. The systolic toe blood pressure was higher among primary healed (30 +/- 13 mm Hg) compared with amputated (22 +/- 15 mm Hg; p < 0.001) and deceased patients (20 +/- 14 mm Hg; p < 0.001). The patients were comparable regarding age, sex, and diabetes and wound duration. Only 41 (19%) patients had intermitten claudication, whereas 153 (77%) lacked palapble pedal pulses, 36% of whom healed primarily. Rest pain occurred in 72 (33%) patients, 38 (47%) of whom had an amputation and 18 (25%) who healed primarily (p < 0.01). Peripheral edema and proteinuria were more common among patients who healed after amputation compared with those who healed primarily (p < 0.001 and p < 0.01, respectively). Signs of sensory neuropathy were found in 158 (77%) patients. There were no differences concerning cardiovascular disease, smoking habits, or short-term metabolic control between patients who healed primarily or after an amputation. In conclusion, diabetic patients with foot ulcers and severe peripheral vascular disease with low systolic toe blood pressure were not excluded from the possibility of primary healing. The most important risk factors for amputation were a systolic toe pressure of less than 30 mm Hg, peripheral edema, rest pain, and proteinuria.


Structures of grain boundaries in long-chain Te crystals observed by high-resolution transmission electron microscopy. Vacuum-deposited Te crystals, composed of endless chains of the right-handed or left-handed spiral, have been investigated by high-resolution electron microscopy with the aid of image simulation. A (010) grain boundary, which accompanies edge dislocations having an extra layer of the width of one Te chain, has been observed. A through-focal series of images reveal that it is not a reflectional nor a rotational twin boundary but a small angle grain boundary in a single crystal or an inversion twin. The lattice on one side of the boundary is shifted from that on the other side by [001]c/3 + [120]a/8, and inclined at 1.1 degrees around the c-axis of the other side. Also found between crystallites of [100] and [011] orientation is a grain boundary which is built with the (011) facets on one side of the boundary and the (211) or (0,1,10) facets on another side.


High blood pressure is a risk factor for the development of microalbuminuria in Japanese subjects with non-insulin-dependent diabetes mellitus. In this study, 52 nonproteinuric Japanese patients with non-insulin-dependent diabetes (NIDDM) were followed from 1985 to 1990 to investigate the rate of development and progression of microalbuminuria and the factors which influence it. In 1985, 34 patients were normoalbuminuric, and 18 patients were microalbuminuric. Five years later, 11 of 34 initially normoalbuminuric patients (32.4%) developed microalbuminuria, and 6 of 18 initially microalbuminuric patients (33.3%) developed overt proteinuria. At the beginning of the study, hypertension existed more frequently in the patients who later developed microalbuminuria (8 of 11, 72.7%) than in the patients who stayed normoalbuminuric (4 of 23, 17.4%). Age-adjusted values of mean blood pressure (+/- SEM) at the beginning of the study in the patients who developed microalbuminuria (98.2 +/- 3.4 mm Hg, n = 11) were significantly higher than those in the patients who stayed normoalbuminuric (87.3 +/- 2.4 mm Hg, n = 23). In six patients who developed overt proteinuria, initial urinary albumin excretion rates (AER) were higher than those in the patients who stayed microalbuminuric, and four patients who presented with initial AER greater than 100 micrograms/min all developed overt proteinuria. These results indicate that, in Japanese patients with NIDDM, the rate of development of microalbuminuria is faster than that reported in Caucasian IDDM, and preexisting hypertension with relatively poor control of blood pressure may be a risk factor for the development of microalbuminuria.


Effect of crystal and beam tilt on simulated high-resolution TEM images of interfaces. The effects of crystal and beam tilt on high-resolution transmission electron microscope (HRTEM) images of planar coherent interfaces were investigated by multislice image simulations. It was found that a beam tilt of 0.5 Bragg angle (theta B) was sufficient to introduce detrimental artifacts into most images of interfaces in crystals only 1/8 xi 000 thick, while crystal tilt had a much smaller effect even for crystals 1 xi 000 thick. Effects produced in HRTEM images of interfaces by crystal and beam tilt included the introduction of additional periodicities and loss of compositional detail across a boundary, translation of a boundary from its actual position, and apparent mismatch of atomic planes across a perfectly coherent interface. These results indicate that alignment of the electron beam parallel to the optic axis is critical for reliable HRTEM imaging of interfaces in materials. Techniques for obtaining accurate alignment are also discussed.


Improved method for the preparation of TiN-coated WC-Co-based samples for cross-sectional AEM investigation. An improved method for the preparation of cross-sectional thin foils of coated WC-Co samples for studies by analytical electron microscopy is described. A braze alloy is used to join the sections of the sample together and the resulting sample is stable during subsequent grinding, dimpling, and milling operations. Cross-sectional micrographs provide examples of the efficacy of this method. No microstructural alteration associated with the brazing operation was observed.


Comments on the clinical impact of hypertension in type I diabetes. In type I diabetes, the quality of life and, in essence, the long-term prognosis or life expectancy of the patient are invariably related to the manifestation of untoward complications. Increased arterial blood pressure (hypertension) has a great influence in these complications. Cumulative evidence has shown that proteinuric type I diabetic patients are easily susceptible to hypertension and its accompanying sequelae. The debilitating effects of hypertension on the progressive development of diabetic nephropathy leading to renal dysfunction and mortality in renal transplant patients have been documented. Proliferative retinopathy and cardiovascular lesions are also frequent devastating complications in hypertensive-diabetic patients. The mechanism of sodium/lithium countertransport activity and the genetic predisposition to hypertension require further elucidation.


Accurate d-spacings from zero-order Laue zone patterns. Experimental d-spacing values are criteria towards the identification of crystallites by electron diffraction. Conclusive identifications often rely on accurate d-spacings. It is shown here that accurate orthogonal components (in mm) for the primitive unit vectors of a zero-level diffraction pattern can be obtained through least-squares processing of (x,y) coordinates for all spots on the film. Valid vectors from the origin spot to any spot in the plane of the film are integer linear combinations of the two selected unit vectors. Accurate lengths and standard deviations for such vectors therefore can be calculated from the least-squares results. Corresponding d-spacings can then be calculated from the vector lengths on the film and the camera constant. In order to obtain d-spacing values that are not only precise, but also accurate, an accurate value of the camera constant should be used. This requires calibration of the experimental setup with reference materials in the same experimental conditions, with careful control of the sample height. For the same quality of measurements, the improvement in the accuracy of the d-spacings obtained with the proposed method is approximately proportional to the square root of the number of measurements taken. Practically, typical improvement in accuracy is about threefold, and accuracies of a fraction of a percent in d-spacings are achievable in this way. The above approach has been programmed as an option in the NRCBED program.


Severe hyperkalemia in two patients with diabetes after cosyntropin administration. Some patients with diabetes mellitus are at increased risk for the development of hyperkalemia. Included in this group are patients with glucose-induced hyperkalemia who may have renal insufficiency, hyporeninemic hypoaldosteronism, or other impediments to the release or action of aldosterone. In an unusual demonstration of this abnormality, two patients with diabetes, who form the basis of our report, became markedly hyperglycemic and hyperkalemic after cosyntropin administration. To our knowledge, this complication of adrenocorticotropic hormone (ACTH) stimulation testing has not been previously reported. It should therefore be emphasized that the use of cosyntropin as a diagnostic agent can provoke severe hyperglycemia and hyperkalemia in a susceptible subgroup of patients with diabetes mellitus.


Preparation of cross-section specimens for transmission electron microscopy from alpha-Al2O3/Ni solid state bonded bicrystal interfaces. The technique which is described combines the advantages of the techniques formerly proposed in the literature in each stage of the preparation of transmission electron microscopy (TEM) specimens including a single metal-ceramic interface. It allows easy handling of the thin foils in spite of their brittleness. Preferential thinning of the softer material in the two-phase foil is prevented, and both sides of the interface are thinned down to comparable thicknesses. The nickel-alumina bicrystal interface observed in TEM is neat and free from any reaction layer. This method is easily adaptable to other metal-ceramic systems.


InP sample preparation for the TEM by photochemical etching, ion milling, and chemical thinning. Photochemical etching (PCE) as a method for preparation of InP semiconductor plan view samples for the transmission electron microscope is demonstrated and compared to the methods of ion milling and chemical thinning. PCE can produce small area samples for TEM analysis quickly and accurately. Also, the resulting thin regions are surrounded by a built-in stabilizing structure that improves handleability and reduces the occurrence of handling induced fracture.


Interactions between hypertension and diabetes on vascular function and structure in rats. Regional 125I-albumin permeation and glomerular structural changes were assessed in male Sprague-Dawley rats with diabetes and/or hypertension. All rats underwent unilateral nephrectomy 2 weeks after induction of diabetes with streptozotocin. At the same time, one-half of the nondiabetic and diabetic animals were placed on 1% saline drinking water and given weekly intramuscular injections of deoxycorticosterone acetate to induce hypertension (systolic blood pressure greater than 150 mm Hg). Vascular permeability studies were performed after 1 and 3 months of hypertension. Hypertension, alone or in combination with diabetes, had no effect on weight gain, plasma glucose, or food consumption, but did increase 24-h urine volume in nondiabetics. In normotensive diabetics and in nondiabetic hypertensive rats, vascular 125I-albumin permeation was increased in eyes, aorta, and new granulation tissue (formed in a subcutaneous fabric implant), and glomerular basement membranes were thickened without any change in the fractional volume of the glomerulus occupied by mesangium. Urinary albumin and IgG excretion in nondiabetic hypertensive rats was increased much more than in normotensive diabetics. Hypertension and diabetes were additive in their effects on 125I-albumin permeation in eyes, aorta, and granulation tissue, and on glomerular basement membrane thickening, but were synergistic in their effects on urinary albumin excretion and mesangial fractional volume. The magnitude of the increase in vascular albumin permeation and urinary albumin and IgG excretion between and 1 and 3 months was much larger in diabetic hypertensive rats than in rats with hypertension or diabetes alone. Neither diabetes nor hypertension, alone or in combination, had any effect on albumin permeation in skeletal muscle, skin, heart, or brain. These findings demonstrate that hypertension and diabetes increase vascular albumin permeation in rats preferentially in tissues that correspond to sites of clinically significant vascular disease in human diabetics. They also attest to an important interaction between blood pressure-induced and diabetes-induced increases in vascular permeability in these tissues and in structural changes in the glomerular vasculature.


Heparan sulphate in the binding and activation of basic fibroblast growth factor. Heparan sulphate proteoglycans (HSPGs) are widely distributed in animal tissues, but their most prominent locations are cell surface membranes and basement membranes. Their influence on various fundamental aspects of cell behaviour (e.g. cell adhesion, growth and morphogenesis) are dependent on the specific binding properties of the heparan sulphate (HS) chains. These polysaccharides are complex structures in which N-sulphated glucosamine and ester sulphate groups tend to be clustered in discrete regions of the chain separated by sequences enriched in N-acetylglucosamine residues, but with a low sulphate concentration. The sulphated domains contain the sugar residue sequences for interaction with specific proteins essential for HS function. In this review, we describe the plasma membrane HSPGs and their role in regulating the activity of basic fibroblast growth factor (bFGF).


Alterations of glycosphingolipid-based blood group antigen expression on erythrocytes and in plasma studied on consecutive samples after a blood group O to A bone marrow transplantation. A blood group A1Le(a-b+) individual with chronic myeloid leukaemia had received a bone marrow graft from an HLA-identical OLe(a+b-) donor. Twelve months after bone marrow transplantation (BMT), the red blood cells of the patient became agglutinable with anti-A blood group reagents. To elucidate whether the blood group A antigen expression was of plasma or of bone marrow origin, total non-acid glycosphingolipid fractions were prepared from red blood cells and plasma collected 17 months after BMT, and from plasma collected 13, 15 and 19 weeks after BMT. The glycolipid fractions were analysed by thin-layer chromatography and immunostained with monoclonal A-antibodies, and permethylated and permethylated-reduced derivatives of selected plasma samples were analysed by mass spectrometry. The results strongly indicate the presence of host bone marrow-produced blood group A red blood cells. Furthermore, the presence of a blood group H active pentaglycosylceramide type 1 (H-5-1) (Table I), characteristic for an OLe(a-b-) secretor, was seen in plasma 3-4 weeks before clinical chronic graft versus host disease (GVHD). After treatment of chronic GVHD, this expression disappeared. The blood group ALeb (A-7-1) antigen produced by the recipient seems to be present and to increase with time in all plasma samples. This also seems to be the case for the Leb and A-6-1 antigens.


A new method for the analysis of amide-linked hydroxy fatty acids in lipid-As from gram-negative bacteria. Lipid-A represents the ubiquitous, covalently bound hydrophobic component of bacterial lipopolysaccharides (endotoxins). Lipid-As isolated and characterized from rhizobial species have large variations in their backbone sugars, as well as in their hydroxy fatty acid substituents. The sugar backbones consist of either glucosamine and galacturonic acid or glucosamine and 2,3-diaminoglucose. The published procedures for characterizing amide-linked fatty acids do not release all these fatty acids, hence a new method was developed to characterize the amide-linked hydroxy fatty acids. This method involves a mild methanolysis procedure to release glucosamine methyl glycosides which still contain the amide-bound hydroxy fatty acids. The products were analysed by fast atom bombardment mass spectrometry (FAB-MS) and, after trimethylsilylation, by electron impact (E.I.) and chemical ionization (C.I.) gas chromatography-mass spectrometry (GC-MS). The procedure was applied to lipid-A preparations from several gram-negative bacteria. This method allows the unequivocal identification of amide-linked hydroxy fatty acids and also allows determination of the microheterogeneity of the N-acyl substituents in lipid-As from gram-negative bacteria.


Resialylation of sialidase-treated sheep and human erythrocytes by Trypanosoma cruzi trans-sialidase: restoration of complement resistance of desialylated sheep erythrocytes. Trypanosoma cruzi trans-sialidase (TS) is a recently described enzyme which transfers alpha(2-3)-linked sialic acid from host-derived sialylated glycoconjugates to parasite surface molecules [Schenkman et al. (1991) Cell, 65, 1117]. We report here on the ability of TS to transfer sialic acid from donor sialyl-alpha(2-3)lactose to sialidase-treated sheep and human erythrocytes. Up to approximately 50% resialylation of both desialylated red cells could be attained. Resialylation of desialylated sheep erythrocytes restores their resistance to lysis by human complement. This ascribes a possible biological role for T. cruzi TS and demonstrates directly that sialic acid is solely responsible for preventing alternative pathway activation of human complement by sheep erythrocytes.


A new method for sequence analysis of glycosaminoglycans from heavily substituted proteoglycans reveals non-random positioning of 4- and 6-O-sulphated N-acetylgalactosamine in aggrecan-derived chondroitin sulphate. We have developed a new procedure for the sequence analysis of glycosaminoglycans, which is particularly suitable for the analysis of chains from heavily substituted proteoglycans. The procedure has been applied to various aggrecan-derived chondroitin sulphates. The glycans are released from the core protein by alkaline scission of the xylose-serine bond, subjected to reductive amination using p-aminobenzoic acid and finally radioiodinated at an acidic pH. Sequence analysis is performed by using various enzymic degradations, partial or complete, followed by high-resolution polyacrylamide gel electrophoresis, blotting and autoradiography to identify segments extending from the labelled reducing end to the point of cleavage. By using chondroitin C lyase to identify the location of 6-O-sulphated hexosamines, we find that chondroitin sulphate from tracheal cartilage has its 6-O-sulphated repeats concentrated to the extreme non-reducing terminal portion of the chain. In chondroitin sulphates derived from intervertebral discs (nucleus pulposus), the 6-O-sulphated repeats have a biphasic distribution; they occur mostly near the linkage region (i.e. the reducing end), but also in the non-reducing portion of the chain. Chondroitin sulphate from nasal cartilage, which is mostly 4-O-sulphated, displays considerable heterogeneity in the linkage region. Three or possibly more charge variants are observed.


Identification and characterization of an alpha-mannosidase from Trypanosoma cruzi. In this report we describe the first purification and characterization of the acid alpha-mannosidase from the human parasite Trypanosoma cruzi. The purified enzyme exhibited a native mol. wt of 240,000 Da and is apparently composed of four identical subunits of mol. wt 58,000 Da. Each of the four subunits contains one N-linked high-mannose-type oligosaccharide. The alpha-mannosidase exhibited a pH optimum of 3.5 and a pI of 5.9. This low pH optimum and the ability of swainsonine to inhibit its activity suggest that the alpha-mannosidase is a lysosomal enzyme. Antibodies against the T.cruzi enzyme did not react with mammalian lysosomal alpha-mannosidase and, conversely, antibody against a rat lysosomal alpha-mannosidase did not react with the T.cruzi enzyme. Thus, the T.cruzi enzyme appears to be distinct from its mammalian counterpart.


Proteoglycan inhibition of calcium phosphate precipitation in liposomal suspensions. The major proteoglycan in cartilage (aggrecan) is a complex macromolecule with numerous chondroitin sulphate, keratan sulphate, and oligosaccharide substituents. It has been proposed that this macromolecule has an important role in regulating mineralization in this tissue, a process which is initiated by the deposition of apatite in matrix vesicles. We have used a liposome-centred endogenous precipitation method as a model for matrix vesicle mineralization to study the effect of the rat chondrosarcoma aggrecan and its chondroitin sulphate and core protein components on apatite formation from solution. Precipitation was initiated by encapsulating buffered (pH 7.4) 50 mmol/l KH2PO4 solutions in the aqueous centres of 7:2:1 phosphatidylcholine:dicetylphosphate:cholesterol liposomes, adding 2.25-2.65 mmol/l Ca2+ and 1.5 mmol/l total inorganic phosphate (PO4) to the suspending medium (pH 7.4, 22 degrees C), then making the intervening lipid membranes permeable to the Ca2+ ions with the calcium ionophore X-537A. Aggrecan (0.5%) in the suspending medium had no effect on intraliposomal precipitation, but severely reduced (approximately 70% reduction at 24 h) its subsequent spread into the medium. The chondroitin sulphate and core protein were similarly inhibitory. The degree to which aggrecan and its constituent parts inhibited precipitation correlated with their capacity to bind Ca2+ ions. These findings suggest that functional groups in aggrecan blocked apatite growth by linking via Ca2+ bridges to growth sites on the crystal surfaces. Similar Ca-mediated interactions may well have a critical regulatory role in cartilage mineralization.


Immunocytochemical localization of beta 1,4 galactosyltransferase in epithelial cells from bovine tissues using monoclonal antibodies. Post-embedding immunocytochemistry was employed to investigate the distribution of UDP-galactose:N-acetylglucosamine galactosyltransferase (beta 1,4-GT) in epithelial cells from various bovine organs. Several well characterized monoclonal antibodies previously demonstrated to recognize distinct polypeptide epitopes within the primary structure of beta 1,4-GT were applied to thin sections from tissues embedded in Lowicryl K4M, followed by the protein A-gold technique. Immunoreactivity was observed in the Golgi apparatus of epithelial cells from intestine, thymus and trachea. No immunoreactivity was observed in other intracellular structures, including rough endoplasmic reticulum, nuclear envelope and goblet cell mucus droplets. Within the Golgi apparatus, the staining was restricted to several cisternae in the trans region, with most portions of the trans-Golgi network appearing unlabelled. However, in thymic epithelial-reticular cells trans-Golgi network portions resembling classical GERL elements were stained by the antibodies. Thus, although immunoreactivity was subcompartmentalized within the Golgi apparatus in all epithelial cell types examined, the extent of staining within the trans-Golgi network was variable. Immunoreactivity was not detected at the plasma membrane (ecto-galactosyl-transferase), except in the case of a subpopulation of tracheal cells that resemble brush cells. These results suggest that in the epithelial cells examined, the subcompartmental distribution of beta 1,4-GT within the Golgi apparatus is maintained across different types of epithelial cell organization. Moreover, no evidence for a general epithelial cell ecto-galactosyltransferase could be discerned with these reagents.


Management of the feline blood donor.

Management of the feline blood donor. The feline blood donor should be considered a valuable asset to the veterinary clinic. As public awareness increases, so will the demand for high-quality blood products. Meeting this demand will require planning and a blood donor management program tailored to the clinic's needs. Consideration should be given to the areas of blood value, donor selection, blood collection, and maintaining donor health when developing a donor management program. Suggestions for reducing the stress and aggravation often associated with feline blood collection are provided.


Management of the inpatient canine blood donor. The availability of inpatient blood donors as a source for transfusion allows flexibility that is lacking in an outpatient program. Choosing the appropriate dog as a donor is essential to the success of a hospital blood bank. Once a dog becomes a blood donor, routine physical and clinicopathologic examinations are necessary to monitor the animal's health and to ensure the quality of blood products.


Outpatient blood donor program.

Outpatient blood donor program. An outpatient donor program using pets owned by employees or clients is a practical and cost-efficient means of obtaining blood for transfusion. Donors can have blood typed and be screened for certain diseases, and blood can be drawn at a convenient time. Components can be prepared and stored. Although such a program requires a commitment to assemble reliable volunteers, the results is a team effort that can be rewarding and assures an adequate blood supply.


Supplies for blood transfusions in dogs and cats. As awareness of transfusion therapy grows, clients begin to expect the same standard of care for their pets as that found in human medicine. To meet this standard, the practitioner needs a familiarity with the basic tools required for blood banking and transfusion medicine. These tools and the terms used to describe them often are far from self-explanatory to those who do not work in a blood bank. This article attempts to clarify the nomenclature and define and describe the veterinary applications of blood banking and transfusion supplies.


Preparation of blood components.

Preparation of blood components. The processing of blood into various components and the knowledge of component usage enables veterinarians to support and beneficially treat more animals. Blood products include packed red blood cells; fresh frozen, fresh, and modified plasma; cryoprecipitate; platelets; and concentrates. Some methods of preparation of blood products and storage are presented.


Feline transfusion medicine.

Feline transfusion medicine. Anemia is the major indication for transfusion in cats, and fresh whole blood is most commonly administered. Because cats have naturally occurring alloantibodies in plasma, donor and recipient should be blood-typed and/or crossmatched before the first transfusion takes place. Mismatched transfusions are ineffective and may cause life-threatening hemolytic transfusion reactions.


Canine blood transfusions.

Canine blood transfusions. Although the technique of transfusing blood from one dog to another has been known for centuries, transfusion is not easily accomplished in clinical veterinary medicine. There is a lack of blood typing reagents, suitable donors, and commercial blood banks. This situation is beginning to change, and this article focuses on practical and accessible transfusion methods for dogs. Also discussed are recommendations regarding the type of blood product to be used in specific situations, routes of administration for blood products, and complications of blood transfusion.


Transfusions in exotic species.

Transfusions in exotic species. There has been a considerable increase in the popularity of exotic species as pets, particularly, birds and domestic ferrets. Blood transfusions in birds and ferrets are discussed. There is a brief review of hematology, blood collection techniques, the selection and maintenance of donor animals, and the mechanics of transfusion. Because of the marked differences between birds and mammals, attention is given to avian anatomy and physiology as it applies clinically to blood transfusions.


Management of canine von Willebrand's disease. Canine von Willebrand's disease (vWD) is the most common inherited bleeding disorder of purebred dogs. Optimum treatment of affected dogs is influenced by the presence of concurrent disorders, especially thyroid insufficiency, and the nature of hemostatic stress encountered. Blood component therapy, most specifically the use of cryoprecipitate, provides the most effective transfusion support for severely affected dogs.


Red blood cell substitutes.

Red blood cell substitutes. Insufficient supply and risks of homologous blood transfusions have driven the quest for a red blood cell substitute. The recent development of a red blood cell substitute has focused on hemoglobin solutions. The clinical indications for use of a red blood cell substitute in veterinary medicine include blood loss caused by trauma, surgery, or medical causes and other acute anemias. Such a substitute also may have an adjunctive role in radiation treatment and chemotherapy.


Biliary tract reconstruction in liver transplantation. Biliary tract complications are often referred to as the "Achilles' heel" of liver transplantation and various techniques have been developed to overcome them. The two major methods of bile duct reconstruction currently in use consist of either (1) choledochocholedochostomy over a T-tube or, when duct-to-duct approximation is not feasible, choledochojejunostomy over an internal stent, or (2) interposition of the donor gallbladder as a conduit between the donor bile duct and either the recipient bile duct or a jejunal loop. Although these standardizations of biliary tract reconstruction have resulted in a reduction of biliary complications after liver transplantation, further advancement in the elucidation of ampullary obstruction and viability of the donor bile duct is needed.


Bacterial adherence to human gallbladder epithelium. The adherence of Escherichia coli and Pseudomonas aeruginosa to the epithelium of the gallbladders obtained from 32 patients with negative bile culture was quantified by a scanning electron microscope. Of the gallbladders, 5 were histologically normal (group A), 21 had chronic calculus cholecystitis (group B), and 6 had acute calculus cholecystitis (group C). The data were expressed as the mean +/- S.D. of the numbers of adherent bacteria to 1,000 microns2 of the gallbladder epithelium. The number of adherent E. coli were 0.1 +/- 0.2 in group A, 4.2 +/- 2.8 in group B, and 9.2 +/- 3.3 in group C. A similar result was also observed with P. aeruginosa. The number of adherent bacteria, both of E. coli and P. aeruginosa were significantly higher in group C than in groups A and B, and were also significantly higher in group B compared to group A. The amount of bacterial adherence paralleled that of the degree of epithelial damage, and the normal epithelium proved to have an inhibiting ability. Thus, a secondary bacterial infection is more likely to happen in patients with contaminated bile, and therefore, the treatment for acute cholecystitis should be based either on the results of a bile culture or according to predictive factors for bactibilia.


The succinate dehydrogenase inhibition test for evaluating biopsy specimens and resected tumors of advanced gastric cancer. An in vitro chemosensitivity study of both biopsy specimens and surgically resected tumors of advanced gastric cancer from 12 patients was evaluated using the succinate dehydrogenase inhibition (SDI) test. A decrease in succinate dehydrogenase (SD) activity as an indicator of chemosensitivity was determined using cisplatin (CDDP), etoposide (VP-16), and mitomycin C (MMC). In this study, 29 of a total 36 experiments were evaluable (80.6%) and significant correlations were found in all three of the antitumor drugs (P < 0.03). This finding suggests that the SDI test using biopsy specimens may prove valuable for assessing the preoperative chemosensitivity of advanced gastric cancer.


Esophageal resection by cervico-abdominal approach without thoracotomy. The authors report their experience with transhiatal esophageal resection accumulated during the period between January 1978 and March 1990. Indications for the procedure included cancer of the gastric cardia (26.3%), cancer of the hypopharynx (3.8%), cancer of the esophagus (59.2%), and benign esophageal disease (9.8%). Esophageal substitution was performed using a tubulized stomach (63.6%), ileo-ceco-coloplasty (28.5%), left colon (7.6%), and jejunum (0.3%). The majority of patients with neoplastic disease were found to be in an advanced stage (67.3% of esophageal cancer patients and 69.7% of cancer of the cardia patients with stage III disease). The mean intra-operative volume of blood transfused varied between 533 and 1,220 ml. Sixteen patients required hospitalization in the intensive care unit. The mean length of post-operative hospitalization varied between 16.8 and 20.6 days. Operative complications included hemorrhage (0.3%) and tracheal injury (0.6%). Operative (30 day) mortality was 5.8%. Causes of death included respiratory insufficiency (35.2%), pulmonary sepsis (23.5%), abdominal sepsis (17.8%), and others (undefined, 23.5%). The 5 year survival was 48.5% for cancer of the gastric cardia, 57.1% for cancer of the hypopharynx and 11.8% for esophageal cancer.


Evaluation of the measurement of the intraoperative transcutaneous partial pressure of oxygen (PtcO2) as a prognostic indicator in vascular reconstruction. The intraoperative transcutaneous partial pressure of oxygen (PtcO2) was used to monitor 58 vascular reconstructive surgery procedures in 54 patients. The study comprised three groups: Group A (24 limbs without any ischemic symptoms or signs), Group B (45 limbs with intermittent claudication), and Group C (12 limbs with ischemic rest pain, ulceration, and gangrene). In addition in 31 patients the chest wall was monitored simultaneously as a control. The results showed that the PtcO2 values increased immediately and significantly to varying degrees and at varying speeds after unclamping. The controls had higher values than Group A (P > 0.05), Group B (P < 0.05), and Group C (P < 0.05) patients. Further study showed that there were no significant differences between the maximal values in the limbs with good distal vessel run-off in Groups A, B, and C, and in the controls (P > 0.05). It is thus concluded that effective vascular reconstruction in the limbs is indicated by a rapid and marked increase of both the PtcO2 value and the response value, while with a slow and low increase of the value, early graft failure and poor distal vessel run-off should be suspected. We believe that this monitoring method dynamically reflects the functional state during vascular reconstruction and is clinically valid.


Preoperative serum immunosuppressive acidic protein (IAP) test for the prognosis of gastric cancer: a statistical study of the threshold level and evaluation of the effect of the biological response modifier PSK. The prognostic value of immunosuppressive acidic protein (IAP), which is known to suppress various immune responses in cancer patients, was studied in a prospective randomized trial of advanced gastric cancer patients, designed to evaluate the effect of PSK, a kind of biological response modifier with protein-bound polysaccharides. Preoperative serum IAP levels were determined in 228 patients who received radical gastric resection and tests conducted in one laboratory by the single radial immunodiffusion (SRID) method. All patients were followed up for 24 months or more. There was an overall significant difference in disease-free survival time in favour of the PSK-treated group compared with the control group. Preoperative IAP values were strongly associated with disease-free survival time. The statistical analysis to define an appropriate cut-off level for IAP was performed using Cox's proportional hazards model. The most significant difference was observed at the threshold value of 580 micrograms/ml, the hazard ratio being 2.13 with a 95% confidence interval [1.17, 3.88] (P = 0.013). Patients in the PSK-treated group with a preoperative IAP of lower than 580 micrograms/ml showed improved disease-free survival (P = 0.029), however, no significant difference was seen between the two groups when the preoperative IAP exceeded the threshold level. From these results, 580 micrograms/ml is postulated to be the most appropriate threshold value for predicting the prognosis of advanced gastric cancer patients, and it is suggested that PSK would be most effective in patients whose preoperative IAP level is lower than the threshold level.


Increases in immunoglobulin and complement in patients with esophageal or gastric cancer. Based on data providing evidence that the enhancement of serum IgG and IgA is associated with the occurrence of infectious complications following surgery in patients with esophageal cancer, we examined the possible factors contributing to alterations in the serum IgG, IgA, IgM, C3, C4, and CH50 levels. A multiple linear regression analysis was made on data obtained from 71 patients with esophageal cancer and 57 with gastric cancer. In the patients with esophageal cancer, age and protein-calorie malnutrition (PCM) were related to the elevation of IgG levels while the stage of cancer was linked to that of IgA. The sex and IgM levels were also seen to be related. Age and the stage of cancer were associated with reductions in C3, C4, and CH50 levels, although in the patients with gastric cancer, the stage of cancer and elevations of these complement levels were related. Thus, age, PCM, and tumor malignancy are all factors related to the enhancement of IgG or IgA in patients with esophageal cancer.


A two-stage operation successfully performed for giant leiomyosarcoma of the esophagus with hepatic metastasis. Leiomyosarcoma of the esophagus is a rare neoplasm, with only 95 cases having been reported in the literature. Dysphagia is the most commonly noted symptom, however, because of its location in the submucosal layer, the tumor has usually grown to a considerable size by the time this presents. We report herein a case of a 39-year-old man who had no symptoms other than a 7 month history of a cough. After several investigations, the patient underwent resection of the thoracic and abdominal esophagus with lower lobectomy of the right lung through a right and left thoracotomy. The tumor measured 18 x 15 x 8 cm in length and weighed 1,500 g, being the biggest such tumor ever reported. Forty days after the first operation, an extended right hepatic lobectomy of the liver was performed for hepatic metastasis. He was discharged from the hospital 20 days after the second operation and is now doing well. The clinical features and surgical treatment of leiomyosarcoma of the esophagus are discussed herein.


Successful pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension associated with anticardiolipin antibodies: report of a case. Chronic pulmonary thromboembolism with pulmonary hypertension is a rare but most unique syndrome in the broad spectrum of pulmonary embolism. This report describes a successful pulmonary thromboendarterectomy performed for a totally occluded right pulmonary artery on a 43 year old man who presented with positive cardiolipin antibodies. The surgery was performed through a median sternotomy with cardiopulmonary bypass and intermittent periods of deep hypothermic circulatory arrest. We are convinced that this method allows for complete removal of the thrombotic obstruction and should be the procedure of choice for patients with very proximal obstruction of a pulmonary artery.


The use of a biventricular assist device for postcardiotomy profound biventricular failure. A 58-year-old woman who could not be weaned from cardiopulmonary bypass was treated with a biventricular assist device (BVAD) using a centrifugal pump for the left side and a pneumatic pulsatile pump for the right side. At the initiation of the BVAD support, predominant right ventricular failure was recognized and therefore weaning was begun from the left side. The left ventricular assist device was discontinued after 87 h and the patient was finally weaned from the right ventricular assist device after 205 h. Despite the complete recovery of cardiac function, the patient developed renal failure followed by an intractable infection and died of multiple organ failure on the 59th postoperative day (POD).


Complete excision and panpleuropneumonectomy resulting in long-term survival for a teenager with invasive thymoma: report of a case. An 18-year-old girl with invasive thymoma and pleural dissemination underwent a complete removal of the tumor with combined resection of the pericardium and a panpleuropneumonectomy of the left lung. At the time of writing, 70 months later, she was doing well under the classification of grade I performance status with no signs of recurrence. Thus, complete surgical removal of this tumor can prolong the survival time of patients with invasive thymoma and pleural dissemination.


Primary squamous cell carcinoma of the stomach in a seventeen-year-old boy. Primary squamous cell carcinoma (SCC) of the stomach is extremely rare and thought to arise from ectopic squamous epithelium, which in turn could either result from the squamous metaplasia of the gastric mucosa or be congenital in origin. We report herein a case of SCC of the stomach in a 17-year-old male, who died 1 year after undergoing a gastrectomy. To our knowledge, this is the youngest case of primary SCC of the stomach reported in the literature. Further speculative possibilities of the development of primary gastric SCC are discussed following the presentation of this case.


Partial portal arterialization for the prevention of massive liver necrosis following extended pancreatobiliary surgery: experience of two cases. Massive liver necrosis, which is a severe and highly fatal complication after extended pancreatobiliary surgery, may occur due to an interruption of the hepatic arterial flow caused by such events as an excision of the hepatic artery invaded by cancer, a ligation of the postoperatively ruptured hepatic artery, or a thrombotic obstruction of the reconstructed hepatic artery. In order to improve this ischemic state of the liver, we have performed a partial arterialization of the portal vein by making an arteriovenous shunt at the mesenteric vascular branches in two cases. Although a sufficient pathophysiological investigation could not be fully conducted, partial portal arterialization was considered to be effective in one patient, while no clinically noticeable adverse effects were revealed in the other patient.


Survival of human oocytes cryopreserved with or without the cumulus in 1,2-propanediol. Although cryopreservation of human preembryos has been carried out with success, the cryostorage of oocytes, which pose fewer controversial moral, ethical, and legal problems has been much less successful. Various attempts to cryopreserve human oocytes have been mostly unsuccessful and the search for an optimal protocol for oocyte cryopreservation remains elusive. We therefore undertook this study to determine the effect of oocyte cryostorage in 1,2-propanediol. Mature human oocytes with or without their cumuli were cryopreserved in precooled 1,2-propanediol, then thawed and inseminated with sperms for in vitro fertilization. The outcome of insemination and subsequent embryonic development were also recorded and compared. Postthaw cryosurvival rate was significantly better when cryostorage was carried out with the oocyte cumulus intact as compared to those oocytes denuded of their cumuli (54 versus 27%, respectively; P < 0.05). Eight (44%) of 18 surviving postthaw oocytes with intact cumuli were fertilized normally, with cleavage in six, as compared to two (25%) and one, respectively, of those denuded of their cumulus prior to cryostorage. Development to the blastocyst stage was achieved in three embryos derived from oocytes with an intact cumulus at cryostorage. We conclude that 1,2-propanediol can be used with success in oocyte cryopreservation, although the issue of parthenogenecity is still to be resolved. Oocyte's with intact cumulus survive cryostorage better than those without it.


Parthenogenetic activation of human oocytes by puromycin. Our objective was to obtain parthenogenetic activation of unfertilized human oocytes by puromycin and to try to use this procedure for cytogenetic purposes. The setting was our IVF laboratory. Eighty-two spare oocytes from 34 IVF patients were used. In the first series of experiments 39 unfertilized oocytes were cultured in medium containing 100, 50, or 10 micrograms/ml puromycin for 6 to 24 hr. After the appearance of pronuclei they were transferred to plain medium, further cultured, and cytogenetically analyzed. In the second series of experiments 43 oocytes were cultured for 5 to 10 hr in 10 micrograms/ml puromycin, transferred to plain medium, and fixed for cytogenetic analysis 2 hr after nuclear envelope breakdown. Ninety-one percent of the oocytes in the first experiment showed the presence of one or more nuclei. From the pronucleate oocytes additionally cultured in puromycin-free medium, 46% developed further to the metaphase of the first mitotic division or the two-cell stage and 54% remained arrested at the pronuclear stage. In the second experiment 88% of the treated oocytes showed pronuclei or had cleaved, and after withdrawal from puromycin 96% of the pronucleate oocytes entered mitosis. Puromycin induces haploid as well as diploid parthenogenesis in aged human oocytes. A 5- to 10-hr treatment of oocytes with 10 micrograms/ml puromycin yields the highest percentage of activation, and almost all parthenogenetically activated oocytes enter or develop beyond the first cleavage mitosis. Analysis of mitotic metaphase chromosomes from parthenogenetically activated human oocytes may be a promising new approach to preimplantation cytogenetics.


Improved pregnancy outcome with gonadotropin releasing hormone agonist (GnRH-a) stimulation is due to the improvement in oocyte quantity rather than quality. The impact of gonadotropin releasing hormone agonist (GnRH-a) on the quality and quantity of oocytes harvested in in vitro fertilization-embryo transfer (IVF-ET) patients was studied by comparing the results for patients stimulated with gonadotropin alone and with gonadotropin plus GnRH-a. Adding GnRH-a significantly improved the viable pregnancies per transfer and reduced the spontaneous abortions, which seemed to improve oocyte quality. However, when oocyte quality was evaluated by the fertilization rate and the implantation and delivery rates per embryos transferred, there were no significant difference in the results, indicating that GnRH-a did not improve the oocyte quality. On the other hand, GnRH-a significantly increased the average number of oocytes harvested, fertilized, and transferred, and this increased number of oocytes transferred has been demonstrated to increase pregnancy and multiple-pregnancy rates. Multiple pregnancy with more embryos implanted would significantly reduce the abortion rate. Abortion rates decreased inversely to the number of embryos implanted. Our data strongly suggest that the efficacy of GnRH-a on IVF-ET patients was due more to the quantity increase than the quality of embryos transferred.


Antisperm antibodies and in vitro fertilization. The purpose of this study was to investigate the influence of antisperm antibodies in the male, the female, or both partners on the outcome of in vitro fertilization treatment. The results in terms of ongoing pregnancies in the male and female antibody-positive group were the same as in the antibody-negative group. In the double antibody-positive group two of the three patients became pregnant. When high levels of antisperm antibodies were present on the spermatozoa, the fertilization rate was significantly reduced. In the female positive group no clear relationship between the antibody titer and the fertilization percentage could be detected. Abnormal semen quality was responsible for a much lower fertilization rate than the presence of antibodies. The conclusion of this study is that in vitro fertilization provides an equal change of conception in couples with antisperm antibodies in comparison with couples with no antibodies if the other semen parameters are normal.


Pregnancy rate in an oocyte donation program. Oocyte donation programs offer an alternative treatment for infertile women with ovarian failure or abnormal ovarian function. Seventeen cycles of in vitro fertilization and embryo transfer with donated oocytes were performed in 13 women, with a mean age of 34.8 years. The hormonal replacement therapy consisted of a fixed dose of oral estradiol valerate, 6 mg daily, and intramuscular progesterone in oil, 100 mg daily. Estrogen and progesterone were continued for 10 more weeks after embryo transfer if pregnancy was established. After 13 embryo transfers, 8 pregnancies were obtained, for a pregnancy rate per transfer of 61.5%. Today seven pregnancies are progressing normally, including one set of twins. This results suggest that an oocyte donation program using a fixed and simple hormonal replacement therapy is an adequate treatment for these infertile couples.


Characteristics of participants in a gestational carrier program. Genetic parents and gestational carriers in our gestational carrier program were evaluated by psychodiagnostic interview and by the Minnesota Multiphasic Personality Interview-2 (MMPI-2), a widely used objective psychological test, to identify psychopathology and describe personality characteristics. Overall, participants exhibited no overt psychopathology. Personality differences were found between gestational carriers and genetic mothers and genetic fathers and mothers. Clinical interviews revealed that gestational carriers tended to be the dominant partner in the relationship, were motivated by a wish to help an infertile couple, enjoyed being pregnant, showed narcissistic needs, and expressed a wish for secondary financial gain. The majority of gestational carriers stated that they had considered becoming a traditional surrogate but felt they could not surrender a child that was genetically theirs. These results indicate that there is not any predisposing psychopathology which attracts participants to the gestational carrier program.


In vitro fertilization and gamete micromanipulation in the lowland gorilla. Our purpose was to utilize current reproductive technologies to treat an infertile female lowland gorilla. Following pituitary down-regulation with a gonadotropin releasing hormone agonist and follicular stimulation with human menopausal gonadotropins, transrectal ultrasound-guided aspiration of ovarian follicles yielded nine oocytes. Following failed fertilization with both epididymal and electroejaculated sperm, zona dissection and sperm injection were performed and produced one embryo, which was cryopreserved. Immature oocytes were obtained from ovarian sections and were either cultured in vitro or cryopreserved. This report demonstrates that in vitro fertilization techniques, including pituitary suppression, ultrasound-guided aspiration, micromanipulation, and cryopreservation, can be used to assist reproduction in the lowland gorilla.


Zona pellucida surface of immature and in vitro matured mouse oocytes: analysis by scanning electron microscopy. The aim of this work was to determine the morphology of the zona pellucida surface of immature and in vitro matured mouse oocytes by scanning electron microscopy. For this purpose two groups of immature oocytes (germinal vesicle group and metaphase I group) were studied either before or after in vitro maturation. Before in vitro maturation, the germinal vesicle immature group showed mainly an unstructured zona pellucida surface with smooth cumulus cells. The metaphase I immature group showed a more structured zona pellucida with smooth or blebbing cumulus cells. After in vitro maturation, development of the zona pellucida toward a mature surface, related to the initial degree of oocyte maturity, was observed in both groups. These observations show a correlation between the morphology of the zona pellucida surface and the degree of oocyte maturity; the in vitro maturation process can give rise to a proper development of this endowment when immature oocytes are used.


The effect of platelet activating factor on different phases of murine in vitro fertilization. Our purpose was to examine the effect of platelet activating factor (PAF) in different phases of mouse in vitro fertilization and optimal parameters that would enhance the fertilization rate. Various PAF concentrations (10(-7) to 10(-5) M) were selected to investigate its effect on three phases of mouse in vitro fertilization (i.e., sperm capacitation, sperm/oocyte coincubation, and preimplantation embryo growth) in three experimental groups: (I) with PAF treatment in the first phase, (II) with PAF treatment adopted in the first and second phases, and (III) with PAF treatment implemented in all three phases. The improvement of the fertilization rate in PAF treatment groups over the control group ranges from 6.5 to 19.0% (P < 0.05-P < 0.001). The highest enhancement of fertilization rate was achieved under the condition of PAF treatment (10(-6) M) through sperm capacitation and sperm/oocyte coincubation phases. The PAF concentration of 10(-6) M in sperm capacitation and sperm/oocyte coincubation yielded the greatest improvement in fertilization. However, continuing PAF treatment after sperm/oocyte coincubation had no beneficial effect on fertilization and preimplantation development.


Influences of in vitro oocyte aging on microfertilization in the mouse with reference to zona hardening. Our purpose was to investigate the influence of in vitro oocyte aging on fertilization and subsequent embryonic development following subzonal sperm injection with reference to spontaneous zona hardening in the mouse. First cleavage rate was significantly higher in long vs short (69 vs 41%, P < 0.001). However, significantly higher blastocyst formation and hatching were observed in short than long (50 vs 7%, P < 0.001, and 86 vs 50%, P < 0.001, respectively). No significant differences were found for two pronuclei formation between short and long (30 vs 27%). Sham injection revealed a significantly higher parthenogenetic activation in long than short (19 vs 2%, P < 0.001). Zona digestion required a significantly longer time for long compared to short (trypsin--37 vs 29 min, P < 0.01; pronase--17 vs 14 min, P < 0.001). Prolonged culture of mature mouse oocytes in vitro alters the zona pellucida, increases the rate of parthenogenetic activation by subzonal sperm injection, and impairs subsequent embryonic development. Zona hardening appears to be an indicator of oocyte aging.


Demographic differences between younger and older recipients seeking oocyte donation. An older population of women is now increasingly seeking infertility care. The number of these patients may in fact eclipse those of younger patients for whom the method of oocyte donation was initially designed and previously offered. As a group, these older individuals appear to be energetic and demanding, with high expectations regarding the performance and the effectiveness of their fertility care. Physicians need to exercise vigilance in order to emphasize that eggs are not being bought and sold as a commodity and that guarantees of pregnancies cannot be made. Nevertheless, whereas oocyte donation requires all parties, donor, recipient, and doctor, to work together toward a common goal, it still offers women of advanced reproductive age perhaps their best chance at conception, pregnancy, and parenthood.


Nonverbal students and school nurses: using a health-related communication board. This research study, conducted within a self-contained school for mentally disabled students, presents an innovative and creative approach to communication between the nonverbal student and the school nurse. A communication board was designed displaying 40 health-related symbols, thus providing a means for the nonverbal students, ranging in chronological age from 5 to 13 and intelligence ranges (I.Q.) from 5 to 55, to express their health needs during the nursing assessment.


The school nurse's role: early detection of growth disorders. Many school-age children with short stature or apparent growth excess are growing normally; however, for the minority of children experiencing growth problems, treatment may be indicated. The school nurse is in an ideal position to perform a preliminary growth-screening program. For accurate identification of potential growth problems, children must be properly weighed and measured, and the numbers plotted on a growth chart. Growth disorders can be caused by numerous underlying pathologies and diseases. Knowledge of these conditions can raise the index of suspicion so that appropriate referral can be made.


Identifying substance use: an assessment tool for the school nurse. A nursing assessment tool was developed to identify students who may be using drugs or alcohol. The three-part tool enables the school nurse to identify those students who require immediate medical care, as well as those who are impaired by substance use but medically stable. The use of the tool and implications for school nurses are discussed.


Microalbuminuria is no risk factor for restenosis following percutaneous transluminal coronary angioplasty. Microalbuminuria is known to be associated with an increased risk for cardiovascular disease. It is detectable in acute myocardial infarction and could therefore also be a risk factor for reocclusion after percutaneous transluminal coronary angioplasty (PTCA). In our study follow-up coronary angiography was performed in 50 consecutive patients with a mean age of 56 years (38-70) on average 14 months after successful PTCA. Restenosis was defined as a decrease in diameter of 25% or more of the original result and one of at least 50% in vessel diameter. In the restenosis group there were 23 patients, and 27 showed no restenosis. The family history and anamnestic risk profile, results of the initially performed coronary angiography, and laboratory risk factors were comparable in the two groups. Median microalbumin was 11.2 mg/g creatinine in those with restenosis and 9.8 mg/g creatinine in those without. Using a cut-off of 10.0 mg/g creatinine, 12 of 23 patients with restenosis (52%) and 10 of 27 patients without (37%) were positive for microalbuminuria (NS). The incidence of microalbuminuria was higher in both groups compared to historical controls. Thus, in the restenosis group the incidence of microalbuminuria tended to be higher than in the nonrestenosis group, but since this difference did not reach statistical significance, it cannot be used to predict the risk of reocclusion after PTCA.


Intestinal Enterocytozoon bieneusi microsporidiosis in an HIV-infected patient: diagnosis by ileo-colonoscopic biopsies and long-term follow up. A 39-year-old patient with acquired immunodeficiency syndrome was diagnosed as having intestinal Enterocytozoon bieneusi microsporidiosis after persistent watery diarrhea for 30 months and a 16-kg weight loss. Microsporidian parasites were found by light and electron microscopy in tissue specimens of the duodenum, jejunum, and terminal ileum, and by light microscopic examination of stool specimens. When duodenal tissue sections obtained 16 months previously were reviewed retrospectively, E. bieneusi was also found. Until now, diagnosis of intestinal microsporidiosis has been based on examination of bioptic specimens of the upper small intestine because the sensitivity of new coprodiagnostic techniques has not been determined. Our findings of ileal microsporidiosis show that examination of the terminal ileum and ileal biopsy collection in tandem with colonoscopy is indicated for patients infected with human immunodeficiency virus and suffering from unexplained chronic diarrhea. The long-term course of our patient demonstrates that E. bieneusi, although not necessarily life threatening, can cause protracted debilitating diarrhea and wasting in severely immunodeficient patients.


Left main coronary stenosis by a mediastinal lymphoma. A 50-year-old patient presented with a 3-month history of chest pain, a pathological result on electrocardiogram stress test, and signs of coronary heart disease on myocardial scintigraphy. Coronary angiography showed an isolated, moderate tubular stenosis of the left main coronary artery. Coronary bypass surgery was carried out, and intraoperative examination revealed a mediastinal lymphoma which caused the stenosis of the left main artery by external compression.


The influence of simvastatin alone or in combination with gemfibrozil on plasma lipids and lipoproteins in patients with type III hyperlipoproteinemia. Nineteen adult patients with type III hyperlipoproteinemia (HLP) and homozygosity for apolipoprotein (apo) E2 were treated with the 3-hydroxy-3-methyl glutaryl coenzyme A (HMG CoA) reductase inhibitor simvastatin (20 or 40 mg per day) alone or in combination with the fibrate derivative gemfibrozil (450 mg per day) during a 30-week outpatient study. With the 20-mg dose (n = 19) the mean plasma cholesterol level decreased from 13.24 +/- 8.04 at baseline to 8.04 +/- 4.19 mmol/l (mean reduction 39.3%; P < 0.05), and the mean plasma triglyceride level decreased from 13.47 +/- 19.22 to 7.84 +/- 7.71 mmol/l (-41.8%; NS); this was due to a decrease in very low density lipoprotein (VLDL) cholesterol from 8.95 +/- 8.64 to 4.94 +/- 4.24 mmol/l (-44.8%; NS), a decrease in low density lipoprotein (LDL) cholesterol from 3.54 +/- 0.93 to 2.25 +/- 0.59 mmol/l (-36.5%; P < 0.01), and an increase in high density lipoprotein (HDL) cholesterol from 0.72 +/- 0.28 to 0.85 +/- 0.34 (+18.1%; NS). Thirteen patients were treated with 40 mg simvastatin per day. Under this regimen there was a further significant decrease in LDL cholesterol from 2.33 +/- 0.62 to 1.81 +/- 0.49 mmol/l (-22.3%; P < 0.01). In six patients who remained hyperlipidemic on monotherapy combination drug therapy with simvastatin (40 mg per day) and gemfibrozil (450 mg per day) was given. Compared to simvastatin alone the addition of gemfibrozil further lowered plasma concentrations of total cholesterol by 14.9%, VLDL cholesterol by 23.5%, and triglycerides by 17.1%, although this was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)


Bucillamine (a new therapeutic agent for rheumatoid arthritis) induced nephrotic syndrome: a report of two cases and review of the literature. Two cases of nephrotic syndrome during bucillamine treatment were encountered in 1989 in our hospital; both patients had suffered from rheumatoid arthritis for 2 years. They had received 200 mg bucillamine orally per day for 3-4 months before the onset of the nephrotic syndrome. Discontinuation of bucillamine led to complete remission of the nephrotic syndrome within 1 year. Bucillamine is a new therapeutic agent for rheumatoid arthritis developed in 1982 in Japan. Since 1985, 14 cases of nephrotic syndrome, including the two cases reported here have been reported. We review these cases and discuss the pathogenesis.


On the potential of simple repetitive DNA for fingerprinting in clinical, forensic, and evolutionary dynamic studies. The purpose of this review is to discuss critically the practical meaning of a specific genome component, simple repetitive desoxyribonucleic acid (DNA) sequences as clinical and forensic and diagnostic and research tools. Previously, multilocus DNA fingerprinting was the major technology employed to visualize such simple repeat sequences. This technique enables many polymorphic loci to be simultaneously detected thus yielding vast amounts of information. With the advent of enzymatic DNA amplification via the polymerase chain reaction (PCR), individual simple repeat loci can be demonstrated, theoretically even from single DNA molecules and so a wealth of additional approaches have also become feasible. In general investigating, small, known, single copy parts of genomes have not posed truly insurmountable problems if enough material was available. There have even been a few (anecdotal) reports on the amplification of simple repeats from ancient DNA (see, e.g. [30]. Here we would like to after a solid basis for an earnest discussion of the applications of these simple repetitive sequences using various methodological approaches relevant for clinical diagnosis, setting aside the obvious unsolved mysteries of their biology.


Hypothermia in surgical patients.

Hypothermia in surgical patients. During the perioperative period little attention is given to thermoregulation. This can lead to hypothermia which has severe physiological complications. This article discusses the causes and effects of hypothermia in surgical patients and describes a study that the author conducted to discover the level of awareness on the subject among operating department staff.


Care of the paediatric day-surgery patient. Paediatric day surgery minimizes the length of the hospital stay and therefore is less traumatic for both child and parents. This is only true if the day-surgery process encompasses parental participation in care, good communication and a planned discharge process.


Psychological care of neuro-oncology patients and their families. This article examines the psychological needs of neuro-oncology patients and their families and presents two case histories which illustrate the way in which patients and their families can be brought to terms with their situations through skilled nursing intervention.


An open evening for stroke patients and relatives. A cerebral vascular accident (CVA) can cause fear and anxiety about the future for both sufferer and carers. Returning to the community after having been in the security of a hospital ward for many weeks can be traumatic. Nurses should enhance their health education programmes to prepare stroke patients and relatives for life at home.


What is nursing?

What is nursing? Recent efforts to redefine nursing have moved away from the traditional medically dominated approach, towards psychosocial care and forming relationships with patients. This article questions whether the focus has moved too far and urges nurses not to forget the bodily care that patients value and expect.


ABC of first aid.

ABC of first aid. Emergency care is a broad term which usually refers to a wide range of situations, procedures and services administered in a wide variety of emergency situations. This series of articles will examine the nurse's role, both within and outside the hospital. This article will describe what the nurse's first and second responses should be in an emergency.


Careers advice in preregistration nurse education. For student nurses approaching qualification, the range of post-basic choices can be overwhelming. At this time nurses need comprehensive, systematic career guidance, yet it is rarely forthcoming. This article examines some of the reasons why such guidance is so neglected and makes some recommendations for the future.


A human resource management approach to nursing education: 1. Human resource management (HRM) is an entirely new approach to the management of employees. In this the first of two articles, the elements that set it apart from traditional approaches to personnel management will be identified.


Nurses' attitudes to pain control and the use of pain assessment scales. The key to effective pain control is accurate assessment and, more importantly, the belief that what patients state about their pain is true. This research study investigates nurses' attitudes to pain and its assessment, and reveals why pain control continues to be an inconsistent affair.


Caring for patients undergoing treatment for vascular occlusion. In the treatment of arterial and graft occlusion, St George's Hospital has moved the emphasis away from long infusions of streptokinase to short, high-dose, pulsed administration of recombinant human tissue-type plasminogen activator (rt-PA). This has led to a change in nursing management.


Evaluating a health visiting service.

Evaluating a health visiting service. Community participation in the identification of health needs is vital if primary healthcare services are to be appropriate, acceptable and accessible to local people. Health visiting, especially, needs to adopt a flexible approach in order to respond to current health needs.


Stress and the student nurse in accident and emergency nursing. Accident and emergency (A and E) nursing is assumed to be very stressful. This article will briefly examine the concept of stress before exploring the literature on stressors associated with A and E nursing and in particular those associated with student nurses. The implications are explored and important questions posed.


The case against nurse advocacy.

The case against nurse advocacy. This article attacks the notion that nurses either can, or should, act as patients' advocates. It further suggests that nurses' motives for attempting to take the advocate role are, at least in part, disingenuous. Finally, there is a brief look at two alternative means of patient empowerment.


Prevention and treatment of the diabetic foot ulcer. More hospital beds are occupied by diabetics with foot problems than by all of the patients with other complications of diabetes put together. Footcare in the diabetic patient is therefore of paramount importance. This article examines treatment and dressing strategies and advocates a multidisciplinary approach.


A human resource management approach to nursing education: 2. In part 1 of this article, the elements that set human resource management apart from traditional approaches to personnel management were examined. Part 2 will consider the implications of these elements for the management and practice of labour relations within an NHS college of nursing in the 1990s.


Interferon regulatory factor-1 (IRF-1) activates the synthetic IRF-1-responsive sequence (GAAAGT)4 in Saccharomyces cerevisiae. In appropriate mammalian cells, interferon regulatory factor-1 (IRF-1) can activate the virus-responsive element of the IFN-beta promoter (VRE beta") or the synthetic oligonucleotide (GAAAGT)4. The latter contains two copies of the functional equivalent of PRDI, one of the regulatory domains of VRE beta". We prepared yeast strains containing an IRF-1 expression plasmid under the control of the galactose-inducible Gal1 promoter and a reporter plasmid with either (GAAAGT)4, VRE beta", or other test sequences placed upstream of a minimal promoter linked to the beta-galactosidase coding sequence. Upon induction of IRF-1 expression, the (GAAAGT)4-containing promoter was activated, but VRE beta" and all other sequences tested were inactive. Our results showed that IRF-1 belongs to a class of higher eukaryotic transcription factors that can interact with the yeast transcriptional machinery. Our findings also raised the question why the duplicate PRDI-like sequences in (GAAAGT)4 can be activated by IRF-1 synthesized in yeast, but not VRE beta", which also contains at least two PRDI-like sequences.


Elements of the rabbit uteroglobin promoter mediating its transcription in epithelial cells from the endometrium and lung. The rabbit uteroglobin gene is specifically expressed in certain epithelial cells of ontogenetically unrelated origin. In the endometrium, expression is restricted to the glandular and luminal epithelium and is inducible by progesterone and estradiol. In the lung, Clara cells lining the bronchiolar epithelium show constitutive expression of uteroglobin, which is modulated by glucocorticoids. To explore the molecular basis for this cell type specificity, we have transiently transfected the uteroglobin promoter region fused to the chloramphenicol acetyl transferase gene (CAT gene) in the endometrial cell line Ishikawa; in the human lung cell line NCI-H441, which shows morphological Clara cell characteristics; in HeLa cells; and in three fibroblast cell lines. The uteroglobin promoter efficiently drives expression of the CAT gene in Ishikawa and NCI-H441 cells, but not in HeLa and fibroblast cells. To identify the responsible elements we have analyzed progressive promoter 5'-deletion mutants and randomly generated linker scanning mutants spanning the sequence from -258 to -14 of the uteroglobin promoter. Transfection experiments reveal seven mutation-sensitive regions located around -30, -70, -95, -130, -190, -230, and -255. Several mutants display strong cell type-specific phenotypes. Most significantly, the integrity of the region around -190 is essential for full CAT gene expression in Ishikawa cells, but not in NCI-H441 cells.


Elements in the first intron of the alpha 1(I) collagen gene interact with Sp1 to regulate gene expression. Sequences within the first intron of the alpha 1(I) collagen gene act both positively and negatively to regulate expression of the gene. We have further characterized a 274 bp intronic sequence that contains an orientation-specific inhibitory activity and represents a constitutive DNase I-hypersensitive site in the gene. We show that this sequence contains two tandem, unique binding elements for the transcription factor Sp1. In addition, an Sp1-like site, capable of competing for protein binding to the intronic elements, resides in the distal promoter of the collagen gene. The results of experiments with site-directed mutations that abolish binding to the intronic elements indicate that these protein-DNA interactions have an inhibitory effect on the transcriptional efficiency of alpha 1(I) collagen-reporter gene constructs in transient transfection analysis. These data support our conclusion that the first intron plays a complex role, involving multiple protein-DNA binding interactions, in the regulation of expression of the alpha 1(I) collagen gene.


Characterization of two types of ribosomal gene transcription in Xenopus laevis oocytes. When the germinal vesicle of Xenopus laevis oocytes is translocated into the vegetal hemisphere by centrifugation, the normally silent ribosomal spacer promoters are strongly induced. This induction correlates with the permeability of the nuclear envelope to dextran of molecular weight 70 kDa, thus raising the possibility that the transcriptional changes are due to mixing of nuclear and cytoplasmic components. This basic observation prompted a thorough investigation of ribosomal gene transcription in centrifuged oocytes which had the germinal vesicle either in the animal half (A-oocytes) or in the vegetal half (V-oocytes). Two types of ribosomal gene transcription were characterized: (1) in A-oocytes, spacer promoters remain silent, transcription initiation is dependent on the upstream terminator T3, and transcription is highly processive and recognizes sites of RNA 3' end formation (like T2 and T3); (2) in V-oocytes, spacer promoters are induced, transcription initiation is independent of T3, but most transcripts terminate prematurely after less than 150 nt. Furthermore, the transcription machinery in V-oocytes does not respond to T2 or T3 signals. The implications of the present observations for our understanding of the regulation of the spacer promoters and of the function of the upstream terminator T3 are discussed.


Promoting quality through managed care.

Promoting quality through managed care. Managed care organizations will be able to promote quality care as well as control costs by utilizing quality management approaches and practice guidelines. By so doing, organized systems of care could promote adherence to standards of quality and appropriateness. Focusing on systems of care is a major component of the quality improvement process and fits well with the development and utilization of practice guidelines. Practice guidelines, as well as risk management, quality assurance, and quality improvement techniques, can help reduce undesirable variation in practice patterns and prevent problems from occurring. Guidelines may be based on different levels of explicitness ranging from subjective judgment to specific outcomes and patient preferences. The use of guidelines and quality improvement mechanisms will enhance the effectiveness of clinical decision making and enable managed care organizations to work productively with physicians to promote quality.


Is your organization ready for total quality management? The evolution to a Total Quality Management (TQM) or Continuous Quality Improvement (CQI) philosophy is particularly attractive in the health care industry in its search for better ways of doing business to ensure financial survival in the current competitive environment. This article, however, suggests that some organizations may not benefit from attempting to implement methodology to achieve the widely accepted financial and operational benefits, not because of any weakness in the conceptual framework, but because of the culture and/or lack of dedicated resources required to ensure the acceptance and success of the approach. As a result, many providers are discovering that after a few years of implementation, benefits to the organization are not being recognized to the extent possible. Specific issues that have been identified as essential requirements to a successful implementation process or evolution to a continuous improvement culture are described in this article.


The risk of transfusion-associated AIDS: offering patients an active role in their care. This article explores the duty of health care providers to inform patients of the risk of contracting AIDS through blood transfusions that may be necessitated by surgery or other forms of medical treatment. Although the quantitative risk of receiving HIV-contaminated blood in a transfusion is small, the qualitative risk is of a magnitude requiring complete disclosure if a patient's consent to treatment is to be considered adequately informed. Recent litigation confirms the importance of providing patients with the information needed to adequately assess the risks and benefits of proposed treatments that might involve a transfusion and reveals the need to offer the opportunity, where permissible, for autologous and directed donations. A comprehensive program embodying these concerns improves the quality of patient care and reduces exposure to liability for transfusions with contaminated blood.


Unnecessary hospitalization of Medicare patients in Ohio. A preliminary profile. Peer review organizations (PRO) review the health care given to Medicare beneficiaries. If a PRO determines that a hospital admission was unnecessary, the hospital is not reimbursed for the medical care and the case is "denied." The average hospital denial rate on Ohio is 2%; however, the denial rate for hospital admissions of one day or less is 7.5%. An analysis of hospitals and diagnoses for one-day hospital admission denials was performed, showing that urban hospitals and disorders of the circulatory and digestive systems predominate. The inappropriate utilization of health care resources costs millions of dollars per year in Ohio and could be costing the nation billions of dollars. There is an urgent need to research why resources are used less effectively by some hospitals and for some diseases.


Toward effective hospital utilization management. Ten lessons from case studies. The challenges presented by managed care arrangements and third-party utilization controls have led hospitals to strengthen internal utilization management programs. This article reports findings from a set of case studies on how hospitals have adapted their utilization management programs to their environments. While knowledge acquired from case studies should not be overgeneralized, the findings of these studies suggest some lessons that merit consideration by hospitals advancing their own programs in utilization management.


Bacterial vaginosis: a subtle yet serious infection. Bacterial vaginosis, previously designated nonspecific vaginitis, is the most common vaginal infection in reproductive-aged women. It is properly diagnosed using three of the four following criteria: (1) presence of homogenous, thin, milklike vaginal discharge; (2) vaginal pH > 4.5; (3) fishy odor on alkalinization of the vaginal secretions; and (4) presence of clue cells on microscopic examination of vaginal secretions. In recent years, numerous gynecological and obstetrical complications have been linked to this disease. Treatment of choice remains oral metronidazole, with clindamycin vaginal cream offering promise of similar efficacy with fewer side effects. Thorough and individualized treatment of asymptomatic women and sexual partners remains controversial. Patient education should be a pivotal part of effective therapy.


Vulvovaginal candidiasis: a current update. Vulvovaginal candidiasis (VVC) is one of the most common reasons a woman may visit her medical provider. In fact, vaginal complaints account for 10% of all visits each year, with the occurrence of VVC nearly doubling in the past ten years. The diagnosis of VVC is usually straightforward and the majority of patients readily respond to treatment with local antifungal therapy. However, 5% to 25% of these patients relapse, suffering recurrent symptoms within 1 to 3 months of treatment. The chronicity of these candidal infections becomes very frustrating to both patient and provider. The cause may be unclear and the course of treatment unsubstantiated in medical literature. Therefore, to minimize recurrence clinicians must always use a systematic approach to diagnosis, treatment, and follow-up for acute and chronic vulvovaginal candidiasis.


Cytolytic vaginosis: a common cause of cyclic vulvovaginitis. Cytolytic vaginosis (CV) infection is a little recognized but common cause of cyclic vulvovaginal complaints in women of reproductive age. Often misdiagnosed as candidiasis, most women have tried myriad antifungal medications to little or no avail. The history and physical examination is often similar to that seen in women with vaginal candidiasis. However in CV infection there is a luteal phase pattern of symptom recurrence. An astute clinician can make this diagnosis on vaginal microscopic examination and by meticulously ruling out other infections. Management consists of discontinuing all antifungal agents, using pads instead of tampons with menses, and taking baking soda sitz baths. Baking soda douches may also be helpful. As clinicians become familiar with CV infection, more women will be diagnosed and managed appropriately, leading to a long awaited resolution of their chronic vaginal complaints.


Vulvovaginitis in the prepubertal child. In prepubertal children the majority (25% to 75% of diagnoses made in referral centers) of complaints of vulvar inflammation and secondary vaginitis are benign in nature. This nonspecific vulvovaginitis responds well to hygiene measures and education. A child with persistent, purulent, or recurrent vaginal discharge deserves a complete assessment with cultures. When these complaints arise, clinicians must always be alert to the possibility of sexual abuse in children and therefore must conduct a sensitive and thorough history in addition to the examination.


Vulvovaginitis in the postmenopausal woman. Determining the cause and appropriate treatment of vulvovaginitis in the postmenopausal woman is complicated by the effects of decreased endogenous estrogen as well as normal aging changes. The symptoms of vulvovaginitis remain the same at any age but after menopause these symptoms can be the result of atrophy alone. Estrogen is the treatment of choice for atrophic vaginitis. The differential diagnosis and treatment of sexually transmitted diseases, candidiasis, and vulvar dystrophies are described and various alternatives to estrogen use are included.


Vulvar dermatoses.

Vulvar dermatoses. Dermatologic manifestations of vulvar disease can be confusing, the cause ambiguous, and the course of treatment long. Without a specific complaint, the vulva is often overlooked during a routine pelvic examination, and is often simply "the means to go through" in order to perform the routine Pap smear. The clinician must develop an awareness of the importance of dermatologic manifestations related to the vulva. A systematic approach is necessary to determine the pathogenesis and clinical behavior of vulvar conditions. This article will focus on identification of the various classifications of vulvar dermatoses, the causes of these conditions, differential diagnoses, accurate assessment, and management of cutaneous vulvar conditions.


Vulvar vestibulitis syndrome.

Vulvar vestibulitis syndrome. Vulvar Vestibulitis Syndrome (VVS) is a condition characterized by dyspareunia, introital erythema, and tenderness. A subset of vulvodynia, VVS may be acute or chronic. If acute, a specific underlying cause is often identified, and when properly treated the condition is likely to fully resolve. In contrast, chronic VVS is less well understood and is often multifactorial. Treatment is aimed at providing symptomatic relief and should begin with the least invasive approaches such as the use of topical xylocaine, oral antiviral therapy, acupuncture, and hypnotherapy. Interferon injections may be tried as last line medical therapy. Surgery has no role in treatment of acute VVS and is considered a last resort therapy for management of chronic VVS. Effort should be made to support the patient throughout the lengthy management process, encouraging patient participation, including negotiation of the treatment plan, and providing ongoing counselling and education.


Vulvovaginitis: promotion of condom use to prevent sexually transmitted disease. Many studies have suggested that merely warning people about the dangers of sexually transmitted diseases (STDs) and urging the use of condoms as protection will not result in widespread use of condoms. Regular condom use appears to be grounded in knowledge of its effectiveness, perception of STD risk, and belief in a partner's acceptance. But these are not the only barriers to condom use. Negotiating condom use often comes at a sensitive stage in intimate relationships, when individuals prefer to avoid such discussions and simply to trust the powerful and compelling feelings of mutual attraction. This review will consider (1) the effectiveness of condoms in preventing STD transmission, (2) barriers to the use of condoms, and (3) recommended strategies to promote acceptance and use of condoms by heterosexual women.


Vulvovaginal conditions: social, psychological, and sexual considerations. Women experiencing vulvovaginal conditions are affected socially, psychologically, and sexually. Although vulvovaginitis is a common women's health problem, these considerations are overlooked in the literature and, unfortunately, often in practice, as well. This article presents a discussion of the social, psychological, and sexual issues to be considered when treating women with vulvovaginal conditions, including implications for practice.


Recombinant LD78 protein, a member of the small cytokine family, enhances osteoclast differentiation in rat bone marrow culture system. Cytokine LD78 is a member of the small inducible protein family involved in cell growth, wound healing and inflammation. However, its exact function is not known. In this study, we demonstrated that recombinant LD78 alpha and its variant LD78 beta proteins stimulate osteoclast-like cell formation in rat bone marrow cultures in the presence of 1 alpha, 25-dihydroxyvitamin D3. This enhancing activity was independent of prostaglandin synthesis. This is the first report which describes the effect of proteins involved in the small inducible protein family on the differentiation of osteoclasts.


The progesterone antagonist, RU486 does not affect basal or estrogen-stimulated cancellous bone formation in the rat. Although it has been suggested that progesterone may have a role in preventing postmenopausal bone loss, a number of studies have shown that progesterone has no additive effect on estrogen therapy. We have recently found that high-dose estrogen stimulates bone formation in rats. The effect of progesterone on this anabolic action of estrogen has not been tested. We therefore investigated the role of progesterone in combination with endogenous or exogenous estrogen on bone formation in rats using RU486, which has been shown to be a potent progesterone antagonist without detectable agonist effects. Three-month-old Wistar female rats were treated for 17 days with RU486, and histomorphometric indices of bone formation were measured at the proximal tibial metaphysis after administration of double fluorochrome labels. Animals treated with RU486 (10 mg/kg) showed no change in either bone formation rate or double-labelled bone surfaces compared to vehicle-treated controls. Estrogen (17 beta-estradiol, 4 mg/kg) increased both indices by more than double compared with controls. RU486 did not affect the indices of increased bone formation in estrogen-treated rats. Estrogen also exhibited inhibition of longitudinal bone growth, while RU486 had no effect either in normal or estrogen-treated animals. These results show that the progesterone antagonist affects neither the stimulatory effect on formation nor the inhibitory effect on longitudinal bone growth by estrogen. These results suggest that progesterone does not play a significant role in either bone formation or bone growth in the rat.