Effect of Buckberg cardioplegia and peripheral cardiopulmonary bypass on infarct size in the closed chest dog. To simulate a human catheterization laboratory setting of controlled reperfusion during myocardial infarction, regional infusion of commercially available Buckberg cardioplegic solution and peripheral vented bypass were administered in the closed chest dog. Studies in open-chest dogs have demonstrated a significant reduction in infarct size and improvement in regional wall motion with a similar controlled reperfusion method using infusion of substrate-enriched (Buckberg) cardioplegic solution during cardiopulmonary bypass coupled with left ventricular venting. After 100 or 180 min of balloon occlusion of the proximal left anterior descending artery, controlled reperfusion was performed with cardioplegic infusion and vented bypass. Dogs matched for occlusion time underwent balloon deflation without bypass or cardioplegia (uncontrolled reperfusion groups). Microspheres were used to quantify coronary ischemia during balloon inflation. All four groups (n = 8 to 9 per group) were followed up at 1 week to determine regional wall motion and infarct size. Qualitative echocardiographic analysis demonstrated no significant difference among groups in recovery of regional wall motion at 1 week; however, wall motion improved significantly in all groups between the ischemia and 1-week recovery periods. The histologic infarct size compared with the area at risk for dogs with uncontrolled versus controlled reperfusion, respectively, was 17.9 +/- 10.5% versus 31.9 +/- 8.3% (p < 0.05) for dogs with 100 min of occlusion and 40.1 +/- 11.7% versus 46.2 +/- 8.4% (p = NS) for dogs with 180 min of occlusion. A greater rate-pressure product in the dogs with controlled reperfusion after 100 min of occlusion (p < 0.05) may explain the larger infarct size observed for that group. These results demonstrate that regional infusion of substrate-enriched cardioplegic solution in combination with peripheral vented bypass does not further reduce infarct size after prolonged ischemia in the closed chest dog (compared with uncontrolled reperfusion).


Effect of chronic supraventricular tachycardia on left ventricular function and structure in newborn pigs. The purpose of this study was to examine the effects of supraventricular pacing tachycardia on left ventricular function and myocardial structure in newborn, immature pigs and to determine whether immature pigs respond to supraventricular tachycardia differently from adults. Previous studies have shown that supraventricular tachycardia causes dilated cardiomyopathy in adult animals; however, in humans, supraventricular tachycardia-induced congestive heart failure occurs most frequently in children and newborns. Because some clinical diseases may cause myocardial failure in adults but rarely do so in children, it was hypothesized that the effects of supraventricular tachycardia in newborns may be different from those in adults. In two groups of newborn swine (3 weeks of age), left ventricular volume, mass and function were assessed with simultaneous echocardiography and cardiac catheterization and myocardial structure was examined with light and electron microscopy. Six piglets underwent 3 weeks of left atrial pacing tachycardia (240 beats/min) and six littermates served as a control group. Both groups were followed up for 3 weeks. At the end of the protocol, left ventricular dimensions increased in the piglets with supraventricular tachycardia compared with values in the control group, but there were no differences in left ventricular mass. Systolic function, assessed by fractional shortening, peak ejection rate and maximal rate of pressure development, was decreased in the group with supraventricular tachycardia. The fractional shortening-end-systolic stress relation in the piglets with supraventricular tachycardia decreased below normal values. Left ventricular diastolic function assessed by the relaxation time constant was prolonged, the peak filling rate was decreased and left ventricular stiffness was increased in the supraventricular tachycardia group. The morphologic data demonstrated that supraventricular tachycardia did not change total myocyte volume but did decrease total myofibrillar volume. Supraventricular tachycardia caused dilated cardiomyopathy in immature pigs. These changes in left ventricular function were associated with a decrease in cellular contractile proteins. Thus, the effects of supraventricular tachycardia on left ventricular function and structure in immature animals were comparable to previous findings in mature animals.


Echocardiographic "smoke" is produced by an interaction of erythrocytes and plasma proteins modulated by shear forces. This study was designed to determine the blood elements responsible for spontaneous echocardiographic contrast. Spontaneous contrast or "smoke" is an echocardiographic image usually found in low flow conditions. Two blood elements, erythrocytes and platelets, have been related to the generation of smoke. The echogenicity of porcine blood products was assessed in static and flow conditions and was graded on a digitized videodensity computer program that assigned a score of 0 for black and 100 for white images. Blood elements were circulated from a small tube (4-mm diameter) into a larger cylindric chamber (30-mm diameter) under controlled flow rate conditions. The following blood products were studied: whole blood, platelet-depleted blood, platelet-rich plasma, platelet-poor plasma, erythrocytes suspended in saline solution, adenosine diphosphate (ADP) added to platelet-rich plasma, and saline solution as a control medium. As blood flow was increased in 30 ml/min increments from 0 to 180 ml/min, whole blood echo videodensity (scale 0 to 100) progressively decreased in the larger tube from 38 and 42 to 20, 12, 14, 16 and 14, respectively. When flow increased from 0 to 30 ml/min in the smaller tube, corresponding to a wall shear rate of 0 to 80 s-1, the blood entering the chamber was completely echolucent. The echogenicity of blood products in the larger tube was for static flow (0 ml/min) and high flow (180 ml/min), respectively: platelet-depleted blood = 36 and 14; platelet-rich plasma = 2 and 2; platelet-poor plasma = 0 and 0; erythrocytes in saline solution = 8 and 12; ADP added to platelet-rich plasma = 0 and 15; saline solution = 0 and 0. Because platelets alone were nonechogenic but platelet-depleted blood produced a flow-dependent echogenicity similar to that produced by whole blood, platelets may not be involved in the production of smoke. However, when platelets were aggregated by ADP, they were echogenic but in dense clumps and in a flow-independent pattern not typical of the smokelike images. Erythrocytes suspended in saline solution had an intermediate density image. Echogenic smoke appears to be due primarily to the interaction of red blood cells and plasma proteins at low flow and low shear rate conditions.


Choline: an important nutrient in brain development, liver function and carcinogenesis. Choline is required to make certain phospholipids which are essential components of all membranes. It is a precursor for biosynthesis of the neurotransmitter acetylcholine and also is an important source of labile methyl groups. Much attention has been given to the effect of supplemental choline upon brain function, i.e., enhancement of acetylcholine synthesis and release. In addition, choline supplements administered to rats in utero or shortly after birth permanently after brain function. The mechanisms for this effect is unknown and under investigation at this time. Healthy humans fed diets deficient in choline, and humans fed parenterally have decreased plasma choline concentrations and develop liver dysfunction that is similar to that seen in choline-deficient animals. In experimental animals, fatty liver occurs in choline deficiency because phosphatidylcholine synthesis is required for very low-density lipoprotein secretion. This accumulation of lipids in liver may explain why choline-deficient rats spontaneously develop hepatocarcinoma. We found that choline deficiency was associated with the accumulation of 1,2-diacylglycerol, an activator of protein kinase C. Several lines of evidence indicate that cancers might develop secondary to abnormalities in protein kinase C-mediated signal transduction.


Effect of interleukin-2 on some micronutrients during adoptive immunotherapy for various cancers. In 20 patients, we investigated the effect of interleukin-2 (IL-2) treatment during adoptive immunotherapy for various cancers on circulating levels of: thiamin; biotin; folate; pantothenate; riboflavin; nicotinate; vitamins A, B6, B12 and E; carotenes; free and total cholines; inositol; and free and total carnitines. Of the above micronutrients, only vitamins A, B6, B12, inositol, carotenes and folate varied markedly from normal levels (pre IL-2 exposure) to abnormal levels (post IL-2). Following IL-2 exposure, every patient's B12 level was significantly elevated; 50% of the levels were abnormally increased above 1000 pg/ml. Extreme significant elevations of inositol were also seen in 90% of the patients. In contrast, IL-2 exposure depressed normal vitamins A, B6, carotene, and folate levels to subnormal; 90% of the patients became B6 hypovitaminemic; 60% for vitamin A, 80% for carotene, and 45% for folate. Other micronutrients tested showed no clear deviations from normal levels post IL-2 exposure. Some reasons for micronutrient variations are discussed.


Vitamin E and cancer prevention: recent advances and future potentials. Many animal and in vitro experiments have shown that the supplementation of diet with vitamin E within a certain dose range reduced the risk of chemical- and radiation-induced cancers. In vitro studies revealed that alpha-tocopheryl succinate (TS) induced differentiation and growth-inhibition in certain animal and human tumor cells in culture, whereas alpha-tocopherol (alpha-T), alpha-tocopheryl acetate (alpha-TA) and alpha-tocopheryl nicotinate (alpha-TN) were ineffective, alpha-TS also reduced basal and ligand-stimulated adenylate cyclase activity, and expression of c-myc and H-ras oncogenes in certain tumor cells in culture. The relative efficacy of various forms of vitamin E in cancer prevention in animal or human models has not been evaluated. Human epidemiologic studies utilizing retrospective and prospective case-control experimental designs are not suitable for evaluating the role of vitamin E in cancer prevention due to several inherent problems associated with these methodologies. Intervention trials utilizing vitamin E with appropriate biological and statistical rationales are most suitable for testing the role of vitamin E in cancer prevention in humans. Some human trials utilizing vitamin E alone or in combination with other nutrients are in progress.


Plasma amino acid responses of trained athletes to two successive exhaustion trials with and without interim carbohydrate feeding. The purpose of this research was to measure changes in selected plasma amino acids (AA) during two successive exercise trials to exhaustion. Eleven trained male athletes completed these trials at weeks 4, 6, 8 and 12. Blood samples for each test were collected after a 12-hour fast at times (in minutes) 0 (Resting), 45, 90, 135, 180, at exhaustion (EI), after a 20-minute recovery period, and at the second exhaustion (EII). At the end of EI, subjects consumed an artificially sweetened water replacement (placebo) treatment or a carbohydrate (CHO) replacement (1.1 g CHO/kg BW) in order to determine any effect of CHO replacement on changes in energy substrates or AA, adjusted for plasma volume changes. From baseline to EI, alpha-aminobutyric acid, alanine, glycine, isoleucine, serine, valine threonine, and tyrosine decreased significantly (p less than or equal to 0.05), while taurine increased significantly. During the recovery period following EI, isoleucine, leucine, ornithine, phenylalanine, tyrosine, urea and valine increased significantly. From the end of recovery until EII, alanine, aspartic acid, glycine, isoleucine, leucine, ornithine, phenylalanine, serine, threonine, tyrosine and valine decreased significantly. CHO replacement had no effect on the mean change scores for any AA from EI to the end of the recovery period and affected only serine, citrulline, glycine and threonine from the end of the recovery period to EII.


Role of nutrition in the management of malnutrition and immune dysfunction of trauma. Current nutrition support improves patient outcome in trauma patients. It appears to do so by limiting the adverse effects of specific nutrient or generalized nutrient deficiencies. Immunosuppression, however, continues as a significant clinical problem. This immunosuppression appears to be part of the inflammatory response that accompanies trauma, and in part, to represent the need for conditional nutrients in this setting. Three nutrients that are being evaluated include arginine, uracil as ribonucleic acid and omega-3 polyunsaturated fatty acids. Animal studies report improved immune function. Early clinical trials are reporting improved immune function and patient outcomes.


Benefits of oral protein supplementation in elderly patients with fracture of the proximal femur. Malnutrition has been often suggested as contributing to both the high incidence of hip fracture in elderly people and its complications. In a recent prospective controlled randomized study, the clinical outcome of elderly patients with osteoporotic fracture of the proximal femur (hip fracture) improved by giving a simple oral dietary supplement. This study, however, did not prove that protein was responsible for the clinical improvement since the supplement also contained vitamins and minerals. We addressed this question by comparing the clinical outcome and bone mineral density (BMD) changes in elderly patients with hip fracture, receiving two different dietary supplements with different protein contents. Sixty-two patients (mean age 82) admitted into the orthopedic ward for fracture of the proximal femur were randomized into two groups. One group (n = 33) received 250 ml/day of an oral nutritional supplement containing protein (20.4 g), mineral salts (Ca: 0.525 g) and vitamins A = 750 IU; D3 = 25 IU) for a mean of 38 days. A control group (n = 29) received the same supplement dose, but with no protein, for the same period of time. The clinical course was significantly better in the group receiving protein, with 79% having a favorable course as compared to 36% (p less than 0.02) in the control group during the stay in the recovery hospital. The rate of complications and deaths was also significantly lower in the protein-supplemented vs the control group (52 vs 80%, p less than 0.05) 7 months after hip fracture. The median hospital stay was significantly lower in the protein-supplemented group (69 vs 102 days, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


The Salt Step Test: its usage in the diagnosis of salt-sensitive hypertension and in the detection of the salt hypertension threshold. The Salt Step Test was devised to characterize the response of the hypertensive patient to dietary salt. The test has three phases: unrestricted salt, to document hypertension and customary salt intake; restricted salt (2 g/day), to identify the salt-sensitive patient; and stepwise increased salt (each step = 1 g/day), to find the level that precipitates hypertension. The Salt Step Test identified that out of 30 well-established adult hypertensives, 13 were salt-sensitive. It also revealed that in each salt-sensitive patient, a distinct level of salt (range 3-16 g/day) precipitated hypertension, i.e., a Salt Hypertension Threshold. Definition of the Salt Hypertension Threshold should be useful in providing specific, individualized guidelines for dietary salt restriction.


Predicting total body water and extracellular fluid volumes from bioelectrical measurements of the human body. Two biological impedance analyzers, a 50 kHz (RJL) and 20-100 kHz (BMA) instrument, and a total body electrical conductivity (TOBEC) instrument were used to estimate total body water (TBW), extracellular (ECF) and intracellular (ICF) fluid volumes by repeated measurements of 16 normal men (19-38 years old) to assess which, if any, would provide the best estimates. At 3-week intervals, TBW was determined by deuterium dilution, ECF by bromide dilution, ICF by difference (TBW-ECF) and lean body mass by density. Prediction equations were obtained by regression; predicted values for the body fluid volumes were calculated and the results were statistically evaluated. Both the TOBEC and the BMA provided rapid and reliable estimates for body fluid volumes with standard errors of the estimates of about 0.5-1.1 L for ECF, 1.0-1.8 L for TBW, and 1.0-1.3 L for ICF. Part of the error was attributable to standard tracer-dilution methods.


Modification by food of the calcium absorbability and physicochemical effects of calcium citrate. The food-calcium (Ca) interaction was examined in 12 healthy women (mean age 38 years) maintained on a constant metabolic diet. They underwent three phases of study, comprised of control (no Ca), Ca citrate (1 g Ca/day) during meals, and Ca citrate separately from meals. Each phase was 7 days in length and two 24-hour urine samples were collected on days 6 and 7. The rise from the control phase in urinary Ca was slightly more prominent when Ca citrate was given with meals than without (68 and 62%, respectively). The fall in urinary phosphorus was equivalent at about 25% between Ca citrate phases. The rise in urinary citrate and pH and the decline in urinary ammonium were more prominent when Ca citrate was given with meals; however, the changes were small or nonsignificant. The urinary saturation of Ca oxalate, brushite or monosodium urate did not differ between the two Ca citrate phases. There was a nonsignificant rise in serum iron during Ca citrate phases. The results suggest that: 1) dissolution and absorption of Ca citrate might be slightly greater when given with food than without; 2) that the ability of Ca citrate to attenuate crystallization of stone-forming Ca salts in urine is not modified by food; and 3) that Ca citrate may not impair iron absorption from food.


Comparison of in vitro and in vivo tests for determination of availability of calcium from calcium carbonate tablets. In vitro tests of calcium (Ca) availability and the oral Ca load test were conducted on eight brands of calcium carbonate (CaCO3) tablets (products A-H) each providing 500 mg Ca. Data were collected over three experiments with nine to 11 healthy premenopausal women testing two to four products. Subjects followed a low Ca diet (less than 10 mmol/day). On test mornings, fasting subjects collected baseline urine for 2 hours (-2 to 0 hours), then ingested the tablet with water. Urine was collected from 0 to 2 hours and 2 to 4 hours; for products E-H, urine was collected for an additional 2 hours (4 to 6 hours). Blood was sampled at hours 0, 4 and 6 during testing of products E and F. Three in vitro tests were run: the United States Pharmacopeia (USP) dissolution test, USP disintegration test, and a disintegration test using vinegar. Ca excretion rose significantly at hours 2 to 4 (p less than 0.05) compared to baseline for seven products. Ca excretion either fell or remained constant between hours 4 and 6. Serum Ca rose and serum parathyroid hormone fell at hour 4, compared to fasting values, suggesting that 4 hours represents peak response time. In vivo availability, measured as the incremental increase in Ca excretion (mmol/mmol creatinine) in hours 2 to 4 compared to baseline, did not correlate significantly with results of the USP dissolution test but did with results of either the USP disintegration test or the vinegar test.(ABSTRACT TRUNCATED AT 250 WORDS)


Further studies of the effect of zinc on intestinal absorption of calcium in man. In a previous study dietary supplementation with 140 mg zinc (Zn) as Zn sulfate (ZnSO4) per day significantly decreased absorption of calcium (Ca) during a low Ca intake (230 mg/day) but not during a normal Ca intake (800 mg/day). The purpose of the present study was to determine whether smaller doses of Zn would also inhibit Ca absorption during the 230 mg Ca intake, and whether the 140 mg dose of Zn would inhibit Ca absorption during a Ca intake less than 800 mg/day. To investigate the first aspect, 100 mg Zn as ZnSO4, was given daily during a low Ca intake (230 mg/day) in six studies, and in the second phase, 140 mg Zn as ZnSO4 was given during a Ca intake of of 500 mg/day in five studies. Intestinal absorption of Ca was determined with tracer doses of 47CaCl2 in control studies and in the two Zn supplementation studies. Results showed that 100 mg Zn/day during a low Ca intake (230 mg/day) did not inhibit Ca absorption and that 140 mg Zn given during the 500 mg Ca intake also did not affect the absorption of Ca.


Hypothesis: etiology of atherosclerosis and osteoporosis: are imbalances in the calciferol endocrine system implicated? Atherosclerosis and osteoporosis are currently considered unrelated diseases. Osteoporosis involves bone calcium (Ca) loss and predominantly affects females after menopause. Atherosclerosis is an illness predominantly affecting males, and is primarily characterized by abnormal lipid metabolism. However, pathological calcification of the arterial wall is an underlying feature of atherosclerosis. Ca homeostasis is thus important in atherosclerosis as well as in osteoporosis. Men also develop osteoporosis although at a later age than women, and, as osteoporosis progresses in women, there is an accompanying calcification of arteries leading to increased incidence of atherosclerosis in aging women. Thus, during old age, both atherosclerosis and osteoporosis are prevalent in both males and females. The dramatic increase in atherosclerosis among women as they develop osteoporosis suggests that the two illnesses may be more closely related than previously realized. The use of vitamin D as a food supplement coincides with epidemic onsets of atherosclerosis and osteoporosis, and excess vitamin D induces both conditions in humans and laboratory animals. These observations suggest a role for chronic vitamin D excess in the etiology of the two illnesses. Magnesium (Mg) deficiency, nicotine, and high dietary cholesterol are contributing factors that accentuate adverse effects of vitamin D.


Improving dietitians' teaching skills.

Improving dietitians' teaching skills. Many health professionals lack important teaching skills, perhaps adding to patient difficulties in understanding and adopting therapeutic diets. Research suggests that teaching skills improved after dietitians took a continuing education course entitled "Effective Patient Teaching." Our study tested whether dietitians' new skills would persist in the field and whether selected patient outcomes would differ as a result. Thirty staff dietitians from six urban hospitals were videotaped teaching patients, then randomly assigned to take the Effective Patient Teaching course or not (control group). Follow-up videotapes were made after 1 week, 1 month, and 3 months. After each teaching session, patient satisfaction and recall were assessed. Two judges rated 20 teaching skills, which were divided into four subsets for analysis. Repeated measures analyses of variance showed overall gains only for the group that took the Effective Patient Teaching course, which scored higher than the control group at 1 week and 1 month, but not at baseline or 3 months. Gains occurred in presentation skills and essential teaching functions. Throughout the study, interpersonal skills were high and adherence promotion skills were low for dietitians in both groups. Groups did not differ on patient satisfaction or recall. Improvements in dietitians' teaching skills translated to the field immediately after they completed the continuing education program, but not all gains were sustained after 3 months. We recommend that dietitians assess their teaching and adherence promotion skills, obtain training where warranted, and periodically reassess the application of those skills during patient teaching sessions.


Cravings and aversions of pregnant adolescents. Adolescents from 31 eastern Tennessee counties were interviewed during the third trimester of pregnancy (n = 97) and at 1-year postpartum (n = 64) to assess cravings and aversions, beliefs about dietary cravings, and how these factors influence dietary intake. Characteristics of cravings and aversions were assessed using a semistructured interview. Beliefs about cravings during pregnancy were measured with a 13-item Likert-type scale (alpha = 0.79). Two 24-hour recalls and 2 days' food records provided dietary data. Most adolescents (86%) reported cravings during pregnancy. They most frequently reported cravings for sweets, especially chocolate; fruits and fruit juices; fast foods; pickles; ice cream; and pizza. Many participants (66%) experienced aversions during pregnancy toward previously liked foods. The most common aversions were to meats, eggs, and pizza. Fewer cravings and aversions were noted during the first year postpartum. No significant relationship existed between craving and aversions and belief scores. Adolescents craving sweets during pregnancy consumed more sugar and energy than those who did not crave sweets. Cravings generally resulted in increased intake, and aversions led to decreased food consumption. On the basis of these results, we suggest that nutritional assessment of pregnant adolescents include questions about cravings and aversions.


Self-reported and measured weights and heights of participants in community-based weight loss programs. Self-reported weights and heights of 82 adults were compared with measured weights and heights 1 to 3 years after participation in community weight loss programs. The mean self-reported weight was 2.3 +/- 1.9 kg lower than measured weight (P < .05). Differences in underreporting were not significant for gender or age group. Heavier individuals misreported their weight to a greater extent (P < .05) than lighter persons, and individuals who had not recently weighed themselves underreported their weight to a greater extent than those who had weighed recently (P < .05). On the average, height was overreported by a mean of 1.8 +/- 2.7 cm. Overreporting increased with increasing height, and men overestimated their height to a greater extent than women (P < .05). Younger subjects reported their height more accurately than those older than 60 years. Results of our study are similar to those of previous investigations that examined self-reporting bias in subjects enrolled in weight loss programs. The mean discrepancy in body weight, however, was greater than that reported in samples drawn from the general population. Our findings indicate that self-reported weight and height values in overweight populations should be interpreted with caution.


Dietary patterns of elderly Boston-area residents defined by cluster analysis. The dietary patterns of 680 noninstitutionalized, predominantly white, elderly volunteers from the Boston area (447 women and 233 men) were examined by cluster analysis of food contribution to energy intake. Data were derived from 3-day dietary records. The four major patterns identified corresponded to high consumption of (a) alcohol, (b) milk, cereals, and fruits, (c) bread and poultry, and (d) meat and potatoes. The resulting clusters of subjects differed significantly in gender, education, income, and frequency of smoking. Those with diets high in milk, cereals, and fruits had the highest intakes of micronutrients and the best hematologic profile. Those with high meat and potato intakes had the lowest intakes of micronutrients and lowest levels of plasma folate and vitamin B-6. High alcohol consumers had lowest blood levels of riboflavin and vitamin B-12 and highest levels of high-density-lipoprotein cholesterol. Those with high bread and poultry intakes had lowest reported energy intakes, but, paradoxically, they had the highest mean body mass index. Neither total serum cholesterol nor cholesterol intake varied significantly among groups. Our findings suggest that the nutritional status of the elderly may be improved by promoting food patterns rich in milk, fruit, and cereals and by counseling the elderly to limit consumption of alcohol and meats high in saturated fats.


Nutrient intakes of 2- to 10-year-old American children: 10-year trends. Nutrient intakes of American children aged 2 to 10 years were compared for the years 1978 and 1988 using a unique nutrient assessment system designed and developed by the Nutrition Department at General Mills. This system integrated data from three sources: 14-day food consumption diaries collected from 4,000 households in the Market Research Corporation of America Menu Census panel surveys; serving-size data from the spring 1977 Nationwide Food Consumption Survey; and nutrient data from the Michigan State University Nutrient Data Bank. The results indicate that energy and macronutrient intakes remained fairly constant over the 10-year period. Average daily vitamin and mineral intakes were lower in 1988 than in 1978 for the majority of those studied; however, most nutrient levels remained over 100% of the Recommended Dietary Allowances (RDAs). For more than 50% of the population, the intakes of calcium, vitamin B-6, and zinc were below the RDAs. Our findings indicate the need for continued monitoring of the impact of changing food consumption patterns on the diets of American children.


Effects of dietary calcium from dairy products on ambulatory blood pressure in hypertensive men. The effect of consumption of 400 mg vs 1,500 mg of dietary calcium per day was examined in 13 male volunteers who had been diagnosed as hypertensive. Dietary calcium consumption was varied by manipulation of the intake of dairy products over 4-week periods. Caffeine intake (mean = 500 mg/day) was monitored. Neither laboratory blood pressure measured by standard sphygmomanometry nor ambulatory blood pressure monitored by automated sphygmomanometry varied significantly among men consuming baseline, low-calcium, or high-calcium diets (laboratory blood pressure = 136/83, 133/83, and 137/84 mm Hg, respectively; ambulatory blood pressure = 136/86, 138/87, and 138/87 mm Hg, respectively). Serum ionized calcium values did not vary with the three diets (1.25, 1.26, and 1.25 mmol/L, respectively). The parathyroid hormone level decreased (39 mmol/L vs 37 mmol/L) and the urinary calcium:creatinine ratio was elevated (0.41 vs 0.50) in the high-calcium diet. Consumption of a diet containing 1,500 mg calcium per day over 4 weeks did not produce a significant decrease in blood pressure or alterations in calcium metabolic indexes.


Journal reading habits of dietitians.

Journal reading habits of dietitians. Professional journals are an important resource for continuing education. To explore the journal reading habits of registered dietitians (RDs), we mailed a questionnaire to all RDs in the state of Delaware. Responses were received from 71 RDs (47%) who identified 44 professional journals they rely on for current, practical information. RDs who have journals available at work tend to devote more time to reading at work than at home. The Journal of The American Dietetic Association was clearly the professional journal read with most regularity by respondents. Articles of practical interest, followed by abstracts and book reviews, were sections most widely read. Lack of time was the primary reason RDs identified for not devoting adequate time to reading. Many attempted to resolve this problem through reliance on newsletters and less involvement with journal articles. Suggestions for improving and maximizing journal reading habits are offered.


Professional attitudes of dietetics students and practitioners. The purpose of this study was to develop and validate an instrument for measuring differences in professional attitudes of dietetics students and practitioners. Comparisons were made between junior and senior dietetics students, new and experienced (5 years or more) registered members of The American Dietetic Association (ADA), and registered ADA members and registered nonmembers (individuals who dropped ADA membership). The sample consisted of 371 junior and senior students from 18 coordinated dietetics programs and 1,041 dietetics practitioners. Principal component analysis was used to categorize conceptually 51 professionalism statements into 13 factors identified as professional attitude scales. Mean scores for the two scales "personal obligations for professional development" and "mastery of substantive content" were highest for all three groups; lowest scores were for the scale "professional isolation." Overall, significant differences were found on eight scales for one or more of the comparison groups. Students rated the scale "respect for the profession's intellectual challenge" higher than did new and experienced registered ADA members. Discriminant analysis indicated that junior (70%) and senior students (65%) were successfully differentiated on four scales, new (62%) and experienced (60%) registered ADA members on five scales, and ADA members (70%) and nonmembers (72%) on four scales. Results of this study could be used by educators to support inclusion of concepts of professionalism in dietetics curriculums. Results also could aid practitioners in marketing their knowledge and skills by presenting a more positive professional image to clients.


The effects of probenecid on the excretion kinetics of stanozolol, an anabolic steroid, in rats. The pharmacokinetic behaviour and the mechanism of renal excretion of stanozolol (STZ), as affected by co-treatment with probenecid, were studied in male Sprague-Dawley rats. Pharmacokinetic parameters following intravenous (i.v.) administration of STZ (20 mg kg-1 body wt.) were measured in both STZ-treated (control) and STZ plus probenecid-treated (treatment) groups. In order to assess the renal clearance of STZ, bolus doses of STZ and inulin (40 mg kg-1 body wt.) were injected i.v. either in the presence or absence of probenecid (40 mg kg-1 body wt.). The blood and urine concentrations of STZ were determined by capillary gas chromatography-mass spectrometry (GC-MS). In the probenecid treatment group, the area under the plasma disappearance and urinary excretion curves (AUC) of STZ were significantly decreased (P < 0.01) and the volume of distribution (Vd) and total clearance (CLt) were significantly increased statistically (P < 0.05 and P < 0.01, respectively). No remarkable differences in the urine flow rate, urine pH values, glomerular filtration rate (GFR) or renal clearance were observed in the treatment group. However, the clearance ratio in the treatment group was significantly increased from 11.72 to 17.27. From these results, it is suggested that the significant decrease of AUC, i.e. increase of disappearance of STZ in plasma by co-administration with probenecid, is due to the increase of the clearance ratio.


Retention of inhaled perfluoroisobutene in the rat. Perfluoroisobutene (PFIB) is produced by the pyrolysis, and as a by-product during the manufacture, of polytetrafluoroethylene. When inhaled it produces a fulminating and sometimes fatal pulmonary oedema similar to that of phosgene after a latent period of 6-8 h. As part of a study to determine the retained dose and the factors that control the amount retained, this study has investigated the retention in rats of inhaled PFIB at concentrations of 10, 50 and 250 micrograms l-1 in a flow-through system combining head-only exposure and plethysmography. Uptake of PFIB was measured by gas chromatography during elevated and reduced inspired volume and respiratory rate induced by exposure to increased CO2 and injection of pentobarbitone, respectively. The percentage of PFIB retained in the upper airways and lungs was found to be 27.5, 28.1 and 23.7% of the amount inspired at the three concentrations tested. The rate of uptake (nmol min-1 kg-1) of PFIB was a power law of the amount inhaled, an n-fold increase in minute volume producing an nb-fold increase in uptake, where b varied between 0.4 and 0.85. Thus, doubling the inhaled dose produces a 1.3-1.8-fold increase in uptake with a corresponding decrease in percentage retained. The relative contribution of respiratory rate and tidal volume upon PFIB retention could not be defined.


Magnetic resonance imaging of the rat brain following acute carbon monoxide poisoning. Magnetic resonance (MR) may be used for repeatedly and non-invasively imaging the brain. Until now, no studies have used this approach to study the effects of carbon monoxide (CO) poisoning in a defined animal model. Conscious, Levine-prepared female rats (unilateral carotid artery and jugular vein occlusion) were exposed to 2400 ppm CO for 90 min, with or without the infusion of 50% glucose solution; CO-stimulated increases in blood glucose and lactate occurred in both groups, while blood pressure and body temperature fell. One to four hours following termination of CO exposure, increased cortical pixel intensity, cortical surface area and brain midline shift were observed on the operated side of the brain in some rats of both groups (i.e. responders = R), providing evidence of edema. At sacrifice, 5 h following termination of CO exposure, gross water content was increased on the left side in the corresponding cortical slices in R rats, providing another measure of edema. Significant positive correlations were found between left to right pixel intensity difference and water content difference, and between the extent of midline shift and water content difference. The elevations of blood glucose and lactate concentrations, and the magnitudes of CO-induced hypothermia and hypotension were similar to those in past studies, but appeared to exert no effect on the severity of cortical edema in terms of differences in pixel intensity, surface area, midline shift or gross tissue water content. Thus, the observed differences between the R rats is not explained by the available data.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of 3-methylcholanthrene or diethyl maleate on the hepatotoxicity of acetaminophen. This report presents a set of investigations on the hepatotoxic action of acetaminophen (AA). Male mice of Balb C strain were given [3H]acetaminophen in doses of 100, 300 and 600 mg kg-1 with or without pretreatment with 3-methylcholanthrene (3MCh) or diethyl maleate (DEM). The results of this study show that AA administered in moderate doses brings about necrotic changes due to adduct formation with macromolecules. Adduct formation was inversely correlated with the level of glutathione. Both modifiers enhanced hepatic necrosis and lethality. Diethyl maleate exerted these effects without enhancing covalent binding to macromolecules, while 3MCh increased both adduct formation and lipid peroxidation.


Pulmonary reactivity to vanadium pentoxide following subchronic inhalation exposure in a non-human primate animal model. An experimental study was conducted to evaluate changes in pulmonary reactivity resulting from repeated vanadium pentoxide (V2O5) dust inhalation. The study assessed pulmonary reactivity to V2O5 through the use of provocation challenges, and compared V2O5 reactivity before and after subchronic V2O5 exposure. A total of 24 adult, male cynomolgus monkeys (Macaca fascicularis) were exposed by inhalation for 6 h per day, 5 days per week, for 26 weeks. Two V2O5-exposed groups (n = 8 each) received equal weekly V2O5 exposures (concentration x time) with different exposure profiles. One V2O5-exposed group received 0.1 mg V2O5 m-3 on Mondays, Wednesday and Fridays, with a twice-weekly peak exposure of 1.1 mg V2O5 m-3 on Tuesdays and Thursdays, and was included to investigate the influence of an exposure regimen with peaks on the development of pulmonary hyper-reactivity. The other V2O5-exposed group received a constant daily concentration of 0.5 mg V2O5 m-3. A control group (n = 8) received filtered, conditioned air. Pre-exposure challenges with V2O5 produced a concentration-dependent impairment in pulmonary function, characterized by airway obstructive changes (increased resistance and decreased flow). Analysis of respiratory cells recovered from the lung by bronchoalveolar lavage demonstrated that airway obstruction was accompanied by a significant influx of inflammatory cells into the lung. Subchronic V2O5 inhalation did not produce an increase in V2O5 reactivity in comparison to the control group, and cytological, immunological and skin test results indicate the absence of allergic sensitization. Instead, a trend toward decreased pulmonary reactivity was found following subchronic V2O5 inhalation.(ABSTRACT TRUNCATED AT 250 WORDS)


The pattern of poisoning in urban Zimbabwe. A 10-year (1980 to 1989 inclusively) retrospective analysis of poisoning admissions to the six major referral hospitals in Zimbabwe revealed 6018 cases. The majority of the patients were aged 0-5 years (35%) and 21-30 years (22.6%). The main agents associated with acute poisoning were traditional medicines (22.9% of the total), household chemicals (18.8%, 13.2% of which was due to paraffin), snake and insect envenomation (17.1%), orthodox medicines (16.7%) and insecticides (14.8%, 10% of which is accounted for by organophosphates). Mortality was 15% and the main agents associated with fatality were pesticides, traditional medicines and orthodox medicines, in descending order. The prevention and treatment of intoxication caused by traditional and orthodox medicines, the proper storage and disposal of pesticides and legislation regulating their sale and distribution are of high priority in the fight to reduce poisoning caused by these agents.


User's review of the Canon Colour Copier. The ability to link the new Canon Colour Laser Copier to a computer opens up new boundaries of data manipulation. A report from the user's point of view, describes a system comprising the copier with computer input, slide scanner and flat copy capacity. Information is given on the types of materials produced, the types of users, the cost of purchase and maintenance, and the potential for generating profit.


Medical illustration enters the market economy. The department of medical illustration at the Royal Postgraduate Medical School (RPMS) has been operating as a registered company for just over 1 year. As other similar departments are forced into cost recovery, some may be considering this extra step. This paper sets out some of the pitfalls as well as giving some handy tips which will make the journey down this uneven road a little easier.


Endoscopy and endoscopic photography in ENT. Doctors have been concerned with ear, nose and throat (ENT) diseases since the earliest times, but there was no single specialty before the introduction of endoscopic methods last century. Effective visualization of the ears, nose and throat poses significant problems for the medical illustrator today. The development of endoscopy and endoscopic photography is outlined with background information to help the illustrator who has to work in this field.


Diabetic retinopathy screening service.

Diabetic retinopathy screening service. The planning, establishment, financing and general organization of a Diabetic Screening Service within a District Health Authority can be a daunting task if not handled correctly. This paper outlines such a service, established in 1987, at a District General Hospital serving a population of 202,000 permanent residents. It highlights the necessity for such a service and its diagnostic value to the local diabetic population.


The Sri Lanka cleft lip and palate project--the medical illustrator's contribution. Since 1984, a series of visits to the island of Sri Lanka by an assessment team, and a team of surgeons and anaesthetists, has amassed a huge dataset on unoperated cleft lip and palates and carried out surgery on over 600 patients. In addition, the training of local Sri Lankan professionals was undertaken. The two most recent trips in 1990 are described with reference to the photographic and audiovisual records collected.


Ni-Cds: the memory lingers on.

Ni-Cds: the memory lingers on. The medical photographer's source of power for portable electronic flash has evolved from the disposable, single-use battery via the wet cell to the nickel-cadmium rechargeable battery, and recently to the 'dry-fit' rechargeable battery. This paper looks at the ubiquitous nickel-cadmium rechargeable battery with reference to its charge/discharge cycling and chemical 'memory' during discharge, and compares single-use and other rechargeable batteries with respect to ease of use, capacity and working life.


The image database: pictures and computers. Information technology offers important new ways of using pictures for teaching in medicine. Methods for storing and delivering high quality images for computer-based learning systems are discussed.


The Wellcome Trust tropical diseases videodisc project. This presentation sets out the aims and methodology involved in creating a sophisticated teaching archive in tropical medicine based on the Wellcome Museum of Medical Science. This visual archive will take the form of a videodisc database containing 30,000 video stills combined with a limited amount of moving material. While authoring tools will ensure the continuing production of interactive learning material from the archive, users will have access to several hundred hours of ready made tutorials, and an expert system to teach clinical skills. They will also be able to browse through any part of the archive. Successful management strategies have involved a close and supportive relationship with the project sponsors, the formation of expert groups to solve specific problems, and a process of continuous formative evaluation.


A survey of videodisc and interactive videodisc projects in North America: Part I. Selected videodisc (VD) and interactive videodisc (IVD) programs, projects and topics are presented in two articles in this and a subsequent issue of the journal. Part I reviews the impact of Information Science developments on image management. The American Society of Hematology Slide Bank and other specific applications in urology, paediatric neurology, obstetrical nursing, medical decision making, dental diagnosis and treatment (DDT), and paediatric cardiology, are reviewed as educational and informatics research projects. This is followed by a section on three-dimensional reconstructions of the brain which stresses digital images. Multi-purposing and repurposing are reviewed in two prototype programs. A discussion of the multidisciplinary Slice of Life projects completes this first article.


An interactive videodisc 'cancer patients and their families at home', designed for education in primary health care. This article describes the development of an interactive videodisc program to support professional education in the field of cancer for the primary health care team. Based on a survey of needs, it concentrates on common symptoms and their control, and problems in communication. The educational approach adopted was chosen on the basis of an extensive consideration of the needs, and what was felt most appropriate for adult learners. Plans were carefully reviewed at each stage, with external advisers, and the prototype system independently evaluated in four sites before completing the package. With financial backing from the 'Europe against Cancer' initiative of the European Commission, and close cooperation with national practitioners, Dutch, German, Greek and Portuguese versions of the package have been developed. Local differences in practice are taken into account and translations of key aspects are provided.


Hypermedia in biomedical education: a case study. The origination, development and application of a hypermedia system for use in the life sciences is described. Implemented in the Apple Macintosh HyperCard environment, the project has been designed to make use of commercially produced laser discs as visual archives and has included the production of authoring and navigational tools. We report here on our experience in authoring stacks for undergraduate teaching, monitoring of student use and assessment of effectiveness as a self-teaching resource. Future developments and applications within the biomedical sciences are discussed.


Redial generations of Fasciola gigantica in the pulmonate snail Lymnaea truncatula. Lymnaea truncatula, 4 mm in height, were subjected to infection by a single miracidium of Fasciola gigantica, then raised at 23 degrees C until day 60 of the experiment. Histological study of these snails demonstrated a mean redial burden of 34 parasites at day 60, of which one third were degenerating forms. The mean number of living independent rediae did not exceed 5 for the first and second generations. Conversely, in subsequent generations there were as many as 18 rediae per snail at day 60. The first living redia of the first generation in particular gave rise to daughter rediae. Mature rediae appeared at day 35 and especially concerned the first and second generations at day 60. The authors conclude that development of the first and second redial generations occurs during the same period, and that the forms of the first cohort of the second generation are produced from the first redia of the first generation which originated from the sporocyst.


Ultrastructural observations on the redial tegument of Paramphistomum epiclitum from the planorbid snail, Indoplanorbis exustus. The morphology of the tegument in the redia of Paramphistomum epiclitum (Digenea: Paramphistomidae) resembles that shown by most larval and adult digeneans; an outer surface syncytium is in continuity with the cytoplasm of in-sunken, nucleated cytons. Although tegumental cytons usually contain a single nucleus, some display up to six nuclei. The tegumental syncytium lining the pharynx of P. epiclitum rediae lack underlying cytons. The apical membrane of the tegument is elaborated by folds and microvilli, which presumably facilitate uptake of nutrients and/or exchange of ions involved in osmoregulation. A single type of secretory body, resulting from the fusion of smaller vesicles produced at Golgi complexes in the cytons, occurs throughout the tegument. Uniciliate sensory receptors occur in the surface syncytium particularly around the oral opening.


The diagnostic value of haematuria and proteinuria in Schistosoma haematobium infection in southern Nigeria. Haematuria and proteinuria as detected by chemical reagent strips correlated moderately (r = 0.7) with prevalence and intensity of infection with Schistosoma haematobium in an area of Anambra State, Nigeria. Differences attributable to age and sex were also reflected in a similar pattern, all peaks occurring in the 5-14 year age group. The differences observed with varying levels of intensity and haematuria at both 10 and 50 erythrocytes/microliter (p < 0.001) and proteinuria at 0.3 g/dl (p < 0.01) were statistically significant. At a proteinuria level of 1 g/dl, the observed differences were however not statistically significant (p > 0.5). The percentage of specimens from children (0-14 years) positive for S. haematobium eggs and with at least traces of haematuria and proteinuria (63.4% and 95%, respectively) was higher than in adults (33.3% and 80.2%, respectively). All individuals with more than 50 eggs/10 ml of urine were correctly identified using both indices either separately or in combination. For egg counts of less than 50 eggs/10 ml of urine, false diagnosis occurred in only 5% of all specimens examined. The sensitivity and specificity of haematuria and proteinuria at trace quantities was very high, but haematuria had a higher predictive value for a positive test (PvPt) and was considered the overall better indicator. A combination of both indices did not significantly increase the PvPt. When trace haematuria and moderate proteinuria were combined, both the sensitivity, specificity and PvPt were all above 90%, giving the best overall values in all the combinations made.


Abundance/host size relationship in a fish trematode community. The abundance of six species of trematodes: Aphanurus stossichi, Bacciger israelensis, Diphterostomum israelense, Plagioporus idoneus, Leprocreadium album and L. pegorchis, parasitic in the digestive tract of marine teleostei (Sparidae) collected near Jounieh (east Mediterranean), was analysed as a function of the host-size. In two parasite/host systems, infections were observed from the lowest size classes of the sample, with a clear tendency to an increase of abundance in older fish. In four others, parasites appear only above a rather high threshold class, young individuals never being infected. In the last three parasite/host systems, host invasion may occur early or late, but infection decreases above a well defined size class, old fishes rarely or never being infected. A given trematode species, when parasitizing several host species, shows similar abundance/host size relationships, e.g., P. idoneus in Diplodus vulgaris and Oblada melanura. When more than one species of trematode infects a single host species, curves can be markedly distinct; for instance, L. pegorchis was collected from Pagellus erythrinus below 15 cm. whereas D. israelense parasitized the same fish approximately above the same size. There is no evidence that such a replacement of one trematode by another in the course of host growth is a result of inter-specific competition.


A hidden break in the 28.0S rRNA from Diphyllobothrium dendriticum. Nondenatured and denatured total RNA from the tapeworm Diphyllobothrium dendriticum (Cestoda) was analysed by agarose gel electrophoresis. It was found that the large subunit ribosomal RNA (lrRNA) is 28.0S and the small subunit ribosomal RNA (srRNA) is 19.5S. Following denaturation the 28.0S rRNA was disrupted into a 19.5S subfragment and a 20.7S subfragment due to the presence of a centrally located hidden break. By hybridization of Northern blot membranes with oligonucleotide probes specific for the 5'- and 3'-ends of the lrRNA respectively, we have shown that the 19.5S subfragment is from the 5'-end (the alpha-subfragment) and the 20.7S subfragment from the 3'-end (the beta-subfragment) of the 28.0S rRNA of D. dendriticum.


Experimental infection with Taenia saginata (Poland strain) in Taiwanese pigs. Two 22-day-old Landrace-Small Ear Miniature (L-SEM) pigs, five 45 to 66-day-old Small Ear Miniature (SEM) pigs, and one 16-day-old Holstein calf were each fed 1000, 3000 or 10,000 Taenia saginata (Poland strain) eggs respectively and killed 34-77 days after inoculation. Four of the five SEM pigs and the Holstein calf were susceptible to this parasite. However, two L-SEM pigs and one SEM pig remained negative. The cysticerci recovery rates for the SEM pig and Holstein calf were 36% and 3%, respectively. All cysticerci from the SEM pigs were found in the livers, more in the parenchyma (89%) than on the surface (11%). Only eleven cysticerci in two SEM pigs were mature and the remainder were either immature, degenerated or calcified. The cysticerci in the calf were distributed throughout the body: leg muscles (248), heart (27), tongue (17), intercostal muscles (14), diaphragm (5), kidney (1) and liver (1). Most (299) of the cysticerci were mature, one was immature and 13 were degenerated or calcified. The length, width, diameter of the protoscolex and sucker of the cysticerci from the calf were larger than those from the SEM pigs. However, the diameter of the rostellum of the latter was slightly larger than the former. Hooklets were not found on any mature cysticercus recovered. The results of the present study provide evidence that the SEM pig can be used as an experimental intermediate host for T. saginata.


Influence of desiccation of faeces on survival and infectivity of first-stage larvae of Muellerius capillaris and Neostrongylus linearis. First-stage larvae of pure strains of M. capillaris and N. linearis (Nematoda: Protostrongylidae) from goats were used to assess the influence of rapid desiccation on survival. M. capillaris survived desiccation of faeces better than N. linearis. The latter species was particularly susceptible to duration of storage after desiccation (0 to 10 days). Surviving larvae of desiccated batches of M. capillaris were less able to infect the land-snail Candidula intersecta. Resistance of first-stage larvae to desiccation is a key factor in infectivity and may partly account for the geographical distribution of the two species of protostrongylids.


Experimental infections with Nematodirus spathiger in rabbits. The feasibility of infecting laboratory rabbits experimentally with the ovine nematode Nematodirus spathiger was examined. Eight-week-old rabbits were dosed either with 5000 or with 17,000 third-stage larvae and killed on days 10, 21 or 42 post-infection. With the lower dose, 20 to 40% of the inoculum were recovered at necropsy. Similar values were observed with the 17,000 dose on days 10 and 21 post-infection, but on day 42 the worm population was residual (0.6%). With both dose levels, during the course of infection, the worm populations were mainly composed of fourth-stage larvae and worm egg excretion was low. N. spathiger mainly inhabited the proximal jejunum. The results were compared with N. spathiger infection in sheep to assess the usefulness of the rabbit as an experimental model for Nematodirus infection.


A longitudinal study of porcine serological responses to experimental infections with T-1 and T-3 Spanish Trichinella isolates. Comparison of antibody response and antigen recognition was made by ELISA and western-blot analysis in pig experimental infections by T-1 and T-3 Spanish Trichinella isolates. Two groups of Iberian pigs were experimentally infected with 150 larvae/kg body weight of GM-1 and C-76 Spanish Trichinella isolates as representatives of T-1 and T-3 gene pools respectively. Antibody levels and antigen recognition were measured on days -14, 0, 6, 16, 20, 27, 34, 49, 63 and 82 after infection by ELISA and western-blotting assays. Antibody response against C-76 infection was significantly delayed and lower than against GM-1. The two Trichinella isolates were indistinguishable, however, by western blotting analysis, although recognition of larval antigens was quantitatively higher than adult ones. Interestingly, the principle larval antigenic components recognized by pigs were those recognized by the monoclonal anti-sera NIM-M1. Finally, there were no serological patterns indicative of the stage of infection ("antibody windows") discriminating, for example between early versus late infections.


Acanthocephalan infection in man in northern Nigeria. Acanthocephalan ova, indistinguishable from the ovoid eggs of Moniliformis moniliformis, were detected in the stools of a 45-year-old man at the University of Jos Health Clinic, Nigeria. The patient complained of general body weakness, occasional giddiness and intermittent burning sensations around the umbilicus. Successful treatment with niclosamide and the possible source of infection are communicated.


Ultrastructural localization of bcl-2 protein. Previous cell subfractionation studies have indicated that bcl-2 is an inner mitochondrial membrane protein. We have sought to determine the ultrastructural localization of bcl-2 protein in lymphoma and breast carcinoma cell lines and biopsy material known to overexpress bcl-2 using immunoelectron microscopy. To avoid the possibility of processing artifacts, samples were prepared by three different methods: progressive lowering of temperature, cryosectioning, and freeze-substitution. In all instances the labeling of bcl-2 protein was relatively weak but the distribution the same. In both lymphoma and breast carcinoma tissues, bcl-2 protein was detected on the periphery of mitochondria: little labeling of either the mitochondrial matrix or cristae could be detected. Labeling was also detected on the perinuclear membrane and throughout the cytoplasm, as also indicated by confocal microscopy. These data therefore indicate that bcl-2 protein can be detected at several intracellular sites and that at the likely functional destination, the mitochondria, there appears to be, contrary to expectations, a preferential association with the outer membrane.


GRAMP 100: a membrane protein concentrated on secretory granule membranes and the apical cell surface in exocrine acinar cells. Using a monoclonal antibody (SG10A6) raised against secretion granule membranes of the rat parotid gland, we have identified an antigen that is a common component of both exocrine pancreatic and parotid granule membranes. SG10A6 (an IgM) immunoprecipitates antigen that migrates as a single band (M(r) approximately 80 KD unreduced; M(r) approximately 100 KD reduced) and immunoblots at least two polypeptides that are similar to the reduced and nonreduced immunoprecipitated antigen. This granule-associated membrane polypeptide (GRAMP 100; named for the apparent M(r) in reduced form) is also a prominent component of plasma membrane fractions. Immunocytochemical localization at the electron microscopic level demonstrates the presence of GRAMP 100 on granule membranes, especially condensing vacuoles and exocytotic figures, and the apical plasma membrane. Lower levels of antigen are detected on basolateral plasma membrane and on peri-Golgi membranes that may be part of the endosomal system. Both the cell fractionation and immunocytochemical localization indicate that GRAMP 100 differs in distribution from GRAMP 92 and 30K SCAMPs, two other components of exocrine granule membranes identified with monoclonal antibodies. To date, no polypeptides have been identified with this approach that are exclusive components of exocrine granule membranes.


Immunoelectron microscopic localization of phosphoproteins associated with the mitotic spindle. We examined the immunogold staining of microtubules and microtubule organizing centers using an improved silver-enhancement reagent for small (1-1.4 nm) gold-conjugated secondary antibodies. First, the staining properties of different commercial preparations of gold-labeled antibodies were compared for sample penetration, label uniformity, and labeling density, and Nanogold 1.4-nm gold-conjugated F(ab') was found to be superior to the other probes examined. However, in samples examined for the localization of alpha- and beta-tubulin, gold staining did not extend through the pericentriolar material nor were the centrioles labeled. This apparent lack of centrosomal staining was not due to problems associated with penetration of the antibody probes, since staining adjacent to and within the centriolar cylinder was observed when phosphoprotein antigens recognized by the MPM-2 antibody were localized. The MPM-2 antibodies also localized to mitotic kinetochores, kinetochore fibers, and midbodies, in addition to mitotic centrosomes. The level of MPM-2 staining of the centrosome varied through the cell cycle. At interphase, this staining was restricted within the centriolar cylinder, whereas in mitotic cells extensive staining throughout the pericentriolar material was also observed. These results established the close relationship of MPM-2-reactive phosphoproteins with the centrosome, and suggest that this technique may be useful for ultrastructural localization of other cytoskeletal proteins.


Silver enhancement of gold antibody probes in pre-embedding electron microscopic immunocytochemistry. In pre-embedding EM immunocytochemistry with gold probes, the gold must be small enough to penetrate through cell membranes treated with mild detergents. Antibodies labeled with small gold probes (1-1.4 nm) are too small to be resolved in thin sections but can be seen if they are silver-enhanced after the gold has bound to the antigens in the cells. We investigated several aspects of gum arabic-silver lactate-hydroquinone enhancement solution (Danscher solution) by examining gold-conjugated antibodies embedded in agar, sectioned on a vibrotome, and enhanced with different solutions. The rate of silver enhancement was optimized in 50% gum arabic and 200 mM HEPES buffer, pH 5.8. We also examined chemicals used as developers and found that N-propyl gallate (NPG) gave a more uniform development than the routinely used hydroquinone (HQ). The diameter of the silver-enhanced particles after incubation in osmium tetratoxide (OSO4) decreased somewhat with longer incubation time and higher percentages, but the density (number per unit area) of silver-enhanced particles was little changed. The loss of silver-enhanced particle diameter was reduced by lowering the concentration of OSO4 to 0.1%. Comparison of commercial small gold probes showed that NPG enhancement of Nanogold gave more uniform particle size and a better correlation between enhancement time and particle density. When this procedure was applied to cell cultures with monoclonal antibodies, the silver-enhanced particles were similar to those in the agar sections. When free-floating tissue sections were used, longer silver enhancement times were needed to obtain similarly sized particles. This new NPG-silver-enhancement procedure offers a reliable and easy method to localize proteins in cultured cells and tissue sections by pre-embedding electron microscopic immunocytochemistry.


Immunohistochemical localization of carbonyl reductase in human tissues. Carbonyl reductase, an NADPH-dependent oxidoreductase of broad specificity, is present in many human tissues. Its precise localization, however, has remained unclear, as well as its physiological and possible pathophysiological significance. The present study reports the immunohistochemical localization of the enzyme in normal human tissues. Immunostaining was detectable in all organs investigated. The highest concentrations were found in the parenchymal cells of the liver, the epithelial cells of the stomach and small intestine, the epidermis, the proximal tubules of the kidney, neuronal and glial cells of the central nervous system, and certain cells of the anterior lobe of the pituitary gland. Consistently pronounced staining was also observed in smooth muscle fibers and the endothelium of blood vessels. The results are in agreement with a housekeeping function of carbonyl reductase in the elimination of reactive carbonyl compounds.


Immunocytochemical and biochemical demonstration of formaldhyde dehydrogenase (class III alcohol dehydrogenase) in the nucleus. Alcohol dehydrogenase (ADH), the major enzyme catalyzing the biological oxidation of ethanol in mammals, includes four classes with very different capacities for ethanol oxidation. Class III ADH is present in all the tissues and is well conserved throughout evolution. This enzyme has a low activity with ethanol, is specific for the glutathione-dependent oxidation of formaldehyde, and is therefore a formaldehyde dehydrogenase (FALDH). Until now there have been few and conflicting studies concerning its intracellular distribution, which is important for the understanding of its role in cell function. In the present work we used biochemical and immunocytochemical methods to assess the distribution of FALDH in rat hepatocytes and astroglial cells. With the glutathione-dependent formaldehyde dehydrogenase assay, we found the highest activity in the cytosol of hepatocytes and brain cells (12 and 2.6 mU/mg protein, respectively), but nuclei also exhibited significant activity (1.16 and 2.1 mU/mg protein, respectively). The immunocytochemical results showed the presence of FALDH binding sites in both the cytoplasm and the nucleus of the different cell types studied. Whereas no specific gold particle labeling was seen associated with any cytoplasmic component, in the nucleus the particles were found mainly over condensed chromatin and interchromatin regions. Finally, the gold particle density over both the nucleus and cytoplasm was greater in differentiated than in proliferating astrocytes in primary culture. In contrast, class I ADH, primarily responsible for ethanol metabolism, was found only in the cytoplasm of hepatocytes. We propose that one of the functions of FALDH is to protect cell structures, including DNA, from the toxic effects of endogenous formaldehyde, which is an intermediate in many metabolic process.


Iron content correlates with peroxidase activity in cysteamine-induced astroglial organelles. A subpopulation of astrocytes in periventricular brain regions and in cysteamine-treated neuroglial cultures contains cytoplasmic granules that exhibit an affinity for Gomori stains, orange-red autofluorescence, and non-enzymatic peroxidase activity. The autofluorescence and pseudoperoxidase activity are consistent with the presence of porphyrins and heme iron, respectively. In the present study, we employed diaminobenzidine cytochemistry, transmission electron microscopy, and energy-dispersive X-ray microanalysis (electron microprobe) in an attempt to correlate fine structure with the peroxidase activity and elemental composition of the cysteamine-induced inclusions in cultured astrocytes. In osmicated preparations, these membrane-bound inclusions varied greatly in size, were round or ovoid in shape, and exhibited an intensely electron-dense granular matrix. In non-osmicated preparations, many inclusions exhibited internal membranous partitions producing complex subcompartmentalization. Diaminobenzidine reaction product, indicative of endogenous peroxidase activity, was occasionally observed distributed diffusely throughout the granule matrix. More commonly, peroxidase activity was restricted to specific intraorganellar compartments. Elemental iron was detected in the inclusions by electron microprobe analysis. The presence and concentration of iron in these organelles correlated closely with the presence and intensity of diaminobenzidine staining, suggesting that redox-active iron mediates the pseudoperoxidase reactions in these cells. Cysteamine-induced derangements of porphyrin-heme biosynthesis may be responsible for the proliferation of iron-containing gliosomes in these astrocytes.


Immunocytochemical localization of 67 KD Ca2+ binding protein (p67) in ventricular, skeletal, and smooth muscle cells. By using immunocytochemical techniques, we examined the localization of a 67 kDa Ca2+ binding protein (p67) and calpactin I heavy chain (p36) in ventricular myocytes, skeletal myocytes, and intestinal smooth muscle cells. Immunofluorescence microscopy revealed that the p67 was expressed in all these muscle cells, whereas anti-p36 antibody stained cells in connective tissues but failed to stain these muscle cells. Immunogold electron microscopy was carried out to examine the subcellular localization of the p67 in muscle cells. The results showed that the p67 was exclusively confined to the plasma membrane of muscle cells and the presumptive transverse tubules of the striated myocytes. Immunoblot analysis with anti-p67 antibody showed that the p67 was indeed a constitutive protein of the sarcolemma isolated from rat hearts. These results indicate that the p67 is a sarcolemma-associated Ca2+ binding protein expressed in both striated myocytes and intestinal smooth muscle cells.


Ecto-calcium-dependent ATPase activity of mammalian taste bud cells. Histochemistry was utilized to characterize Ca-ATPases associated with lingual taste buds in the golden hamster. Taste buds showed elevated staining for magnesium- or calcium-dependent ATPase (Ca-ATPase) relative to the surrounding epithelium. At low calcium concentrations (0.1-0.5 mM), intracellular staining predominated. Most of the studies were conducted at calcium concentrations of > or = 10 mM, in which most of the staining was localized to the external face of plasma membranes of taste bud cells (including receptor and basal cells) located in the core of fungiform taste buds, or the entire vallate or foliate taste buds. The peripheral fungiform taste bud cells stained much less intensely, but the peripheral cells adjacent to the core showed intermediate levels. GTP and ITP were just as effective substrates as ATP. Millimolar concentrations of magnesium were as effective as calcium. Inhibitors of intracellular ATPases, including quercetin, sodium azide, and 2,4-dinitrophenol, had no effect on the staining. Therefore, the Ca-ATPase staining of plasma membranes at mM concentrations of calcium is thought to correspond to one or more ecto-Ca-ATPase activities with unknown functions. Roles related to increased energy requirements or to the possible function of ATP as a neurotransmitter or -modulator are proposed.


Quantitation of gold labeling and estimation of labeling efficiency with a stereological counting method. The amount of immunolabeling over a cell compartment of an average cell was estimated by use of an adaptation of the double disector method introduced by Gundersen. The first and last sections of a stack of ultra-thin sections formed a disector in which cell number could be estimated and related to a defined reference volume to give the cell density. Another stack section, selected at random, was immunolabeled and the number of gold particles associated with unit volume reference space (gold "density") estimated in quadrats placed systematically across the section. The ratio of gold density to cell density was used to estimate the number of gold particles lying over a chosen compartment of an average cell, N(gold)/N(cell). Such estimates required neither cell volume nor section thickness measurement and were reproducible. By combining the number of gold particles per cell with estimates of the number of protein antigens per cell, the number of gold particles associated with each antigen could be found (labeling efficiency).


Lectin binding sites as markers of neonatal porcine uterine development. To identify lectin binding sites and to determine if lectin binding patterns change with age in developing neonatal porcine uterine tissues, gilts (n = 3/day) were hysterectomized on Day 0 (birth), 7, 14, 28, 42, or 56. Lectin binding was visualized in Bouin's-fixed uterine tissues with seven biotinylated lectins (ConA, DBA, PNA, RCA-I, SBA, UEA-I, and WGA) and avidin-peroxidase staining procedures. Lectin specificities were demonstrated by pre-incubating lectins with appropriate inhibitory sugars (0.2 M). Staining intensity was evaluated visually (absent, weak, moderate, or strong) for three endometrial tissues; luminal epithelium, glandular epithelium, and stroma. Staining intensities for DBA, PNA, SBA, and WGA were not affected by neonatal age. Staining with these lectins was greater in uterine epithelium (moderate or strong) than in stroma (weak). In contrast, binding patterns for ConA, UEA-I, and RCA-I were affected by neonatal age. Strong epithelial staining associated with ConA binding was observed on all days, whereas stromal ConA staining decreased in intensity from moderate to weak after Day 14. Epithelial staining with UEA-I increased from moderate to strong after Day 28, whereas stromal UEA-I staining decreased from moderate to weak after day 28. Staining with RCA-I was homogeneous for luminal epithelium and stroma but variegated for glandular epithelium on and after Day 7. These observations indicate that a variety of lectin binding sites are present in developing neonatal porcine endometrial tissues and that developmentally related alterations in the distribution and/or orientation of glycoconjugates containing alpha-D-mannose, beta-D-galactose, beta-D-acetyl-N-galactosamine, and alpha-L-fucose residues occur between birth and Day 56 as these tissues mature.


The human erythropoietin receptor.

The human erythropoietin receptor. Molecular analysis of the human erythropoietin receptor (EpoR) promises to yield a greater mechanistic understanding of erythropoiesis and disease states that affect red cell production. The cloned receptor molecule is a 66 kDa membrane protein that is structurally related to a large superfamily of haemopoietin/growth factor receptors. The 66 kDa EpoR alone is capable of binding to erythropoietin (Epo) with nanomolar affinity. The native EpoR may form dimers before or after binding Epo. EpoR dimers and/or associated molecules are probably necessary for high-affinity Epo binding. The 66 kDa EpoR probably exists as a protein complex with as yet unidentified proteins of 100 and 85 kDa. The molecular mechanism of Epo signal transduction remains largely undefined. The possible role of the EpoR in human diseases has been studied in a variety of clinical conditions. A structurally abnormal EpoR gene has been identified in a human erythroleukemia cell line. In polycythemia vera, red cell progenitors exhibit exaggerated sensitivity to Epo and express only low-affinity EpoR. Some cases of hereditary polycythemia may be due to a mutant EpoR conferring enhanced Epo sensitivity. Other pathologic conditions may also be associated with abnormalities of the EpoR or its associated molecules. Soluble, immunoreactive EpoR is detectable in human serum, but its physiological significance is unknown.


In vitro revelations of aplastic anemia. Aplastic anemia (AA) is a most difficult disease to study in vitro. By the time the disease presents, the marrow is already hypocellular and the peripheral blood shows pancytopenia, leaving little material remaining for study. However, an understanding of its pathogenesis could provide insight into the control of normal hemopoiesis since AA is an in vivo manifestation of failure of normal hemopoiesis and may provide a way of examining stromal cell-stem cell relationships. Recent interest in the pathogenesis of AA has resulted from a) new laboratory techniques, such as stem cell purification used with modifications of the long-term bone marrow culture system and analysis of stem cells at the molecular level with X-linked DNA probes, and b) the availability of recombinant human hemopoietic growth factors (HGF) in large quantities. Consequently, analyses of the function of some of the individual components of stromal cell mediated hemopoiesis in AA patients have been performed. This has been paralleled, and in some instances preceded, by clinical trials of HGF in patients with AA.


SCL and related hemopoietic helix-loop-helix transcription factors. The helix-loop-helix (HLH) proteins are a family of transcription factors that include proteins critical to differentiation and development in species ranging from plants to mammals. Five members of this family (MYC, SCL, TAL-2, LYL-1 and E2A) are implicated in oncogenic events in human lymphoid tumors because of their consistent involvement in chromosomal translocations. Although activated in T cell leukemias, expression of SCL and LYL-1 is low or undetectable in normal T cell populations. SCL is expressed in erythroid, megakaryocyte and mast cell populations (the same cell lineages as GATA-1, a zinc-finger transcription factor). In addition, both SCL and GATA-1 undergo coordinate modulation during chemically induced erythroid differentiation of mouse erythroleukemia cells and are down-modulated during myeloid differentiation of human K562 cells, thus implying a role for SCL in erythroid differentiation events. However, in contrast to GATA-1, SCL is expressed in the developing brain. Studies of the function of SCL suggest it is also important in proliferation and self-renewal events in erythroid cells.


Characteristics of the hematopoietic stem cell compartment in adult mice. Mouse hematopoietic stem cells can be enriched from adult bone marrow by a number of methods. The resulting cell populations are heterogeneous in function, suggesting a complex organizational structure within the stem cell compartment. Several assays can be applied to the study of early stages of hematopoiesis; however clonal assays for long-term repopulation, the most critical operational definition of hematopoietic stem cells, are lacking. Further complicating the prospect of understanding early hematopoiesis is the finding that genetic variations among laboratory strains of mice lead to major differences in phenotypic and functional characteristics of hematopoietic stem cells. Application to the human situation of the methodology developed for stem cell isolation and characterization in the mouse will be hampered by the possibility of genetic variations among human subjects and the lack of a well-characterized assay system to detect and quantify cells capable of long-term repopulation of irradiated recipients.


Retinyl acetate and all-trans-retinoic acid enhance erythroid colony formation in vitro by circulating human progenitors in an improved serum-free medium. Retinyl acetate (RA) dramatically increased the production of early (d16) erythroid colonies in vitro by circulating human progenitor cells growing in an improved serum-free (SF) medium. In the absence of either erythropoietin (Epo) or insulin-like growth factor I (IGF-I), RA alone was able to induce the hemoglobinization of cells in these erythroid colonies. RA synergized with Epo or with IGF-I to yield increased numbers of well-hemoglobinized early colonies. In the presence of defined burst promoting activity (BPA) provided by recombinant human interleukin 3 (rHuIL-3) and hemin, RA and all-trans-retinoic acid (ATRA) were identical with respect to their differentiation-inducing function for early erythroid colonies. ATRA increased the number of these colonies in a concentration-dependent manner, with maximal stimulation (3.5-fold) occurring at 30 nM in the presence of 5.5 ng/ml IL-3, 0.1 mM hemin, 3.0 U/ml Epo and 30 nM IGF-I. This appears to be the first demonstration of erythropoietic activity of two metabolic derivatives of vitamin A in SF medium.


Clonogenic assay is not predictive but reflects therapeutic efficacy of interferons in the treatment of chronic myelogenous leukemia. Patients with chronic myelogenous leukemia (CML) have been treated with interferon (IFN) alpha-2b alone or in combination with IFN gamma. In order to predict clinical response to IFN, bone marrow samples from 15 CML patients were incubated with serial dilutions of IFN alpha-2b to obtain the IC50 values for erythroid burst forming units (BFU-E) and granulocyte-macrophage colony forming units (CFU-GM). A dose-dependent inhibition of at least one lineage was observed in all but one sample. An inhibitory effect of greater than 50% was reached for BFU-E in 8/14 patients and for CFU-GM in 10/14 patients. All three patients with no response (NR) to IFN treatment had IFN-sensitive BFU-E and CFU-GM. In four patients with hematologic remission (HR) or partial hematologic remission (PHR), BFU-E or CFU-GM were affected very little by the inhibitory effect of IFN. These observations suggest no predictive value for pretesting IFN sensitivity in vitro. The in vivo effect of IFN on the hemopoietic progenitor cells BFU-E and CFU-GM was evaluated in patients treated with either IFN alpha-2b alone (n = 11), or in combination with low dose IFN gamma (n = 10). All patients were newly diagnosed and not pretreated. After a median treatment duration of 11 months (range 3-25) a significant decrease in BFU-E and CFU-GM was observed in both groups of patients. We conclude that in vitro colony growth reflects the therapeutic efficacy of IFN.


Dynamic changes in cytokine secretion by stromal cells during prolonged maintenance under protein-free conditions. Stromal cells of bone marrow origin produce a variety of known cytokines and some factors exhibiting apparently new biological activities. Several of these were identified by the study of cell to cell interactions and were not found in detectable amounts in media conditioned by the cells. We describe here a culture system that enables the release of stromal cytokines into medium free of any added proteins and supplemented with peptides from casein hydrolysate (0.1%). The absence of serum proteins allows extensive concentration and monitoring of activities that are otherwise undetectable. Stromal cells of the MBA-2.1 clonal cell line were seeded in a stationary bed reactor packed with a carrier of non-woven fabric matrix. After a proliferation phase with serum containing medium, the cells were maintained for over 10 months in protein-free medium. Throughout this extended incubation in the absence of serum or serum replacing proteins, stromal cells retained their viability and continuously released transforming growth factor-beta (TGF-beta), macrophage-colony stimulating factor (M-CSF) and restrictin-P, a cytotoxic factor that specifically arrested the growth of plasmacytoma cells. In addition, interleukin-6 (IL-6) was first undetectable, and later in culture its titer reached a maximum of 180,000 international units (IU)/ml. Concomitantly, the production of restrictin-P diminished and reached its lowest levels at the end of 10 months. The results may imply a possible causal relationship between the expression of IL-6 and restrictin-P, since no similarly significant changes were observed in the titers of M-CSF and TGF-beta. This novel bioreactor system may be adaptable for efficient production of different cytokines under absolute serum-free conditions.


Primary reconstruction of the mandibular alveolar ridge following resection. Standard techniques of mandibular reconstruction aim at the restoration of function. However, the height and shape of the alveolar ridge are often neglected and reconstruction often results in difficulty in subsequent denture wear. Immediate reconstruction of the alveolar process with particulate autologous iliac bone is described, a technique used in 10 patients since 1978.


A nasal vestibular flap for reconstruction of the upper lip. A technique to reconstruct the hair-bearing upper lip by means of a hair-loaded nasal vestibular flap is described. This flap is elevated from the nasal vestibular area, and does not result in nasal deformity. This flap is especially suitable to reconstruct the medial portion of the hair-bearing upper lip in adult males.


Midline cervical cleft. A case report.

Midline cervical cleft. A case report. A case of incomplete midline cervical cleft of the upper neck is reported. It showed histological resemblance to a mature teratoma with three different germ-cell components, including cartilage, striated muscles, small salivary glands, and nerves.


The use of fresh frozen allogeneic bone for maxillary and mandibular reconstruction. The use of fresh frozen bone (FFB) alone, or in combination with autogenous bone (AB), for bony augmentation of the maxilla and mandible in preparation for dental reconstruction with endosseous implants has been studied. Ten patients received FFB +/- AB for augmentation of a severely atrophic mandible (n = 6) or for reconstruction of a jaw defect secondary to trauma or tumor resection (n = 4). Average follow-up was 26.3 +/- 5.4 months. At the time of implant placement, the bone grafts were found to be firm in consistency, well incorporated, and well vascularized in all 10 patients. Twenty-nine endosseous implants were placed an average of 8.3 +/- 3.1 months following bone grafting. One implant failed and was replaced, and one implant remains buried as a nonfunctional unit. All patients have been restored prosthetically by means of 28 of the 29 implants. This preliminary study indicates that FFB may be used alone or in combination with autogenous bone for augmentation or reconstruction of the atrophic maxilla and mandible. The resultant ridge is adequate to support loaded endosseous implants. A potential disadvantage is the minimal risk of disease transmission.


Endosseous implants in the irradiated composite radial forearm free flap. This paper describes the application of endosseous titanium implants that have been inserted into the vascularized bone of the radial forearm composite flap, used for mandibular reconstruction. The technique described allows full orofacial rehabilitation to be achieved, following ablative surgery and adjuvant radiotherapy.


Long-term clinical and radiologic evaluation of autotransplanted teeth. The purpose of the present study was to investigate the radiologic results of 40 autotransplantations (20 molars and 20 premolars) performed in the orthodontic department of the University of Geneva between 1979 and 1990. The sample demonstrated persistence of pulp vitality and continuous root development, followed, however, in most cases by replacement root resorption. The data were in accordance with previously published studies and point to an ideal developmental stage for molar and premolar transplantation to ensure pulpal and periodontal survival.


Shoulder-arm-syndrome after radical neck dissection: its relation with the innervation of the trapezius muscle. In a clinical and electromyographic follow-up of 54 patients who underwent radical neck dissection, vast differences in the individual severity of the shoulder-arm-syndrome were found: 31% experienced severe limitations of shoulder mobility combined with severe pain, whereas 41% suffered only mild discomfort and 28% were free of complaints. These clinical findings were compared to recent anatomical observations concerning individual patterns of innervation of the trapezius muscle. It could be shown that the role of the cervical plexus in the innervation of the trapezius muscle is of great importance and that its subfascial branches are able to maintain the motor supply following radical neck dissection in about 2/3 of patients.


Extensive malignant schwannoma of the mandibular nerve. Case report. An extensive malignant schwannoma of the mandibular nerve in an 8-year-old boy is presented. The clinical presentation, light microscopic findings, and radiographic features are described. The patient was successfully treated with surgery in combination with chemotherapy. He is still well, without evidence of metastasis or local recurrence, 5 years postoperatively.


Breast angiosarcoma metastatic to the maxillary gingiva. Case report. A case of breast angiosarcoma metastatic to the maxillary gingiva is reported. A review of the literature revealed only three previously reported cases. Angiosarcomas often present as benign lesions. The surgeon should maintain a high level of vigilance when patients present with oral lesions and a history of breast tumor.


Second reconstruction of the posterior maxilla with a free latissimus dorsi muscle flap. Case report. This paper reports a case in which a latissimus dorsi free muscle flap was used for a second reconstruction following resection of a maxillary ameloblastoma when the ipsilateral temporalis muscle flap had already been used. The case illustrates the dilemma of immediate versus delayed reconstruction following excision of maxillary tumours.


Intraosseous hemangioma of the zygomatic bone. A case report. Intraosseous hemangiomas of the facial skeleton are infrequently seen, with most cases occurring in the mandible and maxilla. Hemangioma of the zygomatic bone, however, is extremely rare. A case is presented in which selective embolization, resection of the tumor, and immediate reconstruction were carried out.


Esthesioneuroblastoma. A case report.

Esthesioneuroblastoma. A case report. Esthesioneuroblastoma (ENB) is a rare neuroectodermal tumor originating from the olfactory mucosa and therefore usually arising from the nasopharynx. A case in which the diagnosis was made in connection with the extraction of a tooth is reported. Manifestation in the dento-alveolar region is unusual for this tumor. The case presented is also unusual in that the classic symptoms of ENB were not present. Diagnosis, classification, and therapy are described with a brief review of the literature.


Malignant lymphoma presenting as pericoronitis. A case report. A case of diffuse, large-cell non-Hodgkin's lymphoma presenting as pericoronitis in the oral cavity is described. The diagnostic pitfalls are briefly discussed.


Central schwannoma of the maxilla.

Central schwannoma of the maxilla. A case of schwannoma in the maxilla associated with the nasopalatine nerve of a 9-year-old boy is reported. The diagnosis is supported by an immunohistochemical demonstration of S-100 protein within the tumor cells. The patient is free of disease 6 years after tumor removal.


Does metronidazole prevent alveolitis sicca dolorosa? A double-blind, placebo-controlled clinical study. The effect of a single preoperative dose of metronidazole in the prevention of alveolitis sicca dolorosa (ASD) after surgical removal of one impacted, non-infected mandibular third molar was investigated. A patient sample of 270 were given either 1000 mg of metronidazole or placebo at least 30 min before surgery. The preoperative recordings included gender, age, tooth to be removed, experience of surgeon, time of test medication, and duration of surgery. No difference was found between the metronidazole and placebo groups in the occurrence of ASD. The duration of surgery and the experience of the operating surgeons had no effect on the occurrence of ASD. The present study failed to demonstrate any preventive effect of a single dose of metronidazole on the development of ASD.


Sagittal split osteotomy fixed with biodegradable, self-reinforced poly-L-lactide screws. A pilot study in sheep. Self-reinforced poly-L-lactide (SR-PLLA) screws were used to fix bilateral mandibular sagittal split osteotomies (SSO) in six sheep. No intermaxillary fixation was used postoperatively. The follow-up time was 16 weeks, after which the sheep were killed. Both sides of the mandible were photographed and radiographed. The bending strength of the osteotomy was measured on the left side of the mandible. Histological and microradiographic studies were performed on the right side of the mandible. The results showed that the SR-PLLA screws were strong enough to fix the SSO rigidly. The bending force needed to break the bone was greater than that for the average unoperated mandible. The histological and microradiographic studies showed uneventful healing of the osteotomies in all six sheep. The results indicate that this method should be suitable for rigid fixation of SSO and fractures of the mandible in human beings.


Muscle spindles in the mylohyoid muscle of rats. The mylohyoid muscle has several functions in relation to respiration, deglutition, and phonation, but these functions are not fully understood. The interaction of the mylohyoid nerve and muscle in 25 rats was studied by neurophysiologic and histologic methods. Stretching of the muscle elicited electrical responses from the branch of the mylohyoid nerve innervating the mylohyoid muscle, and stretch-sensitive receptors were demonstrated histologically in the mylohyoid muscle. This study indicates that the mylohyoid muscle plays an active role in functions such as swallowing, breathing, and phonation.


Application of the condylar positioning appliance in mandibular sagittal split osteotomies with rigid skeletal fixation. During orthodontic-surgical treatment of dentofacial deformities, centric relation of the mandibular condylar head to the fossa articularis must be maintained. Intraoperative application of the condylar positioning appliance, in combination with different surgical splints, allows three-dimensional adjustment of the jaw segments. The condylar positioning appliance can be used in osteotomies of the mandible alone, in isolated Le Fort I osteotomies, or in simultaneous osteotomies of the maxilla and mandible.


Electrognathographic patterns of mandibular motion after bilateral vertical ramus setback osteotomy. The purpose of this investigation was to study, by means of an electrognathographic procedure, mandibular motion after bilateral vertical ramus osteotomy for correction of mandibular prognathism in 27 adults. Each patient had kinesiographic registrations taken within 1 week before the operation and 6 months postsurgery. The results of the study demonstrated that, on average, orthognathic surgery did not adversely affect the postoperative mandibular motion. On the contrary, postoperative improvement in most of the variables was revealed by analysis of postoperative changes and comparison of the postoperative values with normative data.


Disfigurement and psychosocial handicap of adults with extreme mandibular prognathism. Questionnaires and psychological tests were used to assess the psychosocial impact of mandibular prognathism. Patients with mandibular prognathism were asked to assess the impediments caused by their dentofacial deformity. In addition, they were asked to rate their appearance and to report the effect that it had on their social contacts. The self-assessment revealed that patients felt esthetically impaired, but that they had a fairly positive autostereotype, as revealed by their self-descriptive choices on a personality scale. These results were compared with the assessments made by two different control groups composed of persons with no esthetic impairment. The attitudes of the control groups toward the patients were more negative than perceived by the patients, indicating that mandibular prognathism does result in a social handicap.


Surgically assisted rapid maxillary expansion in adults. Twelve adults with maxillary width discrepancy of greater than 5 mm were treated by surgically assisted rapid maxillary expansion. The procedure consisted of bilateral zygomatic buttress and midpalatal osteotomies combined with the use of a tooth-borne orthopedic device postoperatively. Mean palatal expansion of 7.5 mm (range of 6 to 13 mm), measured in the first molar region, was achieved within 3 weeks in all patients. Expansion remained stable during the 12-month study period, with a mean relapse for the entire group of 0.88 +/- 0.48 mm. Morbidity was limited to mild postoperative discomfort. The results of this preliminary study indicated that surgically assisted rapid maxillary expansion is a safe, simple, and reliable procedure for achieving a permanent increase in skeletal maxillary width in adults. Further study is necessary to document the three-dimensional movements of the maxillary segments and long-term stability of the skeletal and dental changes.


Severely impacted canines: autotransplantation as an alternative. Although orthodontic repositioning of impacted teeth is widely used, the treatment has its limitations. Autotransplantation is an alternative therapy that may be used in selected cases of severe impaction or when orthodontic repositioning is unsuccessful. Two case reports are presented to illustrate the use of the technique in patients with severely impacted canines. Indications and limitations are discussed.