Xenopus laevis sperm proteins, previously identified as surface proteins with egg coat binding capability, are indeed histone H4, histone H3, and sperm specific protein SP2. Recently, four Xenopus sperm proteins thought to be involved in binding to the egg envelope were identified (Lindsay and Hedrick, J. Exp. Zool., 245:286-293, '88). We have studied the three more abundant ones of apparent molecular weight of 14, 19, and 25 kd in SDS-PAGE. We have shown that these proteins are indeed nuclear basic proteins: the 14 kd is the histone H4, the 19 kd is the histone H3, and the 25 kd is the sperm-specific protein SP2.


Immunocytochemical analysis of the association of bovine oviduct-specific glycoproteins with early embryos. The bovine oviductal epithelium synthesizes and secretes a class of oviduct-specific glycoproteins that is present in the luminal fluid when fertilization and early embryonic development occur. The objective of this study was to determine if these characterized glycoproteins become associated with oviductal embryos. Ovarian ova and oviductal embryos were recovered from super-ovulated cows at 72 h after onset of estrus. Eggs were fixed in 3% paraformaldehyde-1% glutaraldehyde and subsequently embedded in Lowicryl K4M. Sections (1 micron) were processed for peroxidase-antiperoxidase immunocytochemistry. Immunolabeling was not detected in any region of ovarian ova. Oviductal embryos, regardless of cleavage stage, exhibited immunoperoxidase staining localized within their zona pellucidae. Sections (100 nm) obtained from a 4- and an 8-cell embryo were also subjected to colloidal gold immunoelectron microscopy to determine conclusively the subcellular distribution of the oviduct-specific glycoproteins. Gold particles were distributed uniformly throughout the width of the zona pellucida. Also, immunoreactivity was observed associated with flocculent material in the perivitelline space and with the vitelline membrane. These results indicate that the bovine oviduct-specific secretory glycoproteins become associated with oviductal embryos. This association may be biologically important to the developing embryo.


Reporting of highly individual genetic typing results: a practical approach. This paper considers the interpretation of serological typing data as a problem in forensic science, as opposed to a problem in population genetics or statistics. Controversies arising in this area are partly due to an overly narrow perspective that ignores basic forensic science principles. After an initial discussion of the special problem that deoxyribonucleic acid (DNA) blood typing poses to forensic science, the three difficulties common to all the proposed interpretive methods are discussed. These are: predicting genotype incidence from allele frequencies, predicting frequencies for the joint occurrence of genotypes in a number of different genetic marker systems, and determining the appropriate population to use to measure the frequencies. The inability to test assumptions that are inherent in our routine methods is noted. This is a procedural weakness that unnecessarily limits the admissibility of DNA typing evidence in court. A practical solution to this problem is offered that begins with minimal assumptions. Initially a statement is made based on (1) how many reference samples the laboratory has typed and (2) how many of these samples show genotypes corresponding to the case samples. The second stage of the presentation begins with a statement that additional assumptions are necessary to fully interpret the evidence and that although these assumptions are scientifically very reasonable, they cannot be absolutely proven. The presentation can then proceed, if desired, to consideration of the specific assumptions and frequency estimates of any of the methods that have been proposed to date. To follow this approach population data must be kept in a form that allows the simple first-stage statement to be made. This means that each individual's record would include typing results in each genetic marker system. Although this method of data storage differs from that used in most forensic science laboratories, it is exceptionally versatile, and allows great flexibility in data analysis.


Isolation of deoxyribonucleic acid (DNA) from saliva and forensic science samples containing saliva. Saliva and saliva-stained materials were examined as potential sources of deoxyribonucleic acid (DNA) for DNA analysis and identity testing. In this paper, the authors demonstrate that DNA was isolated and DNA banding patterns suitable for DNA typing were obtained from fresh saliva and various saliva-stained materials, such as envelopes, buccal swabs, gags, and cigarettes. Furthermore, DNA and DNA banding patterns were obtained from actual forensic evidentiary samples containing mixed saliva/semen stains. The DNA banding patterns obtained from saliva or saliva-stained material were indistinguishable from the patterns obtained from blood or hair from the same individual. Intact DNA was readily isolated and DNA banding patterns were obtained from saliva stored at -20 degrees C and dried saliva stains stored under varying conditions. We conclude that saliva and saliva-stained material can be good sources of DNA for analysis and for DNA typing in certain forensic settings.


Ribosomal ribonucleic acid (rRNA) gene typing for species identification. Deoxyribonucleic acid (DNA) typing of ribosomal ribonucleic acid (rRNA) genes was performed with a polymerase chain reaction (PCR) assay for species identification. A variable region of the 28S ribosomal RNA gene was amplified with primers complementary to flanking sequences phylogenetically well conserved. The products of twelve animal DNAs (human, Japanese monkey, dog, cattle, pig, cat, rabbit, mouse, rat, chicken, frog, and fish) were separated by polyacrylamide gel electrophoresis, each revealing a few bands ranging from 150 to 100 base pairs. The band patterns obtained from each DNA sample differed in number and size, which indicates the applicability of the method to species identification. Samples containing either as little as 1 pg of DNA or degraded DNA of 0.2 to 0.5 kb in length were able to give detectable bands. Postmortem human tissue DNAs were tested as an example. They showed a pattern identical to the human control one, which was distinct from those of the other animals examined.


The effect of ibuprofen on ethanol concentration and elimination rate. Pursuant to a recent driving under the influence (DUI) case, a medical study of six subjects was cited reporting that ibuprofen causes a decrease in the maximum rate of elimination of ethanol. Such a drug interaction is of significant forensic science interest and warrants further examination. This study investigates the effect of ibuprofen on ethanol elimination rate and ethanol concentration in nineteen volunteers. Volunteer subjects were randomly assigned to two groups administered either a placebo followed by ethanol or ibuprofen followed by ethanol. Subjects served as their own control. Blood ethanol concentrations were monitored every 30 to 60 min for up to 4 h with Intoximeter 3000 instruments. A blood sample was drawn at the final Intoximeter test and analyzed for ethanol and ibuprofen by gas chromatography and mass spectrometry, respectively. The mean elimination rate (+/- SD) as calculated using Widmark's elimination factor was 0.018 +/- 0.006 g/dL for ethanol and 0.017 +/- 0.007 g/dL/h for ethanol with ibuprofen. Mean ethanol concentrations (g/dL +/- SD) were: 0.095 +/- 0.026 (ethanol) and 0.095 +/- 0.033 (ethanol and ibuprofen) at 30 min; 0.077 +/- 0.026 (ethanol) and 0.075 +/- 0.031 (ethanol and ibuprofen) at 150 min; and 0.089 +/- 0.025 (ethanol) and 0.087 +/- 0.030 (ethanol and ibuprofen) overall. There was no statistically significant affect of ibuprofen on either the peak blood ethanol concentration or the ethanol elimination rate (p less than or equal to 0.001). These results reveal no evidence of a significant ethanol-ibuprofen interaction.


Comparison analysis of illicit cocaine samples. A rapid method for comparison analysis of illicit cocaine samples has been developed. The raw data are obtained by capillary gas chromatography using a nitrogen-phosphorus detector. The area ratios of four alkaloids (tropacocaine, norcocaine, cis-cinnamoylcocaine, and trans-cinnamoylcocaine) to cocaine are calculated for each sample. These ratios are compiled in a computer database which allows easy comparison of samples and makes possible reliable conclusions regarding their commonality of origin.


A rapid gas chromatographic method for the fingerprinting of illicit cocaine samples. A gas chromatographic (GC) fingerprint method, based on the presence or absence of six congeners, was developed for illicit cocaine samples. The fingerprint utilizes the relative abundances of these congeners towards each other, disregarding cocaine as the main constituent, and can be expressed numerically or graphically in the form of pictograms for rapid visual comparison. The method can be applied directly to a solution of the sample in chloroform, without previous workup procedures. More than 70 unrelated samples were analyzed and a great variation was observed in the parameter composition. On the other hand, a remarkable similarity could be seen between related samples. The GC fingerprint method may be considered an important contribution for sample comparison, as is exemplified by a subdivision of the analyzed samples in different categories, based on the number and types of congeners found.


The analysis and identification of steroids. In October 1987, anabolic steroids were controlled under Schedule IV of Florida State Statute 893. This study was designed to establish a method of analysis and identification of evidentiary cases. Spot tests, Fourier transform infrared spectroscopy (FT-IR), gas chromatography/mass spectroscopy (GC/MS), Fourier transform nuclear magnetic resonance (FT-NMR), thin-layer chromatography (TLC), and extractions were performed on standard and pharmaceutical steroids. Mandelin's accompanied by the sulfuric acid test was found to provide the best indication of a steroid among the following four spot tests performed: sulfuric acid, napthol-sulfuric acid, Liebermann's, and Mandelin's. TLC was successfully performed on the steroid samples using two different eluent systems: TP and TQ. GC/MS was a very useful method of analysis applicable to most steroids, with only a few exceptions. FT-IR spectra were found to match the spectra from the literature for all the standards tested. The combination of the above techniques was used successfully to identify all the standards tested.


Fourier transform infrared/Raman differentiation and characterization of cis- and trans-2,5-dimethoxy-4,beta-dimethyl-beta-nitrostyrenes: precursors to the street drug STP. Fourier transform Raman and infrared spectra of pure cis(Z)- and trans(E)-2,5-dimethoxy-4,beta-dimethyl-beta-nitrostyrene (precursors of the psychotomimetic street drug STP or DOM) were recorded in the solid state. The spectra show characteristic features of the ethylene moiety and of the aryl and nitro substituents which permit ready differentiation and identification of these isomers. A very strong Raman line at 1670 cm-1 from the cis isomer for the C=C stretching mode, in comparison with a strong Raman line at 1641 cm-1 for the trans isomer, affords primary differentiation of these substances. A second characteristic, of both the Raman and infrared (IR) spectra, is that the frequency of the strong symmetric nitro (NO2) stretching band is about 40 cm-1 higher in the cis (1346 cm-1) than the trans isomer (1301 cm-1). All major IR and Raman bands are reported and given vibrational assignments.


Differentiation of side chain isomers of ring-substituted amphetamines using gas chromatography/infrared/mass spectrometry (GC/IR/MS). Common analytical methods used for identifying samples obtained from clandestine laboratories were evaluated for their ability to differentiate between possible amphetamine isomers and homologs. A series of ring-substituted (4-methyl, 4-methoxy, and 3,4-methylenedioxy) amphetamine and N-methylphenethylamine isomers was analyzed using color tests, thin-layer chromatography, gas chromatography/mass spectrometry (GC/MS) and GC/infrared (GC/IR). The N-acetyl derivatives of the isomers were analyzed using GC/IR/MS. GC/IR/MS readily differentiated the 4-methylphenylalkylamine isomers. MS and IR spectra were also obtained for each pair of the 4-methoxyphenylalkylamine isomers and the 3,4-methylenedioxyphenylalkylamine isomers, but differentiation via GC/IR/MS was difficult. The N-acetyl derivatives of each pair of isomers could be readily differentiated using GC/IR/MS. Good library researchable spectra for N-acetylamphetamine could be obtained for IR identification with 10 ng (on-column) and MS identification with 2 ng. The spectrometrically independent IR and MS data obtained for the N-acetyl derivatives indicated that the combination of GC/IR/MS can add a significant level of confidence in the analysis of ring-substituted arylalkylamines.


Neck injuries: I. Occipitoatlantal dislocation--a pathologic study of twelve traffic fatalities. Twelve of 155 persons killed in traffic crashes had occipitoatlantal dislocations. Nine were vehicular occupants, 2 were cyclists, and one was a pedestrian. The dislocations involved various combinations of lacerations of the alar ligaments, the occipitoatlantal joint capsules, the dura mater, the tectorial membrane, the rectus capitis muscles, and the suboccipital muscles. In 2 instances, an occipital condyle failed instead of the corresponding alar ligament, producing condyle fractures. Atlas ring fractures occurred in 3 instances. Axial and subaxial cervical trauma were uncommon. Facial or mandibular fractures occurred in a majority of cases, vault skull fractures were uncommon, and basilar fractures were absent. Pontomedullary brainstem lacerations occurred in 9 of the 12, and 4 had midbrain lacerations. The majority of the victims succumbed to acute neurogenic shock as the sole or the major mechanism of death. The biomechanical basis for occipitoatlantal dislocation is discussed, and the author suggests that distraction, in concert with variable combinations of extension, rotation, and posterior translation is responsible for occipitoatlantal dislocations.


Neck injuries: II. Atlantoaxial dislocation--a pathologic study of 14 traffic fatalities. C1-C2 vertebral dislocations have not been commonly recognized at autopsy. Among 66 subjects with neck injuries, drawn from a series of 155 traffic fatalities, were 14 with injuries at the level of the atlantoaxial motion segment, ranging in age from 8 months to 93 years. Thirteen had sprains or lacerations of the atlantoaxial facet joints, and one had a healed C1 fracture. Six of the 14 had odontoid fractures. None had transverse ligament lacerations. Injuries of the alar ligaments and the tectorial membrane were frequent. Only 3 subjects had subaxial cervical injury. All 14 had evidence of impact to the head or neck. Four had fractures of the mandible or facial bones, and 5 had skull fractures. Subdural and subarachnoid hemorrhages were found in 7 and 6, respectively. Brainstem lacerations were not uncommon, but only one had a pontomedullary laceration. Spinomedullary cord injuries occurred in 5. Acute neurogenic shock was the major mechanism of death in 9 of the 14, including 5 with major cardiovascular lacerations. Delayed effects of craniocerebral trauma accounted for the majority of the remainder. The biomechanical mechanisms are discussed.


Correlation of trauma and cause of death to accident reconstruction: a case of a flight accident report. This paper reports on the disaster that occurred after a flight was hijacked at Baiyuen International Airport in Guangzhou, China, on Tuesday, 2 Oct. 1990. The authors show the results of analyses for the causes of death and trauma and compare the disaster with several previous flight accidents that have occurred in China. The authors show, with the analysis on this accident, the possibility and reliability of reconstructing a disaster by medicolegal investigation.


Big game species identification by deoxyribonucleic acid (DNA) probes. Species identification is important in many big game forensic science cases but cannot always be accomplished because of the lack of adequate techniques. The authors have developed deoxyribonucleic acid (DNA) probes for elk, deer, and antelope by isolating highly repeated satellite sequences. These DNA probes distinguish among deer, elk, and antelope, although not between different species of deer. Because of the high number of sequence copies per genome, these probes are extremely sensitive, requiring less than 10 ng of total genomic DNA. The developmental protocol for these probes is relatively simple and is applicable to many other species.


Comparison of Abbott fluorescence polarization immunoassay (FPIA) and Roche radioimmunoassay for the analyses of cannabinoids in urine specimens. Abbott fluorescence polarization immunoassay (FPIA) and Roche Abuscreen radioimmunoassay (RIA) were compared qualitatively with 142 urine specimens containing 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid. Similar qualitative results were obtained in 132 specimens. When discrepent results were observed, all negative results were within 20% of the 100 ng/mL cut-off. We concluded that FPIA and RIA give comparable results to each other.


Direct analysis for cocaine in urine by high-performance liquid chromatography (HPLC) using a column-switching technique. The analysis of urine for the presence of drugs generally requires that the drug be first extracted from relatively large concentrations of endogenous compounds. By replacing the injection loop with a loop incorporating a cyano precolumn, urine can be injected directly onto the high-performance liquid chromatograph. Interfering compounds are washed off of the precolumn, with the valve in the load position. When the valve is then switched to inject, the mobile phase elutes the cocaine from the precolumn onto the analytical column. A preliminary identification of cocaine and benzoylecgonine can be made using this technique, which requires 100 microL of sample and has a detection limit of 10 ng/mL.


Elevator surfing: a deadly new form of joyriding. A new form of joyride, on top of an elevator as it moves up and down the elevator shaft, has surfaced on college campuses and in housing and apartment complexes with elevators. This practice is called "elevator surfing," and an illustrative case is presented, which is believed to be the first such report in the medical literature.


Fatal dissecting aneurysm of the internal carotid artery with delayed symptoms following facial impact. A fatal dissecting aneurysm of the internal carotid artery occurred in a 16-year-old male following facial impact in an automobile accident. The patient showed no neurologic deficit until two days after the automobile accident, when he suddenly started having seizures and developed right-sided hemiparesis. There was no evidence of direct trauma to the neck externally or internally. The only injuries observed in the head and face were two skin lacerations in the chin area. His condition rapidly deteriorated, and he expired on the fourth hospital day. The gross and microscopic findings for the internal carotid artery are presented. The possible mechanisms for the vascular lesion and a review of the literature are discussed.


Bullet identification: a case of a fatal hunting accident resolved by comparison of lead shot using instrumental neutron activation analysis. Bullet identification by chemical analysis often provides a powerful clue in forensic science. A case is reported in which a hunting accident was resolved by using instrumental neutron activation analysis (INAA) for direct comparison of the trace element content in lead shot. Different preparation batches of lead shot appear to have a high within-group composition homogeneity, and good differentiation is achieved between different batches. Determination of the nickel and antimony content on a bush branch demonstrated that the branch had been perforated by one of the shot pellets, and this helped the detectives in reconstruction of the crime scene.


To live or to die. Causes of mortality among POWs in South Vietnam. I have attempted to evaluate some of the varied reasons for the mortality among a small group of POWs interred in one camp in Quang-Nam, South Vietnam. There were many factors affecting survival: physical, psychological, social, cultural, racial, and, of course, the whim of fortune. The ancient message seems to be, however, that man is an adaptive animal; he learns from his own experiences as well as the experiences of others. Though he is a product of his environment and may be subjugated and destroyed by a strange one, he constantly attempts to work within it, to mold it, and to rise above it. It is the key to survival.


Positron emission tomography in clinical practice. Positron emission tomography (PET) has been considered a research tool; however, advances in hardware and software, along with availability of small medical cyclotrons, make clinical metabolic imaging feasible. There is accumulating data, especially in the areas of neurology and cardiology, to support its use in the appropriate clinical setting and patient population.


Limited incision cholecystectomy.

Limited incision cholecystectomy. Eighty-one consecutive cholecystectomies were retrospectively reviewed; five were dropped because of incomplete data. The remaining 76 were divided into group A, patients who underwent a limited incision cholecystectomy (LIC) defined as less than 10 centimeters, and group B, those who underwent a standard subcostal incision (STD). An STD was used for 18 patients in 1984 and an LIC for subsequent patients unless anatomy dictated extension of the incision for safe surgical exposure. The groups were evaluated for possible benefits and disadvantages of the LIC approach. Multivariate analysis was done to contrast the approaches regarding operative time, operative and postoperative complications, postoperative pain, and hospital stay. The operative time was comparable between the two groups. The LIC approach was superior with less postoperative pain and shorter hospital stay. There were no intraoperative complications or mortality in either group. The postoperative complications were also comparable. No differences were noted in body size, weight, sex, or whether the patient was suffering from acute or chronic disease. The limited incision cholecystectomy can be utilized in the majority of patients with cholecystitis without added operative time or complications when compared to the traditional approach. The benefits of less postoperative pain, shorter hospital stay and better cosmetic results afford a higher degree of patient acceptance. This procedure should be considered when open cholecystectomy is required.


University neonatal centers and level II centers compatibility. Jacksonville experience. Reported are 10 years experience in the development of a Citywide Neonatal Program in the Jacksonville area, which could be helpful as a model for establishing relationships between academic centers and outside Level II nurseries. The four phases of development are documented. An analysis of the financial impact to the academic program is presented and also an outline of the gain realized by the Department of Pediatrics, University of Florida Health Science Center. The positive results in amalgamation of the neonatal services in Jacksonville have far outweighed any potential harmful effects from competition between an academic center and other private nurseries in the city.


Parental perceptions and psychopathology. Various theories of personality and psychopathology hypothesize that there should be a relationship between parental perceptions and level of psychopathology. However, there has been relatively little research investigating the parental perceptions-psychopathology relationship, and much of the research in this area has been methodologically flawed. The present study tested four hypotheses regarding the parental perceptions-psychopathology relationship, using a parental representations measure that circumvents many of the problems that have characterized previous research on this topic. Results indicated that psychiatric patients (N = 66): a) viewed both parents more negatively than did members of a matched sample of 66 normal subjects; b) expressed significantly greater ambivalence regarding both parents than did normal subjects; and c) described both parents at a more primitive conceptual level than did normal subjects. As predicted, there was a parallel relationship between perceptions of the parents and overall level of psychopathology within the inpatient sample. The findings are discussed in the context of traditional trait-oriented personality theories as well as more recent social learning theories of personality.


Fear of abandonment and binge eating. A subliminal psychodynamic activation investigation. Dependency and fear of abandonment by significant others have been theoretically linked to eating disorders, particularly bulimia. This research investigates the hypothesis that unconscious fear of abandonment is one variable underlying binge eating episodes in bulimia. An analogue population of 40 "high eating disorder" undergraduate women and 40 undergraduate women with normal eating patterns viewed either an abandonment or a control stimulus presented at either subliminal (4 msec) or supraliminal (200 msec) exposure durations. Following exposure to an abandonment stimulus, the high eating disorder group ate significantly more crackers in a bogus cracker rating task (p less than .001) than did subjects in any other condition. Contrary to predictions, a subliminal stimulus did not lead to a significant change in self-reported mood. Results provide preliminary support for the psychoanalytic hypothesis that binge eating is a defense against unconscious fear of abandonment.


The relationship of life adversity, social support, and coping to hospitalization with major depression. We evaluated the relationship between life events, social support, coping, and depression in 27 male inpatients meeting the requirements for Research Diagnostic Criteria major depressive disorder and in 35 age- and sex-matched nonpatients. Overall, the hospitalized depressed patients reported significantly more events and difficulties than did the controls, but this difference in statistical significance disappeared after excluding from analysis "non-independent" happenings which could have been brought on by depression. More hospitalized depressed patients (23 of 27, or 85%) than controls (8 of 35, or 22.9%) experienced markedly threatening events and difficulties ("marked adversities") in the 6 months before their interview. The depressed group also reported having significantly fewer social supports, being less satisfied with the emotional component of this support, and using more emotion-focused coping than the controls. A discriminant analysis predicted depressive status from a combination of marked adversities, reduced number of social supports, and greater use of emotion-focused coping. The results indicate that the relationship of life events to depression is complex. The excess number of events might be partly a product of dysfunctional behavior that "produces" depression-related events which might, in turn, exacerbate depression; simultaneously, patients are more likely to experience highly adverse events which might precipitate the depression in the first place. Reduced social supports and the use of emotion-focused coping appear to also be associated with hospitalization for major depression.


Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. A population of the fire fighters who had been exposed to a natural disaster were screened using the General Health Questionnaire 4, 11, and 29 months after a natural disaster. On the basis of these data, a high-risk group of subjects who had scored as cases and probable cases and a symptom-free comparison group were interviewed using the Diagnostic Interview Schedule 42 months after the disaster. The prevalence of posttraumatic stress disorder (PTSD), affective disorders, and anxiety disorders was examined. Only 23% of the 70 subjects who had developed a PTSD did not attract a further diagnosis, with major depression being the most common concurrent disorder. Comorbidity appeared to be an important predictor of chronic PTSD, especially with panic disorder and phobic disorders. The subjects who had only a PTSD appeared to have had the highest exposure to the disaster. Adversity experienced both before and after the disaster influenced the onset of both anxiety and affective disorders.


Posttraumatic stress disorder among injured survivors of a terrorist attack. Predictive value of early intrusion and avoidance symptoms. Fifteen injured survivors of a terrorist attack on a civilian bus were followed during their admission, and 12 of the 14 living survivors were examined 10 months later. A substantial amount of distress was found, in the entire group, across the study. Four patients (33%) suffered from diagnosable PTSD on follow-up. Symptoms of intrusion and denial, recorded during admission, failed to predict PTSD, and were not significantly correlated with psychiatric symptoms on follow-up. This paper discusses the finding of low predictive validity of early PTSD symptoms, and suggests that measures of arousal should be added to those of cognitive symptoms in future prospective studies of traumatic stress.


Negative symptomatology in schizophrenic outpatients. This study examines the prevalence of negative symptoms, and assesses the convergence of negative and depressive symptoms in 60 chronically ill schizophrenic outpatients. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms and the negative symptom cluster of the Brief Psychiatric Rating Scale (BPRS). Depressive symptoms were assessed with the depression subscale of the Brief Symptom Inventory and the depressive symptom cluster of the BPRS. A majority of patients in this group of relatively stable, schizophrenic outpatients demonstrated mild to moderate degrees of both negative and depressive symptoms. Correlations were not significant between negative symptom and depressive symptom measures, which suggests that the symptom constructs are relatively independent. Comparisons between a subgroup with prominent negative symptoms (N = 18) and a subgroup with minimal negative symptoms (N = 32) also revealed no significant group differences in variables that characterize clinical course (i.e., age of onset and frequency and duration of hospitalization) or in the severity of depressive symptoms. This lack of any significant differences on the clinical course variables may be partially explained by the heterogeneity of negative symptoms. The constellation of negative symptoms may differ not only in etiology but also in their temporal relationships to other aspects of the patient's clinical course. Longitudinal studies will be needed to track the long-term outcome of negative and depressive symptoms.


Dream structure in Parkinson's patients. Dream reports of patients with Parkinson's disease (PD) were analyzed to ascertain whether cognitive deficits associated with this nonfocal brain pathology influence dream structure or dream recall. Fifteen outpatients with idiopathic PD were sampled (diagnosed from 1 to 10 years and currently in stage II or III of Hoehn and Yarh's scale); all were without psychiatric symptoms or major medical illnesses and were currently being treated with L-dopa. After an adaptation night in the sleep laboratory, each patient spent a night in which he/she was awakened at least twice in rapid eye movement sleep and asked to report dream experience. Thirteen patients were able to report at least one dream. Overall frequency of dream recall (71.4%) was fully compatible with normative data for the elderly. Multiple regression analyses showed that both the length of the dream report as story and the organization of contents into coherent episodes (analyzed using Mandler and Johnson's story grammar) varied significantly in relation to level of cognitive functioning and, in part, of language comprehension, but not in relation to age, illness duration, and dose of L-dopa.


The use of electroconvulsive therapy in patients with dissociative disorders. The psychiatric literature generally discourages the use of electroconvulsive therapy (ECT) to treat depression in dissociative disorder patients, but contains little data on outcome. This prospective study of ECT in three dissociative disorder patients demonstrates that ECT is indicated for severe treatment-resistant depression in such patients. Their Hamilton Depression Scale scores fell by 50%, they were remarkably clinically improved, and they maintained their gains for at least 4 months. The ECT proved helpful when depression was felt by most of the active alters rather than just by one depressed personality. Mini-Mental State Examination scores and clinical observation revealed no unusual confusion or side effects from ECT. These patients' dissociated condition was not altered by ECT, which indicates that ECT neither treats nor impairs treatment of dissociation. Electroconvulsive therapy can be helpful in the overall treatment of dissociative disorders by alleviating severe depressions which block utilization of psychotherapy.


The Separation-Individuation Inventory. Association with borderline phenomena. The Separation Individuation Inventory (SII; Christenson and Wilson, J. Nerv. Ment. Dis., 173:561-565, 1985) was designed to assess adult psychopathology construed in terms of the concepts of separation and individuation (Mahler, Pine, and Bergman, The Psychological Birth of the Human Infant: Symbiosis and Individuation, 1975). Its reported use is confined to the original authors' paper, which compared scores of 20 subjects with borderline personality disorder with the scores of staff control subjects. We report the association of the SII with two self-report measures of borderline personality diagnosis and phenomenology. Our British samples, from the staff and residents in a therapeutic community for severely personality-disordered clients, thus complement the original American work. The SII was found to have good internal consistency, respectable screening parameters, and high correlations with indications of trait psychopathology. We suggest a slight modification to the scoring of the inventory and two main areas for additional research.


Effect of external urinary collection system on colonization and urinary tract infections with Pseudomonas and Klebsiella in men with spinal cord injury. Urinary tract infection of men with spinal cord injuries has been associated with a high incidence of colonization of the patients with gram-negative bacilli. We have examined the factors influencing colonization of 119 patients with Pseudomonas and Klebsiella and studied methods of reducing this colonization. The urethra, perineum, rectum, and drainage bag of all patients were cultured on selective media at two week intervals until discharge. The use of the external urinary collection system (EUCS) was discontinued in a group of patients at night, in an attempt to reduce colonization. Pseudomonas and Klebsiella were isolated from one or more body sites in 65 percent and 69 percent of total culture days. The urethra, perineum, rectum, and drainage bags were reservoirs of Pseudomonas and Klebsiella in men with spinal cord injuries, even in the absence of urinary tract infections. The EUCS proved to be an important factor influencing colonization. Pseudomonas and Klebsiella colonization was higher in patients using the EUCS. Removal of the EUCS at night reduced urethral colonization with Pseudomonas, but did not significantly reduce urethral colonization with Klebsiella. The prevalence of bacteriuria with Pseudomonas and Klebsiella was not significantly influenced by the use of the EUCS.


The serum lipoprotein profile in veterans with paraplegia: the relationship to nutritional factors and body mass index. Individuals with spinal cord injury have a shortened life expectancy, with coronary heart disease as a leading cause of death. Identifying potentially reversible risk factors would be expected to be of value in the long-term care of the person with a spinal cord injury. We addressed the relationships among diet, body mass index, and serum lipid levels in 28 veterans with paraplegia compared to 52 age-matched ambulatory veteran controls. There are no significant differences in body mass index or in total caloric, saturated fat, or cholesterol intake between those with paraplegia and the control group. The serum HDL cholesterol level is significantly lower in those with paraplegia compared to the control group (35 +/- 2 vs 49 +/- 2 mg/dL). There are no significant differences noted in serum total cholesterol, LDL cholesterol, or triglycerides between the groups. Total caloric intake decreases significantly with age in the control subjects but not in the subjects with paraplegia. Inverse correlations are found between serum HDL cholesterol and serum triglycerides levels both in those with paraplegia (r = -0.54, p less than 0.005) and in the controls (r = -0.42, p less than 0.001). In our group of subjects with paraplegia, serum lipid levels appear to be independent of dietary intake and body weight.


Immobilization osteoporosis in paraplegia. The pathophysiology of osteoporosis as it relates to immobilization or disuse osteoporosis in paraplegics is briefly reviewed. The physiology of bone formation and resorption is discussed, and the influence of piezoelectric forces on bone integrity and the consequences of the loss of this effect in paraplegics is addressed. When bone is stressed, negative charges accumulate on the side from which the stress is applied and positive charges accumulate on the opposite side. Presumably the collagenous component of bone plays the major role in the generation of electrical potentials. Another mechanism important in the generation of electrical potentials is created by liquid planes streaming past solid planes. Diminished forces acting on bone, as in paraplegia, are translated into changes in the activity of bone remodeling units which can be assessed by histomorphic and histoenzymatic techniques. Other biochemical and endocrine consequences of immobilization involve increased serum calcium, decreased serum parathyroid hormone (PTH), and decreased dihydroxy-vitamin D synthesis. Urinary hydroxyproline and calcium excretion are increased, as is stool calcium. The bone loss that follows immobilization may produce an increased susceptibility to fractures involving long bones more than the spinal column, and is due more to decreased bone formation than to accelerated bone resorption. The treatment of immobilization osteoporosis primarily involves early remobilization, but other treatments, including the use of electrical fields and the administration of bisphosphonates, calcitonin, and a growth hormone are being actively investigated.


Autonomic hyperreflexia with spinal cord injury. Autonomic hyperreflexia occurs in up to 85 percent of individuals with spinal cord injuries above the major splanchnic sympathetic outflow. In such cases, paroxysmal reflex sympathetic activity develops in response to noxious stimuli below the level of the neurologic lesion. The clinical features of autonomic hyperreflexia are due largely to reflex sympathetic adrenergic and cholinergic discharges with dysfunctional supraspinal regulatory control. Cephalgia, diaphoresis, flushing, tachycardia or bradycardia, and paroxysmal hypertension are most commonly observed. Although a variety of stimuli can provoke autonomic responses of variable magnitudes, bladder and bowel distention continue to account for most episodes. Removal of the offending stimulus is important to restoring the autonomic nervous system to its baseline activity. Current understanding of the pathophysiology, clinical features, and medical management of this fascinating but potentially serious complication of spinal cord injury are reviewed.


Applying functional analysis to psychological rehabilitation following spinal cord injury. There have been numerous attempts to categorize the responses of individuals to spinal trauma on the basis of generalized stage theories of grief reaction, and personality theory. A number of these studies are critically appraised and a behavioral model, based on functional analysis, is proposed as a more constructive framework for future research. Such an approach is applied clinically to the activities and development of the Clinical Psychology Service provided to the Mersey Regional Spinal Injuries Centre in Southport, England. A number of examples of clinical and research practice are included, highlighting the applicability of functional analysis to individual and systems level investigations.


The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992. The Urinary Tract Infection Consensus Conference brought together researchers, clinicians, and consumers to arrive at consensus on the best practices for preventing and treating urinary tract infections in people with spinal cord injuries; the risk factors and diagnostic studies that should be done; indications for antibiotic use; appropriate follow-up management; and needed future research. Urinary tract infection (UTI) was defined as bacteriuria (102 bacteria/ml of urine) with tissue invasion and resultant tissue response with signs and/or symptoms. Asymptomatic bacteriuria represents colonization of the urinary tract without symptoms or signs. Risk factors include: over-distention of bladder, vesicoureteral reflux, high pressure voiding, large post-void residuals, presence of stones in urinary tract, and outlet obstruction. Possible physiologic/structural, behavioral, and demographic risk factors were identified also. Indwelling catheterization, including suprapubic, and urinary diversion are the drainage methods most likely to lead to persistent bacteriuria. Infection risk is reduced with intermittent catheterization, but more severely disabled people who require catheterization by others are at greater risk for UTIs. Clean self-intermittent catheterization does not pose a greater risk of infection than sterile self-intermittent catheterization and is much more economic. However, care must be given to proper cleansing of reusable catheters. Quantitative urine-culture criteria for the diagnosis of bacteriuria include: catheter specimens from individuals on intermittent catheterization greater than or equal to 10(2) cfu/ml; clean-void specimens from catheter-free males using condom collection devices greater than or equal to 10(4) cfu/ml; and specimens from indwelling catheters of any detectable concentration. Dip stick screening tests may offer promise as an early warning system of UTI since they can be self-administered. Symptomatic UTI should be treated with antibiotics for 7 to 14 days. Longer courses have not been beneficial. In patients with symptomatic UTIs, it is not necessary to wait for the results of cultures before starting treatment. Asymptomatic bacteriuria need not be treated with antibiotics. There is little evidence presently to support the use of antibiotics to prevent infections. Following a recent episode of febrile UTI, possible contributing prior events should be reviewed. The upper tracts should be evaluated (imaging studies) to identify possible abnormalities. A common concern among people with spinal cord injuries is that physicians will alter bladder management programs without regard to lifestyle needs. Social/vocational flexibility may be more important to them than a state-of-the-art bladder management program. Future research should focus on obtaining more representative samples and investigate psycho-social-vocational implications as well as additional clinical-medical factors.


Growth of tumour cell lines in polymer capsules: ultrastructure of encapsulated PC12 cells. Recent studies indicate that polymer-encapsulated PC12 cells release sufficient amounts of dopamine to significantly alter behavioural paradigms in animals with unilateral lesions of dopaminergic midbrain neurons. Because cell fine structure provides a useful measure for assessment of storage function, exocytosis, metabolism, cell activity and cell viability, we examined the ultrastructure of PC12 cells grown in semi-permeable polymer capsules maintained in vitro or implanted into the forebrain of rats or guinea pigs. Encapsulated PC12 cells remained viable and continued to divide for the entire evaluation period of six months. Overall morphologies of encapsulated PC12 cells were similar in both environments and they resembled PC12 cells grown in monolayer cultures. In short-term cultures, encapsulated PC12 cells typically contained abundant quantities of chromaffin cell-like granules. The encapsulated cells had initially abundant microvilli on their surfaces which decline in frequency over time. After long-term enclosure for ten weeks or more, fewer secretory granules were detected in the cytoplasm of cells in capsules cultured in vitro and in brain-implanted capsules. Some cells in implanted capsules had long slender filipodia that were not present on PC12 cells in cultured capsules. The morphological changes of PC12 cells may correlate with altered growth conditions such as serum and oxygen concentrations, the presence or absence of growth factors in different environments, and with changes of cell interactions related to cell densities and build up of debris within the capsules over time. Since dopaminergic PC12 pheochromocytoma cells remain viable in semi-permeable polymer capsules for at least six months, such 'cell-capsules' could provide an alternative to dopamine-secreting embryonic neural grafts in dopamine replacement therapies.


Immunocytochemical mapping of noradrenergic projections to the rat spinal cord with an antiserum against noradrenaline. The mapping of noradrenergic innervation was performed in transverse and longitudinal sections of the adult rat spinal cord using noradrenaline immunocytochemistry. Noradrenergic fibres and terminals were distributed in the dorsal horn (mainly in the superficial part), in the vicinity of the different groups of motoneurons, and concentrated in the intermediolateral cell column and around the central canal. The ultrastructural study showed principally axodendritic synapses in the ventral horn and in the intermediolateral cell column. Fewer axosomatic synapses were detected. In the dorsal horn, noradrenaline-innervation was predominantly non-synaptic. It is hypothesized that the noradrenergic modulation of nociception is not mediated through classical synapses. The concept of 'volume transmission' can explain such an influence. Conversely, noradrenaline may be involved in the control of locomotion and automatic functions through conventional synapses.


Early development of the Lurcher cerebellum: Purkinje cell alterations and impairment of synaptogenesis. The postnatal development of the heterozygous Lurcher (Lc/+) mouse cerebellum is characterized by Purkinje cell death with a concomitant reduction in granule cell number. In order to evaluate possible relationships between these two events, this study investigates early morphological abnormalities of the Purkinje cells and possible defects in the formation of their synaptic investment. Cerebella of Lurcher and control age-matched (from P8 to P16) mice were analysed by calbindin immunostaining, silver impregnation and quantitative electron microscopy. Direct signs of Purkinje cell anomaly are obvious from P8, four days before the onset of the necrotic process. These signs include the presence of axonal swellings and perinuclear clumps of chromatin, and a general delayed process of maturation, evidenced in cell bodies (incomplete development of the basal polysomal mass) and in dendritic trees (hyperspinous dendrites, delayed formation of proximal and distal compartments). Also from P8, the external granular layer is reduced in thickness. Despite these abnormalities, the onset of the synaptogenesis between Purkinje cells and their specific inputs (parallel fibres, climbing fibres and basket cell axons) takes place on schedule and, at P8, no defect has been noticed. On and after P10, the rate of parallel fibre synaptogenesis is decreased. Very few climbing fibres translocate from their perisomatic to their peridendritic locations, and basket cell axons fail to develop 'pinceau' formations. All these results suggest that before the death of the Purkinje cell by P12, there is an impaired maturation of these neurons provoked by the Lurcher gene action. The hypoplasia of the external granular layer and the altered synaptic investment of the Purkinje cell after P10 are considered to be consequences of the early Purkinje cell defect.


The origin and development of retinal astrocytes in the mouse. Astrocytes, a class of glia which appear in the mammalian retina late in development, have been postulated either to originate in situ from Müller cells or extra-retinally from the optic stalk epithelium, only subsequently invading the eye. The site of origin and the developmental characteristics of retinal astrocytes were examined in the mouse, a species not previously studied for this purpose. Sections of normal eyes and stalks at different ages were examined. Cells positive for glial fibrillary acidic protein (GFAP) were first observed at post-conceptional day 17 at the optic disc end of the stalk. From this site, the GFAP-positive cells migrated into and across the retina at a rate of approximately 290 microns per day, reaching its edge by post-conceptional day 28. While migrating across the retina, the astrocytes progressively increased in size and morphological complexity, observations confirmed by measurement of their fractal dimension. Over the same period, a wave of differentiation swept along the stalk in the cranial direction. Further evidence that retinal astrocytes are born outside the retina emerged when foetal hemiretinae with or without optic stalks were explanted to the chorioallantoic membrane of the chick. When examined one to twelve days later, no explant cultured without the optic stalk contained GFAP-positive astrocytes, while explants with the stalk left attached contained relatively normal numbers of astrocytes. We observed, using fluorescence confocal microscopy, that retinal astrocytes in the mouse as in the rat, associate predominantly with blood vessels, not axonal bundles. It was of interest to determine whether this class of glia is essential to the normal cytoarchitectural development of the neural retina. Morphological analysis of the explants revealed no observable differences in cytoarchitecture or in the timing of developmental events between retinae maturing with or without astrocytes. It was therefore concluded that astrocytes may not be essential to the normal structural development of the murine retina.


Sensitometric comparison of direct- and indirect-exposure films used in intraoral radiography. In Japan, some dentists use indirect-exposure (screen) films for intraoral radiography, without the use of intensifying screens. The purpose of the present investigation was to determine whether film speed, inherent contrast, and latitude of Japanese indirect-exposure films used without intensifying screens were comparable to those of direct-exposure (non-screen) films used for intraoral radiography. The characteristic curves of Kodak Ektaspeed ("E" speed) and Ultra-speed ("D" speed) films were used as standards for comparison. Indirect-exposure films without intensifying screens were extremely slow compared with direct-exposure "E" and "D" speed films. Therefore, they should not be used for intraoral radiography because they needlessly expose the patient to excessive X-ray radiation. The direct-exposure films Hanshin Hi-Fi and Hanshin New Silver were equivalent in speed, higher in contrast, and narrower in latitude than Kodak Ektaspeed film. In general, the indirect-exposure films had lower speed, lower contrast and wider latitude than the direct-exposure films. Their speed and contrast would have been increased if intensifying screens had been used. Therefore, indirect-exposure films without intensifying screens should not be used for intraoral radiography.


Finite element model of facial soft tissue. Deformation following surgical correction. The finite element method is used to predict facial deformation following orthognathic surgery for mandibular prognathism. The deformation is calculated using a model that assumes severe skeletal class III malocclusion. The possibilities and limitations of this method for clinical application are described.


A case of eosinophilic granuloma arising in the mandible. Eosinophilic granuloma is a disease of the reticuloendothelial system and its pathogenesis is not yet completely clear. The histopathological findings are granulomatous proliferation of histiocytes accompanied by diffuse infiltration of eosinophils. We recently experienced a case of eosinophilic granuloma arising monostotically in the body of the mandible in the 76 [symbol: see text] region. There has been no local recurrence 17 months after surgical removal of the lesion.


Cephalometric evaluation of crib therapy for cases of mixed dentition (open bite). The effect of crib therapy for the treatment of cases of open bite was investigated. Extrusion of the lower and upper incisors and intrusion of the lower first molars were the most significant effects of the appliance. Intrusion of the lower molars resulted in decreased lower facial height. These findings were considered to result from the posterior tongue posture. Thus, the clockwise pattern of the mandibular complex was changed to a counter-clockwise pattern.


Clinical and immunological characteristics of patients with rheumatoid arthritis and periodontal disease. Various clinical and immunological parameters were determined in patients with RA and patients with adult periodontitis. There were no significant differences between the two groups with regard to the number of missing teeth, although pocket depths and gingival inflammation scores were significantly increased in the periodontitis group (p less than 0.05). Salivary IgM levels were below the minimum detectable level in both groups, and no significant differences were evident between the two groups with regard to salivary IgG and IgA levels. However, serum IgG, IgA and IgM levels in RA patients were significantly higher than in periodontitis patients (p less than 0.05), indicating enhanced humoral immunity. The present findings suggest that RA patients are not a risk group for advanced periodontal problems in comparison with age- and sex-matched systemically healthy controls.


Brain damage following subarachnoid hemorrhage: the imbalance between anti-oxidant systems and lipid peroxidative processes. We have studied the pattern of enzymatic antioxidant activities (Cu-Zn superoxide dismutase = SOD, Mn-SOD and glutathione peroxidase = GSH-Px) in brain cortex of rats subjected to experimental induction of subarachnoid hemorrhage (SAH), in order to discuss the modifications of antioxidant systems in relation to the development of lipid peroxidative processes occurring in brain cortex. Lipid peroxidation (quantified as TBRAs content) did not show significantly changes, when sham-operated and SAH rats were compared; meanwhile at 1 hour TBARs content shows an increasing trend both in sham-operated and hemorrhagic rats. The release of leukotriene C4, the major lipoxygenase metabolite, is significantly enhanced at 1, 6 and 48 hours after SAH induction. Cu-Zn SOD activity is significantly reduced at 6 and 48 hours after SAH induction; Mn-SOD activity is significantly affected at 1, 6 and 48 hours after the hemorrhage. GSH-Px activity is significantly reduced only in the late phase (48 hours) after SAH. The results of the present study suggests that: (a) in brain compartment a significant reduction of antioxidant enzymatic activities is related to the increasing trend of enzymatic lipid peroxidation; (b) antioxidant activities showed specific time-dependent modifications: Cu-Zn and Mn SOD activities, which are specific scavengers of superoxide radicals, showed an early impairment, while GSH-Px activity is significantly reduced only after 48 hours; (c) the enhancement of enzymatic lipid peroxidation via the lipoxygenase pathway seems to play a primary role in brain response to SAH. These results should be considered the rationale for pharmacological treatment with antioxidant compounds for brain protection against detrimental effects of subarachnoid hemorrhage.


Clinicopathological experience with intraventricular neurocytomas. Intraventricular neurocytoma is a rare clinicopathological entity that has been recently described. We are reporting our experience with four diagnosed cases and the previously reported cases from the available literature are reviewed. These neoplasms occur mainly in young adults, and their histological diagnosis is difficult on light microscope, because they are almost indistinguishable from oligodendrogliomas. Nevertheless, the presence of tumoral cells arranged around nucleus-free fibrillary zones, resembling the large rosettes of pineocytomas and the immunohistochemical demonstration of synaptophysin are useful data for the pathological diagnosis. This diagnosis is easy on electron microscope, because it demonstrates the neuronal nature of tumoral cells. Regarding prognosis, we have found increasing evidence that these tumors are associated with a favourable course after surgery, and at present there is no clear evidence of the usefulness of radiotherapy.


Antiplatelet treatment after carotid endarterectomy: a pilot study. The present study was undertaken in patients subjected to endarterectomy for extracranial carotid stenosis in order to verify the efficacy and the safety of medical treatment with indobufen (2-[4-(1-oxo-2-isoindolinyl)-phenyl] butyric acid), a drug which has been successfully used in the long-term treatment of cardiovascular ischemic diseases, and which showed a significant antiplatelet effect. One hundred thirty-eight patients entered into the study with previous diagnosis of cerebrovascular ischemic event within 3 months before surgery. Patients were treated after surgery with indobufen 400 mg/die/orally in the first 2 months after discharge and than 200 mg/die/orally. The planned duration of medical treatment was 24 months. Any patient interrupting the medical treatment for a cumulative period greater than 30 days/year was excluded from the analysis; the end points of the study were considered death and the occurrence of disabling stroke. Eleven patients were considered as dropped out because of treatment interruption. The operative (at 1 month after surgery) mortality rate was 0.79%. The cumulative operative mortality and morbidity rate was estimated in 2.37%. The mean follow-up period was 6 months and the cumulative mortality rate at 36 months was estimated in 7.14%. The cumulative risk/year of TIA or ischemic stroke is higher than the risk for myocardial infarction, but the long-term mortality rate mainly depends on the latter complication which occurred later. Treatment with indobufen after carotid surgery seems to be effective as far it was restricted to an homogeneous group of patients presenting symptomatic extracranial carotid disease.


EEG and the linear skull fractures.

EEG and the linear skull fractures. The EEGs of 111 children under the age of 16, and 21 adults after a head injury with a linear skull fracture were reviewed. From our results it can be concluded that linear skull fractures do not add any significant abnormality or any variation to what is stated for EEGs of minimal to mild concussions.


Case report and review of the literature: arachnoid cyst of the fourth ventricle presenting as a syndrome of normal pressure hydrocephalus. The Authors report a case of 4th ventricular arachnoid cyst that presented clinically with the criteria of normal pressure hydrocephalus (NPH). Only a few cases of intraventricular arachnoid cyst have been recorded in the literature; the present case is the second reported case diagnosed as a syndrome of NPH.


The relationship of occlusion, parafunctional habits and recent life events to mandibular dysfunction in a non-patient population. This study investigated the association between occlusion, oral habits and stress relative to the level of mandibular dysfunction in the total population and in specific diagnostic subgroups (normal, joint disorder, muscle disorder and joint/muscle disorder). A total of 269 nursing students were given a questionnaire and examination. The questionnaire included items to calculate an oral habit index and a social readjustment rating scale. The examination included items to calculate an occlusal index, two craniomandibular indices and a diagnostic criteria for specific subgroups. In the total population there was a positive association between mandibular dysfunction and three postulated risk factors. The total population was then divided into diagnostic subgroups. There was a positive association between the degree of mandibular dysfunction and parafunctional habits for normals, muscle disorders and joint/muscle disorders. There was a positive association between mandibular dysfunction and occlusion for normals only. Finally there was a positive association between mandibular dysfunction and stress for muscle disorders only. The results suggest that associations between postulated aetiologic factors and mandibular dysfunction vary depending on whether the subjects have a muscle and/or joint disorder. Since all associations were weak, other possible risk factors need to be investigated.


Cervico-medullary junction hemangioblastomas. Report of two cases and review of the literature. Reporting two cases of dorsally located cervico-medullary hemangioblastomas the Authors discuss clinico-biological features, diagnosis and therapy of this vascular neoplasms, analyzing the cases reported in detail in the available literature. In this site the tumor has often an exophitic development, adhering more or less extensively to the posterior surface of medulla oblungata, where progressively creates a niche. Transient neurogenic arterial blood hypertension, by possible involvement of the dorsal nucleus of vagal nerve, together with the lack of postoperative respiratory disturbances constitute the main clinical features of differentiation with intraaxial hemangioblastomas of the brainstem. Actually MRI represents the radiological investigation of choice, even if angiography still plays an important role in the correct preoperative diagnosis of hemangioblastomas. The therapy of dorsally located cervico-medullary hemangioblastomas is the total removal of the lesion also in asymptomatic patients, being the late surgical results generally successful.


A rare case of Toxocara canis arachnoidea. The Authors present a case of Toxocara canis arachnoidea located in the cervical zone. The rarity of the case and the extreme rarity of the position are emphasized. In fact in medical literature there exists a description of only one similar case which was also observed by one of the authors.


Reinforcement of acrylic resin denture base material with metal or fibre strengtheners. The effect of different metal and fibre strengtheners on the fracture resistance of polymethylmethacrylate was tested. Different types of commonly used metal wire and glass fibre, as well as carbon and aramid fibres, were used as strengtheners in test specimens. There were 21 groups, and each group contained 12 test specimens. Each metal strengthener had a beneficial effect on the fracture resistance of the polymethylmethacrylate (P less than 0.001-0.01). Some fibres, which were silanized for better adhesion, also had strengthening properties.


The clinical performance of a posterior composite resin restorative material, Heliomolar R.O.: 3-year report. A posterior composite resin restorative material was evaluated over a 3-year period by means of a controlled clinical trial. A total of 52 composite resin restorations and 52 amalgam alloy restorations were included in this trial, and were examined with regard to marginal integrity, surface texture, anatomical form and proximal contact with adjacent teeth. There were no significant differences in clinical performance between test and control materials, which both gave good service over the period of evaluation. Only five restorations (one of amalgam and four of composite resin) failed during the trial. Plastic replica dies were used to support the clinical examinations of the restorations, and such dies were found to be helpful.


Determining the accuracy of gypsum casts made from type IV dental stone. A study was conducted to evaluate the accuracy of casts made in Type IV dental stone. The results indicate that all casts distort, but that significant differences exist between various brands of die stone.


Longitudinal study on torque transmitted from a denture base to abutment tooth of a distal extension removable partial denture with circumferential clasps. Not only forces but also torque exerted on abutment teeth are important factors for planning the construction of distal extension removable partial dentures. The purpose of this study was to make longitudinal analysis of torque transmitted from denture base to a direct abutment tooth of these dentures with circumferential clasps. The results are summarized as follows: (i) Vertical Max. MT (maximal mean value of torque) was decreased and became constant after one or one and half months of the insertion of new dentures. (ii) Lateral Max. MT in one subject was changed from the lingual direction to the buccal direction while in another subject it was constant. (iii) In the vertical direction, there were no remarkable differences of Max. MT and Ave. T (average value of torque) between subjects. Max. MT was 5-10 x 10(-3) kgm-1 in the downward. Ave. T was 2-3 x 10(-3) kgm ss-1 in the downward and 0.3 x 10(-3) kgm ss-1 in the upward. (iv) In the lateral direction, there were considerable differences of Max. MT and Ave. T between subjects. Max. MT was less than 20 x 10(-3) kgm. Ave. MT was 2-8 x 10(-3) kgm ss-1.


Reproducibility of temporomandibular joint vibrations (electrovibratography). Surface electrovibratographic (EVG) recordings were obtained from the temporomandibular joints (TMJ) of clinically normal subjects (absence of TMJ sounds) and clinically abnormal subjects (presence of TMJ sounds). As examined through single factor analyses of variance and coefficients of intraclass correlation, the EVG recordings showed excellent reproducibility. The analyses showed also that, in comparison with clinically normal TMJs, the vibrations of clinically abnormal TMJs had higher median (+79%) and peak (+137%) frequencies, higher peak amplitudes (+740%), and higher intensities as expressed through the estimated total energy contents (+1843%) and the integrals (+1215%) of power spectrum density functions.


Microleakage studies comparing a one-visit indirect composite inlay system and a direct composite restorative technique. Problems related to leakage have been observed with direct-filled composite restorations. The development of indirect system of fabrication followed by cementation should theoretically reduce this phenomenon. The present study compares the leakage around directly placed composites with composite inlays prepared by a surgery-based system. The results indicate that the amount of leakage is reduced with the inlay system, but that it is not eliminated.


A preliminary study of manducatory behaviour influenced by stress and dental occlusion. Stress and dental occlusion often are incriminated as causes of dysfunction of the manducatory system. How and in what degree these two factors came through has not yet been clearly worked out. Our study is carried out on a group of rats presenting one or both of these two factors and we proposed to examine the duration and frequency of some components of their behaviour--intake of solid food and grooming, to detect some possible perturbations on manducatory behaviour caused by stress and/or occlusal interference. Our study shows that stress induced by emotion or occlusal interference will change the microstructure of behaviour rather than the global component in itself. This implies that we must find a clear definition of the different types of microstructure to find out which ones are changed by the two incriminating factors and which part of the behaviour component will remain stable.


Masticatory function in hemimandibulectomy patients. Surgical resection of a segment or loss of continuity of the mandible can adversely affect most of the structures essential for mastication. Five subjects who had hemimandibular resections for cure of squamous cell carcinoma were studied. Masticatory function tests were conducted pre- and post-surgery and post-prosthetic rehabilitation. A 0.5-g Frito corn chip served as the test food, and a sieve analysis was used to evaluate swallowing threshold and masticatory performance. Ten controls were studied in order to determine corresponding normative scores. Post-surgery results indicate that the extent of mandibular resection and loss of continuity tend to decrease masticatory function. The time required to perform the mastication test, and the number of strokes required to achieve swallowing threshold were increased. Prosthetic rehabilitation did improve masticatory function in some patients. Loss of mandibular continuity may not be an absolute predictor of decreased masticatory function.


Digital imaging techniques for dental alloy castability quantification. In this study, mesh monitors cast from experimental compositions of a Ni-Cr-Be alloy are evaluated by the application of image analysis techniques. Castability values obtained by this method are then contrasted with those from three commonly employed manual counting procedures. While castability values obtained by all methods reflect the effect of compositional variations, a comparison of results with respect to evaluation method indicates that the image analysis technique consistently yields higher castability values, especially evident in the poorly casting groups. The apparent explanation for these observed differences is that with imaging, segments that are partially cast to varying degrees are not arbitrarily eliminated from the data, as is the usual practice in manual counting methods; therefore, castability values obtained by using the imaging technique will very closely reflect an actual alloy volume of each cast monitor.


Local stimulation of proteoglycan synthesis in articular cartilage explants by dynamic compression in vitro. Cultured bovine articular cartilage was subjected to 50 ms, 0.5-1.0 MPa compressions repeated at intervals of 2-60 s for 1.5 h and simultaneously labeled with 35SO4. The compression was delivered with a 4-mm-diameter nonporous loading head on an 8-mm-diameter cartilage explant. This method created directly compressed (central) and uncompressed (border) areas within the tissue. Analysis of the whole explant under a 0.5 MPa load showed significantly increased 35SO4 incorporation by compression repeated at 2- and 4-s but not at 20- and 60-s intervals. When the incorporation was studied separately in the border and central areas, a statistically significant stimulation was noticed in the central area with a 4-s cycle, while the border area was stimulated with a 2-s cycle. Autoradiography of the central area showed that the stimulation with 0.5 MPa and a 4-s cycle occurred through the whole depth of the cartilage, while raising the pressure to 1 MPa or the frequency to 2 s reduced the stimulation, particularly in the superficial cartilage. In the border area the stimulation with 0.5 MPa and a 2-s cycle was noted in the superficial zone only. The stimulation of proteoglycan synthesis is thus limited to certain loading frequencies and pressures and occurs in specific areas under and around the loaded site. Its rapid appearance suggests enhanced glycosylation or sulfation of core proteins or enhanced speed of posttranslational processing.


Metabolic and biochemical status of articular cartilage following cryopreservation and transplantation: a rabbit model. To determine the fate of transplanted cryopreserved articular cartilage, an animal model employing the proximal humerus in the rabbit has been developed. Previous studies have been hindered by problems of postoperative joint instability, secondary injury due to immobilization, and paucity of cartilage for analysis. This experiment demonstrates the survival and function of transplanted cartilage by quantitative assessment of metabolic and biochemical parameters. Forty-five New Zealand white rabbits underwent transplantation of the right proximal humerus. In 29 animals, the proximal half of the humerus was resected and replaced by a cryopreserved osteoarticular allograft. Autograft procedures were carried out in the remaining animals. Following sacrifice at 3, 6, 9, and 12 months postoperatively, articular cartilage was analyzed for gross appearance, collagen synthesis, proteoglycan synthesis, and water, hydroxyproline, hexosamine, and hexuronic acid contents. The results indicate that the cryopreserved osteoarticular allografts retained their metabolic and biochemical integrity and behaved as viable and biologically functional units 1 year postoperatively.


Link protein shows species variation in its susceptibility to proteolysis. Human cartilage link protein exists as three native components, while equine, bovine, and porcine cartilage link protein exist as two and Swarm rat chondrosarcoma link protein exists as only one component. These nonhuman link protein components represent intact protein structures, and there is little evidence for proteolytically modified forms in nonhuman tissues. In human cartilage, the proteolytic production of modified link proteins increases with age, whereas high amounts of such products were not seen in the nonhuman tissues. However, the small amounts of link protein fragments that were observed in the nonhuman cartilages were of a similar size to their human counterparts. On digestion of human proteoglycan aggregate with stromelysin, rapid modification of the link protein components occurred, whereas the aggregates from nonhuman cartilages showed incomplete cleavage of their link protein components. The relative resistance of nonhuman link protein to stromelysin may in part be due to a unique amino acid substitution present near the enzymic cleave site.


The dermatan sulfate proteoglycans of the adult human meniscus. The dermatan sulfate proteoglycans decorin and biglycan were extracted from pooled adult human menisci with 4 M guanidinium chloride and purified by successive cesium chloride density gradient centrifugation, ion exchange chromatography, and gel filtration. A final yield of about 2 mg of dermatan sulfate proteoglycan per gram of wet tissue was obtained. The proteoglycan is predominantly decorin with some biglycan, and the dermatan sulfate chains contain about 70% of their uronic acid residues as iduronate and possess about three times as much 4-sulfation as 6-sulfation of their N-acetylgalactosamine residues. On gel filtration under associative conditions, about half of the proteoglycan exhibits self-association. This includes most of the biglycan but also a substantial proportion of decorin. The molecules that show self-association appear to have longer dermatan sulfate chains, though there is no apparent difference in their overall composition. The predominance of decorin in the adult meniscus and its ability to interact both with itself and collagen fibrils is compatible with a role in maintaining tissue integrity and strength.


[99mTc]diphosphonate uptake and hemodynamics in experimental arthritis: effect of naproxen in the canine carrageenan injection model. The impact of naproxen treatment on juxta-articular hemodynamics and bone metabolism in experimental juvenile arthritis was studied in the articular carrageenan injection model. Unilateral gonarthritis was induced for 12 weeks in eight dogs receiving naproxen (dosage, 2 mg/kg) and eight controls. Regional blood flow was assessed by the microsphere method, plasma volume by the distribution space of [125I]fibrinogen, and bone metabolism by the 2-h uptake of [99mTc]diphosphonate ([99mTc]DPD). Synovial effusion was less prominent with naproxen treatment as judged by joint fluid volume and pressure. Naproxen reduced the arthritic capsular hyperemia, almost normalized a severe blood flow increase in patella and both juxta-articular epiphyses, ameliorated an expansion of plasma volume in the patella and the distal femoral epiphysis, and normalized an increased [99mTc]DPD uptake in subchondral femoral bone and the tibial cortex. Significantly increased arteriovenous shunting in the arthritic extremity was unaffected by naproxen. The study suggests that long-term cyclooxygenase inhibition offers protection against hemodynamic and metabolic changes in juxta-articular bone secondary to synovial inflammation.


The functional recovery of peripheral nerves following defined acute crush injuries. This study evaluates the effect of crushing load on functional recovery of the sciatic nerve. Male Sprague-Dawley rats were divided into five groups: sham operation, resected sciatic nerve, and 100 g (13 mm Hg/mm2), 500 g (50 mm Hg/mm2), and 15,000 g (1,000 mm Hg/mm2) of sciatic crush load (groups 1-5). In groups 3-5, a 5-mm segment of sciatic nerve was crushed for 10 min using a specially designed crushing device. Motor functional recovery was assessed from hind-limb walking tracks by calculating a sciatic functional index. There was no detectable functional deficit in the group receiving sham operations, while the resected sciatic nerve group exhibited complete dysfunction for the full duration of the experiment. All groups subjected to crush exhibited an initial deficit that gradually recovered to normal by day 14 (100-g crush), day 39 (500-g crush), and day 53 (15,000-g crush). Histological changes were also related to the initial crushing load and the length of the recovery period. Results indicate that the crushing device described is able to administer an adjustable, defined crush injury to the rat sciatic nerve, and that the functional deficit resulting from such an injury can be easily monitored with a sciatic functional index. The rate of recovery of crushed nerves was directly related to the initial load. All crushed nerves recovered in this experiment, even after the application of a 15,000-g load for 10 min.


A longitudinal study of the matrix changes induced in the intervertebral disc by surgical damage to the annulus fibrosus. A 5 x 5-mm anterolateral incision was made in the annulus fibrosus (AF) of lumbar discs of 16 sheep; four animals of similar age not operated on were used as controls. The experimental animals were sacrificed 2, 4, 6, 8, 12, and 18 months postoperatively (PO), and the incised and adjacent lumbar discs were collected. Discs were dissected into four zones: AF (zones 1 and 2) and nucleus pulposus (NP) (zones 3 and 4) corresponding to the half of the AF in which the cut was made and its opposite half, and the complementary halves of the NP. Each zone was analyzed for moisture, proteoglycan (PG), collagen, and noncollagenous protein (NCP) content. The PG extractability, aggregation, and hydrodynamic size were also examined. The NP of injured discs showed a significant loss of PGs and collagen 8 months PO, but NCP levels increased. In the incised discs, PG aggregation initially declined but recovered to within control values 6-8 months PO. The NP of discs adjacent to the incised disc also showed time-dependent changes in matrix components that included loss of collagen and PG; however, the AF matrix remained essentially uneffected. Double immunodiffusion studies indicated that a sizeable proportion of the NCPs present in the injured discs (but not the adjacent lumbar discs) were derived from serum.


Trunk muscle cocontraction: the effects of moment direction and moment magnitude. This study investigated the cocontraction of eight trunk muscles during the application of asymmetric loads to the torso. External moments of 10, 20, 30, 40, and 50 Nm were applied to the torso via a harness system. The direction of the applied moment was varied by 30 degrees increments to the subjects' right side between the sagittally symmetric orientations front and rear. Electromyographic (EMG) data from the left and right latissimus dorsi, erector spinae, external oblique, and rectus abdominus were collected from 10 subjects. The normalized EMG data were tested using multivariate and univariate analyses of variance procedures. These analyses showed significant interactions between the moment magnitude and the moment direction for seven of the eight muscles. Most of the interactions could be characterized as due to changes in muscle recruitment with changes in the direction of the external moment. Analysis of the relative activation levels, which were computed for each combination of moment magnitude and direction, indicated large changes in muscle recruitment due to asymmetry, but only small adjustments in the relative activation levels due to increased moment magnitude.


Cross talk in surface electromyograms of human hamstring muscles. Signals generated from muscles other than the muscle(s) of interest (cross talk) can confound the interpretation of surface electromyograms (EMGs). In this study, the amount of cross talk in surface EMGs of human hamstring muscles was estimated using a protocol in which the quadriceps femoris was electrically stimulated via the femoral nerve. EMGs were recorded from the vastus lateralis and the medial and lateral hamstring muscle groups. The amplitude of the EMG response of the vastus lateralis to electrical stimulation was adjusted to match that of its maximum voluntary effort (MVE) under isometric conditions. Subsequent power density spectrum analysis showed that the median frequencies of the signals generated by electrical stimulation and MVE were not significantly different. In conventional bipolar recordings, cross talk in lateral hamstring EMGs averaged 17.1% MVE and in medial hamstring EMGs 11.3% MVE (average-rectified values). The double differential technique significantly reduced cross talk to 7.6% MVE for the lateral hamstrings, and to 4.2% MVE for the medial hamstrings. The double differential technique appears to be more selective than the bipolar technique when recording EMGs from muscles with highly active neighbors and thus should be used in such situations. Software simulations of the double differential technique also appear to be more selective than the bipolar technique and may be used when the number of amplifiers available is limited.


A comparative analysis of streaming potentials in vivo and in vitro. Streaming potentials (SPs) measured in vivo at a specific site on intact cortical bone (canine tibia) have been compared with measurements from the same site in vitro, tested as an excised bone strip soaked in Hank's balanced salt solution. The amplitude of SPs per periosteal strain in vitro was larger in 13 tibias than in vivo (by an average x6.5 at 1 Hz), but values per transcortical strain difference were similar. In vitro, SP magnitudes rose more sharply to an asymptotic value as a function of bending frequency than did in vivo signals, possibly because of a difference in the internal state of canaliculi and/or Haversian systems. Similarly, SP response to step-loading decreased to zero more slowly with time in vitro than in vivo. Difficulties encountered in preliminary measurements due to electrical shunting through electrolyte and soft tissues suggest the need for caution in using both in vivo and in vitro SP measurements to extrapolate to electric field strengths on the cellular level.


Chemotherapy and surgery in a murine osteosarcoma. Surgical and chemotherapeutic effects on pulmonary metastatic disease were evaluated in the MGH-OGS murine osteosarcoma. The tumor responded to three sequential injections of doxorubicin with prolonged growth delay but cisplatin administration (although given in doses sufficient to cause weight loss and significant mortality) was not effective in controlling local disease progression. Using a protocol with three injections of doxorubicin (0.006 mg/g of body weight), it was observed that disease-free survival was enhanced when one of the three doses of doxorubicin was given at the time of surgery (perioperatively). By marginally resecting the primary tumor and permitting its regrowth, a model was developed with recurrent primary and metastatic disease present simultaneously. It was observed in this model that amputation or resection of the recurrent primary lesion resulted in pulmonary metastatic growth acceleration. Using this recurrent primary tumor model, doxorubicin's effect on pulmonary metastatic lesions was enhanced when the drug was given at the time of amputation.


Bone formation near direct current electrodes with and without motion. The osteogenesis induced in the medullary canal of rabbits by the implantation of moving and stationary wire electrodes was studied with and without the simultaneous application of 20-microA constant direct cathodic current. After 3 weeks, the formation of new trabecular bone in the canal was studied and measured microscopically. Electrically stimulated osteogenesis was not observed at stationary electrodes. As in previous studies with this model, a movable electrode alone stimulated new bone formation whose area was 7-10% of the canal area. The amount of this bone was not statistically increased by the addition of cathode current. Movable, electrically active cathodes were associated, however, with fluid-filled spaces incorporated within the new trabecular bone. When mechanical stimuli were controlled, we were not able to demonstrate that the direct current stainless steel cathode acts either as an inducer or a substantial enhancer of medullary osteogenesis.


A comparison of cortical strain after cemented and press-fit proximal and distal femoral replacement. Proximal and distal femoral replacements with intramedullary stems are usually cemented in place but frequently show severe bone remodeling changes in the long term, which can contribute to a loosening process. The remodeling is likely to be associated with stress and strain distribution. This study compared the strain patterns, particularly the maximum principal strains, between cemented and press-fit components in five cadaveric femurs by using a photoelastic coating technique. The specimens were loaded with 2,000 N in the sequences of intact femur and press-fit and cemented stems. On the medial side of the bone for proximal femoral replacements, the strain values for the press-fit stems on the proximal, middle, and distal regions were 73 +/- 11%, 78 +/- 15%, and 80 +/- 15% of normal, respectively, but for the cemented stems they were 53 +/- 15%, 57 +/- 19%, and 60 +/- 20%. The differences were statistically significant (p less than 0.05). On the lateral side, the overall strain values for the press-fit stem were higher than those for the cemented stem, but the differences were not statistically significant (p greater than 0.05). On the medial side of the distal femoral replacement, the strain values for the press-fit stems in the proximal and middle regions were significantly closer to normal than for the cemented stems. Because the press-fit femoral stems (both the proximal and distal replacement) transferred closer to normal strains than the cemented stems, less adverse bone remodeling may be expected, which could be reflected in increased longevity.


Home infusion service delivery system model: a conceptual framework for family-centered care in pediatric home care delivery. The Home Infusion Service Delivery System model is presented as a conceptual framework for the delivery of pediatric home care. This bicycle-shaped model provides important insights into the interrelationships of available resources for parents seeking home health care for their child. The model is based on nine key elements of family-centered care. Discussions of the model identify the roles and relationships among the family system, four interdependent service delivery systems, the physician, and a total quality management program that coordinates the health care delivery for the child. Examples focus on the delivery of pediatric home infusion therapy. By supporting the family as the primary care giver, this model provides a better fit between consumer need and service delivery.


AIDS--pharmacologic update.

AIDS--pharmacologic update. No one discounts the cruel nature of the Acquired Immunodeficiency Syndrome epidemic or the pain and devastation left by the virus that brings a lingering death to people in the prime of life. And no one dismisses the horrifying surge in the number of cases over the past decade. In 1981, 189 cases of AIDS were reported to the Centers for Disease Control; in 1990, 43,339 cases were reported. Research and technological advances have resulted in advanced treatment modalities aimed at symptomatic treatment of the disease process itself, opportunistic infections associated with the disease, and possibly prevention. These issues are addressed in this update.


Patients' preference regarding portable pumps. The growing number of home parenteral nutrition patients has encouraged the development of portable infusion pumps. The authors found that the individual who meets the criteria for home therapy is also the same individual who welcomes independence. The portable pump further enabled these individuals, who have already undergone a major lifestyle change, to achieve the desired independence. Twenty-three home parenteral nutrition patients were surveyed regarding pump satisfaction and operation. The distinct psychological advantage provided was the final motivating factor.


Endoscopic laser ablation of obstructing congenital duodenal webs in the newborn: a case report of limited success with criteria for patient selection. Standard approaches to intrinsic obstructing duodenal lesions in the newborn include laparotomy with enteroenterostomy, bypassing the obstruction, or duoduodenotomy with excision. The advent of improved pediatric flexible fiberoptic endoscopes and fiberoptic laser technology makes endoscopic ablation of duodenal webs and windsocks in the newborn possible.


Surgical therapy and long-term follow-up of childhood hereditary pancreatitis. Treatment and a 15-year follow-up survey of 42 patients with hereditary pancreatitis (HP) were compared with 28 patients with idiopathic recurrent pancreatitis (RP) of childhood. There was no difference between the two groups except for pancreatic ductal dilatation and stones in patients with HP. Longitudinal pancreaticojejunostomy (20) or resection and drainage procedures (7) were more commonly required in patients with HP than RP (55% v 14%). There was no surgical mortality. Postoperatively, immediate and complete relief of symptoms was obtained in 43% of patients with HP and 25% of patients with RP. In the remainder, recurrent attacks of pancreatitis abated over 2 years such that 81% of the surgical patients were in good or excellent health. Occasional symptoms persisted in 52% of HP patients and 25% of RP patients. Of the 20 patients with HP or RP undergoing longitudinal pancreaticojejunostomy extending from the head to the tail, 75% were symptom-free on follow-up. However, 3 of 6 patients with poor results had also undergone this procedure. At long-term follow-up of patients who did not undergo operation, 75% of HP patients and 90% of RP patients reported excellent or good health despite the persistent symptoms in 68% and 42%, respectively. Surgery for childhood HP is dependent on the complications present. Longitudinal pancreaticojejunostomy is beneficial for ductal dilatation and associated pseudocysts or pancreatic ascites. The performance of this procedure in the absence of consistent pancreatic duct dilatation will give poor results. Patients without ductal dilatation and the majority of patients with RP may eventually lead near normal lives without resorting to surgery.(ABSTRACT TRUNCATED AT 250 WORDS)


Intravenous therapy education in associate degree nursing programs. Questionnaires were sent to 250 National League of Nursing-accredited associate degree registered nursing programs in the continental United States to determine what components of intravenous therapy were being taught, how these components were being taught, and where in the curriculum these components were being taught. The questionnaire also included questions that could provide insight into intervening variables such as support from clinical facilities and administrative support.


Quantitation of transplanted hepatic mass necessary to cure the Gunn rat model of hyperbilirubinemia. The minimal hepatic mass necessary to reverse the metabolic defect of unconjugated hyperbilirubinemia in the rat model of Crigler-Najjar type I deficiency was determined using heterotopic (auxiliary) partial liver transplantation (HLT) and orthotopic liver transplantation (OLT). In HLT, the donor graft consisted of the right upper and/or right lower hepatic lobe(s) depending on the final mass of liver tissue desired for transplantation. The mass of the donor graft ranged from 12% to 23% of the whole organ (n = 12). The serum unconjugated bilirubin levels decreased quickly after HLT from a preoperative value of 8.98 +/- 0.34 mg/dL to 0.63 +/- 0.11 mg/dL in 24 hours, which was similar to OLT in which the levels decreased from a preoperative value of 8.20 +/- 0.44 mg/dL to 0.24 +/- 0.07 mg/dL in 24 hours. Conjugated bilirubin was excreted from the graft liver shortly after OLT and also from both the host and graft livers after HLT. This study demonstrates that using as little as 12% of the whole liver mass in HLT reduces serum bilirubin significantly in 24 hours in a fashion similar to whole-organ OLT. The clinical application of alternative therapies to whole-organ OLT such as HLT or hepatocyte transplantation may provide sufficient replacement therapy in metabolic disease.


Coagulation plasma factor levels are early indicators of graft nonfunction following liver transplantation in children. Following liver transplantation, the decision to retransplant in cases in which graft function is marginal must be taken early. Plasma coagulation factor monitoring was evaluated as an early predictor of graft failure requiring retransplantation in the first posttransplant week. Plasma levels of fibrinogen, factors V, VII, VIII, IX, antithrombin III, protein C, and plasminogen were measured in all patients at 0, 12, 24, 48, 72, 96, and 120 hours posttransplant in 46 patients who received 56 grafts and results were compared between livers that failed early (group 1) and those that functioned adequately (group 2). Six grafts were included in group 1: one patient died before retransplantation, four were retransplanted once, and one patient was retransplanted twice. Three grafts had primary nonfunction (PNF), 2 had obstructed portal veins, and 1 had a long period of warm ischemia during the initial transplant. In group 1, plasma levels of factor V were significantly lower than in group 2 at 24, 48, and 72 hours posttransplant (21.2% +/- 14.2%, 12.4% +/- 4.5%, and 13.0% +/- 5.0% v 39.1% +/- 23.9%, 48.8% +/- 31.9%, and 60.9% +/- 25.9%; P less than .05, P less than .01, and P less than .005, respectively). Similarly, plasma levels of factor VII were significantly lower in group 1 over the same period of time (7.3% +/- 2.7%, 4.2% +/- 1.8%, and 4.7% +/- 2.5% v 27.4% +/- 17.1%, 34.1% +/- 21.6%, and 34.8% +/- 18.6%, respectively; P less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)


Cross-species transplantation: NK cell number and function are normal in fully xenogeneic chimeras (rat----mouse). When untreated F344 rat bone marrow is transplanted into B10 mouse recipients conditioned with total body irradiation, stable fully xenogeneic chimerism (rat----mouse) results. Chimeras are specifically tolerant to the donor strain of rat, survival is excellent (greater than 80% at 8 months), and all stem-cell-derived lineages are produced by the rat stem cell. We have previously demonstrated normal function of T-lymphocytes in these chimeras, but have not examined the immune function of natural killer (NK) cells present. Because NK cells play a critical role in immune surveillance, absence of function could result in a serious immunodeficiency state. We present data here to suggest that rat NK cells that have developed in a mouse stromal environment are normal in function as well as number. In all fully xenogeneic chimeras tested from 8 weeks to 8 months following bone marrow transplantation, NK cells were present at a normal level (10% to 16%). NK cells function in these chimeras, as tested by spontaneous lysis of YAC tumor cell targets, was normal or superior to normal F344 rat and B10 mouse NK cells.