[Clinical usefulness of the ROMCheck Membrane Immunoassay--a new method for the demonstration of the rupture of fetal membranes]. An investigation of the clinical usefulness of ROMCheck Membrane Immunoassay, a new method for the detection of amniotic fluid in the vagina, was undertaken. The ROMCheck-test is a monoclonal antibody test against fetal fibronectin in amniotic fluid. It was compared to commonly used methods as ferning, Nile blue staining of fetal cells and Nitrazine paper. We examined twenty pregnant women with suspected rupture of membranes and twenty women with apparently intact membranes receiving routine prenatal care. We found that clinical detection of amniotic fluid in the vagina resulted in a positive ROMCheck-test. When the ROMCheck-test was negative there was no indication of rupture of membranes. When the ROMCheck-test was positive and the other tests were negative, we could not exclude the possibility of the presence of amniotic fluid in the vagina at the time of examination. The test is a useful tool in identifying the presence or absence of amniotic fluid in the vagina.


[HIV testing and HIV surveillance of a venereological clientele in Denmark]. The object of this investigation was to evaluate the suitability of unlinked anonymous HIV screening of persons visiting one of eight out of the nine Danish clinics for venereal diseases in the national HIV surveillance. Data were collected during the period July 1, 1990-March 31, 1991 and included: gender, sexual orientation, history of intravenous drug use (IVDU), syphilis testing and HIV testing. A total of 7,455 persons participated of whom 75% were tested for HIV antibodies. The HIV test activity was significantly higher among male IVDUs than homo/bisexuals, and higher among female IVDUs than heterosexuals. The overall HIV prevalence among tested individuals was 0.6%, ranging from 0.1% among heterosexual women to 5.3% among female IVDUs. A total of 81% were tested for syphilis with an overall HIV prevalence of at least 1.1%, ranging from 0.2% among heterosexuals to 9.3% among homo/bisexual men. Since the non-participation is great and the venereological clientele is very heterogeneous, using blood taken for syphilis serology from this group for unlinked anonymous HIV screening, would not be particularly important as a supplement to the Danish HIV surveillance.


[The ring chromosome 14 syndrome].

[The ring chromosome 14 syndrome]. Two children with ring chromosome 14 are described. Both children have only few phenotypical features suggestive of a chromosome abnormality. Both have, however, epilepsy which is typical for the ring chromosome 14 syndrome. Chromosome examination is recommended in children with mental retardation and epilepsy which is refractory to treatment.


[Ring chromosome 18].

[Ring chromosome 18]. Ring chromosome 18 (46,XX,r(18)) has previously been reported in about 70 patients. Another patient with the well-known physical and cytogenetic characteristics and, in addition, skeletal abnormalities in the feet, is presented here.


[Prevention of pneumococcal infections in the elderly by vaccination]. Streptococcus pneumoniae still causes serious infections especially in elderly people, despite relevant antibiotic treatment and intensive therapy. At present, Statens Serum-institut annually receives about 650 pneumococcal strains isolated from blood and cerebrospinal fluid for typing from the departments of Clinical Microbiology in Denmark. Of these strains about 55% were isolated from persons aged 60 years or older. The incidence of pneumococcal pneumonia in elderly people is said to be 4-8/1000 persons/year in countries similar to Denmark. In the USA, pneumococcal vaccination is recommended for groups at risk including immunocompetent adults > or = 65 years old. Since 1978, pneumococcal vaccine has been available in Denmark, where the only indication for vaccination has been and still is intended or already performed splenectomy in persons older than two years of age. According to the literature, the protective efficacy of vaccination of elderly persons is 60-70%. Since vaccination is, furthermore, without risks we believe that vaccination of elderly people in Denmark should be advised.


[Sex chromosome abnormalities and sex determination genes. Review of the literature]. Molecular analysis of structural chromosomal abnormalities, involving the sex chromosomes, has provided us new knowledge concerning sex determination in humans. This has raised three hypotheses of sexual differentiation, which will be discussed even though none of these can explain all abnormalities involved. Meiotic recombination which normally takes place during the male meiotic cell division, can give rise to sex reversal syndromes such as XX male and XY female, if crossing over is abnormal. Analysis of these abnormalities has made it possible to map sex determining regions on chromosome Y, and to construct a deletion map. Methods using DNA probes, are capable of identifying Y-specific sequences in persons with sex reversal. This means a more optimal counselling, possibilities of prenatal diagnosis, and opportunities for selecting patients with risk of gonad cancers, for extirpation.


[Identification of Y chromosome material in an XX male by means of fluorescent in situ hybridization]. This article describes a case of 46,XX male, the most frequent form of sex reversal syndromes in humans. A method of identifying Y chromosome material in these and other patients with structural chromosomal abnormalities involving chromosome Y is given. Chromosomes from a phenotypically normal male child without any congenital malformation, where prenatal diagnosis revealed the female karyotype 46,XX, were analysed using fluorescence in situ hybridisation (FISH). The analysis revealed an X chromosome, containing Y chromosome sequences on the tip of the short arm. The sequences are not normally visible in conventional cytogenetic analyses of XX males. The breakpoint on Y was determined to be in the region of Yp11.2, which is proximal for the putative sex determining gene on Y. The results are consistent with theories of abnormal crossing-over during the paternal meiotic cell division where meiotic recombination can give rise to structural abnormalities, which can then cause sex reversal syndromes. Prenatal diagnosis of structural sex chromosome abnormalities has become available using the FISH method.


[Measurement of intestinal blood supply in patients with suspected intestinal ischemia]. The object of the investigation was to illustrate the diagnostic yields of measurement of the intestinal blood supply before and after a test meal and of abdominal angiography recorded in patients in whom chronic intestinal ischaemia is suspected. A retrospective review including 18 patients (age range 36-79 years) was undertaken. The diagnosis of chronic intestinal ischaemia was established in four patients on the basis of measurement of the blood supply to the intestine and abdominal angiography and vascular reconstructive interventions could be performed. These interventions were technically successful in three cases. Control flow measurement was only performed in one patient after the operation. This showed normalized postprandial blood flow. By large, measurements of the blood supply to the intestine were free from complications. In cases of suspected chronic intestinal ischaemia, the combination of abdominal angiography and measurement of the blood supply to the intestine appear to supply the necessary information for selection of patients for vascular surgical interventions.


[Urethral stricture in Greenland].

[Urethral stricture in Greenland]. In a retrospective survey, the 46 patients treated for urethral stricture at Dronning Ingrids Hospital, Nuuk, (the main hospital in Greenland) during the four year period August 1987-August 1991 are investigated, and the consequences of not treating urethral stricture are illustrated by a case. The patients are middleaged and older men generally with long and multiple strictures close to the sphincter. Gonorrhoea is the common cause of the stricture. The patients have obstructive symptoms, urinary infections and haematuria. Furthermore, nearly 1/4 of the patients have complications in the form of scrotal and perineal abscesses, and reduced renalfunction and rapidly lethal disease because of sepsis are seen. The urethral strictures tend to recur after treatment. Urethral stricture disease is undoubtedly underestimated in Greenland, and the investigation stresses this serious complication of venereal disease.


[Epidemiological studies on scalded children admitted to the burns unit at the Hvidovre hospital during 1981-1990]. During the ten year period 1981 to 1990, a total of 436 children aged 0-5 years were admitted for scalds at the Burns Unit of Hvidovre Hospital. We did not find any reduction in the number of admissions during this period nor was any change in the patterns of scalds found. Water, tea and coffee were the main causal agents of scalds and the dominant group of scalded children was between the ages one to two years. In 37% of cases, the scalds required grafting and the average stay in hospital was 16 days. The background for this unchanged pattern could be that the prophylactive campaigns have been insufficient.


[Combination therapy with pamidronate and calcitonin in hypercalcemic crisis caused by primary hyperparathyroidism]. Pamidronate (aminopropylidene diphosphonate, APD) is known to be an effective agent in lowering plasma calcium in cancer associated hypercalcaemia and in primary hyperparathyroidism. Combined therapy with pamidronate and calcitonin has proved efficient in the treatment of severe cancer-associated hypercalcaemia. A 66-year-old woman in hypercalcaemic crisis caused by primary hypreparathyroidism was successfully treated with this combined therapy. Albumin corrected plasma calcium was 5.26 mmol/l on arrival and the PTH level was very high. The combined therapy lowered the plasma calcium to normal and made it possible to perform elective parathyreoidectomy. A 5.8 g parathyroid adenoma was removed. It is recommended to consider combined therapy with pamidronate and calcitonin in the emergency management of hypercalcaemic crisis.


[Axillary dissection in primary surgical treatment of breast cancer: risk of false-negative axillary status]. The present study evaluates the extent of axillary dissection as part of the primary surgical treatment of operable breast cancer. Data are from the period January 1979 to August 1990 and were collected prospectively as part of the Danish Breast Cancer Cooperative Group protocols for low-risk mammary carcinoma. The series consists of 6774 breast cancer patients aged 69 years or younger. The number of axillary lymph nodes removed was related to the frequency of ipsilateral axillary recurrence, recurrence-free survival, and overall survival after a median of five years follow-up, respectively. The recurrence-free survival and overall survival rate were directly related to the number of axillary lymph nodes removed. The difference in outcome is believed to be caused by false-negative classification of axillary-positive high-risk patients in groups of patients where only a few axillary lymph nodes were removed.


[Determination of estrogen receptor status in breast cancer by immunocytochemical examination of fine-needle aspirates]. Estrogen receptor status was determined by immunocytochemical examination of fine-needle aspirates in 109 cases of primary invasive breast carcinoma. The results were compared with those from biochemical determination performed on tumor cytosols. Positive agreement was found between qualitative determination (positive/negative) by the two methods in 83% of the cases, and after semiquantitative stratification into three groups the results corresponded in 76%. The predictive value of a positive result on fine-needle aspirate was 96%, and 57% of a negative result. It is concluded that immunocytochemical determination of estrogen receptor status of breast carcinomas on fine-needle aspirate with the applied technique cannot replace the current standard biochemical method.


[What do we know about consultation hypertension?]. This review article examines the essential literature concerning "white coat" hypertension. It is stated that "white coat" hypertension is present in approximately 20% of patients with diagnosed mild to moderate hypertension. It is concluded that the pathophysiology of "white coat" hypertension is incompletely investigated; that the prognosis for untreated "white coat" hypertension seems fair; medical treatment being scarcely required. It is concluded further that more accurate diagnosis of mild to moderate hypertension, including the use of ambulatory blood pressure monitoring, will reduce the overall expenses by approximately million Danish crowns annually (approximately 2,000,000 pounds).


[Treatment of hemangioma in children with recombinant interferon]. Pulmonary haemangiomatosis and large haemangiomas endangering vital structures and with a potential association of consumptive coagulopathy are rare but severe diseases in infancy and childhood. Therapy with glucocorticoids, cytostatics and surgical intervention has not proved satisfactory. From experience with Kaposi's sarcoma, about 20 children with severe forms of haemangiomatous disease have now been treated with alpha-interferon with promising results. Mechanisms of action are unknown, but these could include a cytostatic effect, inhibition of the abnormal proliferation of endothelial cells, fibroblasts and smooth muscle cells. Furthermore, alpha-interferon could inhibit the paracrine and autocrine effects of locally produced growth factors. Also, alpha-interferon could promote the production of prostacyclin, which inhibits platelet aggregation, leading to reduced damage and consumption of platelets. Long term treatment is mandatory. Initial daily doses of 2 to 5 million U/m2 are administered subcutaneously. Side effects in this dosage interval are uncommon in childhood. Future studies are needed to establish exact guidelines for the use of alpha-interferon in childhood, but the clinical experience hitherto obtained points to the fact that treatment is effective in severe forms of haemangiomas and pulmonary haemangiomatosis.


[Salicylic acid poisoning].

[Salicylic acid poisoning]. The study analyses the role of salicylic acid (SA) in fatal intoxications with special reference to potentially avoidable, accidental poisonings. The study indicates a relation between SA intoxication and the presence of an infection of the respiratory tract. All deaths in Denmark in the period 1980 through 1989 registered as caused by SA were analysed as were all deaths submitted to forensic toxicological examination in a defined region of Denmark in the years 1985 through 1989. During the decade 1980 through 1989 the number of fatal intoxications due to SA increased from approx. five per year to approx. 23 per year. During the same period the sales of SA decreased. Many deaths in the material were registered as accidental, and an increasing frequency of accidental deaths was seen with a lower social level. Frequently, an infection of the respiratory tract was either indicated in a hospital case record or a police report, or found at autopsy.


[Value of routine follow-up after infrainguinal arterial reconstruction]. Longterm patency of infrainguinal bypass procedures may be established on the basis of clinical evaluation and ankle pressure measurements. With the aim of assessing whether these parameters could predict grafts at risk for occlusion, we identified 24 patients in whom the bypass had occluded between 3 and 12 months postoperatively, but following at least one follow-up. These patients were compared with a control group consisting of further 24 patients operated on during the same period, but in whom the bypass was patent. Prior to graft occlusion only nine (39%) patients had complained of claudication, and a significant drop in ankle pressure was demonstrated in seven (29%) patients. These figures were significantly higher than the one (4%) patient in the control group who complained of claudication and the other (4%) patient who developed a drop in ankle pressure (p < 0.02 and 0.05, respectively). Graft surveillance based on patients' history and ankle pressure measurements are insufficient parameters for identification of grafts at risk for occlusion. However, the occurrence of claudication and/or a significant drop in ankle pressures are associated with a high incidence of graft thrombosis.


[Asymptomatic benign mediastinal teratoma]. A case of asymptomatic benign mediastinal teratoma is presented. The necessity for definite diagnosis of mediastinal tumours is stressed together with the need for conferences involving several specialties.


[Colchicine treatment of recurrent steroid-dependent pericarditis in a patient with post-myocardial-infarction syndrome (Dressler's syndrome)]. The usual treatment of pericarditis consists of non-steroid anti-inflammatory agents. In cases where the symptoms and/or the pericardial effusion persist or progress, the disease can be arrested in the majority of cases by employing steroids. In some patients, it may prove difficult to conclude steroid treatment as gradual withdrawal results in recurrence and it may, therefore, be necessary to continue with large doses of steroid for prolonged periods. There is, however, a possibility for another form of treatment. The present authors present the case history of a patient with pericarditis on the basis of the post-myocardial-infarction syndrome and in whom the symptoms recurred several times during attempts at gradual withdrawal of prednisolone. Treatment with colchicine was commenced. The patient rapidly became symptom free and has now been symptom free for 45 weeks without prednisolone. Colchicine was withdrawn after 33 weeks without recurrence. It is considered that trial of colchicine treatment can be recommended in cases of recurring pericarditis particularly when there are problems (recurrence) on attempted withdrawal of steroid treatment. Naturally, it is important to exclude specific causes requiring other forms of treatment as the cause of the pericarditis (e.g. malignant disease, tuberculosis, systemic disease etc.).


[Sudden, unexplained infant death--sudden infant death syndrome. Forensic pathological aspects]. Delimitation of the sudden unexplained infant death syndrome (SIDS) is difficult as the diagnosis is made by exclusion. The difficulties in the differential diagnosis are concentrated on interpretation of the significance of positive viral and bacterial findings, inflammatory changes in the respiratory organs, heart and central nervous system together with malformations. Classification of SIDS appears, therefore, to vary according to time and place. New techniques, e.g. DNA analysis, have explained the etiology in a few per cent of the cases but have not yet solved the riddle of SIDS. The article reviews hypotheses about apnoea, arrhythmia, overheating and inefficient surveillance of the infant. It is emphasized that assessment of risk factors for SIDS requires valid epidemiological investigations where the basis for the diagnosis is a uniform classification of SIDS infants as compared with other groups of sudden death in infancy. An investigation of this nature has been initiated in the Nordic countries. It is important to examine and treat infants with abnormal sleep apnoea but generalized employment of monitoring has not reduced the number of unexplained infantile deaths.


[Significance of sleeping position on the occurrence of sudden, unexplained infant death. An epidemiological review]. The cause of the sudden infant death syndrome (SIDS) is, according to the definition, unknown. Epidemiological research during recent years has identified a series of probable risk factors. One of these is the use of prone position as sleeping position. In the Western European countries, Australia and New Zealand, a total of 14 case-control studies illustrate a possible connection between the prone position and SIDS. Eleven of the studies revealed a significantly increased relative risk (RR) of between 1.4 and 12.5 for SIDS when using the prone position, while the three remaining studies did not demonstrate increased RR. A meta-analysis of the results of the 14 case-control studies showed an RR of 2.4 for SIDS in the prone position as compared with other sleeping positions. In a single prospective cohort study from Australia, an RR of 3.1 was found for SIDS in the prone position. Interventions in which parents are advised not to place the infants in the prone position during sleep appear to have resulted in considerable reduction in the number of cases of SIDS according to preliminary reports from Great Britain, the Netherlands, Norway and New Zealand. A series of methodological problems can be demonstrated in the published results of these studies, including limited size of study populations, inadequate matching of control groups and absent confounder control. Nevertheless, the total epidemiological evidence, also where Denmark is concerned, speaks in favour of altered recommendations for sleeping positions of infants, particularly because there is no documentation to suggest that the prone position offers any advantages to health.(ABSTRACT TRUNCATED AT 250 WORDS)


[Favourite sleeping positions among infants in the county of Roskilde. Is there a connection with sudden, unexplained infant death?]. The purpose of this study was to investigate the distribution of the favourite sleeping positions and other possible risk factors for SIDS among infants in a Danish county, and to compare the distribution af sleeping positions with the sleeping positions reported in SIDS-cases from the same district. Information about favourite sleeping positions at the age of one month and four months was collected by interviews with parents, performed consecutively by health visitors at the routine examinations of 174 infants aged eight months. Information about sex, birthweight, gestational age, complications of delivery, mother's age and maternal smoking in pregnancy was collected for each child from the Birth Registration form. Thirty-two SIDS-cases from the 10 year period 1982-91, mostly based on police reports, were analysed retrospectively as regards sleeping positions and other possible risk factors. The distribution of different sleeping positions at the age of one month/four months was: prone 59%/52%, lateral 39%/41%, supine 2%/6%. There was a significant negative correlation between birthweight and use of the prone position. Among the SIDS-cases, the prone sleeping position was reported in 18 of 21 cases (86%), where this information was available. In conclusion, the prone sleeping position seemed to be associated with an increased risk of SIDS (estimated OR 4.1) but some of this difference can be accounted for by the more frequent use of this position among children with low birthweight and other risk factors.


[Testing an ultrasonic scanner for determination of urinary bladder volume]. Bladderscan BVI 2000 is a portable ultrasound scanner, specially constructed for determination of bladder volume. We have tested this scanner for accuracy, systematic errors and the training required to use it. The bladder volumes measured by ultrasound scanning were compared with the true volumes. Fifty-six measurements were made. We found the accuracy of BVI 2000 sufficient to determine bladder volumes as either small or large. We found no systematic errors. No special training is required to use the scanner. The device is thus useful in most clinical situations when greater accuracy than indicated here is not necessary.


[Cystectomy for urinary bladder cancer. Postoperative complications and mortality]. During a period of ten years, 111 patients with cancer of the bladder were treated by total cystectomy. In 69 patients a preoperative radiation dose of 40 Gy was administered, 23 received 60 Gy and 19 received no radiation. The crude-survival was 50%. The postoperative mortality was low, 3.6%.


[Primary malignant pleural neoplasms. Diagnostic code 163.09]. The code 163.09 indicates a primary malignant pleural neoplasma-malignant mesothelioma. We have reinvestigated 173 patients, who were discharged from a department of pulmonary medicine with this code number during a 8 1/2 year period. A revision during which repeated biopsies, course of the disease and, in some cases, autopsy were considered, revealed that 63 were confirmed as having a malignant mesothelioma, 94 had neoplastic disease secondary to malignancy elsewhere, 13 had benign changes and in three cases the records were missing. Malignant mesothelioma entitles the patient to compensation if he has worked with asbestos. An occupational history was present in 94% of those suffering from mesothelioma and in 71% of the remaining patients. Among patients with mesothelioma a history of asbestos exposure was obtained in 44%, a history of no exposure in 22% and no specific mention of asbestos in 34%. In the group of patients who did not have mesothelioma 14% had known exposure to asbestos, eight none and in 78% no specific information concerning asbestos was available. Twenty-three of the 63 patients with mesothelioma had been notified to the workmens' compensation board. Retrospectively, we found that 12 more patients should have been notified. Eight patients who did not fulfil the criteria for malignant mesothelioma had erroneously been notified to the board for compensation. We find that code 163.09 frequently has been used as a working diagnosis, which could not invariably be substantiated. Although malignant mesothelioma had been suspected, previous history concerning asbestos exposure was often incomplete or absent. A correct occupational history and aggressive bioptical procedures are essential in all cases where malignant mesothelioma is suspected.(ABSTRACT TRUNCATED AT 250 WORDS)


[Pseudomonas infection associated with whirlpool bath]. After using a whirlpool-spa when the chlorine concentration in the water was very low (0.1 mg/l free chlorine) approximately 20 persons developed a follicular rash. No cases were registered in bathers when the chlorine concentration was acceptable (0.9-1.2 mg/l). The same sero-group and phagetype of Pseudomonas aeruginosa was cultivated from a patient and from the piping system of the spa. The importance of following directions for the installation of whirlpool-spas and regulations for their operation and control is strictly stressed. The National Agency for Environmental Protection is asked to reinforce the existing regulations concerning whirlpool-spas.


[Pseudomonas bacteremia developing after whirlpool bath]. Whirlpools may be responsible for transmission of microbial infections among the bathers if the technical hygienic conditions in the care of the bath are not observed. Two cases of infection with Pneudomonas bacteria were observed after use of whirlpools in a deluxe summer chalet. On the basis of the documented cases, the necessity for specific requirements concerning the installation, running and control of whirlpools used commercially should be considered. In their advisory brochures, the responsible authorities should ensure that the requirements made concerning whirlpools should be intensified so that these baths in summer chalets which are rented out should be subject to public control. Owners and users of whirlpools should be aware of the importance of meticulous hygiene in their care.


[Acute myelo-meningo-radiculitis caused by the spirochaete Borrelia burgdorferi]. A case of severe myelo-meningo-radiculitis with Lyme neuro-borreliosis is described in a patient aged 33 years suffering from insulin dependent diabetes mellitus. It is essential to examine the cerebro-spinal fluid for Borelia burgdorferi specific intrathecal antibody production if sensory radiculitis persist and, finally, if there are focal motor signs and unexplained lymphocytic pleocytosis in the cerebro-spinal fluid. Early diagnosis is very important in order to shorten the course of the illness and recovery.


Changes in action potential kinetics following experimental bladder outflow obstruction in the guinea pig. The effect of experimental bladder outflow obstruction on membrane electrical activity of guinea pig detrusor smooth muscle was studied. Using an intracellular microelectrode technique, action potentials were recorded from single smooth muscle cells to determine the effect of outflow obstruction on action potential (AP) kinetics. Bladder outflow obstruction resulted in smooth muscle hypertrophy with bladder weight gain to 2.7 times control levels after 8-12 weeks' obstruction. The changes in the AP kinetics noted with obstruction-induced bladder hypertrophy were a prolongation of the AP duration and a decrease in the maximum velocity of depolarization and repolarization. The AP amplitude, after hyperpolarization and overshoot potential in addition to the resting membrane potential (RMP) did not change significantly with bladder outflow obstruction. The values of these AP parameters were not affected significantly by the application of atropine and guanethidine in smooth muscle tissue from either control or obstructed bladders. These results suggest that the active electrical properties of the detrusor smooth muscle membrane are changed significantly by obstruction-induced bladder hypertrophy. Furthermore, the results suggest that adrenergic and cholinergic neurotransmitters do not contribute to these changes in AP kinetics following obstruction. The changes in AP properties with outflow obstruction-induced bladder hypertrophy were compared with those previously reported for the hypertrophic myocardium and were discussed in relation to the known impaired contractile properties of obstructed bladder smooth muscle.


Effects of bacteria involved with the pathogenesis of infection-induced urolithiasis on the urokinase and sialidase (neuraminidase) activity. It has been hypothesized that urinary urokinase and sialidase may play a role in urolithiasis. If these theories have substance it is to be expected that microorganisms may also affect these enzymes, since the association between urinary tract infection and renal stone formation is well known. It is generally assumed that Proteus mirabilis and Staphylococcus albus, which produce the urea-splitting enzyme urease, are responsible for stone formation. However, the importance of non-urease-producing microorganisms (Escherichia coli and Enterococcus) in urolithiasis is unclear. Spectrophotometric studies were therefore devised to clarify this problem. Microorganisms associated with infection-induced stones (Proteus mirabilis and Escherichia coli) respectively inhibited the urokinase and stimulated the sialidase activity. In contrast, microorganisms which were not associated with infection stones (Bacillus subtilis) had significantly less effect on urokinase and sialidase activity. This study may explain infection-induced stone formation and could open a completely new line of research.


In vitro adherence of Staphylococcus saprophyticus, Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus aureus to human ureter. Staphylococcus saprophyticus adhered to human ureteral epithelium in vitro. The levels of adherence, which were determined quantitatively with the scanning electron microscope, correlated well with bacterial hemagglutinating activities with sheep erythrocytes (r = 0.9459, P < 0.01). Transmission electron microscopy revealed that the adhering bacteria and the hemagglutinating bacteria possessed similar pili-like structures on their cell surfaces. Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus aureus did not adhere to the epithelium. Only S. aureus adhered markedly to the connective tissue of the ureter, and adhesion of this organism was direct via its cell wall. This adherence test system clearly showed up differences in the abilities of these staphylococcal species to adhere to the urinary tract.


The effect of repeated instillations of antiseptics on catheter-associated urinary tract infections: a study in a physical model of the catheterized bladder. The activity of three antiseptic bladder washout solutions was examined in a physical model of the catheterized bladder. Tests were performed against cultures of four common urinary tract pathogens that had established themselves in the model and colonized the surfaces with biofilm. Double instillations of chlorhexidine (0.02% w/v) at 6-h intervals failed to eliminate Pseudomonas aeruginosa, Proteus mirabilis, and Providencia stuartii from the bladder model. Escherichia coli, however, was susceptible to a second instillation provided that it was performed within 12 h. Supplementing chlorhexidine with EDTA and TRIS potentiated its activity against E. coli. Mandelic acid (1.0% w/v) was the most effective of the agents, double instillations eliminating all but Pr. mirabilis infections.


Urinary trypsin levels observed in pancreas transplant patients with duodenocystostomies promote in vitro fibrinolysis and in vivo bacterial adherence to urothelial surfaces. This study evaluated the role of activated urinary trypsin in mediating the increased incidence of infectious and hemorrhagic lower urinary tract complications in pancreas transplant patients with pancreatico-duodenocystostomies (PDC). The effect of trypsin concentrations corresponding to those observed in the urine of PDC patients were studied using an in vitro assay of clot lysis and an in vivo assay of bacterial-urinary tract adherence. Results were compared with those of parallel assays performed using urine from a pancreas transplant patient with a duodenocystostomy and control human urine. All trypsin concentrations studied demonstrated fibrinolytic activity. Fibrinolysis increased as a direct function of both trypsin concentration and duration of substrate exposure (P < 0.0001). Fibrin lysis resulting from the urine of the transplant patient was 4.6 times greater than that predicted based upon assays of total trypsin content in the sample. Fibrinolytic activity in control urine specimens was 0.16% of that observed in transplant urine specimens. Exposure of the rat urinary bladder to 200 micrograms/ml trypsin concentrations, or transplant urine, resulted in a significant increase in bacterial adherence over that seen in control urine from treated animals (P < 0.05). These findings demonstrate a significant effect of urinary trypsin on physiologic processes involved in hemostasis and the prevention of urinary tract infection. Active urinary trypsin may play an etiologic role in hemorrhagic and infectious lower urinary tract complications observed in patients with a PDC.


Study of kidney and liver viability in the rat after exclusive aortic perfusion using intracellular ATP measurement. To find whether the liver can be procured after exclusive aortic perfusion, three organ perfusion models were used in three groups of donor rats. Group 1 underwent liver wash-out via the portal vein; in group 2, the kidneys alone were perfused via the aorta; and group 3 underwent simultaneous aortic perfusion of liver and kidneys. All perfusion flow rates in the three groups were adjusted to physiological values. Harvested organs were transplanted and recipient animals were killed 4 h after transplantation to study liver and kidney viability by using intracellular ATP measurement. Liver ATP was lower (P < 0.005) in the portal perfusion group (group 1: 1.396 +/- 0.412) than in the aortic perfusion group (group 3: 2.181 +/- 0.061). Kidney ATP was comparable in groups 2 and 3:1.066 +/- 0.09 vs 1.059 +/- 0.273 (mumol/g) tissue). Liver cooling was quicker with portal perfusion than with the aortic flush (20 degrees C in 20 s vs 15 degrees C in 60 s). Aortic perfusion at a physiologic flow rate has no detrimental effect on renal viability studied by intracellular ATP measurement. We conclude that liver cooling via the aortic route only is a good alternative to portal perfusion and seems to give good preservation. Application of this observation to emergency procurement in humans is still the subject of controversy.


Renal effect of dopexamine hydrochloride in patients with chronic renal dysfunction. Dopexamine hydrochloride, a dopamine analogue, has been reported, both experimentally and clinically, to increase renal blood flow (RBF) and improve renal function in normal kidneys. The availability of computer-enhanced radionuclide scintigraphy, which provides accurate non-invasive measurement of changes in RBF, enabled us to study the renographic effects of dopexamine hydrochloride in patients with chronic renal dysfunction (CRD). Ten patients suffering from CRD and ten normal kidney donors were the study population. Renography was performed, heart rate (HR) and blood pressure (BP) measured, and hematological and biochemical tests carried out before and after intravenous infusion of dopexamine 2 micrograms kg-1 min-1 for 60 min. The patient population displayed significant increases in total cortical and medullary RBF and renographic clearance rate (CR), while in kidney donors the RBF was increased in all kidney regions with no change in CR. HR increased in both groups, while BP showed no significant changes. The hematological and biochemical changes were transient and returned to preinfusion levels after 24 h. It is concluded that dopexamine hydrochloride 2 micrograms kg-1 min-1 increases RBF and CR in patients with CRD.


Low-voltage coagulation for welding sutures watertight: an experimental study. A rat model was developed to test the watertightness of sutures. In this model it was proved that welding by use of low-voltage coagulation current did not improve on the watertightness obtained with conventional skin suturing. The mean leak pressure after welding was about 4.2 cm H2O, i.e. statistically significantly lower than the mean leak pressure of the conventional suture, which is 14.1 cm H2O. Neither addition of protein solder nor an additional conventional suture improved these results. It is therefore concluded that low-voltage coagulation is unsuitable for welding tissues.


[Sex differentiation disorders from the andrologic viewpoint]. Abnormal sex differentiation with ambiguous genitalia now leads to prompt and comprehensive diagnostic evaluation in the neonate. If necessary, phenotypic gender assignment is done very early and appropriate surgical correction is performed. Management at puberty and later is more difficult. Andrological guidance at this time covers problems of genital identification, sexuality and fertility. The different types of abnormal differentiation, i.e. genetic, gonadal and phenotypic alterations, may result in different andrological problems, e.g. hypogonadism including micropenis and undescended testes, lack of secondary sex characteristics and impotence. With respect to fertility the major problems are testicular azoospermia and/or congenital abnormalities of the male reproductive tract. Any proposals for treatment have to take account of all these different aspects of pathogenesis and the natural course of the disease. In each case, andrological guidance must be formulated with due consideration for the results of genital determination in childhood, including surgical correction.


[Treatment of hypospadias].

[Treatment of hypospadias]. Treatment of all forms of hypospadias is difficult. Several abnormal components have to be differentiated and corrected in a very tight space, in addition to which the blood supply must be preserved and infection prevented. Technical progress now allows early correction (around the age of 12 months) in a single procedure, using methods that date back to the last century. Cosmetic results are as important as functional ones. The glans should be reconstructed around the neomeatus, and the penile shaft should be straight. Microsurgical techniques, short transurethral urinary diversion and reliable dressings are important. Strategies, the sequences of surgical procedures and a selection of practical methods are presented and discussed.


[Treatment of bladder exstrophy. Reconstruction or urinary diversion]. Bladder exstrophy is seen in 1 of 30,000-40,000 live births, and is seldom treated in many urological departments. Treatment options for children with exstrophy are upper urinary tract diversion or reconstruction of the bladder and plastic surgery of the bladder neck to gain urinary continence by the age of 4-7 years. Historical reviews report continence rates of 10-30% after a staged approach with primary reconstruction and secondary bladder neck repair. This formerly meant upper urinary tract diversion as a third stage in 70-90%. Multiple operative procedures could be avoided when primary diversion was done. The best results were reported following antirefluxive implantation of ureters into the sigmoid colon (ureterosigmoidostomy). In boys, the base of the bladder was removed, leaving a small residual bladder which together with the reconstructed epispadias served as a "seminal tract". Total removal of the bladder was performed in girls. Long-term follow up of upper urinary tract diversion showed disturbances of serum electrolytes, urinary tract infections and stone formation, and after ureterosigmoidostomies an increased rate of colon carcinomas was documented. These results led to renewed interest in reconstruction. The technique of bladder neck reconstruction was changed, resulting in a higher rate of late urinary continence: augmentation cystoplasties, clean intermittent catheterization and the artificial sphincter help to achieve a continence rate of more than 90%. This goal was reached only after multiple operations and without knowledge of the long-term sequelae of augmentation cystoplasties. The years to come will show whether new concepts of ureterosigmoidotomies, such as the sigma-rectum pouch, will be preferable, or a late urinary tract diversion after failed reconstruction. Most centers are now agreed that primary reconstruction of bladder exstrophy should be attempted in the newborn child.


[Neurogenic disorders of bladder emptying in closed spinal dysraphism]. Closed (occult) spinal dysraphism, e.g. lipomyelomeningocele, intraspinal lipoma, diastematomyelia, the tethered spinal cord in its various forms and dysgenesis of the sacrum, is often diagnosed late and only symptoms of neurogenic bladder dysfunction are present. A lipomyelomeningocele mostly causes detrusor and sphincter dysfunction, as was the case in five of six children among our patients. However, improvement of neurological and urological symptoms after the operation can only be achieved in about 40%. Four of eight children with diastematomyelia suffered from neurogenic bladder dysfunction; three have meanwhile undergone surgery with complete recovery in one, no relevant change in the second, and worsening in the third. Originally a specific term, the "tethered spinal cord" when associated with spinal dysraphism has taken on a more general meaning. Nowadays this term is not only used for a short, thickened and tight filum terminale, but comprises any pathology, which prevents the spinal cord from ascending. MRI examination of the craniovertebral junction and spinal cord of patients with treated myelomeningocele often reveals secondary pathologic changes: these may be areas of cord atrophy, hydromyelic cavitation or ventral compression from arachnoid cysts with clinical symptoms mostly after the age of 5 years. In these children a changing urodynamic pattern may therefore be caused by such a pathology and is an indication for a thorough neurological examination including MRI. Of all the dysrhaphic states mentioned above, sacral dysgenesis is the most frequent. The sacral osteological anomaly, as a numerical and as a structural anomaly, also determines the neuro-urological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)


[Idiopathic left-sided varicocele. An ontogenetic abnormality?]. Phlebograms for sclerotherapy of varicoceles were performed in 659 patients. In 484 cases no valves of the left spermatic vein could be demonstrated. However, 172 patients showed sufficient valves or absent insertions of the spermatic veins at typical point with retrograde flow through collaterals (persistent intercardinal anastomoses). The value of nutcracker phenomena I and II is discussed. Ontogenetic disorders in the development of the secondary abdominal venous system are responsible for the occurrence of the idiopathic left-sided varicocele.


[Obstructive uropathy after kidney transplantation. Experiences with endourologic incision of ureteral stenoses]. Between 1985 und March 1991 we have managed 8 upper urinary tract obstructions in kidney transplants using an endourological approach. After a graft rejection was excluded an obstruction was initially diagnosed by nephrosonography and further confirmed by IVP or antegrade pyelography. To investigate the urodynamic relevance of the stenosis, all patients underwent preoperative diuretic isotope renography. In all cases a percutaneous pyelostomy was done to preserve renal function. 7 of these 8 patients demonstrated a stenosis of the ureter, while in one case, the obstruction was caused by a coagulum in the renal pelvis. Incision of the stricture then was performed with a flexible knife antegrade or retrograde and stented for 4-6 weeks. In 6 out of 7 cases with a proven stenosis of the ureter, the cold knife incision lead to a successful outcome, while in one patient, the kidney had to be removed due to uncontrolled bleeding 12 days after successful percutaneous incision. Our results indicate, that the cold-knife-technique for the management of upper urinary tract obstructions in kidney transplants is a promising, fast and in most of the cases effective method. Due to its minimalinvasive character and excellent results, this approach is able to replace open reintervention in most cases.


[Vaginal estriol administration in treatment of postmenopausal urinary incontinence]. In an open, prospective, multicenter, controlled study, 629 female subjects suffering from stress and urgency urinary incontinence were treated with vaginally administered estriol at a dose of 0.01 g daily for 3 weeks, and 0.01 g bi-weekly for a further 3 weeks. All data of 552 patients were available at follow-up after 6 weeks of treatment. The subjective improvement in symptoms of stress urinary incontinence (SUI) was 82% for grade 1, 77% for grade 2, and 69% for grade 3. Voluntary urinary control and symptoms of urgency were improved in more than 80% of patients. Frequency was reduced in almost 50%. Compared with conditions at the outset of the study, after 6 weeks, vaginal lubrication is normal in 77%, and intercourse is no longer painful for 88%. Objective parameters were: no change in existing descent of the anterior vaginal wall, and normal cytoscopic findings in 66% of the patients in whom these were previously pathologic. Vaginal atrophy improved in approximately 40% of cases. A quality of life score revealed improvement in 72%, no change in 20% and worsening in 9% of patients compared with conditions at the start of therapy. During therapy, symptoms worsened in 1%; 2% of patients suffered from the adverse effects, with vaginal itching and burning sensations. Our results confirm the value of topical estrogen application as a cornerstone of efficient treatment of stress and/or urge incontinence in the postmenopausal patient.


Winter outbreaks of laminitis in dairy calves: aetiology and laboratory, radiological and pathological findings. During the winter months of 1984 to 1989, outbreaks of laminitis occurred in up to 6 per cent of all the dairy calves aged four to six months on a dairy farm in a village in Israel. The clinical signs were reluctance to move, an arched back, overgrown hooves, supracoronary swelling and occasional walking on the carpus; most of the calves were unthrifty. Owing to the regular recurrence of the disease, the feeding and haematological, radiological and pathological changes in both the affected and normal calves at the farm, and in normal calves at another farm in the same village were studied. In the affected calves there were significant increases in serum protein concentration and in the activities of creatine phosphotinase and gamma-glutamyltransferase. Radiography showed dilated PIII vascular channels and some PIII rotation. Post mortem studies revealed haemorrhages in the laminar section of the hoof. The management of the farms differed in the protein level of the milk replacer and the 'starter' diet used during the first few months. The affected farm used feeds containing 18 per cent digestible protein whereas the unaffected farm used feeds containing 15.3 per cent digestible protein.


Actinobacillosis in bovine caesarean sections. An infection with Actinobacillus lignieresii, which was spread by a veterinary surgeon, caused problems after caesarean sections in cows on several farms. The wounds became hard about six weeks after the operation, and a few weeks later small abscesses developed and later the wounds were covered with small and large granulomas. The general health of about 20 per cent of the affected cows was poor and in these cows multiple granulomas could be detected in the abdomen by rectal palpation.


[Nicotinamide coenzymes in the regulation of cellular metabolism in various types of diabetes]. Hypoglycemic and hypolipidemic effects of nicotinamide in insulin-dependent and noninsulin-dependent types of diabetes have been investigated. Hypoglycemic effect of nicotinamide in alloxan- and streptozotocin-induced diabetes resulted in activation of NAD+ biosynthesis and corresponding alterations in the redox state of free nicotinamide coenzymes. Increase in the free NAD+/NADH ratio was accompanied by inhibition of key gluconeogenic enzymes and by a decrease in the rate of 2-14C-incorporation into glucose in liver tissue and by inhibition of sorbitol formation in lens tissue. Nicotinamide exhibited hypolipidemic effect in db/db mice with noninsulin-dependent diabetes. The agent inhibited the enzyme of primary steps of lipogenesis, altered the structure of intercellular CoA pool and lowered the rate of lipid biosynthesis in liver tissue, thus normalizing blood lipoprotein compositions.


[The biological effectiveness of the proteins in the specialized product "Ovolact" in the nutrition of patients following reconstructive surgery on jaw bones with congenital deformities]. Postoperative feeding with a special-purpose foodstuff Ovolact proved superior to tube feeding in patients on after treatment following surgical correction of congenital jaw defects. This was evident from assessment of anthropometric and protein metabolism parameters. Nitrogen metabolism underwent positive changes reflecting the product value for maintenance of protein status of the above patients. Therefore, Ovolact can make more effective postoperative rehabilitation in jaw reconstruction.


[Seasonal dynamics of the indices of humoral immunity in children aged 3 months to 1 year in relation to nutrition in an arid zone]. The paper reports seasonal data on humoral immunity of 245 Turkmen and 240 European infants aged 3-12 months. Allowances were made for climatic conditions of the arid zone and essential feeding. In summer there were reduced levels of IgM, IgG in the serum and insufficient supply with thiamine and ascorbic acid. IgA serum level was the lowest in spring. IgA strongly correlated (r = 0.7-0.8) with thiamine and ascorbic acid intake in spring, IgM and IgG with retinol and thiamine in summer. The above changes in humoral immunity in summer are associated with growing incidence of intestinal diseases and lower body mass in the infants in the condition of arid zone.


[Polyvitaminization--an effective method of optimizing the vitamin status of children]. Insufficient vitamin value of the food rations for children at nurseries is expressed in lowered levels of vitamins and their metabolites in the urine, as well as in a higher frequency of vitamin and, particularly, polyvitamin deficiency in children, especially, in the winter-spring period. Improvement of the quality and increasing the quantity of food, prophylactic administration of polyvitamins in the periods of higher vitamin deficiency would be effective and real ways for optimization of vitamin status of children. Dragee "Undevitum" and "Hexavitum" proved to be most effective among the prophylactic polyvitamins, the synergy of action of their components provides the improvement in the values of renal excretion of vitamins and their metabolites, as well as reduction in the frequency of micro-symptoms of polyvitamin deficiency.


[The provision of vitamins to school children in rural regions of Lithuania]. Providing with vitamins of schoolchildren was studied in some regions of Lithuania during the winter-spring period. The biochemical blood count has revealed insufficient providing of schoolchildren with ascorbic acid, beta-carotene, vitamins B1, B2 and B6. Decreased levels of ascorbic acid in urine, as well as micro-symptoms of hypovitaminosis (ascorbic acid, thiamine and riboflavine deficiencies) have been recorded.


[Experimental basis for the use of vitamins in the multimodal treatment of stomatological diseases]. The "Aerovit" vitamin complex prevents metabolic acidosis development and increased the rate of oxidation in tissues, which is accompanied by predominance of oxidized metabolites of glycolysis and Krebs cycles, by activation of their key enzymes as well as by an increase in the ratio of SH/SS-groups in water-soluble protein and low molecular weight fractions, by a decrease in activity of lipase. At the same time, patterns of acid-alkaline equilibrium were normalized in blood. Preventive effect of the vitamin complex was noted in treatment of the diseases accompanied by acidosis; in parodontitis the vitamins suppressed the atrophy of maxillary alveolar bone structures, normalized the acid-alkaline equilibrium in blood and decreased the rate of metabolic acidosis in liver and bone tissues.


[The iron deficiency status and the actual nutrition of women in Gorno-Altai]. Standard methods (questionnaires, peripheral blood count, iron pool) were employed to study epidemiology (prevalence and risk factors) of iron deficiency in the women of the Altai mountains and the relation of this deficiency with essential nutrition. Hemoglobin dispersion was found to depend on fuel value of the ration, total protein levels, polyunsaturated fatty acid content.


[The status of the actual nutrition of pregnant women in an epidemically unfavorable region of Kazakhstan]. Questionnaire survey and body mass control followed by computer estimation of the diet chemical composition were conducted in 30 pregnant women in summer and autumn. Deficiency in intake of meat products, vegetable oil, potatoes reached 15.2-34.7, 24.2-55.8, 55-65.7%, respectively, in the trimester I and II. The dietary lack of fish, eggs, vegetables, fruit could be hardly compensated by bakery foods and sweets. Protein deficiency rose to 25-38.3%, that of fat 19.1-25.2%. Intake of carbohydrates was satisfactory, though mineral salts and vitamins were provided incompletely.


[The selenium content of food products and the blood of inhabitants of Norilsk]. The intake of trace element selenium by Norilsk citizens was assessed by its levels in the serum, food and soil. It was found that soil and food made in the Norilsk region are rich in selenium, its serum concentration in the population is normal (102 micrograms/l). References to such values for the Moscow and Zaporoje (Ukraine) regions are made. Low selenium levels in the serum may be indicative of pulmonary diseases.


[The effect of the zinc content in the rations of experimental animals on the absorption, distribution and accumulation of cadmium chloride in the body with different methods of administration]. Intravenous (20 kBk) and intragastric (400 kBk) cadmium chloride administration to 45 white noninbred rat males kept for a month on a semisynthetic isocaloric diet including 0.0005 and 0.001% zinc were evaluated for absorption and distribution. Radionuclide findings provided the conclusions that: the absence or excess of zinc in the diet stimulates cadmium absorption from gastrointestinal tract; cadmium distribution in the viscera (the liver, kidneys, pancreas) varies with route of entry, the least accumulation of oral cadmium in the above viscera is observed in animals receiving optimal zinc quantities.


[The effect of the composition of food rations on the free amino acid content and the indices of the acid-base balance in the blood during aging]. In experiments on aging rats fed 5 different rations by protein, tryptophan, prevailing base or acid equivalents it was found that tryptophan and plant protein deficiency, high levels of acid equivalents affect serum amino acid composition, aggravates acidosis. Restriction of basic food substances intake in parallel with prevalence of base equivalents made amino acid pool optimal, increased base serum reserves and contributed to longer life-span.


[The effect of water-soluble sorbents on the exocrine function of the liver]. The effect of water-soluble sorbents on exocrine function of the liver was studied in chronic experiments on 2 dogs with a brought out bile duct. It is shown that choline and digitonin sorbents exhibit choleretic properties similar to those of cholestyramine. Choline sorbent causes a drop in the concentration of (2-4-fold) cholic acid in the bile unlike digitonin sorbent. No prolonging action was seen upon cholestyramine administration, while choline sorbent do demonstrate it. Cholesterol and bilirubin levels do not respond noticeably to the above sorbents.


[The effect of protein-calorie food deficiency on the activity of enteral enzymes in growing rats]. 30-day changes in enteral enzymes were followed up in test and control growing white rats. Test animals received protein- and calorie-deficient feeding. It was established that retardation of growth was more marked in protein than in calorie deficiency.


[The effect of nutritional factors on lipid peroxidation in the microsomes of rats of varying ages]. 5-month- (mature) and 24-month-old (old) male Wag rats were examined for lipid peroxidation products and antioxidant enzymes activity in the liver cytosol. Imbalanced rations are shown to contribute to enhancement of lipid peroxidation entailing accumulation of lipid peroxidation products and inhibition of antioxidant enzymatic activity. Enrichment of food with antioxidant vitamins and fibers leads to lowering of age-related peroxidation.


[Experimental evaluation of the allergen activity of a peptide preparation produced from an enzymatic hydrolysate of milk proteins using ultrafiltration]. Noninbred guinea-pig experiments were performed to investigate specific potential allergenicity of cow milk proteins (CMP) consisting of casein (80%) and serum proteins (20%), of low-molecular peptides (LMP 20/80) produced from CMP 20/80 by enzymatic hydrolysis and ultrafiltration; to evaluate nonspecific effect of test diet CMP 20/80 and LMP 20/80 on anaphylactic response of the animals to ovalbumin and histamine LD50. LMP 20/80 versus CMP 20/80 had a hypoallergenic effect. Potential mechanisms of low anaphylactic sensitivity induced by LMP 20/80 are discussed.


[A comparison of methods of determining 4-pyridoxic acid in urine]. Routine fluorescent assays for urine 4-pyridoxic acid (4-PA) in variants of lactone 4-PA external standard (variant 1) and internal 4-PA standard (variant 2) were compared to high performance liquid chromatography. Correlation between the two values were defined by specially derived equation. The internal standard is preferable, as variant 1 presents underestimated results. Variant 2 is limited to high 4-PA concentrations, being unfit in low ones for overestimating the data. The chromatography proved most reliable and specific.


The Breast Cancer Prevention Trial (BCPT) in West Virginia. Female breast cancer is a major medical problem with significant public health ramifications. During the next decade, more than 1.5 million women in the United States will be newly diagnosed with invasive breast cancer. The Breast Cancer Prevention Trial (BCPT) is an NIH-sponsored study which will determine whether long-term tamoxifen therapy is effective in: 1) Preventing invasive breast cancer, 2) Lowering the incidence of fatal and nonfatal myocardial infarction, and 3) Reducing the incidence of bone fractures. Sixteen thousand women, including at least 100 from West Virginia who are > or = 35 years of age at increased risk for breast cancer, will be randomized between placebo and tamoxifen during a two-year period. For each participant, the annual and lifetime probability of developing breast cancer will be estimated utilizing a computerized model of risk assessment. The placebo or tamoxifen will be administered for at least five years. Toxicity, compliance, monitoring of quality-of-life assessment, and lipid and lipoprotein evaluations are major components of this trial.


Cardiopulmonary arrest in pregnancy: the role of caesarean section in the resuscitative protocol. A 36-year-old black multipara at 32 weeks gestation was referred with apparent peripartal cardiomyopathy. Upon arrival, she was found to be in pulmonary edema; and shortly thereafter developed cardiopulmonary arrest. She failed to respond to initial attempts at cardiopulmonary resuscitation but subsequently responded after Caesarean section and pericardiocentesis. This case exemplifies the unique aspects of performing cardiopulmonary resuscitation on a gravid female in the latter part of pregnancy and that Caesarean section should be considered an integral part of the resuscitative protocol when standard protocols fail.


Efficacious treatment of the common wart (verruca vulgaris). A relatively benign lesion, the common wart (verruca vulgaris), probably occurs sometime during the lifetime of most individuals. Since it is usually self-limited, it may attract little attention unless it appears on the sole of the foot, adjacent to a fingernail or toenail, or somewhere on the face. Anyone with a serious interest in the etiology of the wart is directed to the many excellent works on this and related viral lesions. The purpose of this paper is to tell of one doctor's search for a reasonable, non-surgical, non-invasive treatment that would be acceptable to most patients.


Tuberculosis chemoprophylaxis.

Tuberculosis chemoprophylaxis. The incidence of tuberculosis in the United States, after decreasing for many years, has recently begun to climb at an alarming rate. This rise is due mainly to excess cases in high-risk groups including human immunodeficiency virus-infected patients, the elderly, the foreign born, and the homeless. In the United States tuberculosis has been associated with a 10% mortality despite adequate treatment. The tuberculin skin test is a safe and inexpensive test for detecting tuberculous infection. To improve its predictive value the diagnostic criteria for classifying a positive reaction have recently been revised. High-risk populations should be screened to identify those persons who would most benefit from preventive treatment. Isoniazid therapy taken for 6 to 12 months is a safe and highly effective means of preventing tuberculous infection from developing into active disease. The most worrisome toxicity of isoniazid, fatal hepatitis, is extremely rare; when patients are monitored closely the incidence of death from hepatotoxicity is less than 0.01%.


The 10-year experience of an academically affiliated occupational and environmental medicine clinic. Occupational and environmental diseases are underrecognized. Among the barriers to the successful diagnosis, treatment, and prevention of these conditions are inadequate consultative and information resources. We describe the 10-year clinical and training experiences of an academically affiliated referral center that has as its primary goal the identification of work-related and other environmental diseases. The University of Washington Occupational and Environmental Medicine Program has evaluated 6,048 patients in its diagnostic and screening clinics. Among the 2,841 seen in the diagnostic clinics, 1,553 (55%) had a work-related condition. The most prevalent diagnoses included asbestos-related lung disease (n = 603), toxic encephalopathy (n = 160), asthma (n = 119), other specific respiratory conditions (n = 197), carpal tunnel syndrome (n = 86), and dermatitis (n = 82). The clinics serve as a training site for fellows in the specialty training program, primary care internal medicine residents, residents from other medical specialties, and students in industrial hygiene, toxicology, and occupational health nursing. The program serves two additional important functions: providing consultative services to community physicians and training specialists and other physicians in this underserved area of medicine.


Controlling a syphilis epidemic.

Controlling a syphilis epidemic. In 1986 the rate of infectious syphilis (primary and secondary) in Los Angeles County began to rise from previously stable levels of about 23.5 per 100,000 to peak at 55.6 per 100,000 in 1987. The incidence of congenital syphilis increased from 205 cases in 1987 to 575 cases in 1989. The county's Sexually Transmitted Disease Program instituted a disease-specific plan to address the epidemic. Factors considered in designing the program included the high morbidity and mortality associated with congenital infection, the existence of latent infection, self-limiting symptoms, and the availability of an inexpensive screening test and curative treatment. Policy changes implemented comprised expanded screening, expanded surveillance, increased contact tracing, and the initiation of condom promotion programs. To evaluate the relative effectiveness of Los Angeles County's syphilis control efforts, the epidemic curve for infectious syphilis was compared with trends in other urban areas. Although the rate of infectious syphilis climbed a year earlier in Los Angeles than in other cities, it returned to baseline levels when other cities' rates remained at epidemic levels.


Predicting risk for medical malpractice claims using quality-of-care characteristics. The current fault-based tort system assumes that claims made against physicians are inversely related to the quality of care they provide. In this study we identified physician characteristics associated with elements of medical care that make physicians vulnerable to malpractice claims. A sample of physicians (n = 248) thought to be at high or low risk for claims was surveyed on various personal and professional characteristics. Statistical analysis showed that 9 characteristics predicted risk group. High risk was associated with increased age, surgical specialty, emergency department coverage, increased days away from practice, and the feeling that the litigation climate was "unfair." Low risk was associated with scheduling enough time to talk with patients, answering patients' telephone calls directly, feeling "satisfied" with practice arrangements, and acknowledging greater emotional distress. Prediction was more accurate for physicians in practice 15 years or less. We conclude that a relationship exists between a history of malpractice claims and selected physician characteristics.


Gastrointestinal complications of nonsteroidal anti-inflammatory drugs. Nonsteroidal anti-inflammatory drugs have become increasingly popular, with more than 90 million prescriptions being written annually. These drugs inhibit the intracellular cyclooxygenase enzyme system, thus blocking the production of various prostaglandin compounds. This, in turn, interferes with normal mucosal protective mechanisms, leading to local injury. Gastrointestinal complications of nonsteroidal anti-inflammatory drug use include ulcerations, hemorrhage, perforation, stricture formation, and the exacerbation of inflammatory bowel disease. Treatment involves stopping the drug if at all possible and then instituting more specific therapy depending on the anatomic area that has been injured.


Personal renewal.

Personal renewal. After John Gardner's presentation on "Self-Renewal" to THE WESTERN JOURNAL OF MEDICINE Editors' Meeting, (*) Joseph Murphy, MD, Special Editor for Wyoming, asked the former Secretary of Health, Education, and Welfare, "Where are you in your life's cycle?" Dr Gardner, who is 80 years old, answered, "When Chief Justice Oliver Wendell Holmes, Jr, was in his 90s, he was asked a similar question and said, ;I'm like a race horse cantering along after the race is over, cooling down.' Well, I'm nowhere near cantering! I'm still in the race, pushing the world." race, pushing the world."John Gardner, who received his undergraduate degree from Stanford and PhD from the University of California, Berkeley, taught at the college level for several years before he joined the Carnegie Foundation. As president of Carnegie Corporation and Carnegie Foundation for the Advancement of Teaching, he began to "push the world" toward education and in 1964 received the country's highest civilian honor, the Presidential Medal of Freedom. He has also pushed it toward political reform by founding Common Cause, toward grass-roots political action by founding the Urban Coalition, toward leadership training by founding the White House Fellows program, and toward volunteerism by founding the Independent Sector (a coalition of for-profit and not-for-profit organizations and foundations). His books, including Excellence, Self-Renewal, No Easy Victories, and On Leadership, have pushed readers to new understanding of themselves and of organizations to higher levels of creativity and energy to get important work done. His current research focuses on discovering and defining the characteristics of healthy, vital communities. His call to "keep on keeping on," indeed, to push the world, leads to constructive change. Active people become effective people, infused with the energy and optimism that good hard work inspires. I think you will find this paper as invigorating to read as it was to hear.


[Biochemical indicators of the nutritional status of the body in various diseases of the digestive system]. In 45 patients with chronic digestive tract diseases (gastric and/or duodenal peptic ulcer, cholecystolithiasis, conditions after gastrectomy and cholecystectomy) the biochemical parameters serving as indicators of the nutritional status of the organism (Hb, Bc, Fe, Ca, alkaline phosphatase) were determined. In the group with postgastrectomy syndrome the serum calcium level was decreased. The other parameters were normal in all groups of patients.


[Appendicitis and its atypical causes].

[Appendicitis and its atypical causes]. The authors analysed 2849 patients who were admitted to the Department of General Surgery, Regional Hospital in Pisz in the years 1980-1989 with symptoms suggestive of appendicitis. In 983 cases surgical intervention was abandoned, because the symptoms regressed spontaneously or were caused by diseases of other organs. The pathological conditions associated with appendicitis are analysed in 1866 surgically treated patients. Cases of appendicitis caused by Oxyuris vermicularis, Salmonella-enteritidis and actinomycosis (one case each) and appendicular carcinoma (2 cases) are described in more detail. Attention is called to the aetiology, pathogenesis and treatment of these rare causes of appendicitis.


[Cigarette smoking as a risk factor of premature labor]. The effect of cigarette smoking by parents on the incidence of premature labour was analysed. Premature labours accounted for 14.1% of all labours. Cigarette smoking by pregnant women was a significant risk factors for prematurity, it increased significantly hypoxia caused by chemical pollution of the environment and contributed to intrauterine hypotrophy in premature babies. The per cent of smokers among premature babies with normal weight was 37.4%, but among premature babies with the syndrome of intrauterine hypotrophy it was 58.4%. The per cent of heavy smokers was significantly in the group of premature babies, and also the duration of smoking habit by mothers was longer.


[Acute appendicitis in pregnancy].

[Acute appendicitis in pregnancy]. A retrospective analysis is reported of 110 pregnant women with acute appendicitis on the basis of inquiry with participation of 23 surgical centres in the period 1979-1989. Attention is called mainly to diagnostic difficulties and peculiarities of the clinical course of this acute abdomen syndrome in pregnancy. The authors found that acute appendicitis was most frequent in primiparae in the 1st and 2nd trimester of pregnancy and the always high mortality was caused mainly to delay of operation.


[Evaluation of N-acetyl-beta-D-glucosaminidase (NAG) and its isoenzyme activities in the urine of children with primary and secondary hypertension]. The total activity of N-acetyl-beta-D-glucosaminidase (NAG) and its isoenzymes A and B was determined in the urine of 18 children aged 9-18 years with essential hypertension and 21 with nephrogenic hypertension. The results were compared with those in a control group of 30 healthy children. The obtained results show that in children with stabilized hypertension (above the 95 centile) of essential type the proportion (above the 95 centile) of essential type the proportion of urinary isoenzymes are changes, with higher activity of the B isoenzyme. On the other hand, in children with nephrogenic hypertension the total activity and the activity of the B isoenzyme are increased. After reduction of blood pressure following hypotensive treatment (below the 90th centile) the activity of NAG and its isoenzymes was again normal in essential hypertension and was much reduced in nephrogenic hypertension. The study demonstrated that hypertension leads to transient damage to the proximal tubules which is reversed by effective hypotensive treatment.


[Mediastinal infiltration in children with acute lymphoblastic leukemia]. The clinical and haematological analysis is presented of six out of 68 cases of acute lymphoblastic leukaemia in children. In these six cases mediastinal involvement was found. They accounted for 8.8% of all patients and all were boys aged over 4 years. In all these cases the course was dramatic, with high risk and with signs of poor prognosis: infiltration of organs, very high leucocyte counts. T-cell blasts. The evident clinical uniformity of the symptoms and laboratory similarity of these cases suggest that they should be isolated as a separate subgroup, and therapeutic failures observed as yet indicate the necessity of caution in prognosis.


[Lyme disease--also a childhood disease]. In the light of a survey of the world literature Lyme borreliosis, an epidemic disease caused by gram-negative organisms Borrelia burgdorferi is described. The disease has three phases with involvement of the skin, the nervous system, the cardiovascular system and joints. Treatment with antibiotics is effective. The disease lies in the fields of interest of various specialties including paediatrics.


[Controversies regarding the use of 0.75% bupivacaine]. Controversies are described regarding wide introduction of bupivacaine with raised concentration (0.75%) of the active components, which has been introduced in other countries in the strongest local anaesthetic agent used as yet but in early 1980s it has been withdrawn from several western countries in view of possible serious cardiovascular side effects. Presently, after a number of studies it been demonstrated that these suppositions were unfounded and the observed complication were due errors in anaesthesiological techniques and not to an exceptional cardiotoxicity of the drug.


[A case of histiocytosis X complicated by recurrent spontaneous pneumothorax]. A rare case of the generalized of histiocytosis X is described. Due to pulmonary involvement the disease was complicated by three episodes of spontaneous pneumothorax.


[A case of nephrotic syndrome in chronic glomerulonephritis with coexistent diffuse thrombophlebitis]. A case is described of nephrotic syndrome with coexistent thrombosis of the splenic vein and the common iliac veins. The possible pathological mechanism of tge disease and the therapeutic and diagnostic difficulties during this disease superimposed upon chronic glomerulonephritis are discussed.


[A case of bilateral acoustic neuroma in a 19-year-old girl]. A rare case of bilateral neurinoma of the acoustic nerve is described. The patient was a girl aged 19 years without external evidence of von Recklingshausen disease.


[Acute encephalopathy in ethylene glycol poisoning]. Poisoning with ethylene glycol is the most frequent poisoning in our country. Acute encephalopathy during this poisoning may be a cause of important diagnostic difficulties, especially in the initial phase of the poisoning, due to the variety of symptoms and signs. Three cases of this poisoning are reported. All patients were erroneously referred and admitted to neurological hospital department. It is postulated that in each case of coma of unknown aetiology with signs suggesting damage to the brain stem and hyperventilation arterial blood gasometric examination should be done and blood and urine should be taken for toxicological investigations. In the treatment of glycol poisoning the most important task is to correct metabolic acidosis and to apply early dialysis treatment in serious intoxication.


[Evaluation of the effectiveness of delayed-action propranolol in the treatment of arterial hypertension]. The reported study was carried out in 25 patients aged 21 to 58 years with essential hypertension in second stage of WHO classification. During three months in 10-day courses they were given alternately 1 placebo tablet or 160 mg propranolol retard in one dose daily. The values of the heart rate and blood pressure were compared before and after the treatment. A significant decrease of systolic and diastolic blood pressure and heart rate was noted. The comparison of blood pressure and heart rate values after 10 days on propranolol with those before the treatment showed a statistically significant reduction of these parameters. This is an evidence that the hypotensive action of propranolol retard develops already during 10 days of treatment.


[Diagnostic difficulties in pleural mesothelioma]. The analysis is reported of 29 case records of patients admitted in the last 25 years to the Department of Pulmonary Diseases and Tuberculosis, Medical Academy in Gdańsk with suspected pleural malignant mesothelioma. In 16 cases the diagnosis was confirmed by histological examination, and in 13 cases the diagnosis of mesothelioma was based on the whole clinical picture and cytological examination of pleural effusion. The most frequent symptoms included dyspnoea, pain, progressing weakness. In most cases signs of increasing effusion volume and sometimes also of pleural thickening were found on medical and radiological examination. The mean survival time was 5 months. The results of treatment were not satisfactory.


[Epidemiology of cholelithiasis among professionally active persons in the Katowice province]. In the workplaces of the City of Katowice 2867 subjects in 5 age groups were studied by inquiry, physical examination and gallbladder ultrasonography. Calculi in the gallbladder were found in 344 subjects that is 11.99%. The prevalence of calculi was much higher in females, and in both sexes it increased with age. The study confirms the value of USG in the diagnosis of gallbladder calculi and the possibility of its use for screening of the general population.


[N-acetyl-beta-D-glucosaminidase and diurnal excretion of hydroxyproline in chronic viral hepatitis]. In 37 patients with chronic active hepatitis, in 14 with chronic persistent hepatitis and in 11 with normal histological pattern of the liver the serum activity of N-acetyl-beta-glucosaminidase and the 24-hour excretion of hydroxyproline with urine were determined. The 24-hour excretion of hydroxyproline was similar in all groups of patients, while the activity hepatitis and higher than in those of chronic persistent hepatitis (36.9 +/- 12.9 i.u. per 100 ml versus 22.4 +/- 8.2 i.u. per 100 ml, p less than 0.05). In patients with high serum NAGL activity cirrhosis developed significantly more frequently.


[Dynamics of the changes in insulin requirement during the treatment with biosynthetic human insulin]. In 20 patients treated previously with porcine insulin human recombined insulin Eli Lilly was tried. During one year of its use under strict therapeutic conditions a significant decrease of the requirement for insulin was achieved, especially in the first three months of the trial, especially in patients with shorter duration of diabetes. At the same time, carbohydrate metabolism improved significantly. No side effects of the new insulin were noted.


[Microbiological evaluation of the effectiveness of gynalgin in the treatment of vaginitis]. The microbiological effectiveness of the preparation Gynalgin produced by POLFA Pharmaceutical Works in Rzeszów was assessed in cases of vulvovaginitis in 55 patients with clinically diagnosed inflammatory conditions of the lower genital tract, who were given Gynalgin tablets in 10-day courses. Vaginal smears were examined three times for the presence of bacteria, fungi and trichomonas vaginalis (before and immediately after the treatment, and two weeks later). In the initial examination in five vaginal smears mixed bacterial flora was found, in 6 smears trichomonas was present, in 4--bacteria and fungi, and in one--trichomonas and fungi. After the treatment in control examinations I and II the number of the isolated bacterial strains was lower, trichomonas was no longer present, and the number of fungi was reduced evidently. In the light of these microbiological examinations Gynalgin was found to exert a strong fungicidal, bactericidal and antitrichomonal activity, and the results of laboratory investigations agreed with those of clinical trials of Gynalgin effectiveness.


[Thrombocytopenia in newborn infants caused by autoimmune thrombocytopenic purpura in their mothers]. Five cases of congenital thrombocytopenia caused by immunological thrombocytopenia in mothers are presented. In one newborn whose mother had normal platelet count after splenectomy performed for ITP transient congenital thrombocytopenia was observed after birth. One child died due to intracranial hemorrhage. Practical conclusions are presented with regard to the diagnosis and management of neonatal thrombocytopenia caused by maternal ITP, and prophylactic management is suggested to prevent the complications of neonatal thrombocytopenia in case of maternal ITP.


[Evaluation of physical fitness of children with mitral valve prolapse into the left heart atrium]. Effort tolerance was assessed in 25 children with idiopathic syndrome of mitral valve leaflet prolapse into the left atrium. The children were aged 9 to 15 years. The results of the ergometric test confirmed the clinical observations suggesting that children with the syndrome tolerate exercise as well as their healthy peers.


[The so-called stroke headache].

[The so-called stroke headache]. Sudden violent headache occurring for the first time in life suggests subarachnoid haemorrhage and requires diagnostic management. In 20 cases the authors failed to find blood in cerebrospinal fluid, but in 8 cases the protein level was raised. The patients were examined again after 2-10 years, and had control neurological examination and CT of the brain. In half the cases similar headaches returned after various time periods, and haemorrhage was again ruled out. In all patient chronic headaches of lower intensity developed. Control CT examination showed in 7 cases scars or atrophy of brain tissue. It is difficult to qualify such headaches as migraine and other known types of headache. Recently in the literature a new name has been coined for them--thunderclap headaches, and some authors regard them as a sign of minor intracranial haemorrhage. CT changes, raised protein level in cerebrospinal fluid, and the type of pain may suggest haemorrhage. The usefulness of cerebral arteriography in such patients should be considered. We propose the name of stoke headache for suggesting the cause and special management.


[Evaluation of glucose and cholesterol levels in the mother and newborn infant in the perinatal period]. In 30 live born newborns the connections were assessed between glucose and cholesterol levels in umbilical cord blood after birth, and also in maternal blood before and two days after birth. Statistically significant differences of glucose and cholesterol levels were found between mothers and newborns in the perinatal period. Attention is called to greater independence of cholesterol (total, free and esterified) levels in newborn and mother in perinatal period.


[Arterial hypertension and arrhythmia].

[Arterial hypertension and arrhythmia]. In patients with hypertension and presence of left ventricular hypertrophy arrhythmias of ventricular origin occur more frequently than in hypertension without this hypertrophy. Ventricular arrhythmias predispose to sudden death. It is accepted presently that left ventricular hypertrophy in patients with hypertension should be regarded as an additional risk factor for sudden death. The use of hypotensive drugs reducing the mass of the myocardium may be justified.


[Viruses and bacteria in the etiology of acute respiratory tract infections in young children]. Respiratory infections in small children are among the major problems in paediatrics. They are caused most frequently by viruses or bacteria. The role played by certain types of respiratory viruses in these infections is discussed, considering selected subgroups of children and the seasonal incidence of infections. The usefulness of certain virological investigations in clinical diagnosis is analysed. In the description of bacterial respiratory infections in small children attention is called also to certain bacteria belonging to opportunistic commensals and the importance of anaerobes. The main stress is laid on infections of newborns and infants which may be connected with the transfer of pathogens from mothers. Attention is called to the necessity of close monitoring of the aetiological factors of acute respiratory infections in the youngest children which could increase the accuracy of therapeutic management and prophylactic measures which should be regarded as a very important factor in the control of these infections.


[Clinical picture of tuberculous peritonitis]. The clinical picture of tuberculous peritonitis in productive form with formation of an abdominal tumour 18 x 20 cm in dimensions is described. The patient was a boy aged 19 years from rural environment. The diagnosis was based on bacteriological investigations, histological examination and clinical manifestations. Attention is called to diagnostic difficulties in cases of tuberculous peritonitis without positive tuberculin tests and with pulmonary fibronodular tuberculosis.


[Congenital toxoplasmosis in a 6-week-old infant]. A case of congenital toxoplasmosis was observed in an infant aged 6 weeks with fatal outcome. Histological changes produced by Toxoplasma gondii in the brain are described.


[Steroid-resistant nephrotic syndrome in 2 children with milk protein intolerance]. Two cases of steroid-resistant nephrotic syndrome with mesangial proliferation were observed in which prednisone treatment resulted in remission only after milk-free diet. In both children intolerance to cow milk protein was demonstrated, and in one of them a family history of this intolerance was elicited.


[Metastasis of penile cancer to the heart in a 20-year-old patient]. A case of penile cancer was observed in a 20-year-old patient with very extensive remote metastases. On autopsy metastases were found to the heart and brain which are exceptionally rare in penile cancer.


[A rare case of tuberculosis of the maxilla, zygomatic region, maxillary sinus and facial skin in a patient with diabetes mellitus]. In an 82-year-old female diabetic tuberculosis involved the maxilla, zygomatic region, maxillary sinus and facial skin. No other foci of tuberculosis were found in the organism. The diagnosis and treatment are described stressing the extreme rarity of this involvement by tuberculosis.


Women and sexually transmitted diseases. This paper presents a brief review of historical developments in women's health care. It describes the current campaign against sexually transmitted diseases (STDs) and assesses the campaign's success in light of its history and the reality of women's lives. The authors suggest that women are forced into a double-bind in which they are expected to take responsibility for the prevention of STDs although they may not have the ability to do so. Modifications are suggested which take into account gender-role socialization and social group norms.


Sociodemographic correlates of alcohol consumption among African-American and white women. Correlates of abstention and heavier drinking were examined among 654 African-American and 474 white women, aged 19-70+, from a representative sample of households in Erie County, New York. Discriminant function analysis was employed to investigate the relationship between alcohol consumption and race, age, church attendance, family history of alcohol problems, household density, marriage, socioeconomic status (SES), employment and parity. Abstention was compared with drinking, and light/moderate drinking was compared with heavier drinking in the total sample and within each race. Compared to drinkers, abstainers were older, more religious, more likely to be African-American, or to be of lower SES. Racial differences in the correlates of abstention were found with respect to church attendance (positive association in African-Americans only), SES (negative association in African-Americans only), and household density (positive association in whites only). Compared to light/moderate drinkers, heavier drinking women were younger, less religious, more likely to be white, to have a positive family history, or to live in less crowded households. Racial differences in the correlates of heavier drinking were found with respect to church attendance (negative association in African-Americans only), parity (positive association in African-Americans only), and marital status (more heavier drinking among unmarried white women). Racial differences in the correlates of alcohol consumption document the need for further examination of the culture-specific determinants of women's drinking patterns.


Secretaries, depression and absenteeism. This study examines the prevalence of Major Depressive Disorder; missed work; and mental health services use among secretaries and other women employed full-time. In a random sample of 3,484 women employed full-time, women employed as secretaries were significantly more likely to be depressed than other women even after controlling for socio-demographic characteristics (odds ratio = 1.69, 95% confidence interval = 1.05, 2.73). Secretaries were significantly more likely to report missing work in the last three months (odds ratio = 1.77, confidence interval = 1.01, 3.11); a finding not attributable to depression. Secretaries were also more likely to seek mental health services, but this finding was not significant (odds ratio = 1.78, confidence interval = 0.55, 5.78). It is possible that these findings are attributable to a selection effect whereby depressed women, and women who are likely to miss work, become secretaries. A second possibility is that women employed as secretaries have more "nonwork role stress" than other employed women. Alternatively, job conditions which result in dissatisfaction and stress may lead to depression and absenteeism. We believe our findings warrant further investigation into the work environment of secretaries.


Sexual exploitation in advertising health and wellness products. This paper examines the way women are portrayed by the media in photographs advertising health and wellness products. Data were collected from five different health and fitness magazines. For purposes of this study, only advertisements in which women appeared were used in the analysis (N = 191). Findings suggest that a high percent of advertisements: (1) place women in submissive positions to men; (2) place women in unnatural poses; (3) emphasize dismemberment of body parts; (4) focus on sexuality rather than wellness.


Primary care arrangements and access to care among African-American women in three Chicago communities. African-American women of child-bearing age residing in three high-risk communities in Chicago were surveyed regarding their primary care arrangements and access to care (n = 552). This study examined factors which differentiated women who used office-based practices from those who used institutional settings (community clinics, health department clinics, hospital-based clinics) for primary care. Results of multivariate analysis indicate that women who used office-based practices were more likely than those who used institutional settings to see the same provider, to walk to their provider, to have less travel time and to walk in without an appointment. They were less likely to be hospitalized in the past year and less likely to report the availability of family planning at their usual source of care. Satisfaction with care, insurance status and sociodemographic characteristics were not associated with use of a particular facility type. Implications for organizing comprehensive health services for this population are discussed.


Surgical treatment of immune thrombocytopenic purpura. The role of surgery in the treatment of immune thrombocytopenic purpura (ITP) is still discussed. The aim of this study was to verify our criteria of patient selection for splenectomy, to analyze the results of a protocol for the evaluation of the hemorrhagic risk, and to discuss long-term results of 70 patients with ITP who underwent surgical treatment from 1984 to 1990. All patients received steroid therapy. Sixty-two patients were given high doses of IgG (600 mg/kg/iv bolus) pre-operatively in order to obviate the need for intra-operative platelet transfusions. Forty-three patients showed a significant increase in the platelet count, 8 a moderate increase, while 11 patients did not respond. No operative mortality was observed, however postoperative minor complications occurred in 14 (20%) patients. Accessory spleens were found in 11 (15.7%) patients. Mean follow-up was 21 months. Response to splenectomy was considered as complete (platelets greater than 150,000 mm3 with no need for medical treatment) in 63 (90%) patients. No response was observed in 7 patients. In 2 of the non-responders postoperative indium-111 scan revealed accessory spleens and ITP remitted after accessory splenectomy. All non-responders were in the group of patients who did not respond to the pre-operative infusion of high dose IgG. It can be concluded that splenectomy is a safe and effective treatment for ITP and that response to pre-operative infusion of IgG may be considered as predictive for the outcome after splenectomy.


Small bowel anastomosis with the biofragmentable anastomosis ring and manual suture: a prospective, randomized study. A total of 170 patients undergoing upper gastrointestinal surgery requiring a jejuno-jejunal enteroanastomosis were randomized into two groups according to the method to be employed at the enteroanastomosis. The most common procedures were partial gastrectomy for benign disease (84 patients), partial or total gastrectomy for malignant disease (35 patients), and bilioenteral bypass (31 patients, 25 for malignant disease). The enteroanastomosis was created by manual suture (3-0 Dexon, two layers) in 89 patients and with the Biofragmentable Anastomosis Ring (Valtrac-BAR) in 81 patients. Both end-to-side (101 patients) and side-to-side (69 patients) reconstructions were done. No ruptures or obstructions of the jejuno-jejunal anastomosis occurred. The postoperative recovery of the gastrointestinal tract was similar in the two groups in duration of nasogastric drainage, intravenous fluid therapy, and intestinal paralysis. Nor was there any difference between the groups in the duration of the postoperative hospital stay. Ten patients, 7 in suture-group and 3 in BAR-group, died postoperatively of causes unrelated to the enteroanastomosis. Thus the mortality rate was 7.9% in the suture group and 3.7% in the BAR group. The biofragmentable ring offers a safe alternative to manual sutures for small bowel anastomoses.


Chondrosarcomas of the head and neck.

Chondrosarcomas of the head and neck. Chondrosarcomas of the head and neck are uncommon. Over a 35-year period (1950-1985) at our institution, 557 patients had an established diagnosis of chondrosarcoma. In 28 (5%) of these patients, the tumor was located in the head and neck region. A retrospective analysis was performed in an attempt to accurately define clinical characteristics, management, and outcome in these 28 patients. The patient population consisted of 15 males and 13 females whose ages ranged from 10 to 72 years, with a median of 38 years. Ten (36%) patients were untreated and 18 (64%) previously treated patients were referred for further management. The primary sites were maxilla (11), cervical vertebrae (7), mandible (3), skull (2), sphenoid and ethmoid sinuses (2), frontal sinus (1), nasal septum (1), and orbit (1). Lesions arising in the larynx were excluded from this study. The most common presenting symptom was a painless mass. Surgery was the definitive treatment in all patients. However, adjuvant radiation therapy or chemotherapy was utilized for residual disease in almost half of the cases (13 patients). Follow-up ranged from 5 to 35 years. Twelve (43%) of the 28 patients were known to be alive and free of disease more than 5 years after surgery. The most common cause of death was uncontrollable local disease (88%). However, only 3 of the 10 previously untreated patients developed local recurrence. For all patients, the median interval from time of first recurrence until death was 25 months (range 6 to 70 months). Positive margins in 8 of 12 patients resulted in local recurrence and eventual death.(ABSTRACT TRUNCATED AT 250 WORDS)