[Transplantation of pancreas and islet cells in insulin dependent diabetes mellitus--status after 25 years]. The Danish study group for metabolic studies after transplantation of the pancreas. Development of combined pancreatic and renal transplantation and transplantation of islet cells in the treatment of insulin-dependent diabetes mellitus is reviewed. Transplantation of the pancreas is undertaken in Denmark on the indication of diabetes mellitus complicated by terminal diabetic nephropathy in patients who are considered, in advance, as candidates for renal transplantation. During recent years, improved results have been obtained by combined pancreatic renal transplantation with patient survival of up to 96% and graft survival of up to 84% after two years. Despite normal HbA1C, the intermediate metabolism is abnormal after combined pancreatic and renal transplantation. At present, it does not appear to prevent or arrest development of diabetic retinopathy while the results indicate that progression of diabetic nephropathy and neuropathy can be halted. Development in islet cell transplantation is promising. As yet, there has only been limited success with transplantation of foetal islet cells and this also involves great ethical problems. Xenographic transplantation of foetal islet cells may be of current value in the future. During recent years, 20% of islet cell transplantations from adult human donors have resulted in insulin independence for briefer periods (maximal 24 months, January 1992). Improved methods have been developed in immune modulation, immune isolation and cryopreservation and these make purification and harvesting of adequate quantities of islet cell mass possible to obtain exogenic insulin independence. Development of new immune suppressives has not improved the results. In the future, islet cell transplantation will possibly become part of the treatment of insulin-dependent diabetes mellitus.


[Aluminum allergy caused by DTP vaccine]. All children referred to two private dermatological practices from 1 Jan. 1985 to 31 Dec. 1990 who had pruritus and subcutaneous infiltrates in the areas of immunization with Di-Te-Pol vaccine were patch tested with a Finn Chamber or with 2% aqueous aluminium chloride. Di-Te-Pol vaccine contains aluminium hydroxide. Contact allergy to aluminium was demonstrated in 32 children (20 girls and 12 boys). Of the three patch test methods used, testing with 2% AlCl3 occluded with a Finn Chamber proved to be the most sensitive. Immunization of children who have been shown to be allergic to aluminium should be carried out with vaccines which do not contain aluminium.


[A comparison of the pattern of readmissions of long-term/geriatric patients and internal medicine patients]. A comparison was undertaken between the frequencies of admission of medical patients over the age of 64 years and long-term/geriatric patients admitted to a large county hospital. The pattern of readmission is described in relation to the age groups and sex. The period of observation was nine months. In the investigation, the relationship between the distribution of men and women in the normal population was taken into consideration and a correction factor was calculated. A total of loll patients (CP) discharged from an acute medical department (AM) had 1954 readmissions (GI). In the long-term medical department (LMA) 158 CP had a total of 328-GI. The number of CP readmitted in each age group and sex reflects the representation of the group concerned in the background population, although a tendency was observed for slightly more admissions, the older the CP were. No difference in the pattern of readmission was observed concerning CP readmitted from AM and readmitted to all departments including AM. Similarly, despite some scatter, there was no difference in the GI pattern in CP discharged from LMA and readmitted to all departments including LMA. In addition, no significant difference in the GI pattern was observed as compared with the AM patient group and the LMA patient group. As patients referred to LMA have, quite naturally, poorer performance than the patients who were discharged directly from medical or surgical departments, it may be concluded that, after treatment in LMA, no difference between the patient groups was found if the GI frequency was taken as a yardstick. As GI, just as other measurements of turnover, only provides an expression of the status at a given moment, the author considers that it is of importance both for the departmental and the political planning that the GI frequency is followed as part of the current assessment.


[The dosage-effect-curves for propofol in young and elderly patients--and modification of these following fentanyl]. Forty-eight patients between 20 and 40 years and 48 patients between 60 and 80 years, none of whom had received premedication were subdivided at random for induction of anaesthesia with propofol (Diprivan) in four doses with or without prior administration of fentanyl. ED95 (effective dosage for 95%) for the young patients was 3.4 mg/kg and, for the elderly patients, 2.4 mg/kg. When 4 micrograms/kg fentanyl was administered five minutes prior to induction of anaesthesia, ED95 was reduced by 10% in the young patients and 20% in the elderly patients. In both the young patients and the elderly patients, the mean arterial blood pressure (MAP) three minutes after induction was found to be reduced by 2-26%. No further reduction was observed. The pulse did not alter significantly from the original value. When 4 micrograms/kg of fentanyl was administered five minutes prior to induction of anaesthesia, a significantly more pronounced decrease in MAP was found in young and also elderly patients during the entire period. This decrease in MAP was dependent on the dosage in the group of elderly patients. During the period of investigation, the pulse decreased 5-35%, except in the group of the young patients who received the smallest doses of propofol, where an increase of 15-20% was observed. It is concluded that induction of anaesthesia with propofol preceded by administration of fentanyl, may be followed by a considerable reduction in MAP.


[Chronic recurrent multifocal osteomyelitis]. A case of chronic recurrent osteomyelitis (CRMO) in a girl aged ten years is presented. This is an unusual inflammatory process which involves multiple osseous sites recurrently. The symptoms are insidious pain in the limbs associated with fever and, occasionally, pustulosis palmoplantaris. The disease is characterized by recurrent exacerbations but is self-limiting. Complete investigation including bone biopsy should be carried out for differential diagnostic reasons but repeated invasive investigations and repeated antibiotic treatment should be avoided on recognition of the disease. No consistent laboratory findings, apart from raised erythrocyte sedimentation rate, are found.


[Pathological gambling].

[Pathological gambling]. The case of a patient with a pathological urge to gamble is presented. Until 1990, gambling casinos were prohibited in Denmark. In 1990, a new law was enforced which permitted six casinos in Denmark. Previously, no reports were available in the medical literature concerning pathological gambling in Denmark. The incidence of pathological gambling will probably increase as a consequence of the new law.


[Cyclosporin A treatment of adult patients with severe nephrotic syndrome]. This investigation is an assessment of the cyclosporin A-prednisone treatment which has been employed in all cases of therapy-resistant nephrotic syndrome in adults (n = 18) since January 1985 at the Department of Nephrology at the State University Hospital. Following an average duration of treatment of 20.7 months, five patients were in complete and eight in partial remission. All of the patients with minimal change disease (three patients) achieved complete remission. Recurrence after withdrawal of cyclosporin A occurred in three out of five patients. Cyclosporin A was withdrawn in five patients on account of suspected cyclosporin A nephrotoxicity. Hypertension, which was slight to moderate in the majority of cases, occurred frequently during treatment. Compared with the prognosis and frequency of complications in the untreated nephrotic syndrome and the frequency of side effects with the previously administered immunosuppressive treatment, the frequency of side effects with cyclosporin A treatment was acceptable. Until the indications are elucidated, adult patients with otherwise intractable nephrotic syndrome should be referred to special nephrological departments for possible cyclosporin A treatment.


[Malignant melanoma of the skin in Denmark--epidemiology, diagnosis and treatment]. About 700 new cases of malignant melanoma of the skin are registered annually in Denmark. The incidence is increasing rapidly and the number of new cases increases by more than 5% per annum. The most important phenotypical risk factors are the number of acquired pigmented naevi and exposure to sunlight is the most important risk factor in the external environment so that severe sunburn in children and intermittent intense exposure to sunlight increase the risk of melanoma. The thickness of the tumour at the time of the diagnosis is the most important prognostic factor. The prognosis deteriorates with increasing thickness. Treatment is primarily surgical. In cases of inoperable local melanoma and regional recurrences, irradiation may be administered. Chemotherapy and/or immunotherapy are of experimental character. In the light of the rapidly increasing incidence, it is important that knowledge of risk factors for development of the disease and the clinical characteristics of early melanoma is spread to not only the medical profession but also to the general public.


[Intraoperative complications during cementation of hip arthroplasty. Avoiding air embolization during cementation]. Circulatory collapse is known to occur during cementation of hip arthroplasty. The pathogenesis is multifarious, but the most important cause is believed to be formation of air embolism during insertion and cementation of the femoral component followed by air embolism in the heart. Inserting the cement retrogradely with a cement gun following distal plugging of the femoral cavity with spongiosa and using a plastic catheter for suction drainage reduces the air embolisation. Cement producing as little heat as possible during the setting should be used. Maintaining anaesthesia with N2O air embolism and should be avoided during and after cementation. Pre- and intraoperative care of the patient's circulation and oxygenation is essential. The use of pulse oximetry, capnography and precordially recorded Doppler ultrasound are recommended for monitoring air embolism.


[Antibiotic prophylaxis in lung surgery. A review]. The most important postoperative infections in general pulmonary surgery are empyema, pneumonia and wound infection. Risk factors are underlying malignant disease and the duration of the operation. The extent of pulmonary resection also appears to be of a certain significance. Five prospective randomized, double-blind, placebo-controlled investigations are available. Together, these investigations demonstrate that prophylactic antibiotic treatment, in which the first dose is administered immediately prior to operation, reduces the frequency of pneumonia (from 27% to 17%) and the frequency of wound infection (from 18% to 4%). Despite antibiotic prophylaxis, empyema occurs with frequency of 3%. Prophylactic antibiotic treatment has also reduced the duration of hospitalization and the postoperative employment of antibiotics. The relatively few comparative investigations have not indicated unanimously that any particular antibiotic was more advantageous than other. At present, we have insufficient knowledge about the pathogenesis of the above mentioned postoperative infections. Such knowledge could increase the possibility of other prophylatic measures.


[Primary aneurysmal bone cyst. Evaluation of the symptomatology, treatment and prognosis based on 21 patients]. PABC is a rather rare, non-malignant osteolytic bone disease, affecting children and young people. Most frequently, it is localized to the metaphyses of the long bones. The present material consists of 21 cases, treated in the Orthopaedic Hospital in Aarhus between 1973 and 1991. Nineteen patients were treated with curettage of the cyst followed by bone grafting to the cavity. Six (31%) had recurrences. Five were operated again without any recurrence. The last patient has not yet received any further treatment. Two patients were initially treated by bone resection. No postoperative complications occurred. Curettage of PABC followed by bone grafting is recommended as the treatment of choice, in spite of the recurrence rate mentioned above. Because of the risk of recurrence after this treatment, regular follow-up examinations are necessary until healing has occurred i order to treat a possible local recurrence in time.


[Hypertrophic obstructive cardiomyopathy complicated with bacterial endocarditis]. A patient with hypertrophic obstructive cardiomyopathy (HOCM) and Staphylococcus aureus mitral valve endocarditis is reported. Bacterial endocarditis occurs with increased frequency and the prognosis is worse in these patients. All patients with HOCM should therefore be given antibiotic treatment every time they undergo invasive procedures to prevent potentially fatal bacteraemia.


[Changes in mental function after anesthesia and surgery]. Minor short-term depression of mental function is seen after anaesthesia and surgery. However, general anaesthesia does not seem to cause permanent damage or depress mental function beyond the first 2-4 postoperative days and no significant advantages of regional anaesthesia, as regards to cerebral function, are found after this period. Severe cases of long term mental deterioration after surgery and anaesthesia may be explained by other factors such as per- and postoperative complications. The risk of mental disturbance is increased in patients with psychiatric disease or presenile dementia and may be due to ongoing treatment with tricyclic antidepressant and neuroleptic drugs. Centrally acting cholinergic drugs, hypotension and hypoxia together with postoperative pain and sleep deprivation should be avoided.


[Pneumomediastinum].

[Pneumomediastinum]. Pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea and oesophagus. The etiology may be spontaneous/resulting from exertion, traumatic, iatrogenic or it may be due to inflammation, neoplasm or perforation of a hollow abdominal organ. In pneumomediastinum resulting from exertion, a pressure gradient occurs and this causes rupture of marginally situated pulmonary alveoli. Air escapes from the alveoli into the perivascular adventitia and dissects its way along the vessels to the mediastinum. The commonest symptoms are pain in the thorax in 80-90% of the patients, followed by sensation of oppression and dysphagia. Stethoscopic examination reveals crepitation synchronous with pulse and respiration in half of the cases. The diagnosis is verified by radiographic examination of the thorax where air can be seen as vertical radio-translucent regions in the mediastinum and along the borders of the heart. Patients with pneumomediastinum should be admitted to hospital for investigation as treatment of a possible basic condition, e.g. rupture of the oesophagus or bronchus, is important. In uncomplicated cases, the mediastinal emphysema disappears in the course of a week. Mediastinotomy with incisions for relief of pressure may prove necessary.


[Duration of immunity and occurrence of secondary vaccine failure following vaccination against measles, mumps and rubella]. The present article illustrates the extent of secondary vaccine failure after vaccination for measles, mumps and rubella (MMR). Secondary vaccine failure means loss of the immunity induced by vaccination to such an extent that infection becomes possible. Serological investigations carried out with follow-up periods of up to 16 years after vaccination for measles, 21 years after vaccination for rubella and 12 years after vaccination for mumps reveal that loss of antibodies occurs with the elapse of time but that the clinical significance of this is probably very limited. Where all three types of vaccination are concerned, secondary vaccine failure has hitherto been very seldom. Infection with measles after secondary vaccine failure is generally described as running a milder course. In rare cases, rubella re-infection has resulted in infection in utero, so that a slight risk of congenital rubella cannot be entirely excluded after successful vaccination. No extensive systematic investigations of the effect of revaccination have been carried out and, similarly, the optimal interval between two or more vaccinations has not been illustrated in more detail in the literature. Subclinical infection is not uncommon after all three vaccines. Where measles is concerned, immunity may possibly be regarded as a continuum which, depending upon the antibody level, protects the individual from various degrees of clinical disease. If wild virus can be spread via individuals with subclinical infections, it is doubtful whether population immunity (herd immunity), which is necessary to eliminate the three diseases, can be attained in large populations.(ABSTRACT TRUNCATED AT 250 WORDS)


[Changes in measles, mumps and rubella (MMR) immunity until the year of 2002 after the introduction of MMR vaccination]. In order to decide whether vaccination for measles, mumps and rubella should be introduced at the age of five years, calculations of the immunities in various age groups were performed until the year 2002 with and without vaccination at the age of five years. These calculations are based on the knowledge of immunity in the various age groups before the MMR vaccination programme was instituted in 1987 and knowledge of the compliance with vaccination obtained to date. Future predictions reveal that it is of decisive significance that compliance with vaccination among 12-year-olds is increased as rapidly as possible to 0.7 and to 0.8 in the subsequent year, if the level of immunity present prior to institution of the vaccination programme is to be maintained. The second vaccination given at a shorter interval after the first would prevent about 150 cases of illness in all per annum among 6-12 years-old. However, this should not be introduced at the expense of vaccination at the age of 12 years, which should be continued for at least 10-15 years yet. Possible abandoning of vaccination at the age of 12 years 10-15 years hence presupposes that adequate numbers of the children have been vaccinated twice at an early age and that it is sufficiently certain that secondary failure of vaccination does not occur to any significant extent.


[Clinical picture of acute pulmonary embolism. Relations to the degree of vascular obstruction]. In 132 consecutive patients treated for pulmonary embolism, duration of symptoms, number of embolic episodes before the diagnosis, circulatory affection (stable circulation (n = 61), reversible shock (n = 60), circulatory collapse (n = 11), electrocardiographic findings and systolic pulmonary pressure (n = 60) were analysed in relation to 1) underlying diseases (orthopedic surgical patients (n = 43), gynecological-abdominal surgical patients (n = 22), preembolic healthy patients (n = 42), miscellaneous medical patients (n = 25)), and 2) the obstruction of the pulmonary vascular bed quantified by a scintigraphic or angiographic score. While embolic score did not differ between the groups of underlying diseases, preembolic healthy patients with deep vein trombosis (n = 30) had longer mean duration of symptoms (14 days), more embolic episodes, (1.7 episode) and higher pulmonary pressure (72 mmHg) than the material on an average with values of 7 days, 0.9 episodes and 57 mmHg, respectively (p less than 0.001). Among patients with reversible shock or circulatory collapse, half had at least one previous embolic episode, one fifth from two to four. Embolic score correlated well with the circulatory affection (p less than 0.001). A high pulmonary pressure correlated with long duration of symptoms and a high number of embolic episodes (p less than 0.002). Sinus tachycardia and electrocardiographic signs of acute right ventricular strain (complete and incomplete right bundle branch block, SIQIIITIII-pattern and inverted T-waves in V2-4) correlated positively to the circulatory affection and inversely to duration of symptoms and number of embolic episodes (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


[Aggressive treatment of acute pulmonary embolism. 132 consecutive patients treated with heparin, streptokinase or embolectomy, 1975-1987]. During 1975-1987, 132 patients were treated for acute pulmonary embolism with heparin (n = 41), streptokinase (n = 52), or embolectomy (n = 39). In 1984, the indications for embolectomy were broadened to include all patients with central emboli, also those who were circulatory stable. The heparin-, streptokinase-, and embolectomy groups differed from each other as regards the degree of circulatory impairment (stable circulation/reversible shock/circulatory collapse: 68/32/0% versus 52/48/0% versus 16/56/28%, p less than 0.0001) and embolic score (20 for complete obstruction; 5.6 +/- 3.4 versus 8.7 +/- 2.8 versus 13.2 +/- 2.4, p less than 0.0001), but were comparable in terms of prognosis (30-day mortality/10-year survival +/- standard error: 7%/61 +/- 9% versus 13%/59 +/- 9% versus 18%/61 +/- 10%). Stable circulation, reversible shock, and circulatory collapse prior to embolectomy resulted in 30-day mortalities of 0%, 9%, and 45% respectively (p less than 0.01). During 1984-1987, no early or late deaths after embolectomy were observed in patients without circulatory collapse (n = 10). In comparable patients (embolic score greater than or equal to 9, symptom duration less than or equal to 7 days, no circulatory collapse), streptokinase treatment (n = 13) and embolectomy (n = 25) resulted in 10-year survival +/- standard error of 46 +/- 16% and 82 +/- 10% respectively (p less than 0.0001) and in an embolic score-reduction (score before minus score after treatment) of 5.7 +/- 2.3 and 10.5 +/- 2.9, respectively (p less than 0.0001). Embolectomy during extracorporeal circulation should be considered the treatment-of-choice in patients with acute central emboli.


[Extracardiac rhabdomyomas].

[Extracardiac rhabdomyomas]. Two cases of extracardial rhabdomyomata are described. One case was discovered incidentally at autopsy while the other was primarily examined by needle aspiration biopsy. As far as the authors are aware, this is the first case to be reported.


[Acute vasculitis and arthritis caused by Parvovirus B 19 infection]. A 35-year old woman was admitted with fever, polyarthritis and severe vasculitis. The symptoms resolved spontaneously within a week. Two weeks later, her seven year old son developed erythema on arms and legs and the typical "slapped cheek syndrome" characteristic of erythema infectiosum. Both cases were due to acute infection with Parvovirus B 19 as demonstrated by the presence of IgM-antibodies to Parvovirus B 19. The cases are described in order to draw attention to the possibility of Parvovirus B 19 infection as the etiological agent for acute vasculitis in adults.


[Necrobacillosis].

[Necrobacillosis]. Necrobacillosis is an infection caused by the anaerobic Gram-negative rod Fusobacterium necrophorum. The infection is most common in previously healthy young adults and is characterised by sore throat followed by rigors, septicaemia and the formation of metastatic abscesses, often in the lungs. The infection has a certain mortality, which is reduced when early and sufficient treatment is administered. The treatment is a prolonged course of penicillin and/or metronidazole. Two case histories and a review of the literature are presented. The purpose of this article is to make the clinician aware of the syndrome, which is so characteristic that the diagnosis can be made from the clinical picture alone before bacteriological verification.


[Foot zone therapy and bronchial asthma--a controlled clinical trial]. Thirty patients with proved bronchial asthma receiving treatment with inhaled steroid in dosages of less than 1,000 micrograms daily were subdivided at random into two groups of 15 patients. One group received foot zone therapy and the other merely uniform clinical care but without "placebo foot zone therapy". The "active" group received a total of ten foot zone therapy sessions of one hour at intervals of one week. The asthmatic symptoms, consumption of medicine and the objective pulmonary function parameters were followed-up during the subsequent six months. Decrease in consumption of beta-2-agonists and increase in peak-flow levels were observed in the group which had received foot zone therapy, but the same changes were observed in the control group. The authors do not find that this investigation demonstrates that foot zone therapy is of effect on the disease bronchial asthma. They conclude, however, that the favourable effect in both of the groups are due to increased care and control which occurred in both patient groups.


[Clinical trial of 2 highly sensitive pregnancy tests--Tandem ICON HCG-urine and OPCO One-step Pacific Biotech]. The highly sensitive pregnancy test, Tandem ICON HCG-urine, was compared with OPCO "One-step" Pacific Biotech in the gynecological and obstetrical department of Randers Hospital. The purpose was to determine the test specificity and sensitivity of the pregnancy tests in women with possible pregnancies. The test sensitivities were found to be 0.83 and 0.63 for ICON and ONE, respectively. We experienced one and four cases of negative pregnancy tests and ectopic pregnancies with ICON and ONE, respectively. In all cases, the diagnosis of ectopic pregnancy was suspected by other means and the patients submitted to operation. The ICON test showed its supremacy in diagnosis while ONE was easier and cheaper.


[Elimination of human chorionic gonadotropin in serum and urine after uncomplicated induced abortion during the first trimester]. Serum chorion gonadotropin was measured weekly in 12 women from the time of legal first trimester abortion until values were below 10 IU/L. The elimination followed a 2-component curve. The half-life in the first few days was 1.1 day, hereafter 4.2 days. Serum-HCG decreased to less than 10 IU/L within 22 to 40 days. The elimination of serum-HCG was found to decrease so uniformly, that values which do not decrease must be considered abnormal. A sensitive bedside urine-HCG test was found to be positive from 13 to 31 days after the abortion.


[PermCath as intravenous access in chronic hemodialysis]. PermCath is a dual-lumen silicone catheter for permanent venous access for hemodialysis. During an observation period from 1 July 1988 to 30 June 1991, 49 PermCath were inserted in 32 patients. In 24 patients (75%), the PermCath was used as sole method of access for hemodialysis through the observation period. Six of the 24 patients required changing of the catheter once, and in three patients the PermCath functioned properly only after the third insertion of a PermCath. In eight patients, vascular access could not be accomplished using the PermCath and these patients were all hemodialyzed through another vascular access. Four patients developed bacteraemia and one patient developed thrombosis of the subclavian vein during the observation period. Insertion of the PermCath is easy and, in case of malfunction, changing or removal of the catheter is easily accomplished. The PermCath is recommended as an alternative to existing techniques for intravenous access for hemodialysis.


[Routine coronary arteriography in younger patients with acute myocardial infarction]. Coronary arteriography was performed in 50 patients aged 40 years of less all of whom had had acute myocardial infarction (AMI). Forty-seven patients had at least one risk factor for development of ischaemic cardiac disease. Smoking and familial predisposition were the commonest predisposing factors. Seventeen patients had stenosis in a single coronary artery only. Six patients had three-vessel disease and none had stenosis of the main stem of the left coronary artery. Eight patients had no stenoses. All patients with three-vessel disease had sign of ischaemia after infarction. The type of infarction was related to the number of stenosed vessels, so that patients with Q-wave infarction had a greater number of stenoses than patients with non-Q-wave infarcts. A congenital coronary in the form of abnormal origin of the left coronary artery from the pulmonary artery was the cause of AMI in an isolated case. On the basis of this retrospective investigation, the authors have assessed the value of routine coronary arteriography (CAG) in 50 relatively young patients who had recently sustained AMI. CAG does not appear to be indicated as a routine procedure in all of these patients but could have been performed primarily on the basis of symptoms or the findings from non-invasive investigations.


[Non-surgical treatment of acute cholecystitis in high-risk patients. Percutaneous drainage of the gallbladder and removal of stones]. Eight high-risk patients with acute cholecystitis were submitted to subhepatic percutaneous drainage of the gall-bladder as the initial treatment. One patient died a few days after the intervention. Six patients had stones in the gall-bladder. Cholecystectomy was performed in one of these in five, the stones were removed by a percutaneous endoscopic technique after dilatation of the drainage canal. No noteworthy complications occurred.


[Ultrasonically guided Biopty-biopsy of focal liver processes]. During a period of three years, 51 patients with focal hepatic changes were submitted to 55 ultrasonically guided Biopty-biopsies. Histological diagnoses could be established in 45 patients at the first biopsy which corresponds to a diagnostic certainty of 88.2% Histological diagnoses were established in 49 patients which corresponds to a certainty of 96%. The frequency of complications was 3.9%. Biopty-biopsy is recommended as a good method because it is easy to carry out and provides just as good results as other methods of biopsy. In addition, it can provide more histological information than aspiration biopsies which are, however, somewhat cheaper.


[Vaginitis emphysematosa].

[Vaginitis emphysematosa]. Vaginitis emphysematosa is a benign, uncommon condition characterised by the presence of gas-filled cysts beneath the vaginal epithelium. Cases has been reported in pregnant women, in patients with diseases of the cardiovascular system and in patients with Trichomonas or Gardnerella vaginitis. To date the etiology and pathogenesis have not been fully elucidated. A case of vaginitis emphysematosa in a patient with cardiovascular disease is described.


[Ketamine. A controversial anesthetic agent]. On the basis of a review of the literature, a survey is presented concerning the controversial anaesthetic agent ketamine, its pharmacology, mechanism of action and employment. Particular emphasis is placed on the cerebral, cardiovascular and pulmonary effects and the clinical employment. Similarly, the side effects and their prophylaxis are described. It is concluded that ketamine is considered to be a valuable preparation which can be employed both in and outside hospital.


[Ketamine as a broncholytic agent in status asthmaticus and as an anesthetic for patients with bronchial asthma]. Ketamine was introduced into clinical anaesthesia in 1965. Since then it has been demonstrated to lower airway resistance and to increase lung compliance in the asthmatic patient. It has also proved useful in anesthetizing asthmatic patients with or without symptoms. In several case reports it has been used successfully in the management of status asthmaticus resistant to conventional therapy but so far no controlled clinical trial has been carried out to support this empirical use of ketamine. The limited magnitude of the side effects permits the use in status asthmaticus when all other treatment has failed. Experiments with animals and with human preparations have suggested one or more of the following mechanisms of action: a sympathomimetic effect, a direct relaxant effect, an antagonism to histamine and acetylcholine and a membrane stabilizing effect as with local analgesics. Until investigations have been published ketamine is recommended as an anaesthetic for the asthmatic patient and for the patient who has previously reacted with bronchospasm when intubated or anaesthetized. Prospective clinical trials should be planned.


[Surfactant treatment of newborn infants with respiratory distress syndrome primarily treated with nasal continuous positive air pressure. A pilot study]. In this pilot study, Curosurf (200 mg/kg) was administrated to 34 patients with the respiratory distress syndrome in nasal-CPAP therapy with FiO2 requirements greater than 0.60 and/or TcPCO2 greater than 8 kPa. The surfactant was instilled during a short period of intubation or in a few cases via an intratracheal catheter (Ch. 6). The age of the patients on surfactant treatment ranged from two to 72 hours. Eighteen patients could be maintained on nasal-CPAP after treatment with Curosurf and only a few complications were seen in these infants. The other 16 patients subsequently required artificial ventilation and had a higher incidence of pulmonary and extrapulmonary complications. On the basis of these observations, we plan a randomized trial to investigate whether, administration of surfactant reduces the need for ventilator treatment and improves the odds for uneventful recovery in this category of patients.


[Morbidity of children attending day care centers in Copenhagen illustrated by social, physical, environmental and hygienic factors]. Sick leave among the children in 24 day nurseries in Copenhagen was registered during a period of one year. The physical, environmental and hygienic conditions of the institutions were assessed by means of interviews and inspection, supplemented by information from the local authorities. Sick leave constitutes 7.5% of the days during which the institutions were open and the average number of sick days per child varied from 14.6 to 24.4. Comparisons with similar investigations are inclusive on account of variations in the methods of registration and age distributions. It was characteristic of the institutions investigated that these included a number of old institutions in flats, many in streets with considerable traffic and where the conditions of ventilation and space do not conform with present-day standards. In some of the institutions, the hygiene is unsatisfactory, particularly where ventilation, outdoor activities and hand-washing are concerned. A statistically significant connection was found between amount of traffic at the institution, the hygiene and playroom area per child, on one hand, and absence due to sickness, on the other, as assessed by a statistical model for sick leave for child in a given institution. In order to prevent sickness, it is concluded that efforts to improve hygiene and space are desirable and, similarly, further research concerning the effects of atmospheric pollution is relevant.


[Ondine's syndrome (alveolar hypoventilation)]. Ondine's syndrome is a rare condition characterised by alveolar hypoventilation during sleep on account of an abnormality in the automatic control of respiration. The respiration centre does not react adequately to the carbon dioxide tension in the blood required to maintain normal ventilation. We present a description of the course in an infant with congenital Ondine's syndrome because a therapeutic possibility is now available, viz, implantation of a phrenic nerve pacemaker. The infants showed respiratory insufficiency shortly after delivery. This disappeared on tactile stimulation. The infant had generalised hypotonia with absent patellar reflexes and weak sucking reflexes and, at the age of one week, seizures developed. The infant was treated with assisted ventilation but this could be reduced to use only during the period when the infant slept. The infant was in good health with normal psychomotor development until the age of two years. Plans had been made to implant a phrenic nerve pacemaker. Unfortunately, the infant developed Syncytial-virus pneumonia complicated by bacterial superinfection and developed severe anoxic brain damage which subsequently proved fatal.


[Hematological abnormalities in alcoholism]. The most common haematological abnormalities in alcoholism are raised mean corpuscular volume of the erythrocytes and thrombocytopenia. The etiology is multifactorial including malnutrition with folate deficiency, a direct toxic influence of alcohol and sequestration in an enlarged spleen. Sideroblastic anaemia caused by interference of alcohol with the metabolism of pyridoxine is common and so is haemolytic anaemia caused by hypersplenism and megaloblastic anaemia. Leucopenia can be seen and is probably caused by a direct toxic effect of alcohol on the bone marrow. Other potentially toxic changes are impaired chemotaxis, motility and adherence of the granulocytes and impaired blast-transformation of the lymphocytes. In the bone marrow, vacuolized precursors of myelo- and erythropoiesis are seen. The bone marrow may be hypocellular. Other changes in the bone marrow are increased but ineffective erythropoiesis with defective iron metabolism, vacuolized pro-erythroblasts, multinucleated erythroblasts, megaloblasts and iron-containing plasma cells.


[Can progression of myopia be prevented? A literature review]. There is no simple explanation as to when or how myopia commences, nor is there any simple method of preventing the progression of myopia. Non-surgical methods have been attempted: sight training, exercise, drugs to induce cycloplegia and to reduce intraocular pressure, as well as contact lenses and bifocal glasses; none of these have been able to prevent progression. Promising results have been disappointing when these treatments are repeated on larger groups of patients without investigator bias. Surgical procedures for the prevention of progression are not carried out in Denmark at present. New methods of reinforcing the scleral wall also in low grade myopia have been reported from Moscow. Compounds are being injected and transplants are being inserted behind the eye. It is exciting to see whether these results can be reproduced, if trial of this type of treatment is permitted in Denmark.


[Pregnant women's knowledge about HIV and AIDS]. This investigation is based upon information from 820 pregnant women who replied to a questionnaire about AIDS during the period 17.4.1989-14.7.1989. The questions included sources of information, knowledge about routes of infection and risk groups and the extent of spread of infection and disease in the population. 95% agreed to participate. Knowledge had been obtained primarily via the electronic media, while the health services had limited significance. The employment of sources of information depended on age and occupation. Apart from knowledge about the risk involved in breast feeding, the women were, in general, well informed about routes of infection. Knowledge about risk groups and the current extent of spread of infection was, on the the other hand, deficient. Defective knowledge was concentrated in groups which may be characterized by age (less than 24 years) and occupation (trained and untrained workers and the group of "other occupations"). Information obtained from health staff was connected with better knowledge about the extent of spread of infection. The majority of women desired routine information about AIDS in connection with antenatal control. Prophylactic measures should be based, among other things, on knowledge about development in the knowledge in the population and its employment of sources of information, so that specific information may be directed to certain groups of the population by using the most frequently employed and most effective routes of information. The knowledge of population groups, the attitudes and behaviour should be followed continuously.


[First year experience with a system of mandatory reporting of HIV-positive cases in Denmark]. During the period 1. Aug. 1990 to 31. July 1991, a total of 87,779 HIV-tests were carried out in Denmark on individuals other than blood donors according to the laboratory notification system. Of these 853 were HIV-positive which corresponds to a HIV prevalence of 0.97%. During the same period, 602 persons were notified by doctors as HIV-positive, corresponding to a percentage of notifications of 70. Out of the 602 persons, 84 were repetitions. The sex of two persons was not stated. Further 164 (36%) were previously found to be HIV-positive. Thus there remained 332 (64%) persons who could be classified as positive for the first time. In the material of HIV-positive individuals for the first time, 79% were men and 21% women. The mean age for men was 36 years and 26 years for women (p less than 0.001). 66% of the men were estimated to be infected by homosexual contact, 19% by heterosexual contact and 9% by intravenous drug use. Nineteen of the heterosexually infected men (39%) stated that they had been infected by a woman from a high-endemic region, three by a female drug user and 24 (49%) did not know the source of infection. Thirty of the heterosexually infected women (63%) were considered to be infected by a man from a high-endemic region and 21 of these women were born and had grown up in this region. Six of the women (13%) were considered to have been infected by a bisexual man and eight (17%) by a man without known risk behaviour. HIV-positive persons were notified from all Danish counties, including 57% from Greater Copenhagen. The geographical distribution is not identical for the two sexes. For men, 63% were from Greater Copenhagen and 14% from Jutland while the corresponding distribution for women were 35% and 28% (p = 0.001).


[Ultrasonically guided pericardiocentesis]. Ultrasonically guided pericardiocentesis was performed on 25 occasions in 23 consecutive patients. Incipient cardiac tamponade was present in 22 patients and the procedure was performed for diagnostic purposes in one patient. In 21 cases, 5.7 French pig-tail catheters were employed and 1.2 mm lumbar puncture needles in four cases. In 19 out of 22 patients (86%) with incipient cardiac tamponade the ultrasonically guided pericardiocentesis was considered successful. In one patient, the catheter was misplaced in the right atrium, one patient developed pyopericardium and one patient developed transient tachycardia. In two cases, no material could be obtained. Ultrasonically guided pericardiocentesis is preferable to "blind" puncture and the procedure should be carried out by physicians with experience in interventional ultrasound.


[Utilization of cardiovascular drugs in Denmark from 1978 to 1990]. In Denmark, the total sale of medicine increased from 3.1 billion Danish crowns in 1981 to 5.9 billion Danish crowns in 1990. This increase of 91% must be seen in relation to changes in the consumer price index which increased by 77% during the same period. The greatest increase was observed in the sale of antacids and preparations for the treatment of peptic ulceration (189%), drugs for asthma (225%) and antihypertensive drugs (409%). Subdivision of the group of antihypertensive agents reveals an explosive increase in the sale of calcium-blockers (in 1990: a total of 158 million Danish crowns) and angiotensin-converting-enzyme (ACE)-inhibitors (in 1990: 100 million Danish crowns). Both of these therapeutic principles had been introduced in the nineteen eighties. During the same period, slighter decreases were observed in the consumption of diuretics (194 million Danish crowns in 1990) and beta-blockers (204 million Danish crowns in 1990). This development in the sales figures documents an alteration in the patterns of prescription by practitioners. It must, however, be emphasized that the drugs mentioned here have several different therapeutic indications, some of which were first established during the above mentioned decade. No randomized investigations in the treatment of hypertension are available in which recent therapeutic principles with calcium-blockers and ACE-inhibitors were compared with the previously well tested therapeutic principles involved in diuretics and beta-blockers.


[Accidents with high-pressure cleansing devices--a new mechanism of injury]. Air and water powered tools are employed increasingly in industry and involve new possibilities for occupational casualties. A new mechanism of trauma is described where the cause of death was an injury to the head, similar to a firearm wound. The "missile" was the water beam from the victim's own high pressure cleansing device, which was able to produce water pressure up to 900 atmospheres resulting in high water velocity of 300 meters/second. As prophylaxis, new legislations, as a result of understandings between employers and employees in the member states of the Common Market, are under preparation at present.


The early development of neurosonology: III. Pulsatile echoencephalography and Doppler techniques. From the earliest days of echoencephalography, it was noted that echoes from intracerebral interfaces showed systolic pulsations both in amplitude and range. Recordings of larger pulsations in range could also be obtained from the walls of intracranial arteries. It was hoped that clinical information might be obtained from recording and measuring these pulsations. Since it was easier to build equipment that recorded pulsations in amplitude, most work was confined to the recording of amplitude pulsations. However, such recordings of both amplitude and range pulsations usually used range gates in order to isolate the echo of interest and movement of the echoes within the gates introduced artefact in the recordings. Such artefact was more easily identified in recordings of range rather than amplitude. None of these types of recordings resulted in the development of a clinically useful examination in either the living or dying patient. However, the recordings of range fluctuations were able to demonstrate the presence of Traube-Hering waves in the blood vessels of the brain, thus suggesting that these vessels received an autonomic innervation in addition to their chemical sensitivity. Such range recordings also showed that, as a result of the increase in cerebral volume with the arrival of each systolic pulse wave, the brain moved centripetally to compress the cerebral ventricles and downwards to compress the basal cisterns and venous sinuses. The volume increase in the brain was accomodated by displacing cerebrospinal fluid and venous blood outside the rigid skull. When such a venting mechanism was over-taxed, as may result from increased intracranial pressure, it was postulated that the systolic pulse pressure wave, which could no longer be adequately attenuated by the compensatory venting of blood and cerebrospinal fluid outside the rigid skull, gave rise to shock waves which damaged the periventricular ependymal interface and the underlying brain with the production of progressive hydrocephalus. The development of ultrasonic Doppler techniques was quite a different matter and led to a number of clinically useful examinations as the technology became increasingly developed. The Doppler frequency shifts were displayed in various forms culminating in the display of their whole spectrum. Directional displays added further information and the ability to use short pulses enabled the Doppler shift and velocity of blood flowing in small regions of blood vessels to be recorded. Two-dimensional displays of the Doppler frequencies present in blood flowing in vessels were developed concurrently with duplex techniques which made B-mode displays of the blood vessel of interest in a tomogram of the surrounding tissues.(ABSTRACT TRUNCATED AT 400 WORDS)


1975-2000: a quarter century of ultrasound technology. The most popular forms of ultrasonic diagnostic technology experienced a major transition around 1975 with the introduction of real-time B-mode imaging and the combination of real-time imaging with pulsed Doppler in the Ultrasonic Duplex Scanner. At about the same time, the superposition of Doppler data as color on the gray-scale B-mode image was conceived and demonstrated. Since that time, the instruments have been commercialized and distributed broadly. Except for advancements in scanhead design, the introduction of dynamic focussing on echo receive, and conversion of the instruments from analog to digital processing, little has changed in ultrasound instruments; their size, price, features, and portability have been constant. A fully trained examiner using the most modern instrument made in 1978 can easily adapt the same examination methods to instruments made in 1990. The major change in ultrasound technology has been the increased application of ultrasound examination, specifically Doppler examinations to new organ systems. These trends will change in this final decade of the century. The comments here are from a perspective of noninvasive vascular diagnosis. Each of the advancements in ultrasound technology have resulted from the combined efforts and cooperation of many people. I will not attempt to credit those people here.


Computed estimates of maximum temperature elevations in fetal tissues during transabdominal pulsed Doppler examinations. Measured characteristics of ultrasonic fields were obtained in submissions from manufacturers of diagnostic ultrasound equipment for devices operating in pulsed Doppler mode. Simple formulae were used with these data to generate upper limits to fetal temperature elevations, delta Tlim, during a transabdominal pulsed Doppler examination. A total of 236 items were analyzed, each item being a console/transducer/operating-mode/intended-use combination, for which the spatial-peak temporal-average intensity, ISPTA, was greater than 500 mW cm-2. The largest calculated delta Tlim values were approximately 1.5, 7.1 and 8.7 degrees C for first-, second- and third-trimester examinations, respectively. The vast majority of items yielded delta Tlim values which were less than 1 degree C in the first trimester. For second- and third-trimester examinations, where heating of fetal bone determines delta Tlim, most delta Tlim values were less than 4 degrees C. The clinical significance of the results is discussed.


Cellularity and fibrin mesh properties as a basis for ultrasonic tissue characterization of blood clots and thrombi. This in vitro study was designed to evaluate the ability of ultrasonic tissue characterization (UTC) based on power spectrum analysis of backscattered radio-frequency echo signals to distinguish two prominent variables of thrombi: cellularity (primarily red cell content) and fibrin-mesh density. Six types of clots simulating thrombus components were prepared by varying red-cell and platelet concentrations and shear forces during clotting. Data were acquired with a linear-array transducer, digitized, and analyzed in terms of slope and intercept parameters obtained from normalized power spectra of radio-frequency echo signals. Increased cellularity and fibrin-mesh density both produced lower slope and higher intercept values, which permitted statistically significant discrimination of cellularity and mesh density in the six types of clots analyzed. Shearing forces and (to a lesser degree) platelet concentrations increased fibrin-mesh density. This study suggests that UTC based upon the power spectrum of echo signals may be used to detect and follow compositional differences that have clinical relevance in the diagnosis and follow-up of thrombi.


Bubble cycling and standing waves in ultrasonic cell lysis. Two quite different but potentially complementary hypothetical mechanisms have been proposed to explain the dependence of ultrasonic cell lysis in vitro on exposure vessel rotation. One mechanism proposes that resonant-size bubbles are trapped in planar arrays by standing waves in the sample and that exposure vessel rotation sweeps cells through the bubble arrays. The other mechanism, for which there is now considerable support, proposes that exposure vessel rotation simply allows bubbles to recycle after having been driven through the medium by the ultrasound. We report here the results of efforts to further discriminate between, and quantify, the relative contributions of these two mechanisms. Murine P388 cells were exposed to 1.07 MHz continuous-wave (CW) ultrasound for 5 min at 5 W/cm2 (ISP) using various exposure vessel compositions and exposure configurations. Experimental treatments were designed either to minimize or maximize standing waves in the sample tube, or to minimize the potential for bubble recycling while maximizing standing wave formation. The results of these experiments indicate that bubble cycling is responsible for the majority of cell lysis occurring in the rotating exposure vessels, but that a significant contribution to total lysis is provided by trapped bubbles under some conditions.


Ultrasound Doppler spectral analysis in the diagnosis of occlusive lesions of the carotid arteries. To evaluate the accuracy of Ultrasound Doppler Spectral Analysis (USDA), 432 carotid arteries were examined [group I consisted of 145 cases of normal ICA (internal carotid artery), group II--187 cases of ICA stenosis and group III--100 cases of ICA occlusion]. The maximal systolic peak (Smax), maximal diastolic peak (Dmax), the spectral broadening index (SB) and the pulsativity index (PI) were calculated and related to the degree of stenosis as determined by contrast arteriography. Our results indicate that the change of the value of Smax is the main diagnostic criterion: for carotid arteries' stenoses, it increases to over 3.2 kHz. A Smax over 6.0 kHz is a veritable index of ICA stenosis above 50%: in such cases as the stenosis increases by 10%, this corresponds to an approximately 1 kHz increase of Smax. In ICA occlusion, the main criterion was the absence of blood flow in the distal ICA segment. The UDSA sensitivity in hemodynamically insignificant stenosis is 73.9% which is far higher than in the periorbital Doppler examination; in hemodynamically significant stenosis and ICA occlusions, the sensitivity is 98.6 and 99%, respectively.


Duplex scanning of the peripheral arteries: correlation of the peak velocity ratio with angiographic diameter reduction. The correlation of the peak systolic velocity (PSV) and the peak velocity ratio (PVR, calculated as intrastenotic PSV divided by proximally recorded PSV) with percent diameter reduction was studied in 62 patients with peripheral arterial occlusive disease. PSV values correlated well with angiographic diameter reduction (r = 0.81, n = 106 stenoses), but due to large variability the sensitivity and specificity in the detection of greater than 50% stenoses were only 66% and 80% (for a cutoff value of 180 cm/s). The PVR showed less interindividual variability and exhibited a strong correlation with percent diameter reduction (r = 0.93,n = 106 stenoses). A 2.4 fold increase of the peak systolic velocity values with respect to the proximal site (i.e., PVR = 2.4) or more indicated a more than 50% stenosis with a sensitivity of 87% and a specificity of 94%. Figures for PVR are provided to quantitate the degree of stenoses in the 50-99% range. Calculation of PVR may normalize for patient variation and allow noninvasive quantification of lumen narrowing with high sensitivity and specificity.


Cerebral blood flow velocity: the influence of myocardial contractility on the velocity waveform of brain supplying arteries. Indices of Doppler-derived velocity waveforms of arteries perfusing the brain are used as relative measures of neonatal brain blood flow. Using a dog model, we investigated the influence of changes in myocardial contractility, induced by dobutamine, on the blood flow velocity waveform of the vertebral artery. The following indices of the velocity waveform were investigated during control states and during 5 or 10 micrograms/kg/min dobutamine infusion: peak systolic flow velocity (PSFV), temporal mean flow velocity (TMFV), end-diastolic flow velocity (EDFV) and acceleration time (ACC-time). PSFV and ACC-time of the vertebral artery showed a strong relationship with myocardial contractile state. These results indicate that PSFV of an artery supplying the brain or indices which combine PSFV with MFV or EDFV should not be used for noninvasive assessment of brain blood flow or cerebral vascular resistance. ACC-time may prove to be very useful in assessing changes in myocardial contractile state.


Noninvasive measurement of diameter changes in the distal abdominal aorta in man. An ultrasound phase-locked, echo-tracking system was used to determine the dynamic properties of the distal abdominal aorta in 10 Caucasian male subjects (mean age, 25 years). Recordings were made at rest and during the blood pressure increase resulting from isometric exercise. The pressure diameter curve was nonlinear with an inflection at about 90-110 mmHg. Above this pressure range, the vessel was stiffer (less compliant), but the pressure diameter relationship was roughly linear above as well as below the inflection. Individual pressure diameter curves showed hysteresis, i.e., the aorta had a smaller diameter during expansion than during retraction at corresponding pressures. The pressure strain elastic modulus (Ep) and stiffness (beta) were at rest [Mean Arterial Pressure (MAP), 81 mmHg] 0.70 10(5) N/m2 and 6.0, respectively. During isometric exercise (MAP, 122 mmHg), Ep increased significantly by 91% and stiffness (beta) nonsignificantly by 27%. The variability of the compliance determinations was 5% when the ultrasonic system was combined with intra-arterial blood pressure measurements and less than 7% when combined with auscultatory blood pressure measurements. It is concluded that the phase-locked, echo-tracking system fulfills clinical requirements for routine measurements of vascular compliance.


Modest enhancement of ultrasound-induced mutations in V79 cells in vitro. V79 cells were insonated (1 MHz, 35 W/cm2, 2 min continuous wave) under temperature conditions previously reported to cause a large increase in acoustic cavitation. The goal was to increase the ease of detecting ultrasound-induced mutations. The data supported the hypothesis that a 3 degrees C gas-equilibration period followed by insonation at 37 degrees C resulted in a detectable increase in resistance to 6-thioguanine with 6 trials per regimen.


High-resolution real-time ultrasonic scanner. High spatial resolution is required for echographic exploration of the skin, microvessels or small laboratory animals. With the scanner described here, high resolution is obtained by means of a strongly focused, wide-band 17 MHz center frequency transducer (-6 dB bandwidth: 22 MHz). The movement of this transducer above the skin provides a 6 mm wide and 5 mm deep echographic cross-section with an image rate of 15 images/s. The resolution is about 0.08 mm in axial and 0.2 to 0.3 mm in lateral directions. The device was tested on phantoms in water and in vivo on normal and pathological skin in the Department of Dermatology. With the easy-to-handle probe, explorations were made on psoriasis, basocellular carcinoma, malignant melanoma and sarcoidosis.


A velocity evaluation phantom for colour and pulsed Doppler instruments. We describe a phantom designed to evaluate the velocity measurements made with colour and pulsed Doppler instruments. Using a belt to translate a large volume of semi-rigid material through the entire Doppler sample volume eliminates many of the problems associated with flow and string phantoms. A servo-motor with feedback circuitry ensures accurate control of the belt velocity with an uncertainty in the mean velocity of 0.14%. The phantom provides velocities with typical variations of 0.07 cm/s. We have demonstrated the usefulness of this phantom by evaluating the linearity and accuracy of three pulsed Doppler instruments over belt velocities ranging from 0 to 80 cm/s. In addition, the measurements show the effects of the wall filter at low belt velocities. Using this phantom, we have quantified the accuracy, linearity and precision of the velocity measurements made by three colour Doppler instruments. The results also show regions where the colour instruments are aliased and where the wall filter dominates.


Temperature rise in a tissue-mimicking material generated by unfocused and focused ultrasonic transducers. The temperature elevation in a homogeneous tissue-mimicking material with tissue-like thermal and acoustic properties, generated by unfocused and focused ultrasonic transducers operating at 1.0 and 3.5 MHz frequencies, was measured. It was found that in the vicinity of a transducer front face, both transducer surface heating and ultrasound absorption are important sources for tissue heating. As for heating due to ultrasound absorption, the experimental results are compared with theoretical predictions for nonperfused tissues resulting from different beam models. The experimental data are in reasonable agreement with the results calculated from a model developed by Nyborg and Steele, a Gaussian beam model and from the model used by the National Council on Radiation Protection and Measurements (NCRP).


Genitourinary tract nuclear oncology.

Genitourinary tract nuclear oncology. Currently available routine radionuclide procedures and on-going investigational scintigraphic studies of genitourinary tract tumors were reviewed. Emphasis was focused on the most commonly encountered tumors located in the kidneys, bladder, and prostate. Other imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), and sonography have replaced many of the routine radionuclide imaging procedures providing high-resolution images and anatomic details. The advantages of radionuclide procedures with their simple, uninvasive, and functioning nature will continue play important role in our management of tumors of the genitourinary tract.


Radioisotopic evaluation of renal transplants. Owing to the noninvasive nature, ready availability, and efficacy, radionuclide studies remain widely utilized following renal transplantation for monitoring changes in the functional status and detection of detrimental complications of the grafted kidney. Whereas surgical complications, including vascular occlusion, urine extravasation, drainage obstruction, hematoma, or lymphocele formation, can often be detected effectively, specification of other underlying causes of deterioration of parenchymal function, including acute tubular necrosis (ATN), various types of rejection, and cyclosporine A nephrotoxicity (CyA-NT), frequently cannot be derived independently from the findings of a study without clinical correlation. Besides imaging, plotting of renogram or time/activity curves, numerous quantitative methods have been introduced to provide objective measurements of the blood flow, as well as to gauge the capability of concentration and excretion of the transplanted kidneys. However, the findings whether qualitative or quantitative all have overlapping zones. There is no abnormal image, graphic, or numeric index absolutely specific for any of the possible posttransplant renal parenchymal complications. The differentiation of such conditions may best be achieved through chronologic association of the sequential changes, with or without quantification, detected in serial studies with the clinical presentation and findings.


Radionuclide quantitation of renal function. Quantitation of renal function may be performed with a variety of radiopharmaceuticals which reflect slightly different renal functions. Plasma sampling techniques and imaging techniques have been used to derive absolute measurements of renal function. The addition of imaging permits the determination of relative or "split" function. Time-activity curves from renal studies provide other quantitative parameters of function reflecting arterial supply, renal cortical function, and patency of the renal collecting system. Quantitative radionuclide studies of the kidneys provide comprehensive, reproducible, and objective assessments of renal function.


Diuretic renography: concepts and controversies. Diuretic renography has proved to be a reliable, noninvasive test for the diagnosis of upper urinary tract obstruction. False positive and false negative results may occur but can be minimized by careful attention to technique. The timing of diuretic administration, state of hydration, and furosemide dosage appear to be the key methodologic variables.


Nuclear medicine evaluation of hypertension. Noninvasive diagnosis of renovascular hypertension using nuclear medicine techniques has evolved in the past 30 years through improvements in imaging equipment, radiotracers, and, most recently, captopril intervention. Characteristic patterns of normal and abnormal renograms using typical radiotracers are demonstrated, including renal artery stenosis. Comparison with other tests, both invasive and noninvasive, are made with the aim toward identifying anatomic as well as physiologic definitions of renovascular hypertension. Pitfalls in the methodology are also described. The main advantage of captopril renography is enhancement of the sensitivity, and particularly the specificity, of the radionuclide diagnosis of renovascular hypertension. Available investigations have identified captopril renography as the likely procedure of choice in the noninvasive identification of renovascular hypertension.


Radionuclide genital imaging.

Radionuclide genital imaging. Despite the emergence of newer cross-sectional imaging approaches, radionuclide techniques have maintained a significant role in genital imaging. While ultrasound is clearly superior for evaluation of scrotal anatomy, radionuclide scrotal imaging remains the most effective method for differentiating between testicular torsion and epididymitis. Labeled red blood cells have been used for varicocele detection in infertile men. Since radionuclide techniques can demonstrate the physiologic status of organs, they play a useful role in evaluating men with impotence (penile scan) and infertile women whose tubal patency is in question (radionuclide hysterosalpingogram).


Analysis of kidney volume growth during the fetal period in humans. The growth of fetal kidney volume was studied in 290 specimens taken from 145 fresh human fetuses (85 males and 60 females) with gestational age ranging from 13 to 36 weeks postconception (WPC). Normative equations and curves of the growth of renal volume were obtained for male and female fetuses and for the whole sample in the second trimester (13-24 WPC) and in the third trimester (25-36 WPC) of gestation. There was no difference between the growth in volume of the right and left kidneys. Fetal kidney volume increases with a more intense rhythm in the early fetal period (13-24 WPC). During the second trimester, there was no difference between the values for renal volume of male and female fetuses. In the third trimester, male fetuses had renal volumes significantly greater than the female fetuses. The normative parameters of renal volume could have practical applications in detection and monitoring of renal anomalies in fetal and perinatal urology.


Composition of fluids obtained from human epididymal cysts. The fluid composition of five epididymal spermatocoeles, one epididymal cyst and a hydrocoele was examined. The fluid obtained from the spermatocoeles was a dilute suspension of mainly immotile spermatozoa. The sperm-free fluid contained less protein, phosphate, glucose, triglyceride and cholesterol than serum but more testosterone and chloride than peripheral blood. It contained no epididymal secretion products. Proteins in the fluid differed from those in serum. From the fluid composition these cysts appeared to be continuous with the rete testis, either dilatations of efferent ducts or Haller's superior aberrant duct (vas aberrans of the rete testis). Fluid from an epididymal cyst containing no spermatozoa was mainly of similar composition. In contrast, hydrocoele fluid resembles blood serum.


Quantitative evaluation of the growth of established cell lines on the surface of collagen, collagen composite and reconstituted basement membrane. As a step in the development of a system for assessing growth of human urothelium and transitional cell carcinoma, the growth of two established cell lines on collagen-based membranes has been evaluated. HT1080 (metastatic human fibrosarcoma) and WI38 VA13 (virus-transformed human fibroblasts) were grown on substrates of collagen, collagen/hyaluronic acid or chondroitin sulphate and reconstituted basement membrane (Matrigel). Cell growth was quantified using a new fluorimetric assay utilizing carboxyfluorescein diacetate. There were differences in morphology between cells grown on collagen and those grown on polystyrene. There were, however, no differences in growth of the WI38 VA13 cells on collagen compared with polystyrene, but growth of the HT1080 cells was increased on membranes of collagen/2.5% hyaluronic acid and collagen/5% chondroitin sulphate, and decreased on Matrigel. Adequate growth on collagen substrates is dependent on cell line. The fluorimetric assay used was suitable for quantifying cell growth on such substrates.


Immunoreactive low-molecular-weight epidermal growth factor in urine of patients with renal cell carcinoma. A specific heterogeneous enzyme-linked immunosorbent assay (ELISA) has been established in order to determine levels of low-molecular-weight epidermal growth factor (EGF) in the urine of patients with renal cell carcinoma who had undergone unilateral radical nephrectomy. Urine specimens, i.e., 20 pre- and postsurgical specimens from a group of patients and 22 from a control group, were assayed after the urine had been freed from high-molecular-weight proteins (greater than 30 kDa) and salts. EGF levels were expressed as urinary EGF/creatinine ratios, and a highly significant decrease (alpha = 0.0005 by Student's t-test) of urinary EGF was found in the patient group prior to surgery. The cancer patients also showed an additional loss of urinary EGF after unilateral nephrectomy (alpha = 0.0005 by Student's t-test). These data correlate with our previous findings that pro-EGF gene expression is decreased in human renal carcinoma and support the concept that low-molecular-weight urinary EGF is derived from high-molecular-weight kidney pro-EGF.


Metastatic potential of human renal cell carcinoma: experimental model using subrenal capsule implantation in athymic nude mice. The aim of this study was to determine whether subrenal capsule (SRC) implantation is a suitable model for the study of the metastatic potential of our human renal cell carcinoma (HRCC) lines and to establish new sublines with enhanced metastatic ability. NMRI athymic nude mice 7-11 weeks old received SRC implantation of our HRCC lines RC43 and RC21. These lines were not metastatic when implanted s.c. Mice were killed after 4 or 8 weeks, or when moribund. With the RC43 cell line the success rate for implantation was 69%, with 89% of these showing metastases. The average volume of the implanted tumour fragments was 0.5 mm3 (range 0.28-0.7), the average volume at the primary site at the time of death was 9087 (9-32000) mm3. Metastases were found in lymph nodes, liver, spleen, peritoneum, psoas muscle, pancreas, diaphragm and skin. The average volume of the metastases was 4139 (0.5-9000) mm3. Growing cell lines were established in vivo and in vitro from one splenic, one peritoneal, one diaphragmatic, and one hepatic metastasis. These sublines have faster in vivo and slower in vitro growth rates than the parental lines. With the RC21 cell line the success rate for implantation was 56% and the metastatic rate 78%. The average volume of the implanted tumour was 0.8 mm3 (0.28-1.2), the average volume at the primary site at the time of death was 2685 mm3 (1.4-6534) and the average volume of metastases was 7.1 mm3 (0.5-37.5). Metastases were found in lymph nodes, lung and skin. No establishment was attempted for RC21 because of the small dimensions of these metastases.(ABSTRACT TRUNCATED AT 250 WORDS)


Elevated levels of serum aldolase A in patients with renal cell carcinoma. To clarify whether serum aldolase A is a useful biomarker for renal cell carcinoma (RCC), we determined serum levels of the aldolase A isozyme by an enzyme immunoassay in patients suffering from RCC, other urological tumors, and benign urological diseases. Forty-six of 126 patients with RCC (37%) had elevated serum aldolase A. The positive rates were 23% in stage I, 40% in stage II, 63% in stage III, and 46% in stage IV. In 10 (83%) of 12 patients whose serum levels had been elevated preoperatively, these were reduced to within the normal range after nephrectomy. Four of 7 patients (57%) with progressive disease had elevated levels of aldolase A. In contrast, the positive rates were only 9.9% in 71 patients with other urological tumors and 5.8% in 52 cases of benign urological diseases. High concentrations of aldolase A isozyme in RCC tissues might be reflected in elevated serum levels. The present findings indicate that serum aldolase A is a useful biomarker for monitoring the clinical course of patients with RCC.


Ras oncogene point mutations in bladder cancer resistant to cisplatin. Bladder tumors respond to cisplatin-based chemotherapy in 68% of cases, but only 30% will have a durable response. Recent studies have suggested that ras point mutations may produce cisplatin drug resistance in cell lines. To determine the role of ras point mutations in human tumors resistant to cisplatin, we evaluated ten tumors exposed to cisplatin and eight untreated bladder tumors for ras point mutations. Using polymerase chain reaction DNA amplification and allele-specific oligo-hybridization, we found that only one of the ten treated tumors and none of the untreated tumors harbored a ras point mutation. We conclude that ras point mutations occur infrequently in untreated bladder tumors and do not appear to correlate with cisplatin drug resistance in vivo.


[Emotional-psychiatric disorder and the illness concept]. Who is abnormal--who is sick? Illness is an abnormal state. Abnormal psychological states are manyfold and rich in variations. Therefore it is necessary to define what is insanity and what is personal problem, personal disorder, personal decompensation or only any form of suffering. The problem is important with regard to therapeutical and legal decisions.


[Suicide in psychologically healthy patients]. Suicide of mentally healthy persons is of special interest for life insurance. The different positions of suicide research are founded in different definitions of disease in psychiatry and general medicine. The definitions of sickness and mental health are also of importance for emergency medicine and care for the dying. It's fact that most people commit suicide self responsible.


[ICD-10 in psychiatric diagnosis. The concept and initial practical experiences]. With introduction of ICD-10 from 1992 in WHO-memberstates there will be considerable change in psychiatric diagnoses. It is the first time that an operational diagnostic approach is introduced in psychiatric routine with a WHO-classification system. Following a historical overview basic concepts of ICD-10 and the most important innovations are demonstrated in view of the results of field trials. The new classification was widely accepted during the first tests, reliability of diagnosis could be improved. It should not be overlooked that in spite of methodological perfection many problems regarding content still have to be solved.


[Toxic polyneuropathies].

[Toxic polyneuropathies]. Toxic factors may have damaging effects on the peripheral nerves at different sites: on the axon, on the myelin sheath, on the cell bodies and on the vasa nervorum. The toxic neuropathies can be divided up into polyneuropathies induced by drugs, by industrial, environmental and stimulant poisons. Mostly symmetrical sensory symptoms and signs are the first disturbances, often followed by symmetrical motor pareses. Some polyneuropathies induced by amiodarone, benzene, lead, cimetidine, chloroquine, dapsone, gentamycin, gold, imipramine, hexacarbons, nialamide, penicillin, triorthocresylphosphate and vincristine are primarily dominated by motory losses. Polyneuropathies induced by amitriptyline, ethylene, oxide, lead, chlorprothixene, heroin, hydralazine, methaqualone, nialamide and penicillin show an asymmetrical distribution pattern of the neural losses. In some types of toxic polyneuropathies the cranial nerves and the autonomic nerves are particularly involved. The clinical symptomatology of the most important types of toxic neuropathies are described shortly. The best therapy is, of course, termination of exposure to the toxic substance concerned.


[Epidemiologic aspects of multiple sclerosis]. Epidemiology plays a prominent role in the search for environmental risk factors in multiple sclerosis (MS). The basic pattern with the predilection for temperate zones of the globe, whites, females and medium age groups was confirmed throughout. Whether or not MS is increasing in frequency is highly debated. Although no clear risk factors have been demonstrated so far, a certain association of the MS risk with the factors "low temperatures and precipitation", "consumption of animal proteins/fats or meat", "familiar occurrence of MS" and with a late occurrence of common childhood infections became obvious. Many other putative risk factors were not confirmed in most studies.


[May an epileptic patient participate in sports?]. Epilepsy is a frequent disease. The question of possible sport activities and epilepsy is important because of the prominent role of sport in the population. The present paper deals with problem if epileptic patients can freely participate in sport or whether they are restricted to a certain extend by their disorder. The aim of this review is to determine the factors which may or may not interfere with sport for the epileptic patient.


[Muscular dystrophy as a risk factor in anesthesia]. Three cases of muscular dystrophy are reported on (8 years, 4 months, 10 months) in which serious conditions arose under anaesthetic (bradycardia, asystolia, hyperkalemia, rising CPK). In the first two cases there was no way of avoiding a fatal outcome, but in the third case the child survived with no permanent damage. The cause of incidents of this kind is discussed first as being hyperkalemia due to acute rhabdomyolysis, and secondly malign hyperthermia. There were no indications of malign hyperthermia in this case. It is hardly possible to distinguish this in an acute clinical ward, as the clinical symptoms are very similar. If it is known that muscular dystrophy is present, depolarising relaxants should be given sparingly. This also applies, as the first case shows, for muscular dystrophy of the Becker type, which can on the whole be regarded as benign in comparison with progressive muscular dystrophy of the Duchenne type. In this instance a forensic and anaesthetic expert's opinion even had to be produced at the request of the Public Prosecutor. The post mortem was carried out under the heading of a possible "mistaken medical treatment" but there was no evidence to justify such an assumption.


[The geriatric day care clinic--a model also for the management of demented patients?]. The semi-stationary way of clinical treatment (day clinic) is of great importance for the geriatric field. As to diagnostics and therapy of demented patients, day hospital treatment reveal a number of advantages and disadvantages. In particular for fairly serious or seriously ill demented patients daily journey to and from the hospital are too much for them, and their clinical picture deteriorates. On the other hand, the patient benefits from a further integration into the domestic environment alongside with intensive diagnostics and therapy which is not feasible for in-patients. The need of the elderly to keep up their independence in their familiar habitat with all social and emotional contacts can be met better rather by semi-stationary diagnostics and treatment than during a full-time stationary care at the hospital.


Bovine spongiform encephalopathy: aspects of the clinical picture and analyses of possible changes 1986-1990. A standard questionnaire was used to record the presence of specific clinical signs reported for histopathologically confirmed cases of bovine spongiform encephalopathy observed before June 30, 1990, and the frequencies of these signs were analysed. The signs most frequently recorded were apprehension, hyperaesthesia and ataxia, and there were variations in the frequency with which some signs were recorded in animals observed at different times during the epidemic. These variations were considered to be the result of differences between observers and differences in the duration of the illness, rather than a change in the clinical picture, which could possibly have occurred with a change in the nature of the agent to which the cattle had been exposed, or to a change in their response to the agent.


Influence of width and bends on the ease of movement of pigs along races. Pigs could be moved along a race 120 cm wide more quickly than along a race 45 cm wide. The presence of a bend with an angle of 45 degrees slowed their progress by about 10 per cent, a bend of 90 degrees or 120 degrees slowed them by 19 per cent and a 180 degrees bend slowed them by 44 per cent. There was little evidence of any interaction between the effects of width and angle of bend; the effect of a sharp bend could not be compensated for by increased width. The pigs became accustomed to the races and moved more quickly in later runs.


Application of in vitro fertilisation techniques to obtain calves from valuable cows after slaughter. The ovaries of two infertile cows of high breeding value were recovered after slaughter, and a total of 222 oocytes were obtained. Of these, 156 were classified as of good or fair quality and were subjected to in vitro maturation, in vitro fertilisation (using frozen semen from three bulls of high breeding value) and in vitro culture procedures. After eight days, 27 embryos were obtained, of which 13 were transferred fresh, and 14 were frozen. Three recipients of fresh embryos became pregnant; two calved and one aborted at four months. One of eight recipients of frozen-thawed embryos became pregnant but aborted at three months.


Conservative treatment of oesophageal stricture in five foals. Three foals under four weeks old and two under six months old with a history of oesophageal obstruction, had oesophageal strictures of different characters in the rostral cervical oesophagus. One case, which was complicated by severe inhalation pneumonia, was euthanased without any treatment and in another initial treatment by bougienage under general anaesthesia was attempted without success. The four surviving cases were provided with progressively firmer and coarser food, starting with liquid only, over a period of three to four weeks. The treatment is recommended in the early stages of stricture maturation and for strictures which do not involve the deeper layers of the oesophageal wall.


A combination of methotrimeprazine, midazolam and guaiphenesin, with and without ketamine, in an anaesthetic procedure for horses. A combination of 0.5 mg/kg of methotrimeprazine, 0.1 mg/kg of midazolam and 100 mg/kg of a 10 per cent guaiphenesin solution was investigated for the induction of recumbency in 15 horses; the addition of 1.6 mg/kg of ketamine was also evaluated in 15 horses and anaesthesia was maintained with halothane in oxygen. The horses became recumbent quickly and smoothly and they recovered quietly, with little ataxia. Tachycardia occurred after induction, but no other changes from pre-operative values were observed until halothane in oxygen had been given, when hypothermia, hypotension, bradypnoea, hyperoxaemia, respiratory acidosis and decreased respiratory minute volume developed. Horses given ketamine in addition to methotrimeprazine, midazolam and guaiphenesin were easier to intubate and recovered more quickly than horses receiving only methotrimeprazine, midazolam and guaiphenesin.


Acute toxicological studies on paraquat: pathological findings in beagle dogs following single subcutaneous injections. Sixteen beagles were allocated into 4 groups, each group consisting of 2 males and 2 females, which were injected sc with 1,3,5 or 7 mg paraquat/kg. The beagles were observed for 2 w after the administration. At the end of the observation period all the dying and surviving dogs were studied pathologically. The LD50 was calculated as 1.8 (1.0-6.1) in males and 3.5 (2.4-10.1) mg/kg in females. Clinical laboratory tests showed increases in segmented neutrophils and monocytes, decreases in lymphocytes, slight decreases in chloride, moderate increases in BUN, GOT, GPT and phospholipids, slight increases in uric acid, total protein, creatine, total cholesterol and total bilirubin, and prolonged prothrombin times. Marked edema, congestion and hemorrhage of lungs, as well as slight congestion in various organs, were observed grossly. In histopathological examination, marked pulmonary hemorrhage and congestion, fibroblast-like cells in alveolar septa, breakdown of alveolar walls, thickening of alveolar walls and pleura, mild congestion and degeneration of the liver, and mild degeneration of renal tubules were observed. The cause of death was respiratory distress and renal failure. The surviving animals had mild atelectasis of the lungs. Electromicroscopic examination on the surviving animals revealed the appearance of spindle-shaped cells, proliferation of type II alveolar cells and fibroblasts, mitosis of fibroblasts, and abundant collagen fiber in the lung, calcium deposition, stratification and thickening of basement membranes, and localized necrotic epithelial cells in the proximal tubules of kidneys, and stratification of intramitochondrial cristae of the liver. Pulmonary fibrosis in the switchover stage was present with participation from type II alveolar cells, fibroblasts and myofibroblasts.


Toxic effects of low levels of dietary Jatropha curcas seed on Brown Hisex chicks. Jatropha curcas seed, a multi-purpose medicinal plant product, was fed at 0.1 and 0.5% to Brown Hisex chicks for 4 w to measure it's effects upon growth and the structure and function of vital organs. Liver and kidney function tests included serum SDH, GDH, GOT, total protein, potassium and other serum constituents in addition to total tissue lipids and hematology. J. curcas intoxication in chicks was characterized by growth depression, hepatonephropathies and widespread hemorrhages and congestion.


The effect of malathion, an organophosphate, on the plasma FSH, 17 beta-estradiol and progesterone concentrations and acetylcholinesterase activity and conception in dairy cattle. The effect of malathion on jugular plasma concentrations of follicle-stimulating hormone (FSH), estradiol (E2), progesterone (P4) and acetylcholinesterase (AchE) on conception in dairy cattle during a cloprostenol (prostaglandin F2 alpha analogue, PG)-induced estrus was studied. Malathion (1 mg/kg, intraruminally) given at the onset of estrus (48 h after PG) did not alter the plasma FSH or E2 concentrations but significantly (P less than 0.05) inhibited plasma P4 concentration. The mean P4 concentration in the malathion-treated group on days 8 and 12 were 0.8 +/- 0.4 and 1.0 +/- 0.5 ng/ml, as compared to 2.6 +/- 0.0 and 2.4 +/- 0.3 ng/ml in the control group. There was a nonsignificant (P greater than 0.05) inhibition of plasma AchE activity in malathion-treated cattle. Conception was 16.6% in malathion-treated cows and 50% in controls. Inhibition of progesterone secretion and poor conception occurred after the single intraruminal dose of malathion at the onset of estrus.


Methylene blue can be used to treat methemoglobinemia in cats without inducing Heinz body hemolytic anemia. Methylene blue (MB) is the drug of choice in the treatment of methemoglobinemia (MTHB) in humans and most domesticated animals, but is reported contraindicated in cats. Although prolonged treatment of cats for urologic syndromes with MB-containing antiseptics causes Heinz body (HB) hemolytic anemia, there is no evidence to suggest that single or repeated therapeutic doses of MB cause hemolytic anemia. We investigated the efficacy and safety of MB in reversing nitrite-induced MTHB in cats. Forty random-bred adult cats (20 males and 20 females) were divided as follows: Group 1, 1.5 mL saline/kg bw iv (control); Group 2, 1 dose of 1.5 mg MB/kg bw iv; Group 3, 2 doses of 1.5 mg MB/kg bw iv 4 h apart; Group 4 1 dose of 1.5 mg sodium nitrite/kg bw iv; Group 5, 1 dose of 1.5 mg sodium nitrite/kg bw iv followed by 1 dose of 1.5 mg MB/kg bw iv 1 h later; and Group 6, 1.5 mg sodium nitrite/kg bw iv followed in 2 h by 2 doses of 1.5 mg MB/kg iv 4 h apart. One iv dose of MB sufficiently and rapidly reversed MTHB in the cats without increasing circulating HB-containing red blood cells. Giving 2 iv doses of MB without or after sodium nitrite significantly increased the frequency of circulating HB-containing red blood cells. Pre-exposure to sodium nitrite potentiated the HB-inducing effect of 2 doses of MB. Hemolytic anemia was not observed or demonstrated in any of the cats groups.


Inhibition of intestinal glucose absorption in rats treated with 2,3,7,8-tetrachlorodibenzo-p-dioxin. Male Sprague-Dawley rats were injected with either 125 micrograms 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)/kg or vehicle (pair-fed and ad libitum-fed controls). Transfer of water, electrolytes and D-glucose as well as fats of a tracer dose of the non-metabolizable radioactive marker 3-O-methyl-D-[U-14C]glucose was studied in isolated perfused jejunal segments 1, 2, 7, and 21 d after treatment (TCDD-treated and pair-fed control rats) and after 26 d in ad libitum-fed controls. TCDD-treated rats demonstrated reduced feed consumption and loss of body weight. Active intestinal absorption of glucose was significantly inhibited 30 and 22% compared to pair-fed controls, respectively 2 and 7 d after TCDD treatment. After 21 d the inhibition (14%) was less significant. There were no differences in glucose transfer between severely starved pair-fed controls (body weights 370 +/- 26 g) and ad libitum-fed rats (body weights 512 +/- 15 g). Water absorption and transfer of sodium and calcium was not influenced by TCDD treatment. However, a significant increase of potassium transfer was observed in parallel with impaired glucose absorption. The uptake of 3-O-methylglucose into mucosal tissue was not impaired, whereas the transfer to the serosal side was significantly inhibited by 30-60% compared to pair-fed as well as ad libitum-fed animals from day 2 until the end of the experiment. These results suggest that TCDD is involved in an inhibition of glucose transport at the basolateral membrane.


Fetotoxic response of technical quinalphos in rats. Technical Quinalphos was administered po to pregnant rats through day 6-20 of gestation at doses of 0.5 or 1.5 mg/kg body weight. Quinalphos produced enzymatic changes in liver and serum of dams associated with mild pathomorphological changes in liver and brain. Fetotoxic effects were not observed at the tested dose levels as determined by total number of implantations, percentage resorption, live fetuses, crown rump length and fetal weight. A few insignificant skeletal deformities were noticed. A significant inhibition of acetylcholinesterase activity in fetal brain and placenta indicated possible transmigration of quinalphos from dams to fetuses.


Role of socialization, stress and sex of chickens on response to anesthesia and on response to an organophosphate neurotoxicant. The influence of socialization of chickens on response to exogenous substances in the presence and absence of stress was examined. Chickens of both sexes were habituated to human beings (socialized) by being talked to and offered food from the hand of the caretaker. After 19 w, half the socialized group and half the unsocialized group were subjected to stress (loud noises for 120 sec twice daily) for 2 w. At the end of this period, response to 37 mg pentobarbital/kg iv was evaluated by length of sleeping time. Males slept longer than females, and males that were socialized but not stressed slept significantly longer than other males. Stress and socialization did not significantly affect pentobarbital sleeping time in females. This indicated that response to pentobarbital was dependent on sex and on socialization, with the most notable effects occurring in socialized males. Socialized and nonsocialized, stressed and unstressed male and female chickens were also administered a single po dose of 360 mg tri-ortho-tolyl phosphate (TOTP)/kg. This organophosphorus ester induced a delayed neuropathy that caused ataxia in all the chickens. The ataxia was significantly more pronounced earlier in males than in females, although the sex difference became insignificant 18 d after dosing. Socialized chickens were ultimately more affected. Noise stress did not affect TOTP-induced ataxia. This indicated that response to an organophosphate neurotoxicant was also dependent on sex and socialization, with the most notable effects again seen in socialized males. Response to endogenous substances in chickens depends both on sex and on familiarity to humans.


Effect of phenobarbitone pretreatment on the toxicity of temik and sumicidin in Nubian goats. Pretreatment of Nubian goats with 14 daily doses of 20 mg phenobarbitone sodium/kg increased the toxicity of temik (aldicarb) and sumicidin (fenvalerate) as reflected by the development of more severe clinical signs and lesions and in death in the pre-treated goats.


Subchronic oral administration of acemannan in the rat and dog. Acemannan is the USAN-accepted name for long-chain polydispersed beta-(1,4)-acetylated polymannose with interspersed O-acetyl groups, with a mannose monomer/acetyl ratio of approximately 1:1. This complex polysaccharide is extracted from Aloe vera (barbadensis Miller); the technical material contains approximately 78% acemannan. Technical grade acemannan was administered po to rats for 14 d at 5% of the diet and for 6 mo at up to 2,000 mg/kg/d, and to beagle dogs for 90 d at up to 1,500 mg/kg/d without significant effect on any parameter measured in either species.


A regional poison center's experience with poisoning exposures occurring in schools. The nature of and response to poisonings in the school setting has not been characterized. To define these problems a retrospective review of calls to a Regional Poison Information Center (RPIC) involving school exposures was done for the 1988-89 academic year. 362 cases were reported; 74% were reported by school nurses, 10% by other school employees, 10% by parents, 5% by health care facilities, and 1% by students themselves. Ingestions accounted for 45% of exposures, dermal 24%, ocular 19%, inhalation 7%, with the remainder being combinations of routes. Correct treatment prior to RPIC consultation occurred in only 40% of the cases. None developed major symptoms, 23% had minor and 10% had moderate symptoms. High school students accounted for the greatest number (20) of suicide gestures, while middle schools reported more cases of substance abuse. School nurses often were unaware of situations until several hours later. 61% of suicide gestures were referred to an HCF; 7 of these developed moderate symptoms. Exposures to chemicals in science or vo-tech classes accounted for 102 cases; 28% were referred to a HCF and 15% had moderate symptoms. There was often a delay in evaluation by the school nurse and initial decontamination was inadequate or absent. Parents were often instructed by school personnel to contact the RPIC for information and then relay it to the school. These delays could have resulted in greater toxicity. School nurses should be targeted for educational programs by poison centers, but teachers and other school employees must also be included since often they are the first at the scene. Students should be instructed to report exposures to a teacher immediately.


Factors influencing non-compliance with poison center recommendations. Non-compliance with prescribed therapies has long been recognized by medical practitioners in all fields as an important factor influencing the probability of a favorable outcome. Few references in the literature address this factor with regard to poisoning. Principles of assessing and improving compliance may also be applied to the advice given by poison information providers. Cases involving lay callers, who failed to comply with poison center recommendations, were studied. The type of advice, reason given for failing to comply, and outcome were assessed. 205 poisoning cases from the 12-mo period were analyzed involving 129 children and 76 adults. In 34 pediatric exposures of children where syrup of ipecac was recommended but not given, 29.4% of parents cited the influence of a family member in deciding not to comply; 47% indicated the potential risk of the exposure was not perceived accurately. In 90 cases of non-compliant referrals of children to emergency departments, 60% of parents minimized the threat of a serious outcome despite explanation of the expected risk. In 76 adult cases, 70 patients refused referral to an emergency department; 26% admitted to sociopsycological reasons, including public status, undisclosed drug abuse, or fear of reprisal. Sequelae developed in 31% of the children and 46% of the adults which may not have occurred if poison center recommendations had been followed. Willingness to comply with a recommended behavior is influenced by factors such as motivation, concern, perceived threat posed by the exposure, and perceived barriers. A compliance model relative to poisoning is needed to reduce risk and promote a favorable outcome.


Hepatotoxic constituents in the rumen of Brachiaria decumbens intoxicated sheep. Spectroscopic examinations of purified extracts of the rumen content of sheep intoxicated by Brachiaria decumbens revealed the presence of a mixture of sapogenins, identified as 3-spirostanols. These isomeric steroid sapogenins (C27H44O3) are believed the toxic principles in causing toxicity in sheep after feeding on B. decumbens.