[Biliary tract surgery in patients of 70 and older: an assessment of our experience with 100 consecutive cases].

A series of 100 consecutive patients aged 70 years and older having biliary tract lithiasis observed over a 19-year period (1970-1989) at the 1st Surgical Department of the University of Rome was analyzed in an effort to define morbidity and mortality. Eighty-eight patients underwent surgical treatment. Three patients died postoperatively (3.4%); 12 patients had local and 13 general complications. The highest incidence of complications occurred in patients with associated diseases and bacteriobilia. A long-lasting symptomatology involved a more frequent exploration of the common bile duct. Morbidity and mortality were not significantly related to the type of surgical procedure performed. Elective biliary tract surgery is a safe procedure even in aged patients.


[Desmoid tumors of the abdominal wall].

The authors report their experience in the management of desmoid tumors, rare benign neoplasias, locally aggressive and potentially recurrent after surgery. Etiopathogenetic, diagnostic, and therapeutic features of these tumors are analysed and the value of surgery as well as chemo- or radiotherapy is considered.


[Diaphragmatic hernias due to "strain": apropos a case report].

After a brief report on the pathophysiology of diaphragmatic hernias, the authors describe a case of strain diaphragmatic hernia. Considering the rarity and the difficulty to make an immediate diagnosis of this pathology, the authors stress diagnostic problems of strain chest pain and surgical treatment of strain diaphragmatic hernias.


[Idiopathic retroperitoneal fibrosis].

The authors, on the basis of a case recently observed dwell upon the natural history, the etiopathogenesis, and diagnosis of idiopathic retroperitoneal fibrosis. After confirming that medical therapy may be successful in selected cases only, different surgical procedures are analysed. It is concluded that outcome and prognosis of these subjects depend on early diagnosis.


Use of the fiberoptic bronchoscopy in the elderly.

The authors emphasize the primary role fiberoptic bronchoscopy has for diagnostic and therapeutic purposes in the elderly affected by pulmonary disease. Safety, efficacy and tolerability of the method in the elderly are obtained through a preliminary and careful evaluation of the patients, either clinical or instrumental.


[The optimal implantation of the peritoneal-jugular shunt with LeVeen valve].

The authors underline the efficacy of peritoneovenous shunting with LeVeen's valve in the treatment of refractory ascites in cirrhotic patients. Selection and appropriate preoperative management of patients are essential to assure good immediate and long-term results.


Spatial arrangement of the interpositorubral projection in the rabbit. A retrograde HRP study.

The objective of this investigation was to analyse the organization of rubral afferents from the cerebellar interpositus nuclear complex (NI) in the rabbit. Free HRP was employed as a retrograde tracer to identify the distribution patterns of labeled cells in the anterior and posterior interpositus nuclei. The interpositus projections distribute throughout nearly the entire contralateral red nucleus (RN) except for its rostralmost parvocellular region (RN-PA) which does not correspond to the usually distinguished parvocellular subdivision of the red nucleus (RN-P). The central and lateral regions of the posterior interpositus nucleus (NIP) project (nearly exclusively) to the medial region of the RN. The lateral region of the anterior interpositus nucleus (NIA) sends projections to both the lateral and medial regions of the caudal three-quarters of the RN. Thus, the lateral region of the RN appears to be under nearly exclusive control of NIA. The rostral one quarter of the RN receives cerebellar afferents from the NIP only and caudal pole of RN from the NIA exclusively. Comparison of labelling patterns indicates absence of topogrophic differentiation of projections from the NIP, whereas dorsoventral topography in the NIA can correlate to the rostrocaudal and mediolateral arrangement of the RN. Collectively, interpositorubral projections in the rabbit are similar to those in other species only in basic features.


Permeability-related structures in developing and mature microvessels of the chicken optic tectum.

The mode and the temporal sequence of the modifications undergone by permeability-related structures in the neural microvessels have been ultrastructurally and morphometrically investigated in optic tecta of 6, 14, and 18 incubation day (i.d.) chicken embryos and of 30 day chickens. Horseradish peroxidase was utilized as a permeability marker. The endo- and exocytosis-related structures (vesicles and vacuoles) and the interendothelial junctions remarkably change during development: the density of the vacuoles is decreased at the 14th i.d., while that of the vesicles becomes significantly low at the 18th i.d., both reaching lowest values in the chicken; the passage of the marker through the endothelial junctions begins to be hindered from the 14th i.d., parallel to the perivascular arrangement of astrocytic glia endfeet, and it is completely blocked at hatching time. The findings suggest that the optic tectum microvessels are permeable, and thus immature, in the early development and progressively acquire morphofunctional features of vessels provided with barrier devices during the pre- and post-natal development of the brain.


The vasopressin positive elements in the hypothalamic magnocellular nuclei of rats treated with histamine.

The vasopressin (AVP) positive elements of the hypothalamic supraoptic (SON) and paraventricular (PVN) nuclei, were investigated in 180 male rats through immunohistochemical, morphometric and statistical methods. The rats were subdivided in the next groups: 20 control rats; 40 rats treated with physiological saline intraperitoneal via (ip); 40 rats treated with physiological saline intracerebroventricular via (icv); 40 histamine (HA) treated rats, ip; and 40 HA treated rats, icv. The labeled nerve cells appear in the lateral part of the PNV and the SON of the control animals. These neurons have central nucleus and vasopressin positive cytoplasmic granulations. After the treatment with physiological saline, ip or icv, no alterations were observed. In HA treated rats, icv, numerous neurons strongly labeled were observed in these hypothalamic nuclei. Vasopressin positive nerve fibers and large droplets were also found both in the SON and in the PVN of these animals. The vasopressin positive material in the control rats and in HA treated rats, ip, is similar. The morphometric and statistical studies confirm these findings. The results are discussed in this paper.


ATP-sensitive K+ channel-independent, insulinotropic action of glucose in the B-cells.

Although closure of the ATP-sensitive K+ (K+ ATP) channel produced by glucose metabolism in the B-cell has been considered mediating the major signal for glucose-induced insulin release, evidences indicating the existence of the K+ ATP channel-independent, insulinotropic action of glucose have recently been accumulated. Namely, glucose stimulates insulin release by the B-cell with a full inhibition of the K+ ATP channel closure by diazoxide, a K+ ATP channel opener, provided cytosolic calcium is elevated. Glucose clearly elicits insulin release even if the K+ ATP channel is maximally inhibited by high concentration of sulfonylurea. In this case, glucose-induced insulin release is associated with net increase, not decrease, of K+ outflow, indicating glucose is opening K+ channels. Thus, closure of the K+ ATP channel is highly unlikely to be the mechanism responsible for the insulinotropic action of glucose under these conditions. The K+ ATP channel-independent glucose action is dependent upon physiological glucose concentration (2-30 mM) and the degree of cytosolic calcium elevation. The K+ ATP channel-independent, glucose-induced insulin release shows gradually increasing monophasic pattern which temporally resembles the second phase response of glucose-induced insulin release. The role of glucose metabolism in the K+ ATP channel-independent glucose action remains to be established. Glucose action at the B-cell can now be subdivided into two classes: one is the K+ ATP channel-dependent and the other is the K+ ATP channel-independent. The two branches may be mutually interrelated to cause normal, biphasic insulin secretion.


Subcellular distribution of differently glycosylated forms of active and inactive renin in rat kidney: effect of sodium depletion and captopril treatment.

Distribution of differently glycosylated forms of active and inactive renin was investigated in fractions prepared by discontinuous density gradient centrifugation of rat kidney cortex homogenate. Concanavalin A (con A) chromatography separated active and inactive renin into three differently glycosylated forms in both cytosol and granule fractions: a minor con A unbound form (I), a loosely bound form (II), and the most predominant tightly bound form (III). After a long-term stimulation of renin synthesis and secretion by sodium depletion and captopril treatment the relative proportion of active renins I and II in granules significantly increased, while that of active renin III decreased. The relative proportion of inactive renins I and II in granule compared to cytosol fractions was significantly higher and that of inactive renin III was lower. The results indicate that glycosylation might have some relation to the rate of sorting of prorenin into the granules, or of its processing within granules. Alternatively, it might influence the rate of inactive renin release via the constitutive pathway.


In vivo role of corticosterone in regulation of insulin receptors in rat adipocytes during hypokinesia.

The role of corticosterone in the changes of insulin receptors of rat adipocytes during hypokinesia was investigated. Three groups of adult male Wistar rats (1. intact; 2. adrenalectomized; 3. dexamethasone treated) were exposed to hypokinesia for various period. The plasma levels of corticosterone, insulin and glucose and the binding of insulin (125I-TyrA-14 monoiodoinsulin) to isolated adipocytes were determined. A significant increase of plasma corticosterone level and a decrease of insulin binding to adipocytes were found in rats exposed to hypokinesia for one day. After 3 and 5 days of hypokinesia the corticosterone level in plasma was decreased to the concentration observed in the control animals. Also the binding of insulin to adipocytes returned to the values found in control group. In adrenalectomized rats exposed to hypokinesia no changes of insulin receptors in adipocytes were noted. The treatment of rats with dexamethasone (both, the intact and adrenalectomize ones) resulted in a decrease of insulin binding in fat cells. These results showed that an increase of corticosterone in plasma after the short term exposure to hypokinesia or the injection of dexamethasone to intact or adrenalectomized animals are followed by the decrease of insulin receptors in adipocytes suggesting that glucocorticoids participate in the regulation of insulin receptors in adipocytes during short term hypokinesia.


Interrelations between steroid hormone secretion and morphological changes of porcine corpora lutea at various periods of luteal phase.

Four types of porcine corpora lutea (CL) were excised at 4 various stages of the luteal phase. One part of corpora lutea was homogenized and the concentration of progesterone (P4), estradiol (E2) and androgens (A) was assayed in adequate extracts. Second part of luteal cells obtained from each of four types of CL was cultured as separate monolayers and steroid secretion was measured after 24, 48 and 96 h of culture. The concentration of P4 in homogenates of CL type 2 and 3 was twice as high as that in type 1, while a decrease to minimum level in type 4 was observed. In cultures, maximum increase in P4 production was observed after 24 h, being the highest in type 1 (2800% of initial P4 concentration) and type 2 (320%) while in types 3 and 4 no increase was observed. The contents of androgens (A) in CL homogenates increased 3 times in type 2 and 3 and finally decreased in type 4 as compared with type 1. In cultures, maximum increase in A production was observed after 24 h, being the highest in type 1 (640% of A concentration prior to culture), while in types 2, 3 and 4 it was about 200%. The content of E2 in homogenates of CL types 1 and 2 was very low, but increased to about 200% in type 3 and to about 2500% in type 4.(ABSTRACT TRUNCATED AT 250 WORDS)


GABA activity in dispersed bovine pineal cells: effect on serotonin release and calcium and chloride uptake.

The presence of gamma-aminobutyric acid (GABA) and peripheral and central benzodiazepine receptors in the mammalian pineal gland prompted the examination of GABAergic transmission in dispersed bovine pineal cells. The effect of GABA on 3H-serotonin (5HT) release was examined in bovine pineal cells. GABA, by acting through GABA B receptor subtype, decreased 5HT release and by acting through GABA B, and presumably through GABA A receptor subtypes, inhibited depolarization-induced 45Ca2+ uptake in bovine pinealocytes. GABA, by acting on GABA B as well as on GABA A receptors, prevented the 5HT2- or 5HT1C-mediated stimulatory effect of serotonergic agonists on calcium uptake in pineal cells. GABA augmented 36Cl- uptake by bovine pineal cells. These results are interpreted to indicate that, by regulating the release of 5HT, GABA may modulate the synthesis and action of melatonin.


'Depletion' of ATP by 2-deoxyglucose: secretion by electroporated human neutrophils is not restored by readdition of ATP.

Studies of intracellular signal transduction are facilitated by the use of permeabilized cell systems, which permit the ready manipulation of the cytosol. These model systems have helped to define the roles that small solutes, particularly Ca2+ and nucleotides, play in stimulus-response coupling. In circumstances where the full depletion of intracellular ATP contents is required, some investigators have resorted to prior treatment with metabolic toxins, with the expectation that the role of ATP in signal transduction could then be more unambiguously studied. However, in the work reported here, we found that treatment with 2-deoxyglucose (2-DOG) irreversibly altered the cells: when poisoned human neutrophils were then permeabilized, the cells failed to degranulate well in response to Ca2+, and their sensitivity to Ca2+ could not be recovered by the readdition of ATP. Inhibition of secretion by 2-DOG was most pronounced when low concentrations of Ca2+ were used as the stimulus. Preincubation of the cells with only 1 mM 2-DOG for 10 min at 37 degrees C (prior to washing and permeabilizing the cells) was sufficient for maximal inhibition. Even without preincubation, high concentrations of 2-DOG directly inhibited secretion. The refractory nature of poisoned cells was not restored by the presence of Mg2+ and/or ATP. The protein kinase C agonist phorbol myristate acetate also did not restore sensitivity of secretion to Ca2+. Addition of ATP and/or GTP to the permeabilization medium (to maximize penetration of the nucleotides) failed to restore sensitivity; tracer studies demonstrated that these conditions were adequate for repletion of the nucleotide pool. These data indicate that human neutrophils poisoned with 2-DOG were irreversibly altered, such that restoration of the putative deficiency (ATP) was without effect. Experiments in which such preincubation measures are employed should be viewed with caution.


Peptide growth factor interactions in embryonic and fetal growth.

Peptide growth factors are expressed by multiple tissues in the animal and human embryo and fetus. They undergo specific interactions which control the rate of cellular proliferation, tissue differentiation and the induction of specific morphogenic events such as mesoderm formation in the embryo. Biologic control may not only be exerted at the level of growth factor synthesis and receptor expression but by the sequestration and storage of growth factors by extracellular matrix molecules. In the case of insulin-like growth factors (IGFs), storage maybe mediated by attachment to specific IGF-binding proteins which may additionally modulate biological potency. Basic fibroblast growth factor (basic FGF) and transforming growth factor-beta (TGF beta) directly bind to glycosaminoglycan molecules. Release of growth factors from these stores may be by local proteolytic action. A sequential expression of basic FGF, IGF-II and TGF beta occurs in the ovine fetal epiphyseal growth plate as chondrocytes progress from a proliferative to a postmitotic, hypertrophic state. Cellular phenotype may be largely explained by the relative amounts of these autocrine growth factors within the growth plate.


Understanding the different phases of fetal growth.

Fetal growth was studied in 78 newborns who had serial scans in pregnancy. Weight at birth correlated with growth in the first 2 trimesters but better with the growth between 28 and 32 weeks. The correlations for weight at growth cessation were better than those for weight at birth. Crown-heel length at cessation did not correlate with fetal growth in the first 2 trimesters. Maternal weight increase correlated with fetal weight and crown-heel length but not with head circumference at cessation. Maternal prepregnancy weight correlated with fetal growth between 28 and 32 weeks, but not with fetal growth in the second trimester. A negative correlation was found between estimated duration of growth cessation and relative head circumference at birth.


Estimation of fetal weight by ultrasound.

Estimation of fetal size by ultrasound has supported two recent concepts of fetal growth. Firstly, the normal weight gain is constant from 28 weeks of gestation until several weeks after term; about 27 g/day. Secondly, the average weight of fetuses born preterm is lower than the average weight of fetuses of the same gestational age who remain in utero. This means that up to 40% of infants born at 28-30 weeks of gestation are small-for-gestational age, when related to the biological optimum. Unfortunately, the test-retest variation of fetal weight estimation is as much as 50% of the standard deviation of the gestational-age-specific fetal weight distribution. This means that fetal growth has to be followed for many weeks to document statistically significant deviations. No study has, as yet, demonstrated the value of this approach to distinguish between intrauterine growth retardation and growth along low centiles by fetuses of reduced growth potential.


Recent aspects of steroid biosynthesis in male sex differentiation. Clinical studies.

Recent discoveries in molecular biology have much clarified the regulation and function of steroid-converting enzymes. Most progress has been made in the area of cytochromes, which regulate the side chain cleavage of cholesterol (P-450 SCC) and the 17 alpha-hydroxylase and 17,20-desmolase (or 17,20-lyase) activities (P-450 17 alpha), as well as in 3 beta-hydroxysteroid dehydrogenase. Nevertheless, there are some discrepancies between fundamental knowledge and clinical experience, which are difficult to understand: why is it for example possible that cases with 'pure' 17 alpha-hydroxylase or 17,20-desmolase deficiency exist, when there is only one cytochrome regulating both steps? After a brief review of clinical and biochemical findings in the various defects of testosterone biosynthesis, a case is discussed, which is of interest in this respect. This XY patient with female external genitalia, who has been shown to have compound heterozygous mutations, had 'pure' 17,20-desmolase deficiency up to adolescence, but additional 17 alpha-hydroxylase deficiency with hypertension developed thereafter. From this observation, it has to be concluded that as yet unknown, possibly age-dependent modulating factors exist, which influence the activity of the cytochrome. Also the estrogen replacement given to the patient might have played a role in this change.


[Quantification of menstrual bleeding in women using intrauterine devices (IUDs)].

A study in the changes of menstrual blood loss produced by the of 11 different intrauterine devices (IUDs) in 319 voluntary women attending a voluntary program for Family Planning at the Instituto Mexicano del Seguro Social (IMSS). The results showed that two IUDs increased bleeding above 80 mL in the case of Lippes Loop D and the copper T 380. The following IUDs: Cu T 200 and 220, as well as ML-250 increased blood loss moderately; copper 7 produced a slightly higher blood loss (not statistically significant) "T" IUDs liberating progesterone or progestagens (Nor 8; Nor 2; Net 10) all produce a significant decrease of the menstural flow, reaching 93.5% (of the control value) in women using "T" IUDs liberating 8 micrograms of Levonorgestrel. Excessive bleeding in women with IUDs (over 80 ml) is checked significantly by the use of non-steroid anti-inflammatory prostaglandin synthesis' inhibitors such as 500 mg of mefenaminc acid or 250 mg of Naproxen thrice daily for 5 days.


Genes involved in androgen biosynthesis and the male phenotype.

A series of enzymatic steps in the testis lead to the conversion of cholesterol to the male sex steroid hormones, testosterone and 5 alpha-dihydrotestosterone. Mutations in any one of these steps are presumed to alter or block the development of the male phenotype. Most of the genes encoding the enzymes involved in this pathway have now been cloned, and mutations within the coding regions of these genes do, in fact, block development of the male phenotype.


Cloning and mutational analysis of SRY.

A candidate for the male sex-determining gene has recently been isolated. This sex-determining gene (SRY) has been found to be mutated in some individuals with failed testis development, and, in mouse transgenesis, the SRY murine homologue (Sry) causes female-to-male sex reversal. The cloning of SRY should facilitate the characterisation of other genes in the testis-determining pathway and provide information on the mechanism of mammalian developmental decisions.


Role of the androgen receptor in male sexual differentiation.

The two androgens responsible for all aspects of male sexual differentiation are testosterone and dihydrotestosterone. The action of both these steroids is mediated by a specific intracellular receptor, the androgen receptor, which is a member of the nuclear receptor superfamily. The androgen receptor gene has been cloned and is located on the X chromosome at Xq11-12. Mutations of this gene have been found in subjects with both complete and partial androgen insensitivity. In a study of 27 subjects with the androgen insensitivity syndrome, we have identified mutations in 14, using a rapid mutation screening assay. The same technique has also been used to determine carrier status in an affected family. We have also identified a mutation in two brothers who show perineal hypospadias as the only evidence of undervirilisation. Familial severe hypospadias should therefore be included as part of the phenotypic spectrum of partial androgen insensitivity. The study of naturally occurring mutations of the androgen receptor gene is providing further information on the function of the androgen receptor and its role in normal male sexual differentiation.


Comparison of epidemiological data on congenital hypothyroidism in Europe with those of other parts in the world.

The actual worldwide incidence of congenital hypothyroidism (CH) is based on the results of screening in parts of the world where screening is mandatory, i.e. most of Europe, USA, Canada, Cuba, Australia, New Zealand and Japan. In other parts of the world, some indications are given by the results of pilot studies. In Europe, mean overall incidence (1985-1990) for the countries included in our inquiry is 1/3801--in each country for the same period: Austria 1/3,930, Belgium 1/3,750, Czechoslovakia 1/6,037, Denmark 1/3,777, Finland 1/3,969, France 1/4,132, FRG 1/3,827, Greece 1/3,314, Hungary 1/5,632, Israel 1/3,152, Italy 1/3,150, The Netherlands 1/3,723, Norway 1/3,069, Portugal 1/3,139, Spain 1/3,216, Switzerland 1/3,913, UK 1/3,398 and Turkey (pilot study 1989-1992) 1/2,943. In comparison, the figures for the USA for the whole country are similar for the mean overall incidence (1988-1990): 1/4,119. But large variations exist between the states, the reasons of which are perhaps related either to technical problems or to the ethnic background in each state. In Canada and Japan, modifications of screening procedures have led to similar figures for the last years in our possess, Canada (1986-1988) 1/3,884 and Japan (1990) 1/3,856. The figures (mean overall incidence) for Cuba (1987-1991) 1/2,325, for Australia (1985-1990) 1/1/3,331 and for New Zealand (1987-1990) 1/4,496 are quite comparable. So in these countries where the screening is established, no great variations are noted as in certain parts of the world with pilot studies: Argentine (Buenos Aires; 1985-1990) 1/4,407, Chile (1991-1992) 1/2,514, Brazil (Porto Alegre; 1987-1991) 1/4,429.(ABSTRACT TRUNCATED AT 250 WORDS)


School achievement in children with hypothyroidism detected at birth and search for predictive factors.

Neonatal screening of hypothyroidism started in 1975, and now sufficient hindsight is gained to assess school results in children with hypothyroidism and compare them to IQ tests. From the 85 cases of hypothyroidism detected in the Midi-Pyrénées area, 40 have enrolled in or finished primary school and 18 started secondary school. School achievement was assessed by school test results in French and mathematics using specific grids for each class and by retention rates. These results were compared to control groups. The hypothyroid group obtained identical results in French to those of the control groups but scored lower in mathematics. Grade retention rated higher in hypothyroid children (20%) than in the control groups (12.5%), especially in the first primary school grade. The search for predictive severity factors revealed significant differences between the grade repeater group and the nonrepeater group: more cases of athyrosis (75 vs. 25% for ectopia), lower T4 levels at birth, lower bone surface, lower IQ at 4 and 7 years, neurological troubles of fine motricity and coordination, and lower socioeconomic level. These results should shortly be taken into consideration in order to isolate a group at risk and undertake specialized care to improve school results in this group.


Testicular adrenal-like tissue in a patient with 17 alpha-hydroxylase deficiency.

Testicular adrenal-like tissue (TALT) have been observed in patients with congenital adrenal hyperplasia, and is usually associated with 21-hydroxylase deficiency; in 3 cases with 11 beta-hydroxylase deficiency. We report a case of male pseudohermaphroditism with 17 alpha-hydroxylase deficiency (17OHD) who also had TALT. To our knowledge, this is the first report about the association of 17OHD and TALT. Also, the patient had high levels of serum aldosterone--an unusual finding in patients with 17OHD. A possible pathogenic mechanism is discussed.


Comparison between short- and long-term insulin-like growth factor response to recombinant human growth hormone.

Eight growth-hormone-deficient children were treated with recombinant human GH (rhGH). Results of the short-term metabolic response to rhGH performed at the start of therapy during a 5-day introduction period and long-term results on growth were analyzed. We could not find any correlation between the effects on the short-term metabolic test and the growth response during long-term therapy, namely between the urea and insulin-like growth factor-I response during the short test and the increase in growth velocity. The short-term test is not a good predictor of the long-term response.


The diagnostic value of integrated growth hormone secretion studies shorter than 24 hours in normal- and short-growing children.

Spontaneous growth hormone (GH) secretion is evaluated by measurement of the 24-hour integrated concentration of GH (24-hour IC-GH), a major diagnostic procedure, or by shorter protocols such as monitoring 6 h during sleep. We have evaluated several possibilities for shortening the procedure by comparing the results of an abbreviated procedure to the 24-hour IC-GH studies. The study population consisted of 50 children with classic GH deficiency (group GHD), determined by provocative testing, and 45 children who had a subnormal secretion of GH (group N), determined by low 24-hour IC-GH but normal GH provocative tests. Twenty-two children of normal height and stature served as a control group. All the children were prepubertal, while there was no overlap between the lower 5th percentile of the 24-hour IC-GH of the control subjects (3.3 micrograms/l) and the upper 97th percentile of the 24-hour IC-GHs of the N and GHD groups (2.9 and 2.7 micrograms/l, respectively), there was a considerable overlap between the IC-GH of control subjects and that of the GHD and N groups measured in all the abbreviated blood withdrawal protocols, except for the 10-hour daytime and the 12-hour nighttime protocols of the GHD patients. It should be noted that there was only a small overlap between the control and the GHD groups during the 12-hour daytime protocol. We have found that the longer the blood collection period the greater the sensitivity and the specificity. We conclude that the 24-hour IC-GH test is the best diagnostic tool for identifying children with subnormal GH secretion.


Effect of arginine on the GHRH-stimulated GH secretion in patients with hyperthyroidism.

Patients with hyperthyroidism have reduced GH responses to pharmacological stimuli and reduced spontaneous nocturnal GH secretion. The stimulatory effect of arginine on GH secretion has been suggested to depend on a decrease in hypothalamic somatostatin tone. The aim of our study was to evaluate the effects of arginine on the GH-releasing hormone (GHRH)-stimulated GH secretion in patients with hyperthyroidism. Six hyperthyroid patients with recent diagnosis of Graves' disease [mean age +/- SEM, 39.2 +/- 1.4 years; body mass index (BMI) 22 +/- 0.4 kg/m2] and 6 healthy nonobese volunteers (4 males, 2 females; mean age +/- SEM, 35 +/- 3.5 years) underwent two experimental trials at no less than 7-day intervals: GHRH (100 micrograms, i.v.)-induced GH secretion was evaluated after 30 min i.v. infusion of saline (100 ml) or arginine (30 g) in 100 ml of saline. Hyperthyroid patients showed blunted GH peaks after GHRH (13.2 +/- 2.9 micrograms/l) as compared with normal subjects (23.8 +/- 3.9 micrograms/l, p < 0.05). GH peaks after GHRH were only slightly enhanced by arginine in hyperthyroid subjects (17.6 +/- 2.9 micrograms/l), whereas, in normal subjects, the enhancement was clear cut (36.6 +/- 4.4 micrograms/l; p < 0.05). GH values after arginine + GHRH were still lower in hyperthyroid patients with respect to normal subjects. Our data demonstrate that arginine enhances but does not normalize the GH response to GHRH in patients with hyperthyroidism when compared with normal subjects. We hypothesize that hyperthyroxinemia may decrease GH secretion, both increasing somatostatin tone and acting directly at the pituitary level.


First-phase insulin release in adult cystic fibrosis patients: correlation with clinical and biological parameters.

Adult patients with cystic fibrosis (CF) are at high risk for developing insulin-dependent diabetes mellitus. Therefore, the fast insulin release (FIR) to intravenously administered glucose was measured in 23 adult CF patients. The influence of the clinical parameters and type of gene deletion on the amplitude of the FIR, defined by the sum of the 1st- and 3rd-minute insulin concentrations was analyzed. In 11 of the 18 normoglycemic patients with exocrine pancreatic insufficiency and the 3 nontreated diabetic CF patients studied, an FIR value lower than the 3rd percentile was found. The female patients had higher mean FIR values than the male patients (62.8 +/- 39.6 vs. 27.9 +/- 17.9 mU/l; p < 0.05). No influence of age, body mass index, or pulmonary or liver involvement on the FIR was found. Subjects heterozygous for the delta F508 deletion had a similar insulin response as homozygous patients. The FIR level correlated negatively with the basal glucose level (r = 0.4; p < 0.001). In conclusion, 61% of the adult nondiabetic CF patients with exocrine pancreatic insufficiency presented a loss in acute insulin response, which could not be predicted by clinical or genetic parameters.


Studies on the association of NIDDM in Japanese patients with hyperthyroid Graves' disease.

We attempted to analyze the association of hyperthyroid Graves' disease with non-insulin-dependent diabetes mellitus (NIDDM). Forty-nine patients (23 males and 26 females; 7.6%) of a total of 647 patients with hyperthyroid Graves' disease had NIDDM, several years before or after Graves' disease was diagnosed. Only 1 patient had insulin-dependent diabetes mellitus. Compared with the general Japanese population (n = 9,133), the incidence of NIDDM (n = 348; 3.9%) in patients with Graves' disease was higher in all age groups. Only 4 patients (8.2%) of the 49 hyperthyroid patients with NIDDM had a history of being overweight (body mass index > 25). In contrast, 276 (79.9%) of the 348 diabetic patients were currently or previously overweight. Moreover, the incidence of a family history of diabetes (13 of the 49 hyperthyroid Graves' patients with NIDDM; 26.5%) was also lower in the patients with NIDDM in the general Japanese population (50% incidence). The male:female ration in patients with Graves' disease and NIDDM was 1:1.1; much different from that in the total Graves' disease population (1:4.1). Analysis of the HLA loci A, B, C, DR and DQ (35 determinations) in 35 hyperthyroid patients with NIDDM and in 386 subjects from the general population revealed a highly significant difference between them in the incidence of HLA-Cw4, -DR2, -DQw1, -DQw3 and -DQw4. This study suggests that there was an association of Graves' disease with NIDDM. A significant association of HLA-DR and -DQ loci was observed in hyperthyroid Graves' patients with NIDDM.


Is preoperative fasting necessary?

The effects of fasting and of histamine (H2) antagonists on gastric volume and acidity were studied in 56 baboons undergoing various surgical procedures under general anesthesia and randomly allocated into 4 groups; group A--fasted for 14 hours; group B--given 100-120 ml of water 3 hours before surgery; groups C and D--also given 100-120 ml of water 3 hours before surgery; in addition, the former received cimetidine 10 mg/kg IM and the latter ranitidine 1.5 mg/kg IM 30-40 minutes before anesthesia. There were no significant differences between groups A and B with respect to the gastric volume and pH. Both ranitidine and cimetidine significantly (P < 0.02) reduced gastric volume and increased gastric pH. Thus, prolonged withholding of oral fluids does not reduce the gastric volume or increase gastric pH. H2-antagonists are effective in reducing both gastric residual volume and pH.


An ultrasound study of the effect of chronic lead exposure on endometrial cycle changes in the female cynomolgus monkey.

The effect of up to 10 years of lead (Pb) exposure (1500 micrograms/kg BW/day) on endometrial cycle changes in adult cynomolgus monkeys (n = 30) were examined by real-time ultrasound. Pb exposure had no effect on peak serum estradiol (E2) or progesterone (P4) concentrations, menstrual cycle length, and endometrial response to gonadal steroids as determined by ultrasound.


Chronic Pseudomonas aeruginosa endobronchitis in rhesus monkeys: I. Effects of pentoxifylline on neutrophil influx.

Host defense abnormalities in cystic fibrosis (CF) against Pseudomonas aeruginosa (PA) lead to excessive neutrophil influx into the infected lungs, resulting in pulmonary complications. We have developed a rhesus monkey model of chronic PA endobronchitis by intrabronchial instillation of PA-embedded agar beads, utilizing flexible fiberoptic bronchoscopy. Treatment of infected monkeys with pentoxifylline suppressed neutrophil influx and ameliorated pulmonary damage. The results suggest a method by which neutrophil influx and pulmonary damage in CF patients can be managed or prevented.


A non-invasive technique for the control of intestinal parasites in rhesus macaques (Macaca mulatta).

Control of intestinal parasites is a major concern in maintaining the health and well-being of captive primates. This study established that percutaneous application of ivermectin was as effective as subcutaneous administration for the control of nematodes in captive rhesus macaques. The method is less intrusive than the standard subcutaneous or oral delivery routes and did not adversely affect the health of any of the study subjects.


Gestational diabetes mellitus in a cynomolgus monkey with group A streptococcal metritis and hemolytic uremic syndrome.

Gestational diabetes mellitus was diagnosed retrospectively in a ten-year-old female cynomolgus monkey. The mother developed severe purulent group A streptococcal metritis resulting in fetal sepsis. After parturition, the mother died from signs consistent with hemolytic uremic syndrome.


Spontaneous cardiomyopathy resembling acute rheumatic heart disease in an owl monkey.

A wild-caught male Aotus vociferans died spontaneously during quarantine. Histologic examination of the heart showed several small myocardial arteries replaced with fibrinoid necrosis and adjacent inflammation that included lymphocytes and large histiocytic cells. Less often, similar inflammatory foci were observed in the myocardium interstitium. The lesions observed in the heart of the owl monkey resembled Aschoff bodies.


Oral squamous cell carcinoma in capuchin monkeys (Cebus apella). Report of two cases.

Two neoplasms were observed in two feral male Cebus apella monkeys of approximately 12 and 14 years of age. Histologically, the tumors were well-differentiated squamous cell carcinomas, one affecting the soft and hard palates reaching the nasal cavity and the other involving the oral cavity floor and the inferior maxillar.


Pasteurella haemolytica infection in a Goeldie's monkey.

An adult male Callimico goeldii died spontaneously. At necropsy, small whitish foci were found randomly distributed on the liver surface. Histologically, the foci were composed of mixed inflammatory cells with predominant polymorphonuclear cell infiltration and central areas of necrosis. Microbiological cultures revealed a Gram-negative coccoid-bacilli with bipolar staining. Biochemical analysis revealed that the microorganism was Pasteurella haemolytica.


Arterial blood pressure values in children and adolescents in the Lublin population. Epidemiological studies.

The frequency of arterial hypertension occurrence in the adult population is estimated at 10-20%. In the last decade attention has been called to hypertension in children and adolescents. The purpose of the present study was to determine the arterial blood pressure in the studied age groups of children and adolescents in the elementary and secondary schools in Lublin, and to establish the prevalence of hypertension in this population group.


Certain aspects of interaction between sodium valproate and other anticonvulsant drugs in the therapy of epilepsy in children.

The serum valproate (VPA) concentration and the clinical effects of polytherapy with other antiepileptic drugs: phenobarbital (PB), clonazepam (CZP), diazepam (DZ), clobazam (CLO), ethosuximide (ESX) were estimated. VPA serum levels were reduced when this drug was combined with phenobarbital. Clobazam given together with valproate led to an increase in the serum concentration of the former drug. VPA serum levels were without significant changes when the drug was combined with either ethosuximide or 1-4-benzodiazepines. The best therapeutical effects were found after polytherapy sodium valproate with ethosuximide and clobazam in primary generalized seizures.


Comparison of the effects of Salbupart and Partusisten on the serum levels of insulin, glucose, sodium and potassium in pregnant women.

The effect of tocolytic treatment with Salbupart and Partusisten in imminent premature labour on the serum levels of insulin, glucose, sodium and potassium was studied after 24 hours, and in some cases after 48 and 72 hours from the beginning of intravenous tocolytic treatment. The control group comprised healthy pregnant women receiving no tocolytic treatment. Statistical analysis showed that Salbupart and Partusisten raised the levels of insulin and glucose in the serum in pregnant women, but Salbupart increased more the insulin level and the raised levels of insulin and glucose persisted longer after Salbupart. No effect of these preparations on the serum levels of sodium and potassium in the studied pregnant women was noted.


Malarial placental infection and low birth weight babies.

Two hundred and fifty six mothers and their newborns were subjected to clinical and haematological tests for the evidence of malaria. Placentae of these were examined histopathologically for malarial parasites and malarial pigment. Forty six placentae showed scanty malarial pigment ingested by monocytes. These appearances were associated with focal syncytial necrosis and proliferation of cytotrophoblastic cells. Plasmodium falciparum was found in cord blood of six cases. The mean weight of newborns born to mothers having no evidence of malarial placental infection was 2,763 kg, while mean weight of newborns belonging to infected placentae was 2,143 kg. The difference was highly significant.


The effect of Salbupart on the value of placental perfusion pressure in extracorporeal experiment.

The purpose of the study was determination of the perfusion pressure as an expression of the resistance of placental vascular bed after administration of various doses of Salbupart. In a series of 29 experiments with extracorporeal perfusion of the fetal part of the placental from spontaneous labours after physiological pregnancy it was observed that the medicament given in one dose reduced the vascular resistance in the afterbirth. A beneficial spasmolytic effect of Salbupart may be expected in certain cases of pathological pregnancy associated with increased resting tonus of the placental vessels. The pharmacological management for stimulation of placental adenyl cyclase may be treated as supplementation of deficient endogenous catecholamines enhancing the adaptation mechanisms of the fetus and placenta.


Liver schistosomiasis in Kuwait. Clinical presentations and pathological findings.

This is a study on hepatic schistosomiasis including twenty eight cases, diagnosed over nine years period in a district general hospital in Kuwait. The clinical and histological picture in relation to the type of parasite is reviewed and the role played by S. haematobium species in the pathogenesis of liver disease affecting the immigrants in Kuwait is pointed out. The significance of the incidental finding of the schistosomal eggs in the liver and of the associated HBV infection is discussed. The topographic relation of schistosomal eggs and the surrounding granuloma to the fibrosis is described and these findings are related to the morphogenesis of this lesion.


Salbupart effect on rabbit heart and brain.

In connection with the widespread use of the product Salbupart POLFA in the treatment of imminent premature labour the effect of this medicament on rabbit fetuses was studied. In all, 29 fetuses were examined, particularly with histological examination of the heart and the central nervous system. No harmful effects of the medicament on these organs was found. In the fetal central nervous system Salbupart produced more intense staining of myelin sheaths by Heidenhain's method which may suggest earlier maturation of the brain.


Simultaneous determination of coagulation and fibrinolysis parameters for diagnostics of disseminated intravascular blood coagulation (DIC).

A diagnostic method is described for determining the parameters of the human blood plasma coagulation and fibrinolysis by turbidimetry. Diluted plasma with thrombin and streptokinase is mixed to initiate clot formation and subsequent clot dissolution. The resultant profile of absorbance versus time is analysed to determine six parameters: plasma coagulation time, the rate of coagulation, fibrinogen concentration, the rate of fibrinolysis, fibrin clot half-lysis and lysis time. The assay is precise, sensitive and requires 0.1 ml plasma. The method has a good correlation with generally accepted haemostatic tests and allowed us to recognize the stage of DIC syndrome for less than 10 minutes. This new approach was successfully applied for studying the haemostasis in patients with acute intestinal infection.


Diagnostic value of some subjective and objective symptoms of gastric ulcer.

Some subjective and objective symptoms, that are believed to be specific of peptic ulcer, were analyzed in 425 patients with endoscopically confirmed gastric ulcer. It was noted that the pain syndrome may have variants while pain after meals remains a typical sign of gastric ulcer. But asthenic habitus, tendency to sinus bradycardia and arterial hypotension, the absence of a coated tongue, and the tendency to erythrocytosis and decelerated ESR were not typical for the observed patients. The results suggest that some traditional concepts of typical clinical picture of peptic ulcer should be revised.


[Rainbow trout and zebrafish, two models for continuous toxicity tests: relative sensitivity, species and organ specificity in cytopathologic reaction of liver and intestines to atrazine].

In order to elucidate cytopathological alterations in hepatic and intestinal cells, immature rainbow trout (Oncorhynchus mykiss) were exposed for five weeks to 10, 20, 40, and 160 micrograms/l of the herbicide atrazine (2-chloro-4-ethylamino-6-isopropylamino-s-triazine; model 1). For comparison, ultrastructural changes in female zebra fish (Brachydanio rerio) liver were studied after exposure to 100, 1,000 and 10,000 micrograms/l atrazine for three months (exposure from egg stage to sexual maturation; model 2). Neither epithelial nor glandular cells in the gastrointestinal tract of rainbow trout reveal cytological modifications following exposure to atrazine. In contrast, hepatocytes of rainbow trout and zebra fish clearly display dose-dependent and species-specific cytopathological effects at 40 and 1000 micrograms/l, respectively. In rainbow trout (model 1), rough endoplasmic reticulum (RER) appears of particular diagnostic value for the effects of atrazine, since it already shows a full spectrum of cytological alterations after 40 micrograms/l, and since in cells without RER modifications no further cytopathological symptoms can be revealed. At 40 micrograms/l atrazine, further changes include disturbance of the intracellular compartmentation, increased heterogeneity of mitochondria (longitudinally arranged cristae, branching, size), formation of myelinated bodies as well as immigration of macrophages and granulocytes along the biliary system and the space of Disse. The separation of peripheral storage areas from the central organelle-containing cytoplasm is no longer evident at 80 micrograms/l, and the phagocytic activity of invading macrophages is drastically increased. Following exposure to 160 micrograms/l atrazine, additional pathological changes comprise clubshaped deformation of mitochondria, formation of myelinated bodies in the intermembranous space of mitochondria, increase of degranulated ER cisternae and lysosomes, as well as perisinusoidal accumulation of lipid droplets. Deformation of the nuclear envelope, elevated mitotic activity and an increased number of nuclei with two or more nucleoli indicate interactions between atrazine and the nucleus. In the liver of female zebra fish (model 2), atrazine-induced alterations are limited to increased parenchymal variability, disturbance of the intracellular compartmentation, partial RER fractionation and vesiculation, club-shaped deformation of mitochondria and an increase in the number of lysosomes, myelinated bodies and invading macrophages at 1000 micrograms/l atrazine. After three months at 10,000 micrograms/l, mortality of zebra fish is increased to 100%. According to cytopathological alterations of hepatocytes following long-term exposure, susceptibility of the test model rainbow trout to atrazine appears higher than that of the model zebra fish.(ABSTRACT TRUNCATED AT 400 WORDS)


Changes in human plasma dopamine-beta-hydroxylase activity after ketamine and halothane anesthesia.

The intravenous administration of ketamine hydrochloride to fifteen patients undergoing surgery produced no change in circulating plasma dopamine-beta-hydroxylase (DBH), although it produced a significant increase both in systolic blood pressure (BP) and diastolic BP during anesthesia. Halothane anesthesia that depress BP also produced no change in plasma DBH activity.


The influence of hemodialysis on plasma fluoride.

Since storage of fluoride in the skeleton has been blamed as an etiologic factor in the development of renal osteodystrophy, we studied the influence of hemodialysis on plasma fluoride levels in 17 patients with chronic renal failure on regular hemodialysis. The fluoride level in dialysate was found to be 19 micrograms/L, and 7.2 +/- 1.2 micrograms/L in healthy persons. Before hemodialysis, the mean fluoride level was 117.3 +/- 8.4 micrograms/L. It decreased to 113.3 +/- 8.5 micrograms/L at the first hour of dialysis and to 105.7 +/- 8.6 micrograms/L at the end of the dialysis, with no significance. We suggest that it would be appropriate to use "very low-fluoride" dialysate in order to reduce the plasma fluoride levels in patients with chronic renal failure.


Experimental studies of pancreatic transplantation after freezing and thawing.

The successful rat pancreatic transplantation, after 30 minutes cryopreservation at -80 degrees C, is presented with the normal graft function till the 6th postoperative day maximum. The freezing device used by the authors is shortly described. The choice of optimal freezing and thawing parameters is discussed. Organ freezing is a hopeful method which could serve to preserve the solid organs for a long period of time. Our former experimental research showed that slow freezing (1-2 degrees C/min) and fast thawing (> 100 degrees C/min) had produced less damage to the pancreas of the rat [1]. Recently we performed rat pancreatic transplantation after freezing and thawing the donor pancreas with the parameters mentioned above.


C-myc gene expression in stage I endometrioid adenocarcinoma of the uterus.

Expression of a c-myc proto-oncogene product known as p62 (c-myc) was studied in 18 cases of stage I endometrioid (typical) adenocarcinoma of the uterus by immunohistochemistry and correlated with mucin production and other pathologic features. Cytoplasmic staining of tumor cells for c-myc product was seen in all cases and nuclear staining in three cases. Endometrial stromal cells were invariably negative and myometrial nuclear staining was seen in three cases. Within the tumor itself, whereas intense staining was frequent in high grade tumors with deep myometrial and vascular invasion, faint to moderate staining was frequent in well differentiated tumors with superficial myometrial invasion. A general tendency was also seen for greater staining in the myometrial component of the tumor than in tumor located in the endometrium. Whereas staining in the latter was frequently patchy in distribution, c-myc expression was invariably uniform in the myometrial component. Mucin production was somewhat greater in endometrial than myometrial components but did not correlate with c-myc expression or other pathologic features. This study demonstrates that c-myc is variably expressed in endometrial carcinoma and high c-myc expression can be associated with populations of tumor cells selectively capable of myometrial and vascular invasion.


Therapeutic effect of gevilon in patients with hyperlipoproteinaemia.

Authors examined 46 patients with hyperlipoproteinaemia divided according to hyperlipoproteinaemia type II A, II B, IV. After one month of isocaloric diet the patients were given a single night gevilon dose of 900 mg for a period of 3 months. After therapy we examined lipid metabolism, liver and kidney function, carbohydrate metabolism, hematopoietic system and water--electrolyte balance. In all groups increased levels of cholesterol, beta-lipoproteins and triglycerides were significantly reduced after 3 months of gevilon treatment. In all patients the HDL/LDL ratio increased close to normal values. No impairment of kidney or liver function hematopoietic system and electrolyte balance after 3 months of treatment were noted. Because gevilon is easy to apply and has a limited number of side effects, it is very readily taken by the patients who have lipid balance disorders.


[Employment of continuous biotest systems for monitoring the Rhine river].

As a part of the work of the German Commission for the Prevention of Pollution of the River Rhine biological test automats are developed and proved in a research project. The joint project "Development, Testing and Implementation of Biotests for the Monitoring of the River Rhine" sponsored by the Federal Ministry for Research and Technology (BMFT) and the Federal Environmental Agency (UBA), aims to provide a scientific and technical basis for an improved Rhine monitoring system. To realize a biological effect monitoring with functional subjects at the trophic levels of producers, primary and secondary consumers and destruents, the test spectrum includes algae, mussels, daphnia, fishes, and bacteria. Moreover, at the suborganismic level a test system with plant protoplasts is tested. Assessment schemes for the evaluation of measuring data and alarm situations, and limit values for releasing alarms are defined by the Working Group "Biotests for the Monitoring of the River Rhine" (WIR). By means of applicability criteria the most suitable biotests are chosen and recommended for the use on the River Rhine. The first results are presented in this paper.


[Use of bioreactors for continuous water monitoring].

A commercially available bacterial toxicity monitor ("Toxiguard", BTG Anlagentechnik, Bochum, Germany) was tested for continuous river monitoring. Operating with biofilms, this system shall detect toxic substances in the water. River water passes through two bioreactors forming a biofilm of characteristic river bacteria. The indicating parameter of the biomonitor is the respiration rate of this bacterial biofilter. The remaining oxygen content in the effluent from the biofilter is measured continuously by an oxygen electrode. This value is related to the dissolved oxygen (DO) of the river water measured in a by-pass. In presence of inhibitory substances the DO content in the biofilter increases because of the reduced respiration activity of the bacteria. The addition of nutrients may lead to an increase of biomass and of respiration activity. This results in an increasing oxygen difference between DO contents in the biofilter influent and effluent. Therefore, the degree of poisoning is better perceptible. Moreover each nutrient causes a distinct biofilm with a specific sensitivity against chemicals. This effect will be shown for Sodium-Pentachlorophenolate (Na-PCP).


[Evaluation criteria for a behavioral fish test for continuous water monitoring].

Conventional fish flow through chamber tests respond only to massive injury of the animals. For this reason an indication of certain contaminants in sublethal concentrations is often impossible. The multi-parameter fish test described here aims to increase the test sensitivity in the sublethal range. The highly automated system allows to quantify and assess changes in the behaviour patterns of a small shoal of test fishes. The behavioural parameters are measured with the video-processing system "BehavioQuant". The object-related parameters swimming height, covered way, and number of turnings during the measuring cycle are recorded for each animal. As additional criteria the shoaling behaviour of the fishes is quantified and evaluated by the system. Test organisms are golden orfes Leuciscus idus melanotus.


Cyst-based toxicity tests. VI: Toxkits and Fluotox tests as cost-effective tools for routine toxicity screening.

During the last two decades microbiotests have been developed which are independent of recruitment, maintenance and/or culturing of live stocks of test organisms. "Culture and maintenance free" microbiotests have been worked out in the Laboratory for Biological Research in Aquatic Pollution at the University of Ghent, with selected aquatic invertebrates. The new approach is based on the use of "resting stages" (cysts) as inert biological material from which live test organisms can be hatched "on demand". The "cyst-based" bioassays have recently been miniaturized in Toxkits. Four cyst-based screening tests have reached the stage of commercialization: two freshwater 24h-LC50 tests (Rotoxkit F and Streptoxkit F) and two estuarine/marine 24h-LC50 bioassays (Rotoxkit M and Artoxkit M), based on cysts of rotifer and crustacean species, respectively. Recently, the same laboratory has also been focusing on the development of a "rapid" (one hour) sublethal bioassays with aquatic invertebrates. The so called "Fluotox" screening test is based on the visual observation of in vivo inhibition of an enzymatic process, using a fluorescent substrate. Besides the advantages of rapidity and cost-effectiveness, the Fluotox assay also appears to have a remarkable predictive potential for mortality, as displayed by the remarkable correlation between the Fluotox 1h-EC50's and conventional 24h-LC50's with the same species.


[The luminescent bacteria test for clean water legislation].

Luminescent bacteria (Photobacterium phosphoreum) may be used, on the one hand, for classical toxicity tests based on the inhibition of respiration or growth and, on the other hand, their luminescence itself may become the test criterion. Such a luminescence inhibition test is commonly called a luminescent bacteria test. It may be conducted with fresh bacteria or with conserved ones. The luminescence parameter is, just like the parameter oxygen consumption, a summative parameter for undisturbed metabolic processes. Dilution series are prepared to determine the concentration level at which no inhibition of the luminous intensity is detectable in comparison with reference samples. This paper highlights the necessity of standardizing the test methods (the influence of toxic substances depends on test duration and temperature) and describes the standardized procedure established by the DIN-Arbeitskreis "Leuchtbakterientest" (Working Group of the German Institute for Standardization for the luminescent bacteria test) using freeze-dried, liquid-dried, and fresh bacteria (DIN 38,412, part 34). Results of wastewater analyses are presented and the wide range of applications is described. The choice of biotests for applications under the Federal Water Resources Management Act (Wasserhaushaltsgesetz--WHG) and the Wastewater Charges Act (Abwasserabgabengesetz--AbwAG) is discussed and the reasons for the selection of the luminescent bacteria test are explained. Within the framework of a test battery of bioassays, this test shall be used according to section 7a WHG both for evaluating the technological level of wastewater treatment and for routine monitoring of wastewater discharges. In March 1992, this test (DIN 38,412, part 34, edition March 1991) became part of the general administrative regulations for wastewater (Rahmen-Abwasser-Verwaltungsvorschrift-RAV).


[Examination of the water supply with the alkali and alkali-earth supplement optimized DIN luminescent bacteria test, exemplified by the Saar river].

The light intensity emitted by luminescent bacteria is influenced by both the osmolarity and the ion composition of the test medium. The addition of potassium and calcium ions to a sodium chloride solution causes a considerable increase in the light intensity of bacteria. If these elements occur in the proper concentrations in the test material, the luminescence in the test sample will be higher than in the control sample containing only sodium chloride. This physiological dependence did not find the due consideration in the establishment of the German standard method for the luminescent bacteria test using Microtox bacteria (German Institute for Standardization DIN 38,412, Part 34--edition March 1991) where only the osmotic balancing by sodium chloride was taken into account. For testing chemicals, the luminescent bacteria test with Microtox reagent can be run without problems by the procedure that is recommended by Microbics Corporation and which became part of the DIN standard method. The situation is different when analyses of natural waters or effluents from wastewater plants are concerned, where matrix effects have to be expected. Stimulation of light intensity can be a reflection of a nonoptimized test medium and in the worst case may cause false negative results. The new ASW (artificial sea-water) luminescent bacteria medium according to Klein, which besides sodium contains potassium, magnesium, and calcium ions, brings stimulation to both samples and controls, effectively reducing enhancement and increasing the inhibitory effects of samples from the River Saar. However, high light stimulation rates measured in parallel tests with the DIN procedure could not be caused by the low concentrations of alkaline and alkaline-earth ions in the samples. The experiments indicate that there must be additional influencing substances which have not yet been identified. Furthermore, the experiments show that the matrix effects of unknown origin that will exert a positive influence on the light emission may be compensated by addition of alkaline and alkaline-earth ions.


[Neutral and zwitterionic detergents: dependence of biological effectiveness on critical micellar concentration].

The biological activity of various zwitterionic and nonionic detergents was studied as a function of the corresponding critical micellar concentration (CMC-values). The criteria chosen to measure biological activities were inhibition of bioluminescence, lysis and cell-killing of Vibrio fischeri, hemolysis, and inhibition of Daphnia magna. When Zwittergent-detergents were studied in three different bioassays their biological activity increased with decreasing CMC-values. However, the biological activity of various TWEEN-detergents and alkylglucopyranosides depended on CMC-values in a very different way. We therefore conclude that CMC-values, length of alkylgroups and charge are parameters not yet sufficient to predict the potential toxicity of detergents.


[The role of endogenous opioids in modulation of immunosuppression in fish].

We have previously shown that social confrontation between aggressive fish (e.g., Tilapia) produces a suppression of several immunological parameters--nonspecific cytotoxicity and mitogen-stimulated proliferation in pronephric lymphocytes--in the subordinate fish. By using the opioid antagonist, naltrexone, we now demonstrate indirectly that this immunosuppression is in part mediated by the endogenous opioid system. Evidence is presented that naltrexone-mediated reversal of immunosuppression may be limited to the populations of the cytotoxic and T-cell lineages. The proliferative response to lipopolysaccharide is unaffected by naltrexone. Our data also demonstrate that serum from subordinate (immunosuppressed) fish is immunosuppressive in normal fish: an effect that can be reversed by naltrexone. These results support a link between the neuroendocrine and immune systems in these animals.


The British Columbia Mammography Screening Program: evaluation of the first 15 months.

We report our experiences in the first 15 months of a government-funded pilot project begun in 1988 to study the feasibility of rapid throughput, low-cost screening mammography in British Columbia. The primary goals of the project were (1) to determine the unit cost of screening mammography within the context of the program; (2) to design and put into operation a centralized system of data collection, analysis, and quality control to enable calculations of cancer detection rates, biopsy rates, biopsy yield ratios, staging, and other specific cancer characteristics; and (3) to study compliance in the community where the program was offered. A total of 11,824 women had mammography at a unit cost of U.S. $32.66. Computerized analysis revealed that (1) 11% of women had known primary risk factors; (2) findings on mammograms were interpreted as abnormal in 9% of screening examinations; (3) breast cancers were confirmed in 47 (22%) of 211 patients who had biopsies, and 87% of these were stage 0-1. The overall cancer detection rate was four per 1000, with five per 1000 for women who had not had mammography in the preceding 2 years and one per 1000 for women who had had mammography in the past 2 years. The results show that screening mammography can be conducted at low cost. Data collection and analysis and compliance were sufficiently convincing to initiate province-wide expansion.


Cranio-orbito-zygomatic measurements from standard CT scans in unoperated Crouzon and Apert infants: comparison with normal controls.

Cranio-orbito-zygomatic measurements taken from standard axial computed tomographic (CT) scans of unoperated patients with Crouzon syndrome (6 males, 14 females) and Apert syndrome (6 males, 10 females) under 1 year of age were compared to each other and to normal controls (40 males, 35 females). Fifteen cranio-orbito-zygomatic variables were measured and repeated. Means and standard deviations were computed for each sex, and means were pooled since they were not significantly different. Correlation coefficients for repeat measures (intra-observer error) of each variable showed good reproducibility. Only the lateral orbital wall angle differed between the syndromes (p = .034), suggesting that upper facial differences (as measured by these variables) do not manifest themselves at this young age. All measurements for both syndromes, except one, were outside the 95 percent confidence range for age-matched controls. Measurements taken from standard CT scans provide an objective comparison between specific syndromes and the normal population.


Arterial hypertension and neurovascular compression at the ventrolateral medulla. A comparative microanatomical and pathological study.

Intraoperative observations and animal experiments suggest that neurovascular compression at the left ventrolateral medulla is a possible etiological factor in essential hypertension. In pursuing this hypothesis, the authors examined the neurovascular relations in the posterior cranial fossa of 24 patients with essential hypertension, of 10 with renal hypertension, and of 21 normotensive control patients. Artificial perfusion of the vessels and microsurgical investigations during autopsy identified the vascular relations at the brain stem and at the root entry zone of the caudal cranial nerves. There was no evidence of neurovascular compression at the ventrolateral medulla on the left side in any patient from the control group or among those with renal hypertension. Two normotensive patients had neurovascular compression at the right ventrolateral medulla by the posterior inferior cerebellar artery. In contrast, all patients with essential hypertension had definite neurovascular compression at the left ventrolateral medulla. Additional compression of the right side was seen in three of these patients. Based on the anatomical appearance, it was possible to define three distinct types of neurovascular compression at the ventrolateral medulla. Common to all three types is the compression of the medulla oblongata at its rostral part just caudal to the pontomedullary junction and lateral to the olive in the retro-olivary sulcus. Comparative histopathological study of the microsurgically examined brain-stem specimens revealed no differences between patients with essential hypertension, those with renal hypertension, and normal controls. There was a structural integrity at the site of neurovascular compression at the ventrolateral medulla. The microanatomical findings of this study show that neurovascular relations at the ventrolateral medulla in essential hypertension give rise to pulsatile compression on the left. This supports Jannetta's hypothesis of neurovascular compression at the left ventrolateral medulla as an etiology of essential hypertension.


An algorithm for ordering pretreatment orthodontic radiographs.

A study was conducted to identify selection criteria for ordering pretreatment orthodontic radiographs. Thirty-nine orthodontists evaluated six test cases. They provided information on the rationale for ordering each specific radiograph and the impact of the radiograph on the diagnosis and treatment plan. Skeletal relationship of the jaws was the most common indication for a radiograph request, followed by root formation/length and molar position or development. Of the radiographs, 16% produced a change in diagnosis, and 20% produced a change in treatment plans. The criteria specified for the radiographs, their impact, and relevant information in the literature were used to develop an algorithm or set of decision rules that, when tested on the six test cases, resulted in a 36% reduction in the total number of radiographs.


Solution studies of the interactions between the histone core proteins and DNA using fluorescence spectroscopy.

The equilibrium interactions between histone H2A-H2B and H3/H4 subunits with 200 base pair chicken erythrocyte DNA have been studied by monitoring the fluorescence polarization of a long-lived fluorescence probe covalently bound to the histone subunits. These studies have brought to light the formation of highly asymmetric complexes exhibiting very high histone/DNA stoichiometries as well as very high apparent affinities. The stoichiometries observed for these non-nucleosome complexes depended both upon the concentration of the histones and the concentration of the DNA 200mer. The observed stoichiometries varied approximately between 4 and 16 histone octamers/DNA 200mer and the affinities were in the nanomolar range. These results are discussed in terms of their in vitro as well as their possible in vivo significance.


Examination of Koch's postulates for Borrelia burgdorferi as the causative agent of limb/joint dysfunction in dogs with borreliosis.

Borrelia burgdorferi has been implicated as the causative agent of borreliosis in dogs, which is characteristically a limb/joint disorder, but can be associated with multiple-organ dysfunction. Attempts to reproduce this disease by inoculating dogs with B burgdorferi have not been successful. In the study of this report, B burgdorferi from Ixodes dammini ticks was used to induce signs of limb/joint dysfunction, fever, anorexia, depression, and systemic infection in dogs. A pure culture of this bacterium from the blood of an infected dog has been used to fulfill Koch's postulates for B burgdorferi as the causative agent of limb/joint dysfunction associated with borreliosis in dogs.


Cocaine abuse: an expanding healthcare problem for the 1990s.

Cocaine, the most addictive recreational drug available, has increased in popularity and widespread use in the past decade. Crack, a new form of cocaine that is smoked, is purer and more rapidly absorbed into the vascular system, greatly increasing the risk of overdose. Cocaine produces many physiologic effects on the body systems. This case report focuses on two cardiovascular responses related to cocaine use: cardiomyopathy and coronary vasospasm. Cocaine abusers may present with complaints of chest pain or other nonspecific symptoms that require diligent assessment skills to be recognized as cocaine-related. Therefore, it is essential that nurses be knowledgeable about the effects of cocaine and the symptoms of cocaine abuse.


Patients' perceptions of pulmonary problems and nursing interventions during hospitalization for Pneumocystis carinii pneumonia.

The descriptive, correlational study examined patients' perceptions of pulmonary problems and nursing interventions in a sample (n = 201) of persons living with AIDS hospitalized for Pneumocystis carinii. Additionally, the study assessed differences in physiological variables, patient symptoms, and functional status based on the type of problems identified: dyspnea, pulmonary problems without dyspnea, and nonpulmonary problems. A total of 601 problems was identified including 61 instances of dyspnea and 83 reports of other pulmonary problems. The remainder of the problems was nonpulmonary. Nursing interventions associated with dyspnea and pulmonary problems other than dyspnea were mainly broadly defined interventions such as oxygen and medication administration. When patients were placed into three groups based on identification of dyspnea, pulmonary problems without dyspnea, or only nonpulmonary problems, there were no differences between groups in functional status or patient symptoms of pain, nausea, or fatigue as measured by the Quality Audit Marker. This study demonstrated that hospitalized patients with Pneumocystis carinii present with a broad array of problems. Contrary to expectations, dyspnea was not ubiquitous but was reported by less than one-third of this sample. When dyspnea was present there were few independent nursing interventions that patients identified. Studies are needed to test effective strategies for the nursing management of dyspnea and a large variety of other patient problems associated with HIV infection.


New nurses, new spaces: a preview of the AACN History Study.

This article previews selected findings of the American Association of Critical-Care Nurses History Project that is being conducted under the auspices of the Center for the Study of the History of Nursing at the University of Pennsylvania. Using methods of social history research, we reviewed pertinent literature, studied documents of institutions and organizations, and interviewed a broad array of participants. Analysis of this evidence resulted in a history of the evolution of nursing and hospital care for patients with life-threatening illnesses during the 40-year period since 1950. We explored the effects of changing public and professional ideas about the nature of critical illness, the effects of technology, and the historical dimensions of critical care nursing. Special attention was given to the events and circumstances that led to the development of AACN and the reciprocal relationships between AACN and the care of critically ill people.


Nurse/physician collaboration: solving the nursing shortage crisis.

This summary article discusses the status of the nursing shortage in the United States, with emphasis on successful strategies to address it. Liaisons between the American Association of Critical-Care Nurses (AACN) and the Society for Critical Care Medicine, as well as with the American College of Cardiology, are highlighted, with primary emphasis on the strategy of nurse-physician collaboration.


Future of critical care.

Critical care, as a specialty in both nursing and medicine, is well recognized and the number of people requiring hospitalization for critical illnesses continues to increase. The purpose of this paper is to examine the future and the changes that lie ahead in critical care. New and expanding roles for nurses are projected along with a continued refinement and expansion of the critical care medicine subspecialty for physicians. A variety of changes in critical care are anticipated that reflect our increasing abilities in biotechnology, basic and clinical research, and data management. These changes are viewed for their obvious impact on cost, ethical controversies, and patient care and outcome.


Monitoring and management of acute circulatory problems: the expanded role of the physiologically oriented critical care nurse.

The intensive care unit is set apart from other hospital patient care areas by (1) physiological instrumentation that permits better assessment and more effective therapy and (2) more intensive nursing. These capabilities allow nurse and physician intensivists to evaluate tissue perfusion and tissue oxygenation by the temporal patterns of oxygen delivery and oxygen consumption, as well as hemodynamics. Such evaluation provides important insight into the functional impairment of hemorrhagic, traumatic, septic, and postoperative shock. Using artificial intelligence-based systems, complex clinical algorithms--tailored to specific patient conditions--have been developed and are described. These algorithms are based on both invasive and noninvasive monitoring systems and on clinical experience with a large series of high-risk surgical patients.


Superior vena cava syndrome: etiology, diagnosis, and treatment.

Superior vena cava (SVC) syndrome is a critical condition in which an intrathoracic mass lesion compresses the SVC and promotes the development of head and upper body edema and cyanosis. SVC syndrome develops in 10% of patients with a right-sided malignant intrathoracic mass lesion. Diagnostic evaluation and emergency therapy are always necessary to assess and alleviate airway obstruction, cerebral venous hypertension and symptoms secondary to mediastinal compression. Radiation therapy and venous bypass of the obstructed SVC are both used successfully as early treatment. Although radiation therapy to the malignant process may provide initial decompression, a more sustained decrease in venous pressure occurs in patients who also undergo decompressive SVC surgical bypass. SVC bypass should be considered early in the course of patients with profound cerebral or laryngeal edema, patients with extensive thrombosis of the SVC, and in rare patients afflicted with severe venous hypertension and in whom a tissue diagnosis requires a mediastinal exploration.


Clinical comparison of two- and three-wavelength systems for continuous measurement of venous oxygen saturation.

To evaluate clinically the accuracy of continuous SvO2 systems to reflect reference SvO2 values over a 24-hour period. Randomized clinical trial. Six-bed cardiac surgical intensive care unit of a 540-bed federal facility. Sixty postoperative cardiac patients. Random assignment to a two- or three-wavelength continuous SvO2 catheter for postoperative SvO2 monitoring. At 4-hour intervals over a 24-hour period, mixed venous blood samples were analyzed with a reference cooximeter and compared with the monitor value of the SvO2 catheter. A reference cooximeter method to measure SvO2 in mixed venous blood; SvO2 as measured by the in-line, SvO2 catheter system. SvO2 measured by the three-wavelength system did not differ significantly from the reference SvO2 measurement. In contrast, SvO2 measured by the two-wavelength system was significantly lower than the reference SvO2 measurement within 4 hours of admission to the critical care unit and remained significantly lower throughout the 24-hour study period. The results of this clinical study confirmed a previous study in dogs, showing that SvO2 is measured more accurately by the three-wavelength continuous monitoring system.


Room-temperature thermodilution cardiac output: central venous vs right ventricular port.

To assess the accuracy of room-temperature thermodilution cardiac output measurements from the right ventricular port. In addition, waveform patterns were evaluated to determine the actual location of the right ventricular port. Central venous port cardiac output measurements were compared with right ventricular port cardiac output measurements using the same right-heart catheter. The general intensive care unit of Memorial Sloan-Kettering Cancer Center. Thirty-seven critically ill cancer patients with 38 different right-heart catheters were evaluated. Four injections of 10 mL normal saline at room temperature were made through each port; the results of the last three injections were averaged. Cardiac output determinations from both ports were completed in less than 10 minutes. The order of port injection was random. No difference was noted between cardiac output determinations from the two ports in a paired t test. Of 38 right-heart catheters, 17 were in the right ventricle and the other 21 in the right atrium. A comparison of ports in the 17 right ventricle catheters showed no difference with a significant (P < .01; R2 = 0.96) correlation. Thermodilution cardiac output measurements using 10 mL normal saline at room temperature can be determined accurately using the right ventricular port if the central venous port becomes nonfunctional.


Evaluation of a system for intragastric pH monitoring of intensive care unit patients: preliminary report.

A new pH probe-tipped nasogastric sump tube is available to monitor gastric pH conveniently. This study assesses its ability to measure gastric acidity accurately. The accuracy of the combined pH probe nasogastric tube (GrapHprobe ST) was determined by comparing it with standard buffer solutions (pH 1.0, 2.0, 4.0 and 7.0) traceable to the National Institute of Standards and Technology. Gastric pH values obtained were compared with values obtained using indicator paper and a calibrated glass electrode on gastric aspirate. Although statistically significant differences were found in vitro between the pH of three of the buffer solutions and the pH values obtained by the nasogastric sump tube, the results were within 0.5 pH unit. When rounded to the nearest pH unit, all values were the same as the buffer solutions. No significant difference was found in the pH values obtained during in vivo testing. The GrapHprobe ST measured gastric pH within reasonable accuracy in this small series.


Minimizing diagnostic blood loss in critically ill patients.

Blood loss from diagnostic procedures in critically ill patients needs to be minimized. Traditionally, when drawing blood from arterial lines, the initial sample used to clear the line has been discarded (open method). Use of a temporary reservoir enables this discard sample to be returned to the patient (closed method). Critically ill surgical patients were prospectively randomized to the open or closed method of drawing blood from arterial lines. Blood loss to diagnostic sampling was measured in both groups. A comparison study (n = 1657) of these two methods revealed that blood loss to the patient was significantly decreased (P << .01) using the closed method. Mean blood loss per patient per day was 69 mL in the open group (n = 873) vs 35 mL in the closed group (n = 784). Use of the closed method when drawing blood from arterial lines results in a significant decrease in blood lost to diagnostic procedures.


The effects of ocean sounds on sleep after coronary artery bypass graft surgery.

To investigate the influence of ocean sounds (white noise) on the night sleep pattern of postoperative coronary artery bypass graft (CABG) patients after transfer from an intensive care unit. A before and after trial with an experimental and a control group was used in this intervention study. A large public hospital with primary, secondary, and tertiary care facilities. A consecutive sample of 60 first-time CABG patients was systematically assigned to the experimental or the control group. For the experimental group, the sounds were played on the Marsona Sound Conditioner (Marpac Corporation, Wilmington, NC) for three consecutive nights posttransfer from the ICU. No control of environment, except for the elimination of white noise, was done for the control group. The Richards-Campbell Sleep Questionnaire, a visual analog scale, provided self-reported sleep scores on six variables. Analysis of covariance was used to test the difference between the posttest scores of the groups, with the pretest used as the covariate. There were significant differences in sleep depth, awakening, return to sleep, quality of sleep, and total sleep scores; the group receiving ocean sounds reported higher scores, indicating better sleep. There was no difference in the falling asleep scores. The use of ocean sounds is a viable intervention to foster optimal sleep patterns in postoperative CABG patients after transfer from the ICU.


Cardiopulmonary support in the intensive care unit.

The cardiopulmonary support system is an extracorporeal device that allows for rapid cardiopulmonary support of the critically ill patient in the intensive care unit. It provides immediate and complete support of cardiac and pulmonary functions to maintain perfusion to vital organs in patients who are severely physiologically compromised (eg, in cardiogenic shock, adult respiratory distress syndrome or pulmonary edema). Successful cardiopulmonary support requires systemic anticoagulation, percutaneous venous and arterial cannulation and careful monitoring by the critical care team to maintain adequate tissue perfusion and oxygenation. Although patient mortality can occur secondary to bleeding, embolism or sepsis, this technique provides life-sustaining circulatory and respiratory support until definitive treatment can be initiated.


Sodium nitroprusside-induced cyanide intoxication and prevention with sodium thiosulfate prophylaxis.

Sodium nitroprusside is an antihypertensive agent used frequently in the critical care setting. Recently, the Food and Drug Administration (FDA) published a report that led to a labeling change emphasizing the pharmacokinetics of nitroprusside with metabolism to highly toxic cyanide. Although evidence validates that cyanogenesis occurs with nitroprusside administration, prevention and treatment of cyanide poisoning is rarely instituted in clinical practice. Simultaneous infusion of thiosulfate with nitroprusside provides the sulfur donor necessary to prevent cyanide accumulation. Cyanide combines with thiosulfate to form the less toxic sodium thiocyanate, which is then excreted. A 10:1 ratio of nitroprusside to thiosulfate in the infusion eliminates the possibility of cyanide intoxication without altering the efficacy of nitroprusside.


Coronary artery bypass graft surgery in older women and men.

To compare women and men younger than 70 years of age and 70 years or older undergoing coronary artery bypass surgery. Retrospective chart review, case-control series. University medical center. All women (n = 465) having first-time isolated coronary artery bypass surgery between 1983 and 1988, and 465 men matched for age and year of surgery. Predominantly white; 33% were 70 years or older. Medical record data: demographics, preoperative comorbidities, perioperative and postoperative complications, mortality, length of stay. Preoperatively, women 70 years of age or older had a higher incidence of congestive heart failure, renal disease and hypertension, and a lower incidence of smoking history compared with women less than 70 years old. Men 70 years or older had a higher incidence of congestive heart failure and renal disease, and a lower incidence of smoking history compared with men less than 70 years old. There was no difference in mortality between older and younger women, whereas the mortality rate for older men was higher than that for younger men. There were fewer differences between women younger than 70 and those 70 years or older in incidence of postoperative complications than between men of those same age groups. Among patients 70 years or older, incidence of postoperative congestive heart failure was greater in women than in men. There were no other differences between women and men younger than 70 and those 70 years or older in incidence of postoperative complications. Controlling for the influence of postoperative complications, age was related to length of stay for women and men. Older women were at no greater risk of mortality or the occurrence of postoperative complications compared with younger women or older men. A functional component influencing recovery and length of hospital stay needs to be considered to provide optimal nursing care after surgery.


Spouse adaptation to mate's CABG surgery: 1-year follow-up.

The purpose of this study was to describe spouses' life stressors, supports, perceptions of illness severity, role strain, physical and mental symptoms of stress, and marital quality 1 year after the mate's coronary artery bypass graft surgery. This descriptive study was the third component of a longitudinal panel investigation. (The first component was a period within 48 hours of surgery, and the second was 6 weeks after discharge.) One year after the mate's surgery, spouses received the following instruments in the mail: the Family Inventory of Life Events and Changes, the Norbeck Social Support Questionnaire, the Cantril Ladder Scale, the Strain Questionnaire, the Role Strain Scale and the Dyadic Adjustment Scale. Subjects were a convenience sample of 49 women whose husbands were alive 1 year after their first bypass surgery. Of the women in the sample (n = 49), 98% were white, and the mean age was 56 years. Social support was moderate and significantly less 1 year after surgery than during the first two components (48 hours and 6 weeks after surgery). Women still perceived their husbands to have some illness severity 1 year after surgery. They continued to have physical and mental symptoms of stress and had significantly greater role strain than during the first two periods. Marital quality was average. Spouses reported making several life-style changes. During the first year after the patient's bypass surgery, spouses experienced many changes. Although physical and mental symptoms of stress remained the same, role strain increased and social support decreased. The findings suggest testing of such interventions as stress management and time management techniques, support groups, and other psychoeducational interventions. Although the situation remains difficult for the spouse 1 year after the patient's surgery, nurses and physicians can foster and support spouses through many adjustments and changes.


Urinary bladder/pulmonary artery temperature ratio of less than 1 and shivering in cardiac surgical patients.

Temperature gradients that normally exist between body areas may be altered as a result of heat generated by shivering. Two core thermal gradients between pulmonary artery and urinary bladder were compared with shivering in 37 coronary artery bypass graft patients. Pulmonary artery and urinary temperature were measured every 15 minutes, and shivering was evaluated electromyographically. Shivering developed in 28 patients (76%). With shivering the pulmonary artery/urinary bladder temperature ratio was less than 1 but in the nonshivering group was greater than 1. Correlation (r value) between pulmonary artery and urinary temperature ranged from 0.93 to 0.99. Rate pressure product was higher in the shivering group than in the nonshivering group. A pulmonary artery/urinary bladder temperature ratio of less than 1 was seen with shivering in this subset of patients. Pulmonary artery and urinary bladder temperatures are readily available clinically. The combination of a ratio of less than 1 and an increase in rate pressure product should be considered suggestive of shivering in coronary artery bypass graft patients.


Gastric intramucosal pH: a noninvasive method for the indirect measurement of tissue oxygenation.

Monitoring the adequacy of tissue oxygenation is an important goal in the care of the critically ill patient. Global alterations in tissue oxygenation are inferred from changes in systemic oxygen transport (defined as the product of cardiac output and arterial oxygen content) and total oxygen consumption. These parameters, however, cannot measure the level of oxygenation of specific tissue beds, in particular those that are first affected by hypoxia, such as the gastrointestinal tract and the kidneys. Gastrointestinal tonometry is a new method for measuring the partial pressure of carbon dioxide of the gastrointestinal mucosa. This information can be used in conjunction with the arterial blood bicarbonate to calculate the pH of the mucosa. Mucosal acidosis correlates well with the onset of anaerobic metabolism in response to hypoxia or sepsis. This review discusses the basic principles of tonometry, the results of experimental and clinical studies, and the practical aspects related to the implementation and use of tonometers in patients in the critical care unit. Gastrointestinal tonometry is a relatively noninvasive device that appears capable of measuring metabolic changes produced by hypoxia. Because of the sensitive nature of the gastrointestinal mucosa, these changes often occur well in advance of other, more common, indices of hypoxia. The use of the tonometer may become a routine procedure in the overall monitoring of critically ill patients.


Pulmonary artery pressure measurement in patients with elevated pressures: effect of backrest elevation and method of measurement.

To determine whether pulmonary artery pressure measurement is accurate if the head of the bed is elevated; to compare the end-expiratory graphic recording and digital monitor methods for pulmonary artery pressure measurement; to determine whether either mean arterial pressure or mixed venous oxygen saturation changes during backrest elevation. Nonrandomized clinical trial. A six-bed cardiac surgical intensive care unit of a 540-bed federal facility. Twenty-five postoperative cardiac surgical patients with elevated pulmonary artery pressures (systolic higher than 35 mm Hg). In supine patients pulmonary artery pressures were measured at each of the following backrest elevations: 0, 20, 30, 45 and again at 0 degrees. Measurements were obtained once during mechanical ventilation and once during normal breathing after extubation. End-expiratory graphic recording of pulmonary artery pressures; digital monitor values of pulmonary artery pressures; mean arterial pressure; and mixed venous oxygen saturation. No statistical difference was found in pulmonary artery pressures measured at each of the backrest elevations during mechanical ventilation or normal breathing after extubation. Pulmonary artery diastolic and pulmonary capillary wedge pressures obtained with the digital monitor method were significantly lower than the end expiratory graphic recording method during normal breathing after extubation but not during mechanical ventilation. No changes in mean arterial pressure or mixed venous oxygen saturation occurred during backrest elevation. These results show that pulmonary artery pressures can be measured accurately with the head of the bed in an elevated position. The data indicate that obtaining pulmonary artery pressure measurements from the digital display of the bedside monitor is accurate when respiratory wave form fluctuations are minimal but may lead to inaccurate values with prominent respiratory fluctuations. Further research is needed to validate this finding in different patient populations and with other models of monitoring equipment.


Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery.

This study explores: (1) the feasibility of involvement of nursing staff in routine bedside testing of activated clotting time and (2) joint implementation with resident medical staff of a preformulated plan for management of mediastinal bleeding after cardiac surgery. Patients were divided randomly into two groups, an experimental group (n = 108) subjected to ACT testing and management by protocol, and a control group (n = 146) treated by independent medical decisions. Bleeding, volume of blood replaced, abnormal coagulation profiles and reoperations to control bleeding and its consequences were all reduced in the study group. We concluded that bedside measurement of activated clotting time by nursing staff, associated with therapy based on a flow diagram, enhanced the overall management of early mediastinal bleeding after cardiac surgery as compared with independent management decisions by resident medical staff. In addition, the method provided a sensitive and reliable means of detecting and correcting rebound heparinization in the early postoperative period.


Parental coping and activities during pediatric critical care.

To investigate the relationship of locus of control, parental age, and state anxiety to parental coping and activities performed during hospitalization of a child in a pediatric critical care center. Cross-sectional. Pediatric critical care center at a university medical center. A convenience sample of 47 parents of 47 children hospitalized in a critical care center. Parental coping strategies and activities performed during hospitalization in a critical care center. Older, more self-directed and less anxious parents were found to use coping strategies focusing on problem solving rather than on their emotional response to a child's hospitalization. Further, those who used the problem-focused coping modes were more likely to be involved in caring for the child, while parents who used emotion-focused coping modes participated less in care activities. Appropriate strategies to bolster coping and reduce stress of parents need to be constantly reassessed because coping mechanisms vary according to parental age, locus of control, anxiety level, and parental involvement in child-care activities. More research is needed in the changes of parental coping mechanisms with time and child-care activity, to assess the benefits of interventions planned to encourage a problem-focused approach.