[8 cases of thrombotic thrombocytopenic purpura]. Eight cases of the thrombocytopenic thrombosis are presented. Etiological factors, prognosis, and actual therapy are discussed. An emphasis is on the significance of freshly frozen plasma administration in the treatment of this disease.


[Familial occurrence of Glanzmann thrombasthenia]. Glanzmann's thrombasthenia, known also as Glanzmann's disease, is an autosomally inherited hemorrhagic disease with unique abnormalities of platelet functions. Authors present a large family in which Glanzmann's disease was diagnosed in the father and two sons. An analysis of platelet membranes enabled diagnosis of Glanzmann's thrombasthenia type II. A decrease in clot contractibility, fibrinogen binding to blood platelets, and decreased glycoprotein IIb and IIIa levels with marked impairment of GP IIb and IIIa complexes formation were characteristic for affected family members. One daughter died 8 days after birth with the symptoms of hemorrhagic diathesis. Mother and remaining three sons are healthy without the signs of Glanzmann's disease.


[Embolization of the branches of the external carotid artery]. Authors present their own experience with the embolization of the external carotid artery branches. The main indications to embolization included well vascularized and hemorrhagic brain tumors in facial part of the skull, mainly meningiomas, juvenile angiofibromas, and angioneuromyomas. Embolization of external carotid artery was performed in 15 patients. Complete impatience of blood vessel supplying the tumor was achieved in 12 cases, but it was incomplete in 3 cases. Single serious complication in the form of hemiplegia was noted. There were also mild complications in 5 patients, which did not require any intervention.


[Filling of the lower segment of the large intestine with fluid to facilitate ultrasonic examination in diseases of the small pelvis]. Small pelvis space is difficult to examine ultrasonographically as several important organs are localized in relatively small area. The most difficult is the interpretation of the standard USG examination of the abdomen in case of pathologies of the end of large intestine, when filled with feces. In such cases repeated ultrasonographic examination is recommended. Authors propose, that this segment of the colon should previously be filled with fluid. Such a technique improves the level of diagnosis or exclusion of any pathology. Forty two patients were examined with the above technique. Authors think, that it is a progress in ultrasonography of pelvic organs.


[Use of high resolution algorithm in computerized tomography of disseminated lung diseases]. Lobule of the lung is a principal anatomical structure of the respiratory zone in the lungs. Secondary lobule of the lung consists of about fifty primary lobules and is delineated by fibrous interlobular septa. Each lobule is delineated by interlobular septa and blood is supplied by small arterioles of pulmonary artery system. Its shape is conical and size ranges from 10 to 22 mm. The author used algorithm of high resolution in HR CT to present normal distal generations of respiratory area of the lungs and the same in 32 patients with disseminated lesions to the lungs. It is known, that lobule of the lung may be involved in very important pathologies. The author shown that significant architectural rearrangement takes place in pulmonary lobules and adjacent areas in the course of disseminated pulmonary diseases. The process include thickening of interlobular septa, consolidation of lobular area, changes in the shape of lobuli, and appearance of small cysts. The use of HR CT enables imaging in such pathologies which normally are inaccessible to conventional radiologic examinations.


[Recanalization of occlusion of the peripheral segment of the femoral artery by the Kensey method]. The aim of the presented study was to analyse the surgical technique and results of recanalization of the peripheral segment of iliac artery with Kensey's technique. Altogether 16 patients were operated. Arterial patency was observed in 14 patients immediately after surgery. This number decreased to 11 after a 3-month follow-up. Complications in the form of perforation of the arterial wall, hemorrhage at the site of puncture and thrombotic lesions in the reconstructed arterial channel were seen in 4 cases. Authors' own experience suggests that Kensey's technique together with laser surgery are the treatment of choice in case of iliac arterial occlusion in patients, in whom classic surgery is contraindicated.


[Usefulness of biliary scintigraphy using technetium Tc 99m mebrofenin for detection of disorders of patency of the bile ducts]. The value of the dynamic 99mTc-mebrofenin liver scintigraphy in the diagnosis of extrahepatic bile ducts patency has been assessed. The study included 176 patients in whom an occlusion of bile ducts of any degree was excluded in 111 cases, and bile ducts patency disorders were diagnosed in 65 patients. Time of the appearance of radiolabelled mebrofenin was measured in the selected segments of bile ducts. Time of appearance of radioactivity in the intestines was also noted. Another diagnostic criterion was persistent stasis of radioactivity in the choledochus. Basing on these criteria, patients were classified as "sick" or "healthy". It was possible to exclude the disease in case of negative result with the probability level of 91%. Positive result of scintigraphy points to the impaired patency diagnosis with 96% probability. Technique is simple, free of complications and contraindications. It is also of high predictive value. These features make the procedure particularly useful in the diagnosis of bile ducts patency.


[Cytogenetic studies in fragile X syndrome]. The main purpose of this work has been to find a method which would enable the diagnosis of FXS at the cytogenetic level. The studies are based on the analysis of chromosomes from 24 cultures on RPMI-1640 base with an addition of 5-fluoro-2'-deoxyuridine (FUdR) as inhibitor of thymidylate synthetase. The results indicate, that the cultures with the addition of FUdR could considerably improve the expression of fragile X chromosome. It is of great importance, particularly un the cases in which the presence of this marker is very low. It was possibly to specify the significant percentage and the exact position of breaks, gaps and fragile sites, mostly present in autosomes. It could mean, that such factors may play a significant role, apart of X chromosome, in the pathogenesis of FXS. The results of work prove, that this kind of method could be used as a screening for cases with fragile X syndrome.


[Correctness of diagnosis of celiac disease based on personal data]. A way of coeliac disease diagnosis was assessed in 348 children, Only 14% of patients has been examined according to ESPGAN recommendations and in the proper time. Diagnosis has been completed in 123 patients, and coeliac disease has been diagnosed only in 38 of them. The I biopsy has not been performed in 96 children, the II biopsy--in 136 children, gluten-free diet has not been observed in 105 children after the I biopsy. Other causes of diagnostic failures included: prolongation of the consecutive stages and improper histological evaluation, change of biopsies order, erroneous clinical evaluation. Diagnosis according to ESPGAN recommendations is practically very difficult and time consuming. Immunological markers of coeliac disease (IgA EmA, ARA) should lead to simplification and adjustment of those recommendations in Poland.


Primitive neuroepithelial tumors with vermiform processes (filiform neuroepithelial tumors). Immunocytochemical and ultrastructural study of 2 cases. Two unique, poorly-differentiated neuroepithelial tumors are described, one in a 35-year-old woman with an anterior mediastinal tumor and one in a 71-year-old woman with a left femoral mass. Immunocytochemical stains demonstrated Neuron specific enolase in both tumors and Chromogranin in one. Electron microscopy showed the cells of both neoplasms to contain abundant, thick, vermiform, organelle-free processes, previously described solely in large cell lymphomas. Rare dense-core granules were present, and very few processes were suggestive of neurites. These observations enlarge the spectrum of poorly differentiated neuroepithelial tumors.


Distribution of tissue markers in acinic cell carcinomas of salivary gland. Eight cases of acinic cell carcinoma of the salivary glands were histologically reclassified and their immunohistochemical expression and distribution for various tissue antigens were examined. The epithelial elements were divided into tubuloglandular components, microcystic patterns and solid nests. The authors' results indicated the following: 1) The duct luminal cells of tubuloglandular components have distinct epithelial features with cytokeratin (KL 1), alpha 1-antichymotrypsin (alpha 1-ACT), transferrin, lactoferrin, IgA, and carcinoembryonic antigen (CEA) positivity. 2) The cyst-lining cells of microcystic pattern expressed immunophenotypes similar to those of the duct luminal cells. 3) The acinic cells in solid nests had positive results for KL 1, alpha 1-antitrypsin (alpha 1-AT), transferrin, lactoferrin and vasoactive intestinal polypeptide (VIP). 4) The clear cells in solid areas had positive results for KL 1, alpha 1-AT, transferrin and VIP. Both the clear cells and the neoplastic acinic cells showed a rather similar pattern of immunoreactivity. Therefore, the clear cells may transform from the neoplastic acinic cells. 5) Secretory products in tubuloglandular and microcystic patterns had positive results for alpha 1-ACT, lactoferrin, IgA and CEA. 6) The basement membrane-like material between the neoplastic islands has distinct positivity for alpha 1-AT. The result suggests that alpha 1-AT is a useful marker of basement membrane-like material.


[Diagnosis of choledochal cysts in children with special reference to ultrasonographic examination]. Early diagnosis of the choledochal cysts in childhood, especially obstructing bile outflow to the duodenum, is an important clinical problem; often leading to serious complications--if not treated. Authors treated 5 children with choledochal cysts. Three out of them have been treated surgically. Ultrasound examination is sufficient to diagnose the disease, if the cyst is connected with intrahepatic bile ducts. If such a case is not possible to be imaged, cholescintigraphy and thin-needle biopsy with contrast filling are necessary to confirm the diagnosis.


[Evaluation of the phenylalanine tolerance test in detection of heterozygote carriers of phenylketonuria gene]. The study aimed at identifying heterozygotic phenylketonuria gene carriers with phenylalanine tolerance test performed in Lublin region. Serum phenylalanine concentration has been assayed during fasting and 1 and 2 hours following oral phenylalanine load in the dose of 0.1 g per 1 kg body weight. The study involved 203 individuals of the general population and 29 heterozygotes with phenylketonuria gene. Blood serum phenylalanine was assayed with Guthrie' technique. Statistical analysis has shown that hyperphenylalaninemia is relatively frequent in fasting individuals of the general population (59.1%). The same was demonstrated in 5 heterozygotes. Phenylalanine tolerance test did not allow to identify heterozygotic carries of phenylketonuria gene in the general population though fasting and after phenylalanine load increased blood serum levels of this amino acid are a criterium of hyperphenylalaninemia in the group of tested individuals (29%).


Immunohistochemical examination of routinely processed bone marrow biopsies. Immunohistochemistry was performed on paraffin sections of 169 bone marrow biopsies fixed in a buffered methanol-formalin solution and decalcified with EDTA. The biopsies included specimens with normal hematopoiesis, and specimens that were affected by various hematological disorders as well as some metastatic carcinomas. The results demonstrate that a wide spectrum of antigens was preserved in routinely processed bone marrow biopsies, even after long-term fixation up to 12 days. Markers for granulopoietic cells were lysozyme, elastase, DAKO-M 1, and MT 1. Megakaryopoiesis was stained with glycoprotein IIIa, von Willebrand factor, and Ulex europaeus agglutinin (UEA), and erythropoiesis with LN 1. Normal lymphocytes as well as lymphoma cells of all non-Hodgkin's lymphomas tested were positive for leukocyte common antigen (LCA), and at variable degree, for MB 1, 4 KB 5, LN 1, LN 2, UCHL 1, or MT 1. Reed-Sternberg and Hodgkin's cells in Hodgkin's lymphomas were reactive with Ber-H 2, LN 2 and Dako-M 1. In plasma cell disorders, staining for immunoglobulin light chains gave best results. Metastatic carcinomas showed predominantly staining with EMA, and KL 1. A selected panel of specific cell markers is proposed, which proved to be helpful in routine bone marrow diagnosis in most cases.


[Clinical course of congenital toxoplasmosis in children]. Hundred eleven children with the congenital toxoplasmosis were treated at the Department of Infectious and Parasitic Diseases in Childhood in 1979-1988. Multi-symptomatic toxoplasmosis has been diagnosed in 35 cases, ocular form in 65, oligosymptomatic in 6, and asymptomatic in 5 cases. Clinical symptoms suggesting congenital toxoplasmosis was seen in the majority of children (63 cases) in the first year of life and the disease was diagnosed in 50% of cases (33 children) at this age. Congenital toxoplasmosis in the group of 78 children has been diagnosed later. The majority of cases was ocular form. Diagnosis of the oligo- and asymptomatic congenital toxoplasmosis is possible in the first year of life, only. A titre of antibodies is exclusively an indicator of the immunologic response, not a severity of infection and does not contribute to the prognosis. Antitoxoplasma drugs were administered to 102 children including 33 under the first year of life. Pyrimethamine, sulphonamides, and spiramycin were used in the treatment. Dosage, duration of therapy, and way of administration have been established individually in dependence of patients age and clinical form of the congenital toxoplasmosis. Two out of 35 children with multi-symptomatic congenital toxoplasmosis died whereas 13 demonstrate psychomotor retardation of significant degree despite the fact that 11 of them were treated in the first year of life.


[Observations of children with chorioretinitis in congenital toxoplasmosis]. Hundred eleven children with congenital toxoplasmosis were followed up in the Department of Infectious and Parasitic Diseases in Childhood, Medical Academy in Warsaw, within 1979-1988. Ocular changes found in 91 children including chorioretinitis in 86 microphthalmia in 7, ophthalmic nerve atrophy in 15, vitreous body inflammation in 5, and cataract in 4. Only in 16 children the diagnosis was performed in the first year of life. In 15 children the recurrence of inflammatory process, most frequently in the time of puberty, was noted; twice in 5 of them. It was independent on the treatment which was previously administrated. Serological tests in ocular form of congenital toxoplasmosis do not indicate the dynamic changes in the inflammatory process. It is very important that small children are examined early and the treatment is started in the first year of life.


[Minutiae of skin ridges in Down's syndrome]. Minutiae of the epidermal ridges were examined in 16 children with Down's syndrome and 50 children without genetic and familial abnormalities. Minutiae in standard areas on the hand palms (according to Grzeszyk's concept) were examined. Comparative analysis confirmed by the statistical analysis showed significant differences in the incidence of particular minutiae types on the hand palms of children with Down's syndrome and control group.


Cryopreservation of cytological specimens for immunocytochemistry. A method has been established for storage and preservation of cytological specimens in liquid nitrogen and further processing for immunocytochemistry as smears prepared from thawed cells or cryo-sections of frozen cell pellets. For the experiments cultured cells of a T-lymphoblastic leukemia cell line (ATCC CCL 119) and blood cells of the buffy coat of healthy humans were treated with a cryo-solution (fetal calf serum +5% dimethylsulfoxid) and after freezing stored in liquid nitrogen. Alternatively, cells preincubated with cryo-solution followed by suspension in fetal calf serum without cryo-additive were frozen and stored in liquid nitrogen for the production of cryo-sections. Indirect immunofluorescence and alkaline phosphatase--antialkaline phosphatase based immunoreactions were performed for the decoration of various surface antigens with a panel of monoclonal antibodies. All immunoreactions were repeated at least three times and the stored cell preparations were investigated after different periods of storage (up to four months). The immunoreactions of fresh cells in suspension (which were used as controls) were comparable with those of cryopreserved cells, e.g. cells on smears after thawing and on cryo-sections of cell pellets. The strongest immunoreactions were achieved on fixed cryo-sections. The maintenance of cell morphology of smears from cryopreserved cells was slightly better than of cells from cryo-sections. In our hands the preparation of cell pellets, which are suitable for the storage in liquid nitrogen and the production of cryosections, is a very useful method for immunocytochemical investigations of cytological specimens especially in situations where immunoreactions cannot be performed on fresh material.(ABSTRACT TRUNCATED AT 250 WORDS)


Megakaryocytopoiesis in bone marrow biopsies of patients with acquired immunodeficiency syndrome (AIDS). An immunohistochemical and morphometric evaluation with special emphasis on myelodysplastic features and precursor cells. In 25 patients (22 males, 3 females--median age 39 years) with AIDS (CDC stages IV A-D) and no preceding myelotoxic therapy, morphometry and immunohistochemistry (CD 61-Y 2/51) was performed on trephine biopsies of the bone marrow to evaluate the megakaryocytic lineage. In comparison with megakaryocytes in the myelodysplastic syndromes (MDS) significant differences were evident. In AIDS this cell population revealed a size distribution within the normal range (control group) and no predominance of micromegakaryocytes characteristic for MDS. Furthermore, by determination of the form factors more irregular shapes of cell and nuclear perimeters could be shown. Finally, a not-evaluated number of precursors (promegakaryoblasts) was calculable. Particularly in those patients (n = 15) with AIDS-related severe thrombocytopenia the missing increase in the relative amount of promegakaryoblasts was conspicuous. This result was strikingly different from findings in idiopathic (autoimmune) thrombocytopenia and suggested an impairment of progenitor cell proliferation and differentiation in the acquired immunodeficiency syndrome. In conclusion, morphometry in combination with immunohistochemistry failed to establish characteristic myelodysplastic aspects of the megakaryocytic lineage in AIDS. For this reason, bone marrow lesions in this disorder should be properly termed HIV-myelopathy and not myelodysplasia.


Superficial extending carcinoma (SEC) of the larynx and hypopharynx. In this study the histopathological features of an underestimated architectural variety of infiltrating squamous cell carcinoma of the larynx and hypopharynx, operationally termed as "superficial extending carcinoma", are described. Pathologically, the superficial extending carcinoma is a poorly/moderately differentiated infiltrating squamous cell carcinoma showing an entirely or predominant superficial type of growth; deep infiltration was confined to the mucosa or limited to a few underlying glandular and/or muscular laryngopharyngeal structures, regardless of the presence of lymph node metastasis or lymph vessel invasion. As defined above, the superficial extending carcinoma may be regarded, from a pathologic point of view, as a laryngopharyngeal counterpart to "superficial esophageal carcinoma". Studying a series of 88 whole organs serially sectioned laryngopharyngectomy specimens, we found that 6 out of 61 primary laryngeal carcinomas (9.8%) and 6 out of 26 primary hypopharyngeal carcinomas (23%) showed the peculiar architectural features of the superficial extending carcinoma. In 6 cases (2 laryngeal and 4 hypopharyngeal) the tumor was entirely intramucosal or early infiltrated the underlying muscle or gland structures. In the remaining 6 cases (4 laryngeal and 2 hypopharyngeal tumor) a superficial extending carcinoma was found to be associated with a deeply infiltrating squamous cell carcinoma of the "classic" type. Features useful to histopathologic diagnosis of superficial extending carcinoma and to its differentiation from preneoplastic and other neoplastic lesions of the laryngopharyngeal mucosa are emphasized. The possible association of superficial extending carcinoma with multiple synchronous and metachronous neoplastic lesions in the upper aerodigestive tract and the frequent underestimation of its real extension may have important clinical implications.


[Atypical form of phenylketonuria caused by lack of dihydrobiopterin synthetase activity]. A case of non-typical phenylketonuria produced by the inactivity of dihydrobiopterin synthetases is presented. Dihydrobiopterin synthetases are enzymes converting neopterin to biopterin. Presented case indicates a possibility of erroneous classification of hyperphenylalaninemia due to BH4 deficit, if the complete differential diagnosis is not performed. A complete differential diagnosis is necessary in all cases of hyperphenylalaninemia distinguished in neonates during screening tests.


Myxoid liposarcoma with t (12; 16)(q 13; p 11). Possible usefulness of chromosome analysis in a poorly differentiated sarcoma. A chromosomal study was used to establish diagnosis of a poorly differentiated soft-tissue sarcoma occurring in the right thigh of a 57-year-old Japanese female. Histopathologically the excised tumor consisted of a poorly differentiated myxoid neoplasm, without specific features to enable the identification of neoplastic cells. Although a tentative diagnosis of poorly differentiated myxoid liposarcoma was made, ultrastructural examination and Oil Red O fat stain failed to demonstrate the evidence of lipoblastic differentiation, except that occasional cells possessed a small number of fine fat droplets. The diagnosis of liposarcoma was suggested by chromosome analysis of the fresh tumor tissue after short time culture and trypsin-Giemsa banding technique. The tumor cells demonstrated a clonal abnormality characterized by a reciprocal translocation, t(12; 16)(q 13; p 11), which is known as a specific aberration in myxoid liposarcoma. Thus, chromosome study seems to be useful for identifying undifferentiated mesenchymal tumors, which lack morphologic evidence of any specific differentiation, as in the present case.


[Ullrich-Feichtiger syndrome in a 3-year-old boy]. A case of a 3 year old boy with Ullrich-Feichtiger syndrome is presented, because of the rarity of this syndrome. Ullrich-Feichtiger syndrome diagnosis was based on the following clinical signs and symptoms: a) micrognathia with several teeth developmental abnormalities; b) polydactyly (six toes); c) varied genital malformations; d) multiple ocular abnormalities. Cause of these multiple malformations remains unclear.


Relationship between quantity of silver stained nucleolar organizer regions associated proteins (Ag-NORs) and population doubling time in ten breast cancer cell lines. Using a one-step silver staining technique ten human breast cancer cell lines were investigated, determining by means of automated image analysis the mean area of Ag-NORs per nucleus, the total number of Ag-NORs, and the so-called "scattered" and "clustered" Ag-NORs. These parameters were statistically correlated with the population doubling time (PDT) of the various carcinoma cell lines of this series. Our results show that the mean area of Ag-NORs per nucleus (p less than 0.001) is highly significantly correlated to the PDT, whereas all other parameters were less or not significant. It is concluded that the assessment of the area of Ag-NORs by automated image analysis is a simple and reliable method for the determination of cell duplication rates.


Latent thyroid carcinoma in Iceland at autopsy. The annual incidence rate of thyroid carcinoma in Iceland is high, 4.4 pr. 100,000 men, and 11.7 pr. 100,000 women, as published by the Icelandic Cancer Registry for the period 1955-1984. This rate is more than twice that in the other Nordic countries and one of the highest incidence rates reported anywhere. This led us to investigate the prevalence rate of latent thyroid carcinoma in Iceland. We serially sectioned and examined thyroid glands from 201 consecutive forensic autopsies. Altogether, sixteen carcinomas were identified in fourteen glands: fourteen papillary, one follicular and one medullary carcinoma. We conclude that the prevalence rate of latent thyroid carcinoma in each sex does not follow the frequency distribution of clinical disease, being 7.5% in males and 5.1% in females. Comparisons between populations show the same lack of consistency. Further, most, but not all, latent carcinomas of the thyroid gland are of the papillary type. These findings suggest that promoting factors might be of particular importance where incidence and mortality rates are high, but further research is needed into the role of host resistance.


Cystic pancreatic glucagonoma in contact with insulinoma found in a hypoglycemic patient. Cystic glucagonoma in contact with insulinoma was found in the pancreas of a 28-year-old female patient with characteristic hypoglycemic syndrome. Among six tumors in total detected in the tail of the resected pancreas, the largest solid tumor (2.5 cm in diameter) consisted mostly of insulin-containing cells with conspicuous amyloid deposition. Contiguous to this tumor, the second largest nodule, measuring 1.8 cm in diameter, showed cystic changes and consisted of glucagon-containing cells. High concentration of immunoreactive glucagon was demonstrated in the cystic fluid. In addition to the cystic changes of endocrine pancreatic tumors, simultaneous occurrence of glucagonoma in contact with insulinoma appears to be extremely rare and repeated episodes of hypoglycemia may contribute to its pathogenesis.


Malignant schwannoma with rhabdomyoblastic and melanocytic differentiation. This is the first case report of an unusual malignant tumor with components of malignant schwannoma, rhabdomyosarcoma, and melanoma, occurring in an adult. The tumor was observed in the left temple in a 35-year-old man without von Recklinghausen's disease. The possible derivation of this tumor from primitive neuroectodermal cells is discussed.


"Medullary ray glomerular counting" as a method of assessment of human nephrogenesis. Renal weight (left-right combined), as a parameter of renal development, is required to be less than half the normal value for age for a statistically confident diagnosis of hypoplasia. "Medullary ray glomerular counting" (MRGC), counting cortical glomerular generations, has been proposed as a simple technique of possibly greater sensitivity. Recent development of the Disector method for the unbiased stereological estimation of total glomerular number has provided a, hitherto unavailable, "golden standard" with which to determine the diagnostic potential of MRCG. Both "true" (actual number of generations seen) and "assumed" (a subjective "guess" of the total number of generations) MRGC counts were determined in 11 pairs of kidneys from spontaneously aborted, normally developed, non-malformed fetuses (gestational age: 15-40 weeks). Each kidney was randomly analysed blind and on two separate occasions by two paediatric pathologists using a written protocol. Results were compared with unbiased stereological estimates of glomerular number. Intra- and inter-observer and intra- and inter-(left-right)renal reproducibility were analysed. In conclusion, MRGC, using "real" counts, is a highly reproducible parameter of renal development from 15-36 weeks' gestation. Sensitivity for detection of both hypoplasia and maturation delay increase with gestational age and generally exceeds that of renal weight.


The conduction system in human cardiac allografts. A histological and immunopathological study. Twenty-five hearts were lost in the first 103 orthotopic human cardiac allografts in 100 recipients. Twenty-two patients died. The first nine recipients were treated with Cyclosporin A and high dose Prednisolone and the subsequent recipients were immunosuppressed with a triple regimen consisting of Azathioprine in addition to Cyclosporin A and low dose Prednisolone. Twenty grafts were examined at autopsy and three after retransplantation. Fourteen hearts with acute rejection and vascular pathology were investigated regarding the histological and immunopathological alterations due to cellular and vascular rejection. The recipient sinoatrial node was available for examination in 10, the donor node in 13 and the atrioventricular conductive tissue in all 14 grafts. The conduction system was involved in 8 out of 11 allografts attacked by acute cellular rejection. In one allograft in which the patient developed AV block, the cellular infiltrates were almost exclusively observed in the atrioventricular tissue. Most of the cells were T lymphocytes, while macrophages and B cells were present to a lesser extent. There was little evidence of permanent structural damage to the atrioventricular tissue after recurrent mild or moderate episodes of acute cellular rejection. In the sinus nodes, however, risk of traumatic damage to the recipient and donor sinus node was about half and a quarter respectively. Acute and chronic vascular rejection seemed to be equally distributed in the sinus node, atrioventricular arteries and in the intramural branches of the coronaries. No morphological differences were established between the two types of immunosuppressive regimes.


"Solid" variant of aneurysmal bone cyst. A case of the so-called "solid" variant of aneurysmal bone cyst is reported. A 12-year-old girl with a few weeks' history of backache presented with a tender palpable mass located thoraco-spinal in the back at Th 3. Radiologically, the lesion was consistent with conventional aneurysmal bone cyst. Morphologically, it showed fibroblastic, fibrohistiocytic, fibromyxoid, osteoclastic and osteoblastic components as well as small aneurysmal sinusoids. Based on four other well documented cases, the clinico-pathological features and the differential diagnostical problems are discussed.


"Lipoleiomyoma with metaplastic cartilage" (benign mesenchymoma) of the uterine cervix. Benign mesenchymoma (BM) is an uncommon tumor containing two or more differentiated mesenchymal elements in addition to fibrous tissue. A case of BM of the uterine cervix in a 51-year-old woman is reported. This tumor, which we designated "lipoleiomyoma with metaplastic cartilage" because of its morphological features, apparently represents the first documented example of BM of the cervix.


The genetic basis of multidrug resistance. Cellular multidrug resistance, a common side-effect of anticancer chemotherapy frequently leading to failure of the treatment, has been characterized as an acquired resistance to several antimitotic drugs simultaneously. Multidrug resistance could mainly be attributed to the overexpression of the P-170 glycoprotein, considered as a drug-efflux pump encoded by the mdr 1 gene. Overexpression of this protein can be induced either by an accidental amplification or activation or both of the mdr 1 gene. Recent investigations focused on these mechanisms, aiming at a better understanding of the appearance of multidrug resistance during a chemotherapy. P-glycoprotein mediated drug resistance, however, is only one, albeit quite an important detoxification pathway, and some observations revealed genetic interactions with other systems. On the basis of this new knowledge, the development of novel therapeutic strategies to circumvent this clinical side-effect of cancer treatment has already begun.


Amino acid concentrations in serum and urine after intravenous infusion of 1.5% glycine in prostatectomy patients. Glycine 1.5% was given by intravenous infusion at a rate of 50 mg/min over 20 min to 10 patients (aged 57-79 years) scheduled for transurethral prostatectomy. The concentrations of amino acids in serum and urine were measured at 0, 10, 20, 50, 80, and 140 min in the experiments in order to study how elderly men handle a glycine load. The results show an increase in the serum concentrations of alanine, proline, glutamine, glycine, serine, and threonine. The apparent distribution volume for the excess glycine was 33 +/- 9 L, the half-life was 41 +/- 7 min, and the total body clearance was 0.56 +/- 0.08 L/min, while the renal clearance for glycine was 36 +/- 14 ml/min (mean +/- SD). There was an increase in the excretion of all amino acids that could be detected in the urine. The renal clearances of urea and creatinine was reduced in some of the patients. The absence of toxic symptoms is consistent with unchanged serum concentrations of ammonia and glutamate.


Estrogen-induced morphological and immunohistochemical changes in stroma and epithelium of rat ventral prostate. Prostatic smooth muscle cells have been regarded to play a major pathogenetic role during the development of benign prostatic hyperplasia (BPH) in elderly men. Altered hormonal signals (increased estrogen) have been made responsible for the "metabolic" transformation of prostatic smooth muscle cells, which were thought to produce increased amounts of connective tissue fibers observed in BPH. In order to find out the role of metabolically "activated" smooth muscle cells, hormone stimulation experiments were performed in male rats. The effects of androgen deprivation and estrogen stimulation were recorded by semiquantitative analysis of intermediate and myofilament proteins in stromal smooth muscle cells. In castrated or estrogen-treated or estrogen-treated and castrated animals, the reduction of the glandular lumen is the most obvious morphological alteration, accompanied by an increase in connective tissue. Regressive changes occurred most rapidly in castrated animals (already within the first week), slower in castrated estrogen-treated animals and still slower in normal estrogen-treated animals. Regression of the epithelium was accompanied by a marked decrease in immunoreactivity for prostatic binding protein (PBP) in castrated animals, while PBP immunoreactivity in estrogenized animals was retained for up to 6 weeks. Smooth muscle cells became atrophic in castrated animals. This effect was attenuated in estrogen-treated animals. There was no indication for enhanced collagen synthesis by smooth muscle cells. Actin and desmin-immunoreactivity were only slightly altered in experimental animals and showed a changed distribution pattern. Prostatic smooth muscle cells respond less markedly to hormonal alterations than do the fibroblasts.


On pharmacokinetic evaluation of model drugs distribution into rat central lymph. Numerous experimental data obtained in the studies of factors influencing the transfer of model drugs (diazepam, inulin, hippurate) into the lymphatic system were evaluated using compartmental pharmacokinetic analysis. The selection of kinetic equations for lymphatic data analysis in respect to blood ones is specific. Lymphatic kinetic equations correspond in every case tested with those used generally in blood kinetic analysis of drugs administered perorally. The lag time parameter is useful in this lymphatic analysis, too.


Reserpine ulcers in morphine dependent and withdrawal rats. Reserpine ulcers were produced in dependent and withdrawal rats. The reactivity of isolated duodenum and colon to morphine and papaverine was tested in both groups of animals. Chronic administration of morphine decreases the development of post reserpine gastric ulcers, while in withdrawal rats it increases their occurrence. Relaxation and contraction responses of duodenum taken from the dependent rats showed tolerance. On the other hand, withdrawal rats displayed increased responses as compared with placebo group. Colon of dependent rats showed stronger responses to morphine and papaverine which indicates the lack of tolerance to morphine or enhanced receptors sensitivity. Stronger responses of colon in both dependent and withdrawal rats suggest the lack of tolerance in this segment of the gut. In withdrawal rats which obtained reserpine and placebo responses to papaverine were similar. It is suggested that reserpine decreased the sensitivity of mu receptor to morphine.


The prostatic epithelial cell in dysplasia: an ultrastructural perspective. The histologic features of prostatic duct-acinar dysplasia have been difficult to analyze ultrastructurally, because of the difficulty in properly selecting and processing such small, randomly situated grossly invisible lesions. We have succeeded in identifying dysplastic foci by examination of the cut surfaces of tissue slices under low magnification. Dysplasia foci were excised from the slices and were compared to adjacent normal tissue by both light and electron microscopy. By electron microscopy (EM), normal secretory cells were filled with myriad tiny clear vacuoles, which were markedly diminished to absent in the cytoplasm of dysplastic cells. Both apocrine and eccrine secretion characterized normal epithelium and were diminished in dysplasia. EM showed striking features of nuclear abnormality more prominently than light microscopy, and qualitative basement membrane abnormalities were revealed. By EM analysis, dysplastic epithelium resembled that of invasive carcinoma more than normal epithelial cells.


Cytotoxic effect of xanthotoxol (8-hydroxypsoralen) on TCTC cells in vitro. The effect of xanthotoxol (8-hydroxypsoralen) on proliferation of TCTC cells in vitro has been studied. Xanthotoxol at concentrations of 5 to 50 micrograms/ml inhibited the growth of cells. In cultures with xanthotoxol, decreased amount of cell protein, mitotic index, and decreased ability to form a colony, were observed. Moreover, xanthotoxol disturbed mitoses elevating the number of mitotic cells in the telophase stage. An increase of giant and multinuclear cells was also found. On the basis of these results it can be concluded, that 8-hydroxypsoralen which in comparison with other psoralens is not sensitive to photostimulation, inhibits the cell proliferation anyway. This fact shows that the mechanism of the psoralens activity is to some extent independent from the photostimulation.


Isolation and characterization of transforming growth factor beta response variants from human prostatic tumor cell lines. In this study we examined the relation between the response to transforming growth factor beta (TGF beta 1) in vitro and the growth in vivo of 1-LN-PC3-1A (1-LN) human prostatic carcinoma cells. 1-LN cells resistant to the growth-inhibitory effects of TGF beta 1 were isolated after exposure to 2 ng/ml TGF beta 1 in an anchorage-independent growth assay. Cloning of TGF beta 1-resistant and -sensitive populations produced 2 clones (R2-6 and 1-LN clone 4), which maintained relatively stable resistance or sensitivity, respectively, in the absence of TGF beta 1 for up to 12 passages. Colony formation by the R2-6 cells in the presence of TGF beta 1 was 2-10 times greater than that of 1-LN clone 4, depending upon the TGF beta 1 concentration. Injection of 1 x 10(5) R2-6 cells into athymic nude mice produced tumors with a significantly shorter latency interval as compared with 1-LN clone 4 tumors (P < 0.0001). Western immunoblotting showed that higher levels of latent TGF beta 1 protein were secreted into the culture medium by 1-LN clone 4 cells. Acidified conditioned media from both clones inhibited mink lung epithelial cell DNA synthesis. Neutralizing monoclonal antibody to TGF beta 1 but not TGF beta 2 abrogated this inhibitory effect. Comparison of the different sensitive and resistant clones showed that in vitro sensitivity to TGF beta 1 and in vivo tumor latency interval were not invariably correlated. Thus, the TGF beta 1 response phenotype in vitro was not always predictive of growth delay in vivo.


Synthesis and some central pharmacological properties of new derivatives of 2,3-dihydroimidazo[1,2-a]pyrimidine-6-carboxylic acid. Twenty one derivatives of 2,3-dihydroimidazo[1,2-a]pyrimidine-6-carboxylic acid (6 n-butyl amides and 15 free acids) bearing the aromatic ring in position 1 or 2 were obtained. They were synthesized by aminolysis or hydrolysis of respective ethyl esters. Pharmacological studies on the central action of eight compounds 1, 2, 4, 5, 7, 8, 9 and 10 were carried out on mice and rats. The most active compounds, producing sedation and hypothermia, and 1, 2 and 5. The compounds decreased amphetamine-induced hyperactivity. Besides, compound 2 exerted analgesic effect in mice.


Dose-dependent induction of ornithine decarboxylase and S-adenosyl-methionine decarboxylase activity by testosterone in the accessory sex organs of male rats. The dose-dependent induction of ornithine decarboxylase (ODC) and adenosylmethionine decarboxylase (AMDC) activity in the different lobes of the prostate and the seminal vesicles (SV), 24 hours after administration of testosterone to castrated Wistar rats, has been studied. ODC and AMDC activities were low in all lobes 10 days after castration. A dose of approximately 300 micrograms testosterone/100 g body weight (B.W.) gave an ODC activity of 50 percent of maximum response, and at 600 micrograms/100 g B.W. maximum activity was reached in all the prostatic lobes and the SV. In the lateral and dorsal prostate, and the coagulating gland, the dose of testosterone giving 50% of maximum AMDC activity was reached after administration of between 450 and 600 micrograms/100 g B.W. In the ventral prostate and SV, the dose giving a 50% response was approximately 700 micrograms/100 g B.W. In conclusion, all prostatic lobes showed a clear dose-response relationship concerning the activity of ODC and AMDC following administration of different doses of testosterone. We have found minor differences in androgen responsiveness between the lobes when looking at the dose requirements for induction of AMDC activity. The dose-response curves could possibly be useful as a rapid in vivo bioassay for compounds with anti-androgenic properties in the prostate.


Both-bone forearm fractures in children. Treatment of both-bone forearm fractures remains a difficult dilemma for the orthopedist. We assessed the results of 33 children treated with closed reduction and a long-arm cast using traction with finger traps in neutral rotation. Patients were grouped according to age and analyzed for residual angulation and range of motion (ROM). Despite some residual angulation and loss of rotation, all patients were fully active with no functional restriction at follow up. For patients 10 years old or younger with less than 30 degrees of post-casting angulation, full ROM and minimal residual angulation on radiograph can be expected. For patients ages 11 to 15 years (the oldest patient in this series was 15), residual angulation is likely and approximately 60% of patients will have residual loss of less than or equal to 30 degrees of rotation. In spite of this, we found no evidence of functional loss at follow up. Our series supports the continued use of closed manipulation as an effective treatment in children with both-bone forearm fractures.


Evaluation of the degree of effectiveness of biobeam low level narrow band light on the treatment of skin ulcers and delayed postoperative wound healing. Twenty-one patients with 31 postoperative delayed open wounds resistant to conventional therapy were randomly allocated to three groups. Group 1 was treated with red low level narrow band (LLNB) light (660 nm); group 2 was treated with infrared LLNB light (940 nm); and group 3 was treated with a placebo such as the Biobeam machine (no light irradiation). Group 1 showed a significant improvement compared to groups 2 and 3 (t-test).


Energy demands for walking in dysvascular amputees as related to the level of amputation. Cardiac function and oxygen consumption were measured in 25 patients who underwent amputation for peripheral vascular disease (PVD), and in five similarly aged control patients with PVD. Five patients at each of the midfoot, Syme's, below-, through-, and above-knee amputation levels and the five controls were measured at rest, normal walking speed, and maximum walking speed on a treadmill. At normal walking speed, all of the patients functioned at approximately 80% of their cardiac capacity. Normal walking speed and cadence decreased and oxygen consumption per meter walked increased with more proximal amputation. The ratio of cardiac function and oxygen consumption at normal walking speed as compared with at rest increased with more proximal amputation, and the capacity to increase walking speed and oxygen consumption lessened. Our results suggest that peripheral vascular insufficiency amputees function at a level approaching their maximum functional capacity. At more proximal amputation levels, the capacity to walk short or long distances is greatly impaired.


Cumulative trauma disorders.

Cumulative trauma disorders. Cumulative trauma disorders have increased five-fold since 1979 and now account for up to 47% of workplace injuries. Nerve entrapment, tendonitis, and other soft tissue injuries are the most common diagnostic groups. Both occupational and non-occupational factors contribute to the etiology of these disorders. Epidemiology, differential diagnosis, and interventions for treatment are reviewed.


Quadricepsplasty: the Judet technique and results of 21 posttraumatic cases. Twenty-one quadricepsplasty procedures were carried out on 21 patients over a 14-year period due to posttraumatic stiffness of the knee joint. Three patients (14.2%) required mobilization under anesthesia in the early postoperative period. The average interval between injury and quadricepsplasty was 18 months (range: 5 to 49 months). Preoperatively, all cases showed less than 90 degrees knee flexion. At follow up, 12 cases (57.2%) achieved more than 90 degrees flexion, while nine patients (42.8%) exhibited under 90 degrees flexion. Flexion gain was between 60 degrees and 90 degrees in six cases (28.5%) and less than 60 degrees in 15 cases (71.5%). Results were assessed according to Judet et al. There were 14 excellent and good (66.6%) and seven fair (33.3%) results. No poor results were found in this series.


Dermatoglyphics in sudden infant death syndrome. An analysis of digital and palmar dermatoglyphic patterns was conducted in 173 victims of the sudden infant death syndrome (SIDS). The results expose four dermatoglyphic regions with pattern frequencies differing from those in a control population. These are an excess of Sydney creases, hypothenar patterns, open fields (with fewer vestiges) in interdigital region IV, and arches on all digits (females only). These findings indicate a genetic or early intrauterine environmental influence in SIDS infants. An increased incidence of dysmorphism and anomalies including recognition of specific syndromes support this contention. One could speculate that these dermatoglyphic deviations reflect specific genotypes and/or phenotypes particularly vulnerable to postnatal challenges. Differences in multiple dermatoglyphic categories support the concept of heterogeneity of the SIDS population and multicausality of SIDS.


Morphometric study on pulmonary arterial thickness in pulmonary hypoplasia. This study addresses the question of whether pulmonary hypoplasia is associated with structural changes of the pulmonary arteries. Quantitative (medial thickness, external radius) and qualitative (airway level) parameters of pulmonary arteries were assessed in eight hypoplastic lungs and eight lungs from age-matched fetuses without underlying primary pulmonary disease. The gestational ages ranged from 16 to 40 weeks. Relative medial thickness of the pulmonary arteries was related to the external radius and to the type of accompanying airway. Medial thickness was significantly higher in pulmonary hypoplasia than in normal fetal lungs. In contrast to normal fetal lungs, muscular arteries extended to the intra-acinar level in pulmonary hypoplasia. These arteries had medial thickness values up to a maximum of 80%.


Fetal listeriosis during the second trimester of gestation. Listeriosis is common and is implicated in about 3% of second-term abortions examined in our laboratory. Maternal fever was followed rapidly in all instances by the expulsion of a nonmacerated fetus. Chorioamnionitis was always present and was associated with placental microabscesses. Leukocytic infiltrates were frequent in fetal tissues, being present in adrenal, lung, and skin. Listeria monocytogenes was isolated from 8 of the 205 abortions that had microbiological cultures (3.9%). The clinical features and morphological lesions were so characteristic that the diagnosis of listeriosis could be made in 5 of the 217 fixed abortuses received during the same period, but without culture. In contrast to the third trimester of pregnancy, there were no inflammatory lesions in the central nervous system in our small series.


Association of Down syndrome and segmental tracheal stenosis with ring tracheal cartilages: a review of nine cases. Four patients with Down syndrome and midtracheal stenosis, three with proven absence of the midtracheal pars membranacea ("hourglass trachea"), are reported. Five previously reported patients who had Down syndrome and tracheal stenosis of this type are summarized. Respiratory difficulty and stridor were the reported clinical features of all but one of the patients whose clinical story is available. That approximately half the patients with tracheal stenosis with hourglass trachea and midtracheal absence of the tracheal pars membranacea reported had Down syndrome suggests that the association of this pattern of congenital tracheal stenosis with Down syndrome is, although infrequent, significant.


Juxtagonadal mesonephric glomeruli in fetuses of 11 to 21 weeks of gestation. Mesonephric glomeruli and tubules were found in the juxtagonadal region in 11 fetuses ranging in age from 11 to 21 postmenstrual weeks. Although mesonephric excretory function into the fourth month of gestation has been postulated, mesonephric glomeruli have been previously acknowledged anatomically only during embryonal and early fetal life. The present observations indicate that mesonephric glomeruli persist as anatomical structures into the midtrimester of gestation. The conclusion that the observed glomeruli are mesonephric is based on their location and the known strong anatomical and functional ties that bind mesonephros and gonad during development.


Poorly organized parasitic conjoined twins: report of four cases. We report four examples of parasitic conjoined twins (PCT) that created difficulties in diagnosis and treatment because of their unusual presentation and poor internal organization. Case 1 appeared as a tumor on the back containing an adrenal gland and part of the small bowel and stomach; two spines with spinal cords were present. Case 2 was similar, but mature and immature renal tissue were included and a meningocele with Arnold-Chiari type II malformation was recognized in the autosite spine. Retrospective interpretation of both cases suggested that the left lower limb and pelvis were part of the parasites. In case 3 the parasite was attached at the perineum and lower abdomen, contained a rudimentary spine in continuity with the coccyx of the autosite, and was partially covered by scalp. Case 4 presented as a limblike tumor attached at the suprapubic region. All cases were complicated by disruptions in the autosites. Surgical treatment was successful in cases 1, 2, and 3. These four anatomically poorly organized PCT are best categorized as intermediate between teratomas and the more common types of PCT.


Web-like malformation of the carotid artery and multicystic encephalomalacia. Multicystic encephalomalacia and hydranencephaly lie within a spectrum of brain lesions linked to ischemic cerebral damage. Causes include vascular malformation, thrombosis, embolism, infection, and toxins. We describe an infant with multicystic encephalomalacia associated with a peculiar web-like malformation of the right common carotid and left subclavian arteries. We postulate that this luminal bridging is a congenital malformation resulting from defective canalization of the medium-sized blood vessels but could represent organized and recanalized thrombi, the etiology of which remains unknown.


Perinatally acquired neonatal tuberculosis: report of two cases. Perinatally acquired neonatal tuberculosis occurs rarely, is difficult to diagnose, may be the indicator of untreated tuberculosis in the mother, and could result in nosocomial transmission to neonatal patients, visitors to neonatal intensive care units, and health care workers. The disease may be more common in certain ethnic and social groups. Neonatal mortality approaches 30%. We report two cases with different outcomes. A neonate was treated for clinical miliary tuberculosis and survived; Mycobacterium tuberculosis was cultured from bronchoscopic washings, maternal genital fluids, and tissues. A second infant died at age 46 days, and autopsy disclosed miliary tuberculosis of lungs, mediastinal and mesenteric nodes, liver, spleen, and bone marrow. The lungs were most severely affected, but the placenta and central nervous system were not involved. The histopathology was not granulomatous. After the diagnosis in the infant, the mother was ascertained to have pulmonary and genital tuberculosis. Fetal and neonatal tuberculosis could be acquired transplacentally as prenatal tuberculous chorioamnionitis, perinatally through aspiration and ingestion of infected maternal genital tissues and fluid, or postnatally through droplet spread from cases of active tuberculosis. These two neonates probably acquired the disease perinatally from maternal genital tuberculosis.


Maxillo-mandibular development in cerebrocostomandibular syndrome. Cerebrocostomandibular syndrome is a potentially lethal developmental disorder characterized by mental handicap, palatal defects, micrognathia, and severe costovertebral defects. We report a 3-day-old male neonate who died of respiratory difficulty that began at birth. Micrognathia, glossoptosis, high-arched palate, and hypoplasia of the lower half of the face were present. Multiple posterior rib defects and a narrow rib cage were associated with pulmonary hypoplasia. The rib gaps were filled with fibrovascular tissue. A facial bone study showed multifocal growth retardation involving the septal cartilage, vomer, and mandibular condyle, indicative of maxillomandibular growth arrest. The tongue had an abnormal genioglossus muscle and papillae.


Pigmented villonodular synovitis in the sacral joint with extensive bone destruction in a child. We report a 12-year-old girl who had pigmented villonodular synovitis with extensive bony erosion around the left sacroiliac joint. The lesion mimicked a primary bone tumor clinically and radiologically, but was a typical pigmented villonodular synovitis (PVNS). The sacroiliac joint is an unusual site for PVNS, especially in the pediatric age group.


Rhabdomyomatous mesenchymal hamartoma of skin. A distinctive dermal and subcutaneous hamartoma composed primarily of disorganized skeletal muscle and mature adipose tissue, designated rhabdomyomatous mesenchymal hamartoma of skin, was recently reported. We have observed two histologically similar though less polypoid lesions in boys aged 4 years. Both were also on the chin and present since birth, suggesting that site and age, as well as histology, may be characteristic. The location on the chin in three of the four neonates may reflect an etiology of aberrant embryologic development of the platysma muscle as it inserts superficially into the dermis over the mandible.


Reactive follicular hyperplasia of intraparotid lymphoid tissue presenting as a recurrent parotid enlargement. A patient who had reactive lymphoid hyperplasia of intraparotid lymphoid tissue, clinically presenting as a recurrent parotitis, is described. The case offers a new etiologic mechanism for recurrent parotitis.


Axonal dystrophy presenting as the megacystis-microcolon-intestinal hypoperistalsis syndrome. Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a neonatal intestinal syndrome, characterized by defective peristalsis and bladder dilatation, refractory to pharmacological treatment. Examinations of bowel and bladder have failed to demonstrate a pathological explanation for this syndrome. We describe a 7-month-old female infant with MMIHS who had generalized axonal dystrophy of her central, peripheral, and autonomic nervous systems, which may provide a neuropathological explanation for some cases of MMIHS.


Sudden death in supravalvular aortic stenosis: fusion of a coronary leaflet to the sinus ridge, dysplasia and stenosis of aortic and pulmonic valves. Supravalvular aortic stenosis (SVAS) is an uncommon congenital cardiac anomaly. We report sudden death, occurring during exercise, of a child who had SVAS with fusion of the right coronary aortic leaflet to the supravalvular aortic ridge, resulting in a closed sinus of Valsalva except for a few pinpoint fenestrations in the dysplastic leaflet. In addition, both aortic and pulmonic valves were dysplastic and stenotic. We postulate that near total isolation of the right coronary artery ostium from the aortic lumen compromised the blood supply to the hypertrophied ventricles. We emphasize the importance of other cardiac anomalies associated with SVAS as well as the development of coronary insufficiency.


Massive perinatal hepatic necrosis from maternal oxytocin overdose. Review of clinical records regarding administration of oxytocin may provide clues to the etiology of hepatic infarction in the neonate. The authors present a case in which a large and rapid maternal overdose of oxytocin (17,300 mU over 20 min) during end-stage labor was associated with neonatal death and extensive hepatic infarction. These findings represent novel complications of oxytocin administration.


The pediatrician's role in the diagnosis and treatment of substance abuse. Abuse of drugs and alcohol is pervasive in our society. The role of the pediatrician as a health-care provider from birth through young adulthood includes recognizing the stigmata in newborns of prenatally ingested drugs as well as being able to treat neonatal drug withdrawal syndromes. Questioning about drug use and other closely related topics should be incorporated into all health-care maintenance visits, starting at the age of 10 y, with parental participation and anticipatory guidance being offered. Physical examination and laboratory testing are not as helpful in confirming an impression of substance abuse as a comprehensive interview and a full appreciation of the warning signs of substance abuse. Treatment of the problematic user with a multidisciplinary team that understands adolescent development and behavior as well as the problem of substance abuse is crucial. The decision to treat the teen in an ambulatory or inpatient setting is determined by the extent of abuse, underlying medical problems and psychopathology, and the degree of family dysfunction. The pediatrician must not avoid addressing these issues with patients. If, however, upon identifying an adolescent or a newborn with a drug problem, the pediatrician feels uncomfortable or ill-prepared to manage the patient, appropriate professional referrals are warranted. Despite exercising the referral option for treatment, as advocate for child and family, the pediatrician remains professionally bound to track all drug abuse-related referrals while continuing to participate in the general ongoing care of the patient and family. Finally, the pediatrician should retain a public advocacy role in the community by offering educational, preventive, and supportive efforts in the continuing struggle against drug abuse.


Acute and chronic immune thrombocytopenic purpura. Disorders that differ in more than duration. Immune thrombocytopenic purpura is a relatively common disease that occurs in both pediatric and adult populations. The acute form predominates in children and the chronic form is seen much more often in adults. The diagnosis is one of exclusion but often can be made on the basis of thorough history taking and physical examination and a limited number of laboratory studies. More intensive diagnostic studies, including bone marrow examination, may be needed to rule out other causes of thrombocytopenia. For patients in whom spontaneous remission does not occur, effective treatments are available, and morbidity and mortality rates are quite low.


Control of type II diabetes. Reaping the rewards of exercise and weight loss. After a complete physical examination to identify possible complications, patients with non-insulin-dependent (type II) diabetes mellitus should be placed on an exercise program and a weight-control diet. Individualizing these regimens according to patients' health goals and personal interests enhances the chance of success. Exercise guidelines must be followed to ensure the patient's safety. Weight loss, however moderate, should be encouraged, and once a reasonable weight is obtained, a balanced maintenance diet should be recommended. Patience and persistence by physicians and patients can bring success in management of type II diabetes with nonpharmacologic means.


Vocal cord dysfunction mimicking bronchial asthma. Vocal cord dysfunction is a possible cause of wheezing and dyspnea in patients who do not respond to conventional asthma therapy. A carefully taken history, pulmonary function testing, and, most important, direct visualization with a flexible laryngoscope during an acute attack allow physicians to differentiate vocal cord dysfunction from asthma. Speech therapy, inhalation of helium and oxygen, and psychiatric counseling play a role in management.


Acute urinary tract infection in women. What kind of antibiotic therapy is optimal? Urinary tract infections continue to be a major health problem for women. Understanding of the pathogenesis of urinary tract infections has improved; Staphylococcus saprophyticus has been recognized as a common causative agent, and low-colony-count infections are misdiagnosed less often. Traditional therapy with 10 days of amoxicillin (Amoxil, Wymox) or ampicillin (Omnipen, Totacillin) is no longer considered optimal. For women who fulfill certain clinical criteria, short-course therapy is recommended--preferably 3 days of trimethoprim-sulfamethoxazole, or trimethoprim alone (Proloprim, Trimpex) if the woman is allergic to sulfonamides. Longer therapy is indicated for women with complicated, prolonged, or recurrent infections. To appropriately treat patients and avoid overtreatment that would increase both costs and the incidence of side effects, physicians need to stay abreast of information about pathogens, mechanisms of disease, new drugs, and common resistance patterns.


Retinoid therapy for aging skin and acne. Primary care physicians should be familiar with the effects and appropriate uses of retinoids. Topical tretinoin (Retin-A) can reverse photoaging of the skin, although some transient, undesirable side effects usually occur. In patients with acne vulgaris, topical tretinoin and systemic isotretinoin (Accutane) are the only agents that act upon the apparent underlying causes. Recurrence is unlikely after successful results are achieved. Chronic hypervitaminosis A presents insidiously, and physicians must maintain a high index of suspicion. Complete history taking should always include questions about the patient's use of vitamin supplements.


Polyps in the colon. Answers to key questions. Adenomatous polyps in the adult colon and rectum are of great clinical importance because they can undergo malignant degeneration. Size and histologic type are useful in predicting the likelihood of malignancy. In most cases, biopsy is required to distinguish small adenomas (< 1 cm) from hyperplastic polyps, which do not undergo malignant degeneration. An adenomatous polyp found during proctosigmoidoscopy warrants total colonoscopy with polypectomy, because of the possibility of a synchronous adenoma or cancer. Periodic colonoscopic follow-up is advised, because of the high rate of recurrent ("metachronous") adenomas. The optimal screening technique for colorectal polyps and early cancer in the general population remains to be defined. The most commonly used program at present entails periodic fecal occult blood testing and flexible proctosigmoidoscopy. Diets high in fiber and low in fat may have protective effects against the development of colonic neoplasms.


Nuclear myocardial perfusion imaging in acute myocardial infarction. Which technique is best? Although diagnosis of acute myocardial infarction is usually based on the patient history and electrocardiographic findings, nuclear myocardial perfusion imaging has an important role in assessing myocardial damage and predicting patient prognosis. In this article, Dr Umfrid discusses the unique characteristics of technetium Tc 99m sestamibi that make it especially useful in managing acute myocardial infarction.


Dysphagia. A practical approach to diagnosis. Our diagnostic approach to a patient with dysphagia begins with detailed history taking and physical examination. On the basis of findings, a radiographic and/or endoscopic study of the esophagus is done. We usually have barium-swallow radiography done initially, and if the radiographs are equivocal, upper gastrointestinal endoscopy is performed. Manometric studies are reserved for patients with suspected motility disorders.


Sideroblastic anemia. A diagnosis to consider in alcoholic patients. Alcoholic patients who present with anemia can pose a diagnostic challenge. Although deficiencies of iron, vitamin B12, and folate commonly result in anemia, bone marrow suppression of red blood cell production related to the direct toxic effects of alcohol can cause a form called sideroblastic anemia. This case report describes a patient presenting with acute alcohol intoxication and anemia in whom extensive evaluation revealed a hematologic picture compatible with acquired sideroblastic anemia.


Benefits and risks of oral contraceptive use. As a general rule, the lowest-dose oral contraceptive should be prescribed that minimizes side effects while maintaining contraceptive protection. A woman who experiences mild side effects should be encouraged to tolerate symptoms for three menstrual cycles before a decision is made to change the prescription. Compliance may also be improved by informing women of the noncontraceptive health benefits of oral contraceptives: less menstrual blood loss and a lower incidence of menorrhagia, irregular bleeding, benign breast disease, endometrial cancer, dysmenorrhea, ovarian cysts or tumors, and salpingitis. Adequate patient education and supportive counseling are key factors in patient satisfaction and hence compliance.


HIV infection in athletes. What are the risks? Who can compete? The activities of athletes and personnel who provide their medical care may place them at slightly greater risk for infection with human immunodeficiency virus (HIV) than their nonathletic peers. At this point, there is no reason to disallow participation of athletes who are HIV-infected. Thus, sports physicians need to assume that they are at risk for accidental exposure to HIV and use appropriate precautions. Most important, physicians can educate athletes, coaches, and trainers to practice "safe" athletics and medical care to minimize the risks of exposure to and transmission of HIV. Testing for HIV can be encouraged for athletes who may be at risk and should be done for any athlete who specifically requests it. Physicians should encourage further study to clarify the specific issues and risks of HIV infection created by athletic competition and prepare to deal with the changing knowledge about HIV and AIDS.


Tetanus. A threat to elderly patients.

Tetanus. A threat to elderly patients. Tetanus rarely occurs in young persons now that childhood immunization programs are widespread. Many older patients, however, are not completely immunized, and mortality in this group is high. Since many of the wounds from which tetanus arises are minor, patients may not bring them to medical attention. Thus, physicians should include assessment of immunization status during routine office visits in all age-groups and provide immunization against tetanus and against diphtheria if indicated.


Cardiac enzymes. How to use serial determinations to confirm acute myocardial infarction. Although acute myocardial infarction can be diagnosed on the basis of clinical history, electrocardiographic (ECG) findings, and abnormalities of creatine kinase (CK) and lactate dehydrogenase (LDH) enzyme levels, measurement of cardiac enzyme levels is the most reliable way to confirm or exclude the diagnosis. If the MB isoenzyme of creatine kinase (CK-MB) remains normal during the 48 hours after the suspected clinical event, acute myocardial infarction can be reliably ruled out; if CK-MB values become elevated and the LDH isoenzyme pattern (LDH2:LDH1 ratio) becomes "flipped," the diagnosis can reliably be made. However, if CK-MB values become elevated but the LDH isoenzyme pattern remains normal, the diagnosis is less firm and ECG and myocardial imaging techniques may be needed to confirm or exclude myocardial infarction.


Echocardiography. Using its many capabilities to evaluate myocardial infarction. How can the suspicion of myocardial ischemia be confirmed without putting the patient through an invasive procedure? In patients who have had myocardial infarction, how can those at risk for pump failure and other complications and future cardiac events be identified? How are such complications detected? The answer to all these questions is echocardiography. The authors review how to use the technique and provide illustrative images.


Infusion rate and pharmacokinetics of intravenous pamidronate in the treatment of tumour-induced hypercalcaemia. We report the results of two consecutive randomized studies in the treatment of malignant hypercalcaemia with intravenous pamidronate. Overall normocalcaemia was achieved in greater than 90% of patients and a single infusion of 60 mg pamidronate given over 2 hours was as effective in restoring normocalcaemia as infusions given over 4, 8 or 24 hours. Similarly duration of normocalcemia after treatment with pamidronate and the control of the symptoms of hypercalcaemia were independent of infusion rate. Study of the pharmacokinetics of pamidronate in the treatment of hypercalcaemia show this drug to have a very high clearance due to calcified tissue retention and renal excretion. The initial half life of the drug in plasma is very short and most of the drug is cleared before distribution equilibrium is achieved. Short infusions of pamidronate are as safe and effective as infusions given over a longer time and are therefore to be preferred because of their greater convenience.


Systemic lupus erythematosus in 50 year olds. We compared the clinical and serological characteristics of 15 patients with onset of systemic lupus erythematosus after the age of 50 with those of 232 younger patients. The sex distribution was similar in both groups. All 15 patients were Caucasian. Autoimmune thyroiditis was found in 20% of the elderly patients. Initial manifestations, which presented more frequently in the older group, included thrombocytopenia (P < 0.05), sicca syndrome (P < 0.01) and cardiomyopathy (P < 0.005), whereas butterfly rash (P < 0.05) presented more frequently in the younger group. Analysis of cumulative clinical symptoms showed that butterfly rash (P < 0.05) and livedo reticularis (P < 0.05) were less frequent in the elderly. However, this group presented a significantly increased incidence of sicca syndrome (P < 0.005) and cardiomyopathy (P < 0.005). Antibodies to double-stranded DNA tended to occur less frequently in older patients (P < 0.05).


The late presentation of postero-lateral congenital diaphragmatic hernias. Four patients presenting after the neonatal period with a combination of respiratory and gastro-intestinal symptoms and signs which point to the diagnosis of congenital postero-lateral diaphragmatic hernias are discussed. Late presentation is more common than previously acknowledged. Early correct diagnosis and treatment are associated with an excellent clinical outcome.


Intussusception in the adult: clinical, radiological and histological features. Intussusception in the adult is an unusual cause of bowel obstruction. Unlike in childhood the clinical presentation is not clear cut and there are no distinct pathognomonic features. The radiological features are variable. Five patients presented to Frenchay Hospital over a five month period. The patients' clinical courses demonstrate the differing presenting features. Ultrasound investigation and CT scanning may show characteristic signs. Surgical treatment is mandatory as there is nearly always an underlying pathological abnormality which may be malignant.


The role of faecal Candida albicans in the pathogenesis of food-intolerant irritable bowel syndrome. Candida albicans was sought in stool samples from 38 patients with irritable bowel syndrome and 20 healthy controls. In only three patients with irritable bowel syndrome was C. albicans discovered and these patients had either recently received antibiotics or the stool sample had been delayed more than 24 hours in transit. C. albicans was isolated from none of the control stool samples. We conclude that C. albicans is not involved in the aetiology of the irritable bowel syndrome.


Endoscopic therapy for bile duct stones in a geriatric population. During the 5 year period to May 1988, 137 consecutive patients (age range, 65-102 years; median 84 years) with a diagnosis of choledocholithiasis, were referred to The Middlesex Hospital Geriatric Department. Endoscopic sphincterotomy was successful in 96.2% of cases and immediate biliary drainage was achieved in all but one of these patients. Stones were cleared endoscopically in 73.3% and surgically in 4.7% of cases. Long-term stenting was employed in 14.3% of patients. The 30 day mortality after endoscopic or surgical treatment was 4.7% (six deaths), although death was probably unrelated to therapy in half the cases. Deaths were due to procedural cardiorespiratory arrest (1), pancreatitis (1), pneumonia (2) and cerebrovascular accident (2). Endoscopic treatment is effective even in a high-risk geriatric population. After sphincterotomy patients with intact gall bladders should be managed expectantly.


Tumours of the accessory lobe of the parotid gland. Three cases of tumour of the accessory lobe of the parotid gland are reported and the surgical aspects discussed. An approach through a routine parotidectomy incision is preferred to direct incision over the mass.


Carotid sinus syndrome after carotid artery surgery. A 63 year old woman had been intensively treated for recurrent carcinoma of the neck. Following acute vascular surgery of the carotid artery, she developed the vasodilatory type of the carotid sinus syndrome. The presentation of this type of the syndrome was remarkable, since it is usually associated with primary or metastatic carcinoma in the neck region. Previous cancer treatment may have modified the course of disease in this patient, which ultimately had a lethal outcome.


Addisonian crisis presenting with a normal short tetracosactrin stimulation test. We report the case of a 70 year old man who presented with physical and biochemical features suggestive of Addison's disease, but had a normal short tetracosactrin (Synacthen) test. Six months later he re-presented with similar clinical features but with an abnormal response to tetracosactrin confirming the diagnosis of Addison's disease. We recommend that if adrenal insufficiency is strongly suggested further investigation should be performed to exclude this diagnosis.


Suprasellar ectopic pituitary adenoma presenting as cranial diabetes insipidus. We describe the occurrence of a supracellar ectopic pituitary adenoma in a 34 year old woman who presented with cranial diabetes insipidus and subsequently developed galactorrhoea-amenorrhoea. The tumour was demonstrated by both contrast computed tomography scan and magnetic resonance imaging with gadolinium enhancement and was confirmed at operation. Histological examination showed that the suprasellar lesion consisted of a pituitary adenoma while the pituitary biopsy revealed an unrelated pituitary microadenoma embedded in normal pituitary tissues. A review is made of the reported cases of ectopic pituitary adenomas.


Non-secretory multiple myeloma presenting as primary plasma cell leukaemia. A case of non-secretory multiple myeloma presenting as primary plasma cell leukaemia in a 65 year old woman is presented. Bone pain was the initial clinical manifestation. Laboratory analysis showed 20% of circulating immature plasma cells. Despite the presence of osteolytic lesions, no M-component could be demonstrated in serum protein electrophoresis, and serum and urine immunoelectrophoresis. Bone marrow aspirate demonstrated an 83% infiltration of plasma cells showing various degrees of immaturity. Immunofluorescence with monoclonal antisera demonstrated intracytoplasmic kappa light chains in a high percentage of plasma cells. Immature plasma cells without cellular capacity to synthesize and excrete complete immunoglobulins could be more aggressive, leading to an initial leukaemic process. Previous work regarding possible pathogenetic mechanisms, clinical and laboratory features, and response to treatment of this extremely rare association are reviewed.


A late complication of pectus excavatum repair. We report a late complication of pectus excavatum repair which highlights the importance of a chest X-ray in evaluating chest pain in patients who have had previous chest surgery. It also raises the question of whether or not implanted wires should be electively removed following bony union.


Sub-clinical systemic lupus erythematosus presenting with acute myocarditis. A 46 year old woman presented with fever and normochromic anaemia followed rapidly by severe myocardial failure, unresponsive to maximum inotropic support and broad spectrum antibiotics. There were no classical clinical stigmata of systemic lupus erythematosus (SLE) but a possible immunological cause was looked for, and on the basis of her immuno-serology a diagnosis of SLE-like disease was made. She responded rapidly to high dose steroids. The importance of considering the possibility of SLE or 'lupus overlap' in an acutely ill 'undiagnosed' patient is emphasized. The relevance of instigating appropriate immuno-serological tests in the course of such an illness is discussed.


Acute intermittent porphyria treated by testosterone implant. The hereditary disorder acute intermittent porphyria is potentially fatal. Many more females present with active disease than males and some have attacks related to their menstrual cycle and pregnancy. We present a female patient who was diagnosed while pregnant at 19 years. She subsequently developed life-threatening attacks pre-menstrually at 24 years; these were associated with weight loss. Initial treatment was with high calorie feeding via a naso-gastric tube, followed by a gastrostomy. Subsequent gonadotrophin suppression with intranasal luteinizing hormone-releasing hormone analogue (buserelin) thrice daily met with limited success. We implanted 100 mg of testosterone subcutaneously in November 1989. The buserelin was discontinued in January 1990 and menses returned 3 months later. There have been no serious attacks since then. Repeat implantation was performed at 6 monthly intervals until her present pregnancy. Baseline biochemical parameters have remained high and unaltered despite treatment although the testosterone has clearly had a marked clinical benefit, without side effects.


Eradication of Helicobacter pylori: therapies and clinical implications. This review presents a critical evaluation of the role of Helicobacter pylori eradication in the management of peptic ulcer disease and non-ulcer dyspepsia. On current evidence, H. pylori eradication therapy seems likely to emerge as the most rational and cost-effective treatment for duodenal ulcer. The role of H. pylori eradication in the treatment of gastric ulcer and non-ulcer dyspepsia is unclear and requires further study. The emerging problem of antibiotic resistance in H. pylori is of major clinical importance and a prime cause of treatment failure. There is increasing evidence of a link between H. pylori and gastric cancer but it is premature to recommend large-scale eradication of H. pylori as a valid strategy for the primary prevention of gastric cancer. The search continues for the ideal H. pylori eradication regimen.


The evaluation of dizziness in elderly patients. Twenty-one elderly patients with dizziness underwent a comprehensive medical and otoneurological evaluation. The majority had vertigo, limited mobility and restricted neck movements. Poor visual acuity, postural hypotension and presbyacusis were also frequent findings. Electronystagmography revealed positional nystagmus in 12, disordered smooth pursuit in 18, and abnormal caloric responses in nine. Magnetic resonance imaging showed ischaemic changes in six out of eight patients. Although dizziness in the elderly is clearly multifactorial, the suggested importance of vertebrobasilar ischaemia warrants further consideration as vertigo has been shown to be a risk factor for stroke.


Influence of cigarette smoking on the outcome of coronary care unit admissions with chest pain. We studied the effect of current smoking habits in the period immediately before admission to hospital in 90 consecutive patients presenting with chest pain, 50 of whom were shown to have myocardial infarction. Urine cotinine/creatinine (cot/creat) ratio measured within 4 hours of admission was used as an objective marker of cigarette smoking in the preceding 18 hours. Fifty-seven patients had urine cot/creat ratios suggesting recent smoking, although four of these denied smoking. Patients with myocardial infarction had higher median cot/creat ratios (3.31 micrograms/mg, range 0-17.8) compared with patients with non-infarct chest pain (0.5 microgram/mg, range 0-37.2). Sixteen patients with cardiac rhythm disturbances following infarction had significantly higher cot/creat ratios than the 34 infarct patients without this complication (median and range 8.34 micrograms/mg; 0-17.8 V. 1.87 micrograms/mg; 0-16.4, P < 0.01). Tobacco use in the 24 hours before myocardial infarction may predispose to cardiac rhythm disturbance, irrespective of infarct size.


Behçet's syndrome in Scotland.

Behçet's syndrome in Scotland. We present the clinical details and HLA typing of 15 Celtic Caucasian patients (four male, 11 female) with Behçet's syndrome (International Study Group criteria). The males affected were younger than the affected females, and three of these males had severe uveal involvement. Two of the 15 patients had the A2 Bw6 Dr4 haplotype but this did not confer family penetrance. Eight had gastrointestinal involvement: two females required ileostomy, two females had chronic diarrhoea, one female had severe ileitis and oesophageal lesions, two males had peptic ulcers, and one female had a peptic ulcer and primary biliary cirrhosis. All of those who developed gastrointestinal symptoms had either the Dr4 or the Dr7 antigens. This study is the largest HLA survey of Celtic Caucasians with Behçet's syndrome. The clinical features and HLA haplotypes are markedly different from 'Arab' and 'Japanese' varieties of Behçet's syndrome. The expression of the Dr4 and Dr7 antigens in those with gastrointestinal involvement possibly implicates class II antigens (Dr) in the pathogenesis of the manifestations of Behçet's disease in the bowel.


Peptic oesophageal stricture: an age-related problem? A one year retrospective study of 76 patients with peptic oesophageal stricture was performed. Analysis of results showed a significant age-related risk of developing peptic oesophageal stricture. Possible age-related risk factors are discussed. Pitfalls in diagnosis and management are highlighted and the role of H2 receptor antagonists, antacids and omeprazole are discussed.


One year experience in the treatment of familial hypercholesterolaemia with simvastatin. Patients with heterozygous familial hypercholesterolaemia (FH) have a substantially increased risk of atherosclerosis due to very high plasma levels of cholesterol. Recent evidence has shown that coronary heart disease in these patients may regress with lipid-lowering therapy. In this study the efficacy and safety of simvastatin, an inhibitor of the enzyme 3-hydroxy-3-methylglutaryl coenzyme A, was investigated in 30 patients with FH over a period of one year. Substantial reductions in the plasma concentrations of total cholesterol (-28%), low-density lipoprotein (LDL) cholesterol (-32%), intermediate-density lipoprotein (IDL) cholesterol and apolipoprotein (apo) B (-33%) were achieved with 20 mg/day of simvastatin; there were no significant changes in triglycerides high-density lipoprotein cholesterol or apo A. In contrast to previous studies, 40 mg/day of simvastatin did not result in a further statistically significant fall in LDL cholesterol, IDL cholesterol or apo B in the group as a whole. The drug was well tolerated and no adverse clinical or laboratory events were recorded. In particular, no ophthalmological, hepatic or renal disorders were observed and there were no sleep disturbances. We conclude that simvastatin is an efficacious and safe drug to treat patients with heterozygous FH and that rarely will the dose need to be increased above 20 mg/day.


Is bed rest useful after diagnostic lumbar puncture? A randomized study of 110 patients undergoing their first diagnostic lumbar puncture was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache. There was no difference between the mobile (n = 54) and bed rest (n = 56) groups in the incidence of post lumbar puncture headache (32% versus 31%, respectively). We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient, as well as on nursing staff.


Cerebellar manifestations of prostatic carcinoma. We present two patients known to have prostate cancer who presented with acute cerebellar signs. The neurological deficit of the first patient was due to a paraneoplastic cerebellar manifestation and progressed, despite evidence of response of the primary prostate tumour to hormonal manipulation. The second case, resulting from a solitary cerebellar metastasis, was amenable to surgical intervention and subsequent hormonal manipulation. This latter patient has experienced no recurrent neurological signs after a period of 7 years follow-up. This is the first report of a paraneoplastic cerebellar deficit and, to our knowledge, only the sixth case of parenchymatous cerebellar metastasis of prostatic origin to appear in the literature.


Bilateral carpal tunnel syndrome associated with interleukin 2 therapy. We report the development of synchronous bilateral carpal tunnel syndrome in a woman with metastatic colorectal cancer, undergoing treatment with recombinant interleukin 2. A carpal tunnel decompression was carried out on the hand which was more severely affected, with a gradual recovery in median nerve function. To the best of our knowledge, this is the first reported case of carpal tunnel syndrome in association with recombinant interleukin 2.


Empty sella developing during thyroxine therapy in a patient with primary hypothyroidism and hyperprolactinaemia. A 35 year old woman presented with severe primary hypothyroidism and galactorrhea. A very high prolactin level was also detected and computerized tomography scan of the sellar region demonstrated an enlarged pituitary gland associated with contrast enhancement. Replacement therapy with thyroxine corrected both biochemical and clinical abnormalities but empty sella developed during this therapy. It is concluded that empty sella may be related to thyroxine-induced shrinkage of lactotroph and/or thyrotroph cell hyperplasia.


Suppurative thyroiditis with oesophageal carcinoma. A 68 year old, previously well woman presented with dysphagia, weight loss and a neck swelling. Investigations revealed a right-sided thyroid abscess with fistulous connection to the upper of two oesophageal carcinomas, a previously unreported association. The resistance of the thyroid to infection and the mechanisms of thyroid abscess formation in this patient are discussed.


Antibody responses to combinations of antigens in white Leghorn chickens of different background genomes and major histocompatibility complex genotypes. Antibody responses in chickens to SRBC, Newcastle disease (NDV), and Brucella abortus (BA) were compared when given singly or in combination. Chickens used in the present experiment originated from a cross and then backcrossing of White Leghorn populations that had been selected for high (HA) or low (LA) antibody response to SRBC antigens. The populations used in the current study were segregating for MHC haplotypes B13 and B21. The experiment had a 2 x 3 x 6 factorial arrangement of treatments (two background genomes: HA and LA; three MHC haplotypes: B13B13, B13B21, and B21B21; and six antigen treatments: SRBC, NDV, or BA only, SRBC plus NDV, SRBC plus BA, and NDV plus BA). Antigens were administered either i.v. (SRBC) or i.m. (NDV and BA) when chicks were 42 days of age. Blood was obtained 27 days later (69 days of age) for antibody determinations. A significant background genome by MHC haplotype interaction for BA antibodies was due to relatively high titers in Line HA chickens of MHC genotypes B13B13 and B13B21. Background genome by MHC genotype interactions were not significant for SRBC or NDV antibodies. Antibody titers to SRBC were higher in background genome HA than LA, and similar among MHC genotypes. Antibodies to NDV were lower in chickens of MHC genotype B21B21, but there were no differences due to background genome. For each of the three antigens, antibody responses were highest when administered singly rather than in combination. Antibody titers were lower for SRBC when given with BA, and for BA titers when given with NDV.(ABSTRACT TRUNCATED AT 250 WORDS)


The effect of meal feeding on small intestine weight. Two trials were conducted using feed forms of pellets and mash to determine whether parts of the digestive tract (small intestine) were enlarged by meal feeding. Results obtained show that meal feeding of broilers significantly increases small intestine weight for both mash and pellet broiler groups when compared with continuously fed broilers. The body weight, feed conversion, and mortality did not differ between the continuous-fed versus meal-fed groups. Pelleting the diet during the growing period (3 to 6 wk of age) significantly improved both growth rate and feed conversion of broilers.


Yolk sac absorption and initiation of growth in broilers. A series of three experiments was conducted to determine the role of the yolk sac in initiation of growth in broilers. In Experiment 1, absorption of the yolk sac was found to precede initiation of growth in newly hatched broilers by approximately 24 h. Because the yolk sac is essential for early initiation of growth, in Experiments 2 and 3 it was removed and diets with incremental fat levels of 3, 6, and 10% were fed to assess whether fat was essential for optimal growth during the neonatal period. Results suggest that dietary fat has its greatest effect on growth after 10 days of age. Therefore, initiation of growth may be more closely dependent upon other nutrients.


Effects of light sources and the presence or absence of males on reproduction of female breeder turkeys. The effects of sodium vapor (SV), daylight fluorescent (DF), and incandescent (IN) light sources and the influence of the presence or absence of males on reproduction of female turkeys were evaluated. Hens under SV and DF lights consistently laid more eggs than those under IN lights. There were no significant differences in hen-day egg production among hens in the physical presence of males and hens allowed visual and vocal contact with males. However, hen-day egg production was significantly lower for females in pens in which males were absent. Fertility, hatchability, days to first egg, egg weight, and egg specific gravity were unaffected by light source treatments or by the presence or absence of males in pens of females.


Beak trimming effects on beak length and feed usage for growth and egg production. Two experiments were conducted to compare beak treatment effects on pullets of three genetic stocks. Within each stock, equal numbers were assigned to three treatments: no beak trimming (IN), beak trimming once (1X), and beak trimming twice (2X). Beak treatment, genetic stock, and age effects along with interactions among main effects were examined for production-associated traits during rearing and brief periods of early egg production. Beaks of 1X and 2X pullets remained shorter than those of IN pullets through final measurements at 36 and 32 wk of age in Experiments 1 and 2, respectively. However, differences in beak length decreased as age increased. Upper beaks of 2X pullets remained shorter than those of 1X pullets, but lower beaks of 1X and 2X pullets did not differ by 20 wk in Experiment 2. Weight gains, feed usage, and efficiency of growth were affected by beak treatments. Beak trimming reduced gains, feed eaten, feed wasted, and total feed used, and 2X pullets used their feed more efficiently for weight gain and egg production. A general decrease occurred in differences among beak treatments for weight gains, feed eaten, feed wasted, and efficiency of gains with increasing age during rearing. Nevertheless, significant differences in feed consumed, feed wasted, and efficiency of feed used for egg production indicated an economic advantage in favor of beak trimming.


Effect of induced molting on the course of infection and transmission of Salmonella enteritidis in white Leghorn hens of different ages. Previous work in the authors' laboratory had shown that inducing molt using a 2-wk feed removal protocol in 58- to 84-wk-old White Leghorn hens increased the severity of intestinal infection by Salmonella enteritidis (SE). As susceptibility to infection can be influenced by age, a study was conducted to compare the effect of the feed removal on infection by SE in 20-, 40-, and 74-wk-old hens. Birds were orally infected with 5 to 10 x 10(6) SE on Day 4 of fast and were sampled for SE shedding 3, 10, 17, and 24 days later. Significantly higher numbers of SE were shed in fasted birds on Day 3 (20 and 40 wk of age), Day 10 (40 and 74 wk of age), and Day 17 (74 wk of age). Transmission of SE to uninfected, contact-exposed birds was observed in all three trials for both the fed and fasted groups. However, significantly more fasted contact-exposed birds became positive for SE on Day 3 (20-wk-old), Day 10 (74-wk-old), and Day 17 (74-wk-old). Significantly more SE was also shed in these fasted contact-exposed birds on Day 3 (20-wk-old), Day 10 (all age groups), and Day 17 (74-wk-old). The current results indicate that the fasting conditions used to induce a molt in hens increase the shedding of SE in direct-infected and contact-exposed hens and this effect does not appear to be affected by age.


Multivariate epidemiological approach to coccidiosis in broilers. A retrospective, case-control study into risk factors of coccidiosis was undertaken using data from 189 broiler flocks. A case flock was defined as a flock in which at least one bird had intestinal lesions on 1 of 6 wk in a 42-day cycle. Flocks wherein such birds could not be detected were defined as controls. There were 187 variables, measured or derived. These were assigned to subsets of data, each subset being a group of variables representing related information. Uni- and bivariate analyses were performed in each subset. Variables and interactions that were significant in these analyses were entered into a multivariate model across subsets. In the final model, seven variables appeared to be significantly associated with detecting lesions in birds of a flock. Differences among breeds covered a range of about an 80-fold change in risk of being a case. At intermittent lighting, the risk of being a case increased about sevenfold compared with continuous lighting. A higher initial (Week 1) environmental temperature decreased the risk of finding lesions in a flock (about .8-fold per degree Celsius). This risk was also lower at a lower average aerial ammonia content (below versus above 14 ppm) and higher maximum carbon dioxide content (above versus below .4 vol%) changing the risk about .3- and .4-fold, respectively. The risk of being among cases increased with more litter (about twofold per kilogram of litter per square meter). Flocks in houses of 600 to 800 m2 were about 9.8 times more at risk of being scored as lesion-positive than those in smaller houses.(ABSTRACT TRUNCATED AT 250 WORDS)