Variations in human liver fucosyltransferase activities in hepatobiliary diseases. The hyperfucosylation of a number of glycoconjugates observed in liver diseases involves the action of several specific fucosyltransferases (F.T.) notably responsible for synthesizing histo-blood group antigens. We determined the activities of alpha 3, alpha 2 and alpha 3/4 F.T. in 35 liver biopsy samples from patients with fatty liver, alcoholic or post-hepatic liver cirrhosis, primary or secondary biliary cirrhosis, acute hepatitis or a normal liver. F.T. activities were measured by transfer of GDP [14C] fucose to asialotransferrin for alpha 3 F.T., to phenyl beta-D-galactoside for alpha 2 F.T. and to 2' fucosyllactose for alpha 3/4 F.T. The diseased liver extracts showed an early increase in non-Le gene-associated alpha 3 F.T. activity (p = 0.001), which was related to the number of steatosic hepatocytes and the degree of intralobular inflammatory infiltration. Overexpression of this alpha 3 F.T. provides an explanation for the strong expression of 3-fucosyl lactosamine structures described in several hepatobiliary diseases. alpha 2 F.T. levels were significantly elevated in the two groups of liver cirrhosis and acute hepatitis (p = 0.05), but not enough to consider alpha 2 F.T. as a sensitive feature of mesenchymal cell injury. All Lewis-positive biopsies displaying biliary alterations showed increased Le gene-encoded alpha 3/4 F.T. activity (p = 0.001), which was related to the intensity of neoductular proliferation. Elevated levels of alpha 3/4 F.T. may be a very early sign of biliary regeneration.


Estradiol-17 beta modifies the induction of spermidine/spermine N1-acetyltransferase activity in the liver of lipopolysaccharide-treated mice. In an attempt to elucidate the effects of estrogen on polyamine metabolism in lipopolysaccharide (LPS)-treated mice, we assayed polyamine content and the activity of spermidine/spermine N1-acetyltransferase (SAT) and ornithine decarboxylase (ODC) in some organs. LPS elevated N1-acetylspermidine levels in the liver and lung and putrescine levels in the liver, lung and spleen. LPS increased the activity of ODC at 6 h and that of SAT at 12 h in the liver. When estradiol-17 beta was simultaneously administered with LPS, the maximum increase in hepatic N1-acetylspermidine levels was found 6 h earlier than in the LPS control. Likewise, the peak of the hepatic SAT activity after LPS-treatment was observed 6 h earlier in the estradiol-17 beta-treated mice than in the LPS control. No such effect of estradiol-17 beta was found in the lung and spleen. The LPS-induced ODC activity was not affected by estradiol-17 beta in the liver, lung or spleen. Estrone and 16 beta-ethylestradiol (an anti-estrogen) were also effective in enhancing the LPS-induced elevation of N1-acetyl-spermidine and putrescine in the liver, while both diethylstilbestrol, which has a potent estrogenic activity without steroid structure and estradiol-17 alpha (a non-estrogenic isomer of estradiol-17 beta) were without effect. Tamoxifen (an estrogen receptor antagonist) did not suppress the estrogen-induced increase in hepatic N1-acetylspermidine levels.


Factors influencing contrast in fast spin-echo MR imaging. Multi-echo pulse sequences for producing T2-weighted images in much reduced imaging times have recently been developed for routine clinical use. A number of recent articles have described the contrast obtained with fast spin-echo (FSE) sequences and have generally indicated that they depict tissues very similarly to conventional spin-echo (SE) imaging. There are, however, some important differences in contrast between some tissues in FSE images. This work presents a detailed study of the contrast obtained with FSE imaging sequences and examines the image sequence and tissue parameters which influence contrast. The use of multiple refocusing pulses produces several subtle effects not seen in conventional SE imaging sequences, and in this study the precise nature and extent of such effects are described. The relative contributions to image contrast of magnetization transfer, the decoupling of J-modulation effects, the production of stimulated echoes and direct saturation effects, of diffusion and of the effects of the differential attenuation of different spatial frequencies, are each quantified. The mechanisms responsible for the brighter fat signal seen in FSE images, as well as the loss of signal from some other tissues, are explained. Computer simulations, phantom experiments, and clinical images are all used to support the conclusions.


Pelvic phased array coil: image quality assessment for spin-echo MR imaging. The NMR phased array coil (PA) provides improved signal-to-noise ratio (SNR) over that available with the body coil. We evaluated image quality obtained with a pelvic PA compared to that obtained with the body coil for spin-echo imaging. Thirty-three women undergoing clinical pelvic MRI were imaged with the body coil followed by imaging with the PA with the same field-of-view (FOV) in 11 patients, and with a small FOV in 23 patients. Image quality was assessed independently by two radiologists. In individual cases there was significant improvement in image quality with the PA, however the expected marked improvement in image quality was not consistently found. Two factors which may limit image quality are increased motion artifact and nonuniformity of signal with distance from the coils. Significant improvements in image quality may occur with improved techniques to decrease motion artifact.


Magnetic resonance findings in sarcoidosis of the thorax. Fifteen patients with sarcoidosis underwent thoracic MRI examinations. The T2 signal intensity of lymphadenopathy varied, with no characteristic pattern noted. Three of four patients with bright lymph nodes on T2 images had stage I sarcoidosis, but low intensity nodes were also seen in stage I patients. Coronal images were complementary to axial images and better depicted subcarinal adenopathy. MRI does not distinguish the lymphadenopathy of sarcoidosis from other entities, but is useful for defining the anatomic extent of disease and differentiating pulmonary artery enlargement from adenopathy.


MR knee imaging: axial 3DFT GRASS pulse sequence versus spin-echo imaging for detecting meniscal tears. The knees of 17 patients (34 menisci) referred for magnetic resonance (MR) imaging to evaluate knee pain were examined using thin axial three-dimensional Fourier transform (3DFT) gradient-refocused acquisition in a steady state (GRASS) images through the menisci, to determine if this method is sensitive and specific for detecting meniscal tears. Results were compared with spin-echo images with long TR and double-echo TE in both coronal and sagittal planes. Arthroscopy results, available in each case, were used as the "gold standard." Twelve meniscal tears were identified at arthroscopy. Axial 3DFT GRASS technique detected 10 of the 12 meniscal tears compared to 9 or 12 using spin-echo technique. With axial 3DFT GRASS technique one false-positive meniscal tear was reported, compared with two false-positive tears on spin-echo images. Axial 3DFT GRASS images were very useful in detecting peripheral tears, showing displaced meniscal fragments, and evaluating complex tears. In this small study, thin axial 3DFT GRASS images were comparable to spin-echo images for detecting meniscal tears, and were helpful in complicated cases in which they provided complementary information to that obtained from spin-echo images.


Mass-like hepatic hypertrophy: MRI findings with histologic correlation. Hepatic parenchyma may hypertrophy following asymmetrical injury. The histologic characteristics of hypertrophic hepatic parenchyma are more similar to normal hepatic parenchyma than is the more severely damaged liver. We present four cases where large hypertrophic masses resembled neoplasm on other imaging modalities or at surgery, but had MRI signal characteristics similar to those of normal liver.


Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy. Magnetic resonance (MR) imaging and isotope lymphography (lymphangioscintigraphy, LAS) was done in 32 patients with peripheral lymphedema (19 primary and 13 secondary). MRI characteristically showed diffuse dermal and subcutaneous edema, a nonedematous, occasionally hypertrophied skeletal muscle compartment, variability in regional lymph node size and appearance depending on the underlying clinical disorder, serpiginous "channels" or "lakes" consistent with dermal collateral lymphangiectasis and sequestered lymph, and increased subcutaneous fat. In contrast, LAS showed dermal diffusion ("backflow"), cross-over with retrograde tracer backflow (reflux), delayed tracer transport, and depending on the cause of lymphedema (i.e., primary or secondary), discrete or poorly defined lymph trunks (tracer "bands") and delayed or nonvisualization of regional lymph nodes. Although not a first-line clinical test, MR particularly in conjunction with LAS noninvasively provides accurate anatomical definition of the peripheral lymphatic system. In contradistinction to LAS, MR can visualize lymph trunks, nodes, and soft tissues proximal to sites of lymphatic obstruction. Together these imaging modalities may substitute for conventional oil contrast lymphography in the evaluation of the pathogenesis and evolution of most lymphologic disorders.


Evaluation of the susceptibility effect on gradient echo phase images in vivo: a sequential study of intracerebral hematoma. Susceptibility effect of intracerebral hematoma was estimated on the phase images of gradient echo (GrE). Thirty-five hematomas were studied 3 hr to 5 yr after the onset, a total of 72 times with use of phase and magnitude images of GrE, as well as T1-, T2-, and density-weighted spin-echo (SE) images at 1.5 T. On the basis of the theory of electromagnetism, phase shift to hematoma was calculated for simplified models with concentric distribution of paramagnetic susceptibility. All hematomas were well visualized by the phase images, the pattern of which changed sequentially. The distribution of paramagnetic susceptibility could be estimated by correlating the observed phase shifts with the calculated one. SE images were necessary to presume the type of magnetic substances. A probable hypothesis of the evolution of intracerebral hematoma is proposed.


The accuracy of signal intensity measurements in magnetic resonance imaging as evaluated within the knee. Quantitative signal intensity measurements are being utilized in both clinical and research magnetic resonance imaging protocols. This paper addresses three questions in quantitative MRI measurements as evaluated within the knee: 1) the accuracy of quantitative measurements; 2) improvement of accuracy by phantom normalization; and 3) the amount of signal change that is clinically significant. Seven normal subjects were imaged on three different days within a 1-wk period. Test-tube phantoms of manganous chloride (MnCl2) were imaged posterior to the knee and were used to normalize each image. The variation in signal intensity within the same subject averaged 20% for both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). The phantom variation was approximately 18%. Signal intensity normalization by background subtraction, background division, phantom division, or a combination of subtraction and division did not significantly improve either the phantom variation or the ligament variation. Given that an individual ligament intensity will be measured with standard errors of +/- 20% of its value, we calculated the minimum increase in signal intensity to be considered abnormal relative to a normal ligament. A relative signal increase of 46% can be considered pathologic with 95% confidence. These findings emphasize that quantitative measurements must be carefully assessed when being applied in clinical settings.


In vivo evaluation of the reproducibility of T1 and T2 measured in the brain of patients with multiple sclerosis. The precision (reproducibility) of relaxation times derived from magnetic resonance images of patients with multiple sclerosis (MS) were investigated. Measurements of 10 MS patients were performed at 1.5 T on two occasions within 1 wk. T1 and T2 was measured using a partial saturation inversion recovery sequence (6 points) and a Carr-Purcell-Meiboom-Gill phase alternating-phase shift multiple spin-echo sequence with 32 echoes. Regions of interest (ROI) were placed both in apparently normal white matter and plaques. The precision (+/- 1.96 SD) and the confidence intervals for T1 and T2 for white matter and plaques were calculated. The precision of T1 for white matter and plaques was respectively +/- 94 msec and +/- 208 msec. The precision of T2 for white matter and plaques was respectively +/- 18 msec and +/- 26 msec. For all measurements the coefficient of variation was about 9%. Judging from our own study and others as well, a precision better than 10% for T1 and T2 would seem unrealistic at present.


Semiautomated quality assurance for quantitative magnetic resonance imaging. It is now well established that MRI can be used for quantitative (as opposed to simply qualitative) measurements, and good accuracy and precision have been obtained in phantom experiments. To make routine quantitative measurements as part of a clinical scanning protocol, however, quality assurance (QA) methods particularly suited to quantification must be developed. We describe a set of QA tests using clinical protocols on test phantoms, with which we have assessed quantitative performance of our Picker 0.5-T scanner (Picker International, Cleveland, OH) over 2 years. We also describe the automated data processing methods we have developed to deal with the large amounts of data generated by these tests.


Analysis of machine-dependent and object-induced geometric distortion in 2DFT MR imaging. Geometric distortion in MR imaging predominantly arises from the inhomogeneity of the static field and the nonlinearity of the gradients. It is the purpose of this paper to analyse the object and machine related contributions to geometric distortion in order to determine which corrections are necessary for attaining a specified precision. System related imperfections were measured by systematic variation of the strength, direction, and polarity of the read-out gradient in imaging experiments on a grid of cylindrical sample tubes. For the 1.5-T system used in this study, static field related errors up to 7 mm and gradient related errors up to 4 mm were observed (midcoronal plane, FOV 400-mm, G-read between 0.5 and 3.0 mT/m). Field related errors were shown to be inversely proportional to gradient strength, whereas gradient related errors turned out to be virtually independent of gradient strength. It therefore seems recommendable to always apply the strongest available selection and read-out gradients when geometric fidelity is given preference to signal-to-noise considerations. Correction of system related geometric distortions in MR images can readily be performed by table lookup. Object-induced distortions of the gradient fields were studied by experiments on a grid of sample tubes immersed into a cylindrical water bath of variable saline concentration. These experiments revealed a negligible influence of the object on the gradient error distribution, and lead to the conclusion that correction for the nonlinearity of the gradients only requires the application of system dependent correction factors. Object-related distortions of B0 were studied by conventional SE and fat-suppressed IR experiments on phantoms and human subjects. In these experiments the polarity of the read-out gradient was reversed. Subtraction images showed significant object-induced inhomogeneities of the static field at tissue-air interfaces and in the immediate vicinity of the object being imaged. A first attempt to correct for object related B0 inhomogeneities was made by contour analysis of the source images. At present this correction still has to be done manually.


Correction of spatial distortion in magnetic resonance angiography for radiosurgical treatment planning of cerebral arteriovenous malformations. A treatment planning system based on magnetic resonance (MR) angiographic imaging data for the radiosurgery of inoperable cerebral arteriovenous malformations is reported. MR angiography was performed using a three-dimensional (3D) velocity-compensated fast imaging with steady-state precession (FISP) sequence. Depending on the individual MR system, inhomogeneities and nonlinearities induced by eddy currents during the pulse sequence can distort the images and produce spurious displacements of the stereotactic coordinates in both the x-y plane and the z axis. If necessary, these errors in position can be assessed by means of two phantoms placed within the stereotactic guidance system--a "2D-phantom" displaying "pincushion" distortion in the image, and a "3D-phantom" displaying displacement, warp, and tilt of the image plane itself. The pincushion distortion can be "corrected" (reducing displacements from 2-3 mm to 1 mm) by calculations based on modeling the distortion as a fourth order 2D polynomial. Displacement, warp, and tilt of the image plane may be corrected by adjustment of the gradient shimming currents. After correction, the accuracy of the geometric information is limited only by the pixel resolution of the image (= 1 mm). Precise definition of the target volume could be performed by the therapist either directly in the MR images or in calculated projection MR angiograms obtained by a maximum intensity projection algorithm. MR angiography provides a sensitive, noninvasive 3D method for defining target volume and critical structures, and for calculating precise dose distributions for radiosurgery of cerebral arteriovenous malformations.


A fast T1 algorithm.

A fast T1 algorithm. Multispectral tissue classification using magnetic resonance T1, T2, and rho images may be useful in diagnosing and locating certain pathology. Techniques for generating the T1 images necessary for this classification scheme often require longer data collection and post processing times than are practical. As a consequence, further development of this classification scheme may be limited. This paper addresses an improvement in the post processing time required to generate T1 images. A nonlinear least-squares algorithm is described for rapidly generating spin-lattice relaxation time images from variable repetition time magnetic resonance images. The algorithm generates a 256 x 256 pixel T1 image from nine variable repetition time images in approximately 60 sec on a VAX-6510 computer.


Motion artifact suppression: a review of post-processing techniques. Patient motion during data acquisition in magnetic resonance imaging causes artifacts in the reconstructed image, which for two-dimensional Fourier transform imaging techniques appear as blurring and ghost repetitions of the moving structures. While the problem with intra-view effects has been effectively addressed using gradient moment nulling techniques, there is no corresponding technique for inter-view effects with equal effectiveness and general applicability. A number of techniques have been proposed for correcting the inter-view effects, and these may be divided into those that minimise the corruption of the data, and those that post-process the data to restore the image. The techniques in the former category are briefly reviewed, then those in the latter category are examined in detail. These are analysed in terms of motion model, model parameter estimation, and data correction.


High density barium sulfate suspension for MRI: optimization of concentration for bowel opacification. In this in vitro study of a potential oral MRI contrast agent, barium sulfate suspension (BSS), the object was to examine the effect of varying barium sulfate concentration on signal intensity while keeping suspension additives the same; and to optimize the concentration of a specific preparation of BSS. A phantom was used to test suspensions with concentrations of barium sulfate ranging from 90% to 220% w/v. T1-weighted, T2-weighted, and gradient echo sequences all showed a decrease in signal as concentration was increased to 170%. Between 170% and 220%, the signal intensity was constant on the T1-weighted and T2-weighted sequences. With the proton density and gradient echo sequences, there was a slower rate of decline in the signal intensity in the 170 to 220% range of BSS concentrations. We conclude that BSS with a concentration in the range of 170% to 220% w/v is optimum for the specific preparation used. We speculate that the behavior of the signal-to-noise ratio with changing concentration is explained by factors including proton density, T1 relaxation enhancement, diffusion effects, and magnetic field inhomogeneity, depending on the particular pulse sequence used.


Dissociation of gadolinium chelates in mice: relationship to chemical characteristics. Tissue distributions of seven 153Gd-labeled Gd chelates were determined at five residence intervals (5 min to 14 days) following intravenous administration of 0.4 mmol/kg to mice. Relationships were sought among physicochemical parameters: thermodynamic and conditional (pH 7.4) equilibrium stability constants (log K and log K'), acid dissociation rate constants (k(obs)), lipophilicity (log P), overall charge, and size (molecular weight). Size and lipophilicity did not correlate with tissue distributions. There were possible correlations between anionic charge and rapid, early renal excretion and between stability constants and long-term residual Gd deposition. Strong correlations (r greater than 0.99) were found between acid dissociation rates and long-term deposition of Gd in the whole body, liver, and femur. This is attributed to dissociation of Gd from the chelates in vivo. Acid dissociation rates may be useful in predicting dissociation of Gd from chelates in vivo.


Localized phosphorus NMR spectroscopy: a comparison of the FID, DRESS, CRISIS/CODEX, and STEAM methods in vitro and in vivo using a surface-coil. The FID, DRESS, CRISIS/CODEX, and STEAM techniques for localized 31P NMR spectroscopy were compared using a Siemens Magnetom SP63 1.5 T whole-body imager and a surface-coil, 80 mm in diameter, acting as transmitter and receiver coil. The comparison was performed with phantom experiments and human in vivo investigations on the calf muscle. The phantom experiments which used the same volume size showed a comparable signal-to-noise ratio for FID and DRESS, while the two fully localized techniques showed a reduction in signal-to-noise ratio to 76% for CRISIS/CODEX and 31% for STEAM. The in vivo measurements confirm the phantom results and reveal that CRISIS/CODEX gains a 2.5 fold higher signal-to-noise ratio than STEAM under the same conditions.


Ethanol-induced fatty liver in the rat examined by in vivo 1H chemical shift selective magnetic resonance imaging and localized spectroscopic methods. In vivo 1H magnetic resonance imaging (MRI), chemical shift selective imaging (CSI), and localized (VOSY) 1H magnetic resonance spectroscopy (MRS) were used to study fatty infiltration in the livers of rats chronically fed an ethanol-containing all-liquid DeCarli-Lieber diet. Conventional total proton MRI showed a somewhat hyperintense liver for ethanol-fed rats, compared with pair-fed controls. CSI showed a dramatic increase in the fat signal intensity for ethanol-treated rats that was fairly homogeneous throughout the liver. However, CSI also showed a substantial decrease in the water signal intensity for the ethanol-treated rats compared to pair-fed control rats. 1H VOSY MR spectra also showed a 5.5-fold increase in the methylene resonance (1.3 ppm) of fat and a 50-70% decrease in the water resonance (4.8 ppm). Relative in vivo proton T1 and T2 relaxation times for the water resonance separate from the fat resonance, determined from modified VOSY experiments, were found to tend to increase and decrease, respectively, for ethanol-treated rat livers compared with controls. The decrease in hepatic water signal intensity could be accounted for by the decrease in T2 and decrease in water density due to the presence of accumulated hepatic fat (approximately 25 mg/g wet weight of liver). When ethanol was withdrawn from the chronically treated rats, fatty infiltration was observed by both CSI and VOSY spectra to revert toward control values with a half-life of 2-4 days. By day 16, however, the signal intensity for hepatic fat was still significantly higher than control levels. In vitro 1H MRS studies of chloroform-methanol extracts confirmed the 5.5-fold increase in total hepatic fat induced by the chronic ethanol treatment, and showed further that triacylglycerols were increased 7.7-fold, cholesterol was increased fourfold, and phospholipids were increased 3.3-fold, compared with liver extracts from pair-fed control rats.


Use of 1H/23Na and 1H/31P double frequency tuned birdcage coils to study in vivo carbon tetrachloride-induced hepatotoxicity in rats. In vivo 1H and 23Na magnetic resonance imaging (MRI) and 31P magnetic resonance spectroscopy (MRS) techniques were used to study CCl4-induced acute hepatotoxicity in rats in situ. One or two hours following exposure to CCl4, a localized edematous region was detected in the liver by 1H MRI. The CCl4-induced edema was localized in a region surrounding the hepatic portal vein. With the use of a 23Na/1H double frequency tuned bird-cage imaging coil an increase in Na+ ion flux was also observed in the same region as the edematous region detected by 1H-MRI. Pretreatment with alpha-phenyl-tert-butyl nitrone (PBN), a free radical spin trap, 30 min prior to CCl4 exposure, was found to reduce the CCl4-induced edematous response in the liver observed in either 1H or 23Na-NMR images. Inhibition of the CCl4-induced edematous response in rat liver by PBN demonstrates that free radical intermediates, arising from the metabolism of CCl4, are possibly the key causal agents in the initiation of the edematous response. In addition, with the use of a 31P/1H double frequency tuned bird-cage imaging/spectroscopy coil, localized 31P spectra (ISIS) were obtained from the regions of CCl4-induced "tissue damage" observed in the 1H-MRI images. The most notable changes observed from the 31P spectra were an increase in inorganic phosphate (Pi) and a decrease in hepatocytosolic pH in the CCl4-treated rat livers in comparison to saline-treated control livers.


Bio-effects of high magnetic fields: a study using a simple animal model. The desire to do clinical imaging and spectroscopy at magnetic field strengths greater than 2 Tesla (T) necessitates investigation of possible bioeffects at these high fields. A simple T-maze was utilized to evaluate the aversive effects of exposure to three levels of static magnetic field (0, 1.5, and 4 T). The right arm of the maze extended into the center of a 30-cm horizontal bore magnet, while the left arm extended into a mock magnet bore with the same dimensions. The self-shielded design of the magnet reduces the fringe field to zero within 1 m of the bore, placing the start box of the maze outside the 5-G line of the magnet. Each rat performed a total of ten trials at each level of magnetic field strength. A follow-up subset was run at 4 T with the maze reversed. At 0 T, the rats entered the magnet freely. No significant differences from the control were observed at 1.5 T. At 4 T, however, in 97% of the trials the rats would not enter the magnet. In the maze-reversed subset a majority of the rats turned toward the magnet, indicating that they had learned an aversive response from the previous trials at 4 T. However, in only 4 decisions out of 58 did the rats actually enter the magnet. Eighteen decisions to turn around were made at the edge of the magnet in a region of strong field gradients (up to 13 T/m) and a field strength up to 1.75 T.(ABSTRACT TRUNCATED AT 250 WORDS)


Artifacts in chemical shift selective imaging. The role of susceptibility effects in the production of artifacts in chemical shift images generated by the selective excitation technique is discussed. The effects are demonstrated in images of phantom samples of agarose gels containing small air bubbles. The artifacts can lead to erroneous interpretations, in which the resonances to be resolved exhibit a relatively small chemical shift separation, such as that between water and soluble carbohydrates (sugars).


MR imaging of diplomyelia.

MR imaging of diplomyelia. We present an unusual case of duplication of the fifth lumbar vertebra and sacrum in a 6-year-old boy. The spinal cord was also duplicated and tethered by bone spurs bilaterally. The imaging features and the embryological basis of diplomyelia are discussed.


MR appearance of intra-abdominal metastatic melanoma. We present a case illustrating the magnetic resonance (MR) features of a large retroperitoneal metastatic melanoma. MR characteristics of intra-abdominal metastatic melanoma have not been reported previously. We report MR features similar to those reported for melanoma metastatic to other sites.


[Primary community health districts and changes in the utilization of a psychiatric service for diagnosis and therapy]. The Authors analyze the activity of Pavia's General Hospital Psychiatric Unit over a ten year period. Data, presented as rates standardized by sex and age, are processed according to patients' residential socio-health districts. The analysis of the results shows marked differences in the Service utilization among different districts. Correlations between these differences and some socio-demographic and clinical variables enable the Authors to put forward some hypotheses in order to understand this pattern of Service utilization. In particular, "high-users" and patients with a past history of admissions to psychiatric hospitals tend to be found especially in the districts which provide the Service with a heavy workload. A closer attention to these patients and to their pathways to care will enable the Service staff to optimize its supply of care and to plan new kinds of treatments.


[Culture and alcoholism].

[Culture and alcoholism]. The paper examines the varying importance which has been attributed to alcohol in different periods and emphasis that today cultural attitudes towards alcohol and alcoholics are becoming increasingly ambiguous: there is growing difference towards teetotallers and substantial permissiveness towards drinkers. This incongruous attitude even goes so far as to romanticise the death of several artists from alcoholism.


[The etiological problem of schizophrenia]. The originality and heterogeneity of hyperthese on the aetiologies of schizophrenia continue to make this entity debatable an uncertain. From the study of the numerous, discordant hypotheses that have accompanied schizophrenia this century, the need emerges for scientific thought that takes in the relativity of single theories and transcends them in a momentaneous suspension of judgment.


[Cognitive-behavioral model and instruments of evaluation. Organization of a rehabilitation center]. The Authors describe the one year experience they had at A.MI.G a rehabilitation centre in Florence. Problems of organization and evaluation are considered. Methods of evaluation have been used to divide the patients in three groups which have been treated differently. Rehabilitating interventions based on verification and therapeutic continuity are shown. Problems which have arisen and considerations on the hypothetic future interventions are considered.


[Revival of convulsive therapy].

[Revival of convulsive therapy]. After a brief review of the history of convulsive therapy, the paper criticises the denigratory campaign which was directed against this form of therapy for many years in Italy and later abroad. It stresses that convulsive therapy is now used worldwide, in spite of a few justifiable restrictions, for these indications and that the risks involved in the therapy itself, which are minimum, have been reduced. The Authors complain that this revival, which is now spreading internationally, has been hardly felt in Italy, especially in university circles.


[Epidemiologic psychiatric investigation in the community health district of Avezzano]. The aim of the epidemiological psychiatric survey carried out among the users of the Mental Hygiene Centre of Avezzano local health district was to study the socio-demographic and clinical characteristics of participants. Data for patients for the years 1979 and 1989 were collected and analysed by studying all clinical records registered during those periods. This choice reflected the need compare user characteristics and methods of using the service following the introduction of the reform decree no. 180/1978. The aim of this retrospective epidemiological survey was to obtain data and information which would serve to formulate answers which responded to the needs expressed by users. The results revealed a heterogenous territorial distribution of psychiatric cases and this provided some indication for the realisation of a complex network of psychiatric network in the Avezzano health district.


The effects of closed-head injury on postural sway. The purpose of this study was to determine the effects of closed-head injury upon postural sway. Forty-eight subjects (26 males and 22 females) between the ages of 18 and 45 were equally divided into four groups corresponding to their level of head injury. Group 1 had not incurred a head injury, group 2 members incurred head injuries but did not lose consciousness, group 3 lost consciousness for less than 6 h, and group 4 lost consciousness for greater than 6 h. All subjects were at least 1 yr postinjury. Each subject performed three trials of six variations of the Romberg test. The center of pressure transmitted through the bottom of the feet was monitored during each 30-s trial. Total, anterior-posterior (AP), and medial-lateral (ML) sway was calculated from center of pressure data. The severely head-injured group generally evidenced greater AP sway than the other three experimental groups for all but one test condition. It was concluded that closed-head injury, particularly when associated with relatively long periods of unconsciousness, results in postural instability.


An analysis of supraspinatus EMG activity and shoulder isometric force development. Injury to the shoulder represents a significant disability to the athlete participating in throwing and other overhead sporting activities. There are few scientifically based rehabilitation protocols regarding the most efficient exercises for the rotator cuff musculature. There is contradiction concerning the most efficient position for supraspinatus muscle electromyographic (EMG) activity. Because the supraspinatus is the most frequently injured musculotendinous structure of the shoulder, the most efficient position for testing and rehabilitation of this structure should be identified. The purposes of this study were to compare two test positions for supraspinatus EMG activity and maximal voluntary isometric contraction (MVIC) force development of the shoulder. Twenty-two subjects performed MVIC in the two recommended testing positions. A paired t-test revealed the prone position produced significantly greater (P = 0.04) EMG activity than the standing test position. An additional paired t-test revealed the standing position produced significantly greater (P = 0.0001) force than the prone position. Since the supraspinatus EMG activity was lowest in the position that produced the greatest shoulder MVIC force, we hypothesize that muscle substitution occurred. We recommend the prone position for supraspinatus rehabilitation and testing.


[Study of acute psychoses. I. The problem of acute psychoses: nosographic classification]. Survey of the first admitted patients for nonorganic and nonaffective acute psychotic decompensation in an Inpatient Treatment Unit, as a part of a Mental HealthCenter, in a General Hospital. Preliminarily the Authors review the concept of "acute psychosis" from Bleuler to Leonhard, Wyrsch, Lanfeldt, the bouffées delirantes of the French literature, the schizophreniform disorder of the DSM III R. The acute psychosis is "a carrefour state" where many types of acute events come together: schizophrenic, affective, reactive. Sometimes, but rarely, acute psychosis is a nosographic unit. This unit needs further evidence.


Isometric exercise training lowers resting blood pressure. Both rhythmic and "resistive" (weight lifting) exercise training can produce modest decreases in resting blood pressure. The next logical point along an exercise continuum consisting of different proportions of rhythmic and isometric efforts is a strictly isometric effort. The purpose of these studies was to assess the effects of isometric, handgrip exercise training on resting blood pressure. To avoid the extreme pressor responses elicited by fatiguing isometric efforts, the isometric exercise training used in this study consisted of brief handgrip contractions separated by rest periods. Modest repeated rises in systolic and diastolic pressures therefore served as the putative stimuli for training adaptations in resting blood pressures. Human subjects in study 1 trained with four, 2-min isometric handgrip contractions with 3-min rests between contractions. The intensity of the contractions was equal to 30% of their maximal effort for each day. The bouts of isometric exercise were performed three times per week for 8 wk. Study 2 training consisted of four contractions of 50% of maximum effort held for a duration of 45 s with 1-min rests. These were performed 5 d.wk-1 for 5 wk. In Study 1, all eight trained subjects had a significant decline in both systolic and diastolic resting blood pressures, with group averages of 12.5 and 14.9 mm Hg, respectively. Seven matched control subjects who did not train had no change in resting pressures. In study 2, subjects were trained in their home or workplace and experienced significant mean declines in resting systolic and diastolic pressures of 9.5 and 8.9 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)


Growth and menarcheal status of elite female gymnasts. The growth and maturity status of 201 elite female gymnasts was considered. The subjects were participants at the 24 World Championship Artistic Gymnastics in 1987. In addition to age at menarche, weight, stature, biacromial, and bicristal breadths, the sitting height/stature ratio, and the Health-Carter anthropometric somatotype of gymnasts 13-20 yr of age were compared with reference data for a nationally representative sample of Flemish girls. Median age at menarche (probit analysis) in gymnasts is 15.6 +/- 2.1 yr compared with 13.2 +/- 1.2 yr in Flemish girls. Anthropometric dimensions increase with age until about 16 yr and then tend to plateau. In contrast to body size, there is little variation in somatotype with age. Compared with adolescent girls, elite gymnasts are considerably shorter and lighter with narrower shoulders and hips, but the differences are more apparent after 17 yr. Elite gymnasts do not differ from nonathletes in relative leg length, but they have proportionally broader shoulders relative to hips. Differences in somatotype occur primarily in endomorphy (especially lower in gymnasts) and to a lesser extent in mesomorphy (higher in gymnasts).


Estradiol and progesterone during exercise in healthy untrained women. Ten eumenorrheic nonathletic women, aged 21-25, were studied on the 8th day following the LH peak in three consecutive cycles. Plasma level and metabolic clearance rate (MCR) of estradiol (E2) and progesterone (P) were measured before and during a 2-h continuous treadmill test at a speed corresponding to 70% of their running speed at anaerobic threshold on three separate occasions. A significant decrease of plasma level of the hormones (-30% and -40%, respectively, P less than 0.01; mean) from resting values was found, while their metabolic clearance rate increased significantly [E2-MCR from 1017 l.d-1 to 1312 l.d-1 (+29%), P less than 0.001; mean; P-MCR from of 2061 l.d-1 to 2988 l.d-1 (+45%), P less than 0.003; mean]. The increase in MCR of the two hormones was significantly correlated with the increase in heart rate and systolic blood pressure accompanying the beginning of the exercise test.


[Medico-social aspects of AIDS].

[Medico-social aspects of AIDS]. The AIDS crisis has brought us face to face with complex medical and social challenges unparalleled in this century. The magnitude of this tragic epidemic is measured not only in the cost in human lives, but also the enormous financial burdens of health care and lost productivity which each and every one of us, as well as future generations, will ultimately bear. This article presents an opportunity to explore a variety of health, social, economic, juridical and working issues of AIDS.


[Schizophrenia and multiple sclerosis].

[Schizophrenia and multiple sclerosis]. On the basis of published data on the frequent incidence of psychiatric disorders in demyelinating diseases, the paper report the case of a 22 year old patient who was brought to the Authors' attention with a schizophrenia-type disorder, with prevalently negative symptoms, and suffering from the advanced stages of a demyelinating pathology. Anamnestic and clinical characteristics reported by other Authors were also evident in this patient: the absence of familiarity for schizophrenic disorders, the absence of earlier psychiatric pathologies, the constant progress of psychosis and limited response to pharmacological therapy. The main results of clinical and instrumental tests are discussed.


The effect of normoxic or hypobaric hypoxic endurance training on the hypoxic ventilatory response. Cross-sectional studies in endurance athletes have demonstrated a diminished hypoxic ventilatory response (HVR) compared with mountaineers or sedentary controls. Conversely, short-term altitude acclimatization may increase the HVR. The longitudinal effect of training, either at sea level or altitude, on HVR has not been previously reported. We therefore studied 21 untrained men and women before and after 5 wk of cycle ergometer training at either sea level or 2,500 m. HVR was determined using the steady-state method (16). Minute ventilation (VE) was measured with a Tissot spirometer during the last minute of 5 min breathing room air, 8% and 12% O2, administered in random order. CO2 was added at the mouth in an effort to maintain end-tidal CO2 at baseline levels. Oxyhemoglobin saturation was measured directly from arterial blood with a hemoximeter (OSM 3). HVR was defined as the positive slope of the line relating VE to O2 saturation in l.min-1%-1. One group of subjects trained at sea level at 70% maximal oxygen uptake (VO2max; N = 7). A second group trained at 2,500 m in a hypobaric chamber, at the same relative exercise intensity (i.e., 70% altitude VO2max) or same absolute intensity (same power output) as group 1 (N = 14). Both groups trained on a bicycle ergometer for 45 min.d-1, 5 d.wk-1 for 5 wk.(ABSTRACT TRUNCATED AT 250 WORDS)


[Mental retardation and psychiatric pathology. Statistical investigation and follow-up]. The Authors describe the organization and aims of the rehabilitation institute "G. Ferrero" of Alba, Cuneo district, Italy. Afterwards they present, analyse and compare 34 items regarding patients over 14 years of age that were present on the 30 November 1978 and 1988. The most important data are: 1) a large rise in average age and stay at the institute; 2) a similar rise in the mental retardation level; 3) the lack of link between handicap level and possibility for the subject to go back to the original family; 4) a considerable increase in the subjects with psychosis or cerebropathia; 5) the poor prognosis for psychotic subjects, that are affected 10 years after and almost never succeed in going back to their original family or in finding a job; 6) big changes that changing types of patients produced in the institute's aims and in treatment, with partial renunciation to rehabilitation and development of nursing and ergotherapy.


Sweat electrolyte loss during exercise in the heat: effects of gender and maturation. Humans may lose large amounts of water and electrolytes from sweat during prolonged exercise in a hot climate. Gender and maturational differences for the total sweat electrolyte losses have not been reported. The purpose of this study was to compare sweat electrolyte losses of prepubescent (PP), pubescent (P) and young adult (YA) males and females, under the same environmental conditions and relative exercise intensities. Twenty-five females (8 PP, 9 P, 8 YA) and 26 males (10 PP, 8 P, 8 YA) cycled for two 20-min bouts at 50% of their peak VO2 in a climatic chamber (42 degrees C, 18% relative humidity). Sweat was collected from a plastic bag attached to the lower back. Total body sweat loss was calculated from the differences in nude body weight corrected for fluid intake, urine, and respiratory water loss. Sweat [Na+] and [Cl-] tended to increase with maturation while sweat [K+] was lower in YA compared with that of PP. Children had a lower sweating rate than YA, even when corrected for body surface area. As a result, total Na+ and Cl- losses per kg body weight from sweat (mEq.kg-1.h-1) were higher in YA compared with those of PP and P; however, no maturational difference was found in K+ losses. Within the same maturational group, there were no gender differences in any of the electrolyte losses. These results may be useful in recommending "optimal" fluid-electrolyte drinks for children exercising in the heat.


Cycling efficiency is related to the percentage of type I muscle fibers. We determined that the variability in the oxygen cost and thus the caloric expenditure of cycling at a given work rate (i.e., cycling economy) observed among highly endurance-trained cyclists (N = 19; mean +/- SE; VO2max, 4.9 +/- 0.1 l.min-1; body weight, 71 +/- 1 kg) is related to differences in their % Type I muscle fibers. The percentage of Type I and II muscle fibers was determined from biopsies of the vastus lateralis muscle that were histochemically stained for ATPase activity. When cycling a Monark ergometer at 80 RPM at work rates eliciting 52 +/- 1, 61 +/- 1, and 71 +/- 1% VO2max, efficiency was determined from the caloric expenditure responses (VO2 and RER using open circuit spirometry) to steady-state exercise. Gross efficiency (GE) was calculated as the ratio of work accomplished.min-1 to caloric expenditure.min-1, whereas delta efficiency (DE) was calculated as the slope of this relationship between approximately 50 and 70% VO2max. The % Type I fibers ranged from 32 to 76%, and DE when cycling ranged from 18.3 to 25.6% in these subjects. The % Type I fibers was positively correlated with both DE (r = 0.85; P less than 0.001; N = 19) and GE (r = 0.75; P less than 0.001; N = 19) during cycling. Additionally, % Type I fibers was positively correlated with GE (r = 0.74; P less than 0.001; N = 13) measured during the novel task of two-legged knee extension; performed at a velocity of 177 +/- 6 degrees.s-1 and intensity of 50 and 70% of peak VO2 for that activity.(ABSTRACT TRUNCATED AT 250 WORDS)


Carotid-cardiac baroreflex response and LBNP tolerance following resistance training. The purpose of this study was to examine the effect of lower body resistance training on cardiovascular control mechanisms and blood pressure maintenance during an orthostatic challenge. Lower body negative pressure (LBNP) tolerance, carotid-cardiac baroreflex function (using neck chamber pressure), and calf compliance were measured in eight healthy males before and after 19 wk of knee extension and leg press training. Resistance training sessions consisted of four or five sets of 6-12 repetitions of each exercise, performed two times per week. Training increased strength 25 +/- 3 (SE)% (P = 0.0003) and 31 +/- 6% (P = 0.0004), respectively, for the leg press and knee extension exercises. Average fiber size in biopsy samples of m. vastus lateralis increased 21 +/- 5% (P = 0.0014). Resistance training had no significant effect on LBNP tolerance. However, calf compliance decreased in five of the seven subjects measured, with the group average changing from 4.4 +/- 0.6 ml.mm Hg-1 to 3.9 +/- 0.3 ml.mm Hg-1 (P = 0.3826). The stimulus-response relationship of the carotid-cardiac baroreflex response shifted to the left on the carotid pressure axis as indicated by a reduction of 6 mm Hg in baseline systolic blood pressure (P = 0.0471). In addition, maximum slope increased from 5.4 +/- 1.3 ms.mm Hg-1 before training to 6.6 +/- 1.6 ms.mm Hg-1 after training (P = 0.0141). Our results suggest the possibility that high resistance, lower extremity exercise training can cause a chronic increase in sensitivity and resetting of the carotid-cardiac baroreflex.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of a functional knee brace on the biomechanics of running. The purpose of the study was to assess the biomechanical effects of a functional knee brace on joint moments of force and joint powers in the lower extremity during the stance phase of running in subjects with a previous ACL injury. Sagittal-plane film records and ground reaction force data were obtained from five previously injured subjects running with and without a functional knee brace and from five healthy subjects running without the brace. Inverse dynamics were performed on these data to obtain the moments of force and joint powers. The angular impulse in the extensor direction was assessed from each moment of force curve, and the work performed during selected portions of the stance phase was assessed from the joint power curves. ANOVA techniques on these variables indicated no significant differences between the brace and no-brace conditions in the previously injured subjects. In comparison with the healthy runners, the previously injured subjects had, on average, 49% and 32% greater extensor angular impulse about the hip and ankle (both P less than 0.05). In contrast, the healthy runners had, on average, 233% greater (P less than 0.05) extensor angular impulse about the knee. The corresponding negative and positive work performed at the knee were 321% and 191% larger (both P less than 0.05) in the healthy runners. The reduction in the extensor moment of force about the knee and the increase in the moments of force about the hip and ankle in the previously injured subjects reduced the stresses on the ACL and tibia while at the same time enabling them to run at the required speed.


Timing of lower extremity joint actions during treadmill running. It has been suggested that a disruption in timing between the subtalar and knee joints may be a possible mechanism for knee injury. It has also been documented that shoe construction can alter rearfoot motion. The purpose of the study was to describe the relationship between the subtalar and knee joint actions during the support phase of treadmill running while wearing different shoes. Twelve healthy subjects ran in each of three running shoes with unique midsole durometers (C1, 70; C2, 55; C3, 45). High-speed video (200 Hz) of the rear and sagittal views of each subject/condition were taken during the last minute of a 5-min run. Retro-reflective markers were processed to determine the rearfoot angle and the sagittal view knee angle. The shoes were also subjected to a midsole material impact test. The impact test results indicated a linear trend in peak g and time to peak g across midsoles with the firmer midsole having a greater peak g and a shorter time to peak g. The results of the kinematic analysis indicated that there were no significant differences among the shoe conditions for the knee flexion parameters. However, there were significant differences in both the magnitude and the time to maximum pronation between the two firmer midsole conditions (C1 and C2) and the softer midsole condition (C3), indicating a nonlinear trend for these parameters. The softer midsole exhibited greater pronation values and a shorter time to maximum pronation.(ABSTRACT TRUNCATED AT 250 WORDS)


Effect of macronutrient composition of an energy-restrictive diet on maximal physical performance. Thirty-six sedentary, mildly obese (30-40% fat), premenopausal women (29-49 yr) were randomly assigned to one of two dietary regimens for an 8-wk double-blind, parallel study of the effect of moderate caloric restriction and macronutrient variation on maximal physical performance. Group 1 (N = 19) consumed 4186 kJ.d-1 (1000 kcal.d-1) with a diet composition of 40% fat, 40% carbohydrate (CHO), and 20% protein. Group 2 (N = 17) also consumed 4186 kJ.d-1 but varied the percent kilojoules to 20% fat, 60% CHO, and 20% protein. Maximal aerobic power was measured using a modified Balke protocol, strength was assessed using isotonic bench and leg press machines and a Cybex 340 isokinetic device during knee flexion and extension, and muscular endurance was taken as the number of sit-ups performed in 1 min. Pre- to post-testing revealed significant (P less than or equal to 0.05) reductions in body weight (group 1, -7.4 kg; group 2, -6.5 kg) within both groups. No significant changes were seen in maximal aerobic power within both groups. Strength measures for both groups showed a trend toward reduction but statistical significance was only evident in right knee extension for group 1 and left knee extension for group 2 (P less than or equal to 0.05). Sit-up number increased nonsignificantly for both groups. Between group differences were not found in any body weight, body composition, or physical performance index. We therefore conclude that in mildly obese women, maximal exercise performance is relatively unimpaired after 8 wk of caloric restriction with either of two diets differing moderately in their macronutrient content.


Effect of iron supplementation on endurance capacity in iron-depleted female runners. The purpose of this investigation was to examine the effects of oral iron supplementation on endurance performance in initially iron-depleted, nonanemic female distance runners. Eighteen iron-depleted (serum ferritin less than 20 ng.ml-1, hemoglobin greater than or equal to 12 g.dl-1) women (22-39 yr) performed a VO2max test and an endurance run to exhaustion. Subjects were pair-matched on the basis of endurance time and then randomly assigned to an iron supplement or a placebo group. Following supplementation, the iron group had a significantly higher (P = 0.03) mean serum ferritin concentration (23.4 vs 15.7 ng.ml-1) and lower (P = 0.04) mean total iron-binding capacity than the placebo group. Both groups increased their time to exhaustion (25.5% and 22.2% for the iron and placebo groups, respectively) but were not significantly different (P = 0.72) from each other. There were also no differences (P greater than 0.05) between the groups with respect to lactate concentrations and physiological measures taken during the two exercise tests. The results of this study suggest that 8 wk of oral iron supplementation improves iron status in iron-depleted female distance runners, but does not enhance endurance capacity.


A technique for locating the center of mass and principal axes of the lower limb. The position of the human body in space is typically recorded using a fixed inertial coordinate system, often referred to as a laboratory coordinate system. Although these fixed reference axes simplify the collection and reduction of such position data, the results produced often have little or no anatomical significance. The purpose of this study was to develop the methods, both experimental and analytical, to construct a set of orthogonal principal axes for each the foot, shank, and thigh segments of the lower limb for use in motion analysis. The axes chosen were determined by targeting specific bony landmarks as suggested by the literature and forming the principal axes with respect to these landmarks. The location of the center of mass of each segment was also determined from these anatomical landmarks. It was found that the foot, due to its less rigid nature and more complex geometry, required a more extensive analysis using a single frame of standing data prior to the analysis of the motion data. The axes formed do not attempt to solve the problems of joint rotation axes, but provide an initial, anatomically significant set of reference axes that may be easily reproduced and utilized in further analyses.


Body composition of healthy sedentary and trained, young and older men and women. This study examined the effects of age and physical activity on body composition and fat distribution by comparing differences between young and older endurance trained men and women with differences between young and older sedentary people. Although indices of total body adiposity (fat mass, percent body fat) were higher in the older than in the young people in both the trained and the sedentary groups, the magnitude of the difference was markedly less in the trained group (P less than 0.01). The average differences in fat mass between young and old sedentary men and women were 10.1 kg and 12.2 kg, respectively, but only 4.3 kg and 5.5 kg in trained men and women. Skinfold thicknesses were approximately 24% and approximately 47% larger at all sites (triceps, thigh, subscapula, pectoralis, umbilicus, suprailiac) in the older than in the young trained men and women, respectively. Similar differences were found between young and older sedentary people except at central, upper body sites, where the relative differences in skinfold thicknesses between young and older sedentary people were 2- to 6-fold greater than in trained people. Thus, people who exercise regularly appear to accumulate less adipose tissue in upper, central body regions as they get older, potentially reducing the risk for the metabolic disorders associated with upper body obesity.


Local induction of tumor necrosis factor as a molecular mechanism of mucosal damage by gonococci. Tumor necrosis factor (TNF) is an endogenously produced cytokine that plays a critical role in mediating septic shock and multi-organ failure, but previous studies of the role TNF in disease have not examined its role in mucosal disease processes. In an experimental model of acute gonococcal salpingitis, gonococcal infection of human fallopian tube mucosa resulted in increased mucosal production of TNF. Recombinant human TNF-alpha damaged fallopian tube mucosa in a dose-response manner and produced epithelial damage with the same ultrastructural features as those observed in gonococcal infection. Blocking production of TNF during gonococcal infection diminished the extent of damage to fallopian tube mucosa. In addition to mediating systemic disease, such as septic shock, TNF is also produced locally, and can play a critical role in mediating mucosal disease processes, such as acute gonococcal salpingitis.


Serum TNF alpha inhibitor in mouse typhoid. Administration of anti-TNF alpha antiserum enhanced a sublethal infection with salmonellae of moderate virulence (Salmonella typhimurium M525) in innately susceptible (Ity(s)) BALB/c mice, indicating that TNF alpha is important in the early response which suppresses bacterial growth in the reticuloendothelial system (RES). However, only transient low levels of TNF alpha were detectable on day 3 in sera from some, but not all, sublethally infected mice. Conversely, on day 4 of the same infection, clear TNF alpha inhibitory activity was detected in some sera. Neither TNF alpha or any inhibitory activity were detected in sera of lethally infected BALB/c mice undergoing an acute, overwhelming Salmonella infection. In contrast, TNF alpha inhibitory activity, but not TNF alpha, was detected in sera of mice showing a cachectic syndrome induced by persistent high bacterial numbers following intravenous inoculation of a very high dose (2 x 10(7)) of the attenuated aro- S. typhimurium SL3261 strain.


Receptor utilization by reovirus type 3: distinct binding sites on thymoma and fibroblast cell lines result in differential compartmentalization of virions. Reovirus type 3/D infects cells following binding to specific cell-surface receptors. The characteristics of these receptors may play an important role in determining post-binding events critical to the viral life cycle. Some cell lines, i.e. L-cells, appear to bind reovirus type 3/D utilizing sialylated proteins as specific receptors for viral adsorption. Such binding results in productive infection. Other cell lines, i.e. R1.1 thymoma cells, bind reovirus type 3/D in a sialic acid independent manner which does not result in productive infection. Yet, a peptide analogue of the viral binding site is capable of inhibiting binding of reovirus type 3 to both cell types, suggesting the same viral epitope interacts with both cellular receptors. When binding of reovirus is studied by electron microscopy, the virus particles enter the L cells via coated pits, and are later seen in large accumulations in endocytic vesicles near the transGolgi network. In contrast, R1.1 cells appear to divert the reovirus particles to a cell membrane elaboration, with reovirus remaining bound to the cell membrane. At later time points with R1.1 cells, there are no apparent intracellular accumulations. These studies demonstrate that viruses can attach to different cells utilizing distinct receptors, and this may play a role in the ability of the virions to productively infect the cells. The capacity of virus to be adsorbed to cellular receptors which do not lead to internalization may be an important mechanism for the sequestration and clearance of virus. These observations have implications for the tissue tropism demonstrated by reovirus type 3/D and other viruses.


Murine hypersensitivity pneumonitis: interleukin-4 administration partially abrogates the disease process. C57BL-6 inbred mice were given intranasal instillations of Faeni rectivirgula (150 micrograms/day, 3 days a week for 3 weeks) to produce a lung inflammatory reaction which mimics Farmers' lung in humans. Challenged mice developed a strong inflammatory response in their lungs, based on various markers (lung index, bronchoalveolar cell number, fibrosis). The effect of interleukin-4 (IL-4) was studied by infusing mice intraperitoneally with 100, 1000 or 10,000 units of IL-4 weekly during the challenge period. It was shown that IL-4 infusion decreased the inflammatory response, as seen by a decreased lung index (1.7 in mice given F. rectivirgula and 10(3) U IL-4 and 1.31 in mice given antigen and 10(4) U IL-4 weekly versus 2.3 in mice instilled with F. rectivirgula). Interleukin-4 infusion also partially abrogated the F. rectivirgula-induced alveolitis, as seen by a decrease in cell numbers in the broncho-alveolar lavage (BAL) (1.3 x 10(5) cells in saline-instilled mice; 8.3 x 10(5) cells in mice given 10(3) U IL-4 and F. rectivirgula; 3.2 x 10(5) cells in mice given antigen and 10(4) U IL-4; 1.8 x 10(6) cells in mice given F. rectivirgula only). Also, it was apparent that IL-4 administration could partially block the appearance of the fibrosis induced by F. rectivirgula (220 micrograms of hydroxyproline/lung in challenged mice; 170 micrograms/lung in challenged mice given 10(3) U IL-4; 131 micrograms/lung in mice given antigen and 10(4) U IL-4 and c. 100 micrograms/lung in control animals). Infusion of 10(2) U IL-4 weekly had no statistical effect on any marker of inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)


Expression of Bordetella pertussis filamentous hemagglutinin in Escherichia coli using a two cistron system. Expression of Bordetella pertussis filamentous hemagglutinin (FHA) has been achieved in Escherichia coli K-12. This involved the construction of a two cistron system where the first cistron was provided by the NH2-terminus (first 98 amino acids) of MS2 polymerase. When the FHA gene sequences were fused to the first cistron, higher levels of expression were obtained and the fusion protein aggregated in inclusion bodies. FHA expressed by the two cistron system, however, appeared to be diffusely dispersed in the cytoplasm.


Cefonicid potentiation of human macrophage activity. This study was undertaken to evaluate the in vitro effects of cefonicid on phagocyte functions such as phagocytosis and intracellular killing of phagocytosed bacteria. At concentrations of half the MIC cefonicid caused human macrophages to ingest and kill Klebsiella pneumoniae at a greater rate than did drug-free macrophages. Bacteria pretreated with subinhibitory concentrations of cefonicid became more susceptible to the phagocytic and bactericidal activity of macrophages than untreated microorganisms. Sub-MIC cefonicid pretreatment of macrophages did not reduce phagocytosis and killing, confirming the inability of beta-lactam antibiotics to cross biological membranes.


Studies on the epidemiology of child infections in the Bari area (south Italy). V. Epidemiology of Toxoplasma gondii infections. Sera from 2790 0-15 aged infants and children were titrated for antibodies to Toxoplasma gondii by indirect immunofluorescent test. Maternal-derived antibodies were found at high rates in the first six months of life (32.9%). The positivity rate declined during the second semester of life (7.5%) and increased again with time (7.8% between 1 and 5 years, 11.2% between 5 and 10 years, 14.4% between 10 and 15 years). No statistically significant differences were found between the sexes. IgM specific antibodies were found at a titre of 1:32 or greater in 41 subjects (1.5%), who also exhibited IgG antibody titres ranging from 1:512 to 1:1024. Our results indicate a remarkable diffusion of toxoplasma infection in our area.


Cytotoxic activity and IL-1 production in mice infected with Aspergillus niger. In this report, we demonstrate an interaction between macrophages and T lymphocytes during A. nigr infection. Supernatants obtained after 48 hrs adherence of infected peritoneal macrophages were able to increase the cytotoxicity of T lymphocytes. Our results also indicate that macrophage supernatant (MS) from mice, in the first 5 days after challenge, is more active on T cell than MS produced later. Splenic T cells activated by IL-1 from mice at 5 days of infection show a significantly increased cytotoxicity, at 10 days after challenge, the cytotoxicity of T cells activated by IL-1 did not significantly differ from non-activated T cells.


Comparison of three immunoassays for the rapid detection of bovine respiratory syncytial virus. Three enzyme-linked immunosorbent assays (EIA) designed for the detection of human respiratory syncytial virus (RSV) were evaluated for the detection of bovine respiratory syncytial virus (BRSV) in bovine lungs and the results were compared with those obtained by a direct fluorescent antibody assay (DFA). The EIA tests used were Directigen EIA, Kallestad Pathfinder EIA, and Abbott RSV EIA. Homogenates of lung tissues obtained from 64 cattle that had died of respiratory disease were used; 32 were positive by DFA and 32 were negative. All EIA's varied in the amount of labor and time involved but their relative sensitivities were similar ranging between 59 and 66% when compared with DFA. The specificity of Pathfinder EIA was lower than those of the Directigen and Abbott tests. The overall agreement between the three EIA's and the DFA was 66-77% indicating that DFA is still the test of choice for detecting BRSV infection in lung tissues of cattle.


Molecular cloning of a specific DNA probe for the identification of Bacillus licheniformis. Bacillus licheniformis has been found to be one of the dominant nosocomial species of Bacillus: laboratories dealing with nosocomial infections must be able to identify Bacillus up to the species level. To date, no DNA probes have been isolated for B. licheniformis although there is a clear need for a direct detection by polymerase chain reaction. The isolation of a B. licheniformis-specific DNA probe, as described in this paper, represents the first step toward accomplishing this goal.


Density-dependent responsiveness to autocrine growth factors of Epstein-Barr virus transformed human B lymphocytes. Analysis of the growth requirements of Epstein-Barr virus (EBV)-transformed B lymphocytes shows that interleukin 1 and thioredoxin, a disulfide reducing enzyme, are able to induce a marked increase in DNA synthesis in the early phases of in vitro culture. By contrast, interleukin 6 induces a steady increase in DNA synthesis comparable to that observed with crude conditioned supernatant. Furthermore, EBV-transformed B cells exhibit a density-dependent responsiveness to autocrine growth factors, thus suggesting that growth regulation of EBV-transformed B cells might result from the interplay between different self-stimulating soluble factors and from the competence of the cells to respond to autocrine growth factors.


Possible relationship between Chlamydia trachomatis and acquired immunodeficiency syndrome. This study suggests the possibility that the intracellular parasite Chlamydia trachomatis (Ct) may facilitate the transmission of the human immunodeficiency virus (HIV) during vaginal or rectal intercourse. This is based on the following findings: a) elevated titers of anti-Ct IgG are present in symptomatic acquired immunodeficiency syndrome (AIDS) patients; b) elevated titers of anti-Ct IgA are found in asymptomatic AIDS patients; c) low anti-Ct IgA titers were observed during the progression of the disease; d) high titers of anti-Ct IgA were found in patients suffering from autoimmune diseases; e) high levels of C3 fraction of the complement are found in many of the Ct patients. The presence of anti-Ct IgA and high C3 may be crucial since IgA inactivates Ct and C3 which may increase the invasion of HIV into the cells. This activity of IgA and C3 in Ct patients may increase the susceptibility of male homosexuals and other risk groups in the population to AIDS.


Use of enzyme linked immunosorbent assay for estimation of antibody to Newcastle disease virus. Serum antibody assay of 1045 serum samples from birds vaccinated with Newcastle Disease vaccine by HI test and ELISA was carried out. Five hundred and twenty seven birds were challenged with virulent virus and data on HI test, ELISA and challenge test results were used for comparison. A good correlation between HI titres, ELISA absorbance and potency was observed indicating the usefulness of ELISA for potency estimation of vaccines and determination of immunization level in vaccinated flocks.


Aluminium, chromium and manganese detoxification mechanisms in Pseudomonas syringae: an X-ray fluorescence study. Pseudomonas syringae cultured in a defined citrate medium supplemented with 1 mM aluminium, chromium and manganese, respectively, appeared to elicit disparate biochemical responses. At the stationary phase of growth aluminium was predominantly present as an insoluble residue. Although virtually none of this metallic element was detected in the supernatant, the bacterial cells appeared to contain some aluminium. Following the initial uptake of chromium the microbe secreted the metal in the supernatant. Only a small fraction of the chromium was localised in the bacterial cells; 91% manganese was biotransformed into an insoluble pellet. No citrate was detected in the exocellular fluid at cessation of cellular growth.


Enzyme-linked immunosorbent assay for the detection of Fusobacterium necrophorum antibody in bovine sera. An enzyme-linked immunosorbent assay (ELISA) with HCl heat extracted antigen of Fusobacterium necrophorum was developed for the detection of antibody in bovine sera. Optimal conditions for antigen concentration and dilution of bovine serum were established. Pretreatment of positive reference serum with the antigens of different bacteria demonstrated no decrease, whereas the serum pretreated with F. necrophorum antigens revealed a decrease in the ELISA values. The apparent difference in ELISA values was observed between the sera derived from cattle infected and not infected with Fusobacterium necrophorum. These findings indicate that the ELISA detects the antibody to F. necrophorum in bovine sera.


Effect of seawater storage on coliforms, faecal coliforms and Escherichia coli. The effect of refrigeration of seawater samples for 24 h prior to assaying coliforms, faecal coliforms and Escherichia coli was assessed. When the initial coliform counts were low, the amount of bacteria in refrigerated samples decreased. When the number of initial total coliforms was high, there was an increase following cold storage. E. coli counts also decreased. Faecal coliforms, when in the initial 200-500 count range, showed a decrease during cold storage but with good correlation (r = 0.9). In all other groups, no correlation between counts of before versus after storage was found. Assessment of seawater pollution following 24 h cold storage should not be made.


Occurrence of haemolysin producing Aeromonas species in the aquatic environment. A total of 532 environmental isolates of motile aeromonads were evaluated for their ability to produce haemolysins. Of those isolates tested, 68 (12.5%) and 18 (3.4%) were found to be alpha and beta haemolytic, respectively. Aeromonas caviae was found to be alpha haemolytic (3.8%) for the first time. Isolates of Aeromonas which were either alpha or beta haemolytic on plate assay also produced detectable amounts of haemolysin in cell free broth assay.


Lactoferrin binding properties of Vibrio cholerae. The lactoferrin binding properties of Vibrio cholerae, a non-invasive pathogen were investigated. Screening of fifty V. cholerae strains of different serogroups and serotypes, showed that 10% of the V. cholerae strains bound to 125I-labelled lactoferrin, and 40% of the 125I-labelled lactoferrin bound to V. cholerae strain 623 could be displaced by unlabelled lactoferrin. Other iron-binding glycoproteins and ferroproteins like ferritin, transferrin, haemoglobin, and myoglobin inhibited the binding of 125I-lactoferrin to a lesser degree. Monosaccharides (GalNac, Man, Gal, and Fuc), and other glycoproteins such as fetuin and orosomucoid also inhibited the binding to a lesser extent. V. cholerae 623 showed a cell surface associated-proteolytic activity which cleaved off the cell-bound 125I-labelled lactoferrin. The generation of cryptotopes on the V. cholerae cell surface by proteolytic digestion favoured the binding of ferritin, transferrin, haemoglobin, and haemin, as well as Congo red, to cells of V. cholerae 623.


Bacterial uptake of 14C-chlorhexidine diacetate and 14C-benzyl alcohol and the influence of phenoxyethanol and azolectin: studies with gram-negative bacteria. The uptake of 14C-chlorhexidine (14C-CHA) by Pseudomonas aeruginosa and smooth, rough and deep rough strains of Escherichia coli was very rapid with maximum uptake occurring within 20 s. Despite the rapid binding, the lethal action of CHA, although concentration-dependent, is comparatively slow and occurs in minutes rather than seconds. This indicates that the initial rapid binding is followed by a second slower action, responsible for the lethal effects of CHA. The lethal action could be accelerated, particularly at modest concentrations of CHA, by the simultaneous presence of phenoxyethanol (POE) or benzyl alcohol (BZA), although the magnitude of the effect was small. Both alcohols had little effect on the binding of 14C-CHA, which does not explain the enhanced bactericidal action of CHA. Uptake of 14C-benzyl alcohol (14C-BZA) by the same strains showed very different patterns with slower and time-related binding. CHA had a marked effect on BZA absorption but no direct link was established between binding patterns and cell death. The CHA neutraliser, azolectin, removed bound CHA (in the presence or absence of POE) very efficiently even at contact times of only 20 s.


Regulation of intracellular osmotic pressure during the initial stages of salt stress in a salt-tolerant yeast, Zygosaccharomyces rouxii. The accumulation of glycerol and inorganic ions as it related to osmotic pressure, and the regulation of intracellular osmotic pressure in a salt-tolerant yeast, Zygosaccharomyces rouxii, were examined for several hours after salt stress. Intracellular contents of glycerol increased for up to 6 h in media supplemented with 1 M and 2 M NaCl and did not increase in medium containing 3 M NaCl. Intracellular contents of Na+ and Cl- reached a maximum value within 1 and 3 h, respectively, in all NaCl-containing media and increases were proportional to the concentration of NaCl in the medium. As glycerol was accumulated in cells, the intracellular contents of Na+ and Cl- gradually decreased in media containing 1 M and 2 M NaCl. After salt stress, cell volume decreased within 1 h and the original volume was re-established for 3 to 6 h in media with 1 M and 2 M NaCl but not in medium with 3 M NaCl. Intracellular concentrations of solutes, which were calculated from the total contents of glycerol and inorganic ions and the cell volume, became almost equivalent to the external osmotic pressure within 1 h after salt stress. Experiments using various inhibitors showed that a large amount of ATP was required not only for the synthesis and accumulation of glycerol but also for the exclusion of Na+ and Cl- from cells under salt-stressed conditions.


Humoral mechanisms in immune neuropathies. Antibody and complement are implicated in the pathogenesis of a number of human, primarily demyelinating neuropathies. The ability of serum and purified, primarily IgM, antibodies to mediate demyelination was demonstrated in both in vitro and in vivo model systems. Complement activation to produce channel-forming terminal complement complexes, C5b-8 and C5b-9, was required for demyelination in vitro. Antibodies implicated in the demyelination of peripheral nerve of GBS patients and patients with monoclonal gammopathy-associated neuropathy bind carbohydrate epitopes on various neutral or acidic glycolipids and glycoproteins of peripheral nerve. In acute monophasic GBS, antibodies of multiple specificities may be induced to different infectious agents. These Ab, following penetration of a damaged blood-nerve barrier, are proposed to bind determinants of human peripheral nerve and participate in demyelination of nerve through activation of complement. These antibodies correlate with the clinical course, the generation of complement activation products, and the response to plasmapheresis. The mechanism by which the blood-nerve barrier is broken in GBS and other inflammatory demyelinating neuropathies and the extent of the role of the cellular immune system remain to be determined. Recent experiments demonstrated that T cells, antibody, and complement could synergistically contribute to central nervous system demyelination in naive rats. A similar synergism would be an attractive hypothesis for demyelination in the peripheral nervous system.


Multifocal motor neuropathy.

Multifocal motor neuropathy. We believe that our present understanding of these syndromes is insufficient to separate CIDP from MMN clearly and consider MMN to be a remarkably multifocal, predominantly motor variant of CIDP with the very unusual electrophysiologic feature of conduction block confined to motor axons. Further studies are clearly needed to clarify fully the relationship between CIDP and MMN and the relationship of MMN and other motor syndromes to various ganglioside antibodies.


Participation in school physical education and selected dietary patterns among high school students--United States, 1991. Inadequate physical activity and unhealthy dietary patterns (particularly diets high in fat and low in fruits, vegetables, and grains) established during youth may extend into adulthood and may increase risk for chronic diseases, such as coronary heart disease and cancer (1-5). This report examines the prevalence of self-reported enrollment, attendance, and participation in school physical education (PE) and examines selected dietary patterns among students in grades 9-12 from two school-based components of CDC's Youth Risk Behavior Surveillance System (6): 1) the national Youth Risk Behavior Survey (conducted during April-May 1991) and 2) individual state and local Youth Risk Behavior Surveys (conducted by departments of education in 23 states and 10 cities during the same time).


Lizard-associated salmonellosis--Utah.

Lizard-associated salmonellosis--Utah. During June 1992, CDC identified a rare Salmonella serotype, S. poano, from a stool specimen from an infant. The specimen was sent from the Utah Division of Laboratory Services. This report summarizes the epidemiologic investigation of this case.


Publicly funded HIV counseling and testing--United States, 1991. Human immunodeficiency virus (HIV) counseling and testing (CT) services provided by health departments are a major component of the national HIV-prevention program. The purpose of HIV CT is to 1) reinforce perception of risk by those who are unaware or uninformed, 2) help uninfected persons initiate and sustain behavior changes that reduce their risk for becoming infected, and 3) identify HIV-infected persons who can be referred for early medical care and counseled to practice safer behaviors. The use of publicly funded HIV CT has steadily increased; in 1991, nearly 2,091,000 HIV-antibody tests were performed, compared with approximately 79,000 tests in 1985. CT services are provided by health departments in 65 HIV-prevention project areas including the 50 states, the District of Columbia, six cities, and eight territories. Each calendar quarter, the programs report to CDC data regarding the number of pretest counseling sessions. HIV-antibody tests, positive tests, and posttest counseling sessions. Information is also provided on self-reported risk category, age group, sex, and race/ethnicity. This report summarizes data reported for 1991.(ABSTRACT TRUNCATED AT 250 WORDS)


Condom use among male injecting-drug users--New York City, 1987-1990. Heterosexual transmission of human immunodeficiency virus (HIV) continues to increase, especially among injecting-drug users (IDUs) and their sex partners. During 1991, 22% of women with acquired immunodeficiency syndrome (AIDS) in the United States reported having had sex with a male IDU; this risk behavior was second to injecting-drug use (48%) as a transmission category for women. To better understand how to reduce heterosexual transmission of HIV, a study on condom use among male IDUs on the Lower East Side of Manhattan, New York City, was conducted as part of CDC AIDS Community Demonstration Projects. This report summarizes the results of that study.(ABSTRACT TRUNCATED AT 250 WORDS)


Surveillance of children's blood lead levels--United States, 1991. Lead poisoning is one of the most common environmental pediatric health problems in the United States (1): in 1984, an estimated three to four million children had blood lead levels (BLLs) sufficiently high to adversely affect intelligence, behavior, and development (2). Because little is known about efforts to monitor BLLs among U.S. children, in 1991, the Council of State and Territorial Epidemiologists (CSTE) and CDC conducted a survey to characterize reporting requirements and data-collection activities for BLLs among U.S. children during 1989. This report summarizes the findings from that survey.(ABSTRACT TRUNCATED AT 250 WORDS)


[Pathogenesis of epilepsy in childhood and adolescence]. After a short discussion of the basic mechanisms of epileptic reactions, the conditions for epileptrogenesis are reviewed. As demonstrated by studies in animal models, distinctive structural and neurochemical characteristics of the brain tissue, probably genetically determined, build a main precondition for seizure manifestation. Starting from these basic concepts, the multifactorial pathogenesis of human epilepsy is discussed with special regard to genetic factors. The seizure liability results from the interaction of several independently transmitted genetic and lesional factors. None of these traits are epileptogenic by themselves, but effective only in interaction with other pathogenetic factors. Genetically determined "normal" structural and functional properties of the brain, e.g. expressed by generalized alpha rhythm, are involved in the complex pathogenesis of epilepsy. From a neurobiological point of view, epilepsy is always a multifactorially determined disease. The nowadays usual separation of idiopathic and symptomatic types of epilepsy may be helpful for communication in daily practice, but represents a simplification under pathogenetic aspects.


[Differential diagnosis of cerebral seizures]. Several non-epileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy and they must be considered in the differential diagnosis. Some of these disorders are discussed in the present review: vasovagal, vasomotor and cardiac syncopes, breath holding spells. Among the sleep disorders, parasomnias, nightmares and the benign neonatal sleep myoclonus are mentioned. Migraine with aura, alternating hemiplegia and benign vertigo of childhood are probably related disorders. Benign myoclonus of early infancy, paroxysmal choreoathetoses and pseudoepileptic or hysterical seizures are further non-epileptic attack disorders to be considered in the differential diagnosis.


[Ophthalmoplegia interna after varicella]. We present the case of a 5 1/2 year old girl. 14 days after the onset of the typical rash, the right pupil was dilated and fixed to light. Her manifest refraction was O.D. +1.0 dpt. No signs of iridocyclitis could be found, the fundus was normal. One year later, the pupil of the right eye was still dilated, whereas accommodation had slightly improved (+0.5 dpt). Internal ophthalmoplegia complicating chickenpox is rare, 13 cases have been reported so far.


[Congenital anhidrotic ectodermal dysplasia in a female infant]. Fever of unknown origin, unability to sweat, hypotrichosis, absent eyebrows and thick everted lips were symptoms in a 3 month old female infant and raised the suspicion of anhidrotic ectodermal dysplasia. After several days of high fever and enteritis our patient presented with convulsions which could hardly be interrupted for a couple of days. Two months later brain scanning revealed serious brain damage. Finally the diagnosis of anhidrotic ectodermal dysplasia was confirmed by the unability to sweat by means of the quantitative pilocarpin iontophoresis test. Skin biopsy showed absence of the eccrine glands.


[Severe human bite injuries in a 7-day-old newborn infant]. It is reported about a 7-day-old newborn showing considerable bite wounds in his face. Due to the evidence of blood group characteristics on his pajamas and by means of a dental impression, the 2 1/2-year-old brother was "found guilty" of having caused the injuries. During a short antibiotic treatment the bite wounds cleared, showing very good results. Jealousy is assumed to be the reason for the incidence. Based on a comprehensive and also child-psychiatric examination of the family, other reasons could be excluded. Similar cases of sibling violence with newborns, partly fatal, are reported in literature. If infants fear to loose the security of their homes, jealousy may lead to severe aggressive reactions.


[Etiology and diagnosis of cerebral infarcts after the neonatal period]. After the neonatal period, cerebral infarctions are very rare in childhood. In the present study we aim to evaluate the etiology and diagnostic procedures of this disorder on the basis of our own experience. We saw four children aged 3 2/12 to 11 4/12 years with a cerebral infarction at our hospital. Three children were followed up until 6 months after the infarction. The case reports are presented. On the background of the literature, the etiology and diagnostic possibilities and requirements are discussed. As the underlying cause, we saw a hemolytic-uremic syndrome in one case, and a (post-)infectious vasculitis following measles resp. scarlet fever in two cases. CCT, NMR, and transcranial Doppler sonography are the diagnostic methods of choice, although none of these by itself is able to diagnose this disorder with any certainty. Therapeutic measures are restricted to the causative disease. The prognosis is good quoad vitam, although serious regarding neurologic sequelae. An early diagnosis of this disorder is essential, because the only known effective therapy is the management of a possibly underlying disorder. Intensive physiotherapy as an additional measure is helpful to avoid neurological sequelae.


[Mucoviscidosis screening with immunoreactive trypsin. Initial experiences in Austria]. Up to now, 16.338 IRT-measurements have been carried out on dried blood spot specimens; 15.505 of them were taken in the first week of life. Related to a provisionally chosen cut-off point of 750 ng/ml, 134 newborns (= 0.86%) showed an elevated IRT-value and subsequently were recalled between the fourth and sixth week of life for a second IRT-determination. Twenty-five out of 116 reinvestigated children again showed an elevated value, as based on likewise provisional, age-dependent reference values. Four of these children subsequently were identified as CF patients by sweat testing. So far, we did not encounter any false-negative IRT values. We also commenced to establish a profile of reference values for the first twelve weeks of life; as yet, there are not enough data for definitely defining these limits of normality. In conclusion, IRT-screening appears to be a reliable method for identifying CF patients in the newborn period. Our preliminary results indicate an incidence of CF of 1 to 3880 in the southeast of Austria.


[Taurine requirement of premature infants in parenteral nutrition]. The aim of our studies was to clarify, which dose of taurine should be added to amino acid solutions, in order to achieve plasma levels in premature infants as they are found during nutrition with mother's milk. In 22 premature infants born in the 30th-35th week of gestation plasma taurine levels during parenteral nutrition were measured on the 5th-9th day of life before and after infusing an amino acid solution supplemented with taurine. For analysis the principle of chromatographical ion exchange was applied. The requirement of taurine was calculated by means of a linear regression between supply and blood level. The mean plasma taurine levels before substitution were 88.7 mumol (95%-range of tolerance: 32.8-240 mumol/l). In premature infants with cerebral haemorrhages significantly higher plasma taurine levels were observed. Continuous parenteral taurine supply of approximately 0.05 g/kg/day was able to raise the taurine level by about 70 mumol/l, which caused a plasma taurine level of above 100 mumol/l in any case. During parenteral nutrition it is possible to achieve taurine levels as high as in breastfed neonates by substituting taurine at an amount of 0.05 g taurine per kg body weight.


[Extrahepatic bile duct atresia. Comparison of surgical and non-surgical therapy]. In recent years hepatoportoenterostomy according to Kasai undoubtedly was the only successful therapy for extrahepatic biliary atresia. Since liver-transplantation becomes more successful than previously, the question arises if the Kasai procedure is still justified. From this point of view a prospective study was started based on the following findings in 15 EHBA-children after hepatoportoenterostomy compared to those in 15 patients without the Kasai procedure: the survival rate at the end of two years of life; the development of ascites until the end of the first year of life; the weight and length percentiles at the end of the first year of life; and the activity of serum cholinesterase. In order to calculate significant differences in weight and length percentiles, the exact Fisher test was used. Serum cholinesterase activities of both the above mentioned groups were compared with each other, as well as with the normal values of a third group of 50 healthy children, by analyzing variances and then comparing one by one with adjustment for multiple comparisons. There was a significant difference between the operated and not-operated group, and in addition between the non-operated and the healthy group. In contrast, no significant difference was detected between the operated and the healthy group. These differences were best demonstrated by the findings of weight and length percentiles and the activity of serum cholinesterase. From this we conclude sofar hepatoportoenterostomy undoubtedly is standard procedure in the treatment of EHGA. However, if the Kasai procedure fails or the liver disease progresses to a greater extent, liver transplantation will become the method of choice.


[Acute diarrheal diseases. Treatment with carrot-rice viscous solution is more effective than ORS solution]. In infants and children, the treatment of acute diarrhoea with glucose-based electrolyte solutions results in rehydration but does not reduce the severity and duration of diarrhoea. In german-speaking countries, rice- and carrot-based solutions have a long tradition in the treatment of diarrhoea and may also reduce stool output and the duration of diarrhoea. Therefore, we evaluated the efficacy and safety of a carrot-rice-based rehydration solution (Na 57 mmol/L, n = 70) and two conventional glucose-based solutions with high or low sodium concentrations (Na 90 mmol/L, n = 48 or Na 55 mmol/L, n = 60) in a prospective study. The study subjects were Pakistani boys and girls between 3 and 48 months of age with mild or moderate dehydration. We measured duration of diarrhoea, fecal and urine output, fluid intake and serum electrolytes. The duration of diarrhoea was significantly lower (p less than 0.05) in the group receiving the carrot-rice based rehydration solution (59.5 +/- 30.9 h) than in the groups receiving the high-Na (75.5 +/- 30.5) and low-Na (74.8 +/- 32.5) glucose-electrolyte solutions. The mean fecal output (p less than 0.01) and fluid intake (p less than 0.001) were also significantly lower in the infants and children receiving the carrot-rice-based rehydration solution. No major electrolyte imbalances were observed in the three groups. We conclude that the carrot-rice-based rehydration solution was safe and more effective than two conventional glucose-electrolyte solutions in the rehydration of infants and children with acute diarrhoea.


AAEM case report #24: electrodiagnosis in posttraumatic syringomyelia. An adult male with C-7 quadriplegia developed neck pain. Axillary F central latencies were prolonged, and MRI showed a syrinx extending to C-1. After shunting, F latencies normalized. At subsequent follow-up, a rostral syrinx persisted by magnetic resonance imaging (MRI); motor evoked potential (MEP) latencies were prolonged but F latencies were normal. Later, the syrinx was less distended by MRI, MEPs normalized, and strength improved. We discuss the electrophysiologic methods available for diagnosing and monitoring posttraumatic syringomyelia.


Insulin increases amino acid transport into rat soleus motor axons. Hyperosmotic neurosecretion was used to measure basal and insulin-stimulated amino acid and myoinosital transport into rat motor nerve terminals. L-Alanine and alpha(methylamino)-isobutyric acid (a nonmetabolizable system A-specific analog) transport was rapid into motor nerve terminals innervating a fast-twitch muscle, the extensor digitorum longus, and slow into motor nerve terminals innervating the soleus, a slow-twitch muscle. A physiological concentration of insulin, 10 microU/mL, increased L-alanine and alpha(methylamino)-isobutyric acid transport into motor nerve terminals in the soleus. Large doses of insulin, 100 or 1000 microU/mL, had no effect on L-alanine or alpha(methylamino)-isobutyric acid transport into nerve terminals in the extensor digitorum longus. There was negligible basal or insulin-stimulated transport of D-alanine or myoinositol into nerve terminals of the soleus or extensor digitorum longus. These studies show that insulin regulates sterospecific amino acid transport into soleus motor axons, but has no effect on the rapid amino acid transport into extensor digitorum longus motor axons. Differences in basal and insulin-stimulated transport suggest that motor axons differ in their metabolism, and might be selectively vulnerable to disease processes.


Improved medium with EGF and BSA for differentiated human skeletal muscle cells. Epidermal growth factor (EGF) and bovine serum albumin (BSA) are both required for serum-free clonal growth of human muscle satellite cells (HMSC). However, neither inhibits differentiation of HMSC, and when both are added to a minimal serum-free differentiation medium, they enhance survival and maintenance of human myotubes. A combination of 10 ng/mL EGF and 0.5 mg/mL BSA, added to MCDB 120 plus 10 micrograms/mL insulin, increases both total protein per dish and total creatine kinase activity, and keeps the myotubes in good condition for a longer period of time. The myotubes become cross-striated and exhibit frequent spontaneous twitching. Substantial amounts of neonatal myosin heavy chain and the MM isozyme of creatine kinase are expressed, together with detectable amounts of adult fast myosin heavy chain. With regular feeding, these cultures can be maintained for at least 3 weeks with no overgrowth by mononucleate cells, and with far less degeneration than with insulin as the only supplement.


Myotrophic effects of an anabolic steroid in rabbit limb muscles. There has been no reliable evidence that the actions of anabolic steroids extend to limb muscles. In this study, female rabbits were treated with anabolic steroid (nandrolone decanoate) or arachis oil placebo for 4 weeks or 12 weeks. After 12 weeks, tibialis anterior muscles of treated animals showed highly significant increases in wet weight (38%), twitch tension (66%), maximum isometric tetanic tension (48%), maximum cross-sectional area (27%), and specific tension (17%). Fiber type composition showed a significant trend toward a less oxidative metabolic character. The experiments provided clear physiological and morphological evidence of a steroid-induced hypertrophy that was not attributable to fluid retention or changes in body weight. Of the muscles examined, the myotrophic effect was confined to the tibialis anterior muscle; extensor digitorum longus, plantaris, and soleus muscles showed no significant response. The work establishes an experimental model for the responses of limb muscles to anabolic compounds.