[Intraluminal pressure profiles in the pharyngeal phase in both normal and abnormal subjects]. Intraluminal pressure change in the pharyngeal phase of swallowing was measured by the station pull-through method, in which a pressure transducer probe was being withdrawn at each 1 cm step from a segment 25 to 8 cm from the nostril. The probe had an outside diameter of 5.0 mm in size and was loaded with two miniature pressure transducers 3 cm apart from each other. Electromyogram of the suprahyoid muscles was simultaneously recorded with a surface electrode as an index of the second phase of deglutition. The three formats to analyze pressure wave forms in swallowing were designed as followings; a swallowing pressure curve showing peak values at each level, a conduction curve of swallowing pressure indicating the times when the peak of the pressure appeared at each level, and a calculation of the onset of relaxation and its duration at the portion of high pressure zone of the upper esophagus (UHPZ). Analyses of the data in 30 normal subjects revealed the following results. 1) All showed swallowing pressure curves with 3 peaks at the levels of the velopharynx, hypopharynx and cervical esophagus. 2) Normal ranges of the pressure at each level of the peak were 48.2-139 mmHg, 46.4-132 mmHg and 9.0-111 mmHg, respectively. 3) Conduction curves of swallowing pressure showed an "S" like figure in all and the gradient was steep at the level of the oropharynx and hypopharynx. 4) The duration of relaxation at the paroxysmal end within the UHPZ was shorter than that at the distal in all. The normal range of the duration of relaxation at the paroxysmal end was 365-833 msec. Profiles of swallowing in 130 patients with dysphagia showed the following results. 5) Pressure curves in swallowing were classified into 4 pathological patterns of curve depending on the site of a lesion. 6) Two of all showed an abnormal pattern of the conduction curve, which was supposed to be originated by a disorder in the preprogrammed process in swallowing. 7) Two of all also showed abnormally earlier onset of relaxation within the UHPZ. 8) Of all, 3 showed short duration of relaxation within the UHPZ abnormally.


[The effect of aging on observation in hearing in the same individuals over a 5 year period]. The purpose of this study was to investigate the process of changes in hearing of pure tones with aging. Among individuals who had undergone thorough medical examination for the purpose of annual health-checks, 293 males (586 ears) whose hearing level had been examined for five years or more were enrolled in this study. Cases having conductive deafness or known sensori-neural deafness were excluded. Since the most typical change with aging is observed at 8 kHz, the investigation was carried out only on hearing at 8 kHz. Hearing level increasingly declined with advancing age. Hearing distribution for young subjects showed a peak in the normal hearing level range. This peak decreased with aging, and another peak appeared at 50 dB. Investigation of differences in hearing in the individuals over the five years showed that most subjects had a hearing level difference of 0 dB up to 54 years of age. From 55 years old onward, however, the difference was 5 dB. This indicates that gradual deterioration of hearing level with aging occurs most frequently. On the other hand, in some subjects, deafness progressed faster. Thirty-four and a half percent of the subjects had deteriorations of 20 dB or more in a single year during the entire observation period. A deterioration of 20 dB or more was noted in 4% of the young and 8% of the elderly. Such rapid progression of deafness was believed to be involved in formation of the 50 dB peak in the hearing distribution.


[Postural control in the elderly].

[Postural control in the elderly]. In order to investigate postural control in the elderly, a stabilometric investigation including fast Fourier Transform (FFT) analysis was conducted in three different age groups. The oldest group was composed of 16 subjects who ranged in age from 75 to 86 years: another group consisted of eight 65 to 74 year olds; the control group was composed of 21 young students. The subject was instructed to stand and look for 30 seconds at a spot in a CRT 50 cm ahead of his eyes, and to control body sway as indicated by the gravitational spot in the CRT. The subject was then told to stand with eyes closed for 30 seconds. Next, a 100 Hz vibratory stimulation was applied to the bilateral Achilles tendon in each trial. The data was filtered with a 10 Hz high cut filter and digitized at 25 Hz, and subsequently analyzed by a microcomputer (PC9801 VM 2). Thus, statistical analysis was performed in terms of area, length, and total frequency spectra from 0.10 Hz to 10.0 Hz in both lateral and antero-posterior directions. Sixteen power spectra of 0.249 Hz step from 0.10 to 3.96 Hz were demonstrated in the CRT and were also compared with those of the young group. When standing naturally, significant increases in body sway were found in terms of area, length, and total frequency spectra in the most elderly group as compared with the other two groups. There was no significant change in Romberg ratio between the elderly and the young groups. However, FFT analysis confirmed the influence of visual cues. When vibration was applied, no increases in body sway with regard to these parameters were demonstrated in the elderly, whereas significant increases were found in the young control group. This was especially evident in the eyes-closed trials, as previously reported. There were few increased frequency ranges in either lateral or antero-posterior sway in the elderly. This might suggest that proprioceptive afferent information play a less important role in elderly than in young subjects. When the subject was requested to minimize his own sway by utilizing visual feedback, no difference was found in this parameter between the elderly and young groups. However, FFT analysis of the elderly group revealed an increase of the power spectra close to 1.0 Hz in both lateral and antero-posterior sway, whereas increases of approximately 1.0 and 2.0 Hz in the power spectra and a decrease in the power spectrum from 0.10 to 0.29 Hz were found in both directions in young subjects.(ABSTRACT TRUNCATED AT 400 WORDS)


[Morphological findings of the tympanic plexus]. A morphological study of the human tympanic plexus was performed. The tympanic nerve patterns on the promontory were classified into two types. The first was the single nerve trunk type, the second the type of nerve which divides into anterior and posterior branches. A tubal branch and a caroticotympanic branch on the promontory were both present in about 90% of the ears studied. Many ganglion cells were distributed on the tympanic plexus. It was concluded that these ganglia were autonomic, based on the nature of their fine structure. We speculate that these ganglia are parasympathetic and that they modulate the functions of vasodilators and secretory glands in the mucosa of the middle ear. In addition, we conducted a fiber analysis of the tympanic nerve and the lingual branch of the glossopharyngeal nerve and made a comparison between them.


[Immuno-injury to the inner ear auditory system following secondary endolymphatic sac immune response]. This study investigated immuno-injury to the inner ear auditory system following inner ear immune response in the guinea pig. The endolymphatic sac (ES) was directly challenged with keyhole limpet hemocyanin (KLH). Auditory brainstem response with click sound stimulation was assessed pre and post KLH challenge of the ES. In systematically presensitized animals, secondary KLH challenge to the ES produced significant elevation of the mean threshold level on day 3 and 17 as compared to that of pre challenge levels. However, no significant prolongation of the latency (N1-N3) was observed. On the other hand, neither phosphate buffered saline injection into the ES nor primary KLH challenges of the ES were capable of elevating the threshold level and changing the latency. These results indicate that elevation of threshold was apparently induced by a secondary immune response of the ES, not by nonspecific mechanical damage to the ES, the central auditory system or KLH toxicity to the inner ear, suggesting that local immune response of the ES is a possible pathogenesis of sensorineural hearing loss.


[A clinical observation of cases which was suspected of congenital cholesteatoma]. Four cases which was suspected of congenital cholesteatoma were treated in the past 15 years. The age of the patients ranged from 4 to 17 years. In all cases, the cholesteatoma arose in the middle ear. In one case the cholesteatoma extended into the mastoid cavity. Tympanoplasty of colummella type III was indicated. Postoperative hearing gain was from 20 to 30dB. Although the incidence is low, otolaryngologists must be aware of congenital cholesteatoma when treating conductive hearing loss with a normal ear drum.


[A cinefluorographic study of hyoid bone movement during deglutition]. A quantitative study was performed to analyze movement of the hyoid bone on swallowing in 71 patients with pharyngo-laryngeal neurosis (44 males, 27 females), who had no abnormal findings either morphologically or functionally. The lateral X-ray cine (30 frames/sec) was taken while the patients swallowed the contrast medium in the upright position, and precise movement of the hyoid bone was examined using a motion analyzer. The movement was divided into 5 phases; initial slow elevation from the resting position (1st elevation phase), then a quick upwards shift to the highest position (2nd elevation phase), where the hyoid bone remained temporarily (static phase), followed by rapid and slow descending shifts towards the resting position (1st and 2nd descending phase, respectively). The resting position of the hyoid bone is significantly lower in males than in females and it seemed to get lower with age in both sex. When compared to the younger group (age 10-30), the older group (age 60-70) had significantly more distance and longer duration of deglutition in the 1st elevation phase, whereas the 2nd elevation phase did not differ among the age group. The results of this study indicate that prolongation of the time and distance of the 1st elevation phase are more significant in the older group, which may well explain the cause of delayed of deglutition.


[Cryptotia: morphometric characteristics and statistical observations]. In the present study we made actual measurements of the normal and affected auricles of patients with unilateral cryptotia and performed a comparative statistical analysis. We also made a compilation of our own cases and other cases reported in Japan, and reported the results of our statistical analyses. The subjects of this survey were 36 patients who came to our outpatient clinic with a chief complaint of cryptotia between 1983 and 1990. Measurements of auricle were made according to the Martin method. We also compiled all cases of cryptotia reported in the Japanese literature to date in which the sex of the patients and affected side were clearly recorded and reviewed associated abnormalities and familial occurrence. Auricle measurements of auricle showed the vertical axis of the affected auricle to be significantly shorter than normal, revealing severe shortening of the upper 1/3 of the auricle. There was no statistically significant difference between the normal and affected auricles on the horizontal plane. The results of our compilation of reports in the literature to date show a male-female ratio of 2:1, a right-left-bilateral ratio of 5:2:3, the presence of other anomalies in 9.2% (7/76), and familial occurrence in 6.4% (15/236). (1) Based on measurements of auricle, cryptotia is defined as a deformity of the upper 1/3 of the auricle and is produced by the sum total of force vectors operating inferiorly and medially. Moreover, based on the data obtained as a result of the measurements performed in this study, there was greater deformity along the vertical axis, and the downward vector was obviously stronger than the inward vector. (2) There were 3 cases of unilateral cryptotia with an adhesion-like deformity of the helix in the normal ear, and the theory that the upper portion of the auricle becomes embedded secondary to cartilage deformity seemed plausible. (3) A compilation of cases in Japan showed a male-female ratio of 2:1 and a right-left-bilateral ratio of 5:2:3, differing little from the ratios in our cases. (4) Familial occurrence in our cases was found in the patient's mother of 2 cases and a male cousin and uncle in 1 case each, suggesting a strong hereditary influence.


Results of combined surgery on the superior oblique and horizontal rectus muscles for A-pattern horizontal strabismus. Results obtained in 32 patients with A-pattern horizontal strabismus and overacting superior oblique muscles treated with combined bilateral superior oblique tenotomies and bilateral symmetric surgery on the horizontal rectus muscles were analyzed retrospectively. The magnitude of reduction of the A-pattern correlated positively (r = 0.69) with the size of the preoperative A-pattern. Overall, 27 of the 32 patients (84%) had a satisfactory reduction in their A-pattern. Esodeviated patients received less correction in the primary position than exodeviated patients. Postoperative complications were minimal if the superior oblique tendon was hooked under direct visualization, and minimal dissection was performed on the surrounding tissue prior to transecting it near the nasal side of the superior rectus muscle.


VEP acuity, FPL acuity, and visual behavior of visually impaired children. Forced-choice preferential-looking (FPL) and pattern-visual-evoked potential (VEP) acuity tests were conducted with 42 children with bilateral moderate to severe visual impairment (age, 4 months to 9 years). Within this group of children, FPL acuity testing was more successful than VEP acuity testing (98% versus 64%). Mean FPL acuity was better than mean VEP acuity (20/155 vs 20/290, P less than .002). For the children who completed both FPL and VEP acuity tests, an acuity difference score (FPL minus VEP) was derived, and compared to difference scores based on normative data. Significant differences were found between visually impaired (VI) and control difference scores (P less than .001). Difference scores of VI were larger than and opposite in sign to the control scores. Rating scores of visual behaviors supported the concurrent validity of the FPL acuities (P = .01), but not the VEP acuities.


Anterior polar congenital cataract and corneal astigmatism. Seven eyes of six patients with anterior polar congenital cataract were examined. All patients presented with corneal astigmatism greater than 1.50 diopters. The combination of these two anomalies has often been responsible for amblyopia and occasionally for squint. The association of corneal astigmatism with this type of congenital cataract is possibly due to a delayed separation of the lens from the surface ectoderm during fetal development and thus may be considered a new syndrome.


Eye muscle prosthesis.

Eye muscle prosthesis. We inserted a silicone rubber elastic band along the course of a paralyzed lateral rectus and of a paralyzed superior oblique to restore alignment and to provide a spring against which the antagonist could pull. The lateral rectus band has been in place for 7 years. It provides alignment and a field of single binocular vision of 20 degrees. The superior oblique band has been in place for 17 months. It provides alignment and single vision over 30 degrees from the primary position except for a restriction in upgaze-adduction to 25 degrees (Brown syndrome) and in downgaze-adduction to 20 degrees. Such engineered elastic bands are a useful addition to current surgical techniques for management of cases of paralysis and restriction.


Factors affecting long-term results of successfully treated amblyopia: age at beginning of treatment and age at cessation of monitoring. The visual acuity of 104 patients who had previously been successfully treated for unilateral amblyopia by occlusion of the good eye was examined 6.4 years, on average, after cessation of treatment. Three age groups were defined, according to the age at which treatment was started: younger (2 to 5.5 years), middle (5.5 to 8 years) and older (above 8 years). In 55% of the patients, the long-term follow-up examination revealed deterioration of the visual acuity. In patients in whom amblyopia had been monitored at least up to the age of 9 years, the age at which treatment was started did not significantly affect the mean amount of deterioration or the mean visual acuity noted at the long-term follow-up examination.


Central nervous system involvement in Leber congenital amaurosis. Sixteen patients with ocular criteria of Leber congenital amaurosis (LCA) were studied. Neurological examination was normal in 11 of 16 patients. The electroencephalogram was normal in six of eight patients, while two had nonspecific theta slowing. Computerized tomography of the brain was normal in two of five; hypoplasia of the cerebellar vermis was seen in one, and mild to moderate ventriculomegaly was seen in two of five. Six patients underwent the verbal subtests of the Wechsler Intelligence Scale and a detailed battery of neuropsychological tests. Subtests dependent on early environmental influences were most severely affected, while culture-free subtests showed average or well above average performance. These results strongly support the hypothesis that children with LCA may be capable of normal cognitive functioning, although they perform poorly on standard IQ tests. This is related to their early environmental and sensory deprivation, rather than to a primary central nervous system dysfunction.


Aplasia of the optic nerve: report of three cases. Aplasia of the optic nerve is a very rare congenital anomaly characterized by an absence of optic nerve fibers, retinal ganglion cells, and the retinal central blood vessels. It may be associated with a wide range of other congenital abnormalities. In the present article, three cases of aplasia of the optic nerve are described. Its pathology and clinical features are reviewed.


Comparison of on- and off-axis photorefraction with cycloplegic retinoscopy in infants. We have compared the performance of an off-axis (knife-edge) photorefractor with that of an on-axis (isotropic) system. Normal infants and children between the ages of 8 and 208 weeks were photographed with each camera both with and without cycloplegia. Refractive errors were estimated for each technique based on equations derived from ray-tracing. These refractions were compared to the results of retinoscopy under cycloplegia. Sensitivity and specificity of the two photorefraction systems were evaluated as a function of the magnitude of meridional hyperopia defined by retinoscopy. We also examined the effect of varying the photorefraction screening criterion. Thirteen percent of the infants in the screening sample presented with +3.50 diopters or more of meridional hyperopia. Using this level of ametropia as a referral criterion, the sensitivity and specificity of the off-axis system for infants without cycloplegia were 83% and 72%, respectively. For the on-axis system, sensitivity and specificity values were 85% and 53%. The use of cycloplegics did not significantly improve the performance of either system, but rather their use degraded the specificity of the on-axis system in the presence of moderate refractive errors. The results of the present study indicate that both on- and off-axis systems are effective in identifying highly ametropic infants, but that the off-axis system results in significantly fewer false positives. Moreover, the off-axis system has the advantages of an inherently greater dynamic range for a fixed camera design, and also more easily interpreted photographs.


Periodic alternating esotropia.

Periodic alternating esotropia. Periodic alternating esotropia (PAE) is a rare ocular motility disturbance observed in association with periodic alternating gaze deviation (PAG) or periodic alternating nystagmus. We examined a 9-month-old developmentally delayed girl who showed PAE occurring synchronously with PAG. The ocular motility disorder consisted of rhythmic alternating fixation with the right eye in abduction, a left face turn and esotropia of the left eye (90 seconds), a changeover phase (10 to 15 seconds) during which the eyes are straight and the head is upright, then fixation with the left eye in abduction, a right face turn, and esotropia of the left eye (90 seconds). There was no spontaneous jerk nystagmus present. These findings continued incessantly during a follow-up period of 18 months. Magnetic resonance imaging revealed pronounced cerebellar vermis hypoplasia. Only three clinically similar cases have been previously reported, but none had been studied with modern neuroimaging techniques.


Rigid gas permeable contact lens correction of aphakia following congenital cataract removal during infancy. Rigid gas permeable (RGP) contact lenses were prescribed and worn with little difficulty by 10 consecutive aphakic infants. Fluoroperm 92 lenses were used instead of silicone lenses (Bausch & Lomb) because of their lower cost, ease in handling, flexibility in design, and better neutralization of astigmatism. Lenses were worn on a daily wear basis (with occasional overnight wear) to reduce the risk of keratitis. Keratometry readings were taken at the time of surgery with the patient in a supine position. Trial lens fitting was performed 1 to 7 days later using a Burton Lamp. None of the patients developed keratitis, corneal neovascularization, or the sucked-on-lens syndrome. The lenses were well tolerated and the parents soon became adept at handling them. We now use RGP lenses as our lens of choice when treating aphakic infants.


Maximum likelihood estimates of the ability of the MMPI and MCMI personality disorder scales and the SIDP to identify personality disorders. The ability of the Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) personality disorder scales and the Structured Interview for DSM-III Personality Disorders (SIDP) to identify personality disorders was estimated statistically using 122 subjects. Each technique was reasonably accurate when various diagnoses were excluded, but they were quite variable in identifying members of specific diagnostic categories. The same general pattern was seen when the disorders were combined into three general diagnostic clusters. The techniques excluded cluster membership fairly well, although there was little agreement across techniques for identifying cluster membership. The MCMI, however, was moderately adept at identifying membership in all three clusters. It was suggested that these instruments should be used cautiously in clinical settings and that additional data on their performance be obtained.


The optic disc in Leber congenital amaurosis. The typical fundus appearance in Leber congenital amaurosis (LCA) in infancy is normal. Later in childhood, clinical heterogeneity develops and a variety of fundal abnormalities may be seen. These commonly include optic atrophy, retinal arteriolar attenuation, and a variety of pigmentary changes. We retrospectively reviewed the optic disc findings of 77 patients with LCA whom we had examined to confirm our clinical impression that the optic discs are frequently normal. Age at examination ranged from infancy to the fourth decade. The optic discs were normal in 53 (69%) of the 77 patients examined; 18 (23%) had varying degrees of optic atrophy; 2 (3%), pseudopapilledema; and 1 (1%), grey discs. The optic discs could not be seen in 3 (4%) patients. We conclude that the optic discs are frequently normal in appearance, even in older patients with LCA.


Early memories and the criminally dangerous. We demonstrated the efficacy of using early memory (EM) data to distinguish postdictively criminally dangerous from nondangerous psychiatric patients. Dangerous patients (n = 30) had been adjudicated not criminally responsible (NCR) for felonies, whereas nondangerous psychiatric patients (n = 30) had no convictions for aggressive offenses. Groups were comparable in age, IQ, socioeconomic status (SES), marital status, and diagnoses. Group racial compositions, however, were significantly different. Statistical analyses were thus performed to clarify the potential effect of this racial confound. Overall, 73% of the dangerous and nondangerous patients were accurately classified via a newly developed EM scoring system, the Early Memory Aggressiveness Potential Score System (EMAPSS). Of those classified as dangerous, 15 of 16 (94%) were actually dangerous. The false-positive rate was an impressively low 6%, suggesting EM aggression is highly predictive of dangerousness postdictively.


Validity of Harris and Lingoes MMPI subscale descriptors in an outpatient sample. The validity of the Minnesota Multiphasic Personality Inventory (MMPI) subscales described by Lingoes (1960) along with his predicted correlates was investigated using clinicians' ratings of 85 outpatient therapy clients. Of the 68 predicted correlates, 30 were significant and supported the description of 16 of the subscales, but not necessarily their ability to discriminate nuances of pathology. The most significant correlations were obtained by the D, Pd and Sc subscales, the fewest by the Hy, Pa and Ma subscales. The lack of significant results for 12 subscales is discussed in terms of subscale unreliability, subscale length, or insufficiencies in the criteria or sample tested. The possibility that several of the unsupported subscales may function in the detection of defensiveness was considered.


The Ego Impairment Index and schizophrenia: a validation study. This study is an extension of our work on a new scale, the Ego Impairment Index (EII; Perry & Viglione, 1991). The index is theoretically based on Beres's (1956) model of ego assessment and was empirically developed on a sample of melancholic, depressed outpatients, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980). The EII is derived from the Rorschach Inkblot Test and offers a single composite score of ego impairment. This study validates the use of the EII with a heterogeneous sample of schizophrenic patients. In support of the trait-like characteristics of the scale, the EII continues to be expressed as a single factor, with a correlation of .98 when comparing the original factor derived from a melancholic population with this sample of schizophrenic patients. Significant correlations were also found between the EII and other clinical indices, including the Magical Ideation Scale, the Schizophrenia Index, and the Minnesota Multiphasic Personality Inventory (MMPI). Finally, the EII was found to differentiate between a paranoid subgroup and a mixed undifferentiated/disorganized subgroup who theoretically have more ego impairment. These results offer support for the use of the EII as an empirical means of quantitatively and qualitatively assessing thought disorder within a theoretical framework. Further research is needed to understand the application of the EII across different diagnostic groups and its relationship to other indices of psychological disturbance.


Barren Rorschachs: a conceptual approach. A discussion is presented of five Rorschach protocols that appear to meet the criteria proposed by Exner and Weiner (1982, p. 31) for "brief and barren" Rorschach protocols. The protocols were obtained from a social service agency treating abused, neglected, disturbed, and delinquent youths. An attempt is made to bring to bear a conceptual approach to these Rorschachs, so that they may be seen as clinically valuable and revealing, hence not "invalid" diagnostic protocols. Emphasis is placed on the subjects' approach to the task, the subject-examiner interaction, and the meaning of the subjects' ostensibly peripheral comments. Recommendations are offered regarding ways to maximize the clinical utility of such protocols.


Rorschach blends, IQ, and the effect of R. A correlation of .351 was found between the Rorschach blend score and the Wechsler Adult Intelligence Scale Full Scale IQ (WAIS FSIQ) score for 70 outpatients. When the total number of responses (R) was partialed out, however, the correlation dropped to .255. We concluded that it is advisable to take into account the effects of R in validity studies showing significant but low correlations. The importance of further exploring the psychological implications of R was stressed.


Self-report, peer-report, and teacher-report measures of childhood depression: an analysis by item. We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.


The effect of MMPI-2 on scoring of special scales derived from MMPI-1. Twenty-nine special scales derived from the Minnesota Multiphasic Personality Inventory (MMPI-1; Hathaway & McKinley, 1983) were scored from MMPI-I and MMPI++-2 (Hathaway et al., 1989) items for a normal and a psychiatric sample. Resulting pairs of mean scores were compared. Absolute differences were found to be small but statistically significant. We concluded that, despite the statistical significance, the small absolute differences suggest that most of the MMPI-I special scales probably can be scored and interpreted from MMPI-2 items. Further research along this line is necessary.


Object relations, defensive operations, and affective states in narcissistic, borderline, and antisocial personality disorder. Rorschach data were used to psychometrically "map" the internal psychological operations of three Cluster B personality disorders, listed in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987), all of which may be organized at a borderline level. Psychopathic antisocial subjects (P-APDs) and narcissistic subjects (NPDs) were highly narcissistic. NPD subjects, however, produced more indices of anxiety and attachment capacity and fewer scores related to borderline object relations and damaged identity. P-APDs and borderline subjects (BPDs) produced similar mean numbers of borderline object relations; however, the BPDs were more anxious, produced more unsublimated aggressive and libidinal drive material, and evidenced greater potential for attachment. BPDs were also less narcissistic than both P-APDs and NPDs. Nonpsychopathic antisocial subjects (NP-APDs) were less borderline than P-APDs and BPDs, less narcissistic in terms of a stable grandiose self-structure than NPD and P-APDs, produced less evidence of attachment capacity than NPDs and BPDs but more than P-APDs, and were similar to BPDs in their proneness to anxiety. The outpatient NPDs and BPDs produced more idealization responses than the incarcerated antisocial personality disorder (APD) groups. We conclude that the behavioral descriptions offered for these three Cluster B personality disorders, when used in conjunction with information such as level of personality organization (Kernberg, 1984), level of psychopathy (Hare, 1980, 1985), and outpatient versus inpatient research settings, may have greater intrapsychic specificity than previously thought.


Rorschach changes following brief and short-term therapy. Two groups of 35 patients each, one treated with brief therapy, averaging 14.2 sessions on a once per week basis, and the other group, treated with a short-term type of therapy, averaging 47 sessions on a once per week basis were administered the Rorschach and the Katz Adjustment Scales-Form S three times. The first administration took place before entering therapy. The brief therapy group was tested a second time at termination of treatment and again 8 to 12 months following termination. The short-term therapy group was tested the second time at therapy termination and the third time 10 to 12 months after termination. Each group reported substantially fewer symptoms at termination and continued to report about the same level of symptom reduction at the second retest. The Rorschach data seem to provide an ample basis from which to argue that considerable improvement occurred in the psychological organization and/or operations of both groups, and this appears to have some confirmation in the self-report data.


Psychometric properties of the revised UCLA Loneliness Scale and two short-form measures of loneliness in Zimbabwe. The cross-cultural reliability in Zimbabwe of the Revised University of California at Los Angeles (UCLA) Loneliness Scale and two short forms of the Revised UCLA Loneliness Scale were investigated. Subjects comprised a sample of 1,354 adolescents and another sample of 754 adults. The reliability of the Revised UCLA Loneliness Scale was acceptable. The internal consistency of an eight-item short form of the Revised UCLA Loneliness Scale was adequate, but the reliability of a four-item short form was low. Factor analysis of the Revised UCLA Loneliness Scale, which yielded two factors similar to those reported in North America by Zakahi and Duran (1982) supported the construct validity of the Revised UCLA Loneliness Scale in Zimbabwe. The Revised UCLA Loneliness Scale and the eight-item short form were highly correlated, but this association was spuriously elevated by the fact the eight-item short form is part of the full scale. Factor analysis of the eight-item short form suggested that this scale does not consistently reflect the factor structure of the full scale. We concluded that the Revised UCLA Loneliness Scale possesses acceptable reliability and factorial validity in Zimbabwe and that the eight-item version is superior to the four-item form of the Revised UCLA Loneliness Scale as a short loneliness measure. However, additional refinements may be needed to further improve the eight-item short version.


Psychometric properties of the Depressive Experiences Questionnaire for adolescents. Items of the Depressive Experiences Questionnaire (DEQ) were rephrased and simplified to make them appropriate for younger subjects. This adolescent form of the DEQ (DEQ-A) was administered to high school students; a factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. Internal consistency as well as short- and long-term reliability for each of the 3 DEQ-A factors were at acceptable levels. Each factor correlated highly with its counterpart factor in the original DEQ, especially the Dependency and Self-Criticism factors. Correlations of the DEQ-A factors with other measures of depression essentially replicate relationships found between these measures of depression and the original DEQ for adults. The reliability, internal consistency, and validity of the DEQ-A indicate that it could be useful in studying depressive experiences in younger adolescents.


No evidence for female-to-female HIV transmission among 960,000 female blood donors. The HIV Blood Donor Study Group. The frequency of female-to-female HIV transmission was assessed among 960,000 female blood donors at 20 large U.S. blood centers during 1990. Of 144 HIV-seropositive women identified, 106 were interviewed. None of the interviewed women reported sex exclusively with women since 1978. Three seropositive women reported sex contact with women as well as with either bisexual men or men who had used i.v. drugs. In this large population, we identified no woman who was infected with HIV from sexual contact with another woman.


Relation between hospital experience and in-hospital mortality for patients with AIDS-related Pneumocystis carinii pneumonia: experience from 3,126 cases in New York City in 1987. There is marked debate about whether outcomes of care, particularly mortality, vary as a function of hospital and physician experience with a disease. This issue is especially important with respect to AIDS because greater than 200,000 individuals have now been diagnosed with this disease. We analyzed discharge data for 3,126 persons with AIDS who had Pneumocystis carinii pneumonia and who were treated at one of 73 New York City hospitals in 1987. In-hospital mortality was 25%. Factors associated with higher chances of short-term death were older age, being black, not having private health insurance, and being severely ill. A logistic regression model indicated that after controlling for differences in patient and hospital characteristics, the chances of death decreased when care was given at hospitals with higher caseloads of patients with Pneumocystis carinii pneumonia. Our findings suggest that hospital experience may decrease mortality in this subset of patients with human immunodeficiency virus disease, although it is unknown whether this is due to differences in quality of care.


Trends in HIV infection among intravenous drug users in Innsbruck, Austria. The first HIV test among intravenous drug users (IVDUs) at the AIDS clinic and/or the drug dependency clinic of the University of Innsbruck was the basis for the calculation of the proportions of those testing HIV seropositive annually over the period 1985-1990. The numbers testing HIV seropositive at the drug dependency clinic declined drastically, from 72.2% in 1985 to 12.5% in 1990 (chi 2 = 29.62, p less than 0.0001), whereas they rose at the AIDS clinic during this period, from 48.4% to 100% (chi 2 = 5.82, p = 0.016). Overall 132 of the 268 (49.2%) individuals examined tested HIV seropositive. There were 102 individuals of the original 146 seronegative IVDUs who were retested, for an overall incidence rate of HIV seroconversion of 5.8/100 persons-years. Risk of seroconversion was associated with a steady sexual partnership with an HIV seropositive IVDU and with an age of less than or equal to 25 years at study entry (13.1 versus 8.7/100 persons-years). No seroconversions occurred in the subgroup of patients treated by the methadone maintenance treatment program. The cumulative incidence (Kaplan-Meier) rate for HIV seropositivity after 64 months was 22%, lower than the proportions testing HIV seropositive found in 1985 at each of the two clinics, which suggests that the speed of the spread of the epidemic of HIV infection among IVDUs has slowed in our region. Counseling of IVDUs should emphasize the risks of sexual acquisition, particularly among persons with steady relationships who may not perceive their risk.


Poor sensitivity, specificity, and reproducibility of detection of HIV-1 DNA in serum by polymerase chain reaction. The Transfusion Safety Study Group. A series of recent studies have reported detection by the polymerase chain reaction (PCR) of cell-free human immunodeficiency virus type 1 (HIV-1) DNA (as opposed to virion RNA) in serum from both seropositive and seronegative persons. To evaluate the sensitivity, specificity, and reproducibility of PCR detection of cell-free HIV-1 DNA, we distributed coded panels containing 98 serum specimens obtained from well-characterized, infected individuals and control blood donors to the two laboratories with reported experience with this technique. Positive results were reported with HIV-1 gag primers (SK38/39) for 48 of 188 separate PCR determinations on DNA extracts from 44 serum samples from seropositive patients (25.5% sensitivity). HIV-1 gag signal was also reported for 28 of 151 PCR determinations on 34 samples from noninfected blood donors (18.5% false-positive rate). PCR for HIV-1 env DNA performed in one laboratory was negative on all specimens from seropositive and seronegative patients. Results for cell-free HIV-1 gag and human genomic (beta-globin or HLA DQ-alpha) DNA were inconsistent on replicate and serial specimens evaluated within each laboratory and between laboratories. These results indicate that current techniques for detecting cell-free HIV-1 DNA in serum lack adequate sensitivity, specificity, and reproducibility for widespread clinical applications.


Diagnosis of HIV infection with instrument-free assays as an alternative to the ELISA and western blot testing strategy: an evaluation in Central Africa. The efficiency of an alternative instrument-free testing strategy was evaluated using a membrane-based rapid screening assay (HIVCHEK and its new version HIVCHEK1 + 2) in serial combination with a particle agglutination assay (SERODIA-HIV). Among 1,054 Zairian individuals at high risk of HIV infection, 573 were Western blot-positive for HIV-1 (54.4%) and none were Western blot-positive for HIV-2. In this group, the sensitivities of the serial combination HIVCHEK plus SERODIA-HIV and HIVCHEK1 + 2 plus SERODIA-HIV were 98.1 and 98.2%, respectively, and the specificities were 99.6 and 99.5% compared with HIV-1 Western blot. The positive predictive values were 99.6% for HIVCHEK plus SERODIA-HIV and 99.5% for HIVCHEK1 + 2 plus SERODIA-HIV; the negative predictive values were 97.8 and 97.9%, respectively. Among 1,495 pregnant women, 90 were Western blot-positive for HIV-1 (6.0%), and 54 of 1,510 blood donors were HIV-1 Western blot-positive (3.6%). None were positive for HIV-2. The sensitivities of HIVCHEK plus SERODIA-HIV and HIVCHEK1 + 2 plus SERODIA-HIV in these groups were 98.6 and 99.3%, respectively, and the specificities were 99.8 and 99.7%. The positive and negative predictive values of HIVCHEK plus SERODIA-HIV were 96.6 and 99.9%, respectively, and they were 94.1 and 99.9%, respectively, for HIVCHEK1 + 2 plus SERODIA-HIV. These instrument-free testing strategies are efficient alternatives for serodiagnosis of HIV-1 infection, although their cost should be further reduced.


Clinical and laboratory profile of AIDS in India. The clinical features and results of laboratory investigations of the first 19 Indian patients with AIDS seen in our hospital are presented. Weight loss, fever, and diarrhea were the most common symptoms. Tuberculosis (TB) was the most common secondary infectious disease; among 13 patients, seven had only pulmonary TB, five had pulmonary and extrapulmonary TB, and one had only extrapulmonary TB. Oropharyngeal candidiasis was found in 11 patients. Other secondary infections were predominantly by virulent bacteria. Opportunistic infections other than candidiasis were infrequent; one patient had cryptococcosis, two had symptomatic cryptosporidiosis, one had noncoagulase-positive staphylococcus septicemia, and one had cytomegalovirus retinitis. Reduced lymphocyte counts (particularly of the CD4 subset), anemia, hypoalbuminemia, hyperglobulinemia, and elevated liver enzyme levels were frequent laboratory findings. Six patients are under follow-up, two are lost to follow-up, and 11 have died. Lymphocyte counts less than 500/mm3 were only seen in those patients who subsequently died. Response to antituberculosis therapy was good in several patients. Thus, the clinical profile of Indian patients with AIDS is not different from the common picture of patients of low socioeconomic and poor hygienic standards; patients presented with TB, undernutrition, and multiple infections. Therefore, a large population of patients with AIDS in India will not be recognized unless they are tested for evidence of HIV infection.


Eleven lymphoid phenotypic markers in HIV infection: selective changes induced by zidovudine treatment. HIV infection induces substantial changes in the expression of many lymphocyte phenotypic markers as well as depletion of CD4 lymphocyte numbers. A comprehensive study was undertaken to determine whether seven lymphocyte phenotypic changes associated with HIV infection (increased CD38, HLA-DR, CD57, and CD71 and decreased CD11b, CD45RA, and leu-8) are altered by zidovudine (ZDV) administration. Levels of the four major lymphoid subsets (CD4, CD8, B, and NK cells) and changes in the serum activation markers neopterin and beta 2-microglobulin (beta 2M) were also measured. Elevated pretreatment expression of CD38 and CD71 was reduced significantly toward normal at 2 weeks by ZDV; however, CD38 and CD71 returned to pretreatment levels at different rates. The kinetics of CD38 reduction and the return to pretreatment levels were similar to those of serum neopterin and beta 2M. HLA-DR decreased in many but not all subjects. CD4 lymphocytes showed a transient increase, most evident at 8 weeks of treatment. Lymphoid phenotypes that did not show significant changes after ZDV therapy included CD57, CD11b, CD45RA, and leu-8 markers as well as CD8 T cells, CD20 B cells, and CD56 NK cells. The fact that some lymphocyte phenotypic markers change toward normal with ZDV treatment and others do not indicates that complex processes underlie immune perturbations of HIV infection. Several phenotypic markers (CD38, CD71, and HLA-DR) that are susceptible to short-term effects of ZDV (but with changes that differ from CD4 T cell changes) are surrogate marker candidates for evaluation in anti-HIV treatment.


Further studies of salivary inhibition of HIV-1 infectivity. An HIV-1/ATH8-cell cytopathic system was used to characterize the previously reported anti-HIV-1 activity of human saliva. Inhibitory activity was demonstrated by monitoring viable cell counts, HIV-1 p24 core antigen, and reverse transcriptase levels. Nonfiltered whole saliva, sterilized by irradiation, protected the ATH8 cells from HIV-1 infection. When HIV-1/saliva mixtures were filtered following incubation, the quantity of virus was significantly less (approximately 50%) than in HIV-1/media-filtered controls, suggesting that salivary aggregation and/or agglutination may be involved in the inhibitory activity. However, a sufficient number of apparently morphologically intact viral particles were still present in the HIV-1/saliva filtrates to lead to infection. When saliva was filtered prior to incubation with HIV-1, these filtrates showed substantial inhibitory activity, although reduced compared with that of non-prefiltered saliva. We conclude that saliva likely has several means by which to inhibit HIV-1 infectivity.


Pilot study comparing the salivary cationic protein concentrations in healthy adults and AIDS patients: correlation with antifungal activity. This investigation compared the salivary cationic protein concentrations of 12 healthy adult controls with those of 12 hospitalized patients with AIDS. Salivas were quantified by capillary electrophoresis using purified cationic protein standards. In parotid saliva, histidine-rich polypeptides (HRPs) 1-6, histatin 6, and lysozyme concentrations were determined. In addition to these eight cationic proteins, submandibular-sublingual saliva was also quantified for histatin 2 and the histatin 2 degradation product. When comparisons were made on the basis of individual proteins, the HRP-histatin concentrations in the AIDS patients showed either statistically significant decreases or a decreasing trend compared with healthy adult controls. When HRP-histatin concentrations were summed for each patient, there were statistically significant differences between the healthy adult controls and the individuals with AIDS in both parotid and submandibular-sublingual salivas. Closer examination revealed that some individuals with AIDS had HRP-histatin concentrations that fell within the normal range of the healthy adult controls. For these individuals, lower than expected salivary antifungal values were obtained. Either decreasing histidine-rich protein concentrations and/or an inability of these proteins in saliva to interact with Candida albicans may contribute to the defective salivary antifungal activity seen in AIDS patients.


Interactions of CD4+ plasma membrane vesicles with HIV-1 and HIV-1 envelope glycoprotein-expressing cells. To study interactions between the human immunodeficiency virus type 1 (HIV-1) envelope glycoprotein (gp120-gp41) and the receptor in the target membrane, CD4, a new experimental system utilizing CD4-carrying plasma membrane vesicles (CD4 PMVs) was developed. CD4 PMVs were prepared by hypotonic lysis of HeLa cells expressing CD4 after infection with recombinant vaccinia virus containing the CD4 cDNA. The CD4 PMVs carried up to 680 CD4 molecules per vesicle. Their fusion with cells expressing gp120-gp41 after infection with recombinant vaccinia virus was monitored by fluorescence video microscopy by using lipophilic fluorescent dyes. Fluorescence changes as a result of fusion occurred within 30 min at 37 degrees C, and little fluorescence changes were seen with cells expressing the noncleaved HIV-1 envelope glycoprotein (gp160). The preincubation of CD4 PMVs with HIV-1 reduced its infectivity 10-fold. The CD4 PMVs were more effective in inhibiting syncytia formation than sCD4. These results demonstrate that CD4 PMVs could be used to study the mechanisms of HIV-1 envelope-mediated fusion and have the potential to inactivate HIV-1.


Spectrotype of anti-gp120 antibodies remains stable during the course of HIV disease. Human immunodeficiency virus (HIV) infection is characterized by a progressive decline in immune functions. The behavior of B-cell clones specifically engaged in the anti-HIV response could play a relevant role in the pathogenesis of such impairment. The spectrotype observed on isoelectric focusing and reverse blotting after antigen challenge is the serum image of antigen-specific B-cell activity and may provide some insight into Ag-dependent B-cell clone recruitment. In this study, we examined the spectrotype of anti-gp120 antibodies in a group of sera from 56 HIV-infected patients, belonging to groups II, III, and IV of the Centers for Disease Control classification, as well as in a group of 31 sera from 12 patients in a 21-month follow-up evaluation (range 7-36 months). All tested sera were positive for gp120 antibodies on Western blot. In the first group of 56 HIV-infected subjects, only 19 displayed well-focused banding patterns. Among these, the spectrotype was found to be consistently oligoclonal, thus confirming clonal restriction of anti-gp120 antibodies previously described by other investigators. No correlation could be established between a particular spectrotype and phase of the disease. The follow-up evaluation in the second group of 31 sera revealed the tendency in each patient to maintain the same spectrotype throughout the course of the disease. These findings confirm clonal restriction of anti-gp120 antibodies in HIV infection and suggest that the number of B-cell clones recruited in the anti-gp120 response remains stable over the course of the disease, at least in the time range explored by us.


Quantification of HTLV-1 proviral copy number in peripheral blood of symptomless carriers from the French West Indies. The development of human T-cell leukemia type 1 (HTLV-1) diseases are related to an increase in the proviral copy number (VCN) in peripheral blood mononuclear cells (PBMCs). Twenty symptomless anti-HTLV-1-positive blood donors, as well as four symptomatic individuals, all from the French West Indies, were studied. The VCN in PBMCs was determined by quantitative PCR. The VCN values for asymptomatic HTLV-1 carriers (range of less than 100 to approximately 9,500/micrograms of DNA) was nearly always less than the values for symptomatic carriers (range of approximately 5,500 to approximately 29,000/micrograms of DNA). Consequently, the proportion of HTLV-1-infected PBMCs in symptomless and in symptomatic individuals ranged from less than 1/1,500 to approximately 1/16 and approximately 1/27 to approximately 1/5, respectively. No correlation could be found between VCN and age or sex, suggesting the importance of factors other than age and sex as influences on the VCN number.


Microbial degradation of shrimp-shell waste. A total of 40 strains of bacteria were isolated and tested for their potentiality to degrade chitin and utilize shrimp-shell waste for the production of chitinase. The activity ratio, percentage of weight loss and enzyme activity were determined for cultures exhibiting highest chitinolytic activities. The most active organisms were identified as Alcaligenes denitrificans, Bacillus amyloliquefaciens, B. megaterium and B. subtilis. The potentiality of the first two organisms to degrade chitin was reported for the first time.


Technical bioenergetics and ecosystem biotechnology. The present work explores some possible practical uses of bioenergetic processes (fermentation, respiration and photosynthesis) in the microbial cell for the purpose of renewable fuel production. These considerations are based on ecosystem biotechnology which include the following main points: 1. Creation of closed energy-transducing ecosystems under laboratory conditions. 2. Production of renewable energy carriers with the help of microbial communities (e.g., mixed cultures of microorganism). 3. Investigation of the role of the individual microoganism in the population or community.


Utilization of organic acids and amino acids by species of the genus Bacillus: a useful means in taxonomy. The type strains of 26 Bacillus species were investigated with respect to their capability to utilize 48 organic acids and 20 amino acids by using phenol red indicator plates and an amino acid analyzer, respectively. In addition, strains of Bacillus sphaericus were found to utilize many organic acids and amino acids in contrast to carbohydrates which are routinely checked. The results obtained indicated an individual utilization pattern for every species investigated, pointing to a useful taxonomic application of these tests for the genus Bacillus.


Immunological homology among azoreductases from Clostridium and Eubacterium strains isolated from human intestinal microflora. Azoreductases from several anaerobic intestinal bacteria have been shown to reduce azo dyes to carcinogenic aromatic amines. To evaluate the structural similarities of azoreductases from four species of Clostridium and one species of Eubacterium, a polyclonal antibody against purified Clostridium perfringens azoreductase was generated in rabbits. This antibody inhibited the azoreductase activity of all five bacteria tested. ELISA showed different degrees of binding of the antibody to various species of bacteria. In a Western blot, the antibody reacted with the purified azoreductases from all four Clostridium species and the Eubacterium species. These results demonstrate that the azoreductases from the bacteria tested share similar antigenic domains, which are probably located in the active site of the enzyme. Azoreductases from these intestinal bacteria are similar enough to be considered as a single group of enzymes with respect to their functions and antigenicity.


Application of newly synthesized detergents in the side chain degradation of plant sterols by Mycobacterium fortuitum. Newly synthesized detergents of polyoxyethylene polyoxypropylene co-polymers (Co-EOPO), polyoxyethylene polyoxypropylene adducts of the diethylene triamine (DETA-EOPO), and steroidal detergents (SDD) stimulate significantly side chain degradation of plant sterols referring to both the sterol degradation and the formation of the product, 9 alpha-hydroxy-androsta-4-ene-3,17-dione (9 OH-AD), by Mycobacterium fortuitum NRRL-B-8119. Highest stimulative effects were observed with derivatives of the DETA-EOPO group. Using compounds of the Co-EOPO group optimal sterol transformation rates were found for polymers with a polyoxypropylene domain of 1400-2000 in molecular weight and with a polyoxyethylene content of 20-50%. Mostly efficient steroidal detergents tested were the 4-cholesten-3-(O-carboxymethyl)-oxime and the amino acid adducts of sterol-3 beta-chlorocarbonates. Detergents were favourably applied as pre-formed sterol-detergent complexes (9:1/w:w) in submers fermentation procedures. By treating harvested resting cells of M. fortuitum with derivatives of Co-EOPO or DETA-EOPO a considerable activation of the cells takes place concerning the sterol degradation and the formation of 9 OH-AD at a high yield in subsequent transformation process on buffer. In solubilization experiments we revealed that there is no correlation between the detergent mediated solubilization of the hydrophobic sterol substrate in the aqueous medium and the transformation activity of the bacterial cells. The detergents are assumed to interact with a multicomponent mesophase (FMCM) which is placed between cells and sterol surface and mediates the transport.


Purification and characterization of beta-xylosidase activities from the yeast Arxula adeninivorans. beta-Xylosidase activity has been detected in cell-free extracts, in culture fluids and as cell wall-bound enzyme of Arxula adeninivorans. With chromatographic procedures used to purify the activity two different forms of beta-xylosidase (denoted beta X-1 and beta X-2) from the cell-free extract and from the culture medium could be separated, but only one form (beta X-2) was present in the cell wall. Both forms are glycoproteins and were deglycosylated by endoglycosidase H treatment. The molecular masses of the enzymes under native and denaturing conditions suggest that beta X-2 is the dimer of beta X-1. M(r) of the native beta X-1 was 60 kDa and after deglycosylation 39 kDa determined by sodium dodecyl sulphate polyacrylamide gel electrophoresis. Some enzymatic properties of beta X-1 and beta X-2 and of their deglycosylated products were studied and showed, with one exception, wide similarities. The maximum activity was reached at pH 5.0 and 60 degrees C. The enzymes hydrolyze only beta-glycosidic bound beta-xylopyranosides and the Km values for p-nitrophenyl-beta-xylopyranoside were determined to be 0.23-0.33 mM. The beta-xylosidase activity was inhibited competitively by xylose. The deglycosylated enzymes were, however, stronger inhibited (Ki = 2.1 mM) as their glycosylated ones (Ki = 5.8 mM).


Metabolic blocks in the degradation of beta-sitosterol by a plasmid-cured strain of Arthrobacter oxydans. Plasmid-harbouring, sterol-decomposing organism Arthrobacter oxydans 317 was treated with sodium dodecylsulphate to obtain a plasmid-cured strain A. oxydans 317 A1 incapable of utilizing 4-androstene-3,17-dione (AD). The strain 317 A1 was unable to degrade beta-sitosterol side chain completely to form AD but could carry out partial degradation as shown by the accumulation of 3-oxochol-4-en-24-oic acid as a major metabolite and 27-norcholest-4-en-3,24-dione as a minor metabolite. The strain could form 1,4-androstadiene-3,17-dione (ADD) from 3-oxo-23,24-bisnorchol-1,4-dien-22- oic acid (BNC) to a limited extent. The existence of metabolic blocks in the conversion of 3-oxochol-4-en-24-oic acid to 3-oxo-23,24-bis-norchol-4-en-22-oic acid and further conversion to AD by the plasmid-cured strain 317 A1 was suggested. Neither the formation of ADD from AD nor the conversion of AD and ADD to 9 alpha-hydroxy derivatives leading to steroid ring opening could be done by the plasmid-cured strain but the 17 beta-reduction of AD and ADD and 1(2)-reduction of ADD were not affected by the absence of the plasmid. It was proposed that plasmid determines 1(2)-dehydrogenation and 9 alpha-hydroxylation of steroid ring structure in this organism.


Effect of cosubstrates on the dechlorination of selected chlorophenolic compounds by Rhodococcus erythropolis 1CP. Effects of aromatic and nonaromatic cosubstrates on the rate of 2,4-dichlorophenol degradation by R. erythropolis 1CP were studied under growth and nongrowth conditions. Glucose and maltose were found to accelerate 2,4-dichlorophenol (initial conc. 50 mg/l) dechlorination from 11 days to 24 and 20 h, respectively. The stimulating effect was observed within the range of glucose concentration of 0.5-2.0 g/l in the medium. Ascorbic acid at a concentration of 10-70 mg/l as a nongrowth substrate also increased the decomposition of 2,4-dichlorophenol, though at a lower degree than glucose. Experiments with washed cells showed the limiting stage of chlorophenol degradation by R. erythropolis 1CP to be, possibly, aromatic ring dechlorination after its hydroxylation. As an additional source of electrons, glucose introduced into suspensions of washed cells grown on 3-hydroxybenzoate made it possible to eliminate the bottleneck in 2,4-dichlorophenol metabolism by significantly accelerating dechlorination of 3,5-dichlorocatechol. Based on the experimental and literature data, the enzyme systems involved in 2,4-dichlorophenol degradation by the culture R. erythropolis 1CP are assumed to be nonspecific.


Magnetotactic bacteria from freshwater lakes in Georgia. Several species of magnetotactic bacteria were discovered in the lakes and ponds of Georgia. Electron microscopic analysis of the bacteria showed a great variety of microbial forms as well as magnetosome arrangements. Pyramidal, cubical or hexagonal magnetic grains could be seen in different species of bacteria. The linear organization of magnetic particles was prevailing, although gathered magnetosomes were also seen. Magnetometric measurement of magnetic particles obtained from coccoid bacteria was performed. Remnent acquisition curves, as well as thermomagenetic curves of investigated material showed that the magnetosomes under study contained pure single-domain magnetite.


Effect of temperature and medium composition on mycelial growth of Streptomyces tendae in submerged culture. To investigate the influence of culture conditions on growth of filamentous bacteria in submerged culture, S. tendae was cultivated at various temperatures and in various media. For this purpose, a temperature-controlled growth chamber was constructed, which allows the cultivation of filamentous bacteria and fungi oxygen saturated medium. To observe the development of mycelia emerging from spores, this growth chamber was mounted on a microscope stage and series of images were analyzed by an image processing system. Growth kinetics obtained in liquid culture were identical to those determined on solid media. Specific growth rate and apical extension rates of individual hyphae seemed to be higher than those observed on solid media, due to a better supply of medium in submerged culture. A two-fold increase in specific growth rate, mean apical extension rate and branching rate was observed when the temperature was increased from 27 degrees C to 37 degrees C, therefore, the length of the hyphal growth unit was not changed. Growth in synthetic media used here was considerably slower compared with complex medium. A decrease in glucose concentration from 40.0 g l-1 to 1.0 g l-1 resulted in an increase in branching rate and specific growth rate, while apical extension rate of individual hyphae was unchanged.


A correlation with type of sulfonamide resistance gene in Escherichia coli and synergy between trimethoprim and sulfamethoxazole. Plasmids carrying type I or II sulfonamide-resistance (Sur) genes were evaluated for their effect on synergy between trimethoprim (Tmp) and sulfamethoxyzole (Smx) in E. coli. Strain J53 containing each of three plasmids (R1, pSa, and R388) with the type I Sur gene displayed a synergistic response to Tmp/Smx; strain LE392 containing a plasmid (RSF1010) with the type II Sur gene displayed no synergy. The difference in synergy between type I and type II Sur genes might be explained by the difference in amount of resistant enzyme produced.


Biosynthesis of pyrrolnitrin. Incorporation of 13C, 15N double-labelled D- and L-tryptophan. Experiments on the incorporation of D- and L-[alanine-3-13C,2-15N]tryptophan into the antibiotic pyrrolnitrin in Pseudomonas aureofaciens confirmed earlier conclusions about the conversion of L-tryptophan into pyrrolnitrin. They also demonstrated that a fraction of the D isomer is incorporated without breakage of the 15N-carbon bond, consistent with the operation of a second pathway from D-tryptophan to pyrrolnitrin. Cell-free experiments confirmed the conversion of 3-(o-aminophenyl)pyrrole into aminopyrrolnitrin but failed to detect enzymatic oxidation of the latter to pyrrolnitrin.


Oxidation of 3 beta- and 17 beta-hydroxysteroids by Nocardia rubra cells in heptane-water system. Oxidation of cholesterol, beta-sitosterol, pregnenolone, androstenolone and 5-androsten-3 beta,17 beta-diol carried out by Nocardia rubra cells in a mixture of heptane-water (25:1 vol.) gave 4-en-3-oxo-steroids with the yield to 100% (cholesterol). Simultaneously oxidation of 17 beta-hydroxy group in androstendiol and in testosterone was observed as well.


[Evaluation of energy metabolism on the myocardium analyzing of creatine kinase isoenzymes in rats]. The purpose of this study is to evaluate the efficiency of energy metabolism in the myocardium by means of the activities of creatine kinase (CK) and CK isoenzyme following age-related change in the heart and experimental heart failure. Wistar strain male rats aged from 3 weeks to 57 weeks after birth were used. The main experimental results obtained are as follows. (1) There were differences in the compositions of CK isoenzyme of the ventricular, atrial, and papillar muscles. No apparent variation, however, was noted among the basal portions of the left and right ventricular muscles, free wall of the left ventricle, and apex. (2) Compositions of CK isoenzyme analyzed from the ventricle and atrium were clearly different. The level of CK-B subunit activity of the ventricular muscle was highest level in the 5-week-old rat, and subsequently dropped significantly in the 24-week-old rat. Thereafter, the level gradually increased with aging. Dramatic change in the energy metabolism in the myocardium occurred in rats more than 3 weeks old. (3) Decrease in activity of m-CK but increase in activity of succinate dehydrogenase analyzed from the ventricular muscle of experimental heart failure induced by monocrotaline was recognized. From these results, the author assumed that the trend of the composition of CK isoenzyme is one of the indices in the determination of the regulation of energy metabolism of the myocardium.


[Prolongation of circulation time during brain ischemia-induced hypertension in the rabbit]. Circulation time (CT) is markedly prolonged when arterial pressure is extremely elevated by global brain ischemia which elicits also bradycardia, decrease in cardiac output and apnea in anesthetized rabbits. To study the cause of the prolongation of CT, we measured separately CT in the large veins, cardiopulmonary circulation system (CPS) and large arteries by a dye-densitometer before and during the brain ischemia, and also examined effects of apnea and bradycardia on CT in the large veins and CPS. CT during the brain ischemia was prolonged in each portion as compared to that before the brain ischemia. The prolongation was shortest in the large veins and longest in the CPS. During the brain ischemia with apnea, there was a significant linear relationship between heart rate and the inverses of CT in the large veins, but not in the CPS. When artificial ventilation was performed during brain ischemia-induced apnea, the linear relationship became significant also in the CPS. We conclude as follows; During global brain ischemia the prolongation of CT occurs primarily in the large arteries due to constriction of the small arteries and it progresses towards the CPS and large veins. The bradycardia prolongs CT in the large veins and CPS, and the apnea may produce hypoxic pulmonary vasoconstriction which may also contribute to the prolongation of CT in the CPS.


Clinical implications of acute cerebrospinal fluid changes following iophendylate myelography. Clinical features and serial cerebrospinal fluid (CSF) samples of 50 patients who underwent myelography with iophendylate were studied. Forty two patients (84%) developed one or more features suggestive of meningism lasting for 2-4 days. There was significant rise in the average (mean) CSF counts from 9.81 in the premyelogram sample to 532.6 at the end of 24 hours (p less than 0.001). Both neutrophil and lymphocyte (p less than 000) count increased. At the end of one week, there was significant decrease of total cells in the CSF to 204 (p less than 0.001). Both, neutrophils and lymphocytes decreased. There was significant rise in total proteins in the 24 hours sample, but the fall at one week was not significant statistically. The sugar and chloride values did not change significantly. All CSF samples were negative for bacterial cultures. In conclusion, a significant proportion of the patients undergoing iophendylate myelography develop clinical features suggestive of meningeal irritation and change in the CSF fractions suggestive of meningitis: however these changes are transient and do not warrant institution of chemotherapy or steroids.


Immunotherapeutic modification of Escherichia coli peritonitis and bacteremia by Tinospora cordifolia. We present here the protective effects of an Indian medicinal plant Tinospora cordifolia as compared to gentamicin in E. Coli induced peritonitis. Pretreatment with tinospora cordifolia or gentamicin reduced mortality in mice injected with 1 x 10(8) E. coli intraperitoneally from 100% in controls to 17.8% and 11.1% respectively. This was associated with significantly improved bacterial clearance as well as improved phagocytic and intracellular bactericidal capacities of neutrophils in the Tinospora cordifolia treated group. In the gentamicin treated mice although bacterial clearance was rapid, polymorph phagocytosis was depressed. Tinospora cordifolia did not possess in vitro bactericidal activity. The results demonstrate that a "prohost approach" may be beneficial in the therapy of peritonitis.


An integrated community based approach in undergraduate medical teaching of maternal and child health--an experiment. The batch of 147 undergraduate medical students (Group I) were trained in maternal and child health (MCH) by allotting them families study wherein either pregnant lady or a new born child was present. The students were made to follow up these mothers and their children for three years on periodic basis by paying home visits and motivating the mothers to attend under five clinic in the community. The students educated the mother regarding child rearing with the help of medical teacher. Another batch of 140 undergraduate medical students (Group II) who did not undergo such community based training but only didactic lectures in MCH were studied as control. The knowledge and attitudes of students in both the groups were tested and compared and significantly higher knowledge and favourable attitude were found in Group I. The attendance of patients of Group I in under five clinics was compared with other children who were not adopted by medical students. The comparison was made between their weight gain, immunizational status and episodes of illness. The beneficiaries in students families had better, attendance and immunizational coverage, more weight gain and less episodes of illness. The difference was found to be statistically significant.


Conjunctival impression cytology--a study of normal conjunctiva. Conjunctival impression cytology was used to study conjunctival ocular surface in 30 normal individuals in the age group of 20 to 60 years. The cytology was graded according to the classification of Nelson. Out of 30 subjects, 26 showed the features of Grade O (average age 28.33 years) and 4 showed grade 1 (average age 56.66 years). The method was very easy to perform, cheap and fast. The relationship of various cells to each other was maintained. This method can be used to study the conditions like trachoma, avitaminosis A and other disorders of conjunctival surface. It can be undertaken by a paramedical worker in an out patient clinic.


Echocardiography and pulmonary artery pressure: correlation in chronic obstructive pulmonary disease. The aim of this study was to assess whether 2 dimensional echocardiography can provide reliable parameters to quantitatively estimate pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease. Twenty subjects, 16 males and 4 females, mean age 54.5 year +/- 4.92 were evaluated. Right ventricular dimensions were measured using subcostal 2- dimensional (2D) approach viz. right ventricular maximum short axis (Rv) and tricuspid annulus (TA). Free right ventricular anterior wall (AW) was measured by M-Mode. A 2D Index was calculated RV x TA + Aw and the same correlated with mean pulmonary artery pressure (r = 0.97). This appears to be a useful non-invasive method foe estimating PH in cases of COPD.


Meckel's diverticulum in children.

Meckel's diverticulum in children. Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.


Mesenchymal chondrosarcoma--a case report. A Case of extraosseous mesenchymal chondrosarcoma occurring in the occipital region in a 26 year old male is being reported. The patient remained free from recurrence on any metastasis even after 2 years of the tumor resection.


Fibromatosis of thyroid gland (a case report). Fibromatosis of thyroid gland is a rare condition encountered in surgical practice. Clinically presenting as goitre, it is treated with near total thyroidectomy with good results. We had one such case under our care at the K.E.M. Hospital, Bombay. Rarity of this condition prompted us to publish the data, the literature is briefly reviewed.


Persistent facial myokymia: a rare pathognomic physical sign of intrinsic brain-stem lesions: report of 2 cases and review of literature. Characteristically continuous facial myokymia is a pathognomonic, exceedingly rare physical sign of intrinsic brain-stem lesions e.g. multiple sclerosis (where the myokymia lasts only for a few months), pontine glioma (where it is unremitting for years). The physiopathogenesis is unclear. Electromyographic patterns are characteristic. Therapy and prognosis are related to the basic aetio-pathological process. Only two out of 132 cases of intrinsic brain-stem lesions in the department of Neurosurgery, Seth G.s. Medical College, Bombay over a period of 3 decades, exemplify its rarity. These two cases are reported here and the relevant literature is reviewed.


Bizarre parosteal osteochondroma in the foot (a case report). A rare case of a bizarre parosteal osteochondroma in the foot is presented. The tumour first described in 1983 by Nore et al is rare in any location and has to be differentiated from a juxta-cortical osteosarcoma and a benign osteosarcoma. Its differentiating characteristics are discussed.


An uncertain future: children of mentally ill parents. Research reports the uncertain outcome of variables affecting the life of a child of an MI parent. Nurses must avoid stereotyping children before assessment; they are to be in the forefront in assessing self-care skills and deficits to guide planning individual interventions for children and MI parents. Long-term research theory-based interventions will enhance mental health in high-risk children and families.


Renal angiomyolipoma (report of 2 cases). Renal angiomyolipoma, a rare benign renal neoplasm constitutes less than 3 percent of all renal neoplasm. Two rare cases of renal angiomyolipoma were reported from the Department of Pathology, Dr. S.N. Medical College, Jodhpur in last fifteen years. Both were not associated with tuberous sclerosis. The relevant literature on the subject is reviewed.


Empowering part-time nurses in the treatment of depressed inpatients. 1. With the consistent number of part-time nurses in the workforce, hospitals would benefit by more actively integrating them into professional nursing practice. 2. Empowering part-time nurses by affording them the opportunity to provide primary care has the potential to effectively use part-time personnel, decrease the workload for full-time staff, offer more flexibility in scheduling, and result in savings for hospitals in terms of nursing recruitment and retention. 3. This program has successfully developed and implemented a model of primary nursing that places three part-time nurses on a team capable of handling two to three primary patients. The success of this model has been attributed to excellent communication, trust in one another's professional skills, and nursing expertise.


Bilateral pulmonary aneurysm in Behçet's disease (a case report). While investigating a chest opacity in Behcet's disease possibility of pulmonary aneurysm should be considered. Contrast enhanced CT is a safe diagnostic method which is useful in confirming or excluding the presence of an aneurysm in such cases. We report here the first case of bilateral pulmonary aneurysms in Behcet's disease.


Role of the family in drug abuse.

Role of the family in drug abuse. A simple random survey of 9863 population out of the total 70,000 population is one slum pocket of Bombay revealed drug dependence in 104 persons. Out of 104, 83.65% smoked 'brown sugar' 10.68% used cannabis and 5.77% opium. Most of the addicts (95.2%) belonged to large families. Family history of alcoholism and drug abuse was present in 41.35%. Parental deprivation was additional contributing factor in 30.7%.


Comparative study of hemoglobin estimated by Drabkin's and Sahli's methods. Hemoglobin was estimated by Sahli's and Drabkin's method in samples collected by finger prick and venepuncture. Statistical analysis revealed a significant difference in the hemoglobin values obtained by the two methods (P less than .01 & P less than .05 respectively). Sahli's method carried out by two different groups of workers in samples of blood collected by venepuncture showed statistically significant difference (P less than .001). This could be due to the inbuilt errors of Sahli's method including a subjective bias due to visual comparison. When same samples were subjected to Drabkin's method by the same group of workers no significant difference in the results were obtained (P less than .05). This is due to reliability of the Drabkins method. The aim of this comparative study of hemoglobin estimation by Sahli's and Drabkin's methods is to emphasize the sensitivity and reliability of Drabkin's over Sahli's and utility of Drabkin's method in undergraduate teaching schedule.


Perceptions of seclusion: comparing patient and staff reactions. Seclusion, or the use of locked, closely monitored containment, is widely used in psychiatric practice and is legally sanctioned. Involving humanitarian, ethical, and legal issues, seclusion poses dilemmas and raises questions for health-care professionals. Among those defending the practice, some would argue that it is used reluctantly and only as a last resort, whereas others consider it to be a positive therapeutic treatment modality, whether used alone or in conjunction with other treatments. Opponents of seclusion disagree, considering seclusion to be punitive, arbitrary, and geared toward serving the needs of other patients and staff. Although professionals have interpreted seclusion differently with regard to its function, efficacy, and impact, the vast majority of patients view it negatively. Wadeson and Carpenter (1976) found that individuals interviewed 1 year after seclusion still felt bitter about the experience; for many, that experience symbolized their entire psychiatric illness.


Using a model to structure psychosocial nursing [corrected]. 1. Specifying a model to guide research projects helps clarify the study, permits several investigators to work in a coordinated fashion on large projects, and facilitates comparisons across studies. 2. This model is composed of seven domains and indicates some of the hypothesized relationships between domains. Adapting the model to individual studies may result in a different number of domains and in the specification of other hypothesized relationships. 3. When possible, researchers should make use of minimum data sets to enhance the comprehensiveness and generalizability of their research.


The mental health review board: a new concept for difficult clients. 1. The Mental Health Review Board concept is a hospital systems approach to the difficult client. Board membership varies with each case and includes representation from all areas of the hospital. 2. The Review Board deals with clients who have exhausted the system, are threatening or abusive to staff, and noncompliant with treatment recommendations. 3. The Review Board contract is the "final offer" for treatment and is without input from the client. Terms of the contract are nonegotiable. Noncompliance results in discharge and referral elsewhere.


The prevalence of recurrent herpes labialis during an army hot weather exercise. A survey was performed on 1,062 of 2,500 (42%) Army personnel participating in a desert training exercise at Fort Irwin, California, in September 1983. The prevalence of recurrent herpes labialis (RHL) and chapped lips was observed during the third week of a four-week training period. Complexion, sex, lip protectant use, age, and time spent outdoors were obtained by observation and interview. Recurrent herpes labialis was found in 46 subjects (4%). Stratified analysis and stepwise logistic regression were used to identify risk factors associated with RHL and to determine the prevalence odds ratios (POR). Risk factors with statistically significant associations with RHL were lip protectant use (POR = 0.19), chapped lips (POR = 2.87), being female (POR = 5.00), and light complexion (POR = 2.48). These findings strongly support the use of lip protectants during prolonged exposure to hot, dry climates as a prophylaxis against recurrent herpes labialis. Additional studies should focus on excitatory factors of RHL; and clinical trials of the efficacy of the lip protectants to protect against RHL and chapped lips should be undertaken.


Supply decisions among dentists working within a fixed-fee system of dental care provision. In Norway fees for dental treatment did not increase at the same rate as prices for other goods and services during the 1980s. The aim of this study was to examine how this decrease in fees in real terms has influenced dentists' work decisions with respect to supply of services. Data on characteristics of the dentist and the dental practice were collected for 1979, 1984, and 1986. The dependent variable was supply of dental services, measured as the number of patient care hours worked per annum. The hourly fee for dental care was equivalent to dentists hourly wage rate. Supply increased as fees decreased. This could be explained either as a response of the patient or the dentist to reduced fees. Although the data did not give conclusive evidence as to which effect was most important, the authors have put forward the view that the main effect was dentists' response to reduced fees. The main argument put in favor of this view is that dentists have an overall knowledge of the effect of a change in fees on their income. The impact of a change in fees is much greater on the provider who supplies the services to many individuals over a long period of time, than on an individual consumer who buys the services once or twice a year. It was concluded that, in the short run, a fixed-fee schedule may not be very effective in limiting costs for dental care.


A profile of black and Hispanic subgroups' access to dental care: findings from the National Health Interview Survey. This study examined which black and Hispanic minority subgroups were least likely to obtain dental care and why, based on logistic regression analyses of the 1986 National Health Interview Survey. Blacks and Hispanics were less apt to have private dental insurance coverage, to be knowledgeable about the purpose of fluoride, to have been to a dentist in the past year, and, when they did go, were more apt to have gone in response to symptoms rather than for preventive reasons, compared to whites. Logistic regression analyses for adults 18 years of age and older and for children and adolescents 2 to 17 years of age showed that the following individuals had the lowest probability of having been to a dentist in the past year: males, members of larger families, adults who were unemployed or in blue-collar jobs, those who lived in the South or nonmetropolitan areas, people who perceived their health to be fair or poor, and those with no private dental insurance. Mexican-Americans were least likely to have been to a dentist regardless of their income or education. In general, the findings confirmed the importance of dental insurance, as well as suggesting a need for more school-based dental programs and public health clinic-based dental health education and outreach efforts for targeting minority children and adults.


The need for toothpastes with lower than conventional fluoride concentrations for preschool-aged children. Since 1945, when community water fluoridation was first implemented in the United States, not only has the procedure grown to cover more than half of the US population, but the development and use of other fluoride methods have expanded greatly. A concomitant, dramatic decrease has occurred in the caries prevalence of US school-aged children. Recent studies indicate, however, that the prevalence and, to a lesser extent, the intensity of dental fluorosis have increased in schoolchildren in both fluoridated and fluoride-deficient areas. Several studies show that young children inadvertently ingest sizable proportions of toothpaste during toothbrushing. Although ingestion of fluoride toothpastes by preschool-aged children may not be the major contributor to the increase in fluorosis, the findings of at least four studies suggest that the use of fluoride toothpastes by young children is a risk factor. The direct dose-response relation between effectiveness and fluoride concentration of toothpastes is far from clear-cut and, at best, is weak. Thus, considering today's reduced risk of caries, it is timely to market fluoride toothpastes in the US with 400-500 ppm fluoride for preschool-aged children, who are still at risk for developing fluorosis, as has been done in several other countries. Dental public health authorities must work with toothpaste manufacturers, professional organizations, and regulatory agencies to facilitate the approval and marketing of such pediatric fluoride toothpastes.


Factors affecting the ingestion of fluoride dentifrice by children. Several factors affecting the amount of fluoride ingested during toothbrushing by 2- to 7-year-old children were investigated. The specific purpose of this study was to determine the contribution of age, the amount of dentifrice used, and rinsing after brushing to the variation in the ingestion of fluoride dentifrice. Four hundred and five children brushed their teeth in front of a portable sink. The tubes of dentifrice in gel (0.24% NaF) were weighed before and after use to determine the amount of toothpaste used. The fluoride content of the collected liquids was determined with a fluoride-ion-specific electrode. The amount of fluoride ingested was derived by determining the difference between the amounts used and recovered. The amount of dentifrice used, the age, and the rinsing habits, entered in a multiple regression model, explained up to 66 percent of the total variation in the amount of fluoride ingested. The amount of dentifrice used accounted by itself for 60 percent of the total variation. Therefore, these results indicate that the quantity of dentifrice used was the most important factor affecting the ingestion of fluoride through toothbrushing by young children.


Comparison of number and mean charge between dental sealants and one-surface restorations. An important concern of the insurer is how sealants, if a covered benefit, will affect the premium. Important factors that may have an influence on determining the premium include the decline in caries rate coupled with the long-term cost to an insurer for sealants vs one-surface restorations. In this study of more than 1 million dentally insured children (aged 5-15), the mean charge ($) for sealants and one-surface restorations was determined, along with the frequency of these procedures, by patient age. For this group of children, 43 percent of one-surface restorations occurred between ages 12-14, whereas 32 percent of the patients received sealants at either 7 or 8 years of age. States varied substantially in the number of sealants as a percentage of the number of restorations. Only three states had more sealants placed than one-surface, posterior restorations. Three states had an annual increase in the ratio of sealant to restoration charge, while 13 states had an annual decrease. With the exclusion of a few states with a minimum number of sealants and restorations in 1988, the highest ratio of the cost of sealants to the cost of one-surface restorations was observed in New York (.60) and New Jersey (.56) and the lowest observed in Kansas and Utah (.37). The ratios for both New York and New Jersey were lower in 1988 than in the previous two years. The ratio of the number of one-surface, posterior restorations to the population served was approximately the same for each NIDR region in the contiguous United States. Alaska and Hawaii had a higher proportion.


Improving dental epidemiologic data collection with computers. A computerized dental data recording system (DDRS) was developed for the New England Elder Dental Study to improve data quality and increase field staff efficiency. The DDRS displays video screens similar to traditional paper forms to record data on coronal and root caries, dentate and denture status, subacute bacterial endocarditis screening, gingival bleeding, calculus, and periodontal attachment level. DDRS provides facilities for date and exam-component time tracking, on-line contextual comments, random record retrieval, editing, data backup, and data output in various data formats. This study compared the DDRS with a paper-form system for data entry accuracy. Dental caries and periodontal disease measurement data from 38 subjects were recorded on paper forms and independently entered using DDRS. The DDRS identified 150 illogical data errors, 39 inconsistent data errors, 7 invalid data and 34 miscellaneous data errors. Four technicians with field experience using both paper forms and DDRS reported time savings using DDRS in the field. DDRS has the potential for additional time savings by minimizing the time for data coding, cleaning, and management. Results demonstrate that DDRS could improve the quality of oral epidemiologic data by mandating strict adherence to protocols, preventing errors, and increasing field efficiency.


Opinions of dentists on the treatment of elderly patients in long-term care facilities. The high prevalence of disorders in the mouths of elderly residents in long-term care (LTC) facilities suggests that the dental services available to the residents are inadequate. A questionnaire was sent to most of the dentists practicing in Vancouver (British Columbia) to solicit their opinions on treating older patients in LTC facilities, and a response was obtained from 334 (55%). It indicated that 19 percent of the respondents had treated old people within this context, although few of them felt they had been educated adequately for the service. Many reasons were offered to explain the small participation. Most respondents had never been asked to attend a facility. Many felt that it interfered with their practice and leisure, and they were concerned about the limited options available for treatment. Dentists who had attended facilities were motivated by a sense of professional or public responsibility, but they were uneasy about the limited options and about the inadequate space and equipment available. In general, the dentists were not interested in attending an institutionalized geriatric population, and they felt ill-prepared for the service.


Pancreatitis in systemic lupus erythematosus: still in search of a mechanism. Pancreatitis in SLE remains an enigma and probably results from multiple pathogenetic mechanisms. However, cases of pancreatic thrombus formation remain few and far between, suggesting that APS is not the major cause of pancreatitis. Whether aPL contribute to pancreatic thrombus formation in rare patients needs to be demonstrated by antemortum arteriographic studies showing thrombus or vasculopathy. The postmortem pancreatic examination of patients who have died of the disseminated vasculopathy-coagulopathy syndrome remains problematic, because if thrombi are found, they may simply represent the endstage of multiple mechanisms, including hypotension, hypoxia, DIC, or TTP, rather than an aPL specific mechanism.


Concordance between clinician and patient assessment of physical and mental health status. The degree of concordance between clinicians' and patients' assessment of the patient's physical and mental functioning was examined in 166 consecutive eligible outpatients with rheumatoid arthritis (RA) using 4-category ordinal scales. The weighted kappa statistic was 0.39 for physical functioning and 0.30 for mental functioning, both indicating a fair degree of concordance. This disagreement differed in magnitude and direction depending on the level of disability present. We conclude that clinicians and their patients with RA often disagree in their assessment of the degree of physical and mental impairment that the patient experiences. These disagreements demonstrate the need for formal assessments of outcome and should be recognized and resolved when managing individual patients.


Rheumatology function tests: grip strength, walking time, button test and questionnaires document and predict longterm morbidity and mortality in rheumatoid arthritis. Four quantitative measures of functional status, grip strength, walking time, the button test, and a questionnaire regarding activities of daily living, were assessed nine years apart in 75 patients with rheumatoid arthritis (RA). After 9 years, 20 patients had died; none were lost to followup. Functional status had declined in more than 80% of patients according to each of the 4 measures, and patients with poor values at baseline were most likely to die over the next 5 years, as reported. We report that baseline values of these measures of functional status were predictive of values 9 years later. These measures may be regarded as "rheumatology function tests" to document and predict morbidity and mortality in RA over long periods.


Bucillamine inhibits T cell adhesion to human endothelial cells. We investigated the ability of bucillamine [N-(2-mercapto-2-methyl-propionyl)-L-cysteine] to prevent T cell adhesion to endothelial cells (EC) isolated from human umbilical vein. When EC were pretreated with bucillamine, T cell binding to the EC was suppressed in a dose dependent fashion. The T cells could bind preferentially to recombinant interferon-gamma (rIFN-gamma) treated EC compared with untreated EC. Bucillamine could also suppress T cell binding to rIFN-gamma treated EC as well as untreated EC. Addition of copper sulfate to bucillamine decreased significantly the percent T cell adhesion to the EC compared with bucillamine alone. The magnitude of inhibition by bucillamine and copper sulfate was similar in EC treated with rIFN-gamma as well as in untreated EC. H2O2 also inhibited the T cell binding to both untreated and rIFN-gamma treated EC. The inhibitory effects of bucillamine with or without copper sulfate on T cell binding to EC were abolished completely by catalase but not by superoxide dismutase. Our results suggest that hydrogen peroxide generated by bucillamine, with or without copper sulfate, inhibits T cell binding to EC. We believe, therefore, that bucillamine may suppress inflammation, such as that in rheumatoid synovitis, by reducing the emigration of chronic inflammatory cells from capillaries into tissue.


Synoviocyte derived granulocyte macrophage colony stimulating factor mediates the survival of human lymphocytes. Synoviocytes have been shown to be effector cells capable of synthesizing and secreting a variety of cytokines and growth factors. We demonstrate here that synoviocyte derived conditioned medium has immunoregulatory properties as it enhances human peripheral blood lymphocyte survival in a dose dependent manner in vitro. The effect elicited by synoviocyte derived conditioned medium from patients with rheumatoid arthritis (RA) was greater than that induced by synoviocyte derived conditioned medium from patients with osteoarthritis. Granulocyte-macrophage colony stimulating factor (GM-CSF) was found in synoviocyte derived conditioned medium with significantly higher levels present in synoviocyte derived conditioned medium from patients with RA. Recombinant human GM-CSF induced survival of human lymphocytes in vitro and a monoclonal antibody to human GM-CSF fully abrogated synoviocyte derived conditioned medium induced survival. Our results demonstrate that synoviocyte derived GM-CSF may be important in the retention of lymphocytes, which is a central pathological characteristic of the rheumatoid joint.