A sex-specific analysis of correlates of homicide victimization in United States cities.

A considerable amount of research has been devoted to determining structural correlates of homicide across places in the United States. However, recent research has found that general correlates may not hold when homicide rates are disaggregated into analysis of specific groups. Adopting a public health approach, we explore the possibility that male and female rates of homicide victimization may show differential patterns of association with selected social-structural risk factors across a sample of U.S. central cities. The results show that both male and female homicide victimization is related to a general set of factors derived from the theoretical framework of social disorganization. At the same time, it is found that these factors are better predictors of male than female homicides. Suggestions are made for research to discern additional factors, perhaps distinct from those of men, related to the rather considerable variation in the prevalence of female homicide across communities in the United States.


[The epidemiological characteristics of influenza in a large urban center (B.) of Romania in 1991].

The peculiarities of the 1991 influenza epidemics in a big urban centre (B.) of Romania were evaluated through clinical and epidemiological active survey and laboratory assays. The results revealed the low rate of endemic morbidity and its significant risk during the fourth trimester as compared to the first, the important implication of the infant population in maintaining the endemic morbidity and of the less than one year old children in the seasonal peaks of the first and fourth trimesters. The laboratory assays revealed the simultaneous circulation but with variable intensity of type A(H3N2), A(H1N1) and B influenza viruses, inducing a high humoral specific protection level in the population. So the risk is low of an important epidemics during 1992. The opportunity is discussed of the prophylactic vaccination with type A(H3N2), A(H1N1) and B circulating strains of all high risk groups, especially of the preschool children from collectivities.


Relationships among marital investment, marital satisfaction, and marital commitment in domestically victimized and nonvictimized wives.

The present investigation examined the association between marital investment, marital satisfaction, and commitment to marriage among physically abused women. We applied an investment model and a social learning model to understanding victimized wives' satisfaction and commitment to stay married. Thirty wives who reported physical abuse and 58 nonabused wives completed measures of marital stability, investment in marital problem solving, and dyadic adjustment. Investment in marital problem solving was assessed by having subjects indicate how much energy that they have put into solving 34 common marital problems and whether their efforts were successful or not successful. Consistent with a social learning model but counter to an investment perspective, correlational and multiple regression analyses for each group revealed that failed investment was significantly related to lower, not greater, commitment. Group differences also emerged. Whereas nonabused wives' commitment was related to their dyadic adjustment abused wives' commitment was related to their level of failed investment. Results are consistent with the notion that women may remain in abusive relationships because of psychological entrapment.


[Epidemiological and virological research on influenza and viral respiratory infections in the southeastern region of Romania in the cold season of 1991-1992].

Investigations pointed out the high level of respiratory diseases and pneumonias in children, especially in the youngest ones (0-1 year-old) during all the surveyed period. An influenza outbreak during the second half of February was registered in the infantile population--school and low-age children--which gave most of the cases. Serology and isolations incriminated an influenza virus related to the A/Beijing 353/89 (H3N2) strain. Isolations worked out after the influenza epidemics pointed out circulation of parainfluenza and adenoviruses. The necessity is emphasized of the anti-influenza vaccination of low-age children.


Predictors of dating violence: a multivariate analysis.

A multivariate approach was used to determine the pattern of predictors associated with engaging in dating violence. Predictors were selected whose relationship to dating violence has been established by earlier research: attitudes toward violence, sex-role attitudes, romantic jealousy, general levels of interpersonal aggression, verbal aggression, and verbal and physical aggression received from one's partner. Participants included 305 introductory psychology student volunteers (227 females and 78 males) who completed a set of scales related to dating relationships. Expecting different patterns of predictors to emerge for men and women, we performed separate multiple regression analyses for each. Of the set of predictors employed, receipt of physical violence from one's partner emerged as the largest predictor of expressed violence for both men and women. In addition, higher scores on attitudes toward violence and verbal aggression, and less traditional sex-role attitudes emerged as significant predictors of expressed violence for men. For women, less accepting attitudes toward violence, more traditional sex-role attitudes, feelings of romantic jealousy, higher general levels of interpersonal aggression, and verbal aggression were predictive of expressed violence. The implications of our findings for future research are discussed.


[The efficacy of a combined therapy against herpes virus genital infections].

A complex immuno-chemical therapy (inhibition of viral replication, stimulation of cell mediated immunity, interferon induction) was applied to 75 patients with herpes virus genital infections. Treatment was followed by complete recovery in 66.7% of the subjects and by considerable reduction of relapse frequency and of pain in the others.


Joint consequences of parental alcoholism and childhood sexual abuse, and their partial mediation by family environment.

This study investigated the effects of childhood sexual abuse and parental alcoholism in a sample of university women. Current symptoms of anxiety and depression were measured together with retrospective reports of subjects' families of origin. Using a 2 x 2 factorial design, main effects on symptoms were obtained for sexual abuse and parental alcoholism, but their interaction was not significant. With respect to family environment, a history of sexual abuse was associated with perceptions that families of origin had less cohesion, more conflict, less emphasis on moral-religious matters, less emphasis on achievement, and less of an orientation towards intellectual, cultural, and recreational pursuits. Similarly, subjects who had alcoholic parents reported less family cohesion, more conflict, and less emphasis on moral-religious matters. Results of analyses of covariance suggested that family environment was a mediator of current symptoms of anxiety, but not symptoms of depression.


Multiple perspectives on groupwork with children of battered women.

As this century ends there continues to be little public attention devoted to child witnesses of woman abuse and few social programs exist to meet their needs. This article presents the findings of a qualitative evaluation of a group program for children of battered women. Interviews were conducted with 16 mothers, 5 fathers, 9 group leaders, and 30 children who participated in 8 groups. Data also included observations of one complete group process (10 groups and 3 family sessions). Both intended and unintended results are presented and recommendations for practice are discussed.


Trends and patterns of justifiable homicide: a comparative analysis.

This paper reports the first national level analysis of police and citizen justifiable homicides for a twelve year period. Utilizing data from the Comparative Homicide File, trends and characteristics of police and citizen justifiable homicides are described and reviewed. Particular emphasis is given to comparing justifiable homicides to criminal homicides. The results establish that while similar to criminal homicide, police and citizen justifiable homicides differ significantly in terms of factors such as circumstance, relationship, weapons, and racial characteristics.


[The prescription of intramuscular injectable drugs: a comparative study].

To find out the personal characteristics of patients who receive intra-muscular medication. To examine those illnesses where this treatment is used. To compare the number of intra-muscular treatments prescribed with the nature of the medication, according to a model of Primary Care and to the doctors training. We are dealing with an observational study, in which a questionnaire was used to find patients' characteristics and the prescription given. SITE. The present study was carried out in the Ibiza Health Centre and two old-fashioned out-patient clinics in our Health Area. The population under study consisted of all those patients above the age of 7 who received intramuscular treatment during the period of the study (October, November and December, 1990). There were no interventions, as this was an observational study. The intra-muscular method of administration was used more in women, people over 50 and those with a very low cultural level. The majority of patients (59.66%) believed that this method was superior to enteric treatments. This method was more often used in out-patient clinics than in the Health Centre (p < 0.01). In the Health Centre less medication treating the Locomotive System (p < 0.001) and more dealing with the Centre Nervous System (p < 0.02) was prescribed. In out-patient clinics more antibiotics, either in combination with each other or with other products, were prescribed (p < 0.01). In the Health Centre the intra-muscular method was used less. Additionally, a smaller proportion of the medication given was intrinsically useless or of unacceptably low value.


[The influence of a prior appointment on primary care consultations in the Murcia region].

Analysis of how the prior appointment system affects various indicators of attendance. A multi-centered intervention study. SITE. Faculty of Medicine. Department of Social-Health Sciences. Patients seen in the general consulting-rooms of urban and rural Health Centres during the same months in two successive years, i.e. before and after setting up the prior appointment system. Introduction of the prior appointment programme (a consultation, with the hour and date arranged beforehand). Questionnaire given to the patient at the end of the consultation. The personal variations of age and sex, and also of those relating to the medical side were compared by means of the questionnaire, before and after the introduction of the prior appointment system. Significant differences were only seen in relation to hospital referral, which tripled; and to the number of prescriptions per person, which increased. The prior appointment system has meant less waiting-time for patients and a rationalisation of consultation time; but it has not substantially altered the content of the consultation.


[Knowledge of the hygiene habits of schoolchildren: a course of urban collaboration in health].

To study the hygiene habits of schoolchildren in Santa Maria de Gracia (an urban site) and La Nora (a rural site), both in Murcia. This stemmed from an initiative of the Health Councils of these places, with the aim of later developing an effective project of Health Education. The Community was conceived as the main player in the Health-Illness process: passive behaviour models were thus abandoned. This was a transversal study of the hygiene customs of school-children from Second and Seventh Grade E.G.B. (General Basic Education: from 8 to 13) in the rural area; from Second and Fifth Grade EGB, from Second Grade BUP (Baccalaureate: from 14 to 16) and from the Second Course of Second Grade FP (Professional Formation) in the urban area. Questionnaires covered the whole of the above population. Crosses according to age, sex and the rural or urban environment were made. Professionals from both the Primary Care Teams, from Educational Centres, from the Department of Socio-Health Sciences of the Faculty of Medicine and schoolchildren interviewed. Using a participatory methodology, a questionnaire was designed and answered by a total of 1,182 students, belonging to 13 Educational Centres. There are shortcomings open to improvement in practically all areas of hygiene habits; with important differences, in particular customs, between boys and girls, between town and country and between younger and older students.


[Vaccination against hepatitis B at the Palma-Palmilla Health Center of Málaga].

To describe the results of a programme of anti-hepatitis B vaccination of high-risk groups. Observational descriptive study, of a retrospective character. SITE. At a community level within the confines of Primary Care in the Palma-Palmilla (Málaga) Health Centre, between June 1989 and March 1990. Individuals with a high risk of Hepatitis B infection, according to a modified CDC (Centre for Diseases Control) scale. The subjects were found during their attendance as patients and from among the Health Centre staff. The second generation vaccine developed by genetic engineering (Engerix B) was used. It was administered by intramuscular injection in a dosage of 20 mcg to those weighing more than 25 kilos; and of 10 mcg to those weighing less than 25 kilos. The vaccination pattern was of three doses in months 0, 1 and 6, followed by a monthly sero-conversion check. 169 individuals began the vaccination programme: 17.7% were health workers and 81.6% lived with carriers of the virus. 87.6% completed the vaccination programme. Sero-conversion in the individuals controlled was 95.5%. Only five patients were sero-negative after the third vaccination. Of these four cases achieved sero-conversion after a fourth or fifth dosage. We found there was a high rate of sero-conversion; and also high acceptance of the programme by those living with a carrier.


[Mental health referrals from a primary care team].

Study of patients' referrals from a Primary Care Team (PCT) to a Mental Health Centre. Descriptive study. Health Centre. Patients seen in the Health Centre consulting-rooms, who are then referred to the Mental Health Centre. The details of age, sex, socio-economic levels, cause of referral, quality of information on the referral form, diagnosis made in the Mental Health Centre and the later development of the case, were all analysed. A total of 90 referrals were studied. There were significant differences between the average ages of men and women. A large number of referrals fell into the 20-40 and under-sixteen age groups. The most frequent diagnoses were of upsets in the frame of mind disturbances with a source in infancy. 90% of the referral forms fulfilled the minimum level of information necessary. The importance of ongoing Mental Health Education of Primary Care professionals, in order to increase the quality of Health Care delivered to the population.


[The follow-up of pregnancy in the province of Salamanca].

To discover the level of health care accorded to pregnant women, the type of professional who attends them, and to what extent guidelines proposed for monitoring pregnancies are carried through. A transversal, retrospective, observational study: without a control and with a random sample. SITE. The data were obtained in a Public Hospital and came from women who had been monitored at all levels of health care, whether public or private. The study was of all the women who gave birth in the General Hospital over a period of three months. An interview was administered to 500 pregnant women. It was found that the number of pregnancies attended to at the Primary Care level is small (9% in Health Centre consultations and 6% by the General Practitioner). The entry of pregnant women into the Health System is late: 48% from the fourth mont. In a high percentage of cases, no explorations of the neck of the womb are made; nor are certain analytic tests (e.g. renal and liver function tests and urinary cultures) and various complementary checks made. 1) Health Education programmes must be initiated at the Primary Care level, in order to draw in at an early stage the pregnant woman. 2) There is a need to use guidelines for pregnancy and develop programmes of ongoing training for Primary Care professionals, in order to improve the quality of health care during pregnancy.


[Enteropathic arthritis].

Description of a clinical case of enteropathic arthritis. Descriptive study. SITE. Health Centre. A clinical case is described, starting with back pain where X-rays perceive no irregularity. Later a diagnosis of Crohn's disease is made. Finally lesions characteristic of anchylo-poyethic spondylitis appear. Corticosteroid treatment. Clinical investigations and complementary diagnoses. Way in which spondylitis presents, with no clear X-ray indications. Importance of closely following the development of this type of patient.


A new low-frequency platelet alloantigen, Vaa, on glycoprotein IIbIIIa associated with neonatal alloimmune thrombocytopenia.

We describe platelet alloimmunization which caused severe thrombocytopenia in a neonate and could only be detected by testing the father's platelets. The platelet-specific antibodies were identified by a monoclonal antibody-immobilized platelet protein assay (MAIPA) using monoclonal antibodies against glycoprotein (GP) IIbIIIa complex (AP2 and 2G12). The previously described alloantigen systems on the GPIIbIIIa complex (HPA 1, HPA 3 or HPA 4) were not responsible for the reaction. In addition the newly described private platelet antigen Sra was not identical to the antigen. The antigen is therefore different from all known platelet alloantigens and was designated Vaa. The antigen was present on the platelets of the affected child. Family studies showed that the platelet antigen was transmitted as an autosomal dominant trait in three generations. No Va (a+) individuals were found in a population study of 250 blood donors, which indicates that the antigen is of low frequency in the Finnish population. The Va antigen was not detectable by immunoblot analysis, which suggests that the epitope may not be a linear peptide structure. The antigen was also destroyed by solubilization of platelets. Thrombin activation of platelets, known to increase the expression of GPIIbIIIa on platelets, did not increase the number of binding sites for anti-Vaa antibodies to the extent observed with anti-HPA 1a binding.


The definition of refractoriness to platelet transfusions.

The relationship between the 1 and 20 h post-transfusion platelet count and three parameters used to define refractory transfusions, namely the corrected increment (CI), platelet increment (PI), and percentage platelet recovery (%REC), was studied in 437 non-HLA matched platelet transfusions given to 102 patients with bone marrow failure. The percentage agreement between common definitions of refractoriness was calculated based on these parameters. As the maintenance of platelet counts above 20 x 10(9)/l is a relevant clinical goal for platelet support, the values of the CI, PI and %REC, which best corresponded to 1- and 20-h post-transfusion counts of 20 x 10(9)/l, were identified. A 1-h post-transfusion CI < 3 (PI < 7 x 10(9)/l or % REC < 8%) corresponded to clinically unsuccessful transfusions with a 1-h platelet count < 20 x 10(9)/l. A 1-h CI > or = 5.5 (PI > or = 12 x 10(9)/l or %REC > or = 14%) corresponded to clinically successful transfusions with a 20-h post-transfusion count of > or = 20 x 10/l. These data tie together the end points reported in the literature for defining refractory transfusions.


Decreasing transfusion exposure risk during extracorporeal membrane oxygenation (ECMO).

Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for neonatal pulmonary hypertension but carries a significant risk for transfusion-related complications. Packed red blood cell (PRBC) and platelet exposure were quantified and reviewed in 17 ECMO survivors prior (Group I, n = 9) and subsequent to (Group II, n = 8) changes in transfusion protocols. Blood product requirements included ECMO circuit priming, maintenance of haematocrit > 0.40 or platelet count > 50 x 10(9)/l, and colloid volume expansion. Group I was exposed to 13.8 +/- 10.2 (x +/- SD) different PRBC units. In Group II, multiple transfusions from single donor units decreased exposure 71% to 3.9 +/- 0.7 units (P < 0.05). Decreases in blood withdrawn (11%) and transfusion volume (7%) were coincident with a 15% reduction in mean bypass time. Platelet volume transfusion decreased from 159 +/- 213 to 93 +/- 64 ml using volume-reduced platelet packs. Total transfusion exposure decreased 59% from 20.8 +/- 17.8 units to 8.6 +/- 2.4 donor units. No transfusion complications occurred during the aggregate 1,926 h on bypass. We conclude that neonates on ECMO have a significant transfusion exposure risk increasing with prolonged duration of ECMO therapy. In addition we noted that concentrated platelet packs decreased transfusion volume by 41%, and multiple PRBC transfusions from single donor units decreased donor exposure by 71% while both strategies decreased the overall transfusion exposure risk by 59%.


Transmission of HIV by transfusion of HIV-screened blood: the value of a national register. The 'Recipients' Study Group of the French Society of Blood Transfusion.

A National Register of transfusion-transmitted infections was opened by the French Society of Blood Transfusion on 1 October, 1986. Out of 54 initially reported cases of HIV-infection, allegedly transmitted by blood components, further investigation could be completed in 33 cases. The transfusional origin of contamination was considered as established or probable in 28/33 cases, either because a potentially infectious unit was identified among those transfused to the recipient (23/28), or because the recipient was known to be seronegative before transfusion (5/28), or both (10/28). In 5/33 cases transfusion was considered as presumably responsible for contamination because no other risk factor was found in the recipient. Among the 33 documented cases of HIV-transmission by screened blood, 29 (88%) occurred between 1985 and 1987, and four (12%) during 1988. Out of 19 implicated donors later found seropositive, 16 belonged to a high-risk group for HIV-infection. The majority of HIV-infections occurred as a consequence of blood donation in the window period between contamination and the appearance of detectable antibodies in the donor's serum (11/19). In three instances, however, human and operational errors led to the release of seropositive units. We conclude that the main value of this Register is to provide a potential trend-indicator of transfusion-related infectious risks, to allow objective documentation of reported cases and to contribute to the improvement of blood transfusion practice.


Guidelines for the use of fresh frozen plasma. British Committee for Standards in Haematology, Working Party of the Blood Transfusion Task Force.

Fresh frozen plasma should only be used to treat bleeding episodes or prepare patients for surgery in certain defined situations. Definite indications for the use of FFP: 1. Replacement of single coagulation factor deficiencies, where a specific or combined factor concentrate is unavailable. 2. Immediate reversal or warfarin effect. 3. Acute disseminated intravascular coagulation (DIC). 4. Thrombotic thrombocytopenic purpura (TTP). Conditional uses: FFP only indicated in the presence of bleeding and disturbed coagulation: 1. Massive transfusion. 2. Liver disease. 3. cardiopulmonary bypass surgery. 4. Special paediatric indications. No justification for the use of FFP: 1. Hypovolaemia. 2. Plasma exchange procedures. 3. 'Formula' replacement. 4. Nutritional support. 5. Treatment of immunodeficiency states.


Group facilitation: building that winning team.

Team building does not occur by chance; it involves using techniques to make it easier for members to contribute their expertise while working with others to achieve quality results. Evaluation of team effectiveness involves assessing both the processes (team interactions and work processes) and accomplishment of goals (out-comes; see box). Productivity and quality that could not be accomplished by individual efforts may be enhanced by effectively working teams.


In vitro and in vivo antidermatophytic activity of saperconazole, a new fluorinated triazole.

The in vitro activity of saperconazole against selected isolates of dermatophytes and its in vivo efficacy in a guinea pig dermatophytic infection model using Trichophyton mentagrophytes were evaluated. Susceptibility testing was determined with an agar dilution method in three media: yeast nitrogen base agar (YNBA), brain heart infusion agar (BHIA) and Sabouraud dextrose agar (SDA). An inoculum of 1 x 10(5) CFU of T. mentagrophytes spores was placed onto the surface of these agars. Incubation was at 32 degrees C for 72 h. The MIC of saperconazole against all isolates was less than 1 microgram/ml, whereas the MIC ranged from 0.1 to > 128 micrograms/ml for fluconazole. The MIC range of saperconazole against Trichophyton species was < or = 0.002 to 0.25 micrograms/ml; against Microsporum species it was < 0.001 to 0.1 microgram/ml; and against Epidemophyton species was < or = 0.002 to 0.25 micrograms/ml. These data showed that saperconazole was the most active compound tested against these selected dermatophytes. The activities of saperconazole against T. mentagrophytes, T. rubrum and M. canis were not affected by the medium. The MICs against these organisms were < or = 0.008 micrograms/ml in SDA, YNBA or BHIA. There were 2- to 4-fold decreases in activity for fluconazole at the same conditions. In vivo, topical treatment with saperconazole at concentrations of 0.125% and 0.25% resulted in 50% and 75% microbiological cure rates, respectively, in the guinea pig topically infected with T. mentagrophytes.


Effects of a novel piperazine derivative (CGP 29030A) on nociceptive dorsal horn neurons in the rat.

In anaesthetized rats and cats, the effects of the piperazine derivative CGP 29030A on the discharges of functionally identified dorsal horn neurons and gamma-motoneurons was studied. The compound exhibited a marked inhibitory action on presumably nociceptive dorsal horn neurons that processed input from high-threshold mechanosensitive receptors in the skin and deep somatic tissues (muscle, tendon, joint). Significant effects were obtained at a dose of 10 mg/kg p.o. and higher; the onset of action was fast (approximately 10 min). In contrast to presumably nociceptive dorsal horn neurons, cells having input from low-threshold mechanosensitive receptors in the skin and deep tissues were not affected by the compound. Thus CGP 29030A has a quite specific action on dorsal horn neurons that probably mediate pain. Systemic effects on the blood pressure and on the activity of sympathetic efferent fibres did not occur. The lack of effect of CGP 29030A on nociceptive neurons in spinalized animals suggests that the site of action is not the segmental spinal cord but the supraspinal CNS. gamma-motoneurons supplying the gastrocnemius-soleus muscle were likewise inhibited by the compound but at a higher dose (equal to and exceeding 30 mg/kg). The data show that CGP 29030A is a compound with marked and specific analgesic action. As it also inhibits gamma-motoneurons, CGP 29030A may be of benefit in the treatment of painful disorders which are complicated by increased motor activity (cramp, spasm).


Perinatal exposure to ethanol affects postnatal degeneration and regeneration of serotoninergic pathways in the spinal cord.

It has been reported that chronic ethanol exposure during intrauterine life may cause severe adverse effects in early infancy that have been termed fetal alcohol syndrome. These alterations may perturb the normal brain development as though alcohol exposure might have altered the basic cellular interrelationship underlying neuronal plasticity. The neonatal lesion of the serotoninergic pathways in the central nervous system with the selective neurotoxin 5,7-DHT supplies an ideal model for studying the effects of substances of abuse on degenerative and regenerative events. The authors' data indicate that perinatal exposure to ethanol (3% in drinking water) causes a more rapid degeneration of the serotoninergic pathways affected by 5,7-DHT; conversely, regeneration and reinnervation of the lumbar spinal cord are markedly improved by ethanol exposure. These results suggest that perinatal ethanol exposure promotes cellular changes that at later stages are capable of improving neural repair in the brain.


Influence of sodium valproate and carbamazepine on GSH levels in rat cerebral cortex.

The effects of sodium valproate (150 mg/kg) and carbamazepine (300 mg/kg), alone and in combination, on the content of glutathione (GSH) were investigated in the rat cerebral cortex. No modification was found either 4, 12 or 16 hours after treatment, suggesting that sodium valproate and carbamazepine do not affect the cortical GSH metabolism in rats.


Etofibrate treatment alters low density lipoprotein susceptibility to lipid peroxidation.

The effect of the lipid lowering drug etofibrate was investigated on lipid peroxidation as well as on cholesterol level. Rabbits were given a 0.1% cholesterol containing diet. Total cholesterol, LDL-cholesterol, triglycerides and lipid peroxidation, expressed as thiobarbituric acid reactive products, were determined. Treatment with etofibrate led to a marked decrease in total cholesterol and LDL-cholesterol. Furthermore, Cu(2+)-induced lipid peroxide formation was reduced in etofibrate treated rabbits. These results could be confirmed in a human study when patients with moderate hypercholesterolaemia were treated with etofibrate (2 x 500 mg/day) for a period of eight weeks. It could be shown that the onset of lipid peroxidation was remarkably increased, an effect which was completely reversible. Thus, etofibrate is effective not only in lowering plasma cholesterol but also in rendering LDL less susceptible to oxidation.


Protection of isolated perfused working rat heart from oxidative stress by exogenous L-propionyl carnitine.

The effect of exogenous L-propionyl carnitine on peroxidative injury was investigated on isolated working rat hearts. The addition of 190 microM hydrogen peroxide to the perfusion buffer caused a marked decrease in aortic flow, minute work and peak aortic pressure, and a release of intracellular enzymes. In the presence of L-propionyl carnitine the haemodynamic damage was significantly lower and enzyme leakage remarkably decreased. The protection was concentration-dependent and the whole structure of the molecule was required, since carnitine alone was found less effective and propionate had no effect. In the absence of hydrogen peroxide L-propionyl carnitine increased heart performance. The effect of L-propionyl carnitine on oxidative stress could account for the beneficial effect of this substance in different models of ischaemic injury. L-propionyl carnitine increases the cardiac performance and protects the rat heart from peroxidation through metabolic and antiperoxidative mechanisms.


Pharmacological properties and toxicology of MED-15, a prodrug of tolmetin.

In this study the pharmacological evaluation of MED-15, a non-acidic prodrug of tolmetin, is described. After oral administration the new compound shows a marked anti-inflammatory activity similar to that of tolmetin, but with minor ulcerogenic action and lower acute toxicity.


Effects of ketoprofen (NSAID) on the pharmacokinetics of pefloxacin and ofloxacin in healthy volunteers.

The influence of ketoprofen (K), a non steroidal antiinflammatory drug (NSAID) on the pharmacokinetics of two fluoroquinolone derivatives: ofloxacin (O) and pefloxacin (P) was studied in ten healthy adult male volunteers. All subjects orally received every 12 h the fluoroquinolone derivative (either O or P) for three days and the combination of the quinolone and ketoprofen (once a day) during the three following days. Two pharmacokinetic studies were performed for each quinolone, on days four and eight of the treatment. Blood samples were taken at times 0, 1, 2, 3, 4, 6, 8, 10, 12 and 24 h after dosing. Urine was collected during 4 time-periods: 0-4 h, 4-8 h, 8-12 h and 12-24 h. Plasma and urine concentrations of the active drug of O and P were measured by microbiological assay. Ketoprofen did not significantly modify the pharmacokinetic parameters of the two fluoroquinolones studied in terms of peak plasma levels, time to peak, area under the curve, elimination half-life, volume of distribution and total and renal clearances.


Glutathione (GSH) improved haemostatic and haemorheological parameters in atherosclerotic subjects.

Blood samples from ten patients with clinically evident manifestations of atherosclerotic disease were used to evaluate in vitro the effects of exogenous glutathione (GSH) on platelet aggregation and on blood filtration and viscosity. In two groups, each of ten atherosclerotic patients, matched for sex, age, prevalent localization, duration and gravity of disease, the effects of GSH infusion (600 mg every day for seven days) on the haemocoagulative pattern, platelet aggregation and blood filtration and viscosity were evaluated in a double-blind, placebo cross-over trial. The GSH in vitro addition resulted in a significant increase in blood filtration and a significant decrease in blood viscosity and platelet aggregation. The venous GSH infusion both significantly decreased blood viscosity and increased blood filtration. Partial thromboplastin time was lengthened after GSH infusion even thought it remained in the normal range.


Suppressive effect of prostaglandin E1, but not prostacyclin, on ouabain-induced ventricular fibrillation in guinea-pigs.

Arrhythmia was produced by the rapid intravenous injection of ouabain 200 micrograms/kg in anesthetized guinea-pigs. The incidence of ventricular fibrillation (V.F.) induced by the ouabain challenge was significantly decreased by the pretreatment with prostaglandin (PG) E1 5 micrograms/kg or propranolol 0.5 mg/kg, but not with prostacyclin (PGI2) 0.5 or 5 micrograms/kg. Also, a significant number of animals treated with PGE1 or propranolol, but not PGI2, showed recurrent reversion to sinus or ventricular rhythm from V.F. and survived more than 20 min after the ouabain challenge. On the other hand, almost all animals treated with PGI2 produced V.F., which converted to cardiac arrest within 20 min after the ouabain challenge. The finding shows that PGI2 has no protective action on V.F. induced by ouabain in anesthetized guinea-pigs. Involvement of norepinephrine released from sympathetic nerve terminals in ouabain-induced V.F. was assumed.


Helical volume CT and its clinical significance.

Helical Volume CT (HVCT) is an X-ray CT scanning technique in which the patient is scanned continuously while the couch-top is moved in the axial direction. It is performed using the Toshiba TCT-900S CT scanner jointly developed by the authors and Toshiba Corporation. This scanner features a large central opening, the inner surface of which is lined with a circular array of 2,304 detectors. The X-ray tube rotates outside the detector array at the rate of one revolution per second. Electrical power is supplied to the X-ray tube through a slip ring mechanism, permitting the X-ray to be continuously generated without any interscan delay. The X-ray tube and detectors move in a "nutate/rotate" pattern. The maximum scanning time is 30 seconds (equivalent to a single breath-hold). To improve image quality, the slice thickness can be selected to equal the distance over which the couch-top moves in one second. The clinical advantages of HVCT are as follows: (1) the examination time is significantly reduced (to minimize the patient's discomfort), (2) continuous data of anatomical structures can be obtained without artifacts due to respiratory motion, and (3) it is possible to obtain superior images for multiplanar reconstruction (MPR), cine-display, and three-dimensional reconstruction.


The relationship between organ perfusion pressure and multiple organ failure during mechanical left ventricular assist.

The purpose of this study was to analyze the relationship between hemodynamics, especially the organ perfusion pressure (OPP = mean aortic pressure-mean right atrial pressure) and multiple organ failure (MOF) in cardiac patients receiving left ventricular mechanical assists (LVA). The subjects were 33 patients who had undergone left ventricular mechanical assists in the Department of Cardiovascular Surgery, Fukushima Medical College Hospital, from March 1985 through March 1990. OPP significantly correlated with the levels of GOT, total-bililubin (TB), BUN and serum-creatinin (s-Cr), oxygenation index (OI) and respiratory index (RI). The cardiac index and left and right ventricular stroke work indices, in comparison with OPP, did not significantly correlate with any of the above laboratory tests. These results indicate that OPP is a simple and reliable index to recognize, and also to prevent MOF during LVA. It was also found that OPP should be maintained at a level higher than 65mmHg to protect the liver, kidneys and lungs.


Recording the bladder electromyogram for bladder activity evaluation during post-operative urinary urgency.

When the intravesical pressure cannot be measured because of continuous drainage, bladder electromyography is an alternative means of evaluating the functional condition of the urinary bladder. However, many problems that accompany this procedure have not been solved. In the present study we tried bladder electromyography with a newly-developed carbon fiber electrode in a patient who underwent an open prostatectomy. It was helpful in recognizing the relationship between urinary urgency and the spasmic activity of the vesicular detrusor muscle.


Bronchoscopy for airway foreign bodies: consideration based on an extraordinarily large one.

An extraordinarily large foreign body was lodged in the trachea of a 14-year-old boy. It was a rectangular piece of lead measuring 35 x 12 x 5 mm and was removed by a lower rigid bronchoscope introduced through a tracheostoma. Based on experiences of this and 6 other cases of tracheobronchial foreign body treated by this method, we discuss what approach should be used to extract tracheobronchial foreign bodies. We believe that lower bronchoscopy is still useful in removing foreign bodies very large or located in the peripheral bronchus, although it is used much less often today than before.


Evaluation of BACTEC 460 TB system for measurement of in vitro anti-Mycobacterium leprae activity of various antimicrobials.

In vitro anti-leprosy activities of various antimicrobials were measured by using the BACTEC 460 TB System. The Growth Index reducing activities of test drugs were strong in clofazimine, KRM-1648, rifabutin, clarithromycin and rifampicin; intermediate in sparfloxacin, minocycline and ofloxacin; and weak in ciprofloxacin, fleroxacin and DDS. Amikacin, pipemidic acid, enoxacin and norfloxacin had no such in vitro activities. There is a close correlation between in vitro and in vivo anti-M. leprae activities of a given agent, therefore indicating usefulness of the BACTEC 460 TB System in evaluation of in vitro anti-M. leprae activity of a given agent.


Demonstration of PGL-I & LAM-B antigens in paraffin sections of leprosy skin lesions.

An investigation on the demonstration of PGL-I and LAM-B antigens in thirty-four paraffin embedded skin biopsies taken from leprosy patients who covered the whole spectrum of the disease and in four control specimens was carried out. Neither the PGL-I antigen nor the LAM-B antigen was demonstrated in the normal skin specimens that were used as negative control; and only the LAM-B antigen appeared in the tuberculosis specimens in which the PGL-I antigen was negative. The PGL-I antigen was demonstrated on thirty-three leprosy samples except one TT sample and the LAM-B antigen, on all samples by immunochemical staining technique. The antigens were identified as intracytoplasmic bacillary staining, in solitary, granular as well as debris patterns; and as soluble antigenic staining, in vacuolar or amorphous pattern. In LL and BL cases, the antigens were detected predominantly from macrophages and peripheral nerves in all five staining patterns; in BB cases, from macrophages mostly in the granular as well as debris patterns, from the nerves in the vacuolar pattern; while in TT and the majority of BT cases, they were mainly from nerve remnants inside the granuloma in the vacuolar or amorphous staining pattern. In addition, it is interesting to note that the immunochemical staining was able to differentiate the foamy change from the hydropic degeneration. We also found that the antigens distributed in arrector pili muscles and the walls of muscular vessels were obviously related to the unmyelinated nerve fibers innervating the smooth muscle cells.(ABSTRACT TRUNCATED AT 250 WORDS)


[Minobu Jinkyo-En under the influence of Nichiren Sect].

Minobu Jinkyo Hospital was established in 1906 by Ryumyo Tsunawaki, who is a Bonze of Nichiren Sect in Minobu Jinkyo-En Leprosy Foundation, in order to extend a hand of assistance to the Hansenites. The characteristic of this hospital was to reduce the tenets of Nichiren to practice with the fervour of Buddhist. In the heart of people, either volunteer staffs or Hansenites, flocked here from various quarters, was fostered the spirit of self-restraint and/or -government under the influence of the Buddhist Sutra. The daily life of Hansenites in Jinkyo Hospital has veered round according as it is said that man is a creature of circumstances. Things are not what they used to be. And, Jinkyo-En which was a desolate waste has come to an oasis in life for the Hansenites. A small and decreasing number of inpatients are found annually and rehabilitation of cured patients back into society has been made possible, now. High aim of Bonze Tsunawaki was to establish rightful place for Hansenites, and it was fulfilled. Minobu Jinkyo Hospital was closed in 1992.


Rising trend of HIV infection with special reference to blood donors.

This paper describes the experience in testing for antibodies to the human immunodeficiency virus (anti-HIV) at a private institution. A total of 31,003 persons were tested between August 1986 and June 1990 including 20, 321 blood donors. The other 10,712 were visitors to the Ohso International Commune (OIC), a commune for followers of Osho Rajneesh. Another 133 patients, 45 of whom had been repeatedly transfused, were also tested. Thirty two persons tested positive-22 blood donors, 4 visitors to OIC and 6 patients. The seropositivity of unselected blood donors was O of 273 donors in 1986, 1 of 2836 in 1987 (0.04%), 2 of 5373 in 1988 (0.04%), 11 of 7201 in 1989 (0.15%) and 8 of 4640 in the first half of 1990 (0.17%). Since non-professional blood donors represent a sample of the general population, a rise in seropositivity in the former may imply a rise in the latter.


Significance of ventricular late potentials in patients with myocardial infarction.

Fifty six patients (52 males, 4 females, mean age 53.6 +/- 8 years, range 35-75 years) were studied to determine the influence of clinical variables, site of myocardial infarction, thrombolytic therapy, documented arrhythmias and left ventricular ejection fraction (LVEF) on the incidence of ventricular late potentials (LP's). LP's were detected in 17 (30.3%) patients; in 6 (26%) patients with acute and in 11 (33.3%) patients with old healed myocardial infarction. 87.5% of the patients in whom LPs were detected had low LVEF. The presence of low LVEF correlated significantly with the presence of LP's (p = .02). LP's were also present in all patients with documented sustained ventricular tachycardia. Clinical variables (Killip and NYHA class), site of myocardial infarction, Q wave versus non-Q wave myocardial infarction and thrombolytic therapy did not relate to the presence of LP's (p > 0.5) Patients of myocardial infarction with low LVEF and a history of ventricular tachyarrhythmias should undergo signal averaged electrocardiography for LP detection. LP presence would identify patients at higher risk of future arrhythmic events within this subgroup.


Oxygen desaturation and tachycardia during upper gastrointestinal endoscopy are transient and benign.

We continuously monitored the arterial oxygen saturation (SaO2) and pulse rate by pulse oximetry in 46 patients undergoing upper gastrointestinal endoscopy for diagnosis (21 cases) or variceal sclerotherapy (25). No premedication or prior topical anaesthesia was used. Significant hypoxaemia (percent drop in SaO2 > 2) occurred in 24 (52%) patients during the procedure; in 16 of these it occurred during introduction of the endoscope. Twenty seven (59%) patients had hypoxaemia during recovery, 25 of these immediately after withdrawal of the endoscope. All these episodes were short-lived and were probably due to gagging; basal levels were reached within 1 to 5 min. Tachycardia (> 100 beats/min) occurred in 41 (89%) patients. Sclerotherapy and history of smoking did not affect the incidence and magnitude of hypoxaemia and tachycardia. Transient cardio-respiratory changes occur during and immediately after endoscopy, but these appear to be clinically benign.


Hypercalcemic encephalopathy in a patient on anti-TB treatment for glandular tuberculosis.

An 84 years old male patient presented with hypercalcemic encephalopathy and mild azotemia while on anti-tuberculous treatment for glandular tuberculosis. He recovered fully during treatment with hydration, intravenous frusemide and oral prednisolone while continuing on the antituberculous therapy.


Gloriosa superba poisoning.

Suicidal attempts by consuming poisonous extracts of a creeper plant Gloriosa superba are frequent in this region. An instance of such poisoning is reported here, wherein a family engaged in business dealing with this plant consumed the crude liquid extract of its root. The symptoms were mainly gastrointestinal. The children had more severe symptoms which included sweating, hypotension, jaundice, bradycardia and convulsions. The features were reversible with symptomatic treatment alone.


Type II paralysis or intermediate syndrome following organophosphorous poisoning.

Three cases of type II paralysis or intermediate syndrome following organophosphorous poisoning are reported. Two patients had an initial improvement followed by development of paralysis of neck flexors, cranial nerves, proximal muscles of the limbs and respiratory muscles, which occurred 48 to 96 hours after the poisoning. All the patients recovered completely.


A comparative study of bronchodilator actions of ipratropium bromide (atrovent) & salbutamol (ventolin) on exercise induced bronchial asthma.

The bronchodilator actions of salbutamol and ipratropium bromide were compared in 30 established cases of bronchial asthma, before and after exercise. It was noticed that after exercise (brisk walk for 3 min.) the PFT values of FVC, PEFR and FEV-1, decreased remarkably from the basal values, the mean fall of 17.91%, 10.68% & 14.8% respectively was noticed. Salbutamol showed improvement in FVC, PEFR, FEV-1, of 20.86%, 15.96% & 17.98% respectively from basal values, while Ipratropium bromide showed improvement by 18.31%, 13.01% & 20.90% respectively. It was also noted that salbutamol is a better drug amongst smokers, patients with family history of bronchial asthma, and in younger age groups. Ipratropium bromide was better in elderly patients (> 40 yrs.) and in those with eosinophillia.


Gelatin particle agglutination assay to detect anti-PGL-I antibodies in leprosy patients and in household contacts: a preliminary study.

A preliminary study of anti-phenolic glycolipid-I (PGL-I) IgM antibody detection using M. leprae gelatin particle agglutination (MLPA) test kit is described. Antibodies were demonstrated in 70% of our leprosy patients taking antileprosy treatment. The percentage of positivity of multibacillary cases was 86.0, whereas that of paucibacillary cases was 30.0. Good correlation was found between bacteriological index and the presence of antibodies. Antibodies were detected in 28% of our patients released from treatment. Fourteen out of 27 household contacts were found to have antibodies but none of the normal controls were seropositive. These preliminary data demonstrate that MLPA test is not applicable as sero-diagnostic test or as a test of cure, but may be useful for epidemiological studies and as a research tool.


Utility of gelatin particle agglutination test (MLPA) for rapid serodiagnosis of leprosy in a hyperendemic area.

The anti-PGL M. leprae specific antibodies were estimated by MLPA test in 79 patients of leprosy, 8 contacts of lepromatous cases and 10 healthy controls in a hyperendemic area. The results indicated an over all seropositivity of 50.6% in leprosy patients. Three of the eight contacts and five of the controls also gave positive results. Higher seropositivity rates were noted in multibacillary patients (73% in lepromatous, 53.6% in borderline, 40% each in tuberculoid and indeterminate and 10% in pure neuritic types). The practical application of MLPA test in its present form as a serodiagnostic procedure for screening subclinical or clinical infections in leprosy patients appear to be of limited value in hyperendemic areas. Further studies involving large series of subjects are necessary for reaching definite conclusions.


Utility of beige mouse in leprosy research.

Dissemination of M. leprae to visceral organs is seen by four months onwards only in beige (C57BL/6/bgj) but not BALB/c mice following intravenous or intraperitoneal infections. Inoculation of the beige mouse derived M. leprae showed all the characteristics of M. leprae, including growth pattern in the foot-pads of BALB/c mice. M. leprae inoculated into foot-pads of beige mice multiplied faster than those in the foot-pads of BALB/c mice. The possibility of using beige mouse in chemotherapeutic studies in leprosy is discussed.


A clinical and radiological study of maxillary antrum in lepromatous leprosy.

Seventy consecutive patients having multibacillary leprosy were questioned about symptoms of nasal involvement and sinusitis. Complete otorhinolaryngeal examination was carried out in all these patients and they were subjected to radiographic examination of paranasal sinuses. Radiological abnormality of maxillary antrum was found in 40 (57%) patients. Radiological changes were unilateral in 25 and bilateral in 15 patients. Localised or generalised mucosal thickening was the most common finding, followed by diffuse opacity. The development of radiological changes in maxillary antrum correlated with high bacterial density (BI 3+ and above), nasal deformity, and disease duration of more than two years.


Variables influencing regularity of leprosy patients in attending treatment clinics.

Regularity in attending clinics as well as taking drugs assume a very significant place in leprosy control programme since irregularity of leprosy patients can lead to poor disease control, drug resistant disease, and development of physical deformities and disabilities thus leading to programme failure. Further, these complications also create socio-economic and psychological problems to the victims as well as their families in myriad ways. This paper reports a study aimed at identifying the variables, among a set of 29 selected demographic, socio-economic and disease-related variables, having significant association with regularity of leprosy patients in attending treatment clinics. It was found that age of the patients, type of family, duration of the disease, time lag between diagnosis of the disease and starting treatment and knowledge of patients and their families about the disease were significantly associated with treatment regularity.


Prevalence of colour blindness among patients with leprosy.

Using Ishihara test plates the prevalence of colour blindness was studied on six hundred and ninety-seven leprosy patients and two hundred and ninety-two normal healthy controls. 7.88% of male patients with tuberculoid leprosy, 12.18% of male patients with lepromatous leprosy, and 0.67% of male controls were detected to be colour blind (red-green deficiency or total colour weakness). The differences between the different groups are significant. Among female patients and controls, only one lepromatous leprosy patient was detected to have red-green deficiency. This suggests the possibility of a genetic predisposition to Mycobacterium leprae infection in patients with leprosy.


Comparison of two multidrug regimens in multibacillary leprosy.

One of the technical problems relating to the multidrug therapy of leprosy is the slow decrease in the bacteriological index (BI) in multibacillary patients. In this study we have compared a regimen containing rifampicin given daily for 9 months with the standard WHO multidrug regimen for multibacillary leprosy. We have found, at the end of two years, a significantly greater fall of BI in patients who had received the regimen containing daily rifampicin as compared to those who had received pulsed doses of rifampicin. The doses of dapsone and clofazimine were similar in these two groups. It appears that daily administration of rifampicin may be useful in treating multibacillary patients in whom reduction in the BI is slower than expected. However, in view of its high cost and the very much increased incidence of type-2 lepra reactions and hepatitis, daily rifampicin therapy cannot be recommended for a control programme.


Induction of lepromin positivity by a candidate anti-leprosy vaccine Mycobacterium w in lepromin negative healthy contacts of multibacillary leprosy patients.

In a hospital based study, 362 household contacts of multibacillary leprosy patients were screened for evidence of leprosy and 54 (14.9%) were found to be having leprosy. The remaining 308 apparently healthy contacts were lepromin tested and 109 (35.4%) were observed to be negative to Mitsuda lepromin. M.w vaccine was administered intradermally to 95 of these 109 lepromin negative contacts. Sixty eight of them could be retested for lepromin A reactivity. Fifty six (82.35%) manifested lepromin conversion. The twelve subjects who did not show lepromin conversion, received a second dose of the vaccine, and eleven subsequently became lepromin positive. The overall lepromin conversion rate was thus 98.5% (67 out of 68). Follow-up of these contacts upto a period of 30 months did not demonstrate reversion of lepromin positivity back to negativity status. No untoward effects of vaccination were observed except for local ulceration at the site of vaccine administration.


Leprosy-derived chemoautotrophic nocardioform (CAN) bacteria closely resemble, or are identical with, Mycobacterium leprae on mycolate and other lipid profiles.

On the basis of thin layer chromatography and gas-chromatography-mass spectrometric studies, the lipid profiles of all the chemoautotrophic nocardioform (CAN) bacteria derived from human and animal leprosy tissues appear to be identical with each other, and closest to or identical with the most probable profile of M. leprae.


Estimated number of leprosy cases in the world.

Planning for disease control requires estimates of the number of leprosy patients from local to global levels. From the mid-sixties to the mid-eighties, global estimates appeared to be constant at between 10 and 12 million. The introduction of multidrug therapy (MDT) in many countries and the consequent reduction of prevalence of the disease has necessitated a reassessment of the global estimate. Based on available information and its interpretation, the number of leprosy cases in the world in 1991 has been estimated at 5.5 million. The number of individuals with deformities due to leprosy, including persons now cured of the disease, has been estimated at between two and three million.


Corticosteroid treatment of extensive hemangiomas: analysis of 22 cases in children.

During the past 16 years, 22 Thai infants with extensive hemangiomas which impaired bodily functions and were life-threatening, especially in Kasabach-Merrit Syndrome have been treated. The incidence of female-to-male ratio was 8:3, all of the hemangiomas appeared between birth and 3 months of age. Among the 22 infants, 11 (50%) had hemangiomas on the head and the neck, and 2 had laryngeal hemangiomas. Two cases of Kasabach-Merrit Syndrome, located at the shoulder and the thigh, were complicated with severe bleeding, infection and congestive heart failure. Ocular impairment, malocclusion, and cutaneous distortion were the most important functional problems. Three cases were associated with other congenital anomalies: intracranial angioma, Dandy Walker Syndrome and Klippel-Trenauncy Syndrome. Prednisone (2-4 mg/kg/d) was used in all cases with other symptomatic treatment. Antiplatelet aggregating and antithrombotic drugs were useful in Kasabach-Merrit Syndrome. Definite response was noted in 72.72 per cent of the patients, doubtful response in 23.32 per cent, and no response in 4.54 per cent which was better than in other reports. There were no serious side-effects of the corticosteroid treatments reported in our careful students.


Antimicrobial resistance of 100 serial gram-negative isolates in two intensive care units.

To determine antimicrobial resistance pattern among gram-negative bacteria isolated from suspected sources of infections in patients hospitalized in two Intensive Care Units (ICUs) at Siriraj Hospital from September 1991 to December 1991, minimal inhibitory concentrations of one-hundred consecutive gram-negative isolates for various antimicrobials were performed using the microbroth dilution method. Of all gram-negative bacterial isolates, 25 per cent were Pseudomonas aeruginosa, 22 per cent Acinetobacter anitratus, 16 per cent Klebsiella pneumoniae, 12 per cent enterobacter, 8 per cent E.coli, 5 per cent non-fermenter, 4 per cent pseudomonas, 3 per cent arizona, 2 per cent A. lwoffii, 1 per cent Aeromonas hydrophila, 1 per cent Aeromonas hydrophila, 1 per cent Proteus rettgeri, and 1 per cent shigella. The in vitro MIC study revealed that 50, 48, 43, 61, 59, 34, 47, 52, 31, 15 per cent of gram-negative isolates were resistant to gentamicin, tobramycin, amikacin, cefotaxime, ceftriaxone, ceftazidime, aztreonam, piperacillin, ciprofloxacin and imipenem respectively. In addition, 64 and 71 per cent of the isolates were resistant to aminoglycosides and cephalosporins being used in the same patients 48 hours before cultures were obtained respectively. The possible spread of resistant gram-negative isolates by cross contamination was not evident by looking at MIC co-variation in sequential isolates of P. aeruginosa. It was concluded that antimicrobial resistance was highly prevalent among gram-negative bacteria isolated from patients already hospitalized in the ICUs. Potent antimicrobials such as imipenem, newer fluoro-quinolones, ceftazidime and amikacin, are often needed for therapy of serious gram-negative bacterial infections in the ICUs.


Pancreas divisum: incidence and clinical evaluation in Thai patients.

Five hundred patients with successful pancreatogram between 1982 and 1990, 8 patients (1.6%) were found to have complete pancreas divisum. The sex distribution was equal (4 men, 4 women), and the average age was 42.5 years (22-77 years). No increased incidence of pancreas divisum in any of the three groups: a group with pancreatitis, a group with unexplained upper abdominal pain, and an incidental group (obstructive jaundice, gall bladder disease, abdominal mass, miscellaneous). These findings show that pancreas divisum is a normal anatomic variant with an incidence of 1.6 per cent in Thai patients, and is seldom a cause of pancreatic symptoms.


Symptomatology and hormonal levels among Thai women with natural menopause.

The hormonal levels and symptoms after natural menopause have been studied in 100 patients. The mean age was 56.8 years while menopausal age was 50.3 years. Postmenopausal symptoms presented 55.0 per cent with the three most common complaints of hot flushes, emotional lability and vaginal dryness, respectively. The levels of plasma FSH, estradiol and testosterone were also reported corresponding to the years after menopause. Both gonadotropins reach a maximum concentration at two to three years after the menopause and then gradually declined. The LH/FSH ratio was 0.6. The mean concentration of estradiol was 10.07 pg/ml, the level remained consistently low during the menopausal period. Testosterone concentration declined little in postmenopausal women.


The effects of medial patellar plica on clinical diagnosis of medial meniscal lesion.

A prospective study involving 190 patients presenting with symptoms suggesting internal derangements of the knee was performed to demonstrate the likelihood of symptoms and signs produced by medial patellar plica to mimic those of medial meniscal lesions. Arthroscopic examination was done in each patient by an independent examiner after the establishment of clinical diagnoses. Only patients with isolated medial patellar plica (Group A, n = 54) and isolated medial meniscal lesion (Group B, n = 19) were further assessed. Although isolated medial patellar plica can produce symptoms and signs similar to medial meniscal lesion, statistical analysis clearly demonstrated that giving way, locking, medial joint line tenderness and positive McMurray test were more commonly detected in Group B (p < 0.05). The sensitivity of detecting either one or more than one symptom or sign included in this study was higher in group B (89.5%), but a positive symptom or sign was more predictive in Group A (39.2%). Considering the variation of prevalence of medial patellar plica in other regions, the results from this study indicate that giving way, locking, clicking, medial joint line tenderness and positive McMurray test would be more predictive of medial patellar plica and thus clinical diagnosis of medial meniscal lesion might be affected if the prevalence of isolated medial patellar plica exceeded 16.6 per cent.


Serum lipid, lipoprotein-cholesterol and apolipoproteins A-I and B of smoking and non-smoking males.

Cigarette smoking is an important risk factor for coronary heart disease, stroke and peripheral vascular disease. Accordingly, we measured the serum lipid, lipoprotein-cholesterol and apolipoprotein A-I, B in 128 cigarette smoking males and 67 non-smoking males. The total cholesterol and LDL-cholesterol in smokers and non-smokers showed no statistical significance. The smokers had significantly higher serum triglyceride and VLDL-cholesterol levels (P < 0.001), but significantly lower HDL-cholesterol levels (P < 0.05) than non-smokers. The apolipoprotein A-I was significantly lower and apolipoprotein B was significantly higher in smokers than non-smokers (P < 0.001). Levels of lipid, lipoprotein-cholesterol were related to the number of cigarettes smoked per day. Triglyceride and VLDL-cholesterol levels were significantly higher in those who smoked > 20 cigarettes/day compared with those who smoked 10-20, < 10 cigarettes/day and non-smokers (P < 0.05). Those who smoked > 20 cigarettes/day had significantly lower HDL-cholesterol than those of non-smokers (P < 0.05). All three groups of smokers had significantly lower apolipoprotein A-I than non-smokers (P < 0.05), whereas, those who smoked > 20 cigarettes/day had significantly higher apolipoprotein B levels than those who smoked 10-20, < 10 cigarettes/day and non-smokers (P < 0.05).


Optic neuropathy in a patient with vitamin B12 deficiency: a case report.

A 19-year-old man presented with blurring of vision for 2 weeks. He also complained of anorexia with weight loss during the past 4 months. Eight years ago, his small bowel from midportion of the jejunum, ileum, ascending colon and transverse colon were resected because of gangrene. He gave no history of exposure to tobacco, alcohol or other toxins. The bone marrow aspiration showed hypocellular with panhypoplasia. Serum vitamin B12 level was low while serum and red cell folate were within normal limits. His visual acuity was 5/200 in both eyes with centrocecal scotomas in both eyes. Other neurologic and ophthalmic examinations were found to be normal. The patient was given intramuscular injections of 1,000 micrograms of cyanocobalamin. Four months later, his visual acuity improved, serum vitamin B12 level and the bone marrow returned to be normal. This is a frank case of optic neuropathy in a patient with vitamin B12 deficiency due to a massive small bowel resection.


Urinoma, a case report with unusual presentation.

A case of urinoma in a 28-year-old man who had received blunt abdominal injury was reported. This urinoma developed from the detached but still functioned upper pole of the right kidney. The misdiagnosis from the previous surgical exploration and subsequent investigations thus delayed the proper management.


Brazilian dengue virus type 1 replication in mosquito cell cultures.

The development of dengue viruses type 1 obtained from acute human sera and inoculated into mosquito cell cultures, was observed by standard transmission electron microscopy and cytochemical staining. It follows the trans-type mechanism already established of other dengue types. Direct passage of single virus particles across the cell membrane seems to be a pathway of entry and exit in dengue-1 infected cells. The nature of numerous electron translucent vesicles and tubules, produced simultaneously during virus replication inside the rough endoplasmic reticulum, was analyzed by cytochemical tests. The largest amount of virus particles was produced inside cell syncytia.


Modeling AIDS vaccines: the cellular level.

This paper discusses current strategies for the development of AIDS vaccines which allow immunization to disturb the natural course of HIV at different detailed stages of its life cycle. Mathematical models describing the main biological phenomena (i.e. virus and vaccine induced T4 cell growth; virus and vaccine induced activation of latently infected T4 cells; incremental changes in immune response as infection progresses; antibody dependent enhancement and neutralization of infection) and allowing for different vaccination strategies serve as a background for computer simulations. The mathematical models reproduce updated information on the behavior of immune cells, antibody concentrations and free viruses. The results point to some controversial outcomes of an AIDS vaccine such as an early increase in virus concentration among vaccinated when compared to nonvaccinated individuals.


Influence of temperature on survival, growth and fecundity of the freshwater snail Indoplanorbis exustus (Deshayes).

To note the effect of temperature on survival, growth and fecundity, newly hatched (zero day old) snails Indoplanorbis exustus were cultured at 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees and 35 degrees C constant temperatures and room temperature (17.5 degrees-32.5 degrees C). Individuals exposed to 10 degrees C died within 3 days while those reared at 15 degrees, 20 degrees, 25 degrees, 30 degrees, 35 degrees C and room temperature survived for a period of 6, 27, 18, 16, 12 and 17 weeks respectively. An individual added on an average 0.21 mm and 0.45 mg, 0.35 mm and 7.94 mg, 0.63 mm and 15.5 mg, 0.81 mm and 27.18 mg, 1.07 mm and 41.48 mg and 0.78 mm and 31.2 mg to the shell diameter and body weight respectively at those temperatures per week. The snails cultured at 15 degrees C died prior to attainment of sexual maturity. On an average, an individual produced 31.9 and 582.77, 54.86 and 902.18, 56.01 and 968.45, 49.32 and 798.68 and 62.34 and 1143.97 capsules and eggs respectively at 20 degrees, 25 degrees, 30 degrees, 35 degrees C and room temperature (17.5 degrees-32.5 degrees C).


Evaluation of the molluscicidal properties of Euphorbia splendens var. hislopii (N. E. B.) (Euphorbiaceae)--1. Experimental test in a lentic habitat.

The latex of Euphorbia splendens var. hislopii, at concentrations between 5 to 12 mg/l, kills 100% of the population of Biomphalaria glabrata in a lentic habitat, after 24 h. The lyophilized latex, stocked for 18 months, killed only 34.2% of the snails, at the concentration of 5 mg/l, and 96.0% at 12 mg/l. No lethal effect was observed among Pomacea haustrum exposed to the same concentrations of the molluscicide.


Dynamics of fibrosis production and resorption in intestinal schistosomiasis of mice.

A histological, morphometric and immunocytochemical study of schistosomal periovular granulomas in the liver and intestines of mice revealed that intestinal granulomas are smaller and contain less collagen than those in the liver. After curative treatment intestinal granulomas undergo a relatively more rapid resorption, although the general pattern of collagen degradation apparently does not differ from that observed in the liver. Tendency to form scattered, usually isolated granulomas that are only mildly fibrogenic, coupled with a well-balanced process of resorption appear as the explanation why intestinal fibrosis is not an outstanding feature of schistosomiasis as it is in the liver.


Parasites of commercial shrimps and fishes in Argentine sea: on the adult and metacercaria of Opecoeloides feliciae n. sp. (Digenea: Opecoelidae).

Opecoeloides feliciae n. sp., first record of opecoelid metacercariae in commercial shrimps of South Atlantic Ocean, parasitizing Cynoscion striatus (adults) and Artemesia longinaris (metacercariae), is described, illustrated and compared with related species of the genus. Adults, immature worms and metacercariae are compared, and rates of prevalence and intensity of infection are also given.


Development of Ascaris lumbricoides eggs from females eliminated after chemotherapy in man.

The development of Ascaris lumbricoides eggs obtained from females eliminated after treatment of infected individuals with a single oral dose of the antihelminthic drugs thiabendazole (50 mg/kg--33 patients) or levamisole (250 mg--independent of body weight--20 patients) was studied. Every female eliminated up to 72 h after treatment were dissected, the uterus isolated and sectioned into small fragments. The eggs were transferred to plastics tubes and incubated at 28 degrees C in 0.1 N H2SO4 for 100 days. Every 20 days, starting from the 20 th up to the 100 th day, the extent of egg embryonation ratio was determined. The culture of A. lumbricoides eggs obtained from females from patients treated with thiabendazole did not contain embryonated eggs until the final period of observation. In contrast, the eggs obtained from females eliminated by patients treated with levamisole (control) presented an embryonation rate of 0.0-98.0% in the same period.


Experimental Chagas' disease in dogs.

This paper describes the development of experimental Chagas' disease in 64 out-bred young dogs. Twenty-nine animals were inoculated with the Be-62 and 35 with Be-78 Trypanosoma cruzi strains. Twenty-six were infected with blood trypomastigotes by different inoculation routes and 38 with metacyclic trypomastigotes from the vector via the conjunctival route. Twenty of the 26 dogs infected with blood trypomastigotes were autopsied during the acute phase. Eleven died spontaneously and nine were sacrificed. Six remained alive until they died suddenly (two) or were autopsied. (four). Twelve of the 38 dogs infected with metacyclic trypomastigotes evolved naturally to the chronic phase and remained alive for 24-48 months. The parasitemia, clinical aspects and serology (IgM and IgG) as well as electrocardiogram, hemogram and heart anatomo-histopathologic patterns of acute and chronic cardiac forms of Chagas' disease as seen in human infections, were reproduced. The most important finding is the reproducibility of diffuse fibrosing chronic chagasic cardiopathy in all dogs infected with Be-78 T. cruzi strain autopsied between the 90th and 864th days of infection. Thus, the dog can be considered as a suitable experimental model to study Chagas' disease according to the requisites of the Word Health Organization (1984). Furthermore the animal is easily obtained and easy to handle and maintain in experimental laboratory conditions.


A medium for inducing conversion of Histoplasma capsulatum var. capsulatum into its yeast-like form.

Histoplasma capsulatum var. capsulatum is a dimorphic fungus that, under special conditions, converts from its more common mycelial form to a yeast-like form. Achieving this conversion, however, has been problematical for researchers. The present study tested conversion rates in ten Histoplasma capsulatum var. capsulatum strains using seven culture media, four of which were conventional and three novel. One of our novel media, MLGema, induced complete conversion of two strains within five days of incubation at 35 degrees C, and of all strains that eventually converted by the time of the second subculturing transfer, under defined experimental conditions. MLGema is also inexpensive and easy to produce.


Catadiscus pomaceae sp. n. (Trematoda, Paramphistomatidae) from Pomacea canaliculata (Lamarck, 1801) (Prosobranchia, Ampullariidae).

Catadiscus pomaceae sp. n. from the intestine of the prosobranch mollusc Pomacea canaliculata (Lamarck, 1801), is described. The host snail was collected from a lenitic biotope belonging to the Riachuelo basin (Corrientes province, Argentina) during 1985-1986. So far the species of the genus Catadiscus Cohn, 1904 have been recorded in amphibians and reptiles. This is the first instance of a species of that genus parasitizing a mollusc.


The epidemiological significance of Chagas' disease in women.

Little is known about the risks associated with Trypanosoma cruzi infection in non-pregnant and pregnant women. From a limited number of studies it appears that in rural areas, parasite rates and rates of serological positivity are similar in both sexes. Abnormal ECG tracings are consistently more frequent in men suggesting that immunity to T. cruzi may be different in females. Complications arising from Chagas' disease in pregnancy are only infrequently reported. Evidence for increased risk of abortion or prematurity is inconclusive except in cases of congenital infection. Most cases of congenital Chagas' disease have been reported from non-endemic areas and there is a suggestion that parasitemic episodes during pregnancy may influence pregnancy outcome. Preliminary evidence indicates that chronic infection can result in in-utero sensitization via passively acquired maternal antibodies. The review concludes that maternal T. cruzi infection carries risks for the child and these warrant systematic research because of their public health significance.


Localized, diffuse, and aggregative-adhering Escherichia coli from infants with acute diarrhea and matched-controls.

Of 126 infants under 2 years, enrolled in a study on the etiology of acute diarrhea in Recife, Brazil, we selected 37 from whom no recognized enteropathogens, except classic enteropathogenic Escherichia coli, were identified. For comparison, we also examined 37 matched-control infants without diarrhea seen at the same hospital setting. This paper had the purpose to determine the prevalence of localized, diffuse, and aggregative-adhering E. coli strains in both groups. Three to five fecal E. coli colonies, of each case and control, were tested individually for adherence to HeLa cells by using the one step 3-h incubation assay. Strains of E. coli showing localized adherence were found significantly more often in patients (37.8%) than in controls (13.5%), p < 0.02, and they were practically confined to EPEC serovars 055:H-, 0111:H2, and 119:H6. In contrast, E. coli isolates exhibiting the diffuse or aggregative patterns of adherence were restricted to non-EPEC serogroups and were more frequently encountered among controls.


Leishmania braziliensis spp. in the nasal mucosa of guinea pigs inoculated in the tarsi.

Two lots of 20 young male guinea pigs were inoculated subcutaneously in the tarsi with 10(4) amastigotes of Leishmania braziliensis braziliensis or L. b. guyanensis to study the susceptibility of this Neotropical hystricomorph rodent the autochthonous parasites. Almost 50% of the animals showed lesions in the inoculation site and had parasitizations that were infective to hamsters, as shown by inoculating homogenates of the dermal lesion, of the spleen, of the liver, and of the nasal mucosa into hamsters at 20, 40, 60, and 120 days after inoculation of the guinea pig. Smears of the above organs showed the presence of amastigotes. Parasites inoculated into the tarsi were detected early in the skin, spleen, and liver of the guinea pig host. Blood cultures made by cardiopuncture on sacrifice of the guinea pigs were uniformly negative. The nasal mucosa of nearly all animals positive in the skin or viscera was invaded early by the parasites, although with greater frequency between 60 and 120 days post-inoculation. The use of this model for the study of mucocutaneous parasitism by L. braziliensis is discussed, together with the phenomena of parasitism at a distance from the inoculation site, the temperature of the body regions affected, and the possible genetic influence on susceptibility of the guinea pig to L. braziliensis.


Evaluation of three serological tests for the detection of human plague in northeast Brazil.

The passive haemagglutination (PHA) test, enzyme-linked immunosorbent assay (ELISA) and the dot enzyme-immunosorbent assay (DOT-ELISA) were used to detect the levels of IgG antibodies against the Fraction 1 (F1) antigen of Yersinia pestis in sera of plague-infected patients from Northeast Brazil. Twenty three selected PHA-positive sera of subjects with bacteriological confirmation of plague were also positive in the DOT-ELISA but only 19 were detected by the conventional ELISA technique. Another group of 186 serum samples from subjects diagnosed as plague-infected by clinical and epidemiological parameters, but PHA-negative, were screened with DOT-ELISA and 11 gave positive results. The specificity of the assays on the serological detection of plague was confirmed in inhibition tests using purified F1 antigen. These results suggest that DOT-ELISA can be an useful, simple and more sensitive alternative for the serodiagnosis of plague in Northeast Brazil.


Malaria seroepidemiology: comparison between indirect fluorescent antibody test and enzyme immunoassay using bloodspot eluates.

Blood sampling on filter paper is a current practice in malaria seroepidemiological studies by indirect fluorescent antibody test (IFAT). There is, however, scant comparative information about the use of bloodspot eluates for detection of malarial IgG antibodies simultaneously by IFAT and enzyme immunoassay (ELISA). Here we report data obtained by both serological methods done on 219 bloodspot eluate samples collected in a rural community in Brazilian Amazon Basin (Alto Paraíso, Ariquemes municipality) where malaria is endemic. Plasmodium falciparum and P. vivax thick smear antigens were used in the IFAT; a detergent-soluble P. falciparum antigen was prepared for ELISA. Substantial agreement of results (Kappa coefficient k = 0.686) was observed when P. falciparum antigen was used in both tests, and IFAT titers were found to be strongly correlated to ELISA antibody units (Spearman correlation coefficient rs = 0.818, p < 0.001). Only moderate agreement (k = 0.467) between IFAT with P. vivax antigen and ELISA with P. falciparum antigen was observed. Spearman correlation coefficient value between quantitative results (IFAT titers and ELISA antibody units) in this case was numerically lower (rs = 0.540, p < 0.0001). Our results suggest that, with P. falciparum antigen, both IFAT and ELISA performed on bloodspot eluates are equivalent for seroepidemiological purposes.


Infection of Anopheles darlingi fed on patients infected with Plasmodium vivax before and during treatment with chloroquine plus primaquine in Costa Marques, Rondönia, Brazil.

Five patients with asexual and sexual parasites of Plasmodium vivax were treated orally with 600 mg chloroquine diphosphate (hour 0) followed with 300 mg at 8, 24 and 48 h later. Primaquine phosphate, 15 mg, was administered concurrently at h 0 and at 24 h intervals for 14 days. Anopheles darlingi were fed before the first dose (h -0.5) and 0.5, 1, 2, 4, 6, 8, 10, 12, 16, 20, 24, 36, 48, 60 and 72 h later. Mosquitoes were examined for oocysts on day 8 and for sporozoites on day 15 after infection. Four of the five patients studied were still infective to mosquitoes from 1-5 h after the first dose of chloroquine plus primaquine. One of these and one other patient, who vomited 15 min after the first dose, became infective again at hours 10 and 12, respectively. Once produced, oocysts in mosquitoes fed on patients before, during and after chloroquine plus primaquine treatment appeared normal and produced sporozoite infected salivary glands. In view of these data, it is concluded that primaquine demonstrated rapid gametocytocidal activity and should be administered concurrently with chloroquine to reduce vivax malaria transmission.


A new host of Trypanosoma cruzi from Jujuy, Argentina: Octodontomys gliroides (Gervais & D'Orbigny, 1844) (Rodentia, Octodontidae).

To identify wild hosts of Trypanosoma cruzi, surveys were conducted in the subandean valleys of Jujuy Province, Argentina, between June 1986 and March 1987. Seventy two mammals from 13 different species were examined by xenodiagnosis. Fifty two of them were mostly rodents trapped at the localities of Maimará, León and Tilcara, and the remainder had been kept in captivity at the Estación Biológica Experimental, in Jujuy. Trypanosoma cruzi infection was detected only in 2 Octodontomys gliroides (2 pos./8 exam. 25%) from all 72 examined mammals. Isolates were called Octodontomys Argentina 1 and 2 (OA1 and OA2). Both infected animals were caught at the archaelogical ruin of Pucará, at Tilcara. Repeated searches for triatomines in the ruin itself and in neighbour houses rendered negative results. Groups of mice inoculated with either OA1 or OA2 isolates became infected between 7 (OA1) to 12 days (OA2) postinoculation PI. Parasitemia peaks were observed between day 12th-14th PI. Scarce amastigote nests were found in myocardium and skeletal muscle. Mortality was observed only for mice inoculated with OA1. Isoenzyme patterns of OA1 and OA2 were identical to one found in dogs and slightly different from that of human parasites in Argentina. Bones from Octodontomys sp., were recently found in a cave, dated 10200-8600 BC, in Pumamarca, near Tilcara, Jujuy. There are evidences that O. gliroides cohabited with man in ancient times and was associated to the domestic cycle of T. cruzi transmission, playing a role like that of domestic caves in Bolivia.


Spatial and seasonal trends of a natural population of Biomphalaria occidentalis in northeastern Argentina.

This study aims to analyze the age structure of a population of Biomphalaria occidentalis on a pond of Riachuelo river basin, which is one of the three most important Middle Paraná river affluents in Corrientes province. Samples were drawn from three stations, where spatial and temporal numerical variations of the snail, as well as its relation with different environmental parameters, mainly temperature, rainfall, pH and conductivity, were analyzed. Snail abundance is given in number of individuals/hour. The differences between the three sampling stations, estimated by nonparametric tests, was nonsignificant. A relative scale to the greatest shell diameter was employed to build the age pyramids. Temporal fluctuations of snail abundance correlated negatively with the highest monthly accumulated temperatures (P < 0.05). Although different floristic compositions were observed at the three stations, no significant numerical variations were detected in B. occidentalis spatial distribution. Reproductive activity took place between March-April and November with overlapping cohort system. During summer (December-February) mortality increased along with temperature and reproductive activity was not evident.


DOT-dye-immunoassay for the diagnosis of schistosomiasis mansoni.

A new serological assay dot-dye-immunoassay (dot-DIA) was evaluated for the diagnosis of schistosomiasis mansoni. This method consist of four steps: (a) biding of antigens to a nitrocellulose membrane (NC); (b) blocking of free sites of the NC; (c) incubation in specific primary antibody; (d) detection of primary antibody reactivity by color development using second antibody coupled to textile dyes. Sera from 82 individuals, 61 with Schistosoma mansoni eggs in the stool and 21 stool negative were tested by ELISA, dot-ELISA, and dot-DIA. A high level of agreement between the methods tested was observed for all sera tested: ELISA x dot-ELISA: 95.1%, ELISA x dot-DIA: 92.7% and dot-ELISA x dot-DIA: 97.6%. In this study, dot-DIA proved to be a feasible, sensitive, rapid and practical test for the diagnosis of schistosomiasis.


Trypanosoma cruzi: effect of phenothiazines on the parasite and its interaction with host cells.

Phenothiazines were observed to have a direct effect on Trypanosoma cruzi and on its in vitro interaction with host cells. They caused lysis of trypomastigotes (50 uM/24 h) and, in axenic medium, dose-dependent inhibition of amastigote and, to a lesser extent, epimastigote proliferation. Treatment of infected peritoneal macrophages with 12.5 uM chlorpromazine or triflupromazine inhibited the infection; this effect was found to be partially reversible if the drugs were removed after 24 h of treatment. At 60 uM, the drugs caused damage to amastigotes interiorized in heart muscle cells. However, the narrow margin of toxicity between antitrypanosomal activity and damage to host cells mitigates against in vivo investigation at the present time. Possible hypotheses for the mechanism of action of phenothiazines are discussed.


Description of Leishmania equatorensis sp. n (Kinetoplastida: Trypanosomatidae), a new parasite infecting arboreal mammals in Ecuador.

Characterization is given of a new parasite, Leishmania equatorensis sp. n., which was isolated from the viscera of a sloth (Choloepus hoffmanni) and a squirrel (Sciurus granatensis), captured in humid tropical forest on the Pacific Coast of Ecuador. Data based on biological and molecular criteria, as well as numerical zymotaxonomical analysis, indicate that this parasite is a new species of the L. braziliensis complex. L. equatorensis is clearly distinguishable from all other known species within this complex, using the following molecular criteria: reactivity patterns with specific monoclonal antibodies, isoenzyme electrophoresis, and restriction-endonuclease fragment patterns of kinetoplast DNA (k-DNA).


Development of Leishmania (Viannia) braziliensis vianna, 1911 in Lutzomyia intermedia (Lutz & Neiva, 1912) (Diptera:Psychodidae:Phlebotominae) under experimental conditions.

The development of Leishmania (Viannia) braziliensis in experimentally infected Lutzomyia intermedia, showed colonization of the hindgut from 48 h after the infective blood-meal, and the migration of flagellates to the foregut, with a massive infection of the cardia at the 5th day post infection. Up to 10 days following the infective blood-meal, very few parasites were seen in the pharynx and cibarium. The role of L. intermedia as a vector of cutaneous leishmaniasis is discussed according to the established criteria.


Rapid in vitro detection of HIV-1-specific antibody secretion by cells-culture with virus antigens.

The present report describes an alternative method for in vitro detection of HIV-1-specific antibody secretion in 24h of culture employing as stimulant of peripheral blood mononuclear cells the disrupted inactivated whole virus adsorbed onto microwells in a commercial ELISA kit plates. The results obtained from this technique have showed high sensitivity and specificity since it was capable of detecting HIV-1 infection early after birth. There were neither false-positivity nor false-negativity when blood samples obtained from HIV-1 seronegative asymptomatic individuals, and HIV-1 seropositive adult patients were analyzed. This rapid, low cost, simple, highly sensitive and specific assay can be extremely useful for early diagnosis of pediatric HIV infection.


[Hormones in milk].

A short review of the presence of hormones and tissues growth factors in milk during various stages of lactation. On comparative grounds, their possible physiological importance for the neonate is discussed.


[Attempts at reconstitution of skin continuity].

Biological and clinical principles of living skin equivalents preparation and application are reviewed. Different models of living skin equivalents, based on both autogenic of allogenic elements, are described.


Influence of short time exposure to an insect growth regulator, hexaflumuron, on mortality and adult emergence of vector mosquitoes.

Hexaflumuron, an insect growth regulator (IGR), was found to greatly affect the development of immatures and emergence of adults of three species of vector mosquitoes, Culex quinquefasciatus, Aedes aegypti and Anopheles stephensi, when larvae were subjected to short time exposure of < or = 1 h. This IGR could completely prevent adult emergence even at a minimum exposure time of 10 min at 0.001, 0.01 and 0.1 mg/l. On treatment, larval and pupal mortality as well as varying degrees of morphogenetic abnormalities were induced in immatures and adults of the three species. Four weeks of control achieved in a slow moving sullage canal breeding Culex quinquefasciatus indicates that this IGR can be of use in such breeding habitats.


The threat of reintroduction of natural transmission of Chagas' disease in Bambuí, Minas Gerais State, Brazil, due to Panstrongylus megistus.

In the Epidemiological Surveillance Program in the county of Bambuí, Minas Gerais, between August 1986 and December 1988, 154 Panstrongylus megistus were captured by the local population in both peridomicile and intradomicile environments. Fifteen (9.8%) of the P. megistus harboured Trypanosoma cruzi. Precipitin tests showed that the most frequent triatomine blood meal sources were birds, but other sources were dogs, men and cats. The isoenzyme characterization of 13 T. cruzi strains showed that six belonged to zymodeme Z1, corresponding to the wild cycle parasites, and seven belonged to zymodeme Z2, corresponding to parasites isolated from chronic chagasic patients (domestic cycle). As P. megistus were found to be naturally infected by parasites from both cycles. They are clearly able to transmit T. cruzi from the wild cycle to the domestic cycle. Furthermore the capacity of P. megistus in colonizing houses was observed in one residence, vacant for several years, in which 153 triatomines were captured. The data show the possibility of P. megistus reintroducing the natural transmission of Chagas' disease in the county if Epidemiological Surveillance is interrupted.


[The importance of inflammatory mediators in immune injury of renal glomeruli].

The article reviews contemporary state of knowledge pertaining to the pathogenesis of immune glomerular injury with particular emphasis on mediation of the inflammatory phase of glomerulonephritis. Distinct classes of humoral and cellular mediators are analysed with regard to their participation in experimental and human glomerulonephritis.


[Long-term results of therapy of patients with diabetes mellitus and secondary resistance to sulfanilamides].

Three groups of patients suffering from diabetes mellitus with secondary sulfanilamide resistance (SS) were observed. The first group was given sugar-lowering drugs since the disease was diagnosed, the second group -- insulin plus hypoglycemic drugs, the third group -- insulin injections. The patients were followed up for 6-10 years, from the time of SS development -- 4.6 years. Stable compensation of diabetes mellitus was better achieved with combined therapy including sugar-lowering drugs per os and insulin, a dose of insulin being less by 22 units than in patients on insulin only. Progression of diabetic angiopathies was also less noticeable in the second group on combined therapy. The most unfavorable course of diabetic angiopathies and their progression were observed in the first group on sugar-lowering drugs per os.


[Predictors of non-insulin-dependent diabetes mellitus].

A random sampling of males and females aged 20 to 69 (1125 males and 1243 females), residing in Moscow, were investigated. The first screening was in 1979, the final one--in 10 years. The program of the first screening included anthropometry, evaluation of the CVS, carbohydrate and fat metabolism, studies on hereditary aggravation with regard to diabetes mellitus (DM); the program of final screening included the state of carbohydrate metabolism. Data processing was done using methods of multidimensional analysis. Independent signs to be used as predictors of noninsulin dependent diabetes mellitus were shown to be the age of 40 and older, a general GTT index of 16, and atherogenicity coefficient values of 3.5 and lower in men, and the presence of dyslipoproteinemia in women.


[Insulin-like growth factor I in patients with newly detected insulin-dependent diabetes mellitus].

Levels of insulin-like growth factor 1 (IGF-1) or somatomedin C were investigated in 12 subjects with only the onset (3-18 mos.) of IDDM. These levels were low as compared to control values (213 + 65 and 450 + 40 ng/ml) and vice versa, growth hormones levels were higher than those in control subjects (14.0 + 8.0 and 7.5 + 1.2 ng/ml). In one month after intensified insulin infusion and three daily injections, the ratio is smoothed (IGF-1 -- 320 + 20 during CSII; 280 + 12 ng/ml during conventional insulin therapy and GH -- 10.0 + 1.2 for CSII and 15.0 + 1.7 ng/ml for CIT). The disturbed GH/IGF-1 ratio correlated with the glycemia level (r = 0.65). A close connection was established between the levels of IGF-1 and C-peptide concentrations in patients with IDDM onset (r = 0.70, p < 0.05), making it possible to influence beta-cell proliferation and to maintain DM remission.


[Glycosylation products in the early diagnosis and prognostic evaluation of carbohydrate metabolism disorders].

HbAIc and FA were investigated as markers in the diagnosis of early carbohydrate metabolic derangements. A group with normal TSH and a high concentration for glycosylation products was singled out. Carbohydrate metabolic derangements in 89 per cent showed a tendency to progression. Interrelationship between glycemia and PH was noted. The diagnostic and prognostic importance of HbAIc and FA was determined, and their combined use for single investigation of carbohydrate metabolism was recommended, making it possible to exclude "accidental" latent transitory hyperglycemia. TSH determination at early stages can be of low informative value, whereas HbAIc and FA measurements can detect disorders of carbohydrate metabolism early enough.


[Myocardial involvement in hyper- and hypothyroidism].

The paper is devoted to early myocardial pathology in patients with hyper- and hypothyroidism (15 patients with diffuse toxic goiter and 18 patients with primary hypothyroidism). They were investigated by radionuclide scintigraphy of the myocardium with -201TlCl. The myocardium in thyroid pathology was shown to suffer from dystrophic disorders, determined by metabolic derangements. The absence of disturbed perfusion processes in the myocardium and a diffuse decrease in metabolic activity of cardiomyocytes were revealed. Similar changes were found in patients without signs of myocardial involvement on ECG.


[Anthropometric indices of newborns and hormone levels in various periods of ontogenesis].

The relationships between anthropometric indices and the hormonal status in ontogenesis were investigated in newborns (137 girls and 151 boys aged 1.5-15); the venous blood levels of cortisol, corticosterone, testosterone, estriol, estradiol, progesterone, triiodothyronine, thyroxin, thyroxin-binding globulin, insulin and somatotropic hormone were determined by radioimmunoassay. At the time of investigation all the infants were practically healthy. Information on body mass and length was obtained from form 112 (Child's Development history). The results have shown that testosterone in boys was genetically determined stronger than in girls. Gene control of body mass and length in the intrauterine period is exercised with the help of the endocrine system. Periodic changing of the dominant genes at subsequent stages of ontogenesis leads to a changed role of certain hormones, directly regulating growth processes.


[Feasibility of predicting the dynamics of human body mass].

An original mathematical model of human energy exchange was developed and implemented on a PC. Energy exchange of healthy volunteers on a free diet and physical activity was simulated by inputting examinees' individualized parameters in the model: total body mass, fatty and lean tissue, nutritional energy capacity, power inputs. The main purpose was to study the reliability of prediction of the time course of total body mass with relation to a dietary caloric value and physical activity of an examinee, which was found to be necessary for working out an optimum metabolic diet, e.g. for patients with diabetes mellitus and adiposity. The authors propose a complete text of a computer program which can be used in research institutes and hospitals.