Effects of the Nd:YAG dental laser on plasma-sprayed and hydroxyapatite-coated titanium dental implants: surface alteration and attempted sterilization.

The Nd:YAG dental laser has been recommended for a number of applications, including the decontamination or sterilization of surfaces of dental implants that are diseased or failing. The effects of laser irradiation in vitro (1) on the surface properties of plasma-sprayed titanium and plasma-sprayed hydroxyapatite-coated titanium dental implants, and (2) on the potential to sterilize those surfaces after contamination with spores of Bacillus subtilis have been examined. Surface effects were examined by scanning electron microscopy, energy dispersive spectroscopy, and x-ray diffraction after laser irradiation at 0.3, 2.0, and 3.0 W using either contact or noncontact handpieces. Controls received no laser irradiation. Melting, loss of porosity, and other surface alterations were observed on both types of implants, even with the lowest power setting. For the sterilization study, both types of implants were first sterilized by exposure to ethylene oxide and then contaminated with spores of B subtilis. After laser irradiation, the implants were transferred to sterile growth medium and incubated. Laser irradiation did not sterilize either type of implant. The spore-contaminated implants in the control group were successfully sterilized with ethylene oxide.


Comparison of stress transmission in the IMZ implant system with polyoxymethylene or titanium intramobile element: a finite element stress analysis.

Using the finite element method, this study modeled a 4.0 x 13.0-mm IMZ implant, restored with a cast gold crown, to examine the influence of the polyoxymethylene (POM) intramobile element (IME) on the transmission of vertical and oblique forces. Stress concentrations in the bone and in components of the implant system were much greater under a 30-degree load than under an equal vertical load. Stress transmission to bone occurred chiefly in the crestal region, and these stresses were not reduced when the IME was modeled in POM rather than in titanium. Maximum stress concentrations occurred in the fastening screw.


Osseointegrated implants in the maxillary tuberosity: report on 45 consecutive patients.

Although the first and second molars usually are lost first in a partially edentulous maxilla, titanium implants are seldom placed more distally than at the second premolar site because of the poor quality of bone often found in the posterior maxilla. The present series encompasses 72 Brånemark implants placed in the third molar-tuberosity area with a success rate of 93% and an average follow-up after loading of 21.4 months. Moreover, two of the failed implants were in patients who had a simultaneous successful implant contralaterally. Keys to this high success rate include the meticulous identification and correction of all pathoses, modification of the drilling sequence to maximize initial implant stabilization, achievement of bicortical fixation whenever possible, gentle handling of the soft tissues and periosteum, and elimination or minimization of transmucosal occlusal loading during osseointegration and of nonaxial loading after connection.


Comparison of impression techniques for a two-implant 15-degree divergent model.

To consistently provide passively fitting implant superstructures, an understanding of the accuracy and precision of all phases of fabrication and connection is required. The initial phase of fabrication, ie, impression making and cast forming, was investigated in an earlier report for a mandibular five-implant model. The current study evaluates the accuracy of working casts produced from impressions using two different transfer copings in a 15-degree divergent two-implant posterior mandibular model. While the indirect method is less cumbersome to use, it was found to be less accurate in the prior study. The purpose of this study was to see if the direct method is more precise for this clinical situation. A transfer was deemed effective in producing experimental casts if distances between specified points on the cast agreed with the corresponding distances on the master cast. The absolute value of the difference in distances between experimental and master casts was compared for the two techniques (two-sample t tests). No significant differences were noted (P > .05), and the power of the tests ranged from 0.70 to 0.96 against the one-sided hypothesis that the direct method had a smaller mean absolute difference in distance than the indirect method. This suggests no clear advantage in using the direct method in similar clinical situations. Comparison of these findings to other impression accuracy studies is made.


Tissue-integrated prosthesis complications.

Over a 78-month period from 1983 to 1990 at the Mayo Clinic, 353 patients involving 407 jaws were restored with 1,778 Brånemark system implants supporting prostheses. Complications involved loss of implant anchorage, soft tissue problems, or mechanical problems. The most predominant complication involved soft tissues. There were 152 patients with loaded prostheses who had no complications and 37 with only one occurrence. Those seen in 160 patients with more than one occurrence were all conservatively managed, so that prosthesis use was only permanently discontinued in 4 patients, who returned to the use of a maxillary complete denture.


A histomorphometric study of unthreaded hydroxyapatite-coated and titanium-coated implants in rabbit bone.

Hydroxyapatite-coated and titanium-coated IMZ dental implants were investigated in an animal study. The implants were placed in the distal femurs of rabbits. Six months after placement, histomorphometric evaluation of the bone-to-implant contact was conducted. The hydroxyapatite-coated specimens demonstrated significantly more direct bone contact compared to the titanium-coated controls.


Histomorphometry of bone apposition around three types of endosseous dental implants.

Three different types of commercially available dental implants (Nobelpharma, IMZ, and Integral) were implanted in the edentulous mandibles of seven adult mongrel dogs. Twenty-one implants were harvested with block sections after 12 weeks and embedded in polymethyl methacrylate resin. Undecalcified sections were prepared with the sectioning-grinding technique. The percentage of bone contacting the implant surface was measured with a self-designed histomorphometry method using a millimeter grid in a stereomicroscope. The results demonstrated a significantly higher percentage of bone along the hydroxyapatite-coated implant than that seen with the titanium-surfaced implant types.


Electron microscopy of bone response to titanium cylindrical screw-type endosseous dental implants.

This study investigated the undecalcified bone and enveloping tissues supporting commercially pure titanium one-stage and two-stage endosseous dental implants placed into the mandibles of adult mongrel dogs. Correlative light microscopy, transmission electron microscopy, and high-voltage transmission electron microscopy demonstrated a dynamic bone interface to the implants. Mineralized tissue was routinely observed within 20 to 50 nm from the implant interface, separated from the implant interface only by an electron-dense deposit. The densely mineralized collagen fiber matrix was oriented parallel to the implant interface, as were osteocytes that were found close to the interface. Osteocytic projections progressed through canaliculi, often directly to the implant interface. Unmineralized areas that appeared to have the potential for mineralization were also identified.


Comparative implant research in dogs: prosthodontic protocol using two-stage ceramic endosseous dental implants.

This report describes one phase of a long-term comparative implant investigation involving 20 of 120 endosseous implants placed in 30 adult mongrel dogs. Fixed prostheses involving 16 of the 20 (4 control implants) two-stage ceramic endosseous implants have been provided using routine prosthodontic procedures and the limited prosthetic components available for the Bioceram Series II implant system. The prostheses have proven to be functional with minimal maintenance. To date, after 1 year of follow-up, 2 of the two-stage implants have exhibited problems caused by fracture of the hexagonal collar. None of the implants to date has been lost and none of the fixed prostheses has required re-cementation or any other type of maintenance other than normal hygiene. Clinical evaluation suggests continued implant and prosthesis serviceability after 1 year in function.


A multicenter study of overdentures supported by Brånemark implants.

Nine clinical centers participated in a prospective study of overdentures supported by Brånemark implants in the maxilla or mandible. The study initially comprised 133 patients provided with 117 implants placed in the maxilla and 393 implants placed in the mandible. The preliminary results indicate a success rate in the mandible comparable with the reports on fixed prostheses. Conversely, overdenture treatment in the maxilla seems to be less favorable than previous reports of fixed restorations. The differences between the fixed and the present overdentures in the maxilla were mainly based on differences in patient selection and bone quality. A total of 32 implants was mobile and removed and another 29 implants were lost to follow-up because of patient dropout up to the first annual checkup after denture placement. A higher implant failure rate occurred in the maxilla. Mucosal reactions were also more unfavorable around implants placed in the maxilla.


A retrospective study of osseointegrated skin-penetrating titanium fixtures used for retaining facial prostheses.

This investigation was conducted to evaluate osseointegrated skin-penetrating facial titanium implants used for anchoring facial prostheses over a 5-year period and to recommend guidelines for the use of osseointegrated implants in the restorative treatment of auricular and orbital defects. The total success rate for implant survival was 95.6% in the auricular defects and 67.2% in the orbital defects. Approximately 10% of the patients will have some skin problems, whereas the remaining 90% will have no or minimal problems. The possibility of achieving osseointegration around an orbital defect is not as good as in the mastoid process. Success criteria for the use of implants in the craniofacial region are given.


Restoration of maxillary residual ridge atrophy using Le Fort I osteotomy with simultaneous endosseous implant placement: technical report.

When residual ridge atrophy of the edentulous mandible and maxilla is accompanied by a skeletal Class III jaw relationship, surgical correction is necessary for optimal functional, phonetic, and esthetic results whenever implant-supported prostheses are to be placed. A method is described in which a single procedure combines the endosseous placement of nonsubmerged titanium implants in appropriate prosthetically predetermined locations with defined advancement of the maxilla. Preoperative diagnostic examinations, cast simulation, and transfer of the latter to the site of surgery are of the utmost importance.


IMZ implants placed into extraction sockets in association with membrane therapy (Gengiflex) and porous hydroxyapatite: a case report.

A buccal plate destroyed by the inflammatory process as a result of a longitudinal root fracture was completely restored by the combined use of an IMZ implant placed in the alveolus of the fractured maxillary central incisor and the principles of guided tissue regeneration. A Gengiflex membrane was used to cover the implant, and porous hydroxyapatite was used as grafting material. At the 6-month reentry, the defect around the implant was completely filled by mineralized tissue.


Reparative bone growth in an extremely atrophied edentulous mandible stimulated by an osseointegrated implant-supported fixed prosthesis: a case report.

This case report demonstrates that severe disuse atrophy of an edentulous mandible can be changed to reparative bone growth through restoration of function and masticatory ability using an osseointegrated implant-supported fixed prosthesis. In 8 years, bone height in the retroforaminal area nearly doubled and a new bony layer remodeled the cranial roof of the mandibular canal.


Role of plasmapheresis in acute disseminated (postinfectious) encephalomyelitis.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating central nervous system disease that is associated with high morbidity and mortality. Although the recognition of ADEM may be facilitated by newer imaging techniques, the optimal treatment of this disease remains uncertain. We describe 4 patients with severe ADEM who responded to treatment that included intensive plasmapheresis. Two of the patients were in coma at the time that plasmapheresis was instituted, and all 4 patients made an excellent recovery. Immunologic studies revealed increased serum IgA levels, increased circulating immune complex levels as measured by the Raji cell assay, and decreased numbers of T and B cells prior to treatment of ADEM. These abnormalities improved following plasma exchange. Plasmapheresis appears to be effective in reversing the neuropathologic process in ADEM. The role of this treatment modality in ADEM requires further evaluation in controlled clinical trials.


Subacute (acute, persistent) thrombotic microangiopathy.

Six patients with prolonged acute courses of thrombotic microangiopathy are reviewed. These patients had in common courses of acute disease requiring plasma support for more than 3 months, with subsequent complete remission. Plasma support requirements may be prodigious, and the acute course may require more than 100 plasma exchanges before a stable remission is achieved. These patients appear to represent a subset of thrombotic microangiopathy distinct from the more common acute T.T.P. course, which resolves in 3-6 weeks, and the chronic relapsing pattern, which may have a short or prolonged acute course.


Evaluation of elutriated single donor platelets collected and stored in a closed system.

Single donor platelets (SDPC) were collected by the elutriation technique in a closed-system integrated with large storage containers. Seven runs of SDPC were stored in a 1.5 liter polyvinyl-chloride trimellitate (PVC-TOTM) storage container, making the ratio of platelet concentrate volume to container volume 1:4.5. An equal volume of pooled multiple donor platelet concentrates (MDPC) was stored in parallel under the same conditions. All haematological data were comparable for both products, except for the degree of leukocyte contamination (5-fold increase in the pool). Under these conditions, the functional, morphological, and metabolic characteristics of elutriated platelets throughout 7-day storage were superior to those of pooled platelets. Although the platelet count was not significantly different in both types of concentrates, the mean pH of pooled MDPC fell to 6.0 on day 5 of storage. Leukocytes were shown to contribute to this pH fall. The extent of cell damage, however, as evidenced by LDH leakage (42.7 LDH units/10(11) platelets/day by differential centrifugation, compared to 5.3 units by elutriation) could not be explained solely on the basis of the leukocyte effect. This indicated that the processing method itself influences the platelet quality. By increasing the surface/volume ratio of SDPC, the initial pH of 7.1 was well maintained throughout storage, platelet metabolic rate was slowed, and the function and ultrastructure improved significantly.


Therapeutic cytoreduction in a 7-month-old baby with acute leukemia.

A 7-month-old girl with acute biphenotypic leukemia [t(4;11)] had accompanying anemia, thrombocytopenia, and a white blood cell count of 535,000/microL with 98% blasts. Before instituting chemotherapy, therapeutic leukapheresis was done to reduce the threat of complications from leukostasis. Using a Cobe Spectra blood cell separator primed with modified blood, we processed 1,395 mL of her blood, removing 201 mL of the buffy coat containing 5.8 x 10(10) white blood cells. This reduced the WBC count to 301,000/microL. Only a single procedure was done, without significant complications. The rationale of this preparatory cytoreduction is discussed critically. Subsequent chemotherapy resulted in a long-lasting remission.


Selective removal of cholesterol by plasmapheresis and the progression of atherosclerosis.

There is a strong correlation of plasma cholesterol levels with the risk of coronary heart diseases as shown by epidemiologic studies. This study was undertaken to evaluate the effect of plasma cholesterol lowering on the progression of atherosclerosis in the homozygous Watanabe heritable hyperlipidemic (WHHL) rabbit. The effect of cholesterol lowering, which was accomplished by thermofiltration (on-line plasma separation with plasma filtration at 39 degrees C) was evaluated by comparison between treated and untreated control groups. Thermofiltration reduced significantly the mean plasma level of total cholesterol (284 vs. 655 mg/dl, P = 0.0005) and the percent aortic area occupied by atherosclerotic plaque (15.0 vs. 44.2%, P = 0.0003). The total lipid and cholesterol contents in the aortas in the treated group were also significantly lower than those in the control group. Microscopically, thickness measurements of the lesions showed that the mean thickness of the fibrous cap and the ratio of the thickness of the intima to that of the media were smaller for the treated group than the control group. This study demonstrated the slowing or stopping of the progression of atherosclerosis by lowering the plasma total cholesterol level in WHHL rabbits.


Collection of peripheral blood mononuclear cells as a byproduct of plateletpheresis with two different blood cell separators.

Peripheral blood mononuclear cells (PBMC) were collected as a byproduct of plateletpheresis of normal blood cell donors using modifications to standard automated protocols on either the CS-3000 or Spectra blood cell separator machine. Comparison of the PBMC products obtained showed X +/- SD WBC yields of 5.3 +/- 3.4 vs. 3.8 +/- 2.0 x 10(9) with the CS-3000 and Spectra, respectively (P < .0001). The majority of the cells were lymphocytes, with 13-15% monocytes with both machines. Sixteen percent of the WBC collected with the Spectra, but only 1% of those collected with the CS-3000, were granulocytes. The CS-3000 PBMC product contained fewer RBC (0.2 +/- 0.1 x 10(11) vs. 2.4 +/- 0.6 x 10(11)) and more platelets (1.6 +/- 0.6 x 10(11) vs. 0.35 +/- 0.39 x 10(11)) in a smaller volume (40 +/- 14 ml vs. 229 +/- 37 ml) than the Spectra products. Comparison of the platelet collections harvested when PBMC were also collected to platelets harvested using standard procedures on the same machine showed no change in platelet, WBC, or RBC yields for the Spectra. A significant increase in mean WBC contamination from 40 +/- 56 x 10(7) to 112 +/- 205 x 10(7) and a small, but statistically insignificant, decrease in platelet yield from 4.1 +/- 1.2 x 10(11) to 3.9 +/- 1.8 x 10(11) was observed in the CS-3000 platelet collections when PBMC were harvested. There was no sustained change in donor lymphocyte counts and no change in acute donor side effects or time requirements when PBMC were collected.(ABSTRACT TRUNCATED AT 250 WORDS)


Folinic acid does not mobilize hemopoietic progenitors following repeated consolidation chemotherapy for acute leukemia.

Folinic acid (FA) has been reported to expand the pool of peripheral blood stem cells (PBSC) after chemotherapy. We evaluated the efficacy of FA for harvesting PBSC following cytotoxic chemotherapy in 4 patients with acute leukemia. After achieving a complete remission (CR), 3 courses of chemotherapy for a consolidation of the CR were administered to the patients. Two successive cycles of leukapheresis were performed during the recovery phase from consolidation chemotherapy, which consisted of an intermediate dose of cytosine arabinoside. For the second cycle of leukapheresis, FA was administered intravenously at a dose of 50 mg/day following consolidation. The yields of either mononuclear cells or burst-forming units-erythroid (BFU-E) were not affected by FA administration. In contrast, the yields of colony-forming units-granulocyte/macrophage (CFU-GM) were significantly decreased in all patients compared to the CFU-GM yields after the first cycle of leukapheresis (P = 0.032). Thus FA is considered not to be effective in expanding the peripheral blood progenitor pool when given in a fashion different from the original report.


[Conversion laparatomies during cholecystectomies under laparoscopy. Apropos of 285 consecutive cholecystectomies].

Retrospective analysis of a consecutive series of 285 cholecystectomies carried out by laparoscopy showed that 47 patients (17.5%) required conversion laparotomy. In 55% of these cases the conversion was due to difficulty in dissecting the gallbladder or cystic duct. Peri-operative cholangiography should be performed routinely, not only to verify the vacuity of the common bile duct (13% of the conversions) but, more particularly, to ensure the integrity of the principal biliary pathway during the dissection (8.5% of the conversions). Cholecystectomy under celioscopy is a proven and safe technique, on the condition that all stages of classical surgery can be carried out under good conditions.


[Aimed fistulization in spontaneous ruptures of the thoracic esophagus after delayed diagnosis. Apropos of 4 cases].

Of four cases of spontaneous rupture of thoracic esophagus treated, three were the object of direct fistulization on a Kehr's drain because of the delay in diagnosis. This technique remains valid since it provides satisfactory drainage without excluding the focus, reduces the time of hospital care when compared with that for simple suturing, and appears preferable to methods of esophageal exclusion which often require a secondary surgical procedure.


[Restoration of colonic continuity after Hartmann's operation].

A retrospective analysis of data from 69 patients treated by Hartmann's operation between 1981 and 1991 determined prognostic factors for colon continuity re-establishment and the mortality of this second intervention. The 15 patients who died during the first month after the Hartmann's operation were excluded from the study, the 54 survivors including 32 men and 22 women, mean age 68 +/- 12 years (range 19 to 87 years). The initial indication for surgery was: complicated sigmoid diverticulis (n = 26), cancer of colon (n = 14) or other site (n = 14). Colon continuity was re-established in 23 patients (42.6%), including 15 men and 8 women, mean age 60 +/- 10 years (range 38 to 78 years). In this latter group, 82.6% of the patients were under 70 years of age, indicative of a significant effect of age (p < 0.001) on re-establishment of continuity. Secondary anastomosis was obtained in 65.4% of cases of complicated sigmoid diverticulitis, whereas re-establishment of continuity was possible in only 7.1% of colon cancer patients (p < 0.001). The mean duration prior to re-establishment was 4.8 +/- 1.6 months (range 2.5 to 9 months). Morbidity was high (47.8%) and mortality 4.3% (1 patient). Hartmann's operation remains indicated for stages III and IV of complicated sigmoid diverticulosis, as well as for other benign affections (volvulus of sigmoid, perforation of sigmoid following injury), although it must be recognized that the possibilities of re-establishment are limited more in elderly patients and that fewer patients with colon cancer can benefit from the procedure. A period of 3 to 4 months appears sufficient to allow healing of the inflammatory phenomena of the initial operation, without the development of excessive retraction of the rectal stump.


[Volvulus of the colon. Apropos of 37 cases].

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.


[Peritoneal dialysis catheters. Immediate outcome after 30 days].

Results of a retrospective study of 124 peritoneal dialysis catheters introduced in 74 patients from October 1982 to November 1991 showed that 91% of catheters were functional at 30 day follow up, allowing continuous ambulatory peritoneal dialysis to proceed under satisfactory conditions. However, surgical replacement was necessary in 21.81% (26 catheters) during the first month, due essentially to mechanical complications: exteriorized or non exteriorized leaks (7 cases), dysfunction with faulty perfusion or emptying (11 cases) and catheter displacement (3 cases). Five catheters (4.25%) had to be withdrawn because of infection, suggestive of the need for prophylactic antibiotic therapy. No determining factor could be found in the present series or in the literature to explain the genesis of these mechanical complications, the cause of which is without doubt multifactorial. Rapid surgical replacement allows functional survival of the majority of catheters without increasing the risk of infection.


[Acute chyloperitoneum].

A patient presenting with the symptomatology of an appendicular syndrome was later diagnosed as having an acute chylous ascites. The etiology was an acute edematous pancreatitis, the anatomy of the lymphatic pathways with the proximity of the pancreas explaining this etiology, as well as the possibility of a pancreatitis secondary to obstruction of the thoracic duct. The early post-operative clinical course was marked by an acute occlusion of small intestine on the 15th day, related to the adherence potency of the chyle. A general review of the acute chylous ascites syndrome showed the prognosis to be generally favorable, with a mortality of 4%, in contrast to the 40% mortality reported for the chronic chylous ascites of adults.


[Perineal hernia after abdominoperineal amputation. Role of epiploplasty and/or irradiation].

Healing of the perineal wound after abdominoperineal amputation is a difficult technical problem for surgeons to resolve. The majority of current therapeutic protocols include pre- or post-operative radiotherapy, and most study results show a reduction in perineal relapses when compared with a control group, but at the price of delayed healing of the perineal wound. This delayed healing reaction varies with the radiation dose. The use of epiploplasty shortens the healing period, but when performed after pre-operative radiotherapy it can predispose to the development of a perineal hernia. Four cases of this complication are described. No standard procedure for treatment of these hernias exists, and although it is possible to use the uterus to fill the perineal cavity, the most effective method appears to be a double perineal and abdominal pathway using a plate.


[Splenic pregnancy. Apropos of a case].

Still nowadays the extrauterine pregnancy causes the 10% of maternal deaths, also in the most developed countries. The splenic localization is really exceptional. The authors of this article describe a case they have studied, by drawing the attention on the criteria followed in order to obtain an early and correct diagnosis for a reduced mortality rate.


[Acute biliary and alcoholic pancreatitis: two different diseases?].

An analysis of 174 patients with an acute biliary or alcoholic pancreatitis who were admitted to the Surgical University Clinic Mannheim from 1986 until 1989 showed significant differences in the course of the disease and surgical treatment. 77.2% of our patients with an acute alcoholic pancreatitis were men. Mean age of all patients was 45.7 years. 72.3% of our patients had a mild pancreatitis and 27.7% a necrotising pancreatitis. In 26.8% of the patients an operation was necessary (necrosectomy, lavage of the lesser sac). In 35% of these patients occurred complications. Total lethality was 9.9% (mild pancreatitis: 0%, severe pancreatitis: 17.6% and total necrosis of the pancreas: 63.6%). 58.9% of our patients with an acute biliary pancreatitis were women. Mean age of all patients was 62.4 years. In 50% of all cases an operation was necessary (in most cases cholecystectomy and extraction of a prepapillary concrement but also necrosectomy and lavage of the lesser sac). In 17% of these patients occurred complications. Total lethality was 11.0% (mild pancreatitis: 0%, severe pancreatitis 8.3% and total necrosis: 77.7%). The conclusion is a surgical therapy depending of the cause of the pancreatitis and also a different prognosis of the disease.


[Measuring visual field loss by automated perimetry in chronic glaucoma stabilized by trabeculectomy].

The progression of field loss was determined by Humphrey Automated threshold perimetry in the short and intermediate term after surgical trabeculectomy for chronic glaucoma: mean indices (MD, PSD et FOV) were studied before and after normalisation of the intraocular pressure. Risk factors such as secondary glaucoma, previous visual field defects and cardiovascular risk factors were significantly correlated to poor or bad progression of field loss: the mean variation of MD = +1.23 dB +/- 2.84 (p < 1.5%), the mean variation of PSD = 0.50 dB +/- 1.37 (p < 6%), but the mean variation of FOV was not significant; so 36% of field defects were improved, 42% were stabilized and 22% were aggravated. When the risk factors were absent, 86% of field losses were stabilised but when cardiovascular factors were present, only 64% were stabilised. These risk factors can also be used to ascertain the prognosis of post-surgical progression of visual field, as already shown in previous reports. Automated threshold perimetry was useful to study the visual field progression with standardized and reliable numerical parameters, allowing statistical computerised management of the patients with glaucoma.


[Surgery of idiopathic epimacular membranes. Prognostic factors].

Seventy consecutive cases of idiopathic epimacular membrane removal were reviewed in order to evaluate the prognosis factors of this surgery. The characteristics analyzed where the duration of the symptoms, pre and postoperative visual acuity and the macular changes on fluorescein angiography. The mean follow-up after surgery was 9 months. Mean preoperative visual acuity was 0.17 and the mean best postoperative visual acuity 0.43. Visual acuity improved by 2 lines or more in 81% of the cases and the mean improvement was 3.5 lines. The complications of epimacular membrane surgery included nuclear cataract (10 eyes underwent cataract surgery), peripheral retinal breaks (3%), and retinal detachment (3%) successfully operated. Three of the main preoperative data were related to better postoperative visual outcome: preoperative visual acuity: eyes with visual acuity of 0.16 or more tended to have better postoperative vision than eyes with poorer preoperative vision (mean postoperative visual acuity 0.5 and 0.34 respectively; p < or = 0.05); duration of visual impairment before surgery: eyes with a visual impairment of less than 2 years had better postoperative vision than the others (mean postoperative visual acuity, 0.5 and 0.3 respectively; p < or = 0.05); the absence of preoperative angiographic macular edema: eyes without preoperative macular edema had better postoperative vision than the others (mean postoperative visual acuity: 0.5 and 0.4 respectively; p < or = 0.05). The normal postoperative pattern of macular vessels and foveolar shape was also a statistically significant factor of good vision recovery.


[Bacterial endophthalmitis. Ophthalmological results of a national multicenter prospective survey].

Under the aegis of the GEEP (Groupement d'Etudes Epidémiologiques et Prophylactiques) a prospective multicentre study concerning bacterial endophthalmitis was carried out over a period of one year long with the contribution of 64 metropolitan ophthalmologic hospital departments. During this survey 143 cases of post surgical endophthalmitis were recorded: 111 of them were secondary to elective surgery, 32 developed after a perforating eye injury. Twenty-four cases of endophthalmitis developed in the absence of surgery were therefore called "medical" endophthalmitis. The frequency of endophthalmitis after elective surgery was 0.32%, and 2.8% after penetrating eye injury. Intraocular samples were obtained in 61.5% of the cases of post surgical endophthalmitis. 53 bacteria were isolated from 50 cases of endophthalmitis. The bacterial nature of the endophthalmitis was proved in 35% of these cases of post surgical endophthalmitis. Bacteria isolated from these cases of post surgical endophthalmitis were gram positive in 86.7%, and gram negative in 13.3% of cases. 20 bacteria were isolated from pseudophakic eyes: 10 of them were Staphylococcus epidermidis. The visual prognosis of endophthalmitis depends on the strain: visual acuity was more than 1/10 in 68% of cases of Staphylococcus endophthalmitis infection, but in only in 7% of cases of Streptococcus endophthalmitis infection. Intraocular injections of antibiotics both in the anterior chamber and in the vitreous, and vitrectomy increased the quality of the visual result. Three months after post surgical endophthalmitis, 35% of those eyes who received systemic and periocular antibiotic therapy, combined with intraocular antibiotics, with or without vitrectomy, recovered a visual acuity of 4/10 or more, instead of only 18% in the group without any intraocular therapy.


[Conjunctival myiasis, a frequent pathology in Corsica].

Fifteen cases have been reported and treated in the Ajaccio eye department. The larva involved is most of the time Oestrus ovis and is responsible for an acute unilateral conjunctivitis. The conjunctiva is swollen and scattered with petechiae due to the hooks of the larva. Five to 15 maggots are extracted with a forceps after instillation of topical anesthetic, leading to relief of symptoms within a few days.


The United States: breakthroughs and waste.

The health system of the United States is in a paradoxical position. At its best, the system is a magnet for those seeking the latest technical breakthroughs. It can offer that excellence because there have never been effective financial constraints on the imagination; the system has become a major economic frontier, at which professional and other entrepreneurs successfully seek their fortune. At the same time, the system is leaving increasing numbers of Americans frustrated and disillusioned. It is beset by excess capacity in many areas, is needlessly expensive, and often bestows unnecessary health services. Yet only the experts are aware of these flaws; most Americans still express high satisfaction with the quality of the services they receive from their doctors and hospitals. The public's major misgivings arise over the awkward and inequitable way in which American health care is financed. The typical private health insurance policy, for example, is tied to a particular job. If the job is lost, so is the health insurance. Furthermore, these policies are priced on actuarially "fair" principles, so sick individuals are forced to pay higher insurance premiums than relatively healthy ones and chronically ill persons often cannot obtain health insurance coverage at any price. Although there are public programs to catch many persons not privately insured, the coverage tends to be insufficiently extensive and deep. Some 35 million Americans, mostly poor, have no health insurance whatsoever. Unfortunately, at this time there is no political force in the United States strong enough to reform the American health system toward greater social equity and economic efficiency, whereas there are numerous groups powerful enough to block whatever reform might harm their own narrow economic interests. Other nations can learn from America's clinical and organizational innovations in health care delivery. They can also learn what not to do by studying the unseemly way in which American health care is financed.


The United Kingdom: effective, efficient, equitable?

The British National Health Service (NHS) has, since its inception, aimed to make health care available to all regardless of income, and it has managed to achieve this goal while keeping costs lower as a proportion of the gross domestic product than many Western countries and at the same time assuring equitable distribution of resources regionally. Until the reforms introduced by the 1989 White Paper, the NHS was characterized by centralized financing and regulation; despite some problems in the delivery and management of care, the system was a popular one. The new reforms hope to enhance efficiency in the NHS by stimulating competition and further decentralizing the management of health care. However, it is not at all certain that in practice the reforms will have the desired effect. Initial costs will be high, people may not respond to incentives as predicted, and the quality of care and access to it could well deteriorate. Nations planning to use the U.K. system as a model are advised to use caution.


Japan: maintaining equity through regulated fees.

Japan was the first non-Western country to introduce social insurance and the first to achieve universal coverage. It has been very successful in helping to bring about high health levels among its citizens at reasonable cost. Consequently, it provides a unique model for the newly industrialized countries of how to adapt modern technologies in structuring their own health care systems. Japan's financing system is organized by the government. Coverage is mandated for all citizens and is supplied by a number of insurance plans, whose variety reflects the differences in their development. The country relies mainly on the private provision of health care, delivered from physician-owned clinics and hospitals. The most prestigious facilities, however, are the public hospitals. Services are fragmented between clinics and hospitals, which compete for a share of the patients in their area. Patients can choose where to seek medical services. Providers are paid by a nationally uniform method and rate, which are decided by one central agency. Increases in payment rates are tied to the ceiling set by the government's general expenditure limitations. A uniform fee schedule has helped to control costs and to ensure equitable access. Challenges remaining for Japan's health care system are caring for an increasingly elderly population and ensuring quality of care.


Germany: solidarity at a price.

The health care system of the Federal Republic of Germany relies on the private sector for the financing, delivery, and payment of care. However, the private sector is regulated by the government to ensure that broad societal interests are being fulfilled. The system has managed to achieve comprehensive coverage and equal access for all citizens, freedom of choice for patients, high-quality medical care, and cost containment. The reason for this success is a combination of decentralized power and decision making and the establishment of an effective negotiation system that takes place at federal, state, and local levels. The system suffers from some problems, however, which will have to be addressed: the present structuring of hospital and ambulatory care results in excessively long lengths of stay in hospital; drugs are overprescribed; the supply of health professionals does not meet the country's needs; more nursing homes are needed; and eastern Germany must be fully integrated into the system.


Canada: the real issues.

Canadians are, by and large, satisfied with their health care system. It is for them a symbol of their community and distinguishes them from the United States. Unlike the health system of that country, it is universal, comprehensive, and accessible, and it costs less as a percentage of GNP to run. The difference between the two systems is rooted in differences in funding. By providing coverage of medically necessary care under a single nonprofit payer (the provincial governments, with guidance and some funds from the federal government), the Canadian system avoids the large overheads and profit incentives that make a fragmented private insurance industry so expensive and inequitable. Whereas health insurance in Canada is socialized, care is not: patients are free to choose among providers, physicians are primarily in private practice, and hospitals are independent, nonprofit institutions overseen by boards of trustees. Canada and the United States view the challenges confronting the Canadian system differently. To Canadians, the real issue is how to improve the management of a popular, effective, and heretofore affordable system, so as to preserve it in a more hostile economic environment. The specific areas of concern are common to all health care systems in the developed world but bear little resemblance to the misleading images of Canada fabricated in the United States for internal political purposes. For Canadians, the proof of their system is that it works, while millions in the United States go without.


On being old and sick: the burden of health care for the elderly in Canada and the United States.

The debate over health care reform in the United States has drawn Canada under the microscope. Canada's health care system is frequently offered as a model for American national health insurance. Curiously absent from this policy discussion is any talk about the relative out-of-pocket costs of alternative models. In this paper, we provide data on these costs for American and Canadian elderly for medical, hospital, and ambulatory pharmaceutical use. Despite the fact that the elderly in America are generally viewed as facing fewer problems with access and out-of-pocket costs than younger Americans, their direct costs far exceed those of their Canadian counterparts. We also present data suggesting that, despite these greater costs, rates of growth in use of these services by American elderly have followed roughly the same pattern as those found in Canada. If Uncle Sam retired north of the border, being old and sick would also mean being wealthier and happier.


Private outlets for public limitations: the rise of commercial health insurance in Israel.

In recent years, dissatisfaction with aspects of the Israeli health care system has grown. Labor conflict and unrest, long waits for elective surgery, increases in out-of-pocket payments for health care, and declining government investment have given rise to a new phenomenon: the increasing use of private services. This has led consumers to seek financing sources for their private care and created opportunities for commercial insurers and sick funds to offer new insurance packages to meet this demand. As a result, over the last five years more than twenty commercial health policies and four mandatory supplemental policies provided by the sick funds are currently on the market. The market for these policies is small but growing, with consequences for the cost and quality of care, access, the level and composition of national expenditures, and the allocation of resources to both the public and private health systems. As the balance between private and public financing changes, so too do the trade-offs between differing objectives. Greater private pluralism and competition at the financing level have many advantages but also make it more difficult for government to manage the tradeoffs that occur. Thus, a changed emphasis in government regulation and policy-making is required.


Health policy regimes and the single European market.

I examine the potential effects of the creation of a single European market on the health policy regimes of the twelve member states of the European Community (EC), arguing that few changes can be expected in the basic nature of those regimes and that a Community-wide health policy regime is unlikely to emerge in the near future. Domestic health policy regimes and care systems will remain the dominant approach to health care delivery, and it is not likely that the American approach will be adopted. However, EC legislation designed to create favorable trade, economic, and fiscal conditions may affect key industries like pharmaceuticals and health insurance, with consequences for national health policy regimes. Patterns in Community-wide policy-making suggest that it will become increasingly difficult to define health issues in purely domestic or international terms.


Pharmaceutical regulation in the European Community: barriers to single market integration.

The European Community (EC) plans to create a single market for pharmaceutical medicines, but the drug industry is closely linked to cultural and societal values concerning health; to the national regulatory agencies responsible for the evaluation of safety, quality, and efficacy of new drugs; to multinational and domestic companies competing in national and international markets; and to varied interest groups of professionals and consumers organized along national and multinational lines. We review the history of the EC's policy proposals, examine reactions from all these interested parties, and assess the prospects for integration into a single market. The contentious debate that continues among the parties over national prerogatives, industrial interests, professional mandates, and consumer concerns clouds the prospects for a system of centralized drug registration that will be acceptable to all EC member states.


Home care in old age: a lost cause?

I consider policy trends and the provision of home care for frail elderly people in four countries: Denmark, the United Kingdom, Germany, and the United States. The differing natures of the health and social services systems of each country and the welfare ideologies that underlie them have affected the expansion of home care for this group of people. Hence, Denmark--and to a lesser extent Britain--has relatively well developed networks of home care services, in contrast to Germany and the United States. However, any significant shift away from predominantly medical and institutional care to more home-based, social care is highly unlikely.


Falling through the cracks: care of the chronically mentally ill in the United States, Germany, and the United Kingdom.

In comparing the development and strength of community-based services for the chronically mentally ill in the United States, Germany, and the United Kingdom, I analyze how the structure of each country's general medical system has influenced services for the chronically mentally ill and the extent to which more universal medical care systems are associated with stronger community-based systems for the mentally ill. Community-based services are frail and inadequate in all three countries, in each country for different reasons. The specifics of organization of the health care system seem less important in shaping these outcomes than the status of mental health care as a national priority.


Residential care for the elderly.

This article maps variations in a standardized way in residential care for elderly people in three Western nations. Measured by the number of available places per person aged sixty-five and over and by the number of staff members per bed in nursing homes, the United Kingdom has the most highly developed standards. The United States ranks second, with Germany lagging considerably behind. The variations are explained by four variables: the pressure of the problem, as defined by the percentage of the population aged sixty-five and over; the caretaker potential in the family system, which alleviates this pressure; the structure and financing of the supply of residential care; and decision-making procedures in health care policy-making. My analysis emphasizes the last two variables. In the United Kingdom and the United States, the public and private providers who supply care have either political or market incentives to expand their services. Germany's mix of public and private, by contrast, is dominated by voluntary associations that are neither responsible to an electorate nor allowed to make profits. Thus, their clients do not have opportunities to articulate their needs. Health care decision making in Germany takes place through a collective bargaining process between the sickness funds and the providers. In such a system, the interests of groups who are not represented at the negotiation table--such as the elderly--tend to be neglected. A national health system of the British type links political decision makers via the election mechanism more closely to the concerns of the public. As older people represent growing proportions of the electorate, their needs find more adequate consideration in the policy process. In the United States, political officeholders also have to pay attention to the needs of increasingly organized older people, since the tax-financed and federally regulated Medicaid system is largely responsible for financing long-term care for the elderly.


Matters of fact: establishing a gay and lesbian studies department.

This article describes the establishment and operation of the first Gay and Lesbian Studies Department in the United States. The evolution of instructional services, administrative and student services, and various aspects of institutionalization are discussed. Short statements by two faculty members of the new Department follow the main article.


Gay and lesbian studies in The Netherlands.

Gay and Lesbian Studies have been rather successful on an institutional level at Dutch universities. The article discusses the social and scholarly backgrounds of this development, the work being done, and the social reception of gay and lesbian studies. The deployment of gay and lesbian studies was possible thanks to the democratic structure of Dutch universities, and to a general acceptance of the aims of gay and lesbian emancipation in Dutch society. The article delineates also the limitations of the Dutch situation, in terms of the "cordon sanitaire" or minority perspective in which gays and lesbians seem to become enclosed. Also, the future perspectives of gay and lesbian studies are discussed.


Lesbian studies emerging in Canada.

This paper provides an overview of Lesbian Studies in Canada historically and currently. The methodology integrates the factual with personal accounts and perceptions. The first sections touch upon theoretical aspects, including: what is Lesbian Studies, the pros and cons of merging Lesbian and Gay, or Lesbian and Women's Studies, mainstreaming versus creating a separate discipline and the threat of cooptation. A brief historical account traces evidence of Lesbian Studies in antiquity, and in the United States and Europe in recent decades. Reports from various Canadian institutions discuss the extent or lack of Lesbian Studies to date. A section on francophone institutions outlines the grass-roots cultural and political pinnings which are necessary to making Lesbian Studies possible in the academy. The paper then focuses on the Lesbian Studies Coalition of Concordia (Montreal), a student group which has struggled for the first series of Lesbian Studies credit courses in Canada.


History's future: reflections on lesbian and gay history in the community.

From its beginnings in the nineteenth century, the lesbian and gay political movement has been linked to a search for lesbian and gay history. In the post-Stonewall period, community-based historians have been fostering interest in the lesbian and gay past and developing distinctive forms for disseminating their research--in particular, the lesbian/gay archive, the slide-lecture presentation, and the community-based audience. Analyzing the content of these forms reveals how the fascination of the artifact, the image, and the Other fosters the construction of both knowledge and identity. It is these forms of knowledge, rather than their content as such, that are in danger of being forgotten as lesbian and gay studies becomes academically institutionalized.


Homosexual, gay, and lesbian: defining the words and sampling the populations.

The lack of both specificity and consensus about definitions for homosexual, homosexuality, gay, and lesbian are first shown to confound comparative research and cumulative understanding because criteria for inclusion within the subject populations are often not consistent. The Description section examines sociolinguistic variables which determine patterns of preferred choice of terminology, and considers how these might impact gay and lesbian studies. Attitudes and style are found to influence word choice. These results are used in the second section to devise recommended definitional limits which would satisfy both communication needs and methodological purposes, especially those of sampling.


Deconstruction, lesbian and gay studies, and interdisciplinary work: theoretical, political, and institutional strategies.

The problematic of cultural self-representation is examined in light of the development of lesbian and gay studies. The issues are examined through the lens of deconstruction as theoretical and political strategy. This examination suggests the value of interventionist work, and seeks to articulate an understanding of interdisciplinary work as exemplary of such an interventionist practice and politic. Relevant theoretical and political implications are explored, most especially in terms of the future developments of lesbian and gay studies.


The mark of sexual preference in the interpretation of texts: preface to a homosexual reading.

Since reading is an interaction or confrontation between the reader and the text--an interaction that depends upon the background and perspectives of the reader as well as on the text being read--we can assume that the dynamics of sexuality and sexual object choice will influence how readers ascribe meaning to literary texts. In fact, although other aspects of our identities come into play when we read, sexual identity is unique and central because of the role that it plays in the creation of subjectivity. Specifically, male homosexuality informs and structures the reading of texts. But what does it mean to be a homosexual reader or to effectuate a homosexual reading of a particular text?


Generations and paradigms: mainstreams in lesbian and gay studies.

The development of lesbian and gay studies is traced from the Stonewell period of the late sixties and early seventies to the present. The effort to establish lesbian and gay studies has brought together several generations of scholars who have produced a variety of conceptual worldviews. These generational mainstreams of thought in lesbian and gay studies include the search for authenticity (1969-1976), the social construction of identity (1976-present), essential identity (1975-present), difference and race (1979-present), and cultural studies (1985-present).


Teaching homosexual literature as a "subversive" act.

If taught in a way that exposes students extensively and closely to its texts, homosexual literature can "subvert" the long-standing cultural notion that homosexuality is and should remain "unspeakable" and "untouchable." The author's working methods and materials in his gay and lesbian literature courses at the New School for Social Research, where he has been teaching the subject since 1979, are organized according to those principles. His courses also have a secondary "subversiveness" in the present academic climate, in implicitly dissenting from the dominant "new-inventionist" trend in gay studies now.


Relapses in multibacillary leprosy patients after stopping treatment with rifampin-containing combined regimens. Marchoux Chemotherapy Study Group.

During the decade between the mid 1970s and the mid-1980s, 12 rifampin (RMP)-containing combined regimens were tested among lepromatous leprosy patients in the Institut Marchoux. The 384 patients who were seen at least once during the period beginning 12 months after completion of treatment were considered eligible for analysis of the relapse rate. By the end of May 1991, relapse, manifested by a significant increase of the bacterial index (BI) and the appearance of new lesions with a BI greater than that of preexisting lesions, had been observed in 68 (17.7%) of these patients. Relapse was confirmed by the presence of viable Mycobacterium leprae in skin biopsy specimens obtained from 54 of the first 61 cases; virtually all of the isolated strains remained susceptible to RMP. The relapses occurred late, about 5 +/- 2 years after stopping treatment; the shorter the duration of RMP administration, the earlier the appearance of the relapse. The variations of the relapse rate among regimens were considerable: total relapse rate ranged from 2.9% to 27.8%, and the relapse rate per 100 patient-years of observation ranged from 0.8 to 6.9. Among the 12 regimens, only the WHO/MDT yielded an acceptable relapse rate (defined as a rate lower than 1.0 per 100 patient-years). However, because the mean duration of follow up was shortest among the patients treated with WHO/MDT, the relative low relapse rate among these patients must be interpreted with great caution.


Does isoniazid increase the hepatotoxicity of the combination prothionamide-dapsone? Isoprodian Study Group.

In order to assess the potential additive liver toxicity of isoniazid to that of a thioamide-containing treatment, a prospective, randomized, double-blind trial of 24 weeks' duration involving 772 adult patients was conducted in four leprosy centers--two in India, one in Madagascar, and one in the Ivory Coast. Patients with multibacillary leprosy were given daily 100 mg dapsone (DDS) and 350 mg prothionamide (PTH) plus monthly 600 mg rifampin (RMP) in combination either with 350 mg isoniazid (INH) or with a placebo. After clinical and laboratory (including HBs-Ag testing) examinations on admission, the side effects (especially gastrointestinal disturbances and liver toxicity) were assessed at regular intervals during treatment by laboratory testing (aminotransferases, bilirubin, alkaline phosphatase) and by recording spontaneous complaints. Analysis of the frequency and seriousness of the side effects was made before breaking the code (with or without INH). Although 10% of the patients had liver toxicity leading to stopping treatment, no significant difference in the occurrence of side effects was observed between patients treated with or without INH. Most (75%) of the observed side effects occurred during the first 4 weeks of treatment, and the time of their onset was not related to INH. Body weight and age were factors related to the frequency of side effects [the higher the body weight, the lesser the rate of side effects (p = 0.03)] and the rate of serious side effects increased with age (p = 0.02). But, again, the frequency of the side effects was not related to INH administration. Therefore, from the present study it can be concluded that INH does not increase the toxicity of the thioamide-containing treatment.


Short-term trial of clofazimine in previously untreated lepromatous leprosy.

Forty-five previously untreated lepromatous leprosy patients were allocated randomly to three groups and treated, respectively, with Regimen A, standard dosage of clofazimine (CLO) in multidrug therapy (MDT) regimen; Regimen B, CLO 600 mg once every 4 weeks; and Regimen C, CLO 1200 mg once every 4 weeks. The duration of the trial was 24 weeks. By the end of the trial, although a few patients in each group did not improve at all clinically, the majority of patients showed clinical amelioration but the responses were slow. While the mean morphological index dropped to the baseline after 24 weeks of treatment, the mean bacterial index did not change significantly. About 80% of the patients in each group remained nasal-smear positive at the end of the trial, but the bacterial loads steadily declined. No significant difference has been detected in these parameters among the three groups. The patients tolerated the regimens very well and the side effects were mild. The results of serial mouse foot pad inoculation demonstrated that the positivity rates of multiplication of Mycobacterium leprae in mice and the proportions of viable organisms reduced gradually in all groups. Because the positivity rate at week 24 in Group C did not differ significantly from Group A, but was significantly smaller than that of Group B, we conclude that Regimen C was as active as Regimen A and could be applied for monthly supervised treatment along with rifampin; Regimen B is less effective and should not be used for the treatment of leprosy.


A rapid and sensitive high performance liquid chromatographic analysis of clofazimine in plasma.

The high performance liquid chromatographic (HPLC) method of Gidoh, et al. has been modified substantially to provide a simple, rapid, and relatively inexpensive procedure for measuring clofazimine in plasma. The modification involves the use of commonly available laboratory reagents instead of custom-made ones. It also employs a solid phase system for efficient extraction instead of the conventional, less efficient and more labor intensive, liquid-liquid extraction. The inclusion of an internal standard (salicylic acid) improves the precision and reproducibility. It is demonstrated that the method can be used to monitor in vivo clofazimine levels as may be required in formal pharmacokinetic studies or therapeutic drug monitoring.


Suppressive effect of circulating immune complexes from leprosy patients on the lymphocyte proliferation induced by M. leprae antigens in healthy responders.

The effect of circulating immune complexes, isolated in the form of polyethylene glycol (PEG) precipitates from leprosy patients, on lymphocyte proliferation was studied. The results obtained showed that PEG precipitates obtained from the borderline lepromatous/lepromatous (BL/LL) types of leprosy patients and those undergoing erythema nodosum leprosum (ENL) had significant suppressive effects on the lymphocyte proliferation induced by Mycobacterium leprae antigens in healthy responders. The percent decreases in the mean values of delta cpm in the presence of PEG precipitates from the BL/LL and ENL groups were found to be 46.8 +/- 22.4 and 65.0 +/- 24.3, respectively. However, no significant suppressive effects (except for ENL PEG precipitates) of these PEG precipitates were observed on the lymphocyte proliferation induced by tuberculin (PPD). Further, PEG precipitates alone (in the absence of M. leprae antigen) from the BL/LL and ENL groups were found to have no effect on the lymphocyte proliferation.


Use of a different buffer system in the phenolic glycolipid-I ELISA.

By changing the buffer system in the phenolic glycolipid-I (PGL-I) enzyme-linked immunosorbent assay (ELISA) the sensitivity of the test was increased without altering its specificity. Using a Tris-HCl buffer, significant titers of > or = 1:300 were found in 53.1% of the sera in paucibacillary (PB) and 98.0% of the sera in multibacillary (MB) groups of patients. Titer levels were also significantly increased. In the PB group of patients with Tris-HCl, the highest titer detected was 1:1200; in the MB group of patients, 1:76,800. Through this modification of the buffer system a more sensitive test was obtained thereby increasing the detectable level of PGL-I antibodies in both the PB and MB groups of patients.


Microtiter particle agglutination test for diagnosis of leprosy.

The results of studying the microtiter particle agglutination (MPA) test for detecting anti-Mycobacterium leprae antibodies in blood sera are presented. The serodiagnostic test is based on the agglutination of colored polyacrolein latex microparticles (PAMP) conjugated with 3,6-di-O-methyl-D-glucose (DMG). Sera from 45 leprosy patients (LL, BL), 34 leprosy contacts, and 148 control subjects were investigated by the MPA test. A correlation between the anti-M. leprae antibodies and the bacterial load was found. In many long-treated leprosy patients increased titers of anti-DMG antibodies were observed, which might be due to specific polyneuritis in them. Four contacts of leprosy patients were also positive in the MPA test. "Nonleprosy" sera did not react in the test. The method proposed proved to be of high specificity and sensitivity for the serological diagnosis of leprosy. The rapidity, simplicity, and visual assessment of the results allow the method to be used in the field for epidemiological studies of leprosy contacts and the general population in leprosy-endemic areas.


Cold fingers in leprosy.

Under conditions of maximal thermoregulatory peripheral dilatation, most healthy subjects (both Indian and European) showed raised blood flow in the fingertips (measured by laser Doppler flowmetry) where the skin temperature is only slightly lower than the core body temperature. Most borderline lepromatous (BL) leprosy patients had much colder fingers and the blood flow was slow: borderline tuberculoid (BT) patients had skin temperatures similar to those seen in healthy subjects, but their fingertip blood flow was reduced relative to that in control subjects. The occurrence of cold fingers and slow blood flow was clearly associated with evidence of sensory impairment to light touch, pressure and temperature. Slower fingertip blood flow was strongly associated with impairment of vasomotor control in this anatomical region, suggesting that both may be a consequence of leprosy peripheral neuropathy, at least in patients with early leprosy, but it is likely that leprosy arteriopathy may contribute to the lowered peripheral perfusion in advanced cases. It is suggested that the simple clinical sign of cold fingers may be of value in the preliminary assessment of patients presenting at any leprosy control clinic in the tropics.


Erythema nodosum leprosum: a possible cause of oral destruction in leprosy.

Apart from vague statements and speculative remarks, the role of ENL in the oral cavity has not been considered in the recent English language literature. A case of oral ENL is reported, and we postulate that ENL plays a prominent role in the intra-oral destruction noted in leprosy. Information gathered from the literature and from our own experience with a series of 37 leprosy patients with oral lesions support this postulation.


Clinical impact of magnetic resonance imaging in foot osteomyelitis.

The impact of magnetic resonance imaging (MRI) on the clinical management of patients with foot inflammation and suspected osteomyelitis was evaluated in 44 patients with 47 foot MRI exams. Twenty-nine patients were diabetic. Bone biopsy or bone culture was obtained in 34 patients, and routine radiographs and bone scan studies were available in most patients for comparison. Magnetic resonance imaging showed reliable identification of bone infection with a sensitivity of 100% and specificity of 95%. Plain radiographs were inaccurate and, as expected, bone scans were highly sensitive (90%) but not specific (33%). The high accuracy of MRI allowed for better identification of patients with osteomyelitis and, therefore, improved targeting of potential operative candidates.


Metatarsus adductus and selected radiographic measurements of the first ray in normal feet.

Radiographic evaluation of hallux abducto valgus frequently involves the measurement of the metatarsus adductus angle, first-second intermetatarsal angle, hallux abductus angle, and proximal articular set angle. While the concept that there is a relationship between untreated metatarsus adductus and hallux abducto valgus deformity is not new, a quantifiable relationship between the metatarsus adductus angle and intermetatarsal angle, hallux abductus angle, and the proximal articular set angle in normal feet is relatively undocumented. The purpose of this study is to document relationships between the metatarsus adductus angle and the other three measurements, and to establish normal values for the intermetatarsal angle, hallux abductus angle, and proximal articular set angle within metatarsus adductus angle subgroups.


First and second metatarsophalangeal joint dislocation. A case report.

A case of dislocated first and second metatarsophalangeal joints was reported along with the mechanics and mechanism of injury. The practitioner must be familiar with the mechanism of injury and radiographic classification to determine the proper indications for closed versus open reduction. The authors' review of the literature did not reveal a similar case involving a dislocation of the first and second metatarsophalangeal joints.


Dermatitis artefacta. Case reports.

Patients who seek care for foot problems may present to the podiatrist with concurrent problems, such as anxiety, depression, phobias, personality disorders, and psychoses. These may or may not have any direct relationship to the pathogenesis of the foot problem. The podiatrist may learn of the presence of an emotional problem directly from the patient or from a family member. In many cases, the patient may be unaware or deny the presence of an emotional problem, leaving the podiatric physician in the dark about the patient's mental health state or its implications for the management of the skin problem. In a review of the psychosomatic aspects of dermatology, Koblenzer offered a working classification of the psychodermatoses. This is helpful to the podiatrist in recognizing those dermatologic disease states in which the various aspects of the individual participate in the disease, signs and symptoms of the disease, and the potential psychological value of the disease for the patient. It is also helpful to the podiatrist for recognizing those dermatoses in which psychiatric consultation may be useful so that recognition, treatment, improvement, and perhaps cure may be effected quickly.


Antibiotic prophylaxis in paediatric surgery.

Effect of antibiotic prophylaxis was studied in 400 children undergoing various types of surgery. Patients were divided into different classes according to the type of operation and each was further randomized into a routine or trial group. The routine group received antibiotics for prolonged periods. In the trial group, "clean" cases (class A) did not get any antibiotics. The "clean-contaminated" (class B) and "contaminated" cases (class C) received peri-operative antibiotics only. Frankly infected cases were not included in this trial. There were 131, 213 and 56 cases in classes A, B and C respectively; of these 13 (3.25%) cases were diagnosed as infected, four in the trial group and nine in the routine group. It was found that a short course of peri-operative antibiotics was equally, if not more effective. Prolonged courses of antibiotics were not only useless and expensive but could also be harmful. For clean cases there is no need for antibiotic prophylaxis. Children behave no differently and these results may be extrapolated to adults.


ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction--a pilot study.

The effect of intravenous streptokinase (SK) on time course of creatine kinase-MB (CK-MB) release and rapid reduction in ST-segment elevation as two non-invasive markers of reperfusion was prospectively studied in 83 patients with first anterior wall AMI (SK group, n = 61; control group, n = 22). CK-MB evidence of reperfusion in the SK group was significantly higher than that in the control group (80% versus 32%; P 0.0001). The rapid resolution of sum of ST segment elevations as an evidence of reperfusion was found in 82% patients in SK group versus 23% in the control group (P 0.0001). Both CK-MB and rapid resolution of ST segment elevations as evidences of reperfusion were found in 69% patients in SK and 14% in the control group (P 0.0001). The proportions of patients with non-invasive evidence of reperfusion with half-dose SK (750,000 units) regimen were comparable to that reported in the literature with full dose SK (1.5 million) regimen. Thus, serial CK-MB and ECG analysis in patients with AMI undergoing streptokinase therapy provides a non-invasive means for assessing therapeutic success. A dose of 750,000 units of SK was found clinically satisfactory using previously validated non-invasive markers of coronary reperfusion and produced results previously reported with 1.5 million units of SK.


Reappraisal of intermediate-term follow-up of radiofrequency ablation of accessory atrioventricular pathways for treatment of Wolff-Parkinson-White syndrome.

To evaluate the safety and efficacy of catheter mediated radiofrequency (RF) ablation in patients with Wolff-Parkinson-White syndrome, 125 patients with accessory pathway (AP) mediated tachyarrhythmias underwent RF ablation. Right-sided APs were ablated from the atrial aspect of the tricuspid annulus (all from the femoral vein approach) and the left-sided APs were ablated from the atrial or ventricular aspect of the mitral annulus. Immediately after ablation, 3 of 8 APs (38%) and 131 of 137 APs (95%) were ablated successfully with RF through a small-tip (2 mm) and a large-tip (4 mm) electrode catheter, respectively. Seven of the 11 APs where RF ablation failed had a later successful DC ablation. During follow-up (3 to 22 months), 11 of the 114 patients (10%) with successful ablation had return of accessory pathway conduction (2 had recurrence of tachycardia (2%)). Complications included transient myocardial injury (peak CK-MB 15 +/- 3 IU/l), transient proarrhythmic effects (more atrial and ventricular premature beats), accidental AV block (1 patient), cardiac tamponade (1 patient) and suspicion of aortic dissection (1 patient). In successful sessions, procedure and radiation exposure time were 3.8 +/- 0.2 h and 45 +/- 4 min, respectively. This study confirms that RF ablation with a large-tip electrode catheter is an effective and relatively safe nonsurgical method for treatment of Wolff-Parkinson-White syndrome.


Short- and mid-term follow-up results after percutaneous transvenous mitral commissurotomy.

This study reports the clinical follow-up for 6 months of 52 patients who underwent percutaneous transvenous mitral commissurotomy (PTMC). PTMC resulted in an increase in mitral valve area from 1.1 +/- 0.3 to 1.7 +/- 0.4 cm2 (p < 0.0001), a decrease in mean left atrial pressure from 16 +/- 7 to 13 +/- 5 mmHg (p < 0.0001), and an increase in exercise time from 4.6 +/- 2.1 to 6.3 +/- 2.3 min (p < 0.0001). At 6 months follow-up, mitral valve area was unchanged (1.7 +/- 0.4 cm2). Of 52 patients, 33 showed clinical improvement and 19 had no clinical improvement after PTMC. Univariate analysis showed (1) younger age, (2) echocardiographic score of 8 or less, (3) existence of mitral regurgitation of less than grade 2 after PTMC, and (4) amelioration in left atrial dimension, mean pulmonary artery pressure and exercise time after PTMC as correlative factors for clinical improvement. In conclusion, PTMC was an effective procedure for mitral stenosis, especially in younger patients with an echocardiographic score of 8 or less. Change in left atrial dimension was a good indicator of the effectiveness of PTMC.


Loss of nocturnal decline in blood pressure in diabetic patients with autonomic neuropathy.

We investigated loss of the nocturnal decline in blood pressure (BP) and its mechanism in diabetes mellitus with autonomic neuropathy (ANP). BP was measured every 30 min using ambulatory BP recorders in 52 diabetic patients and 11 nondiabetic controls. As an index of autonomic nervous dysfunction, CVRR (the coefficient of variation of the R-R interval on ECGs) and diastolic blood pressure response on standing were measured. Plasma volume (PV) was measured with RISA. The difference between daytime mean BP (09:00 to 13:00) and nighttime mean BP (01:00 to 05:00) was analyzed. The normal control group showed a significant reduction in mean BP during the nighttime (-12.8 +/- 7.5 mmHg) as compared with the DM group (-3.3 +/- 8.6 mmHg, p < 0.001). The diabetic patients with loss of the nocturnal decline in blood pressure showed autonomic nervous dysfunction and increased PV. In conclusion, the nocturnal elevation of blood pressure might result from an imbalance between reduced tone of sympathetic and parasympathetic functions in addition to the postural effect and increased plasma volume present in diabetic patients.


Microvascular geometry of the rat heart. Arteriolar and venular capillary regions.

The importance of realistic data regarding microvascular geometry for the understanding of oxygen transport to tissue cannot be underestimated. The purpose of the present investigation was therefore to determine the pattern of capillarization in rat myocardium. The histochemical method used in this study was novel in that it allowed for the discrimination of arteriolar capillary (AC) and venular capillary (VC) regions on the basis of color. Our preeminent finding was that systematic differences exist in microvascular geometry from arteriolar to venular capillary regions in normal rat myocardium. Specifically, VC regions are characterized by greater capillary density; more uniform capillary spacing; shorter segment lengths; and increased capillary diameter. These differences translate to significantly greater capillary length, surface and volume densities on the venular side of the capillary bed. In the face of lower PO2 values towards venules, this distinctive geometry would serve to provide advantageous geometric conditions for oxygen diffusion.


Cardioplegia with adenosine and adenosine triphosphate in the isolated guinea pig heart.

In order to determine the effect of adenosine triphosphate (ATP) and adenosine in cardioplegic solutions, a comparative study has been undertaken in isolated guinea pig hearts using the Langendorff perfusion technique as a model of cardiopulmonary bypass. The hearts (n = 10 in each group) previously being perfused by Krebs-Henseleit solution, were arrested by one of the following cardioplegic solutions: 1) Potassium 20 mM/L (Plegisol), 2) Potassium 20 mM/L+ATP 10 mM/L, 3) Adenosine 10 mM/L, 4) Adenosine 10 mM/L+ATP 10 mM/L. After 45 min of hypothermic ischemia, postischemic recovery of heart rate, ventricular contractility, heart work and postischemic changes in tissue enzymes (LDH, SGOT, SGPT) were compared among the 4 different cardioplegic solutions. Arrest time and number of arrest beats were also recorded and compared among the groups. Although similar beneficial results on postischemic recovery were achieved with adenosine cardioplegia and with ATP supplemented potassium cardioplegia, ATP supplemented adenosine cardioplegia did not show any beneficial effects on postischemic recovery.


Effects of a new antiarrhythmic drug, SD-3212, on canine ventricular arrhythmia models.

The antiarrhythmic effects of a new antiarrhythmic agent, SD-3212, (-)-(S)-3,4-Dihydro-2-[5-methoxy-2-[3-[N-methyl-N-[2-[(3,4- methylene dioxy)phenoxy]ethyl]amino]propoxy]phenyl]-4-methyl-3-oxo-2H-1, 4-benzothiazine hydrogen fumarate, were investigated using canine models of ventricular arrhythmias, i.e. spontaneously occurring digitalis-, two-stage coronary ligation- and adrenaline-induced arrhythmias. SD-3212 suppressed adrenaline-induced arrhythmia and showed some antiarrhythmic effect on digitalis- and 48 hr coronary ligation-arrhythmias. These results indicate that SD-3212 has antiarrhythmic effects common among class IV antiarrhythmic drugs and also has additional efficacy common among class I antiarrhythmic drugs, thus when considering the level of experimental arrhythmias it somewhat resembles propafenone. It may therefore become a clinically useful antiarrhythmic drug among typical class I or class IV antiarrhythmic drugs.


Hibernating myocardium associated with coronary artery dissection and vasospastic angina.

Hibernating myocardium is an uncommon clinical state involving persistently impaired myocardial function. A 61-year-old man was admitted because of vasospastic angina. Coronary angiography revealed coronary artery dissection in the midportion of the right coronary artery, and segmental vasoconstriction was evoked by acetylcholine. In this patient, hibernating myocardium in the dissected region was clearly demonstrated by dipyridamole thallium-201 imaging. This report describes the first documented case of hibernating myocardium associated with coronary artery dissection, and the usefulness of dipyridamole thallium-201 imaging in the assessment of this state. Coronary artery spasm might be relevant to the etiology of coronary artery dissection.


Percutaneous transluminal coronary angioplasty in a patient with Kawasaki disease. A case report of an unsuccessful angioplasty.

A 13-year-old boy with severe coronary stenosis due to Kawasaki disease underwent percutaneous transluminal coronary angioplasty (PTCA). The guide wire and the balloon catheter easily passed through the stenosis in the left anterior descending artery. However, effective dilatation could not be achieved even when the balloon size was increased to 2.5 mm in diameter. We discontinued further inflation of the balloon because serious resistance was encountered on withdrawal of the balloon catheter. In patients with Kawasaki disease, the value of PTCA as a treatment for coronary stenosis is questionable.


Alcohol-induced sinus bradycardia and hypotension in patients with syncope.

We observed 2 cases of repeated episodes of syncope after alcohol ingestion. Both patients were light drinkers and had carotid sinus hypersensitivity. In both cases, alcohol loading tests repeatedly induced sinus bradycardia and hypotension 1.0-1.5 hours after drinking alcohol. Atropine was effective in improving symptoms. A loading test using a glucose solution of equivalent osmolarity and volume was negative. Acute alcohol ingestion usually increases heart rate with variable effects on blood pressure. However, our 2 cases exhibited unusual alcohol-induced sinus bradycardia and hypotension, suggesting a paradoxical increase in parasympathetic activity and/or decrease in sympathetic activity.


[The interleukin-1 content of the blood in patients with a pseudotuberculosis infection and opisthorchiasis].

Interleukin-1 levels were measured according to S. B. Mizel in 25 patients with pseudotuberculosis and concomitant chronic opisthorchiasis and in 25 ones with pseudotuberculosis alone over the course of the disease and in 3 months after it. The controls were patients with chronic opisthorchiasis and normal subjects. Hyperproduction of interleukin-1 by peripheral blood monocytes was found in chronic opisthorchiasis patients and in pseudotuberculosis patients with concomitant opisthorchiasis over the entire follow-up period. In patients with pseudotuberculosis alone interleukin-1 production was found elevated only at the peak of the disease and during early convalescence, that was followed by a stable normalization of this characteristic.


[Interleukin-1 production in patients with subacute and chronic opisthorchiasis].

Interleukin-1 (IL-1) production by peripheral blood lymphocytes was studied in 3 patients with the subacute and in 28 patients with the chronic stage of the disease. Monocyte culture was obtained by the H. R. Recalde method, IL-1 activity was evaluated by the S. B. Mizel modification of the classic LAF-ASSAY. In the subacute stage of the disease IL-1 activity was 3.3 fold lower that in healthy controls and lower than in the total group of patients with chronic opisthorchiasis (Kact. 0.64 +/- 0.09, 2.12 +/- 0.17, 1.83 +/- 0.11, respectively, p < 0.01, p < 0.01). In those with the syndrome of chronic gastroduodenitis IL-1 production was lower than in patients with the syndrome of cholepathy (Kact. 1.55 +/- 0.18 and 2.03 +/- 0.16, p < 0.01). Immediately after praziquantel therapy IL-1 production fell from Kact. 1.82 +/- 0.13 to 1.18 +/- 0.06 (p < 0.01), but 5-6 months later the production of the cytokine normalized in convalescents.


[A quantitative assessment of risk factors in helminthiases].

Presents a quantitative assessment of some risk factors leading to enterobiasis and opisthorchiasis. Suggests a division of these factors into those that can be eliminated easily, conditionally, or not at all.


[Differences in the dynamics of the eosinophilia, blood immunoglobulin E and the level of circulating immune complexes in patients with chronic opisthorchiasis treated with different doses of praziquantel].

Sixty patients with a chronic Opisthorchis felineus infection were administered one-day therapy with praziquantel in doses 25, 40, or 60-75 mg/kg b. m. The former two doses of the drug did not much improve the levels of the examined immunologic parameters. In patients treated with the highest dose of praziquantel a significant decrease of the total and specific IgE and CIC levels, reaching that in the reference groups, was observed in 6-8 months after the treatment, this indicating a 92% efficacy of the drug in this group of patients.


[The characteristics of the clinical course of taeniarhynchiasis and its combination with enterobiasis and lambliasis and fenasal treatment].

A total of 276 patients with taeniasis alone and taeniasis associated with enterobiasis or lambliasis were involved in the study. The most prevalent features in patients of all the three groups were combinations of the painful, dyspeptic and astheno-vegetative syndromes, the least so--an isolated astheno-vegetative syndrome. Combinations of these syndromes more frequently occur in taeniasis concomitant with enterobiasis (61% vs. 51% in taeniasis alone). Associations of taeniasis with enterobiasis or lambliasis are more frequently diagnosed in children. Combinations of the three syndromes were revealed in the patients with taeniasis coursing against the background of chronic gastritis, duodenal ulcer, cholepathies: in 79% vs. 33.3% in an uncomplicated course. Fenasal therapy for 3 days in a daily dose of 3 g proved fairly effective: 85.7 +/- 6.3% of adults and 82.6 +/- 6.4% of children recovered.


[The resistance of Plasmodium falciparum strains to preparations of the 4-aminoquinoline series in the Republic of Guinea].

In vivo measurements of P. falciparum sensitivity to chloroquine diphosphate, carried out in the Republic of Guinea, resulted in isolation of strains with degrees I and II resistance from 5 of the 25 examined patients, that may be due to a wide prophylactic administration of the drug to all patients with fevers without completing the course of therapy in all the patients infected. Such courses are obligatory to prevent the dissemination of chloroquine-resistant strains of the parasite and augmentation of the resistance. Further use of chloroquine and its analogs for the prevention and chemoprophylaxis of malaria in the Republic of Guinea appears still desirable, because the majority of P. falciparum strains are still sensitive to these agents. If no favorable changes are detectable in the clinical parameters of malaria patients in 4-5 days of chloroquine treatment or the condition recurs in 1.5-2 months, assessment of P. falciparum sensitivity to chloroquine is advisable, followed by a rational choice of the drug.


[The current malariological situation in the countries of western Africa. 1. The Republic of Guinea].

Favorable climatic conditions in the Republic of Guinea are conducive to a high prevalence of infectious and parasitic diseases, responsible for 70% of primary consultations of the population, malaria being diagnosed in 40% of cases. Five landscape malariologic zones were singled out in the country, that are characterized by a certain level of malariogenicity. In the lowland/river and mountain/river zones the parasite index of children aged 2 to 9 varied from 16.4 to 45%, and in some foci it reached 63.1%. Foci in the Guinea-Sudan type wet savanna zone are also referred to meso- and hyperendemic ones. The mountain/forest zones are mainly mesoendemic. Malaria foci in the forest/savanna zone in southern Guinea and in the Sierra Leone northern provinces are hyper- and holoendemic, with the parasite index of children aged 2 to 9 being 76.3-92%.


[A trial at using the systemic action of ivermectin for suppressing the vector capacity of ticks (Ixodidae) infected with the tick-borne encephalitis virus].

Adult Dermacentor marginatus hatched from nymphs infected with TBE virus and poisoned with ivermectin retain their vector abilities. Even small individuals with a 1.5-2 times lesser mass as against the reference mass contain the virus in the body in the same titers and the virions in salivary gland alveoli. Administration of an oil solution of ivermectin into the stomach of white mice, nymph feeders, in a dose surpassing threefold the dose recommended for intramuscular injection of this agent completely suppressed shedding of intact nymphs but did not suppress it in those infected. The nymph mass, size and mass of adult ticks hatched from them dropped under the effect of ivermectin dosage build-up in both intact and infected ticks, but these processes were slower in ticks infected with TBE virus. The authors suggest that the ticks infected with TBE virus are much more resistant to the process of gamma-aminobutyric acid depression, the mechanism of ivermectin action. They emphasize the necessity of bearing in mind the possible differences in the reactions to systemic poisons of intact and infected ticks when organizing vector control measures.


[Foci of the rat mite Ornithonyssus bacoti (Mesostigmata, Macronyssidae) and rat-mite dermatitis in Moscow].

High density of the rat population in Moscow in 1990-1991 resulted in the appearance of Ornithonyssus bacoti foci and of cases of the rat-mite dermatitis in humans. A total of 36 foci of the disease were examined and eradicated. A method for the detection of such foci has been developed. Two types of foci are distinguished, communal and industrial, and their specific features as regards the rodent and mite populations and clinical features of dermatitis in humans are described. A system of measures for liquidation of foci of rat mites is suggested, including rat and mite eradication and treatment of the patients. Specific features of these measures for various types of foci and in case of a focus reappearance are enumerated.


[The clinical aspects of the problem of echinococcosis and the means for its resolution].

The author assesses the basic clinical aspects of the problem of echinococcosis. Discusses the problems related to clinical realization of the invasion, clinical and morphologic parameters of the pathologic process development in echinococcosis, as well as problems in the diagnosis, treatment, and organization of the treatment-and-prophylaxis service in areas endemic for this condition. Outlines the major trends of further research of echinococcosis, that may be implemented at a new problem-solving unit that is to be created.


[The attraction of taiga ticks by the smell of the host's fur in nature].

In the "Zhigulevsky" preserve, 46 coarse calico napkins impregnated with 1 ml of an attractant, were placed alternatively as controls and experimental along the road with the interval of 5 meters. The attractant was a methanol wash-off of the hair of a mongrel dog. During 8 hour exposure the experimental napkins were attacked by 20% males and 12.5% females of active ticks living by the road (after the third experiment a complete catch of ticks was carried out). The tick distribution indirectly indicates that the attractant causes a increase of tick horizontal migrations up to 5 meters around the source of odour. The results obtained allow one to suggest a promising granulated attractive and acaricidal agent.


[The variability of the itch mite Sarcoptes scabiei de Geer (Acariformes, Sarcoptidae) in relation to scabies epidemiology. 3. The geographical and seasonal variability].

The statistical modes of individual variability of Sarcoptes scabiei females, developed and described by the authors in two previous papers, has been used to analyze the geographic, seasonal variability and to compare the mite populations with due consideration for the clinical features of the disease. Statistically significant differences in the size and proportion of the samples were found in Moscow, the Moscow region, and the town of Bishkek in spring and summer. A relationship was revealed between the degree of the female back chetoid cover joining and the disease duration, number of burrows in the skin integument and their sites.


[Pathomorphological changes in the liver in experimental superinvasive opisthorchiasis].

Experimental model of Opisthorchis felineus superinvasion was reproduced in 30 piglets aged 3 months. The pigs were infected by feeding them 100 g of sausage fish with the mean invasion intensity of 0.8-1 metacercaria per g of muscle tissue. A repeated infestation with a similar dose was carried out in a month. The invasion developed in 14 of the 30 animals. Histologic examinations of the liver, carried out in 2.5 months after the first infestation, have revealed diffuse persistent hepatitis in 9 animals and aggressive hepatitis in 4. Proliferative changes in the epithelium of the intrahepatic gall ducts with polyposis and diffuse focal infiltration of the wall mucosa with plasma and lymphoid cells, fibroblasts and eosinophils were found, characteristic of human opisthorchiasis. Pigs may be used as a model for experimental opisthorchiasis in research.


[The EGF receptor pathway in human cerebral tumors].

The epidermal growth factor receptor gene is the most frequently involved proto-oncogene in human glial brain tumors, in the present series in agreement with previous reports in literature. It is therefore important to study this gene from DNA to the protein product. The vicinity of cystic fluid (C.F.) to tumor cells of the cystic wall has suggested investigation of possible "E.G.F.-like" autocrine activities in C.F. In 40% of gliomas, E.G.F.-R. gene is amplified and overexpressed. This is never observed in low grade astrocytomas. In 12% of the cases, mutations of the E.G.F.-R. gene are observed. In correlation with genomic abnormalities, E.G.F.-R. is immunoprecipitated in 40% gliomas. The basal phosphorylation of the receptor is increased in 50% gliomas. In C.F., unexpectedly, E.G.F.-R. phosphorylation inhibitory effect is observed. Its biochemical analysis suggests an anti-tyrosine kinase activity. The observation of anti-tyrosine kinase activity in C.Fs suggests the presence of negative modulatory factors of the proto-oncogene activation in tumor tissues. This could have therapeutical interest.


[Giant cholesterol cysts of the petrous apex].

In connection with their two own cases, the authors deal about the giant cholesterol cysts of the petrous apex. The lesions which are to be differentiated from epidermoid cysts are cholesterol granulomas. Their petrous apex location explains their characteristic large appearance. As each cholesterol granuloma, they occur when a bony cell is obstructed. This chronic obstruction induces mucosal edema then bleedings which lead to the formation and, by the lack of drainage, to the accumulation of cholesterol crystals. These crystals initiate a non specific reaction to foreign bodies, a granuloma, which also can bleed. Thus, a continuous cycle perpetuates the growth of the lesion. This lesion, when it is localized in the petrous apex, can reach a big size before the appearance of some signs. Usually, these are otologic (sensorineural hearing loss, tinnitus, vertigo) and/or cranial nerve palsies (V, VI, VII). C.T. scan (well defined, sharply marginated bony expansible lesion with isodense to the brain central part) and M.R.I. (central region of increased intensity on both T1 and T2 weighted images and peripheral rim of markedly decreased signal intensity in all instances) features are characteristic enough to allow diagnose with other petrous apex lesions (cholesteatoma, mucocele, epithelial cyst, histiocytosis X, ...). Surgical treatment must try to evacuate and to aerate the cavity or perhaps to obliterate it with fatty pieces in order to prevent the recurrence.


[Agranulocytosis--a complication of the chemotherapy of echinococcosis with mebendazole].

Only two of the 75 patients with echinococcosis, treated with mebendazole in a dose of 50 mg/kg b. m. for 30 days (single course) and administered from 1 to 13 courses with intervals of 1 to 3 months, developed agranulocytosis eventuating in death in one female patient. Analysis of blood levels of mebendazole and its metabolites permits a hypothesis that high concentrations thereof may have a toxic effect on the bone marrow, inducing its hypoplasia, in subjects sensitive to these substances.