A technique for safe resection of extensive tumours associated with the extracranial internal carotid artery.

Resection of tumours associated with the extracranial internal carotid artery such as carotid body tumours and paraganglionomas carry a hazard of stroke which might occur from temporary clamping of the artery to obtain better control, or from inadvertent damage to the artery which requires ligation. Some extensive tumours have been deemed unresectable because of their extent. Intracranial extension is a further technical challenge. We describe a technique for safe resection of such tumours employing an outlying Pruitt Inihara shunt. During resection of the tumour the shunt allows safe dissection because the internal carotid artery is rendered relatively bloodless. Further, any damage to the artery can be safely repaired, and indeed if necessary the artery itself can be resected and grafted. We have employed this technique in 3 difficult case of paraganglionoma (1) and carotid body tumour (2) whilst at the same time resecting 8 other simple cases without the need for such a technique.


The factors effecting complement activation in open heart surgery.

The activation of the complement system was investigated in 10 patients with rheumatic valve disease having heart surgery. The C3c, C4, leukocyte count and polymorphonuclear neutrophil count were determined in the blood samples taken before anaesthesia, after anaesthesia, 10 minutes after protamine administration and after the closure of the skin incision. In addition, atrial blood samples were taken after the release of the cross-clamp and pulmonary neutrophil trapping was investigated. In this study C3c and C4 consumption was found to take place after 30 minutes of CPB (cardiopulmonary bypass) and 10 minutes after protamine administration; the affects of anaesthesia and heparin were not significant.


Reduced incidence and severity of accelerated graft atherosclerosis in cardiac transplant recipients treated with prophylactic antilymphocyte globulin.

Allograft coronary artery disease (ACAD) is the major factor limiting long-term survival of cardiac transplant recipients (CTRs). Although cyclosporine based triple drug immunosuppression has not decreased the occurrence of ACAD, some preliminary data suggests that prophylactic antilymphocyte preparations may reduce the incidence of this problem. All CTRs at Henry Ford Hospital have uniformly received prophylactic Minnesota Antilymphocyte Globulin (ALG), thereby providing a unique opportunity to investigate this hypothesis. One hundred three CTRs were followed for a median duration of 34 months with annual angiograms begun one year after transplant. Patients who died without an angiogram were considered to have ACAD based on autopsy results or if their death was clinically suspicious. Ninety-two patients underwent at least one angiogram. Fourteen patients had abnormal angiograms. Nine patients were identified as having ACAD by non-angiographic criteria. Five had autopsy proven disease, 3 died suspiciously, and 1 underwent successful re-transplantation for ACAD. By Kaplan-Meier analysis, the risk of developing ACAD was 12% in 1 year, 16% in 2 years, 22% in 3 years, 26% in 4 years, and 29% in 5 years. Risk of ACAD increased with older recipient's age, higher triglyceride levels, and diabetes, but was not affected by active CMV infection, number of acute rejection episodes, and HLA mismatching. These results suggest that prophylactic ALG reduces the occurrence of ACAD.


Somatomedin-C plasma levels after coronary revascularization.

The decrease of Somatomedin-C (SM-C) plasma levels has been recently proposed as an index of acute malnutrition in critically ill patients. In this study SM-C values were determined before surgery for coronary revascularization, on the 2nd and 5th postoperative day. Twenty-four patients were admitted to the study; most of them (16 cases; 66%) presented with an increase of SM-C levels after surgery unlike 8 patients who showed unchanged or decreased levels. Multivariated analysis was applied to the factors that may affect SM-C values. SM-C significantly related to the Modified Predictive Nutritional Index, which was calculated prior to surgery, while no significant relationship was observed with patient age and type of oxygenator. No sign of liver damage was observed, so we concluded that decreased and, perhaps, unchanged SM-C levels after coronary revascularization were probably caused by acute nutritional deficiency. The incidence of this finding was remarkably high (33%) in spite of the absence of apparent malnutrition before surgery.


Multiple primary left ventricular myxomas with multiple intraventricular recurrences.

A 23-year-old male was operated on for two primary left ventricular myxomas of the "complex" type. Ten months later, abnormal echo reappeared and reoperation was carried out to excise 2 recurrent myxomas in the left ventricle. Multiple foci were most likely responsible for the recurrence. No recurrence has been detected for 20 months postoperatively. This may be the first reported case of multiple primary left ventricular myxoma with multiple recurrences in the left ventricular cavity.


A critical appraisal of chromatographic and immunoassay techniques for clinical drug analysis.

Chromatography and immunoassays are the two principal techniques used in research and clinical laboratories for the measurement of drug concentrations in biological fluids. The purpose of this article is to provide the reader with a general overview of these techniques and to present their relative merits and limitations. A glossary of technical terms is included at the end of the review.


Primary cardiac paraganglioma. Case report and review of surgically treated cases.

A 58 year old man with an infiltrating non-resectable left atrial paraganglioma was diagnosed by sternotomy and open biopsy. The patient remains symptom free 16 months after the operation. No evidence of an increase in the size of the tumour has been detected by echocardiography. The literature regarding surgically treated patients with cardiac paragangliomas is reviewed.


The importance of side effects and outcomes in differentiating between prescription drug products.

This study determined the importance of side effects and outcomes (i.e. the control of disease, convenient dosing and cost) in physicians' differentiation of drug products used to treat hypertension, allergic rhinitis, and gastroesophageal reflux. In addition, the study examined whether the importance of particular characteristics attributed to a drug varied with the practice setting. The multiattribute attitude model was used as a framework to examine physicians' perceptions of the importance and the probability of occurrence of specified side effects, results and their prescription intentions. Two groups of physicians were interviewed to identify determinant side effects and results. A questionnaire was used to obtain data by post from a random sample of 2,400 physicians in four types of practices: solo practice, group practice, institution and government (n = 527, 22% response). The findings indicate that the perceived likelihood of occurrence of side effects and results differed with the drug products but did not differ with the type of practice. Practice setting, however, was found to have a significant effect on intention to prescribe. Physicians in each setting differed in their intentions to prescribe certain studied drugs. Finally, physicians in the four settings were found to be similar in their ranking of the importance of particular characteristics of the drug. The control of disease was the most important result in all three scenarios, followed by individual side effects.


Vitamin C aspirin interactions in laboratory animals.

Ascorbic acid concentration has been determined in samples of plasma, leucocytes, urine, faeces and adrenal glands of guinea-pigs after administration of (i) 10, 25 or 100 mg ascorbic acid, (ii) 10 mg ascorbic acid plus 10, 25 or 50 mg aspirin and (iii) 25 mg aspirin and 25, 50 or 100 mg ascorbic acid. When the dose of aspirin was 25 mg or more, the transport of ascorbic acid into leucocytes was inhibited, the plasma concentration of vitamin C was elevated significantly and the excretion of ascorbic acid in the urine was increased in direct proportion to the aspirin dose. Ascorbic acid concentration in the adrenal glands was not significantly elevated after 3 h. When a constant dose of 25 mg of aspirin was given along with increasing doses of ascorbic acid both plasma and leucocyte ascorbic acid levels were elevated but not significantly after 2, 3 and 24 h. Urine ascorbic acid levels did not show any changes with the same doses.


An analysis of clinical pharmacist interventions in an intensive care unit.

In a 6-month study period, 170 pharmacist interventions in an intensive care unit (ICU) were analysed. Of the interventions, 68.8% were solicited and 31.2% were initiated by the pharmacists. The majority of the interventions were initiated by specialists (69.4%) followed by the medical officers (15.9%) and nurses (9.4%). Most of the interventions occurred during the grand rounds (75.9%), followed by ward visits (12.9%) and communication through the satellite pharmacy (10.5%). The most frequent type of intervention made was for indication or therapeutic efficacy followed by general product information, drug regimen, laboratory assessment, disease state, pharmaceutical availability and adverse drug reaction or side effect. It was also found that 83.7% of pharmacists' suggestions were accepted, 6.4% were accepted with changes, and 9.9% were not accepted. The majority of the interventions were made by direct verbal communications followed by telephone and written communications. In conclusion the study indicates that pharmacist therapeutic recommendations form an important integral element of patient care in an ICU.


Drug utilization in community pharmacy.

Drug utilization studies are a powerful means of identifying problem areas in drug consumption. The defined daily dose/1,000 inhabitants/day (DHD), provides an estimate of the proportion of the population who receive drug treatment in ambulatory care at national, regional, local and institutional levels. A new unit and its formula has been developed; defined daily dose/100 consumers/day (DCD), for the determination of drug utilization from community pharmacy allocated in cities where it is difficult to estimate the population covered by each pharmacy. This formula was applied to a community pharmacy to obtain the utilization of drugs for peptic ulcer treatment in 1990 and 1991. The data are compared with regional DHD data and there is good agreement between the results of the two methods. Data on non-prescription drug utilization are not easily available, and community pharmacists could improve the information available for this groups of drugs through use of the proposed formula and unit.


Serum drug level monitoring in affective disorders.

This study surveyed serum level monitoring of lithium and carbamazepine in three psychiatric hospitals, to determine how the service is used with respect to affective disorders. The monitoring of lithium serum levels appears to be carried out in relatively close adherence to recommended guidelines. Carbamazepine serum levels are monitored with a similar frequency to lithium, despite the lack of an established therapeutic window for indications other than epilepsy. Changes in drug therapy, which are consequent upon monitoring of serum drug levels, occurred after only 7.5% of lithium and 13.7% of carbamazepine samples. Changes were made independently of serum level results with greater frequency in carbamazepine-treated patients, although less frequently with lithium-treated patients. Adverse consequences of such changes occurred only once, involving lithium. More research is needed to determine the potential benefits of carbamazepine serum level monitoring in affective disorders because the service appears to be overutilized at present.


Variability in clinical pharmacology of drugs in children.

Numerous factors can lead to variability in pharmacokinetics, pharmacodynamics, efficacy, and toxicity of drugs in infants and children. These may include age, race or genetic status, organ function, underlying disease(s), drug formulation, concomitant drugs, and compliance with therapy. Further research is needed to clarify the mechanisms for variability in drug response to achieve optimal use of drugs in paediatric patients.


A drug usage review of omeprazole.

A drug use review of omeprazole was carried out at two centres in the Yorkshire Region from December 1990 to April 1991. Data collection documents were used and 66 patients in total were audited. Thirteen patients (19.7%) were treated for indications outside the product licence and 18 patients (27.3%) were treated for longer than 8 weeks. Twenty-eight patients (42.4%) received 40 mg daily. Fifty-one patients (77.3%) had received previous therapy with H2-receptor antagonists and in 33% of these patients it was at an inadequate dose or for an inadequate period of dosing or both. The results indicate a need for a prescribing policy for omeprazole.


Non-pharmacological treatment of hypertension.

This paper represents a compilation of the latest scientific research on the non-pharmacological management of hypertension to help practitioners manage this highly prevalent disease. In this regard, recent evidence suggests that nonpharmacological approaches--particularly weight reduction, salt restriction, moderation of alcohol consumption, reduction of cholesterol intake and exercise--may lower elevated pressure and improve the efficacy of pharmacological agents. Non-pharmacological therapy should be stressed for the future treatment of hypertension.


Lupus anticoagulant antibodies inhibit collagen-induced adhesion and aggregation of human platelets in vitro.

The effect of circulating lupus anticoagulant on platelet interaction with collagen and other proteins was tested, with the aim of understanding the role of membrane phospholipids in platelet function. Plasma samples from 26 systemic lupus erythematosus (SLE) patients, containing circulating lupus anticoagulant (LAC), were examined for their effect on adhesion and aggregation of normal human platelets. We find that SLE plasma, but not normal plasma, inhibits platelet adhesion to collagen in a concentration-dependent manner. At a plasma concentration of 1% the inhibition was 73 +/- 9% (mean +/- SD). In sharp contrast, there was no effect on platelet adhesion to fibronectin. Purified IgG from the same plasma samples also had an inhibitory effect. At 15 micrograms/ml (comparable in IgG concentration to 0.1% plasma) it inhibited adhesion to collagen by 33 +/- 11%. Inhibition could be abolished by preincubation of the LAC-containing plasma with cardiolipin (CL), phosphatidylinositol (PI), and, to a lesser extent, phosphatidylserine (PS) but not with phosphatidylcholine (PC) or phosphatidylethanolamine (PE). Inhibition could also be abolished by preincubation of the LAC-containing plasma with a 10-fold excess of washed normal platelets. The effect of 1% LAC plasma on platelet aggregation was as striking, showing 79 +/- 26% inhibition of collagen-induced aggregation, and it could also be abolished by preincubation of the LAC plasma with cardiolipin. In contrast, the effect of LAC plasma on thrombin-induced aggregation was rather modest. Our results indicate that antiphospholipid antibodies interfere with platelet adhesion and stimulation by collagen in vitro and point to an important role of external plasma membrane phospholipids, particularly PI, in collagen-induced platelet activation.


Immunological studies in the hyper-immunoglobulin D syndrome.

Five patients with hyper-immunoglobulin D syndrome (hyper-IgD syndrome) were followed up for 3 to 8 years. In all patients studied, serum IgG3 was high. IgM decreased during the follow-up in all patients. In four of the patients serum IgA was elevated. In four patients the serum IgD kappa/lambda ratio was measured and was found to be raised in all. However, the serum total light-chain ratio and IgG, IgA, and IgM kappa/lambda ratios separately were virtually normal. In two of the patients, clinical symptoms preceded the increase in serum IgD. All patients had a history of severe reactions on immunizations in early childhood. We conclude that in hyper-IgD syndrome, other immunoglobulins may also be affected, in particular, IgA, IgM, and IgG3. The IgD light-chain ratio is also disturbed. We emphasize that clinical symptoms may herald immunological changes. This may be the result of an underlying factor causing both the clinical symptoms and, later, the increasing serum IgD levels.


Serum antibodies to HIV-1 in recombinant vaccinia virus recipients boosted with purified recombinant gp160. NIAID AIDS Vaccine Clinical Trials Network.

Serum antibody responses were studied in detail in four vaccinia-naive volunteers in a phase I trial evaluating primary vaccination with a recombinant vaccinia virus expressing the HIV-1 gp160 envelope glycoprotein (HIVAC-1e, Oncogen/Bristol-Myers Squibb), followed by booster immunization with baculovirus-derived rgp160 (VaxSyn, MicroGeneSys). Prior to boosting, low-titer Fc receptor (FcR)-mediated, antibody-dependent enhancing (ADE) activity was detected in two of four volunteers but no IgM, IgG, IgA, neutralizing activity, or complement-mediated ADE activity was detected. Two weeks after boosting, all four volunteers developed HIV-1-specific IgG with titers of 1:160 to 1:640 by immunofluorescence assay. IgG1 was present in sera from each individual, while IgG2 and IgG3 were present in sera from two individuals, and IgG4 was present in serum from one individual. IgM and IgA were undetectable in all sera. Only one volunteer had IgG to the heterologous HIV-1 isolates, RF, MN, and SF2, after boosting. Serum from this volunteer neutralized the vaccine strain, LAV/IIIB, but not the heterologous strains, RF, MN, and SF2. Antibodies from the remaining volunteers had no neutralizing activity. The neutralizing serum had a positive reaction in a peptide-based ELISA utilizing a peptide corresponding to the principal neutralizing domain of the third hypervariable region (i.e., V3 loop) of the envelope glycoprotein. Neutralizing activity was partially removed by adsorption to this peptide, suggesting that it contained a type-specific neutralizing vaccine epitope. A low titer (1:40 to 1:80) of complement-mediated ADE activity to HIV-1 IIIB was present in sera from three vaccinees after boosting. FcR-ADE activity for HIV-1 SF2 and SF-128A were present in sera from two of these three vaccinees. None of the volunteers developed antisyncytial antibodies. These results indicate that inoculation with recombinant vaccinia followed by rgp160 boosting is the most effective strategy to date for inducing serum antibodies to the envelope glycoproteins of HIV-1, but further study is needed to optimize the functionality and cross-reactivity of these responses.


Effects of in vivo endotoxin infusions on in vitro cellular immune responses in humans.

Studies of the immune response of patients following major injury have identified significant abnormalities, some of which may be due to the effects of endotoxin. To evaluate the effect of endotoxin on the immune system without conflicting variables, we studied 18 normal, healthy male volunteers each on two occasions. In one study, Escherichia coli endotoxin was administered intravenously at a dose of 4 ng/kg. In the other, saline was given. Blood for immune function studies was obtained at either 0, 4, or 24 hr (seven volunteers), 0, 1, and 4 hr (five volunteers), or 0, 4, and 6 hr (six volunteers) postinfusion. Peripheral blood mononuclear cells (PBMC) were isolated and adjusted to the same concentration. Measurements following endotoxin infusion were compared with those of the same volunteers following saline infusion and with those from normal ambulatory laboratory volunteers. Interleukin 1 (IL-1) production by adherent cells was significantly reduced at 1 hr post endotoxin infusion. Significant decreases in number of mononuclear cells, response to phytohemagglutinin (PHA), and production of IL-2 and IL-1 were observed by 4 hr after endotoxin infusion. No significant changes in percentages of monocytes, lymphocytes, or CD3, CD4, or CD8 lymphocytes were observed at any time. By 24 hr postinfusion all values had returned to normal or, in some cases, supranormal levels. Response to PHA by PBMC from volunteers 4 hr following endotoxin was completely restored by in vitro addition of recombinant human IL-2 but was only marginally improved by IL-1. In vitro addition of indomethacin to PBMC cultures responding to PHA reduced the suppression observed after in vivo endotoxin but also was not as effective as IL-2. In a fourth study, seven volunteers were treated as above either with two doses (800 mg each) of the cyclooxygenase inhibitor ibuprofen before endotoxin infusion or with ibuprofen alone. Ibuprofen pretreatment completely restored the PBMC response to PHA to normal and caused a significant decrease in the endotoxin-induced suppression of IL-2 production. However, the decrease in circulating PBMC number and adherent cell secretion of IL-1 was not affected by inhibition of the cyclooxygenase pathway. These results suggest that endotoxin has immunomodulatory effects on both adherent mononuclear-cell and T-lymphocyte function and that more than one mechanism is involved.


The making of public health data: paradigms, politics, and policy.

Public health data do not simply exist: the variables included or excluded from any given data set reflect the choices of individuals and institutions with the power to make these decisions. Their judgement typically is guided by prevailing theories of disease causation, which in turn usually resonate with their society's predominant political, economic, and ideological characteristics. This essay examines the making of public health data as a social process, both historically and in the present, and critiques the routine omission of social class data from US public health data bases, the treatment of "race" and "sex" as primarily biological variables, and their conflation with ethnicity and gender. Overcoming these problems will require developing social theories of disease causation and ending the pervasive silence about the health consequences of class, race, and gender inequalities.


Teaching health policy and politics in U.S. schools of public health.

Because most public health endeavors in the United States are funded by the public sector, public health practitioners need to be adept at working within the political system. However, the 1988 Institute of Medicine report, The Future of Public Health, found that many public health professionals are ignorant or disdainful of political processes and will not participate in activities that they perceive to be political. Our study examined the health policy and politics curricula of the 24 accredited schools of public health in the U.S., finding that most public health students are not exposed to these areas during their graduate coursework. Moreover, those students who do take health policy and politics courses study these areas within the context of health care delivery; the politics of public health and prevention are ignored by most schools of public health. Recommendations for improving public health curricula in health policy and politics are presented, including linkages with prevention activities.


Estimating costs of traffic crashes and crime: tools for informed decision making.

Traffic crashes and crime both impose significant economic and social burdens through injury and loss of life, as well as property damage and loss. Efforts to reduce crashes and crime often result in competing demands on limited public resources. Comparable and up-to-date cost data on crashes and crime contribute to informed decisions about allocation of these resources in important ways. As a first step, cost data provide information about the magnitude of the problems of crashes and crime by allowing us to estimate associated dollar losses to society. More importantly, cost data on crashes and crime are essential to evaluating costs and benefits of various policy alternatives that compete for resources. This paper presents the first comparable comprehensive cost estimates for crashes and crime and applies them to crash and crime incidence data for Michigan to generate dollar losses for the state. An example illustrates how cost estimates can be used to evaluate costs and benefits of crash-reduction and crime-reduction policies in making resource allocation decisions. Traffic crash and selected index crime incidence data from the calendar year 1988 were obtained from the Michigan State Police. Costs for crashes and index crimes were generated and applied to incidence data to estimate dollar losses from crashes and index crimes for the state of Michigan. In 1988, index crimes in Michigan resulted in $0.8 billion in monetary costs and $2.4 billion in total monetary and nonmonetary quality-of-life costs (using the willingness-to-pay approach). Traffic crashes in Michigan resulted in $2.3 billion in monetary costs and $7.1 billion in total monetary and nonmonetary quality-of-life costs, nearly three times the costs of index crimes. Based on dollar losses to the state, the magnitude of the problem of traffic crashes clearly exceeded that of index crimes in Michigan in 1988. From a policy perspective, summing the total dollar losses from crashes or crime is of less importance than understanding the costs and benefits of various policy alternatives. This paper therefore concludes with an example of how our cost estimates can be used to compare the costs and benefits of competing policies.


Changes in Medicare billing patterns: implications for physician payment reform.

This paper examines the changes in the billing for office visits, hospital visits, and consultations in the Medicare program for the period of 1986 through 1988. The analysis does not correct for changes in beneficiary or provider characteristics over the three-year period. Findings indicate $75 million in additional Medicare expenditures due to change in pattern of physician charges for these three commonly performed groups of procedures.


Back to direct payment: German dentists lobby to leave the national sickness fund scheme.

Oral health care in Germany is delivered by private dentists working predominantly in solo practice. Services are financed indirectly by sickness funds for 89 percent of the population. With caries rates declining, dentists' numbers increasing, and federal policies changing the remuneration regulations to enhance preventive behavior in consumers, dentists are concerned about their shrinking incomes. In an attempt to secure their professional interests, a faction among dentists advocates to return to direct payment and to opt out of the sick fund scheme. Their strategy and professional goals are described and the chances of succeeding discussed.


China's Cooperative Medical System: its historical transformations and the trend of development.

The rural Cooperative Medical System (CMS) in China came into existence in the 1950s. Along with the development of the collective economy of agriculture and the promotion of this system by the Chinese Government, the coverage rate of the CMS in the rural areas increased from 1955 through the end of the 1970s, when it was estimated that 90 percent of the rural population was covered by the CMS. Since the rural economic reform in the early 1980s destroyed the rural collective economy on which the CMS was based, The coverage rate of the CMS went down to 5 percent. After 1985, the coverage rate of the CMS began to increase gradually because of the development of the collective fund for supporting the CMS and the governments' efforts to strengthen the CMS. The structure of CMS has changed over time. Traditionally, the CMS was organized at the village level. In order to increase the risk-sharing ability of this system, the trend is for it to be organized at the township level in the future.


Spontaneous recovery of vision in progressive anterior ischemic optic neuropathy.

Four patients with typical anterior ischemic optic neuropathy experienced progressive deterioration of visual function, to acuity levels of finger-counting in two eyes, 20/400 in one, and 20/50 in the fourth. All subsequently enjoyed significant spontaneous recovery of vision to 20/60, 20/60, 20/40, and 20/25, respectively. No previous reports have documented the details of such improvement in the progressive form of anterior ischemic optic neuropathy. The natural history of this common optic nerve disorder is reconsidered in light of these observations. The potential for spontaneous recovery should be taken into account in the interpretation of visual outcome in medical or surgical therapeutic trials for progressive anterior ischemic optic neuropathy.


Papillophlebitis and arteriolar occlusion in a pregnant woman.

Among the pathologic findings affecting the eye during pregnancy, microvascular abnormalities affecting both choroidal and retinal circulation have been reported in cases of complicated pregnancy. We report a case of papillophlebitis and arteriolar occlusion in a pregnant woman without any complications throughout her pregnancy. The patient was placed on glucocorticoids and her vision, visual fields and funduscopic appearance improved almost to normal. Despite the improvement with treatment, the contributing role of glucocorticoids in this case could not be fully determined. Papillophlebitis and arteriolar occlusion should be included among gestational-related vasculopathies.


Compression of the intracranial optic nerve mimicking unilateral normal-pressure glaucoma.

A 66-year-old man developed progressive visual field loss in the inferior arcuate region of the right eye with normal central visual acuity. Intraocular pressures were normal on all but one occasion. The right optic disk showed extensive glaucomalike cupping; the left optic disk was normal. Magnetic resonance imaging revealed a tumor of the right medial sphenoid wing impinging upon the intracranial portion of the right optic nerve. It was resected via a frontotemporal craniotomy. Histopathologic examination revealed a meningothelial meningioma. The visual field and optic disk cupping remained unchanged postoperatively. To our knowledge, this is the first report in which both glaucomalike cupping and visual field loss occurred as the result of a compressive lesion of the anterior visual pathway.


Asymptomatic unilateral papilledema in pseudotumor cerebri.

A 32-year-old asymptomatic woman was found to have unilateral papilledema on routine ophthalmological examination. Subsequent visual field, neuroimaging, and cerebrospinal fluid examinations were consistent with the diagnosis of pseudotumor cerebri. This case demonstrates that pseudotumor cerebri may present as unilateral papilledema in any asymptomatic patient and illustrates the need for thorough neuro-ophthalmological evaluations to allow early detection of cases with atypical presentations to increase the efficacy of therapeutic intervention and prevent progressive visual loss.


Visual hallucinations on eye closure after cardiovascular surgery.

Visual hallucinations on eye closure are very uncommon. The underlying mechanism remains controversial. We report on a new case after carotid endarterectomy and coronary artery bypass graft surgery. The hypothesis of a temporal lobe epilepsy is discussed.


Indolent orbital apex syndrome caused by occult mucormycosis.

The chronic or indolent presentation of rhino-orbital mucormycosis, as defined by the presence of symptoms for more than 1 month before diagnosis, is extremely unusual. A 45-year-old man with stable diabetes presented with a right orbital apex syndrome and minimal ethmoid and sphenoid sinusitis. Progression was indolent, and the diagnosis was not made until 7 weeks after admission, when a third biopsy was prompted by new cavernous sinus and carotid artery thromboses. Mucormycosis was found. The patient improved on amphotericin B (2 g) and strict blood glucose control. A remarkable aberrant regeneration of the right oculomotor nerve was seen following treatment. He remains free of active disease 4 years later. Orbital symptoms in well-controlled diabetics, which may even remain stable for weeks and lack direct signs of tissue invasion, should raise the suspicion of mucormycosis.


Bipolaris-induced orbital cellulitis.

We report a patient who rapidly developed unilateral proptosis and complete ophthalmoplegia following blunt trauma to the orbit. Computed tomography (CT) scan revealed a mass involving the sinuses and orbit with erosion of the cribriform plate. Biopsy of this suspected neoplasm revealed features consistent with allergic Aspergillus sinusitis, but cultures later grew a Bipolaris species. Our review of the literature suggests that when allergic fungal sinusitis involves the orbit, Bipolaris is a more commonly isolated organism than Aspergillus. Additionally, extraocular motility impairment and proptosis occur more frequently than visual loss. Treatment is controversial, but surgical drainage followed by corticosteroids is the most often recommended therapy.


The unidirectionality of cerebral polyopia.

Polyopia, visual perseveration in space, has been associated with seizure activity, afterimage formation, and the presence of visual field defects. It can be interpreted both as a positive and a negative visual phenomenon. A patient with polyopia associated with the acute onset of hemianopsia is presented. The phenomenon has been investigated objectively with a simple procedure. The polyopia was highly correlated to movement of the eyes into the hemianoptic visual field and to increased contrast but not duration of the stimulus. This type of polyopia could be the result of incomplete visual processing due to poor visuospatial localization in a hemianopic field.


Isolated bilateral abducens nerve palsies caused by the rupture of a vertebral artery aneurysm.

We report two cases with isolated bilateral abducens nerve palsies due to the rupture of a vertebral aneurysm. Surgery revealed that the aneurysm did not directly compress the abducens nerve. Within a year after the subarachnoid hemorrhage, the patients gained full recovery from the bilateral abducens nerve palsies. In view of the clinical and operative findings, it may be regarded as a compression and/or stretching of the bilateral abducens nerves by a thick clot in the prepontine cistern, and not as a manifestation of the raised intracranial pressure. The mechanisms of the isolated abducens nerve palsy are discussed.


Ophthalmoplegia as a presenting manifestation of internal carotid artery dissection.

We present the case of a patient with an ipsilateral ophthalmoplegia as the presentation of a traumatic dissection of the internal carotid artery. We hypothesize that the cranial nerves dysfunction occurred because of interruption of the vascular supply to the nerves in the cavernous sinus from the inferolateral trunk of the cavernous carotid artery.


Renal causes of elevated sedimentation rate in suspected temporal arteritis.

The erythrocyte sedimentation rate (ESR) is a frequently used but nonspecific indicator of inflammation or infection. Clinicians often check an ESR in patients with symptoms of headache, facial or jaw pain, and visual loss, as an aid in the diagnosis of temporal arteritis. We present two patients with these complaints, who did not have temporal arteritis, nor any other inflammatory condition or infection, but had ESRs near or above 100 mm/h, leading to diagnostic confusion. An occult nephrotic syndrome, with or without renal insufficiency, can cause such a highly elevated ESR, and was discovered in these patients.


What is the proper integration of optometry and ophthalmology?

The delivery of health care services in America today utilizes a variety of approaches based on many economic, political and social factors. The current health care system is coming under significant review and criticism. Many options are being considered and recommended. This paper addresses possible changes in the delivery of eye care, specifically the relationship between the professions of optometry and ophthalmology, that may be needed in the future.


What are the pros and cons of requiring postgraduate residency training as an entry-level practice requirement?

Postgraduate residency training would produce better trained optometrists to meet the future needs of optometry. While residency training would expose a new graduate to experience that may take years to acquire, currently there is no mechanism in place to accommodate such a program.


How can the optometric profession expand the pool of qualified applicants?

Recruitment endeavors are underway to increase the "dwindling applicant pool" of optometric professionals. Referrals, scholarships and including pre-optometry courses in undergraduate curriculums are some of the recommendations.


Are graduate programs in physiological optics fulfilling their original purpose?

Change has affected physiological optics graduate programs' fulfillment of their original purpose of providing faculty for the schools and colleges of optometry. Relevant change has been divided into two categories: 1) change in optometry and optometric education, and 2) change in the characteristics of students opting for graduate study. The answer to the question posed is that these programs are still preparing faculty for academic careers, but not in the numbers they once did. A few consequences and options are considered.


Characteristics of faculty for a successful basic sciences program.

The author defines characteristics of an ideal faculty for a successful basic science program including strong grounding in the specific discipline, ability to teach with clinical relevance, dedication to teaching above all other considerations, and motivation to integrate optometric science. He illustrates an approach to this ideal as developed at the Southeastern University of the Health Sciences by integrating the basic science faculty for three separate health profession schools. Further, the author describes the profitable examples which have come about through this program.


Basic science research in optometry: are we adequately prepared?

Optometry has not traditionally emphasized basic science research. With the increasing responsibilities taken on for the health care of our patients, it is essential that optometry develop its own scientific base of knowledge on which to rely. The need for good scientific investigators, the need for support for basic science research, as well as the importance of long-range planning for basic science research in optometry are discussed.


Changes are needed to ensure the future of optometry's graduate programs: a critical issue.

Optometry is at a crossroad. As it changes focus and alters course, it must be supported academically by viable research and graduate programs. This requirement is current and pressing. This paper addresses several issues involved in this critical endeavor. Needs and opportunities are discussed.


Ensuring the future of optometry's graduate programs.

Financial burdens, time and family commitments, peer status, insecure feelings concerning academia, and continuing "student" stigma are some of the pressures that discourage optometrists from entering graduate programs in visual science or other fields. In order to ensure the continued future training of optometrists with additional graduate degrees, we must begin to develop better financial packages, proactive recruitment strategies, increased networking opportunities, more secure career opportunities, streamlined graduate programs, and the affirming of the rewards of graduate study by those who have had successful careers.


An analysis of external sources for revenue solicitation for optometric education.

In analyzing the costs of optometric education, it becomes apparent that the cost of operating the educational institution far exceeds the cost of providing the optometric education. A recent survey also indicates that there are rather striking differences in the cost of operating state-sponsored vs. private programs. It is necessary, therefore, to seek alternative sources of funding optometric education rather than relying on annual tuition escalation to cover increasing costs. Such sources include: realistic fees for clinic program services; various forms of state grants, private institution programs, tuition subsidies; foundations; gifts; "industrial partnerships" outside the ophthalmic field; and innovative financing.


Present status and projected needs of the educational facilities in optometry.

Optometry is affected by political, social and economic forces. Optometric leaders must understand that the issues of health care reform, education reform and economic reform can only be met through cooperation of all professionals, educational associations, as well as individual institutions. With good management, innovative use of available funds, and development of personnel, optometry can overcome contracted revenues and prosper through this decade. However, there is no doubt that educational reform is at the doorstep of the health care professions. Optometry must strive to face its challenges now and into the remaining years of this decade.


The pros and cons of developing additional schools and colleges of optometry.

There are no manpower studies to give hard statistics of the number of practitioners needed now and in the future. We will still be increasing the number of optometrists in the country by maintaining the same course we are on now, and show no need for any new optometric schools or colleges. Yet, the present schools and colleges of optometry may need to expand or contract their entering class size as educational reform changes optometric education.


What are the appropriate skills and knowledge of reimbursement systems needed for the entry-level practice of optometry?

Health care reimbursement has increasingly become a major factor in the day-to-day practice of optometry. This paper, originally presented at the 1992 Summit on Optometric Education, outlines the various types of programs the optometrist should be familiar with, and emphasizes the importance of the integration of such knowledge into the curriculum of the schools and colleges of optometry.


What is and what will be the need for formally educated optometric technicians?

The number of two-year degree optometric technician programs has drastically decreased in recent years. The main reasons are budget cuts common to higher education institutions and low enrollments. Two explanations for difficulty in maintaining full enrollments are lack of career awareness and low salaries. Are optometrists in private practice aware of this decrease and do they realize how much more difficult it will be in the future to hire formally educated employees? The optometric profession should evaluate its future personnel needs and address how those needs will be met. Time is of the essence since many of the remaining programs face a great risk of closing.


Non-steroidal anti-inflammatory drugs: current trends in pharmacology and therapeutics.

Non-steroidal anti-inflammatory drugs (NSAIDS) are commonly used for the chronic treatment of many inflammatory disorders. They are also used for the reduction of fever and mild to moderate pain. Because they are readily available to patients as both prescription and over-the-counter medications, it is likely that the practicing optometrist will encounter these agents in the practice setting. NSAIDS are associated with several common ocular and systemic adverse effects that include nonspecific conjunctivitis, blurred vision, allergic reactions and bleeding disorders. This article reviews the mechanism of action of NSAIDS as well as common or severe ocular and systemic side effects.


Ontogeny of glutamine transport by rat liver plasma membrane vesicles.

Glutamine metabolism in the liver is essential for gluconeogenesis and ureagenesis. During the suckling period there is high hepatic protein accretion and the portal vein glutamine concentration is twice that in the adult, whereas hepatic vein glutamine concentration is similar between adult and suckling rats. Therefore, we hypothesized that glutamine uptake by the liver could be greater in the suckling period compared to the adult period. The present studies were, therefore, designed to investigate the transport of glutamine by plasma membranes of rat liver during maturation (suckling--2-week old, weanling--3-week old and adult--12-week old). Glutamine uptake by the plasma membranes of the liver represented transport into an osmotically sensitive space in all age groups. Inwardly directed Na+ gradient resulted in an "overshoot" phenomenon compared to K+ gradient. The magnitude of the overshoot was greater in suckling rats plasma membranes compared to adult membranes. Glutamine uptake under Na+ gradient was electrogenic and maximal at pH 7.5, whereas uptake under K+ gradient was electroneutral. Glutamine uptake with various concentrations of glutamine under Na+ gradient was saturable in all age groups with a Vmax of 1.5 +/- 0.1, 0.7 +/- 0.1 and 0.5 +/- 0.06 nmoles/mg protein/10 seconds in suckling, weanling and adult rats, respectively (P < 0.01). Km values were 0.6 +/- 0.1, 0.5 +/- 0.1 and 0.5 +/- 0.1 mM respectively. Vmax for Na(+)-independent glutamine uptake were 0.6 +/- 0.1, 0.55 +/- 0.07 and 0.54 +/- 0.06 nmoles/mg protein with Km values of 0.54 +/- 0.2, 0. +/- 0.1 and 0.5 +/- 0.2 mM, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


The development of corticosteroid binding globulin-like activity in fetal sheep blood.

Parturition in sheep is initiated by the fetus and is preceded by a rise in fetal cortisol and corticosteroid-binding globulin (CBG) late in gestation. In this study plasma cortisol and CBG concentrations were measured in fetal and maternal circulation from 40 days gestation to early post-partum. The fetal cortisol profile was shown to be triphasic in nature; being high in both the first and last trimester but low in the middle period of gestation. In the last trimester, total cortisol increased steadily, reaching it's highest level just prior to parturition (145 days gestation), before falling to maternal levels over the first 10 days post-partum. The changes seen in CBG concentrations throughout gestation and post-partum mirrored the triphasic nature seen in cortisol levels. CBG was significantly higher at 40, 56 and 140 days gestation than at mid-gestation (77 and 90 days). However, at 145 days gestation there was a significant fall in CBG levels. CBG levels were higher at 1 day post-partum when compared to 145 days gestation, the former rapidly falling to maternal levels over the subsequent 9 days. The maximum binding capacity at 40, 56, 70 and 90 days gestation exceeds the total serum cortisol concentration. However at 140 and 145 days gestation and 1 day post-partum the total serum cortisol exceeds the Bmax. The highest cortisol:Bmax ratio is seen at 145 days gestation due to the fall of CBG binding capacity at this time.(ABSTRACT TRUNCATED AT 250 WORDS)


The retino-hypothalamic tract is involved in prolactin regulation in fetal sheep.

To investigate the role of the retino-hypothalamic tract on fetal prolactin regulation, we examined the effect of ocular enucleation on fetal plasma prolactin. Eleven fetuses of Suffolk ewes were chronically catheterized during fall, and six of them were subjected to bilateral ocular enucleation. All ewes were kept at 12h:12h light:dark cycle (lights on at 0800 and off at 2000). The experiments were performed 5-9 days after surgery (GA control fetuses 125 +/- 1.5, optical enucleation 121.3 +/- 1.5 days). Blood samples were taken from fetuses hourly around the clock, and plasma prolactin and cortisol were measured by radioimmunoassay (RIA). Luteinizing hormone (LH) and Growth hormone (GH) were measured in pooled plasma samples from control and enucleated fetuses by RIA. Average plasma prolactin was 5-fold lower in enucleated than in control fetuses (9.6 +/- 0.5 and 54.2 +/- 3.3 ng/ml, SEM; P < 0.005). Both control and enucleated fetuses presented circadian rhythm of prolactin with acrophase between 1400 and 1830 h. An enucleated fetus was tested for response of prolactin to TRH. Prolactin increased as described in the literature. There was no change in plasma concentration of cortisol, LH or GH after ocular enucleation. Our data indicate that the optical pathway participates in prolactin regulation in the fetal sheep.


Renin-angiotensin and autonomic mechanisms in cardiovascular homeostasis during haemorrhage in fetal and neonatal sheep.

The present study examined the roles of the renin-angiotensin and autonomic nervous systems in cardiovascular homeostasis during slow progressive haemorrhage (20% of measured blood volume over 1h) in fetal (128-132 and 143-148 days gestation) and neonatal (5-9 and 12-20 days post-natal) sheep. Basal plasma renin activity (PRA) was not significantly different in the 4 sheep groups and increased to a similar degree (approximately 2 to 3-fold) during haemorrhage. Mean arterial pressure (MAP) exhibited modest falls in response to haemorrhage in all sheep groups and while heart rate (HR) was well maintained in the fetal groups there was a tendency to bradycardia in neonates. None of these responses was significantly different in age-matched fetal sheep subjected to bilateral vago-sympathectomy, cervical cord transection or bilateral nephrectomy, with the exception of PRA in the latter group which was close to zero throughout. Treatment with the angiotensin II (AII) antagonist, (Sar1-Ala8) AII (Saralasin), significantly increased basal PRA in both fetal and neonatal sheep (approximately 5 to 7-fold). The PRA response to haemorrhage was absent in neonatal sheep treated with Saralasin but significantly increased in fetal sheep. Saralasin significantly reduced resting MAP in both sheep groups and increased the hypotensive and bradycardic effects of haemorrhage in neonatal (approximately 3 to 5-fold) but not fetal sheep. It is concluded that in the perinatal period studied, fetal and neonatal sheep are equally well able to maintain cardiovascular homeostasis in response to moderate haemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)


Glucocorticoids accelerate the ontogenetic transition of cardiac ventricular myosin heavy-chain isoform expression in the rat: promotion by prenatal exposure to a low dose of dexamethasone.

Cardiac myosin heavy chain expression undergoes a perinatal transition from predominance of beta-MHC to alpha-MHC. In the current study, we tested the effects of glucocorticoids in this early transition period, by treating pregnant rats with dexamethasone on gestational days 17, 18 and 19, using doses below (0.05 mg/kg), at (0.2 mg/kg) or above (0.8 mg/kg) the threshold for growth retardation. Cardiac MHC isoforms were resolved with a denaturing SDS-PAGE system, followed by quantitative densitometry. In normal animals alpha-MHC was only 10% of the total on gestational day 18 but rose to 35% by postnatal day 1, and to 95% by the end of the first month postpartum. During the early phase of this transition, the lowest dose of dexamethasone significantly promoted alpha-MHC expression without inhibiting body or heart growth; regression analysis indicated a 40% increase in the slope of MHC isoform transition with respect to tissue weight. In contrast, the higher, growth-retarding doses of dexamethasone either failed to enhance alpha-MHC expression or caused biphasic changes, with inhibition at ages corresponding to the onset of weight deficits; regression analysis indicated that the effects of the higher doses on MHC could all be accounted for by changes in tissue weight. Glucocorticoid levels rise substantially in the period surrounding parturition, and serve to program the development and coupling of adenylate cyclase to membrane receptors; because adenylate cyclase has been shown to elicit the beta-MHC to alpha-MHC transition in vitro, our results suggest that glucocorticoids, along with thyroid hormone and beta-adrenergic stimulation, influence the ontogenetic program of MHC isoform transition.(ABSTRACT TRUNCATED AT 250 WORDS)


Formation of vasculo-syncytial membranes in the human placenta.

Vasculo-syncytial membranes are localised areas of the placental villous membrane where the thickness of the barrier separating the maternal and fetal circulations is reduced to as little as 1-2 microns. Consequently, they are believed to be important sites for diffusional exchange. The morphological appearances suggest that they are caused by the obtrusion of locally dilated segments of the fetal capillaries into the trophoblast layer. This study sought quantitative evidence for the hypothesis by performing stereological analyses on vasculo-syncytial membranes at the electron microscopic level. The results confirmed that a strong relationship existed between the thickness of the capillary endothelium and that of the overlying stromal and trophoblastic tissue at these sites (r = 0.47, P < 0.001), indicating that some asymmetrical stretching or remodelling of the capillary wall was involved. Comparisons were also made between the thickness of the trophoblastic, stromal and endothelial components of the villous membrane in villi obtained from the central and from the peripheral parts of placental lobules, where vasculo-syncytial membrane formation is accentuated. The mean thickness of each component was lowest in the samples from the peripheral region, although the differences only proved to be statistically significant for the stromal layer (P = 0.01). Both sets of data lend quantitative support to the hypothesis that vasculo-syncytial membrane formation is the result of obtrusion of locally dilated segments of the fetal capillaries. The way in which this may be linked to changes in the dynamics of the fetal circulation as gestation advances is discussed.


Effect of NH4Cl acidosis on the function of renin-angiotensin-aldosterone system in newborn infants.

The present study was undertaken to assess the influence of acute metabolic acidosis on the activity of renin-angiotensin-aldosterone system and renal function in a group of seven one-week-old neonates with mean birth weight of 2164 g (range: 1300-3750 g) and mean gestational age of 34 weeks (range: 28-40 weeks) undergoing oral NH4Cl load. NH4Cl was given in a dose of 2.8 mEq/kg to evaluate renal acidification. Prior to and following NH4Cl administration blood acid-base parameters, plasma urinary electrolytes, creatinine and aldosterone concentration as well as plasma renin activity, glomerular filtration rate, urine flow rate and net acid secretion were measured. NH4Cl administration significantly depressed blood pH (P < 0.05), total CO2 content (P < 0.01) and base excess (P < 0.01) and resulted in a significant elevation of plasma potassium concentration (P < 0.05). Furthermore, NH4Cl ingestion significantly increased urine flow rate, sodium, chloride and net acid excretion. In response to NH4Cl acidosis no consistent change in plasma renin activity and plasma aldosterone concentration could be detected. There was, however, an about 50% increase in urinary aldosterone excretion from the control value of 4.1 +/- 1.2 micrograms/day to 6.8 +/- 2.3 micrograms/day (P < 0.05) after NH4Cl administration. These data suggest that the responsiveness of neonatal adrenals to stimulation by metabolic acidosis is blunted, acidosis therefore, may play a minor role in the neonatal hyperfunction of renin-angiotensin-aldosterone system.


The effect of sulphonylurea therapy on serum total cholesterol and high density lipoprotein cholesterol.

A study was conducted on 50 cases comprising 25 patients of non-insulin dependent diabetes mellitus and 25 age and sex matched normal individuals. The diabetic state of the patients was controlled by glibenclamide, a sulphonylurea. The levels of serum total cholesterol and high density lipoprotein cholesterol were measured at the start and 15 and 30 days after glibenclamide therapy. There was a significant (p < 0.001) decrease in the levels of serum total cholesterol from initial 222.96 +/- 31.04 mg% to 218 +/- 28.99 mg% after 15 days and to 211.8 +/- 28.42 mg% after 30 days of therapy. In no case there was increase in serum total cholesterol level. There was a significant (p < 0.001) increase in the levels of serum high density lipoprotein cholesterol from initial 20.96 +/- 4.59 mg% to 21.8 +/- 4.78 mg% after 15 days to 23.72 +/- 5.07 mg% after 30 days of glibenclamide therapy and no case showed a fall in serum high density lipoprotein cholesterol level. This favourable alteration in serum total cholesterol and high density lipoprotein cholesterol was observed in patients of non-insulin dependent diabetes mellitus having ischaemic heart disease as well.


Cervical status as a predictor of preterm labour.

A study was conducted on 140 pregnant women at and after 28 weeks of pregnancy for finding out the relationship of cervical length and position with onset of preterm labour. Incidence of preterm labour was significantly higher (p < 0.001) in women with central position of cervix (54.67%) than that with posterior position of cervix (10.77%). Onset of preterm delivery was closely related to cervical length of 2.5 cm or less irrespective of central (82.75%) or posterior (20%) position of cervix (p < 0.001).


Role of histopathology in the diagnosis of tuberculous synovitis.

A study was conducted on 70 cases of tuberculous synovitis. Maximum number of cases were in the age group of 11-30 years (58.58%) with a male preponderance. Knee joint was found to be most commonly (57.12%) affected. Diagnosis of tuberculous synovitis was possible clinically in 75.72% and radiologically in 67.14% of cases only. Histopathological studies made on biopsy materials obtained from synovial membranes of the affected joints showed the presence of fibrosis, lymphocytic infiltration and epithelioid cells forming typical granuloma of tuberculous lesion. Proliferation of synovial membrane (92.85%), increased number of mast cells (82.95%) and caseation (78.57%) were observed. In all the cases the synovial membrane was of greyish white appearance.


The reliability of urinary cytology in the detection of tumours of urinary bladder.

Detection of urinary bladder tumours by cytological examination of urine was carried out on 193 patients suffering from haematuria. The patients comprised 149 new cases and 44 follow-up cases previously diagnosed as bladder cancer. Urinary bladder malignancy was detected in 72 of new cases and 20 of follow-up cases by cytological examination of urine. Reliability of the findings was checked by histopathological examination of the biopsy material removed from bladder by cystoscopy which detected malignancy in 84 of new cases and 16 of follow-up cases. Thus the sensitivity of cytological examination of urine in detecting bladder malignancy was 92% and specificity of 88%. False positive result was 4% and false negative result was 12%.


Prediction of recovery of Bell's palsy from clinical manifestations.

Sixty patients of Bell's palsy aged between 8 and 72 years, comprising 31 males and 29 females, were studied clinically to find out a method of prediction of recovery in early stage. It was found that young patients with incomplete palsy, unaccompanied by postauricular pain, loss of taste sensation over anterior 2/3rds of tongue hyperacusis and dry eye and recovery beginning within 4 weeks of onset of palsy are likely to make complete recovery, while older patients with complete palsy accompanied by severe postauricular pain, loss of taste sensation, hyperacusis and dry eye and beginning of recovery after 4 weeks of onset of palsy are most likely to have incomplete recovery.


A study of urinary fistulae in Sokoto, Nigeria.

A retrospective study was conducted on 361 women to evaluate the factors influencing the development of urinary fistula. Primipara women (69.8%) in the age group of 15-19 years (51.52%) with a height less than 150 cm (68.14%) were most frequently affected. Prolonged labour (82.79%), spontaneous delivery (57.92%) and delivery by forceps and craniotomy (31.12%) were the most common obstetric causes. Operation by native doctors and lymphogranuloma venereum were responsible for 3.32% and 0.55% cases respectively. Juxtra-urethral fistulae (54.84%) were the commonest type and the size of fistulae ranged from 0.5-1 cm in 65.92% of cases. Of the associated conditions pelvic abnormality was most frequently (45.8%) observed followed by urinary tract infection (26.2%), ammoniacal dermatitis of vulva (22.19%), nerve palsy (20.26%), involvement of rectum and anus (10.5%), gynatresia (9.97%), cystolithiasis (7.4%), secondary amenorrhoea (4.15%) and pregnancy (3.1%). Absence of formal education and presence of poverty were observed in 95% and 75% of cases respectively.


Fibrocalculus pancreatic diabetes in western Orissa.

Skiagram proved 35 cases of fibrocalculus pancreatic diabetes in order to analyse the clinical profile and its correlation with different descriptive epidemiological parameters were studied. Mean age was 25.17 +/- 7.85 years and male to female ratio was 6:1; 65.7% patients were poor (income < Rs 500 per month) and another 28.6% having average income (Rs 500 to Rs 1,000 per month); 74.3% came from rural areas having a family size of about > or = 7 members and sanitation was poor in all the cases. Mean body mass index was 15.93 +/- 3. Severe diabetes (ie, fasting blood sugar level > 251 mg%) and moderately severe diabetes (ie, fasting blood sugar level > 181 mg% but < 250 mg%) were noted in 51.4% and 11.4% cases respectively. Recurrent pain abdomen, infections, neuropathy, retinopathy, nephropathy and keto-acidosis were observed in 52.2%, 40.0%, 42.9%, 8.6%, 11.4% and 2.9% cases respectively. Mean soluble insulin requirement was 41.81 +/- 13.94 units. Four cases in whom pancreatic lithotomy was done, showed less insulin requirement and disappearance of pain. Parotid swelling, chronic diarrhoea and insulin resistance were not observed. Insulin requirement, epidemiological and biochemical parameters were similar to other young diabetics.


Septic cavernous sinus thrombophlebitis: a review of 35 cases.

Thirty-five cases of septic cavernous sinus thrombophlebitis seen over the past 5 years are reviewed. Of these 80% were secondary to infection of the medial 1/3rd of the face. In more than 2/3rds of the cases the infecting organism was Staphylococcus aureus. Even with appropriate antibiotic therapy the overall mortality was 34.3%.


Demographic survey of opinions towards smoking: a pilot study.

A survey was conducted by means of a questionnaire, on 865 smokers to analyse their opinions towards some general aspects of smoking. The subjects were mostly males (97.11%) and belonged to the age group of 21 to 50 years (80%). Heavy smoking is injurious to health is the opinion of most of the smokers (90.41%) particularly when maintained with other addictions (80%); tobacco is harmful not only when smoked but also when used in other forms (63%) and moderate smoking may not be much harmful (43%). However, smoking is not necessary to make or maintain relations with others (70%). Statutory warning has no marked effect on the habit (69.83%), the role of legal restrictions is dubious but advertisements encourage the habit definitely (62.54%). Three out of 4 persons know the problems of smoking and almost the same proportion of the people think that smoking can be stopped or at least checked. But there is difference of opinion about the person to be consulted, if any such problems arises from the habit of smoking. Family physicians may play an important role in controlling the habit.


Vaginal hysterectomy: a new technique of vault closure.

The study was conducted on 200 patients undergoing vaginal hysterectomy at the Lokmanya Tilak Municipal General Hospital, Sion, Bombay over a period of 2 years from January 1988 to December 1989. A new technique of vault closure in 150 patients was compared with that of classical and Heaney's technique 25 cases each. Only 9.33% patients undergoing new technique belonged to the age group of 60 years and above. Out of 150 patients in the new technique 70 belonged to gravida III and IV. Using this new technique it was possible to decrease the average operative time by 5 to 15 minutes and the hospital stay by 2 full days. The postoperative febrile morbidity in the new technique group was 2.66% and 6 patients (3.99%) had significant haemorrhage. Three patients had vault infection contrasting with a significantly higher incidence in other two groups and 1.33% of cases (2/150) had fimbrial prolapse as against 12% incidence with Heaney's technique.


Patient and nurse evaluation of patient-controlled analgesia delivery systems for postoperative pain management.

Five different patient-controlled analgesia (PCA) delivery systems were evaluated for the treatment of acute postoperative pain in 423 patients undergoing elective operations at a large tertiary care hospital. The PCA trial was conducted on four different postsurgical wards over a 5-mo period. All five devices were utilized on each ward for a 1-mo period. According to the nurses, the mean time (+/- SD) required to become comfortable using the Pharmacia Deltec CADD-PCA was significantly longer (50 +/- 37 min) than that using the Abbott Lifecare Plus (19 +/- 17 min), Bard PCA I (17 +/- 14 min), IVAC PCA (17 +/- 14 min), or Baxter PCA Infusor (7 +/- 8 min). With respect to ease of documentation by the nursing staff, the Baxter device was superior to the Pharmacia device. Similarly, mechanical problems were less frequent with the Baxter (6%) compared with the Pharmacia device (71%). The patients felt that the nurses were more comfortable using the Baxter device than the Pharmacia device. The patients also found the Baxter device easier to use, especially at night, and the least likely to interfere with ambulation. In conclusion, 80% of the nurses at this teaching center preferred the Baxter PCA Infusor over four widely used electronic PCA devices for the management of acute postoperative pain. The Pharmacia device was felt by the nurses to be less user friendly than the other programmable PCA devices used in this trial. Of the electronic devices we studied, the Bard and IVAC devices were the most cost-effective.


Effects of a single oral dose of desipramine on postoperative morphine analgesia.

Drugs that block norepinephrine reuptake offer promise as opioid potentiators, because norepinephrine mediates opioid analgesia but not side effects such as sedation or nausea. In a two-by-two factorial design, we randomized 62 inpatients with pain following major surgery to receive either desipramine, 50 mg by mouth, or placebo at 6 a.m. on the first day after surgery. At their first request of pain medication after 8 a.m., they were given intravenous morphine, either 0.033 mg/kg or 0.10 mg/kg. Pain relief and side effects were assessed for 4 hr; peak relief on the visual analog scale (VAS) was the primary outcome variable. Pain relief, side effect scores, and time to remedication were significantly greater with the higher dose than with the lower dose of morphine, verifying assay sensitivity, but desipramine pretreatment did not significantly enhance morphine analgesia. The mean increase in peak VAS relief score after desipramine pretreatment, relative to placebo, was 6%; the 95% confidence interval for this estimate ranged from a 21% reduction to a 34% increase in pain relief. These results differ from a previous report that 1 week of pretreatment with desipramine, 75 mg per day, potentiated postoperative morphine analgesia. We conclude that if desipramine potentiation of opioid analgesia occurs in humans, its demonstration may require higher doses or chronic treatment.


A survey of complications documented in a quality-control analysis of patient-controlled analgesia in the postoperative patient.

Patient-controlled analgesia (PCA) has become a cornerstone of postoperative pain management in many institutions. Despite the extensive use of this analgesic technique, there are not large population studies to determine the frequency or types of complications associated with PCA in the literature. This study looks at 1122 patients over a 1-yr period. Eight significant complications associated with PCA use were noted during this period. These complications were attributable to overdosage (escalating dosage to meet patient analgesic needs or someone other than the patient administering drug through the PCA device) or to interaction of PCA drugs with concurrent medications. There was a much higher incidence of complications associated with PCA pumps featuring continuous infusion in addition to intermittent bolus compared with those employing intermittent bolus alone. The types of complications encountered in this survey demonstrate instances of PCA use that may present a higher risk to the patient and thus require closer monitoring.


Pain profiles of patients with nonorganic chest pain: a preliminary report of the Multidimensional Pain Inventory.

The primary purpose of this report is to extend the range of the Multidimensional Pain Inventory (MPI) to include patients with nonorganic chest pain. Previous research with the MPI has not included this patient population, although this instrument has been used to derive an empirically based taxonomy of patient responses to chronic pain. Scale scores are provided for a sample of 43 chest pain patients and compared with normative scores from samples of chronic lower back pain patients and patients suffering from temporomandibular disorder. The MPI taxonomy was applicable for only 34.8% (N = 15) of this sample. Scale intercorrelations are examined and compared with those derived during development of the MPI, to explore reasons for this low classification rate. The results are discussed in light of cognitive-behavioral factors present in persistent chest pain, with implications for scale development and use of the MPI.


Level of cancer pain knowledge among baccalaureate student nurses.

Inadequate nursing education is a major impediment to effective pain relief for cancer patients throughout the world. This study was conducted to identify the level of cancer pain knowledge among baccalaureate student nurses and to determine whether specific activities affect this level of knowledge. Two questionnaires were administered to 82 baccalaureate student nurses in the final course of their program. Although the students displayed a realistic perspective about the severity and prevalence of cancer pain and psychological dependence, specific knowledge deficits and negative attitudes suggest the possibility of inadequate pain management. Specifically, the students believed that (a) maximal analgesic therapy should be delayed until the patient's prognosis was less than 12 months; (b) the proportion of patients whose pain can be controlled by appropriate therapy is less than is possible; (c) increasing pain is related to tolerance rather than to progression of the disease; (d) the preferred route of administration is intravenous rather than oral; and (e) the degree of respiratory depression, rather than constipation, does not decrease with repeated administration. Significant positive correlations (P < or = 0.05) were found between age and cancer pain knowledge and between attendance at seminars/workshops and time spent reading professional journal articles. Of the 30% of the participants who perceived a particular person to be a source for obtaining information about cancer pain management, 52% specified a practicing registered nurse. Seminars and workshops were chosen by 59% of the students as the most effective way for nurses to increase their knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)


Pain relief: the perspective of Catholic tradition.

Efforts to study patient care from the perspective of Catholic ethics date back four centuries. In the course of this history, a prominent issue has always been management of pain and the efforts to avoid pain. Thus, Catholic theologians were concerned about the effects of pain medication upon the psychic function and considered whether or not hastening death for suffering people was allowed and the ethical norms for using opioids to remove pain when death is imminent. Moreover, the issue of "overmedication" for difficult or elderly patients has been a concern. The President's Commission on Ethics in Medicine and Human Research has utilized many of the principles developed by Catholic theologians when considering the matter of pain relief for dying persons.


Benzodiazepines for acute pain in children.

When pediatric pain is refractory and unresponsive to appropriate use of analgesic agents, there might be additional physical or psychologic dimensions of the pain that are not addressed by the analgesics. In addition to appropriate analgesic therapy, the psychologic needs of the child should be directly addressed and appropriate adjunctive physical modalities employed. Although benzodiazepines lack direct analgesic effects, they can reduce the distress associated with acute pain states by decreasing anxiety, insomnia, and muscle spasms that can be associated with acute pain. Intermediate or long-acting benzodiazepines in modest doses can be useful adjunctive agents when used short term for the treatment of selected acute pain complaints. In the highly distressed school-age child or adolescent with pain complaints relatively unresponsive to appropriate care, judicious use of benzodiazepines is worthy of consideration.


Expression of IgA and IgM Fc receptors on murine T lymphocytes.

Fc receptors are induced on T cells following activation via the TCR. T cells that express Fc receptors transiently have the ability to use two different cognate systems: the TCR and immunoglobulins bound to the Fc receptors. The studies discussed in this article are focused on the Fc alpha and Fc mu receptors that can be induced on certain subsets of murine T lymphocytes. The article emphasizes the role of the T cell receptor for antigen in the expression of Fc alpha and Fc mu receptors on murine T cells and reviews experimental observations that suggest significant molecular heterogeneity of these Fc receptors. The finding that regulation of expression of Fc alpha receptors and Fc mu receptors on T lymphocytes is linked to cellular activation via the CD3/TCR complex implies that these Fc receptors might mediate important functions in the biology and pathology of T cells.


Murine soluble Fc gamma receptors/IgG-binding factors (IgG-BF): analysis of the relation to Fc gamma RII and production of milligram quantities of biologically active recombinant IgG-BF.

The production of soluble forms of low-affinity Fc gamma R by cells expressing recombinant or natural membrane Fc gamma RII, and the structural relationships between these soluble receptors and membrane Fc gamma RII are described. We show that 37-40 kD soluble Fc gamma RII, corresponding to the two N-terminal domains of Fc gamma RII and binding to IgG, are spontaneously produced in vitro by cleavage of membrane Fc gamma RII. Moreover, we describe methods to produce and purify to homogeneity large quantities of endotoxin-free recombinant IgG-binding factor (rIgG-BF) from the culture medium of a cell line transfected with a mutated Fc gamma RII cDNA. These methods include the use of bioreactors for culturing transfected fibroblasts and the purification of rIgG-BF by ion-exchange chromatography and hydrophobic-interaction chromatography. By using such procedures, about 2.4 mg of rIgG-BF were purified from 1 liter of culture medium of transfected fibroblasts. Like natural IgG-BF, the 95-99% pure rIgG-BF suppressed, in a dose-dependent manner, secondary in vitro IgG antibody responses to sheep red blood cells.


Regulation of the expression of murine alpha- and beta-Fc gamma R genes.

Murine low-affinity receptors for the Fc portion of IgG are of two types: Fc gamma RII and Fc gamma RIII. Murine Fc gamma RII and III have 95% homologous extracellular (EC) domains and bind the same ligands, but different transmembrane (TM) and intracytoplasmic (IC) domains. They, however, have unrelated TM and IC domains. Murine Fc gamma RII are single-chain receptors, encoded by the beta-Fc gamma R gene. Murine Fc gamma RIII are composed of two subunits: the ligand-binding alpha-subunit, encoded by the alpha-Fc gamma R gene and the gamma-subunit, encoded by another gene which belongs to a family of genes encoding dimeric subunits of multichain receptors. The expression of murine Fc gamma RII and Fc gamma RIII depends on a number of mechanisms which do the following: (1) determine the tissue-specific expression of the alpha- and beta-Fc gamma R genes by selectively unmethylating DNA in specific 5' sequences in different cell types; (2) regulate the initiation of the transcription of the alpha- and beta-Fc gamma R genes via several transcription factors; (3) up- and downregulate the amount of alpha- and beta-Fc gamma R transcripts in response to cytokines; (4) decide the alternative splicing of IC exons of the beta-Fc gamma R gene and generate the different Fc gamma RII isoforms; (5) possibly regulate the translation of alpha- and beta-Fc gamma R transcripts in different cells; (6) control the assembly of the Fc gamma RIII subunits and their membrane insertion, and (7) determine the turnover of Fc gamma RII and III in the presence and absence of ligands by affecting the internalization, shedding and proteolytic cleavage of the receptors. These mechanisms altogether contribute to make a variety of cells capable of responding differently to antigen-antibody complexes, depending on environmental stimuli.


Fc gamma receptors in cancer and infectious disease.

Through interaction with antibody, IgG Fc receptors provide an interface between specific humoral immunity and Fc gamma R-bearing host cells. Fc gamma R trigger such diverse functions as immune complex clearance, phagocytosis of opsonized pathogens, reactive oxygen intermediate and enzyme secretion, and antibody-dependent cellular cytotoxicity (ADCC). Moreover, Fc gamma R are the exclusive trigger molecules for tumor cell killing by human myeloid cells. Studies of Fc gamma R function have been aided by the use of bispecific antibodies to link cells or pathogens to specific host cell molecules, including Fc gamma R. These reagents have permitted determination of the role of Fc gamma R in ADCC of the protozoan, Toxoplasma gondii, by human effector cells. This approach has also indicated that Fc gamma R do not serve as entry points for viruses such as dengue virus and HIV. Taken together, these results provide insight into the utility of manipulating Fc gamma R function in the therapy of cancer and infectious disease.


Fc gamma receptors: gene structure and receptor function.

Molecular studies of murine Fc gamma R have revealed much exciting new information about the structure and regulation of Fc gamma RI and Fc gamma RII genes and of the Fc gamma RI protein. The Fc gamma RI gene is composed of six exons, whereas the Fc gamma RII gene is composed of ten. The extracellular domains are encoded by individual exons in both genes (three in Fc gamma RI and two in Fc gamma RII); however, the Fc gamma RII gene shows greatest complexity in the region encoding the cytoplasmic tail and membrane spanning region, which is encoded by four exons compared to only one in the Fc gamma RI gene. Expression of Fc gamma RII is controlled by elements within the first 641 bases upstream of the transcription initiation site. The function of the domains of Fc gamma RI has been defined with the surprising finding that in the absence of the third domain the first two extracellular domains function as a broadly specific low affinity Fc gamma RII-like receptor.


Functional capacity of Fc gamma receptor III (CD16) on human neutrophils.

Receptors for the Fc region of immunoglobulin G (IgG) are a structurally diverse group of molecules. Within the three Fc gamma R families (Fc gamma RI, Fc gamma RII and Fc gamma RIII), the presence of distinct genes and alternative splicing variants leads to a variety of receptor isoforms that are most strikingly different in the transmembrane and intracellular regions. An obvious example of structural variation in the transmembrane and cytoplasmic domains is observed in the Fc gamma RIII family. Fc gamma RIIIB, which is nearly identical to Fc gamma RIIIA in the extracellular domains, lacks both transmembrane and cytoplasmic protein domains and is anchored to the cell through a glycosyl phosphatidylinositol anchor. Analysis of Fc gamma RIII function presents a considerable challenge in understanding the role of different Fc gamma R receptors in polymorphonuclear neutrophil (PMN) function. While one hypothesis for the role of Fc gamma RIII in Fc gamma R-dependent PMN effector functions is that Fc gamma RIII serves as a binding molecule which focuses the IgG ligand for more efficient recognition and intracellular signaling by Fc gamma RII, recent observations from a number of laboratories suggest that Fc gamma RIII on PMN can transduce signals across the membrane independent of ligand-dependent engagement of Fc gamma RII. We will review these data and present recent data which suggest that the role of Fc gamma RIII extends beyond direct initiation of functions to a more complex role of synergistic receptor interactions. These findings will be reviewed in the context of the experimental approaches that have been used to examine the roles of Fc gamma RII and Fc gamma RIII on PMN function.


Eosinophil IgE receptor and CD23.

In the present review, eosinophil Fc epsilon RII was compared to CD23, a differentiation marker of B cells. Biochemical analysis revealed that molecules of similar molecular weight were immunoprecipitated from eosinophils and B cells by an anti-CD23 monoclonal antibody (mAb) or by BB10, and anti-eosinophil Fc epsilon RII. By flow cytometry, a correlation was found between the binding of anti-CD23 mAb and myeloma IgE. However, a low expression of different epitopes of CD23 was observed in various hypereosinophilic patients. Northern blot analysis of eosinophil RNA with the cDNA probe of CD23 revealed a weak message in only 3 of the 6 patients expressing membrane CD23. The inhibition by anti-CD23 mAbs of IgE-mediated cytotoxicity and IgE binding to eosinophils clearly indicated the participation of CD23 or a related molecule in IgE-dependent eosinophil functions. However, the differential effects of anti-CD23 mAbs on eosinophils and B cells suggest major differences in the characteristics of the molecule expressed by eosinophils and by B cells.


Expression, regulation and function of human Fc epsilon RII (CD23) antigen.

CD23, also known as the low affinity receptor for IgE (Fc epsilon RII), belongs to a novel superfamily of type-II integral membrane proteins. Fc epsilon RII expression was originally described on B cells but subsequent studies showed that CD23 is expressed on a variety of hematopoietic cells and is regulated by several cytokines (i.e., interleukin-4, interferons) in a tissue-specific manner. In some pathological conditions such as B-chronic lymphocytic leukemia, the CD23 gene is abnormally regulated resulting in CD23 overexpression. CD23 is not only an IgE receptor but also a membrane-bound precursor of soluble molecules that still bind IgE (sCD23 or IgE-binding factors). The functions of membrane CD23 are IgE-dependent and vary according to the cell types on which it is expressed. In contrast, sCD23, in addition to being an IgE regulatory molecule, displays multiple cytokine activities that are IgE-independent.


Receptors for IgA on phagocytic cells.

IgA receptors have been detected on monocytes, polymorphonuclear neutrophils (PMNs) and eosinophils, and on phagocytic cells at mucosal sites. These receptors bind both secretory and serum forms of immunoglobulin A (IgA) and require the Ca2 region of the IgA molecule for ligand recognition. Monocytes and PMNs modulate their expression of the IgA receptor upon treatment with cytokines, such as granulocyto-macrophage colony-stimulating factor, and lipopolysaccharide. Purified IgA receptors appear as heavily glycosylated molecules with an average molecular weight of 60 kD, dropping to 32 and 36 kD upon treatment with N-glycanase. The cDNA sequence encoding the IgA receptor has been determined by expression cloning, and predicts that the receptor consists of two Ig-like extracellular domaines, a transmembrane region and a cytoplasmic tail of 41 residues. Ligation of IgA receptors on phagocytic cells by multivalent IgA complexes induces a variety of responses, including superoxide generation, release of inflammatory mediators, phagocytosis, and killing of various pathogenic microorganisms. Thus the apparent role of these receptors is to amplify the protective effects of the IgA antibody, a function of potential importance to mucosal defense.


FcR may function as a progression factor of nonlymphoid tumors.

Tumor progression is a multistep process involving genetic and epigenetic changes in a transformed clone. Some of these changes may be induced by host factors which may also select for transformed cellular variants with a high ability to survive and propagate. In this article we review studies showing that receptors for the Fc portion of IgG may be expressed on cells from human or animal tumors of nonlymphoid origin. We also review data demonstrating that at least with respect to cells transformed in vitro with Polyoma virus, transformation per se is not sufficient for the induction of Fc receptor expression. We also summarize preliminary data showing that Fc receptor expression is causally involved in conferring a high malignancy phenotype upon transformed cells. Possible mechanisms to explain these observations are discussed.


In vitro inhibition of tumor B cell growth by IgG-BF-producing Fc gamma RII+ T cell hybridoma and by immunoglobulin G-binding factors.

The growth-modulating effect on mouse hybridoma B cells of IgG-BF-producing Fc gamma RII+ mouse T cell hybridomas and of the IgG-BF isolated from the culture supernatants of these cells has been examined. Cocultures of IgG-secreting hybridoma B cells with IgG-BF-producing T hybridomas or with partially purified IgG-BF demonstrated a reproducible inhibition of the tumor B cell growth. The inhibition was due to a cytostatic and not to a cytotoxic effect. Hybridoma B cells cultured in liquid medium in the presence of soluble IgG-BF, or cocultured in semisolid agarose assays with IgG-BF-producing hybridoma T cells did not undergo immediate cytolysis but were prevented from proliferating. Thus, our data indicate that IgG-BF-producing Fc gamma RII+ T cells interfere with the proliferation of transformed B cells, possibly through soluble IgG-BF.


Dehydroepiandrosterone protects mice inoculated with West Nile virus and exposed to cold stress.

The protective effect of pretreatment with dehydroepiandrosterone (DHEA) on stress-enhanced viral encephalitis was studied in mice exposed to cold following inoculation with West Nile virus (WNV). Exposure of WNV-inoculated mice to cold water (1 +/- 0.5 degrees C, 5 minutes/day for 8 days) resulted in a mortality rate of 83% as compared to 50% in nonstressed mice (p < 0.05). The effect of cold stress was more pronounced when mice were inoculated with WN-25, a noninvasive neurovirulent variant of WNV. Mice infected with WN-25 showed no mortality, whereas cold stressed mice inoculated with the same virus had a mortality rate of 67% (p < 0.05). The administration of DHEA (serial injections of 10-20 mg/kg with or without a loading dose of 1 gm/kg) resulted in a significant reduction in the mortality rate of stressed mice inoculated with either virus (p < 0.05). Virus levels in the blood and brain of the DHEA-treated mice, were significantly lower than in the control groups. DHEA also prevented the involution of lymphoid organs in stressed mice. The present study provides direct evidence of the protective effects of DHEA as an "anti-stress" agent. Its ability to prevent mortality associated with WNV or WN-25, and involution of lymphoid organs caused by stress-induced immunosuppression, supports the notion that its activity is based on the modulation of the host response.


Nested polymerase chain reaction for detection of human immunodeficiency virus type 1 DNA in clinical specimens.

A highly sensitive two-step polymerase chain reaction (PCR) method was evaluated for detection of human immunodeficiency virus type 1 (HIV-1) DNA in clinical specimens. The product resulting from the first amplification reaction is used as the template for the second PCR with an internal (nested) primer pair. Even when starting from a single copy of HIV-1 DNA, the double PCR product was readily detected by direct visualization in ethidium bromide-stained agarose gels. Amplification of minute amounts of HIV-1 DNA was successful in a considerable excess of HIV-1 negative DNA than reported previously. All of 85 HIV-1-infected individuals were PCR-positive with at least two of the three sets of primers used, 252 of 255 amplifications allowing unambiguous visualization of a unique DNA fragment of the expected size. The two-step amplification protocol is simple and rapid and fulfills the requirements of sensitivity and specificity for use in a clinical laboratory.


Detection of herpesvirus DNA in the large intestine of patients with ulcerative colitis and Crohn's disease using the nested polymerase chain reaction.

The prevalence of herpesvirus DNA was examined in inflammatory bowel disease tissue. DNA was extracted from resection and biopsy specimens of the large intestine from patients with ulcerative colitis (n = 21), patients with Crohn's disease (n = 29), and patients with noninflammatory bowel disease (controls) (n = 21). The nested polymerase chain reaction was used to detect viral DNA using primer pairs specific for either cytomegalovirus (CMV), herpes simplex virus 1 (HSV1), human herpesvirus 6 (HHV6), varicella zoster virus (VZV), or Epstein Barr virus (EBV). HSV1 and VZV DNA were not detected in any of tissue samples. There was a high prevalence of CMV (81%), HHV6 (76%), and EBV (76%) DNA in ulcerative colitis tissue compared to Crohn's disease tissues (CMV 66%, HHV6 45%, EBV 55%). Control tissue had a relatively low frequency of CMV (29%) and EBV (19%) DNA but a prevalence of HHV6 DNA similar to that of ulcerative colitis (86%). However, the simultaneous presence of HHV6 and CMV and/or EBV DNA in ulcerative colitis tissue (76%) was much greater than in either Crohn's disease tissues (38%) or control tissue (29%) (P < 0.05). There was a low prevalence of CMV, HHV6, and EBV DNA in peripheral blood mononuclear cells from all patient groups. CMV and EBV are capable of reactivating HHV6: the high prevalence of coexistent HHV6 infection with either or both of these two viruses in ulcerative colitis tissue suggests that they may play a synergistic role in the pathogenesis of this disease.


Persistent delta antigenaemia in chronic delta hepatitis and its relation with human immunodeficiency virus infection.

The prevalence of persistent hepatitis delta (HD) antigenaemia and associated factors in patients with chronic infection with the hepatitis delta virus (HDV) were investigated. Among 157 consecutive patients known to be carriers of hepatitis B surface antigen (HBsAg), 36 (23%) had one serum marker of HDV infection (anti-HD and/or HDAg). Nine of the patients with an HDV marker were HDAg positive, including three who were anti-HD negative. A follow-up over a mean period of 13 months showed that five of five patients had a persistent HD antigenaemia. This serological profile was associated with the presence of antibody to the human immunodeficiency virus (anti-HIV) (P < 0.01), serum HIV antigen (HIVAg) (P < 0.2), and the female sex (P < 0.05). Persistent HD antigenaemia could be the consequence of the suppression of T cell cytotoxic activity against hepatocytes expressing HDAg, a lower humoral response, and/or hormonal factors.


Imipenem and cefotaxime resistance: transduction by wild-type phages in hospital strains of Pseudomonas aeruginosa.

A wild-type bacteriophage appeared and was isolated from a Pseudomonas aeruginosa strain resistant to imipenem, cefotaxime, kanamycin and streptomycin (susceptible to carbenicillin, aztreonam, amikacin and fluoroquinolones). The best transducing properties were obtained with phage lysates prepared from bacteria growing on cefotaxime or imipenem. Transducing properties were found specific for individual recipient strain(s) susceptible to all drugs. A high-frequency of transduction was recorded for kanamycin and particularly for cefotaxime resistance determinants, followed by an imipenem determinant. This is now the fourth published wild-type bacteriophage, isolated from lysogenic nosocomial P. aeruginosa resistant to imipenem which was found to transduce this resistance determinant to susceptible pseudomonads.


In vitro activity of cefpirome (HR 810) against enterococci and staphylococci.

The inhibitory activity of cefpirome (HR 810), a new cephalosporin derivative for parenteral use, was tested by agar dilution methods against Enterococcus faecalis (100 strains), Staphylococcus aureus (40 strains) and coagulase-negative staphylococcal species (60 strains) in comparison with other beta-lactam antibiotics. For E. faecalis, the cefpirome minimum inhibitory concentration (MIC) range was 2-128 micrograms/ml, with an MIC50 of 8 micrograms/ml, and an MIC90 of 64 micrograms/ml. The optimal bactericidal activity against strains with MICs of < or = 8 micrograms/ml occurred at 2-4 times the MIC, and the reduction in the initial inoculum was 99.9-99.7% after 24 h incubation at these concentrations. Mec gene-negative staphylococci (both S. aureus and coagulase-negative species) had cefpirome MICs of 0.25-2 micrograms/ml (MIC50 0.5 microgram/ml, MIC90 1 microgram/ml). Mec gene-positive strains had MICs of 0.5-128 micrograms/ml (MIC50 2 micrograms/ml, MIC90 32 micrograms/ml). Strains with borderline resistance to oxacillin which did not harbor the mec gene and which were susceptible to cefpirome maintained their susceptibility even when high-density inocula were used and after several passages in media containing the antibiotic. These studies present some potential advantages of cefpirome over other cephalosporins in the inhibitory activity against Gram-positive cocci.


Antibacterial, antimycotic and trichomonicidal activity of a new nitroimidazole (EU 11100).

The antimicrobial profile of a new nitroimidazole derivative (5-nitro-1-methyl-imidazolyl-2-hydroxy-3 terbutylphenyl carbinol) has been studied. The in vitro activity of the new molecule has been evaluated against both aerobic and anaerobic bacteria, Trichomonas vaginalis, and mycetes, under suitable experimental conditions. The new compound was compared with ampicillin against aerobic bacteria; with metronidazole against anaerobic bacteria, lactobacilli and T. vaginalis; with nistatin and econazole against candida and with econazole and bifonazole against filamentous fungi. The new nitroimidazole derivative has been shown to be moderately active against some anaerobic bacteria belonging to both the Gram-positive and Gram-negative groups. Its inhibitory activity against T. vaginalis was similar to that of metronidazole.


Antimicrobial activity of benzydamine, a non-steroid anti-inflammatory agent.

The antimicrobial activity of benzydamine (BD), a non-steroid anti-inflammatory agent, was studied using different techniques against 38 strains belonging to 12 microbial species comprising bacteria, yeasts and a fungus. The minimum inhibitory concentrations, minimum lethal concentrations, per cent survivors after 30-minute exposure to BD (0.1%), growth curves of 7 selected organisms in subinhibitory BD concentrations and killing times for clinical isolates at different BD levels (0.05-0.15%) were determined. The data obtained throughout this study show that BD is a general antimicrobial agent with a rapid biocidal activity against a variety of organisms at concentrations less than those advocated for treatment of inflammatory conditions.


The efficacy and safety of once-daily ceftibuten compared with co-amoxiclav in the treatment of acute bacterial sinusitis.

The efficacy and safety of a once-daily oral regimen of 400 mg ceftibuten was compared with oral co-amoxiclav 500 mg three times daily in a multicentre, single-blind study. In patients with a bacteriologically confirmed infection, a successful clinical outcome was reported in 25 of 25 patients treated with ceftibuten and 10 of 10 patients treated with co-amoxiclav. In a further group of 88 patients, most of whom had been excluded from the primary efficacy evaluation because no pathogen was isolated pretreatment, overall successful clinical outcomes of 87% and 88% were reported for ceftibuten and co-amoxiclav, respectively. The duration of treatment and the time to resolution of the signs and symptoms of sinusitis were not significantly different in the two treatment groups. The incidence of adverse events was higher in the co-amoxiclav-treated patients (31% versus 15% in the ceftibuten group) as was the incidence of severe events (10% for co-amoxiclav-treated patients versus < 1% in the ceftibuten group). In summary, once-daily ceftibuten can be considered a safe and effective treatment for acute bacterial sinusitis.


AIDS patients with bacterial lower respiratory tract infections: treatment with ofloxacin versus sulbactam-ampicillin.

In this open-label, randomized, parallel-groups study the Authors compare the parenteral administration of a beta-lactamase inhibitor associated with a semisynthetic penicillin (sulbactam-ampicillin) with the oral administration of a 3rd-generation quinolone (ofloxacin), in 20 HIV-infected subjects suffering from lower respiratory tract (LRT) infections. 12 patients were classified as AIDS, 6 as ARC (AIDS related complex) and 2 as asymptomatic seropositives. The risk of becoming HIV-infected and the work load for the health staff were also evaluated. The clinical and microbiological results indicate that oral ofloxacin is as effective as parenteral sulbactam-ampicillin for the treatment of LRT infections in HIV-positive individuals. In addition, the members of the health staff reported significantly less difficulty in administering ofloxacin in respect to sulbactam-ampicillin.