[Lead concentrations in breast milk of women living in urban areas compared with women living in rural areas].

In the last twenty years a great interest has grown up about the accumulation of lead in the environment, because many studies have found relationship between exposure to low lead doses and neuropsychological impairment of children. The Authors have measured and then compared the lead content of milk from women living in city-areas and women living in rural areas, not having professional lead exposure. 34 samples of women milk from the rural areas and 20 samples from the city areas were examined: the lead mean concentration of the rural areas milk samples was 45.62 microgr/l with a range from 0 to 425 microgr/l; the mean concentration of the city areas samples was 126.55 microgr/l with a range from 1 to 472 microgr/l. The data were compared with the Student t-test and the difference was statistically significant at p = 0.01. The Authors examine the correlations between environmental lead accumulation and increased lead concentration in woman milk, laying stress on the possible hazard to health and neuropsychological development of children, mostly of those living in urban areas with heavy road traffic and industrial activity.


[Are metoclopramide dystonias familial?].

Metoclopramide is an antiemetic drug; the effects on CNS (acute dystonic reaction, tardive dyskinesia, parkinsonism) occur in only 1 of 500 patients treated. Acute dystonic reactions are not apparently dose-dependent and suggest individual sensitivity to the drug (idiosyncrasia). We report 4 cases in 2 families (grandmother-grandchild; brother-sister). We feel that, if there is a case of dystonic reaction to metoclopramide, this drug should not be administered to other members of the same family.


[Contribution of echography in the diagnosis of gastro-esophageal reflux in children].

56 children, aged between 0-13 month, affected by chronic vomiting were evaluated both with ultrasound and radiological methods, in a double blind study. 22/56 children resulted to be affected by gastro-oesophageal reflux (GER) with upper GI series versus 18/56 with ultrasound. Four cases, ultrasound negative and X-ray positive, represented a borderline situation in which a mild gastro-oesophageal reflux is to be considered paraphysiological phenomenon. The accuracy and handleness of ultrasound evaluation in GER are emphasized.


[Changes in the consciousness state as a symptom of intestinal invagination onset].

Intussusception is the most frequent cause of intestinal occlusion in children aged 3-5 years. Diagnosis is easy to perform in cases with typical clinical presentation. However diagnosis may be difficult in rare cases with atypical symptoms characterized by SNC involvement, that could delay a convenient treatment. We report 4 cases of intussusception presenting initially with consciousness abnormalities, hypotonia and vomiting. In these cases differential diagnosis with other conditions associated with comatose states has to be performed. Some hypothesis may be considered to explain these clinical pictures: 1. increased endorphins excretion during abdominal pain; 2. neurotoxins of bacterial origin released and absorbed by altered bowel; 3. intestinal hormones abnormally produced during the disease. As recommended by Rachmel, the condition should be suspected in all children presenting with the association of vomiting and lethargy and a radiological or tomographic study of abdomen should be performed also in cases without intussusception typical symptoms.


[Reproducibility of pediatric information collected with various methods: postal/telephone questionnaire and direct interview].

The paper reports on a research aimed to evaluate the repeatability of some paediatric data obtained from the parents by using different collection instruments: telephone interview, mail questionnaire, in-person interview. The study included 699 children consecutively born in the Policlinico Universitario "A. Gemelli" from September to November 1983. After 3 years a questionnaire containing questions about measles, anti measles immunization, age at which the baby started to walk, disease delaying the walking, and orthopaedic examinations was sent by mail to 149 families; the other 550 families were searched for by telephone and, if found, asked the same questions. All the contacted families were invited for a paediatric check-up, during which the same data were collected through direct interview. For each question crude agreement and K statistic (which controls for the agreement attributable to chance) were computed with respect to both the phone/direct and mail direct comparisons. 391 families (56%) were traced for the first interview, due to the high number of them which had moved home. Among these 289 (74%) attended the paediatric check-up. On the whole, rather high values of K statistic were observed, ranging from 0.59 (question on diseases delaying the walking, comparison phone/direct) to 0.93 (question on anti-measles immunization, comparison mail/direct). Due to the small sample size, the estimates concerning the comparison mail/direct are rather imprecise. Although its potential is limited by the low response rate, the study brings good evidence that the information considered is not sufficiently reliable when reported retrospectively by parents. However, the keeping of a prospective individual record containing data of medical interest should be encouraged.


[Indications for therapy of labial frenum].

Reporting some cases and literature researches, the Authors point out the indications of labial frenum therapy. The results show no correlations between teeth diastema and frenum: surgical therapy of frenum is recommended after complete eruption of permanent teeth. The correct surgical procedure must be radical and conducted in a short time: frenectomy prolonged to the incisive papilla, is recommended.


[Short lingual frenum: clinical and therapeutic considerations].

The Authors report researches on the tongue embryology. Real indications of the surgical therapy of tongue-tie are discussed, considering a wide population of 8-age children examined.


Lose weight and win: a church-based weight loss program for blood pressure control among black women.

The Baltimore Church High Blood Pressure Program (CHBPP) offers a behaviorally oriented weight control program consisting of eight weekly 2-h diet counseling/exercise sessions. Pre- and post-program weight and blood pressure measurements were analyzed for 184 black and 3 white women aged 18-81 years (mean 51) who participated in the program in 1984-1986: 88 were taking antihypertensive medication (Rx) and 99 were not (no Rx). Mean weight loss was 6 lb in both groups: -18 to +7 lb in the Rx group and -31 to +3 lb in the no Rx group. The mean systolic/diastolic blood pressure (SBP/DBP) decrease was 10/6 mmHg in the Rx group and 5/3 mmHg in the no Rx group (P < 0.001 for all pre/post comparisons). Final SBP was < 140 mmHg for 74% of participants, versus 52% initially. Final DBP was < 90 mmHg in 92% versus 65% initially. Supporting the inference that BP decreases among weight control program participants reflect program effects, percent changes in SBP and DBP (week 2 to week 8) were significantly correlated with percent change in weight (rs = 0.23-0.36; P < 0.05). Comparison data for 25 women from the CHBPP population showed a mean SBP/DBP increase of 8/2 mmHg over an 8-week interval. Based on follow up measurements 6 months after the end of the 8-week program for 74 of the 187 women, weight lost during the 8-week program was maintained or exceeded by 65%. Net weight change at 8 months from baseline for women in the follow up subsample ranged from -28 to +4 lb; mean (SD) -6 (7) lb. Weight loss and related dietary or behavioral changes resulting from participation in a weight control program can enhance blood pressure control among black women.


[Rett's syndrome: description of a case with abnormal respiratory pattern].

Rett' syndrome is a progressive disorder that occurs in females and is characterized by autistic behavior, dementia, ataxia, loss of purposeful use of the hands, and seizures. Patients with Rett' syndrome have been observed to have stereotyped hand movements (hand-washing) and to exhibit intermittent hyperventilation. To characterize more precisely the respiratory pattern associated with this disorder, SAO2 and pH studies were made during sleep and wakefulness in a girl with this syndrome. These studies showed abnormal respiratory pattern during wakefulness characterized by hyperventilation periods (SAO2 98%, alkalosis) and ipo-apnea (SAO2 80%); during the sleep, ventilation became regular (SAO2 94-96%). The occurrence of disorganized breathing and compensatory hyperpnea during wakefulness with regular, continuous breathing during sleep suggests an altered or impaired voluntary/behavioral respiratory control system.


[True hermaphroditism: description of a case].

An infant with normal male external genitalia and preoperative diagnosis of right hydrocele and left cryptorchidism got operative diagnosis of true hermaphroditism. Left ovary and Fallopian tube were removed. Karyotype was 46.XX/47.XXY. The results of the genetic study are shown.


Characteristics associated with compliance to cholesterol lowering eating patterns.

The achievement of high levels of adherence is the most important objective of nutrition intervention programs. In order to determine characteristics which were most highly related to adherence to a cholesterol lowering eating pattern, a group of 264 men were sampled. Participants had been enrolled for six years in a multi-risk reduction program for cardiovascular disease which included dietary intervention for blood cholesterol. They were asked to respond to 35 statements, each of which was designed to reflect one of seven characteristics: perception of threat of disease, cost-benefit of therapy, quality of care, social support, external environmental media, and internal as well as external health locus of control. There were seven possible responses to each statement, from strongly agree to strongly disagree. Using a reduced rank regression analysis the numerical answers to the items were treated as a set of predictors for the criterion measure, the food record rating (FRR) score which reflected compliance to a cholesterol lowering eating pattern. Overall the seven characteristics accounted for almost half of the variance in the FRR score (multiple R = 0.48). The most highly related characteristics were cost-benefit, quality of care and external environmental media. These results are highly consistent with those obtained in another population, and indicate the importance of minimizing the cost and increasing the benefits of cholesterol lowering programs by providing high quality treatment programs which emphasize tailoring the regimen to the individual. These results also support the importance of public information efforts such as the National Cholesterol Education Program.


[Neonatal hyperthyroidism. A clinical contribution].

A case of female child who had transient signs of hyperthyroidism after the birth is presented. Authors describe the clinical course and discuss the possible pathogenetic mechanisms. The importance of a timely diagnosis, a correct therapy and follow-up is emphasized.


A systematic approach to educating elderly patients about their medications.

The purpose of this study was to evaluate a pharmacist-initiated, total package, patient education program based on the concepts described in the PRECEDE model. This program was directed towards 94 therapeutically complex elderly patients and consisted of a medication history, therapeutic evaluation, patient education needs assessment, patient education session, and a patient feedback/satisfaction telephone interview. Pharmacists identified on average 5.6 medication-related problems and provided an average of 6.2 recommendations. Problems commonly identified involved inadequate drug knowledge (25.5%), noncompliance (22.7%), and inappropriate drug use (17.4%). Typical recommendations included altering drug use (35.9%), improving compliance behavior (18.1%), and improving communication with health professionals (18.1%). Patient satisfaction with the education session was overwhelmingly positive. Based on the findings of this study, it is apparent that a patient education program based on the PRECEDE model can be used successfully by pharmacists to prepare education plans that would benefit the therapeutically complex elderly patient.


Nutrition education for cardiovascular disease prevention among low income populations--description and pilot evaluation of a physician-based model.

Low income Americans are at greatest risk for coronary heart disease but have least access to health promotion programs for life style modification. Primary care physicians may represent one of the few sources of preventive care available to the poor. However, the majority of physicians feel unprepared to help patients achieve dietary change, and few existing nutrition intervention programs address the special needs of low literacy populations. The Food for Heart Program was developed to facilitate dietary counseling experienced by primary care physicians who care for low literacy patients and to overcome barriers to behavior change faced by patients. The program consists of three components: (1) a validated dietary risk assessment that rapidly identifies atherogenic eating habits and requires no nutritional expertise to administer or interpret, (2) a structured diet treatment program that is culturally specific for a southern patient population and links practical behavior change recommendations with results of the diet assessment, and (3) a system for monitoring and reinforcement that prompts physicians to review progress, reinforce prior messages, and reward positive change. Behavior change theory is used to guide the intervention and readability of the material has been assessed at the 5-6th grade level. An evaluation study of the Food for Heart Program suggests that it has a positive impact on physician counseling and that patients are responding favorably to these efforts.


Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study.

A 10-session, self-management training program was designed specifically for persons over 60 years of age having Type II diabetes. It targeted social learning variables, especially problem-solving skills and self-efficacy, found to be related to diabetes self-care in earlier correlational research. One hundred two adults were randomized to immediate or delayed intervention conditions. At posttest, subjects in the immediate intervention condition showed significantly greater reductions in caloric intake and percent of calories from fat than control subjects. The intervention also produced greater weight reductions and increases in the frequency of glucose testing than did the control condition. Improvements among immediate intervention subjects were generally maintained at a 6-month follow-up. Intervention results from subjects receiving delayed intervention closely replicated those for immediate intervention subjects. We conclude that a relatively short-term program can improve self-management skills of older diabetic adults, and that there is an important need for such interventions.


Assessment of the patient-doctor interaction scale for measuring patient satisfaction.

This study assessed the validity, reliability and usability of the Patient-Doctor Interaction Scale (PDIS) in a university-based family practice center. Health maintenance visits and problem visits were included, and data were collected at the time of the visit and again 1 month later. Three different methods of administration (in-person, telephone, and mail) were used to assess usability. Of 91 patients approached, 1 refused to participate. A total of 64 (70%) patients completed the instrument adequately to permit analysis. PDIS scores correlated with overall assessment of patient satisfaction (P < 0.01), suggesting criterion-based validity. Internal consistency (reliability) of the PDIS was indicated by Cronbach's alpha which were consistently greater than 0.80. Scores and return rates varied by method of administration, with the telephone method performing best. The PDIS appears to fulfill the requirements for a valid, reliable and useful instrument to assess patient satisfaction in family practice settings.


A computerized cancer information system.

Cancer information was made available via a computer to patients visiting the University of Connecticut Dental Clinics. The computer program was menu driven. An option allowed users to leave messages for the system owners. The computer program generated a log of usage, user comments and items chosen. The user could choose from the following topics: (1) general information on cancer; (2) diet, nutrition and cancer; (3) smoking; (4) the environment, occupations and cancer; and (5) physical checkups. An option to leave a message for the system operators was the option chosen least. Analysis of the usage log shows that the system was used substantially while people were waiting in the clinic and that at least three or four individuals used the system every clinic day. Such information systems can provide important information to the public. The novelty of the system and the lack of supervision did not deter public use.


[The role of prolactin in neoplastic disease].

The role of prolactin in carcinogenesis in experimental animals and in humans presented.


[2-Acetylaminofluorene--a model mutagen and hepatocarcinogen. Characterization of its interactions with DNA].

2-Aminofluorene and its derivative 2-acetylaminofluorene are well known mutagens and carcinogens. Molecular mechanisms concerning their mutagenic and cancer promotion activity during hepatocarcinogenesis are summarized in the paper.


[Perspectives in the use of cytokines for treatment of neoplasms in children].

This review summarizes the experience with growth factors that have been tested and that currently are being introduced in clinical trials. In addition, author discusses some factors with possible future interest for clinicians.


[Recent views on the role of nerve growth factor and other molecules with well documented neuronotrophic action].

In the present paper recent data of the structure, regulation of production and mechanisms of action of the nerve growth factor and other proteins of well documented neurotrophic influence were reviewed. The purpose of this article was also to discuss the possible role of these molecules in the pathogenesis of some neurological diseases and their potential therapeutic importance.


[Muroctasin, a muramyl dipeptide derivative].

This paper presents a review of studies on the metabolism, pharmacological and clinical properties of a new synthetic muramyl dipeptide derivative N2-/(N-acetylmuramoyl)-L-alanyl-D-isoglutaminyl/-N6-stearoyl-L-lysine(MD P- Lys(L18), muroctasin). Due to its effect on the number of peripheral blood leukocytes this compound is expected to be a useful drug for the treatment of leukopenia induced by cancer chemotherapy or radiation therapy.


[Polymorphism of acetylation and oxidation phenotypes and the risk of neoplasms--pharmacogenetic approach to the epidemiology of neoplasms].

In recent years more and more attention has been devoted to the relation between the appearance of neoplasms and the polymorphism of the acetylation and oxidation phenotypes. The work is an attempt at presenting modern views and statements on that subject.


[Pharmacokinetics of sulphonamides administered in combination with trimethoprim].

Pharmacokinetic properties of sulfametrole, sulfamoxole, sulphamerazine, sulphadiazine, sulphamethoxazole and sulfamethopyrazine, i.e. the sulphonamides administered in combination with trimethoprim have been compared. From the pharmacokinetic point of view sulphadiazine seems to be the most optimal sulphonamide to apply jointly with trimethoprim. Some of long-acting sulphonamides like sulfamethopyrazine and sulfadimethoxine, used as components of above mentioned combinations, possess comparable clinical efficacy in spite of differences of their and trimethoprim half-lives.


Oral mucosal changes related to plasma ascorbic acid levels.

The role of vitamin C in maintaining mucosal health is poorly documented. The purpose of this study was to examine the presence of oral mucosal lesions in subjects with low ascorbic acid (AA) levels in plasma. AA plasma levels of 843 working elderly people in six rural villages in Eastern Finland were determined. All subjects with low plasma AA levels (< or = 25 mumol/l) (n = 106) formed the study group. Controls with normal AA levels (> or = 50 mumol/l) (n = 103) were drawn from the same population. They were matched for age, sex and number of teeth. Oral mucosal lesions in all subjects were recorded clinically using a double-blind method in all subjects. Petechias, leukoplakia and lichenoid lesions were the commonest lesions of the oral mucosa. Only in leukoplakia there was a statistically significant difference between the groups (p < 0.01). Smokers had more leukoplakia than non-smokers. The prevalence of leukoplakia was higher when smoking was combined with AA deficiency.


Use of dental services by students of Helsinki University during six years.

This follow-up study was carried out to survey the utilization of dental services among university students, together with treatment modalities received during their six years of university studies. Initially 20-year-old students were followed during six years, starting from their first year at the University of Helsinki. Results of the questionnaire showed that during the previous 12 months 59% of the students had had a dental appointment, mostly on their own initiative. According to the patient register, 83% of the students, during their studies, had received dental care financially subsidized at the Finnish Student Health Service (FSHS) in Helsinki. During the six years of follow-up, the mean number of appointments was 9.3 per patient (SD 6.8). Female students made dental appointments relatively more often than did male students (p < 0.01). The main treatment modality was restorative care. Patients did not show up for 3.5% of all appointments reserved. One sixth of all visits were made by a group representing 5% of the study group. In conclusion, as the utilization of FSHS dental services was very common, and as restorative dentistry continues to be the main treatment modality among Finnish university students, prophylaxis of caries in systematic dental health care programmes at FSHS is of prime importance and thus has a good possibility to reach each student.


Health habits in a Finnish village.

This study is part of a collaborative study entitled "Life-style and health" which is being conducted in Finland, India and Tanzania, using the same methods. The aim of the study is to describe health habits (smoking, alcohol consumption, use of medical drugs, exposure to sugars and hygiene habits) in Viekijärvi, a village in eastern Finland. Of the villagers 50% of those aged 20 years and over were randomly selected to take part in the study. Of these, 72% (n = 179) returned the standard questionnaire they had been sent. Smoking was as common among men in Viekijärvi as in Finland in general, but less common among women. Alcohol consumption reflected the national consumption. The use of medical drugs was high: 45% of respondents used such preparations daily. The most common exposure to sugar on a daily basis was sugar-sweetened coffee. Most people in Viekijärvi (89%) brushed their teeth at least once a day. A strong positive correlation was found between frequencies of toothbrushing and handwashing mirroring unidimensional hygienic behaviour. The results of this study will form a basis for a health promotion programme, to be developed by the villagers themselves.


Tooth cleaning methods and their effectiveness among adults in rural Tanzania.

This study was undertaken to investigate how various population characteristics affect the choice of different tooth cleaning methods and to estimate their role in preventing occurrence of plaque, calculus and gingivitis among rural adults in Tanzania. Two hundred adults aged 20 years and over were interviewed and clinically examined for plaque, calculus and gingival bleeding. A high proportion (97.5%) of the subjects reported that they clean their teeth every day. Among them, 69.4% used only indigenous tooth cleaning methods, 16.3% only factory made toothbrushes and 14.3% both. Twigs (Chewing sticks) were the most commonly used indigenous tooth cleaning method, followed by charcoal. Together with age, educational and occupational status and tribal origin significantly affected the choice of tooth cleaning method. Men had more often visible plaque than women (OR = 2.84). However, other sociodemographic factors and the method of cleaning teeth were not significantly associated with the occurrence of plaque, calculus or gingival bleeding.


Chlorhexidine solutions, gels and varnishes in caries prevention.

To combat dental caries, a chemical has been sought that possesses stronger antimicrobial properties than fluoride in support of its physicochemical tooth-protecting properties. These searches have led to several agents, of which chlorhexidine (CH) appears most effective. To reduce local side effects of the well-known 0.2% CH mouthwash, a 0.05% CH gluconate + 0.04% NaF solution, pH 5.9, has been developed. Use of this combination over a 2-year period resulted in a 53% reduction in caries increment and a 75% reduction in gingival bleeding, i.e. a clear duality of prevention of oral disease (Luoma et al. 1978). Staining of teeth was minimal and easily removable in about one third of the subjects. To lessen the contribution of patients, chlorhexidine gels, without but more especially with fluoride have been professionally administered. Reductions in salivary mutans streptococci after short periods of gel applications have been found to persist longer than reductions after brief periods of mouthwashing. Reductions of approximal caries increment by about 50% in children, and root surface caries in adults have been obtained through use of CH gels. The effect on root surface caries in adults was equal to that obtained through use of local fluoride applications. Dental CH varnish seems promising, especially because a very short contact time with a tooth may be sufficient to reduce mutans streptococci. No simultaneous effects against caries and gingivitis of CH gels or varnishes has been reported. Comparisons of CH solutions, gels and varnishes, with or without fluoride, in relation to their potentials for preventing oral disease in subjects at risk remain to be accomplished.


Dental caries in the future: a global view.

Although the prevalence of caries has decreased markedly in children, adolescents, and young adults in most industrialized countries, caries continues to be the main reason for tooth loss, particularly among the high risk segment of the population. In many developing countries, where traditional dietary patterns have changed to include sugar-containing foods and beverages, caries prevalence has increased and will continue to do so in the immediate future. Accordingly, it would be a serious mistake to be complacent about caries prevention. In future industrialized countries will see computers playing a significant role in cariology, finding applications not only in research and practice administration but directly in clinical practice as well. They will be used in every operatory in the assessment of caries risk, the recording of caries prevalence, the direct storing of radiographic information, and the restoration of carious teeth, assisted by computer-aided design and computer-aided manufacture (CAD/CAM) technology. Fluoride therapy, both systemic and topical, will continue to be the basis of caries prevention. Dental sealants, which are highly effective in protecting pits and fissures when applied soon after the teeth erupt, will be more widely used in the future when insurance plans will pay for prevention. Substitution of sucrose and syrups by non-fermentable sweetening agents can also reduce caries increments, but most agents are more expensive than sucrose and require consumer education to pay for the additional cost. Caries, as an infectious and transmissible disease, is amenable to prevention by interfering with the chain of transmission or by suppressing the putative pathogens, the mutans streptococci, in infected patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Pharmacological treatment of intermittent claudication: double blind controlled study of Sulodexide vs placebo.

A double blind placebo controlled randomized study was used to assess the clinical variations caused by Sulodexide treatment (100 mg/die) vs placebo in 30 patients with a mean age of 50.3 years suffering from peripheral arterial obstructive disease of the lower limbs (II stage). The general tolerance of the therapy was monitored over the medium-term. There were marked changes in the clinical signs and symptoms in the Sulodexide group, which showed a gradual constant improvement, while they were stationary in the placebo group. Confirmation of the marked improvement in the Sulodexide group was provided by the Winsor index which showed a significant increase in these patients while only a minimum variation was observed in the placebo group. The positive antithrombotic action of the active treatment led to an increase in the blood supply in previously ischemic regions, without creating haemorrhagic risks or disturbing the haemostatic balance. The absence of adverse reactions and good systemic tolerance is also noteworthy.


[Hydatid choleperitoneum: a rare complication of hepatic hydatid disease].

The authors report their experience relative to hydatid choleperitoneum which is a rare complication of hydatid hepatic disease (one case of 236 operated). They underline how such pathology constitutes a clinic and anatomopathological case, well characterized and different from those offered by other complications of this hepatic disease. They draw attention moreover on how preoperative diagnosis is often difficult and consequently how the surgical therapeutic technique requires a very careful examination of anatomic relations of the lesion and recognize, as a chiefly foundation, a radical treatment of hepatic disease and whenever possible, the removal of the pseudomembrane of encystment.


Adenocarcinoma and epidermoid carcinoma of the lung in the elderly.

Primary lung carcinoma, in the elderly, presents some interesting epidemiologic and clinical characteristics. The authors, after reviewing the international literature, stress the differences of behavior and incidence of epidermoid carcinoma and adenocarcinoma occurring in elderly patients as compared to those found in younger patients. They report their experience which is similar to that reported in the medical literature.


[A geriatric case of colonic angiodysplasia].

A case of colic angiodysplasia in an elderly patient affected by chronic renal failure is discussed. Different methods suitable for management of these vascular ectasies are briefly reported. Prominent role of colonoscopy in the diagnosis of such disease is emphasized.


[Venous bypass for treatment of chronic obstructive venous insufficiency of lower limbs].

About 1 to 5 percent of patients affected by chronic obstructive venous disease of the lower extremity, are eligible to surgical treatment, by veno-venous bypass, for the relief of unerely invalidating symptoms. Indications to operation include a class II to III chronic venous insufficiency of the deep venous system, failure of medical treatment continued for at least 12 months, good patency of outflow axis, a significant gradient of pressure between discared and outflow axis, a good quality saphenous vein to be utilized for bypass. The case of an aged patient, successfully treated with a femoro-femoral venous bypass, associating an artero venous fistula, is presented and indications to the operation in the older patients, together with indication to and technical details of performing the fistula are discussed.


[Evaluation of protein compliance in patients with chronic renal insufficiency undergoing hemodialysis treatment].

The majority of hemodialyzed patients manifests a proteic malnutrition. This metabolic status is a main factor in the morbidity and mortality of such subjects. It is therefore necessary to dispose of more adequate diagnostic instrumentation to offset this highly invalidating condition. The ongoing and severe evaluation of the nutritional status by means of up-to-date and sophisticated techniques such as antroproteic parameters may contribute to the maintenance of good conditions while refraining the evolution of various and often lethal complications induced by chronic renal failure.


[Early gastric cancer. Clinical contribution].

The authors report their experience on 37 cases of Early Gastric Cancer on 1978-1990 period. They underline the excellent results obtained with subtotal gastrectomy and lynphectomy without deaths neither returns. They stress the diagnostic precision of endoscopic exam now of first choice in the early diagnosis of Early Gastric Cancer.


[Colorectal carcinoma: our experience].

The authors report their experience for 158 cases of colon rectum cancer, surgically treated on surgical department of USL 1 Marche. Evaluated short term and long term results they conclude that the only possibility to improve presently the survival of this disease resides on early diagnosis depending to secondary prevention programs.


[Primary carcinoma of the gallbladder. Our experience].

The authors focus on some aspects of gallbladder primitive cancer and report their experience about 14 cases. They confirm the malignancy of the disease and the severe prognosis due to diagnostic delay. Only the mucosal localization may be radically treated even by simple cholecystectomy.


[Current status of diagnostic imaging].

The authors overview the diagnostic progresses as based on the state of art of imaging which evolves at an electrifying and committing pace towards of a broader horizon of medical fields. They aim at creating centralized integrated diagnostic units in hospitals and at promoting physicians, and technicians skills.


The problem of thalassemia in Thailand.

About one per cent of the Thai population are affected with thalassemic diseases. In each year there are almost 50,000 pregnancies at risk of having an affected fetus, one fourth of which result in thalassemic newborns. Both alpha- and beta -thalassemia, including hemoglobins E and Constant Spring, are common in Thailand. Their distribution varies from region to region and among different ethnic groups. About 30-40% of the population are carriers of at least one of the abnormal genes. Thalassemias and hemoglobinopathies are common and heterogeneous in Thailand. They combine to give more than 60 thalassemic syndromes with varying clinical severity. Abnormalities can be detected in every organ system. Studies in detail into each clinical problem will lead to better management. Hematological and molecular studies on different types of thalassemia in Thailand have made it possible to give prenatal diagnosis service to those pregnancies at risk of having a thalassemic child. Sporadic services have been given in three centers. Systematic prevention and control program is being planned by the cooperation of both the public and private sectors.


Interaction between endothelial cells and thalassemic red cells in vitro.

Erythrocytes from 45 patients with thalassemia and/or hemoglobinopathies were studied for their cytoadherence property to the vascular endothelial cells in vitro. In plasma free medium, erythrocytes from patients with beta-thal/Hb E both splenectomized and nonsplenectomized, HbH diseases (alpha-thal 1/alpha-thal 2 and alpha-thal 1/Hb Constant Spring genotypes) and homozygous Hb E subjects bind to endothelial cells at a greater number as compared to the binding cell number of normal erythrocytes (p-value < 0.05 in all types). Addition of autologous platelet-rich plasma or whole blood to the culture system causes further increase in the number of adhering beta-thalassemia red cells. Platelet-rich plasma had more enhancement effect than the whole blood. However, no such enhancement of both platelet-rich plasma and whole blood was demonstrated in the culture of normal or alpha-thalassemia erythrocytes. Increased binding between red cells and endothelial cells may contribute to the greater risk of vascular occlusion in thalassemic patients.


[Eosinophils and asthma].

There has been continuing debate concerning the precise role of eosinophils. They appear to be an integral component in the pathogenesis of asthma, albeit their role has not as yet fully delineated.


Thalassemic serum impairs endothelial cell growth in vitro.

Endothelial cells cultured for 3 days in the presence of hemoglobin H pooled sera had significantly decreased cell proliferation compared to those in normal serum. Inhibition was demonstrated at a concentration of 20% pooled serum in the cultured medium. Further decrease was shown in the presence of 30% pooled hemoglobin H sera. Sera from two genotypes of Hb H disease (alpha-thal 1/alpha-thal 2 and alpha-thal 1/Hb Constant Spring) had the same degree of inhibitory effect. Pooled sera from beta-thal/Hb E patients (both splenectomized or nonsplenectomized cases) had no such inhibitory effect. However, at day 4 and 5, the growth pattern relatively declined. Bilirubin at a concentration greater than 4.0 mg% in the medium 199 also caused significant decrease in cell proliferation. Since the diluted Hb H serum had bilirubin less than 4.0 mg%, the inhibitory effect of the pooled HbH serum is thus not due to effect of bilirubin. The difference between HbH and beta-thal/HbE sera in terms of inhibition of endothelial cell proliferation is the new finding that needs further investigation to explain vascularization and hemostasis in the patients of these two genotypes.


Liver tissue injury secondary to iron overload in beta-thalassemia/hemoglobin E disease.

Liver tissues from 17 patients with advanced stages of beta-thal/Hb E disease were examined by light and electron microscopy, with emphasis on cellular damage due to excess iron overload. Various histochemical stains were performed to grade degrees of iron deposition and fibrosis, and to demonstrate hepatitis B surface antigen, in Kupffer cells as well as macrophages. The results of light and electron microscopic studies were correlated. There was a variation in the distribution of hepatic iron and the severity of fibrosis. In most of the cases ballooning degeneration of the hepatocytes, increase in number of lysosomes, hemosiderin and ferritin in hepatocytes as well as in the sinusoidal lining cells were found. The ferro-acidophilic body, representing another important form of hepatocellular necrosis also occurred. So far no precise mechanisms can be concluded.


Brain pathology in 6 fatal cases of post-transfusion hypertension, convulsion and cerebral hemorrhage syndrome.

Six fatal cases of post-transfusion hypertension, convulsions and cerebral hemorrhage syndrome were found in a series of 76 autopsies of thalassemic patients. Five of these cases were hypertensive. At autopsy the brains were all markedly edematous and congested. Visible cerebral hemorrhages were found in 3 patients. Microscopically all cases showed small focal or perivascular hemorrhages and 1 patient had extensive arterial type hemorrhage. Microdissecting aneurysms characteristic of hypertensive cerebral hemorrhage were found in two. No underlying vascular disease was found in these 6 patients. A correlation was attempted between possible causes of post-transfusion hypertension and convulsions and anatomical findings.


Cytoprotective effect of dilazep on hydrogen peroxide-perturbed vascular endothelial cells.

The effect of dilazep and dimethyl thiourea (DMTU) on the hydrogen peroxide-derived injury of culture pulmonary artery epithelial cells (CPAEC) was assessed by colorimetric assay of MTT formazan (MTT formazan assay). When CPAEC were treated with hydrogen peroxide, neither cell lysis nor detachment of the cells from surface of the well was observed. However, the MTT formazan formation was decreased in a time and dose dependent manner. The decrease in the formation was significantly suppressed in the presence of dilazep (0.1 to 10 microM) or DMTU (0.01 to 0.3 microM). CPAEC treated with hydrogen peroxide in the same way enhanced an activation of prothrombin, and this enhancement was significantly inhibited in the presence of dilazep (1 to 3 microM). These data indicate that dilazep exerts a cytoprotective effect against challenges of intracellular oxidant produced by hydrogen peroxide and suppresses augmented procoagulant activity of injured cells.


Novel thrombolytic therapy discovered from traditional oriental medicine using the earthworm.

Since a few thousand years ago, the earthworm has been used as a drug for various diseases in China and the Far East. However, modern scientific pharmacological studies have not so far been performed. We extracted a very strong fibrinolytic enzyme from the earthworm, Lumbricus rubellus. This enzyme was heat-stable and displayed a very broad optimal pH range. Purification of the enzyme was performed and three partially purified fractions were obtained. These three fractions were further subdivided, and six purified fractions (F-I-0, 1, 2, F-II, and F-III-1,2) were finally obtained. Based on results of their enzymatic activities against various substrates, the fraction I enzymes are thought to represent chymotrypsin-like enzymes and the fraction III enzymes to represent trypsin-like enzymes. The fraction II enzyme appears to be neither a trypsin-nor chymotrypsin-like enzyme nor an elastase. We therefore designed trials for in vivo experiments on human volunteers. 120 mg of lyophilized earthworm powder was administered orally to 7 healthy volunteers (aged 28-52 years old) three times after meals every day for 17 days. Blood was withdrawn once a day before and at 1, 2, 3, 8, 11 and 17 days after commencing the administration. The fibrin degradation products (FDP) value, tissue plasminogen activator (t-PA) antigen level and t-PA activities were measured in the blood. Before the administration, the t-PA antigen level was 5.6 +/- 0.38 ng/ml, and it gradually increased until the 17th day. The FDP level was increased on the 1st and 2nd day after the administration, but had decreased and normalized by the 17th day. The fibrinolytic activities also tended to show an increase during the experiment. These results suggest that earthworm powder represents a possible oral thrombolytic agent. The earthworm enzyme may thus be applicable for treating patients with thalassemia.


Hypoxemia in thalassemia.

Data are reviewed describing hypoxemia, a newly identified feature in thalassemia. Evidence indicates platelet aggregation in the pulmonary circulation as being a key factor leading to hypoxemia and cor-pulmonale with right heart failure.


Pulmonary thromboembolism in thalassemic patients.

Chronic pulmonary thromboembolism plays an important role in cardiac failure which is a major cause of death in thalassemic patients over 20 years of age. This report is a study of autopsy lung tissue from 58 patients with beta-thalassemia/hemoglobin E disease (beta-thal/HbE), including whole lungs from five, 13 patients with hemoglobin H disease (HbH), and eight patients with beta-thalassemia major (beta-thal) including whole lung from one. Pulmonary thromboembolic lesions were found in 24 of 58 (41%) patients with beta-thal/HbE, of which 21 of 39 (54%) were splenectomized patients and 3 of 19 (16%) were nonsplenectomized patients, with the incidence increasing with age. Lung maps showed the greatest number of lesions in the lingula, right middle lobe, and anterior segments of both upper lobes. Pulmonary thromboembolic lesions were also found in one of 13 HbH patients and one of 8 beta-thal patients, both splenectomized. Eight of the 27 patients with these lesions had right ventricular and 14 biventricular hypertrophy, reflecting the deleterious effect of such lesions. Possible causative factors are discussed.


Pulmonary microthromboemboli in thalassemic cases.

Lung specimens obtained from wet materials were reviewed for detection of microthrombi. Multiple microthrombi, which were composed mainly of platelets, were seen in the pulmonary arteriole and microcirculation in two autopsy cases with splenectomized thalassemic disease. These findings provide a rational explanation for the increased spontaneous platelet aggregation in the whole blood, and may be an additional factor to the progress of pulmonary dysfunction and hypoxemia seen in splenectomized thalassemic patients.


Pathogenesis of hypoxemia.

Thrombocytosis and morphological changes in shape and size of circulating platelets are commonly found in splenectomized thalassemia patients. Functional abnormalities of the platelets are evidently related to their fragile nature. Spontaneous aggregation of platelets can easily occur following application of mild pressure either from a stirring magnetic bar or due to centrifugal force. Platelets are hyper-reactive to chemical stimulation and the release of platelet granule contents (eg ATP) together with other membranous lipid metabolites, thromboxane A2 and malondialdehyde is markedly enhanced. The lipid soluble antioxidant, vitamin E is depleted from various blood compartments. The findings suggest that circulating platelets in splenectomized thalassemia are continuously attacked by yet to be identified blood borne factor(s) and the defective platelets could play a pivotal role in the pathogenesis of hypoxemia.


Increase in spontaneous platelet aggregation in beta-thalassemia/hemoglobin E disease: a consequence of splenectomy.

Clinical symptoms related with disturbances of the circulatory system are often observed in beta-thalassemia/hemoglobin E (beta-thal/HbE) patients after splenectomy. Pulmonary thrombosis is one of the important contributing factors. However, the pathogenesis of this phenomenon was not known. Previous studies on platelet functions were controversial as platelet-rich plasma (PRP) was employed for all of the studies. By centrifugation, most of the hyperactive platelets were excluded before platelet aggregation tests were performed. Besides, the role of red cells related to platelet aggregation was not investigated. In this study, a platelet function test was designed to avoid these two handicaps of previous work as mentioned, by using whole blood from 15 normal and 40 beta-thal/HbE patients (15 nonsplenectomized and 25 splenectomized) to study spontaneous platelet aggregation. The principle of the test was to evaluate platelet number in whole blood by electronic platelet counter at time 0 (45 minutes after blood collection) and this number was used as 100% of free unaggregated platelets. Then the same specimen of whole blood was incubated at 37 degrees C with continuous stirring by magnetic stirrer in an aggregometer for 8 minutes; at 1 minute intervals free unaggregated platelets were evaluated and calculated as a percentage of the initial control value. The results indicated increased spontaneous platelet aggregation in whole blood of post-splenectomized beta-thal/HbE patients. The residual free platelet number were 24% at 8 minutes after incubation. Effects of red blood cells on spontaneous platelet aggregation were studied by mixing autologous beta-thal/HbE red cells obtained from splenectomized and non-splenectomized patients with platelet rich plasma.(ABSTRACT TRUNCATED AT 250 WORDS)


Spontaneous platelet aggregation in thalassemic children and adolescents.

Spontaneous platelet aggregation was studied in 51 children and adolescents, comprising 30 nonsplenectomized thalassemic patients, 12 splenectomized thalassemic patients and 9 normal children. Spontaneous platelet aggregation was significantly increased in whole blood and platelet-rich plasma of splenectomized thalassemic patients but not in nonsplenectomized cases.


Development of a new method for detection of platelet factor 3 like activity.

We asked the question, "Can thalassemic erythrocytes play some role in alteration of the hemostatic system?", because clinical examination of thalassemic patients shows symptoms and signs related to alterations in hemostatic and circulatory systems, and thalassemic erythrocytes are different from normal erythrocytes. We obtained one of the answers to the question: The erythrocytes of postsplenectomized patients of beta-thalassemia/HbE disease could stimulate their own platelets to aggregate spontaneously. To know the role of erythrocytes in platelet aggregation, we wanted to examine the effect of thalassemic erythrocytes on the coagulation system by focusing of PF3-like activity of erythrocytes, because PF3-like activity of the ghosts of erythrocytes had been reported. For the study, we tried to develop a technique that was accurate and sensitive enough to detect PF3-like activity of blood. The system we developed was the following: 1) We activated the intrinsic coagulation pathway of commercial standard plasma by ellagic acid. 2) CaCl2, a fixed amount of PF 3 and synthetic thrombin inhibitor MD 805 were added to the reaction mixture. 3) At a fixed time, thrombin activity in the mixture was measured by using S-2238 as a substrate. At full activation of the contact system by ellagic acid, the amount of thrombin formed in a certain time depended on the amount of PF3-like substances such as cephalin, freeze-thawed platelets or ghosts of erythrocytes added to the test system, indicating that PF3-like activity of those substances can be measured by the activity of thrombin generated in a fixed time.(ABSTRACT TRUNCATED AT 250 WORDS)


Detection of PF3 availability in whole blood from volunteers and beta-thalassemia/HbE patients: a promising method for prediction of thrombotic tendency.

The platelet factor 3 (PF 3) plays a very important role in activation of coagulation factors and is regarded to be available during activation of platelets. However, membrane fraction of erythrocytes is also shown to have PF 3-like activity, suggesting that the abnormal erythrocytes may accelerate the activation of platelet by forming thrombin on their abnormal membrane or by way of other factors of the abnormal erythrocytes, and may increase the availability of PF 3 in whole blood (WB). To examine this hypothesis, we developed a method for determination of PF 3 activity, because the method now available for the PF3 determination could not detect changes in PF 3 activity with time. The principles of our method were as follows: 1) The reaction system was adjusted so that the amount of thrombin generated in a fixed reaction time correlates with the amount of PF 3. 2) To avoid inhibition of thrombin activity by antithrombin III, a synthetic thrombin inhibitor, MD 805, was added to the system and the activity of thrombin generated was measured by synthetic thrombin substrate S-2238 using A405 as an indicator of the availability of PF3. The results obtained by the method were the following: WB taken from volunteers showed A405 of 0.12 +/- 0.02 at 30 minutes after blood collection and then the A405 increased to 0.27 +/- 0.03 at 90 minutes. However, one volunteer showed the value of 0.59 at 90 minutes, though the value at 30 minutes was 0.16. The platelet number in his WB did not change during the study.(ABSTRACT TRUNCATED AT 250 WORDS)


Morphological assessment of platelet activation in thalassemia.

Platelets from patients with beta-thalassemia/hemoglobin E, both splenectomized and nonsplenectomized cases, were examined in comparison to those from normal subjects by scanning electron microscopy. In normal subjects, the majority of platelets were discoid (mean +/- SD, 81.0 +/- 3.9%) with 17.3 +/- 3.5% type I spherical shapes (platelet with long axis/short axis greater than 1.1) and 1.3 +/- 1.0% type II (long axis/short axis = 1.0-1.1). The thalassemic patients had significant lower percentage of discoid platelets (60.9 +/- 8.1% in nonsplenectomized patients, 49.2 +/- 9.1% in splenectomized patients) and increase in spherical platelets (nonsplenectomized patients had 36.6 +/- 8.3% type I, 4.0 +/- 1.5% type II; splenectomized patients had 43.4 +/- 7.9% type I, 8.3 +/- 4.5% type II). Study of platelet reversibility from pseudopods to smooth surface showed that thalassemic platelets had poorer reversibility than normal platelets. Splenectomized patients had lower platelet pseudopod reversibility than nonsplenectomized cases. The shape changes and impaired reversibility of platelet pseudopods may be associated with the high tendency of pulmonary thrombus in beta-thal/HbE patients.


Protein C and protein S deficiency in thalassemic patients.

To investigate the status of the protein C-protein S anticoagulant pathway in thalassemic patients, we measured protein C and protein S levels of plasma of 30 adults and 18 children with beta-thalassemia/HbE disease, beta-thalassemia major and HbE disease. Mean +/- 1 SD values of protein C, protein S and other coagulant proteins produced by the liver were as follows: protein C 50.4 +/- 17.2%; protein S 58.8 +/- 25.5%; antithrombin III 78.1 +/- 12.8%; PLG 86.4 +/- 18.4%; prothrombin 71.0 +/- 13.1%; factor VII 72.7 +/- 21.5%; and factor X 79.2 +/- 15.6%. Protein C and protein S levels of thalassemic patients were significantly lower than those of other coagulant proteins produced by the liver. Decrease in protein C level was stronger than that of proteins S. gamma-Carboxylated protein C levels of splenectomized patients were significantly lower than those of nonsplenectomized patients. Severe decrease of protein C and protein S may be responsible for occurrence of thrombosis in thalassemic patients.


The molecular basis of alpha-thalassemia in Thailand.

Alpha thalassemia is the most common single gene mutation worldwide. In Thailand there exists 15-30% alpha-thalassemia carriers distributed throughout the country. DNA analysis by Southern blot hybridization reveals that the two major alpha-thalassemia alleles, alpha-thalassemia 1 and alpha-thalassemia 2 have different extents of alpha-globin gene deletion. In alpha-thalassemia 1, approximately 20 kb of DNA including the two linked alpha 1-and alpha 2-genes are removed and only the alpha-globin gene is intact. Total deletion of the alpha-globin gene cluster is rarely observed. In contrast, only one alpha-globin gene is deleted in alpha-thalassemia 2 of which two types have been detected, one involving a deletion of 4.2 kb of DNA (leftward type, -alpha 4.2) and another of 3.7 kb (rightward type, -alpha 3.7); the latter being more common than the former in Thailand. Compound heterozygosity for alpha-thalassemia 1 and alpha-thalassemia 2 results in HbH disease while homozygosity for alpha-thalassemia 1 leads to Hb Bart's hydrops fetalis, the most severe form of thalassemic disease. Three alpha-thalassemic hemoglobinopathies have been detected in Thailand, two of which produce a remarkable reduction in gene product. Upon interacting with alpha-thalassemia 1 gene they can lead to HbH disease. The most common in this group is Hb Constant Spring which arises from mutation of the termination codon in the alpha 2-gene resulting in an elongation of the alpha-globin chain.(ABSTRACT TRUNCATED AT 250 WORDS)


The thalassemic red cell membrane.

The underlying cause of pathology in thalassemia is the premature destruction of red cells, both in the bone marrow and by the reticuloendothelial system. It is generally accepted that the presence of unpaired excess globin chains is the primary circumstance leading to such membrane alterations as oxidation of phospholipids, modification of cytoskeletal proteins and their interactions, reduced membrane-associated ATPase activities, and enhanced permeability of cations. Such perturbations in turn result in the exposure of outer surface neoantigens, enhanced binding of autoantibodies and complement fixation to the outer red cell surface. These factors contribute to the observed distinctive morphologies, increased rigidity and decreased deformability of the thalassemic red cells. In alpha-thalassemic red cells, excess beta-globin chains form homotetramers, Hb H, which are relatively stable and will only damage red cell membrane when precipitated as inclusion bodies, whereas excess alpha-globin chains cannot form such homotetramers and upon synthesis rapidly bind to the cytoplasmic side of the beta-thalassemic red cell membrane, even in young erythroblasts. This difference in properties of the excess globin chains may offer an explanation for the variation in clinical severity observed between these two forms of thalassemia.


Size distribution curves of blood cells in thalassemias and hemoglobin H diseases.

Thalassemias and hemoglobinopathies in Thailand have been examined with a blood cell counter based on electroimpedance principle and obtained size distribution curves of red cells and platelets. Among various disorders, beta-thalassemia/hemoglobin E and homozygous hemoglobin Constant Spring showed severe anemia. Their red cell size distribution curve shifted to the left and overlapped with the platelet size distribution curve. Red cell distribution width expressed by coefficient of variation and the degree of the overlapping were stronger in beta-thalassemia/HbE than HbH. Heterozygous beta-thalassemia showed a narrow red cell distribution curve width with small standard deviation and low England's value. Although the overlapping of size distribution curves cause inaccurate red cell count and platelet count, careful observation of the size distribution curves was proved to have high diagnostic value.


Biophysical changes of red cells with thalassemia-like abnormal hemoglobin.

Hemoglobin (Hb) E and Hb Constant Spring (CS) are known to have thalassemia-like effects. Investigation on the red cell physical changes in these two abnormalities has been done to clarify the diversity of red cell changes between thalassemia and thalassemia-like abnormal hemoglobin (Hb E represents beta-thalassemia and Hb CS represents alpha-thalassemia). Eleven cases with homozygous Hb CS (CS/CS), 7 homozygous Hb E subjects (E/E) and one double heterozygous case with Hb CS and Hb E were included in this study. The red cells were analyzed by the H* 1 hematology analyzer. The E/E red cells had significantly smaller MCV than the CS/CS red cells (p < 0.001). The smaller MCV of E/E red cells was attributed to markedly increased percent microcyte (p < 0.001) and significantly lower percent macrocyte (p < 0.001) as compared to CS/CS red cells. Degree of heterogeneity in cell volume as indicated by red cell distribution width (RDW) was not significantly different between the two abnormal hemoglobin containing red cells. It was also noted that the CS/CS cases had a more significant increase in small RBC than the E/E cases (p < 0.001). Significant lower intraerythrocyte hemoglobin concentration values of the CS/CS red cells as compared to E/E red cells were shown: cellular hemoglobin concentration mean (CHCM) (p < 0.001), percent hyperchromic red cell (p < 0.001) and hemoglobin distribution width (HDW) (p = 0.0367). Higher values for the CS/CS red cells were MCH (p < 0.001) and percent hypochromic red cells (p < 0.001). Red cells from both genotypes had significant decreases in red cell deformability.(ABSTRACT TRUNCATED AT 250 WORDS)


[Urinary tract infections at the hospital and the ambulatory service: etiology and laboratory diagnosis].

An aetiology study was conducted into urinary tract infections (UTI) in order to compare hospital infections with those in outpatients identified from samples sent to the laboratory by general practitioners. Urine culture analysis was performed on 3,483 samples of which 740 came from hospital patients and 2,743 from outpatients. The diagnosis of UTI was based on new criteria: not only the assessment of bacterial proliferation but also clinical factors like sex, symptoms, sampling technique and urinary leucocyte count and the traditional threshold of 10 units forming colonies (UFC/ml) was ignored. In other words the following were all considered positive: all bacterial growths > or = 10(5) UFC/ml independent of other data, all those > or = 10(2) UFC/ml in symptomatic women, those > or = 10(3) UFC/ml in symptomatic men and those > or = 10(2) UFC/ml in catheterised patients. In cases supplied with incomplete anamnestic data bacterial proliferations in the 10(2)-10(5) UFC/ml range were considered positive if the leucocyte count was also significant. The frequency of the various micro-organisms isolated from the positive urine cultures of the two group was then assessed. The study revealed that among outpatients relatively innocuous bacterial like E. Coli, Klebsiella and Proteus accounted for over 75% of UTI cases, but less than 44% among hospital patients. By contrast, more "serious" bacteria like Pseudomonas, Acinetobacter and Serratia were identified in about 20% of hospital cases but only about 5% of outpatients. Finally a comparison was made between in- and outpatient multibacterial UTI which were found to be more common and more aetiologically heterogeneous in hospital patients than in outpatients.


[Treatment of urinary infections with ticarcillin and clavulanic acid (Clavucar) by the intramuscular route].

20 patients suffering from hospital-acquired UTI received intramuscularly ticarcillin 1 g and clavulanic acid 200 mg for 8 days. At the end of antimicrobial therapy 84.2% of the pts presented sterile urine. After 2 weeks 68.4% of the pts continued to have sterile urine. No significant side effects were registered. The results demonstrate that the association of ticarcillin with clavulanic acid can be considered a useful option in hospital acquired UTI.


[Primary lymphoma of the kidney. Description of a case and brief review of the literature].

Stage IV disseminated non-Hodgkin lymphomas show kidney involvement with frequency; on the contrary, primary kidney lymphoma, as the sole presenting feature, is a very rare disease. Non-Hodgkin histological pattern, atypical symptoms, marked discrepancy between parenchymal involvement and impairment of renal function are the main features of this tumor. A case-report of a primary kidney non-Hodgkin lymphoma will be described; a short review of literature on this subject will be discussed.


[Oncocytoma in a horseshoe kidney].

Oncocytoma is a neoplasm that constitutes 4-5% of tumors located in the renal parenchyma. It was studied for the first time by Zippel in 1942 and since than nearly 150 cases have been described. The association between neoplasm and horseshoe kidney is extremely rare. The horseshoe kidney is a malformation which often becomes complicated by infection, hydronephrosis and calculosis, but very rarely by a neoplasm (only 113 cases). The Authors report a case of oncocytoma in the horseshoe kidney and discuss the diagnostic, clinical and therapeutical aspects.


[Comparison between biopsy data and the resistive index obtained by Doppler echography in the evaluation of the transplanted kidney].

Doppler sonography is nowadays considered as a "first step" tool for diagnosis of vascular complications in kidney transplantation. Quite recently, it has been sometimes considered useful and effective investigation in order to obtain information about parenchymal dysfunctional pathologies, particularly about acute rejection. This has been obtained by studying the variation of resistive indexes. The goal of the following investigation was compare Doppler sonography data and histological examination in 50 kidney transplanted recipients in whom the renal biopsy was performed on a clinical basis. In the Authors' experience. Doppler sonography and study of the resistive index does not offer any reliable help in differentiating acute rejection from cyclosporine A toxicity.


[Determination of bone mineral content and correlations with calciotropic hormones in periodic hemodialysis patients].

The investigation on several forms of uremic osteodystrophy by means of bone mineral content (BMC) measurement led to contradictory conclusions. BMC in 27 patients on periodical hemodialysis treatment was measured correlating it to the seric levels of Ca, P, Mg, alkaline phosphatase (AP), calcitonin (Ct), osteocalcin (BGP), intact parathormone (PTHi), c-terminal and mean molecule PTH. Patients on dialysis treatment from a long period of time showed high AP and low BMC levels. This correlation proved significant just for the values recorded at a third distal site of radius. Patients with BMC under the normal range showed higher BGP levels and a longer period of dialytic treatment than those presenting normal BMC. The former showed a Ct inverse correlation as to age and mineralization indexes. Higher values of Ct and BMC have been reported in males rather than in females. Hence BMC is not suited to investigate different kinds of uremic osteodystrophy. Seric PTH dosage is certainly best fitted to discriminate patients affected with hyperparathyroidism from those with low turnover osteodystrophy. BMC determination is a valid support to evaluate the bone mineral loss in patients on haemodialysis treatment. It significatively correlates to the duration of the dialytic treatment; it is higher in female than in male population; it mainly affects cortical components rather than trabecular ones and is related to a seric Ct decrease.


[Vascular access for hemodialysis. Clinical experience].

Seventy-nine arteriovenous fistulas for periodic hemodialysis were created in 62 uremic patients: 64 primary vascular accesses and 15 salvage operations for malfunctioning fistulas. Sixty-three distal and 1 proximal arteriovenous fistulas between the radial artery and the cephalic vein, were created as primary vascular access. The utilization time of the primary arteriovenous fistulas was longer than 5 years in 34%, 3-4 years in 25% and 0-2 years in 41% of cases. Eleven fistulas evidenced thrombosis: a salvage operation (resection-anastomosis) was possible for 9 (89%). A salvage operation was possible for 100% of poor flow fistulas. The utilization's time of the salvage fistulas is longer than 5 years in 15%, 3-4 years in 15% and 0-2 years in 70% of cases.


Personality, self-esteem, stress, and satisfaction among Texas dentists.

Do the personality styles of dentists significantly influence their sense of well-being in their profession? A recent study using the Bi/Polar Inventory of Core Strengths differentiated 218 Texas dentists into eight personality profiles. Patterns VII and V (both risking and practical) as a group reported significantly higher self-esteem, higher ability to cope with stress, lower psychological distress, higher satisfaction with dentistry, and greater likelihood of choosing dentistry again as a career, than did Patterns III and IV (both thinking and theoretical). The results suggest that Patterns VII and V may be the most compatible with dentistry, and Patterns III and IV the least compatible. Also, the practical orientation (preferred by nearly 80% of the Texas dentists sample over the theoretical orientation) may be the single most influential personality trait in terms of compatibility with dentistry. Implications arise in career counseling, dental school admissions committees, and counseling dentists dissatisfied with.


[The expression of 130kDa mosquitocidal protein gene of Bacillus thuringiensis subsp. israelensis in Bacillus subtilis].

Two recombinant plasmid pFZ1 and pFZ2 containing Bti 130kDa mosquitocidal protein gene in opposite insertion orientation were constructed. The expression of 130kDa mosquitocidal protein of Bti in Bacillus subtilis was confirmed by western blotting. The mosquito-larvicidal activity against the larvae of Aedes albopictus was shown by the bioassay.


[Purification and characterization of hec toxin produced by Aeromonas hydrophila].

An extracellular toxin produced by Aeromonas hydrophila from cultured crucian carp with septicemia was detected. The toxin was purified by ammonium sulfate precipitation, DEAE-cellulose chromatography and Sephadex G-100 gel filtration. The factor was a single polypeptide with a molecular weight of 52.5kd determined by SDS-PAGE. The heat-stable toxin possesses hemolytic, enterotoxic and cytolytic activities. The hemolytic activity on human erythrocytes was 3.81 x 10(3) HU/mg, CD50 for Vero cell was 0.26 microgram. The LD50 for crucian carp and mice was 4.44 micrograms and 3.58 micrograms respectively. The toxin was neutralized py homologous antibodies. The toxin shows unique characteristics as compared with other known bacterial toxins therefore the authors propose to name the toxin "hec" toxin.


[A survey of T-2 toxin in wheat by an indirect enzyme-linked immunosorbent assay].

The survey of T-2 toxin in wheat randomly sampled in nine provinces was carried out, employing an indirect competitive enzyme-linked immunosorbent assay. Among 330 samples, 264 samples (80%) showed positive results. The mean concentrations was 53.3 ppb. and maximal concentration was 1122.0 ppb. It was also detected high concentration (84.5-1064.4) of T-2 toxin in human intoxication wheat samples in 1991. The investigation also showed that there existed close relationship between the level of T-2 toxin contamination and the epidemic of wheat scabby.


[The effect of plasmids on the resistance of E. coli to phages].

The introduction of the ColV, I-K94 or R124 plasmid into Escherichia coli K12 resulted in resistance to certain phages. Derivatives of E. coli carrying the plasmid R124 and ColV, I-K94 were resistance to the phages T4, Mel comparing with the plasmid-free parent and the plasmid ColV, I-K94 conferred resistance to the phage Tull*. It suggested that an envelope change caused by the plasmids might be responsible for the resistance because most of the phages fell to absorb to the plasmid-bearing E. coli cells.


[Use of the preparation Iso Mack Retard 60 mg I 120 mg in the treatment of patients with advanced ischemic heart disease].

The purpose of the study was an evaluation of the effectiveness of the preparation ISO MACK RETARD in capsules of 60 mg and 120 mg in patients with advanced exacerbated ischaemic heart disease. The study included 72 patients, in 61 (84.7%) of them very good result treatment, estimated subjectively, was achieved. ISO MACK RETARD in capsules of 60 and 120 mg was well tolerated; in the studied group no side effects were observed.


[Surgical treatment of secondary complications of myocardial infarction].

The results are presented od surgical treatment of 18 patients operated on in the Cardiosurgery Department, Institute of Cardiology, Medical Academy in Lódź, in the years 1985-1989, for complications of myocardial infarction. The material includes such complications as: post-infarction perforation of the septum, and post-infarction aneurysm of the left ventricle. The usefulness of specialized examinations is shown in qualifying the patients for operation, and the method is presented of carrying out operations in these patients in extracorporeal circulation. Good results of surgical treatment were achieved.


[Effect of treatment with HDM vaccine on selected immune parameters in children with bronchial asthma].

The purpose of the study was to trace the changes of certain parameters of humoral and cell-mediated immunity in children with asthma who received the HDM Bencard vaccine as specific immunotherapy. Among the immune parameters the levels of IgG, IgA and IgM and the phagocytosis index were determined, the E-rosette test and the HBT reduction test were done before the beginning of the treatment, after 3 months, 9 months and 3 years of desensitization. The results were subjected to statistical analysis, presented in tables and in diagrams. Of the three determined immunoglobulins only the IgG increased significantly, while the titres of IgA and IgM remained unchanged. Before desensitization the values of the per cent of T-cells in the E-rosette test were below the accepted normal level. During HDM desensitization the per cent of T-cells rose. The phagocytosis index and the NBT reduction test were lower in the asthmatic children than in healthy ones but during the treatment with HDM they reached significantly high values. These results confirmed that mechanism of the action of this immunotherapy is a complex one and influences several structures of the immune system. Raised values of the studied parameters during desensitization correlated with an evident improvement of the clinical status and marked reduction of the frequency of asthma attacks. During the treatment with the HFM vaccine no side effects of this therapy were noted.


[Recurrent abdominal pain in children].

In the paper the results are presented of an analysis of the causes of recurrent abdominal pain in 294 children hospitalized at the Gastroenterology Department, Childrens Health Centre, and the accepted diagnostic programme is evaluated. The children were referred to the CHC, as a rule with a suggestion of organic causes of recurrent abdominal pain. On the basis of carried out examinations the following was diagnosed: in 111 children organic causes (37.8% of the studied group), in 94 children recurrent abdominal pain of functional aetiology (32%), in 53 children psychological background (18%), and in 36 children mixed organic and functional background. These proportions between those groups is the result of the selection carried out at earlier stages of the diagnostic process. In the paper, the correctness and validity of the accepted diagnostic programme are also demonstrated.


[Clinical-morphologic analysis of children dying of intoxication with Amanita phalloides].

The results were subjected to analysis of 23 autopsies carried out in children dying of intoxication with Amanita phalloides. The correlation of the pathomorphological findings with the clinical picture and biochemical pattern was evaluated. The morphological changes were also presented in organs other than the liver which is recognized as the target organ for Amanita phalloides toxins.


[Usefulness of hysteroscopy in the diagnosis and treatment of intrauterine adhesions].

During hysteroscopy intrauterine adhesions were found in 96 patients in a group of women with disturbances of fertility and menstruation. The diagnosis and treatment were carried out with a Wolf hysteroscope using CO2 as the expanding gas. The purpose of the study was evaluation of the effectiveness of treatment of these adhesions by means of hysteroscopy. Normal menstrual bleeding after this treatment was achieved in 75% of the treated patients, and 51% of the patients conceived. Hysteroscopy was useful in the diagnosis, treatment and posttreatment control in cases of Asherman adhesions.


[Results of treatment with ofloxacin for inflammatory conditions in male reproductive organs].

The results are presented of the clinical and microbiological studies of the patients of the Andrological Outpatient Clinic in Warsaw, who were examined for explaining the causes of marital infertility or for elucidation of the cause of testicular pain. Thirty-two men aged 21 to 42 years were chosen, in whom semen investigation demonstrated presence of leucocytes in numbers exceeding 10 per field of vision and with clinical signs of inflammatory process in the male reproductive organs (10 patients) and without clinical signs (22 patients). The patients in whom semen cultures demonstrated presence of bacteria sensitive to ofloxacin were treated with the preparation Tarivid Hoechst for 10-20 days in daily doses of 2 x 200 mg. The clinical signs of inflammation of the reproductive organs regressed in 100% of cases, and in 64% of cases no leukospermia was found after the treatment.


[Minipress in the treatment of prostatic adenoma].

Own results are presented of the use of Minipress in the conservative treatment of prostatic adenoma. On the basis of literature survey, the indications are discussed to this treatment.


[Treatment without plaster cast of intra-articular fractures of calcaneus united by means of a kirschner wire bundle].

A treatment without plaster cast is presented of intra-articular fractures of calcaneus. In nine patients after fracture reduction by the Westhues method or by operation, the fragments were united by means of divergent bundle of Kirschner wires, introduced from the side of calcaneal tuber. The obtained stabilization made possible an early rehabilitation treatment. In no case a secondary displacement of fragments occurred after removal of uniting wires. Poor result was noted only after surgical treatment complicated with osteitis.


[Knee joint cyst].

Ninety cases of knee joint cysts were treated surgically. This included 50 patients with rheumatoid arthritis, 22 patients with degenerative-deforming changes, ten children with true cysts, and eight ones with post-traumatic cysts. Double-contrast X-ray examination with Lipiodol Ultra-fluid and air is of the best diagnostic value. All cases of knee joint cysts were treated surgically with a careful plastic closure of cyst gate. For this purpose the authors used the arcus tendon of the semi-membranous muscle. In cases of rheumatoid arthritis and degenerative changes cyst removal was preceded by synovectomy of the knee joint. Early and remote were good, no recurrence was observed.


[A case of malignant pericardial mesothelioma].

A case is described of malignant pericardial mesothelioma of epithelial type. The diagnosis was made on the basis of autopsy. The patient, a 46-year-old construction technician fell ill with symptoms of pericarditis. Initially, it was connected with a flu infection, and later with tuberculosis. During the 11-week-long treatment, a rapidly progressing worsening of health condition was observed. Death was caused by pericardial mesothelioma complicated with embolism of the pulmonary arteries.


[Myxoma of the left atrium suggesting a connective tissue disease].

A case is presented of myxoma of the left atrium suggesting a connective tissue disease. In the foreground were musculo-articular symptoms, sub-febrile states, considerable loss a body weight. At the same time an increased sedimentation rate, hypergammaglobulinaemia, increased level of IgG and IgM, high CRP level, and the presence of antinuclear antibodies and LE cells were noted. The diagnosis of myxoma was made on the basis of echocardiographic examination. After surgical resection of the tumor all symptoms regressed, and a normalization was observed of the formerly observed abnormalities in the laboratory investigations.


[Hemolytic microangiopathic anemia occurring in a patient with simultaneous cancer in two organs].

A case is described of rarely observed hemolytic microangiopathic anaemia associated with gastric and renal cancer. It is stressed that the diagnosis of this anaemia should be for the doctor an indication for searching for the cause of primary disease in which damage to the small blood vessels develops.


[Primary aorto-intestinal fistula as a diagnostically difficult complication of ruptured abdominal aortic aneurysm].

Three cases are presented of a rare complication of abdominal aorta aneurysm, that is its rupture into the gastrointestinal tract. In two cases the aneurysm ruptured into the duodenum, and in one case into small intestine. The authors call attention to the variety of symptomatology and diagnostic difficulties with the primary aorto-intestinal fistula. This is true especially of cases in which the rupture is the first and not infrequently the only symptom of the aneurysm. The rupture of the abdominal aorta aneurysm into the gastrointestinal tract is still fraught with a very high mortality; out of three patients with primary aorto-intestinal fistula only one was saved.


[Pericardial mesothelioma as a very rare cause of recurrent cerebral emboli].

We described a rare case of a patient with pericardial mesothelioma, which caused recurrent embolism in systemic and cerebral circulatory systems, leading to the death. Symptoms concerning central nervous system dominated clinical investigation results.


[A case of histiocytosis of Langerhans cells].

A lethal case is presented of disseminated for of histiocytosis of Langerhans cells in 16-month-old girl. In the clinical course predominated high fever, opportunistic infections, cell-mediated and humoral immunity disturbances, and gross hepatocellular damage which made impossible carrying out of the treatment with cytostatics. The advances in immunological investigations in these patients are more widely discussed as well as the use of thymus hormones.


[Problems diagnosing cat scratch disease].

The diagnosis of cat scratch disease is hampered by the fact the basic laboratory investigations fail to demonstrate characteristic changes of this disease, and the diagnosis is based usually on epidemiological history and the clinical symptom complex. The diagnosis is confirmed by the complement binging test with the antigen obtained from pathologically changed lymph nodes with values over 1.5 being pathognomonic for the disease, and by the cutaneous tests of Hanger-Rose and Mollaret. The authors present 2 cases treated for the disease stressing differences in its course.


[Passive smoking as the cause of life-threatening intoxication in a child].

A case of poisoning with tobacco smoke was observed in a child aged two years exposed to this smoke. The child had COHb concentration 18%, pallor, tachycardia, tachypnoea, raised blood pressure, tonic seizures and loss of consciousness.


[Studies of the lymphatic system in mice infected with Trichinella pseudospiralis as well as infected and stimulated by Phytohaemagglutin (PHA-P)].

Mice CFW were infected per os with Trichinella pseudospiralis (150 larvae/mice). The mice were divided in two groups: nonstimulated and stimulated intraperitoneally with PHA-P at dose 10 mg/kg body weight. The animals were killed 7, 14, 21, 28, 42, 56, 70 and 150 day post infection (d.p.i.). Spleen et mesenteric lymph nodes were examined histopathologically (Hematoxylin-Eosin) and histochemically (nonspecific esterase reaction) for differentiation of T lymphocytes. The obtained results reveal that T. pseudospiralis infection caused weak mobilisation of mouse lymphatic system lasting only to 70 day of experiment. In the lymphatic organs of infected mice small number of T lymphocytes were observed mostly between 28 and 56 d.p.i. The intraperitoneally stimulation with PHA-P give rise to caused only little mobilisation of lymphatic tissue and small increase of T lymphocytes number. The obtained results were compared with analogic earlier experiments with T. spiralis infection.


[Influence of cadmium on the course of intestinal and muscular phases in mice infected with Trichinella spiralis].

At the first experiment 20 Swiss male mice were infected with 100 larvae and 20 mice with 500 larvae T. spiralis per mouse. Two days after infection (d.a.i.) mice orally received 1.5 mg Cd (water solution CdCl2) each. 40 mice were infected only T. spiralis as control. At the second experiment muscle larvae used were isolated from mice (from the first experiment) which received Cd. 20 mice were infected with 100 larvae and 20-with 500 larvae per mouse. Two d.a.i. mice received 1.5 mg Cd. Mice from both experiments were killed at 5, 10, 20 and 42 d.a.i. Total number of adult T. spiralis worms present in the small intestine and muscle larvae were recovered by conventional technique. Results of the first experiment: the number of adult worms and muscle larvae recovered from mice received Cd. were statistically significant lower as in control. Results of the second experiment: the mean number of adult worms in experimental group and in control were the same but the mean number of larvae per gram of mice muscle were significant higher as in control.


Activity of natural killer (NK) cells in the course of experimental trichinellosis in mice.

B6C3F1 mice were infected with 200 or 500 larvae of Trichinella spiralis per mouse and pulmonary NK cell-mediated clearance of semisyngeneic tumour cells was determined in vivo on days 10, 20, 30, and 60 after the infection. Cytotoxic activity of NK cells in the lungs was substantially elevated on days 20 and 30 after challenge with both "doses" of the parasite. At the same time large granular lymphocytes (LGLs) as well as cells expressing surface asialo-GM1 molecules were isolated in elevated numbers from spleens of the infected as opposed to the normal mice. Expression of other markers of differentiation, such as THy 1, CD4, and CD8 was also enhanced on splenocytes isolated from the infected mice on day 30 but not 20 after administration of the larvae. The present results indicate that NK cell-mediated activity in vivo is stimulated above the baseline level during migration and early muscle phases of the infection with T. spiralis in mice. The possible impact of this effect upon the course of trichinellosis as well as upon the growth of tumours in the infected host is discussed.


Activity of specific IgG, IgM and IgE antibodies in human trichinellosis.

The activity of IgG, IgM and IgE antibodies to somatic antigen of Trichinella spiralis in the sera of patients with trichinellosis at various intervals after infection was examined by means of ELISA. Mathematical analysis of the dose-response curves was used. Elevated level of IgG and IgM antibodies of relatively high avidity and of rather low IgE avidity was documented. Amount or avidity of IgG antibodies was found to be most useful for the diagnosis of trichinellosis (85% positive results in patients' sera). The isotype of IgM avidity constitutes a better diagnostic value than the amount of it (60% and 35% of positive results, respectively).


[Influence of nalcrom (sodium cromoglycate) on the course of the intestinal phase of trichinellosis in mice].

The influence of Nalcrom (sodium cromoglycate) on the course of the intestinal phase of trichinellosis in mice was investigated. The animals infected with 200 Trichinella spiralis larvae were treated with Nalcrom between 7-20 or 3-20 days after infection (d.a.i.). The drug was administered in two doses: 0.6 or 1.7 mg/mouse/day. In the all groups of animals received Nalcrom higher number of mast cells and eosinophils than in the control groups was observed. These results are the opposite of those obtained with Nalcrom in ulcerative colitis in man.


Efficacy of albendazole against Trichinella pseudospiralis and Trichinella spiralis in mice.

Albendazole (Smith Kline, Beecham) in a dose of 20 mg/kg/day was given to B6C3F1 mice exposed to 300 larvae of T. pseudospiralis or T. spiralis. The drug was introduced on days 2, 3 and 4; or 4, 5 and 6; or 18, 19 and 20 after infection. It limited the intensity of intestinal and muscle phases of trichinellosis. Given at the stage of maturation of adult forms and production of new-born larvae, the drug caused almost total elimination of both species from the intestines of mice and a decrease in the numbers of muscle larvae, with a tendency towards a greater reduction of larvae and adults of T. pseudospiralis. The drug did not change the course of infection when given at the phase of infectivity of larvae.


Ecological border of distribution of Trichinella nativa Britov et Boev, 1972 and T. nelsoni Britov et Boev, 1972.

According to the received data Trichinella nelsoni and T. nativa occupied different areas. T. nelsoni was localized in Africa and Mediterranean subregion of Palearctics, T. nativa occupied the continental territory of Eurasia and Neoarctics. Their distribution was limited by the threshold action of certain gradation of low temperatures. The joints of the species borders passed along the isotherm line of -5 - -6 degrees of January, where they made sympatric populations. Outside of this border these species were registered as allopatric populations.


[The role of the nucleus in the mechanism of transformation of muscle after infection by Trichinella spiralis larvae. III. Morphometric analysis of the functional transformation of the muscle cell nucleus after infection].

Morphometric investigations (using the convergence analysis method) of geometric parameters of nuclei and nucleoli of transformed muscle cells were carried in mice 15 days, 30 days and 6 month after infection with T. spiralis larvae. The analysis showed the largest increase of investigated the parameters of 15th day after the infection. The results of morphometric analysis are in agreement with the morphologic, ultrastructural and histochemical observations (published in I and II part) as for as functional changes of muscle cells in various stages of trichinellosis are concerned.


Incidence of insulin-dependent diabetes mellitus in Warsaw, Poland, in children and young adults, 1983-1988.

The 5-year results of the incidence study of insulin-dependent diabetes mellitus (IDDM) in children (0-14 years) and young adults (15-29 years) which began in Warsaw on 1 July 1983 are presented. The overall number of new IDDM patients aged 0-29 registered in Warsaw during 5 years was 165. The average incidence rates in the age groups 0-14 and 15-29 were respectively 5.2 and 6.5 per 100,000 population in males and 4.5 and 4.4 in females. The highest incidence was observed in the age groups 25-29, 10-14 and 15-19 in males, and 5-9 and 25-29 in females. More patients reported the onset of their first symptoms in autumn and winter than in spring and summer. The IDDM incidence rates in Warsaw appear to be lower than those in some other countries for which data on IDDM at ages 0-29 years are available.


Diabetes and impaired glucose tolerance in women aged 20-39 years. World Health Organization Ad Hoc Diabetes Reporting Group.

Age-standardized estimates of prevalence of diabetes mellitus and impaired glucose tolerance (IGT) are presented for women aged 20-39 years in 29 populations. In most cases, diabetes was uncommon (< 1%). Prevalence of diabetes was 1-3% in women in Italy and the United States, 7% in Fiji Indian and Aboriginal Australian women, > 10% in Nauruans and > 20% in Pima Indians. IGT was common (> 3%) in many communities. Prevalence of IGT exceeded 10% in black and Hispanic women in the United States, urban Indian women in the United Republic of Tanzania, Pima Indians and some Pacific populations. In one-third of the populations, prevalence of total glucose intolerance (diabetes and IGT combined) exceeded 10% in women in this age range. In many communities, over 50% of diabetes was undiagnosed prior to the survey. It is concluded that a substantial proportion of abnormal glucose tolerance during pregnancy will go undetected in the absence of screening programmes. An international study is required to define the risk to the mother and the fetus of various levels of glucose intolerance, with a view to formulating international guidelines for clinical practice.


Diabetes in time of armed conflict: the Croatian experience.

During the summer of 1991, armed conflict broke out in the Republic of Croatia. This resulted in many deaths and the displacement of many persons, with population loss in some communities and additional population burden in others. Registration of diabetic persons has been compulsory in Croatia since 1975 and from available statistics compiled by the Vuk Vrhovac Institute for Diabetes in Zagreb it was known that in 1991 there were 111,096 diabetic persons in Croatia, 16% requiring insulin, 46% treated with oral agents and 38% using dietary treatment only. This information helped to plan adequate supplies during the emergency. Contacts with international organizations and friends were of value in overcoming shortages, the most useful gifts being battery-operated blood glucose measuring devices. A study in Zagreb failed to demonstrate an association between the stress of displacement and metabolic control. Somewhat unexpectedly, diabetes and its complications did not present a major public health problem during the first 8 months of the armed conflict, but the long-term effects of these events remain to be seen.


Diabetes mellitus in Egypt.

A series of surveys of diabetes mellitus (DM) have been performed in Egypt recently, using a common protocol and WHO criteria for diagnosis and classification. Average prevalence for the country as a whole for people above the age of 10 was 4.3%, with distinct geographical differences: 5.7% in urban areas, 4.1% in rural agricultural areas, and 1.5% in rural desert areas. In some secluded villages, DM was almost completely absent. Surveys among younger ages indicate prevalence of 0.01%, 0.06% and 0.14% among children at preparatory, primary and secondary school respectively. A high risk of DM is associated with family history of the disease, obesity, premature atherosclerosis and hypertension. The cost of ambulatory outpatient care for DM in Egypt is one of the lowest for Mediterranean countries. However, the cost of treatment of the various complications of diabetes is higher. The total direct cost of diabetes in Egypt in 1990 has been estimated at US$ 74.3 million, with indirect costs due to absenteeism from work adding a further US$ 11.8 million.


Diabetes in Mexico--a serious and growing problem.

According to a recent national health survey, the prevalence of self-reported diabetes in Mexico is 1.2%, but this figure reflects the relative youth of the Mexican population. Age-specific estimates are similar to those for the United States of America, where crude prevalence is higher. Given that self-reporting usually underestimates prevalence by at least 50%, there may be as many as 1.7 million persons with diabetes in Mexico, with a prevalence of approximately 6% in the age range 30-64 years. The average age at death for Mexicans with diabetes is 57 years, compared to 69 years for the population as a whole. Diabetes is the fifth most important cause of death in the Mexican population, and the third cause in people over 45 years of age, in whom it accounts for 10% of all deaths. There is evidence for important increases in diabetes-related mortality over time. Most studies indicate high rates of complications in Mexicans with diabetes and data show that their average length of hospital stay is almost twice as long as for non-diabetic patients. The annual cost of diabetes to Mexican society may be estimated at US$ 15 million for metabolic control, US$ 85 million for additional health services and US$ 330 million for indirect costs--in total, approximately three-quarters of all government spending on health care, or approximately US$ 450 per known diabetic person per year.


Recent developments in the epidemiology of diabetes in the Americas.

The prevalence of diabetes recorded in population surveys in the American region varies from < 1% (rural Mapuche Indians aged 20 years and over, Chile) to almost 50% (Pima Indians aged 20 years and over, United States of America). The prevalence of non-insulin-dependent diabetes mellitus (NIDDM) was approximately 2.5 times higher among Mexican Americans than in non-Hispanic white Americans. In the Mexican Americans, prevalence followed a sociocultural gradient: 16% in low-income barrios, about 10% in middle-income neighbourhoods and 5% in high-income suburbs in San Antonio, Texas. Data from the Hispanic Health and Nutrition Examination Survey indicate prevalence of diabetes in the age range 45-74 years of 24% for Mexican Americans, 26% for Puerto Ricans and 16% for Cuban Americans, compared to 12% for non-Hispanic whites. Figures for a low-income district of Mexico City show a 36% lower prevalence than for Mexican Americans in the USA. Prevalence in Brazil is approximately 7% in subjects aged 30-69 years. Black Americans have a relatively high prevalence of NIDDM, though not as high as the Mexican Americans. There is evidence that complications of diabetes may vary between populations, and that they may be particularly severe in Mexican Americans, and higher in black than in white Americans. The extent to which these differences relate to access to health care and treatment remains to be clarified.


Recent developments in diabetes epidemiology in Europe.

Recent developments in diabetes epidemiology in Europe have included the completion of the European Community sponsored Concerted Action on the Epidemiology and Prevention of Diabetes (Eurodiab), further studies of diabetes and coronary heart disease prevalence in ethnic minority groups in the United Kingdom, and studies of the effect of poor fetal and early post-natal nutrition on the risk of developing non-insulin dependent diabetes (NIDDM). The EURODIAB Concerted Action Programme has provided valuable new information on the incidence of insulin-dependent diabetes mellitus (IDDM) throughout Europe and has drawn attention to an unexpectedly high incidence in Sardinia. In the EURODIAB IDDM complications study, the prevalence of both large- and small-vessel complications of diabetes has been examined, using standardized methods, in 3,279 IDDM patients from 31 centres throughout Europe. The data on risk factors for complications obtained from this study will have significant health policy implications for diabetes in Europe which will be utilized by the current St. Vincent Declaration Action Programme for Diabetes Care and Research in Europe. In another part of the EURODIAB Concerted Action Programme, important information has been obtained on the validity of routinely-collected diabetes health information, such as mortality statistics based on death certificates, and estimates of diabetes prevalence obtained from drug-utilization data.