Serratia marcescens bacteremia associated with schistosomiasis mansoni.

The case of a 21-year-old man coming from rural Paraíba, northwestern Brazil, with schistosomiasis mansoni associated with Serratia marcescens bacteremia, is reported. His main complaints on admission were fever, diaphoresis and chills for ten days, and diarrhoea that lasted for four days. On physical examination he had jaundice and hepatosplenomegaly. Diagnosis of S. marcescens bacteremia was made by isolation of the bacterium in blood culture, and schistosomiasis was diagnosed by rectal and liver biopsies. This is the first time that the association of S. marcescens bacteremia and schistosomiasis mansoni is recognized. Although our case does not fit into the classic definition of prolonged bacteremia associated with schistosomiasis, it can be considered as a mild form of this association. With the improvement of medical assistance and laboratory facilities, early diagnosis of this association will be made more frequently, cases with short duration will be diagnosed few days after the start of the symptoms, and classic prolonged cases will become rarer.


[Pulmonary lymph node in acute juvenile paracoccidioidomycosis (a case report)].

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed "common cold", bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general lymphadenopathy. Foot and right shoulder arthralgias. Six months ago visited a cave, equitation practice, dog and cat contacts and no transfusion, frontal sweats, fever (38.4 degrees C). T.A. was 8/6, tachycardia in generalized lymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatosplenomegaly and no ascites. Bone marrow with eosinophilia; nodule demonstrated presence of P. brasiliensis, hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinal and mesogastric mass (35 to 40 days). Clavicular osteolytic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.


Hypoparathyroidism in chronic alcohol intoxication: a preliminary report.

It is well known that osteoporosis is more common in chronic alcoholists than in age-matched controls. Possible aetiological factors could be: malabsorption of calcium and vitamin D, liver disease, abnormal parathyroid function. With this study, the authors investigated parathyroid hormone (PTH) behaviour in thirteen selected patients with alcohol abuse, free from any clinical or humoral sign of hepatopathy, and in ten healthy subjects as a control group. In alcohol abusers a significant reduction of plasmatic PTH, compared to normal calcium levels were found. A possible direct interaction effect between ethyl alcohol and PTH may be suggested, even if further studies are required.


Role of arterial hypertension in plasma secretion of prostacyclin during renal failure in man.

Cardiac function and morphology in chronic hemodialyzed patients are modified in consequence of both vascular and neurohormonal factors. In the present study we investigate on the role of prostacyclin (PGI2) vasodilator agent, during hemodialytic (HD) treatment. Twenty-four patients (13 males and 11 females; 9 hypertensive and 15 normotensive) aged 58.5 +/- 14.4 years were studied; 2.5 ml of venous blood were collected before (time 0) and 15', 120', and 240' of dialytic session. The PGI2 levels were measured in plasma, after extraction in ethyl acetate by RIA method, as levels of 6-Keto-PGF1 alpha, a stable metabolite. The results have shown as increase of PGI2 levels at 15' in hypertensive HD patients (HHD) from the begin of dialysis that increased until 240'. This phenomenon was more significant in hypertensive than in normotensive group (NHD) (p < 0.05 vs NHD). These preliminary data suggest that in HHD patients the role of PGI2 is more important than in NHD patients as regards the effects on regulation of circulatory tone. The increment of PGI2 levels could be in relation with the sympathetic activation occurred during hemodialytic treatment.


[The IgE system].

The IgE synthesis is regulated by a system of immunocompetent cells (B and T lymphocytes) and cytokines (IL-4, IFN gamma, IL-2, IL-5, IL-6) produced by T cells as a response to antigenic stimuli. IL-4 alone, or associated with other cytokines, determines the CD23+ receptor (FCERII) expression on monocytes-macrophages, eosinophiles, platelets, epidermidis Langerhans cells and B lymphocytes surfaces, inducing its cleavage in a Soluble Factor (IgE-BF), that increases the IgE synthesis. IFN-gamma, on the other hand, plays an inhibitory role on T-dependent phenomena, IL-4-mediated. In patients affected by atopic diseases, associated with oculorhinites, dermatitis and hyper-IgE syndrome, are found high serum levels of IgE, eosinophiles, and a large number of CD23+ cells: this indicates the hyper-reactivity of the IgE system and the IL-4 overproduction.


[Lower back pain in physicians. Epidemiological aspect and risk factors].

The purpose of this study was to evaluate as accurately as possible, in a well-defined population subgroup, the prevalence and incidence of lower back pain, the impact of this symptom on professional activities and personal life, and the influence of risk factors. Members of the medical profession were considered particularly apt to accurately and reliably report their personal experience with lower back pain and were therefore selected for this survey. Five hundred 93-item questionnaires were sent to a representative sample of physicians in the Maine-et-Loire district, France. Response rate was 93%. Prevalence of lower back pain at the time of the survey was 32% and cumulative prevalence was 62%. Static spinal disorders (exaggerated lordosis, scoliosis, unequal length of lower limbs) and injury to the spine were found to be risk factors. Occupation-related stresses to the spine reported as being responsible for lower back pain included bending forward for prolonged periods, lifting weights, driving, and prolonged sitting.


[Coexistence of a molar pregnancy and a live fetus].

The authors are presenting the second reported case of molar pregnancy with a coexistent fetus in which the outcome of both fetus and mother was positive. The diagnosis has been determined in utero as seen in the previously case presented. After a careful examination of world literature, we have accurately evaluated the elements which need to be taken into consideration in order for the pregnancy to progress.


[Variations in lymphocyte subsets in chronic inflammatory and neoplastic pathology in the elderly. II. Discriminant stepwise analysis].

The variations of lymphocyte subsets in chronic inflammatory and neoplastic diseases in an elderly population, have been previously reported. The different behavior of all the subsets that had shown significant variations of frequencies and absolute values within the groups with the Multivariate Analysis of Variance, have been studied. The use of the Discriminant Stepwise Analysis has given the chance to spot the discriminant subsets and their ability in discriminating the inflammatory and the neoplastic groups from each other and from the controls and finally in pointing out all the subsets which did not affect such differentiation.


[Operative risk in the elderly patient: protocol for evaluation].

Authors emphasize the surgical risk in elderly. Mortality and morbidity are pointed out in male and female patients. They report on 30 aged patients operated for various pathologies also discussing the results.


[Immunosuppressive therapy of secondary amyloidosis associated with rheumatoid arthritis or Still's disease].

Ten cases of renal amyloidosis associated with rheumatoid arthritis (n = 9) or Still's disease (n = 1) were studied retrospectively. One patient had end-stage renal failure at first presentation, whereas the nine others had nephrotic syndrome without renal failure as the initial manifestation of amyloidosis. In the three untreated patients, renal function deteriorated steadily and dialysis was rapidly necessary. In contrast, among the six patients given chemotherapy, four had normal renal function under therapy. These favorable therapeutic results are analyzed and compared with previously published data on the treatment of secondary amyloidosis.


[Evaluation of cardiac involvement in systemic lupus erythematosus. Clinical and echographic study].

Thirty-five consecutive patients with systemic lupus erythematosus were enrolled in a prospective study. Investigations included a physical evaluation, tests for antinuclear antibodies and antiphospholipid antibodies, an electrocardiogram, a plain chest film, a 2D echocardiogram and a Doppler study. Clinical cardiac manifestations and alterations of the electrocardiogram were infrequent (17% and 11% of patients, respectively) and no patients had abnormal chest film findings. In contrast, echocardiographic abnormalities were common (82% of patients), although moderate in most instances. Pericardial involvement was found in 15 patients (42.8%); a pericardial effusion was seen in 9 of the 14 patients with inactive disease (p < 0.003), whereas thickening of the pericardium was visible in 4 patients with active disease and 2 of the 21 patients with inactive disease. Valve abnormalities were found in 17 patients (48.5%), but were not related to the presence of antiphospholipid antibodies; valve alterations included verrucous endocarditis in one case, valve thickening in one case, mitral prolapse in five cases, and mild or moderate regurgitation in 15 cases (aortic in 2 cases, mitral in 7 cases, pulmonary in 3 cases and tricuspid in 7 cases). Alterations in ventricular chamber size and kinetics were also fairly common, albeit of uncertain pathogenetic significance. These data confirm the value of 2D echocardiography for identifying and monitoring cardiac involvement in systemic lupus erythematosus, even in patients with no overt clinical manifestations.


[Degenerative spinal disease in an outpatient clinic in Lomé (Togo)].

A survey was conducted to determine the frequency and semiological characteristics of degenerative spinal disease in patients attending a hospital rheumatology outpatient clinic in Lomé, Togo. Seven hundred and one of the 1,821 patients seen over a two-year period had degenerative spinal disease. Spinal disease included lower back pain (n = 385), lumbar and radicular pain suggestive of disk protrusion (n = 137), lumbar and radicular pain with claudication suggestive of stenosis of the spinal canal (n = 42), dorsal pain (n = 24), cervical pain (n = 68) and cervical and brachial pain (n = 45). Clinical patterns were similar to those seen in Western countries. However, lumbar and radicular pain with claudication suggestive of stenosis of the spinal canal occurred at a younger age and mainly affected females. These data are in contrast with previous studies suggesting that lumbar and radicular pain due to disk protrusion and stenosis of the spinal canal are uncommon in Black Africa.


[Acute enterorrhagia in a young adult: emergency treatment].

A case of enterorrhagia sustained by arteriovenous malformation of the caecum in a young patient is reported. The importance of an early diagnosis to avert a serious anemia is underlined. Preminent role of colonscopy and selective visceral angiography in the diagnosis of such disease is discussed. At first a conservative urgently treatment of caecum bleeding is advised. Subsequently, when the patients is in more favourable conditions, an elective surgical operation is considered as essential.


[Long-term results of chymopapain chemonucleolysis].

Results of chemonucleolysis were evaluated (on the basis of residual pain, occupational activities, physical activities, and use of analgesics) in 125 of 162 consecutive patients with lower back pain and sciatica associated with documented vertebral disc protrusion who were managed and followed up for at least five years. Results were satisfactory in 62% of patients. Among 82 patients evaluated during a follow-up visit, 30% were free of symptoms, 38% had lower back pain, and 30% had radicular pain; however, among symptomatic patients, 67% had no limitations of activities of daily living. Results were significantly less favorable in power drill workers and in patients who had chemonucleolysis at the L4-L5 level. These data are evidence that chemonucleolysis provides good long-term results.


[The effectiveness of enoxacin for the treatment of complicated urinary tract infection].

In this study we evaluated the efficacy of enoxacin in treating complicated urinary tract infections (UTI). We isolated 21 bacterial strains from 20 enrolled patients and all the strains showed "in vitro" susceptibility to enoxacin. The most represented bacterial strain was E. coli (47.7%). After 48 hs and after 30 days from the end of the treatment, we observed clinical and bacteriological recovery in 65% and 55% of the patients, respectively. However, 6 out of the 20 patients (30%) interrupted the treatment due to mild-severe side effects. In conclusion, enoxacin showed a good antibacterial activity, but it could be necessary to lower daily dosage and to extend the treating period to prevent side effects.


[Epidemiology and clinical presentation of vulvar cancer].

Recently, we observed a lowering in the average age of women affected by vulvar cancer. Five years after the diagnosis, survival is little more than 50%. Such a severe prognosis is caused both by a late diagnosis and organization lacks of prevention. Etiology and symptomatology of vulvar cancer are widely treated; particular prominence is given to the differential diagnosis.


[Ulnar nerve lesion at the elbow. Epidemiological, clinical and electromyographical data. Apropos of 312 patients].

Four hundred and ninety-three electromyographic ulnar nerve lesions identified in 312 patients were reviewed. During the same period, 1,000 cases of median nerve entrapment were seen in the same department. Among ulnar nerve lesions, 84% were idiopathic and only 52% were responsible for clinical symptoms. In patients with symptoms, three main patterns of paresthesia were seen: exacerbation at night and/or in the morning upon awakening (39%), permanent isolated paresthesia (34%), and permanent paresthesia with exacerbation at night and/or in the morning upon awakening (27%). Objective sensory loss was found in 1/3 to 1/4 of cases. All patients with muscle wasting (11%) also had sensory loss; muscle strength was markedly decreased in 19% of patients. Pain was mild and infrequent (35%). Electromyographic studies revealed a decrease in motor and sensory conduction velocity at the elbow (mean value 36.2 m/sec). Sensory conduction velocity was the most sensitive parameter for detecting incipient or moderate forms, whereas motor conduction velocity was extremely helpful in severe forms. Eighty-three per cent of patients had alterations of both conduction velocities (sensory and motor). In the mildest forms, nerve conduction velocity was normal (13% of cases); in these patients diagnosis was established on the basis of either a partial motor conduction block (3%) or desynchronization of the sensory action potential (10%).


[Dermatomyositis associated with two neoplasms].

A case of dermatomyositis in a patient with two different malignancies is reported. Skin lesions cleared only following exeresis of the second tumor. This case provides the opportunity for a discussion of the main theories put forward to explain relationships between dermatomyositis and malignant disease.


[BCG osteoarthritis on knee prosthesis after intra-vesical BCG therapy].

A case of Calmette-Guérin bacillus (BCG) infection of a knee implant during intravesical BCG-therapy is reported. The course was favorable after replacement of the implant and administration of antituberculous agents. This case of septic osteoarthritis due to the BCG is different from cases of reactive polyarthritis reported after intravesical instillations of BCG. It probably resulted from diffusion of the BCG via the bloodstream.


Endothelial cell heme oxygenase and ferritin induction by heme proteins: a possible mechanism limiting shock damage.

Acutely, hemin sensitizes endothelial cells to oxidants but chronically protects the endothelium through the induction of ferritin. By releasing its heme, methemoglobin can sensitize endothelial cells in a fashion similar to free hemin. Furthermore, prolonged incubation with the endothelium allows methemoglobin to induce heme oxygenase and ferritin and concomitantly to modulate oxidant-mediated cytotoxicity. Methemoglobin but not hemoglobin, metmyoglobin or cytochrome c induces heme oxygenase and ferritin. Heme needs to be released from methemoglobin, since sodium cyanide, haptoglobin, and hemopexin inhibit the induction of these proteins. Neutrophils can oxidize hemoglobin to methemoglobin, which can subsequently induce both heme oxygenase and ferritin. We speculate that in shock with disseminated intravascular coagulation, marginated PMNs oxidize hemoglobin to heme-releasing methemoglobin. If critical defenses such as haptoglobin and hemopexin are overwhelmed, heme enters the endothelin cells, sensitizing them to oxidant damage. Endothelial cell adaptation via heme-induced heme oxygenase and ferritin production might limit ultimate progression to pulmonary and other vascular leak syndromes.


Isolation and characterization of a novel streptococcal superantigen.

The involvement of S. pyogenes (group A Streptococcus) in severe invasive disease, toxic-shock-like syndrome, and episodes of rheumatic fever led us to explore the possibility that these strains produce a novel superantigen. By using a superantigen-specific assay, we purified a 28-kDa protein from culture supernatants that stimulated T cells in an MHC class II-dependent, V beta-specific manner and designated it SSA, streptococcal superantigen. The amino terminus of SSA showed striking resemblance to SEB, SEC1, and SEC3. The structural homology exhibited by SSA to SEB was reflected functionally in that both of these superantigens bound the same class II isotypes. In contrast, SSA differed from SEB and other known bacterial superantigens with respect to its pattern of V beta-specific T-cell activation. SSA stimulated human T cells that expressed V beta 1, 3, 15, and perhaps V beta 5.2. Using SSA-specific antibodies in an immunoblot assay, we screened 26 strains of Lancefield group A Streptococcus and 16 strains of group B, C, and G Streptococcus. We found that SSA was expressed with high frequency in group A strains, but was absent from all other groups tested. These data establish SSA as a novel superantigen secreted by S. pyogenes. Further study of the structure and expression of SSA may reveal a role for this molecule in current episodes of severe streptococcal diseases.


Cloning and expression of the defective genes in delta-aminolevulinate dehydratase porphyria: compound heterozygosity in this hereditary liver disease.

Cloning and expression of the defective genes for ALAD from a patient with inherited ADP were carried out. Two separate point mutations, termed G1 and G2, resulting in a single amino acid change in each ALAD allele, were identified. The G1 mutation (C718-->T) occurred in the allele within the substrate-binding site, producing an Arg240-->Trp substitution; the G2 mutation (G820-->A) occurred downstream of this site in the other allele, resulting in an Ala274-->Thr substitution. Using RT-PCR, the mother, the brother, and the sister were shown to have the G1 defect. Expression of the G1 cDNA in CHO cells produced ALAD protein with little activity; the G2 cDNA produced the enzyme with approximately 50% normal activity. Pulse-labeling studies demonstrated that the G1 enzyme had a normal half-life, while the G2 enzyme had a markedly decreased half-life. These data thus define two separate point mutations, one in each ALAD allele, as well as the altered properties of the two enzymic proteins encoded by the mutant genes in this patient.


Compartmental analysis of RBC circulation through the rabbit kidney.

This experiment involved 12 rabbits of both sexes, weighing 2.1 kg. After anesthesia, the kidneys were exposed, isolated and cannulated in the renal artery, ureter and sometimes in the vein as well. The kidney were perfused through the renal artery with Krebs-Henseleit solution, which were then filtered to be free of particles, gased with 95% O2-5% CO2, and kept at 37 degrees C. We measured RBCs concentrations by means of Coulter Counter in the venous outflow collected, and plotted them against the volume perfused. Using 2 different flow rates, 9 ml/min (group I) and 19 ml/min (group II), we found that the RBCs decreased in a multiexponential decay fashion and a biophysical model for each flow rate was constructed. These models indicated that there were more cell stores (2.20 x 10(10)) in the fast compartment of group II than in group I (1.72 x 10(10)). This difference is not statistically significant, but certainly coincides with urine flow collected from ureter cannula during perfusion. Our present data clearly suggest that in order to clear 99% blood cells out of 10-12 gm rabbit kidneys, at least 3-6 ml of cell free perfusate is required while clearing the whole blood cells out of human kidneys (200-240 gm) may need 600 ml or more. Thus, we recommend that at least 600 ml of perfusate should be used to clear most of the blood cells in the renal vasculature before renal transplantation is performed.


Morphological evidence of pulmonary vascular leakage through gaps observed with casting methods and S.E.M.

We have used selective casting methods to separate pulmonary elastin from vascular elastin in the lungs of rabbits, dogs and pigs. The lungs are digested with 0.1 N NaOH at 75 degrees C for 24 approximately 48 hours with frequent turning as the lungs are filled with air to about 80% of the vital capacity prior to the casting which is done at pressure of 20 approximately 50 mmHg. After vascular injections, we saw many small globular bits of casting material well separated from cast vessels and lying in the pulmonary elastin. Surface forces should make the casting material creep along the vessels even if they are not completely filled, so that the spherical shape is the one expected if the case is extruded into the parenchymal space and the air space. We conclude that this suggests that the pulmonary circulation is partially and temporarily 'open' as seen in the spleen and some other organs, rather than a completely 'closed' one as is generally accepted. At least some of these extravasations may be associated with lymphatics, although we have not proved this.


Effects of hypotensive anesthesia with sodium nitroprusside or isoflurane on hemodynamic and metabolic changes.

The hemodynamic and metabolic changes during induced hypotension with isoflurane (isoflurane group) or sodium nitroprusside (SNP group) were observed in twelve mongrel dogs. These hypotensive effects were evaluated at 30 and 60 minutes after the mean arterial blood pressure was lowered to 50% from the control. Hemodynamic changes were evaluated by measuring systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance. Metabolic changes were evaluated by measuring serum lactate and pyruvate, arterio-venous oxygen content difference and oxygen extraction rate. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. The results were as follows: 1. Isoflurane inhalation 2-4% or SNP infusion 10-20 micrograms/kg/min was required to reduce the mean arterial pressure to 50% of the control. 2. Heart rate was decreased slightly in the isoflurane group but significantly decreased in the SNP group. 3. There were no significant changes in central venous pressure and pulmonary capillary wedge pressure in either group. 4. Cardiac output was reduced in both groups but was more severe in the isoflurane group. 5. Systemic vascular resistance was decreased by 36% in the isoflurane group and 47% in the SNP group. 6. Acidosis was apparent and did not recover to the control until 30 minutes after recovery in the SNP group. 7. Arterio-venous oxygen difference was increased during hypotension in the isoflurane group probably due to decreased cardiac output. 8. The lactate/pyruvate ratio increased slightly in the SNP group.(ABSTRACT TRUNCATED AT 250 WORDS)


Clinical analysis of 34 diffuse axonal injured (DAI) patients below GCS 8.

A consecutive series of 34 severe head-injured patients (DAI) were studied prospectively. Patients were categorized according to a new, simple classification system comprised of four lesion types according to the compression or obliteration of the ventricles or cisterns. Five patients belonged to type II and 19 patients to type IV. Each type was further subdivided into two GCS score ranges (5 to 8 and below 5). The distribution of the posttraumatic infarction was mainly in the frontal and temporal lobes (60% of all cases). Our data demonstrated that the ICP was significantly lower at a 30 degrees head elevation than at 0 degree (18.6 +/- 7.21 mmHg vs 23.0 +/- 10.60 mmHg. t = 4.22 P < 0.001), but head position did not statistically affect CPP (69.4 +/- 19.86 mmHg vs 68.2 +/- 19.87 mmHg. t = -0.54, P < 0.59). The effect of intensive therapy on ICP, CPP and AVDO2 was studied in all cases, employing steroids and diuretics in a modified intensive care scale. In cases where barbiturates were employed, there were statistically significant changes in ICP and AVDO2 (P < 0.001), but CPP was not affected (P < 0.59). Surviving patients were analyzed by using the GOS and the neurological grading score (NGS, Nihon University) of the persistent vegetative state. Our data suggests that head elevation of 30 degrees and barbiturate therapy are more effective on ICP and AVDO2, and NGS more exact than GOS in vegetative patients.


Development of elastin layers in the aortic wall of human fetuses.

The presence of elastin layers in the aortic walls of twelve human fetuses was confirmed with scanning electron microscope pictures after hot alkali treatment and histochemical examination. In addition, the number of elastin layers in aortic walls of 5 different segments were compared in fetuses of varying ages. Aldehyde fuchsin stained slides of elastin ascending aortas showed a range between 27 and 55 layers of elastin in fetuses of 8 weeks to 32 weeks. However, in the lower abdominal aortas, elastin layers decreased from 28 to only 3 layers for fetuses of the same age. Furthermore, as elastin layers decreased from ascending aorta to abdominal aorta with the progression of fetal life, similar changes in the elastin lamellae were observed. These results suggest that while aortas grow rapidly in length, the medial elastin thickens slowly, perhaps due to slow development of hydrodynamic forces and pressures. Also the adventitial elastin appears to lose out gradually along the length from ascending aorta to abdominal aorta.


Culture of melanocytes obtained from normal and vitiligo subjects.

The development of human melanocyte culture in vitro from normal adult skin and uninvolved skin of vitiligo patients is essential to investigate the mechanism of depigmentation in vitiligo and other pigmentary dermatoses. By using selective growth and long-term maintenance conditions, we selectively cultured melanocytes derived from normal foreskins and arm skins, and uninvolved foreskins and arm skins of vitiligo patients. The melanocytes of the arm skins were successfully cultured from the roofs of suction blisters. Melanocyte Growth Media (MGM) consisting of MCDB-153 formulation with basic fibroblast growth factor (bFGF), bovine pituitary extract (BPE), insulin, hydrocortisone, phorbol 12-myristate 13-acetate (PMA) and 10% human AB serum was sufficient to grow the melanocytes from normal and vitiligo donors. Melanocytes from uninvolved skin of vitiligo donors showed no different morphologic features, initial seeding capacity and population doubling time compared with those from normal skin. Melanocytes from both cell types grew without any lag period for more than 6 months (6-11 passages). Melanocytes obtained from foreskins had higher initial seeding capacity and shorter population doubling time than those obtained from arm skins using suction-blistered roofs. Our results suggest that the culture method using suction blisters may be a simple and easy way to obtain melanocytes. In addition, vitiligo melanocytes can be successfully cultured with appropriate growth conditions and may show no defective growth patterns. This culture system will be applied to investigate the basic pathophysiology of vitiligo and other various pigmentary dermatoses.


Electron microscopic study of the cases of minimal change nephrotic syndrome with mesangial IgA deposition.

Twenty-five cases of minimal change nephrotic syndrome(minimal change disease, MCD) with mesangial IgA deposition were evaluated electron microscopically. The thickness of the glomerular basement membrane(GBM) was 3875 +/- 1271 A and 3056 +/- 1201 A in adults and children, respectively. Alteration of the GBM was noted in 3 adults and eight children: splitting in 4, focal thinning in one, widening of the lamina rara interna in 10, and widening of the lamina rara externa in 4 cases. Minimal mesangial electron dense deposits were found in all but one adult, and an increase of the mesangial matrix and minimal mesangial proliferation were observed in 8 and 6 cases, respectively. Electron microscopic findings show representative findings of MCD in our cases. A relationship between the GBM alterations in these cases and frequent association of hematuria is suggested and discussed.


Arthroscopic subacromial decompression.

A study group composed of 11 shoulders in 10 patients underwent arthroscopic subacromial decompression for impingement syndrome. There were no biceps tendon ruptures, acromioclavicular arthritis or glenohumeral instability. Eight men and two women ranging in age from 17 to 65 years (mean age 38.7) with dominant arm involvement in 9/10 were evaluated for an average follow-up of 19.4 months (range 12-26) postoperatively. Based on the University of California at Los Angeles shoulder rating scale, nine (82%) shoulders had satisfactory results and the remaining two (18%) had unsatisfactory results. This is a preliminary report of our early experience in this rather new method of treatment, but the results are encouragingly good.


Congenital absence of gallbladder.

Nine surgically proven congenital absence of gallbladder (CAGB) cases were reviewed. All of them had one or more kinds of biliary symptom. Tests such as abdominal ultrasonography, intravenous or oral cholecystography and even endoscopic retrograde cholangiography not only failed to predict CAGB but misleadingly indicated other similar conditions. Only the abdominal computed tomography (CT), performed on one patient, enabled the accurate diagnosis of CAGB. All the patients underwent abdominal exploration, and CAGB was confirmed by the meticulous dissection of the entire extrahepatic biliary tree and the operative cholangiography. Five patients had concomitant biliary pathologies responsible for their symptoms, but four patients had isolated CAGB. CAGB is a rarely encountered condition for a clinician, but extensive diagnostic work-ups including abdominal CT should be performed in all situations where CAGB is suspected. Thus unnecessary exploration can be avoided in the isolated CAGB case.


Thyrotropin-secreting pituitary microadenoma.

We present a 45-yr-old male with clinical signs and symptoms of mild hyperthyroidism, high serum levels of T3, T4, and FT4 as well as serum TSH concentration. The elevated alpha-subunit level and alpha-subunit/TSH molar ratio were also observed. These findings indicated the presence of hyperthyroidism due to inappropriate secretion of TSH, whose neoplastic origin was documented by nuclear magnetic resonance scan showing a 0. 6 cm pituitary adenoma. Selective pituitary adenomectomy was completely successful; alpha-subunit, TSH, T3, T 4, and FT4 normalized, and euthyroidism was restored. Light microscopic immunohistochemistry showed that the adenoma was composed of TSH-secreting cells.


Tuberculosis of the ribs: a recurrent attack of rib caries.

Rib tuberculosis is an extremely rare condition with the incidence not exceeding 3 percent of all skeletal tuberculosis. The authors experienced a recalcitrant case of pulmonary tuberculosis accompanied by chest wall cold abscesses involving ribs recurring at a new site in approximately 10 months despite of medical and surgical treatment. The patient has twice taken thoracotomy for abscess drainage and during the second thoracotomy, a partial resection of involved ribs was performed.


[Nosology, genetics, neurobiology, and psychopharmacology of schizophrenia].

The development of psychiatric nosology is outlined, and five principles responsible for the organization of psychopathologic symptoms into psychiatric disorders are proposed. Within the frame of reference of the nosologic organizing principles, the evolution and dissolution of the unitary concept of schizophrenia are reviewed, and some of the findings in neurobiologic, genetic and psychopharmacologic validation studies are discussed. It is suggested that findings in family genetic studies and in clinical psychopharmacologic investigations are supportive of Leonhard's (1957) contention that systematic and unsystematic schizophrenia are two distinct populations.


[Women: psychopathology and cultural malaise].

An account of the incidence of mental health and disease criteria in feminine psychopathology is presented as well as a consideration on the increasing medicalization and psychiatrization of women's demand for sanitary help. Symptoms should not be understood separately from the discontent relevant to the place femininity is given in society--hence women's subjective suffering. Observes Freud that, as a child bearer, a woman is more involved with sexual functions--thus placing her at the pulsional pole of culture which reduces a propitiatory space for sublimation processes. Correlatively, Freud sees women as victims of the worst social repression process: women being forbidden to think. Even though discontent, and psychic pain cannot be avoided inasmuch as civilization imposes certain restrictions necessarily, there is, however, an excess of pain related to the feminine position. No cure will be possible if women fail to restore their own place as subjects of their own desire, whose alienation is shown through symptoms.


[Mental disorders in Nicaragua: family perspective].

In recent years the family perspective in Psychiatry has become more important a factor. Therefore this paper is aimed at examining the family structure of mentally disordered people in León, Nicaragua, as well as presenting the use of a Genogram in epidemiological research. 201 families were randomly selected, whose members were interviewed in two steps: a screening, and a diagnostic stage. The family map or Genogram for each family was analyzed with respect to adult and child cases, generations within the family, and other background variables.


[Widows of victims of Nazi concentration camps: their pathology].

The psychosocial situation of widows and orphans of victims of the Nazi concentration camps in Poland are presented. In 1984, 74 widows of victims from the Auschwitz-Birkenau camp were interviewed. This article describes widows' emotional-behavioral reactions when facing the imprisonment and death of their husbands, their difficulties in adapting themselves to widowhood, different adaptative forms of memories of their married life, and consequences relevant to widows' mental health and family, and social consequences of widowhood.


[Proposal of a model of a mental system based on mental functions].

Based on the mental functions according to classical physiological criteria, the authors propose an information management system with heuristical value for Psychiatry. This system assumes that information will be received by the sensoperceptual area, being analyzed within both the cognitive and affective areas later on, the analysis output thus taking place through the psychomotor area. Such a system allows a theoretical structure -correlating some aspects of Neurosciences with psychiatric clinical events, to be elaborated. Furthermore, such a system allows mental disorders to be understood as disturbances in the information processing the nervous tissue performs.


[Comparative psychosocial study of social values].

A culturally readapted scale of the classical Rokeach scale was applied to a 200-subject sample. Subjects were male and female workers on the one hand, and university men and women, on the other hand. The results of the different subsamples were compared by means of statistical techniques. Later, the same comparison was carried out with data from a similar study performed in Venezuela.


[Factors associated with the failure to use condoms among a population of parenteral drug addicts].

Use of condom in sexual intercourse by intravenous drug users has been assessed among a clinical population (n = 139). The multiple logistic regression results show that being a female (OR = 5.1, 95% CI = 2.0-13.2), on drug dependence for a 5-year period or more (OR = 3.0; 95% CI = 1.3-6.9) correlates with non-condom use. Less than 25% of females use condom in their sexual contacts. On the contrary a higher educational level seems to protect subjects against non-condom use (R = 0.3; 95% CI = 0.1-0.8). The most parsimonious model fitting to data at hand includes such variables as sex, educational level, partnership and frequency of sexual intercourse, as well as years on addiction. Other set of variables such as living and working status, age, and previous sexually-transmitted diseases experience are not required for the final model. Emphasis is placed on the need for developing programs aimed at modifying the high risk behavior intravenous drug users resort to in their sexual intercourse, stressing that the main dissemination cause of the human immunodeficiency virus among such a population is due to their sharing drug injections equipment.


The response of the vessel wall to thrombosis: the in vivo study of venous thrombolysis.

The vessel wall is the site of synthesis and regulation of the fibrinolytic system, and this delicate process is overwhelmed by occlusive thrombosis in veins. The endothelium may or may not survive thrombus formation, but has strong powers of regeneration, and is subsequently vital to the process of recanalizing the vessel. The endogenous fibrinolytic response to venous thrombosis is not well delineated but appears to involve both the newly formed endothelium within and beneath the organizing thrombus, together with an increase in tissue plasminogen activator synthesis or storage in distant uninvolved veins. The further use of thrombus models in which the endothelium is not definitely damaged should enable greater understanding of its role. Immunocytochemistry and in situ hybridization may be helpful in defining some of the unanswered questions.


The role of protected extracellular compartments in interactions between leukocytes, and platelets, and fibrin/fibrinogen matrices.

Polymorphonuclear leukocytes express multiple surface receptors that mediate their adhesion to extracellular matrices and to other cells. These receptors also play roles in cell migration and phagocytosis. We have studied the role of one class of polymorphonuclear leukocytes surface receptors, the beta 2 integrins, in the interactions of these cells with fibrinogen. We have found that the beta 2 integrins, CD11b/CD18 (complement receptor three) and CD11c/CD18 mediate attachment of polymorphonuclear leukocytes to fibrinogen-coated surfaces. Polymorphonuclear leukocytes must be stimulated with chemoattractants, such as fMLP, or with cytokines, such as tumor necrosis factor to bind to fibrinogen via these integrins. Moreover, each of these integrins interacts with a different segment of the fibrinogen molecule. PMN adherence to fibrinogen via CD11b/CD18 depends on the carboxy terminus of fibrinogen, whereas adherence via CD11c/CD18 depends on the amino terminus of fibrinogen's alpha-chain. One of the physiological consequences of these interactions is that polymorphonuclear leukocytes stimulated with either chemoattractants or TNF form protected compartments at their interface with fibrinogen-coated surfaces and that elastase released into these compartments is inaccessible to protease inhibitors present in the plasma. These protected compartments exclude plasma proteins of > 40,000 daltons such as alpha 1 anti-proteinase, thereby allowing polymorphonuclear leukocyte proteases to degrade matrix proteins within this compartment without interference by plasma anti-proteinases.


Correlation of in vitro and in vivo decreased fibrinolytic activity caused by dexamethasone.

The effect of dexamethasone administration to rats was studied on blood fibrinolytic activity. PAI-1 levels were dose-dependently enhanced by dexamethasone after a pretreatment period of 5 days while simultaneously a decreased tPA level was observed. These ex vivo measured effects were confirmed in vivo with a specially developed fibrinolysis model. It is concluded that the in vivo measured inhibition of the fibrinolytic activity caused by dexamethasone correlates well with ex vivo measured activities.


Remaining perspectives of mutant and chimeric plasminogen activators.

Potential approaches to improve thrombolytic agents comprise the construction of mutants and variants of tissue-type plasminogen activator (tPA) or of single chain urokinase-type plasminogen activator (scuPA, pro-urokinase), of chimeric plasminogen activators and of conjugates of plasminogen activators with monoclonal antibodies. tPA mutants have been constructed with altered pharmacokinetic properties or altered functional properties, including binding to and stimulation by fibrin, resistance to plasmin and to protease inhibitors. Mutants of tPA described to date, obtained by deletion/substitution of functional domains or of single amino acids, have markedly reduced clearances, but usually also reduced specific thrombolytic potencies. Mutants of scuPA with improved thrombolytic potencies have thus far not been reported. Chimeric molecules containing functional domains of both tPA and scuPA have intact enzymatic properties of uPA and some fibrin affinity of tPA. Surprisingly, chimeras endowed with fibrin affinity usually have unaltered or reduced thrombolytic potencies. However, a chimera consisting of amino acids 87-274 of tPA and amino acids 138-411 of scuPA, with negligible fibrin affinity, has a 10-fold higher thrombolytic potency than scuPA in animal models of venous thrombosis, as a result of a delayed in vivo clearance and a relatively maintained specific thrombolytic activity. Plasminogen activators conjugated with antifibrin or antiplatelet monoclonal antibodies, either chemically or by recombinant DNA technology, are targeted to blood clots, resulting in a 5- to 10-fold increased thrombolytic potency. Thus, it is possible to develop plasminogen activators with improved thrombolytic potency. Whether such agents will be clinically useful remains to be established.


Principles underlying the use of conjunctive agents with plasminogen activators.

Pharmacological thrombolysis is a dynamic situation in which fibrin degradation occurs concomitant to procoagulant activity. The consequences of enhanced procoagulant and platelet activity may delay or prevent thrombolysis or lead to reocclusive events following successful recanalization. Although heparin and aspirin may attenuate ongoing thrombin and thromboxane generation, respectively, a relatively high percentage (10-20%) of patients treated with heparin and aspirin still have complications associated with thrombolysis. This suggests that heparin and aspirin are not universally effective as the heparin-antithrombin III complex may be inaccessible to fibrin-bound thrombin in the microenvironment of the thrombus and aspirin eliminates only thromboxane-dependent platelet aggregation. Therefore, careful consideration must be given to small molecule, active-site thrombin inhibitors which may prove to be more effective than heparin and to fibrinogen receptor antagonists which block aggregation to all known platelet agonists and have a much broader spectrum of activity than aspirin. Hopefully, well-designed clinical trials will be conducted with safe and effective thrombin inhibitors and/or fibrinogen receptor antagonists in thrombolysis and compared to heparin and aspirin such that potentially the overall efficiency of thrombolysis can be improved upon.


Plasminogen activators from the saliva of Desmodus rotundus (common vampire bat): unique fibrin specificity.

The saliva of D. rotundus contains at least four plasminogen activators (PAs) which all require fibrin as a cofactor. D. rotundus salivary PAs (DSPAs) exhibit a sequential array of structural motifs such as "Finger" (F), "EGF" (E), "Kringle" (K) and "Protease" (P) which was elucidated by cDNA cloning and sequencing. The respective domain organizations are: FEKP (DSPA alpha 1 and DSPA alpha 2), EKP (DSPA beta) and KP (DSPA gamma). In all four forms the plasmin-sensitive site of tPA is obliterated, indicating that they function as single-chain enzymes. DSPA alpha 1 differs from alpha 2 by amino acid substitutions found mainly in the F, E and K domain, 11% of the total sequence. DSPA beta and gamma, while being closely related to alpha 2, still exhibit 2 and 13 amino acid exchanges, respectively. These sequence heterogeneities, together with results of Southern blot hybridization experiments, strongly suggest that the four DSPA mRNA species originate from different genes. All four forms of DSPA have been expressed in animal cell culture and DSPA alpha 1 was chosen for a detailed pharmacological characterization. In vitro DSPA alpha 1 activity is enhanced 50,000-fold in the presence of fibrin, whereas the activity of single chain tPA is only enhanced 100-fold. At equally effective thrombolytic doses DSPA causes lower bleeding incidence in a rat mesenteric vein model and exhibits high potency, clot selectivity, and speed in the dissolution of fibrin embolized into the lung of anesthetized rats. In the copper coil-induced dog coronary heart infarction model, at doses that achieve patency at equal rates, reocclusion is significantly less frequent than with tPA. These results indicate that DSPA alpha 1 may be a safer and more efficacious thrombolytic agent than the PAs currently in clinical use.


Modulation of fibrinolysis by thrombospondin.

Thrombospondin is a large, trimeric glycoprotein secreted by activated platelets and growing cells. Thrombospondin copolymerizes with fibrin during blood coagulation and deposits in extracellular matrix. We found that thrombospondin is a slow (rate constant approximately 6.3 x 10(3) M-1 sec-1), tight-binding (Kd < 10(-9) M) inhibitor of plasmin as determined by loss of amidolytic activity, loss of ability to degrade fibrinogen, and decreased lysis zones in fibrin plate assays (Biochemistry 31: 265-269, 1992). Thrombospondin also slowly inhibits urokinase plasminogen activator. The lysis zone when urokinase is put on fibrin plates made from whole plasma is less if thrombospondin is present. The stoichiometry of inhibition is approximately one mole plasmin:one mole thrombospondin trimer, a somewhat surprising result considering the trimeric nature of thrombospondin. These results indicate that thrombospondin is an important regulator of fibrinolysis and degradation of extracellular matrix, particularly when these processes are initiated by urokinase and even when other inhibitors of fibrinolysis are present.


The general medical record. Concepts and suggestions for implementation.

Our view of a general medical record consists of a combination of distinct departmental- and specialty-specific medical records and an organizing kernel that contains arguably critical information. Because this system allows each clinical entity to evolve its own system, clinical priorities do not have to be negotiated or compromised. Additionally, subsystem or departmental medical records can be easily revised without disturbing the general medical record because of the modular design. Although the system seems robust with respect to design considerations, only implementation can provide adequate tests.


DecisionNET: database/network support for clinical decision analysts.

DecisionNET is a proposed remote database/wide-area computer network that should cultivate quantitative approaches to medicine by providing rapid access to medical facts, literature citations, decision models, and commentary of specific use to those involved with quantitative clinical decision making. Increasing accessibility to data and providing a forum for exchange of ideas should prove to be a significant asset to clinicians, either as modelers or as clients. Further work will address specific database implementation, development of a query engine, and coordination of the communications infrastructure. DecisionNET provides a unique model for the growth and maintenance of other medical knowledge bases.


Improved care of patients with diabetes through telecommunications.

This project tested the importance of enhanced information transfer of home monitoring results to health care providers. The study tested whether computer-assisted communication of medical information between the chronic care patient and the physician can result in health care benefit. The information tools were constructed/adapted as a test of this hypothesis for diabetes mellitus. Patients connected a glucometer to an intelligent modem weekly for six to nine months. Graphical and mathematical tools extracted and emphasized the information content of the home monitoring data arriving at the central site. Data smoothing, trend analysis, and calculation of quality control statistics were incorporated into a graphical time series oriented report that was used by the health care provider during an outpatient visit. The integrated home monitoring system was tested on 20 patients with diabetes in a double cross-over design over a 15-month period. A significant improvement in serum glucose control as measured by glycated hemoglobin was shown in the study group, but not in the control group.


Medical Information Service via Telephone. The pioneer of physician consultation services.

The organization and development of MIST were a response to the needs of health professionals in Alabama, principally rural physicians, who expressed a desire to access the knowledge of the faculty at the UAB Medical Center. MIST provides free service on a 24-hour, 7-day-a-week basis for physicians around the world. At any time, practitioners can obtain specific medical information and discuss possible diagnoses or patient-related problems with UAB specialists. MIST, the first and largest medical professional telephone consultation program of its kind, receives numerous requests from other institutions seeking information and advice on developing similar programs. Such programs now exist in many states. One reason for the success of MIST is that it has always enjoyed high visibility with UAB physicians, credibility with the physician callers, and priority within UAB's Office of the Vice President for Health Affairs. As a consultative system, MIST continues to contribute to improved health care for citizens of Alabama and beyond and to save patients and taxpayers the expense of unnecessary or inappropriate treatment. MIST provides consultation and continuing education at the moment of need for the professional in private practice. In return, UAB specialists are given access to vital research and demographic information, as well as patient referrals. MIST plays an important role in removing barriers to education and consultation for busy medical personnel and in facilitating patient referrals to an acclaimed center of research and excellent patient care. Rather than searching for the proper contact, one call to an easy-to-remember number puts the health professional in touch with the appropriate source. Rural doctors, as well as medical personnel working in urban areas, can feel that they are practicing "right next door" to an outstanding university medical center where colleagues who are ready and able to offer expert consultation and support at the critical moment of need are only a telephone call away.


An overview of networking for physicians and problems of network consulting in remote areas.

For computer networking the most suitable operating systems are UNIX or MS-DOS. As networking software UUCP and TCP/IP are most common. Hardware requirements are derived from the operating system and from the networking software. Low-cost solutions, for example, uuPC, a public domain version of UUCP, require only an 8088 processor and a 2400-baud modem. TCP/IP fares better with more powerful processors and requires permanent lines between the connecting computers. In developing countries the introduction of computer networks is hampered by several factors: lack of foreign exchange, price of hardware and software, unreliable electricity and telephone lines, lack of hardware and software support, large distances to the nearest center, and incompatibilities between existing systems and the network. Important aspects for clinical networking in developing countries include appointment scheduling in the referral hospitals, access to laboratory and pathology results from the central laboratory, and primary health care information such as epidemiologic data. Advanced systems, for example, for image processing, are not yet feasible in developing countries.


Protecting the privacy of patient information in clinical networks: regulatory effectiveness analysis.

Patient privacy is one of the major issues in the development of modern clinical information system networks. Such networks will have to demonstrate an appropriate concern for privacy as a precondition of operation. Regulatory effectiveness analysis is a novel technique for measuring compliance with a technological regulatory system. By examining the public policies, legal structures, and technical tools involved in the regulatory system, it is possible to discover discontinuities that may result in noncompliance with the regulatory system.


The use of wide area computer networks in disaster management and the implications for hospital/medical networks.

Computer-mediated communication in various forms is already being used in all phases of disaster management--preparation, response, recovery, and long-term mitigation. However, to date wide area computer networks--particularly the Internet (the supernetwork of networks)--have been used only to a limited extent in disaster management and prevention. Some of these applications are described in this paper. Nevertheless, the high speed and ease of information transfer by computer network and the vast resources becoming available on the Internet make it inevitable that the use of computer networks to temper disasters will increase enormously in the next decade. The Internet will provide a key means through which networks initially dedicated to solely medical purposes and the individuals who use them will become involved not only in disaster response and mitigation worldwide, but in the global community and consciousness that is the Internet.


Some tools for the diffusion of biomedical information using research networks.

Research and academic computer networks provide e-mail and other services to all members of participating institutions. Their usage by biomedical researchers and clinicians is still limited because of several reasons, including limited awareness of the available network resources. An increased use of these networks within the biomedical community would allow fast, effective communications and convenient remote access to information sources. As an example and pilot study, we prepared two network tools to make some information services maintained by our institution also accessible through e-mail. Both tools were implemented using PMDF e-mail software on a DEC MicroVAX connected to the Italian academic and research network (GARR), which is linked to the U.S. Internet. A network server takes care of automatic distribution of documents (files) reporting results of an oncology research/education project. An information server provides for semiautomated support of a consulting service on use of drugs. The feasibility of implementing these tools, based on existing software, further illustrates the potential usefulness of research computer networks for the dissemination of biomedical information.


Expediting prior approval and containing third-party costs for dental care.

Dental insurance carriers frequently require referral of radiographs for determination of prior approval. Radiographs are also often used for obtaining expert opinions before finalizing diagnoses and establishing treatment plans. Traditionally, such referrals have been carried out using the original or duplicate films transmitted through the postal system. Studies concerning alternative communication media for data transmission are presented, namely, the use of switched-digital telephone lines and of electronic mail networks.


Nephropathology consultation via digitized images.

Investigations into a digitized image communications system were prompted by a need to bring expert consultation to physicians in community practice. Pathologists desired the capability to concomitantly view, annotate, and discuss images with referring physicians at distant sites. Methods included evaluation of the human and procedural domain into which the system was to be integrated. The GDCN computer consultation system has the consultant nephropathologist first evaluate the processed biopsy slides, digitize representative images, transmit them with the diagnosis to referring nephrologist, and, finally, conduct an interactive consultation and review of the biopsy and case. Image resolution and compression variables must be set for each individual medical consulting application. For the GDCN, it was found that the 640 x 496 x unlimited color with compression ratios not exceeding 1:32 are acceptable. An obvious improvement of this computerized system over the noncomputerized review sessions is the ability to immediately share and discuss a new image that had not been previously sent. In the old noncomputerized consultation, only images that had been mailed could be discussed. The computerized sessions allow transmission (10 sec) of a new image that the consultation might demand. The computerized sessions also provide the ability to show the referring nephrologist an area of biopsy interest that the pathologist had not previously transmitted. Biopsy slides can be viewed during the consultation, an area digitized, and that image transmitted to the nephrologist during the consultation. Hardware and costs for the sending station were: [table: see text] This system far exceeds the requirements for this particular application; however, it is sufficient to support future, higher-technology computer applications. If necessary, this same system could be used with a less expensive computer, a less expensive camera, software compression, and a single monitor. These alterations could lessen the expenditures by some $8000 and result in a total cost of $10,000. Hardware and costs for the receiving station were: [table: see text] Cost of the receiving station could be reduced by using a less expensive computer and a single monitor system, thereby saving up to $5000 and resulting in a total cost of $7,400. DCCEC and GDCN have elected to use the more expensive, user-friendly and more rapid image transmission system SEND-->IT, rather than the less expensive system mainly because of experience with incorporating the system into the daily activities of the GDCN. SEND-->IT best met the essentials for GDCN.(ABSTRACT TRUNCATED AT 400 WORDS)


Computer communication for international collaboration in education in public health. The TEMPUS Consortium for a New Public Health in Hungary.

Computer conferencing using the Canadian system CoSy is presented, and three related projects are discussed. 1. An extramural university course in epidemiology and medical statistics was taught using CoSy. Computer conferencing can be a useful vehicle for distance education, enabling health professionals to attend "classes" independent of geographical and time constraints. The subjects taught are well suited to this medium. 2. Internet was used to establish a small network of public health researchers and teachers. Participants are from Canada, Hungary, Israel, Norway, and Australia. Networks of this type not only facilitate international collaboration within public health, they also enable international collaborative research and teaching projects that would have been too cumbersome and time consuming to initiate and conduct without this communication facility. 3. "Development of Medical Education for a New Public Health in Hungary," a project funded by the European Community's TEMPUS program, is established with a view to developing the undergraduate and graduate education of public health professionals. It is a joint program between the five Hungarian medical schools and ten universities in the G24 countries. The TEMPUS listserver functions as an important vehicle for communication within this project.


Exchange of Veterans Affairs medical data using national and local networks.

Remote data exchange is extremely useful to a number of medical applications. It requires an infrastructure including systems, network and software tools. With such an infrastructure, existing local applications can be extended to serve national needs. There are many approaches to providing remote data exchange. Selection of an approach for an application requires balancing of various factors, including the need for rapid interactive access to data and ad hoc queries, the adequacy of access to predefined data sets, the need for an integrated view of the data, the ability to provide adequate security protection, the amount of data required, and the time frame in which data is required. The applications described here demonstrate new ways that the VA is reaping benefits from its infrastructure and its compatible integrated hospital information systems located at its facilities. The needs that have been met are also needs of private hospitals. However, in many cases the infrastructure to allow data exchange is not present. The VA's experiences may serve to establish the benefits that can be obtained by all hospitals.


Innovative desktop learning tools. Implications for rural hospitals and physicians.

Innovative methods of providing workplace education for health care professionals may be a key to the survival of rural hospitals in America. Such methods must overcome time, distance, cost and organizational constraints, and take into account the structure of the learning experience. The Texas Hospital Education and Research Foundation has recently been involved in two programs that tested new approaches to worker education using distance-learning strategies. The projects--resource sharing among rural directors of nursing and training for cancer tumor registrars--used computer-conferencing technology. A new model using existing satellite, audio-conferencing, and computer-based instruction augmented by computer conferencing is proposed. The Computer-Related Assisted Distance Learning Enhancement (CRADLE) model integrates existing technologies to provide education to health care workers at their desktop. The Cancer Learning Center (CLC) tested peer collaboration, the primary component of the model. The ultimate goal is to have the system available to all tumor registrars in Texas, and to secure funding to implement rural nursing and rural high-school health occupations education projects. Current projects from set-up through results are presented.


Oogenesis, fertilisation and early embryonic development in rats. I: Dose-dependent effects of pregnant mare serum gonadotrophins.

Five hundred and eight mature female Wistar rats divided into 35 different groups were stimulated with pregnant mare serum gonadotrophins (PMSG) (0, 5, 10, 20 & 40 IU) at the late diestrus stage to induce multiple follicular development. No chorionic gonadotrophin (CG) was used for ovulation induction. The quality of oocytes and their in vitro fertilisability, quality of Day 2-embryos, viability of pregnancy and status of fetuses on Day 14 of gestation and status of embryos retrieved on Day 2, 3, 4 and 5 of pregnancy in different subgroups of rats were examined. Results showed that more oocytes and embryos fertilised in in vivo were retrieved from rats supraphysiologically stimulated with 20 IU of PMSG. However, concurrent with the larger number, higher proportions of abnormal oocytes and embryos were found. High doses of PMSG caused lower in vitro fertilisability of oocytes and greater degrees of embryonic degeneration. Although, the number of oocytes and Day 2-embryos were higher in the 20PMGS dose group, the pregnancy rate was significantly reduced to 27%. In the 40PMSG group no viable pregnancy was noted. Most embryo demise occurred by day 3-5 of pregnancy, probably within the oviducts and before the implantation stage. In rats supraphysiologically stimulated with 20 and 40 IU of PMSG, the number of morphologically normal looking embryos was greatly reduced by Day 3-5 of pregnancy. In the 40PMSG group, there were no embryos retrieved by Day 4 and 5.(ABSTRACT TRUNCATED AT 250 WORDS)


Oogenesis, fertilisation and early embryonic development in rats. II: Dose-dependent effects of human chorionic gonadotrophin.

A total of 950 female Wistar rats in 81 groups were involved in this study. Different groups of rats were stimulated with PMSG (0, 10 & 20 IU) at diestrus followed, 48-52 hr later, by different doses of HCG (0, 10, 20, 30 & 40) for ovulation induction. The dose-dependent effects of HCG, either with or without the use of PMSG for stimulation of multiple follicular development, on the quality of oocytes and their in vitro fertilisability, quality of Day 2-embryos, viability of pregnancy and status of embryos retrieved on Day 2, 3, 4 or 5 of pregnancy in different subgroups of rats were examined. Results showed that more oocytes and embryos fertilised in vivo were retrieved from rats supraphysiologically stimulated with 20 IU of PMSG. The addition of HCG did not increase the number of ovulated oocytes or Day-2 embryos. In other words, the number of oocytes or embryos produced is dependent on the dose of PMSG administered during diestrus rather than on the dose of HCG given for ovulation induction. Hence, no increase in the amount of HCG is required to effectively ovulate bigger cohort of preovulatory follicles in supraphysiologically stimulated rats. As was shown earlier, in vitro and in vivo fertilisation rates were reduced when higher doses of PMSG were used. Similarly, these rates were reduced when increasing doses of HCG were used in rats not previously stimulated with PMSG. When higher doses of HCG were used in rats stimulated earlier with PMSG (10 and 20 IU), the in vitro but not the in vivo fertilisation rates were further reduced.(ABSTRACT TRUNCATED AT 250 WORDS)


Indications for in vitro fertilisation: changing trends: the Norfolk experience.

From January 1987 to December 1990, 1,415 patients were enrolled for in vitro fertilisation (IVF), series 26-41, at the Jones Institute for Reproductive Medicine. They underwent 2,393 IVF cycles. The most common indications were tubal factor (57.3%), male infertility (22.0%), endometriosis (10.9%), and idiopathic infertility (5.2%). This represented a significant decrease in the proportion of cycles performed for tubal disease and an increase in the proportion of cycles performed for male infertility as compared with the earlier series 1-16, 1981-1984. Total pregnancy rates from fresh transfers remained stable for most indications, being the lowest for diethylstilbestrol (DES) exposure (16.7%), and highest for immunologic infertility (47.6%). In addition, patients with polycystic ovarian disease (PCOD) had a high pregnancy rate (47.2%) from fresh transfers but a high first trimester abortion rate as well (19.4%). The ongoing pregnancy rate from fresh transfers for the whole population was around 19.0%, being highest for patients with immunologic infertility (31.8%) and lowest for DES exposed patients (9.3%). The cumulative ongoing pregnancy rate to date for the whole population from fresh and cryopreserved embryos was 21.6% per embryo transfer (range from 13.3% for DES patients to 33.3% for immunologic infertility). The projected ongoing pregnancy rate as obtained from adding the number of cumulative pregnancies to date to the number of predicted ongoing pregnancies calculated from the remaining frozen embryos was 23.9% for the whole population (range 16.7% for DES patients to 33.3% for immunologic infertility).(ABSTRACT TRUNCATED AT 250 WORDS)


Outcome of cryopreservation and subsequent programmed replacement of frozen-thawed embryos in an in vitro fertilisation programme: preliminary report and proposals for improvement.

In order to prevent wastage of good quality embryos and limit the number transferred in fresh in vitro fertilisation (IVF) cycles, 577 supernumerary embryos were cryopreserved for a mean duration of 6.23 +/- 4.7 months (range 1-24). Four hundred and twenty-two have been thawed so far of which 81 (19.19%) were totally lysed, 317 (75.12%) survived with at least 50% of their blastomeres intact and 180 (42.65%) cleaved. Two hundred and sixteen frozen-thawed embryos have been transferred in 62 stimulated and 11 natural cycles involving 61 patients. The mean number of embryos transferred per cycle was 2.96 +/- 0.86. Twenty-one pregnancies resulted from the 62 stimulated cycles (33.87%). No pregnancy occurred in the 11 natural cycles. Overall pregnancy rate was therefore 28.77%. Eleven singletons (eight male; three female) and one set of twins (one male one female) have so far been delivered in good condition:- six (54.5%) by caesarean section, five (45.5%) vaginally, including one by Neville Barnes forceps, one ventouse and the rest were spontaneous. Presentation was cephalic in 10 (91%) and breech in one case (9%). All were delivered at term except one premature (9%). Mean birth weight was 3.23 +/- 0.32 kg for singletons and 2.7 kg for the twins. Despite the diversity of racial, cultural and religious differences in our multinational patient population, we found embryo cryopreservation following IVF generally acceptable and our preliminary results are quite encouraging. Strategies for improving the outcome of future cycles are proposed.


The spontaneous LH surge in ovarian hyperstimulation for assisted reproductive technology.

Thirty-seven patients who underwent assisted reproductive technology programme, in vitro fertilisation or embryo transfer and gamete intra-fallopian transfer, were randomised into two groups in order to evaluate frequency of premature spontaneous LH surge when stimulated with different type of hMG. An hMG (FSH:LH = 1:1) was administered for eighteen patients (group A) and the different highly purified hMG (FSH:LH = 19:1) was administered for nineteen patients (group B). Blood samples are drawn from day 3 of the cycle until hCG administration, and serum LH level are measured in the frozen samples. There were no statistical difference in the total amount of hMG used before hCG injection, days of hMG injection and the number of oocytes retrieved between two groups. The premature spontaneous LH surge occurred only one patient in group A (5.6%), but more frequent LH surge was observed in group B (42.1%) (p < 0.05). It is suggested that the different FSH/LH ratio may be the reason for the difference of the incidence of premature spontaneous LH surge.


Human preimplantation development in vivo: ultrastructural observations.

The ultrastructure of a 2-cell, 4-cell, 7-cell and 16-cell human embryos fertilised and developed in vivo were compared using transmission electron microscopy. Among the structures which exhibited more notable changes throughout these developmental stages, were the mitochondria, ribosomes, nuclear envelope and nucleolus. Mitochondria which were initially round, dense with cristae oriented parallel to the surface changed to oval with less dense mitochondrial matrix and with cristae perpendicular to the mitochondrial membrane. Ribosomes and polyribosomes decreased in amount from 2 to 7-cell stages and increased again at the 16-cell stage. The nuclear envelope exhibited intense blebbing activity at the 4-cell stage, less at 7 and none at 16. The nucleolus initially very dense was progressively infiltrated by chromatin, became reticular at the 7-cell stage and appeared fully mature at the 16-cell stage. This study discloses structural details of human preimplantation embryos which may be of interest in the assessment of comparable material obtained in vitro. Some unique features that may have bearing on the ontogenesis of cell organelles and cell differentiation are discussed.


In vitro fertilisation in capillary tubes for male factor infertility.

In 26 patients with severe factor infertility (total spermatozoa per ejaculate 0.8-6.3 million) in vitro fertilisation was performed using a capillary tube culture system. Spermatozoa were concentrated and incubated with oocytes in a very small volume (10-20 microliters) within capillary tubes. In seven out of 26 patients (27%) at least one oocyte could be successfully fertilised (overall fertilisation rate 11.6%, 22/190 oocytes) and in two patients a pregnancy with the birth of a healthy child could be observed. If sperm progression was only of grade 2 or less no fertilisation could be observed in 10 patients with a total of 75 oocytes. The described capillary technique for in vitro fertilisation using very small volumes for sperm-oocyte culture may be useful in cases of severe oligozoospermia or before considering extreme therapies such as donor insemination of sperm microinjection.


Oocyte maturation in human in vitro fertilisation programmes.

Oocyte immaturity represents a serious loss of efficiency in the in vitro fertilisation (IVF) treatment cycle since it is associated with a great list of detrimental effects mainly reflected in lower fertilisation and pregnancy rates. In stimulated cycles, oocyte maturation depends on stimulation protocol, ovarian response, time of human chorionic gonadotrophin (hCG) administration, hCG to oocyte retrieval interval, and/or time of in vitro culture period before insemination. The present review discusses the influence of these factors on human oocyte maturation and proposes several preventive and corrective measures. Due to the difficulty of ascertaining the grade of oocyte maturity based on morphological and physical properties of the oocyte-corona-cumulus complex (OCCC), fertilisation rate has been considered as an indirect index of nuclear and cytoplasmic maturation. The proportion of immature oocytes increases as the ovarian response to gonadotrophins increases. However, the detrimental effects of oocyte immaturity in high responders may be balanced by the higher number of oocytes retrieved per patient (and available embryos for transfer) and the selection of the best embryos for transfer. Oocyte immaturity might be prevented by delaying hCG injection and/or oocyte retrieval. Corrective strategies would involve in vitro or in vivo culture before insemination; addition of gonadotrophins or epidermal growth factor to the culture medium; and coculture with granulosa cells.


Oocyte maturation and its clinical significance in assisted reproductive technology.

The characteristics and regulation of oocyte maturation in the normal menstrual cycle is reviewed and the mechanisms by which ovarian hyperstimulation with exogenous gonadotrophins, used in assisted reproductive techniques, can disturb this process, is discussed. It is postulated that derangements induced in the maturation of oocytes in the hyperstimulated cycle result in the recovery of poor quality oocytes at egg-pickup which have a reduced potential to undergo normal fertilisation and subsequent embryonic development.


The use of luteinising hormone releasing hormone agonists for ovarian stimulation in assisted reproductive technology.

Although the use of luteinising hormone releasing hormone (LHRH) agonists and human menopausal gonadotrophin (hMG) for ovarian stimulation in assisted reproductive technology has gained wide-spread popularity, a number of major issues regarding their use remain unresolved. In this paper, we examine some of these issues in the light of the results of our own studies. We have found that although the use of LHRH agonists may be advantageous for some patients, its routine use for all patients produces no significant medical advantage compared with conventional stimulation regimens. In a number of prospective randomised studies, we have found that the long protocol of LHRH agonist administration is superior to the short and ultrashort protocols and the administration of glucocorticoids to patients at high risk of developing ovarian hyperstimulation syndrome does not reduce the incidence of this complication. Finally, we have found that when the long protocol of LHRH agonist administration is used, precise timing of human chorionic gonadotrophin administration (hCG) is not important. There are no significant differences in oocyte recovery, fertilisation and cleavage rates, or in pregnancy rates when the results of standard timing of hCG administration are compared with delayed administration. It would, therefore, appear that the major advantage of the routine use of LHRH agonists is for practical, rather than medical reasons.


Methods of sperm preparation for assisted reproduction.

Because seminal plasma contains factors which inhibit the fertilising ability of spermatozoa, it is essential that spermatozoa be separated from it quickly and efficiently. Four basic approaches for this exist: (1) simple dilution and washing; (2) sperm migration (either direct from liquefied semen, from a suspension of washed spermatozoa or from a washed sperm pellet); (3) selective washing procedures (mainly Percoll and Nycodenz density gradients); and (4) adherence methods for the elimination of debris and dead spermatozoa (glass wool, glass beads and Sephadex columns). While the success of a sperm preparation method is often assessed by its yield of motile spermatozoa, it is also vital that sperm preparations for clinical use should be free of any microbiological contaminants present in semen. Other relevant considerations in choosing a method include its technical complexity as well as its material, apparatus and time costs. Any possible exposure of spermatozoa during preparation to deleterious influences that may cause iatrogenic sperm dysfunction must obviously be avoided at all costs. Consequently, methods involving centrifugal washing steps prior to the selection of motile spermatozoa should be discontinued. Direct swim-up from semen remains the simplest way to obtain populations of highly motile spermatozoa and, dependent upon the absolute yield required, can be a very rapid procedure with normal semen samples. Abnormal samples, especially those with increased viscosity, may benefit from a prior filtration on a glass bead or Sephadex column. The initial motile sperm preparation should be washed once (perhaps twice) to minimise seminal plasma contamination of the final preparation. Several rapid, simple discontinuous Percoll gradients giving excellent yields are available.(ABSTRACT TRUNCATED AT 250 WORDS)


In vitro fertilisation in immunological infertility.

Fertilisation occurs through a complex and orderly sequence of changes in both the oocyte and the spermatozoon. Although mechanisms have evolved to protect spermatozoa from recognition by the immune system, there is evidence that a breakdown in protection can occur resulting in homologous or heterologous antisperm antibodies which can immobilise or agglutinate spermatozoa leading to infertility. Antisperm antibodies may affect the reproductive process by interfering with sperm survival and motility and sperm transport through cervical mucus. Fertilisation is also affected, and those oocytes that do fertilise go on to develop poorly. Antisperm antibodies appear to inhibit sperm attachment to and penetration of the zona pellucida. Immune recognition of sperm antigens, which are normally present on the surface of the embryo once fertilisation has occurred, may lead to abortion after implantation. Despite the adverse effects of antisperm antibodies on fertilisation and embryo development, acceptable pregnancy rates can be achieved with assisted reproductive techniques using sperm-washing to remove antibody and using a protein source other than female serum. Further study is necessary to understand the mechanism of immunological infertility and to evaluate newer techniques using micromanipulation of gametes to achieve fertilisation.


Epididymal sperm in assisted reproductive technology.

Infertile men with obstructive azoospermia mainly due to congenital absence of the vas deferens (CAVD) now have the option of trying to father their own progeny. In fact, in the last five years epididymal sperm retrieval microsurgically have been successfully used for in vitro fertilisation of human oocytes. In this report the clinical results of 98 consecutive procedures of microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilisation (IVF) and tubal embryo transfer (TET) are described. An overall fertilisation rate of 17% and a pregnancy rate of 36% per transfer is reported. Five of the 18 pregnancies resulted in abortion (27%) and 13 were delivered at term. Additionally, extra embryos for freezing and potential use for future attempts were made available for 13 couples. Men with CAVD have also allowed the study of spermatogenesis, immunological response and sperm disposal mechanisms in condition of chronic obstruction.


Cytogenetic analysis of oocytes and embryos.

Abnormal embryo development represents the major cause of implantation failures and accounts for the low rate of human infertility in vivo or in vitro. Chromosome abnormalities are widely involved in this process. Indeed, 28.4% of oocytes carry a chromosome aberration, i.e. 25.6% aneuploidy and 2.8% structural anomalies. Fertilisation abnormalities (possibly increased by in vitro procedures) were recorded: 7 to 28% of oocytes from fertilisation failure showed a sperm premature chromosome condensation probably resulting from ooplasmic immaturity. Moreover, 1.6% and 3.8% of inseminated oocytes had either a single or 3 pronuclei demonstrating parthenogenesis or triploidy, respectively. In vitro developmental capacities of embryos depends on the degree of ploidy. Parthenogenetic embryos display a fairly normal development until implantation. Triploid zygotes show an original way of division: half of them divide first into 3 cells and then into 6 cells (via a tripolar spindle) whereas diploid zygotes divide into 2 and then 4 cells. As a consequence of either meiotic or mitotic non disjunctions or fertilisation anomalies, 25 to 71% preimplantation embryos carry a chromosome disorder. As an outgrowth of in vitro fertilisation and embryo transfer, detection of genetic and metabolic defects prior to implantation might be possible in the future. So far, 6 girls have been born in couples at risk of transmitting X-linked disease. This technic will increase the efficiency of IVF and avoid the trauma of repeated abortions.


Oocyte and embryo donation.

Oocyte and embryo donation, first reported in humans in 1983 has helped patients who do not possess functional ovarian tissues or whose oocyte cannot be used for fertilisation, to conceive. Though it is the female counterpart as the donor insemination in the male, it imposes quite different bioethical issues. The article is a review of the oocyte and embryo donation programme in general, with special discussion on regimes of Cyclic Steroid Replacement Therapy, the recruitment of oocyte donors, bioethical issues, and future applications of oocyte donation in medicine.


Micro-insemination sperm transfer (MIST) and its application to male subfertility: current strategies to improve results.

It can be difficult to achieve a pregnancy for patients with severe male factor subfertility. Hence, micro-manipulation techniques, have been applied to this problem. Direct deposition of sperm into the oocyte under the zona (micro-insemination sperm transfer, MIST) has improved the fertilisation rates, but pregnancy rates have been very low. This paper describes the possible new strategies to improve the technique currently. They include methods to improve sperm recovery, to improve acrosome reaction, to improve the quality of embryos by using co-cultures and to wait for good cleavage before transfer, and to improve luteal phase support. There are also many new techniques being developed which may contribute to further pregnancy successes. They include the use of electro-fusion, laser-fusion and the Xenopus cell-free system.


Selective assisted hatching of human embryos.

Overall results of assisted hatching by zona drilling using acidic Tyrode's solution performed during three randomised trials in 330 in vitro fertilisation (IVF) patients are presented. It was demonstrated retrospectively and prospectively that assisted hatching by zona drilling was effective in embryos with thick zonae (> 15 microns). This procedure is called selective assisted hatching. In order to investigate whether the success rate of embryos with thin zonae (< 13 microns) can be improved further, a fourth trial was executed in 40 consenting patients. Embryos with thin zonae were left intact in one group (control), while the outside of zonae of similar embryos were thinned with acidic Tyrode's solution. Results thus far indicate that embryos with thin zonae do not benefit from this technique. Embryonic implantation (fetal heartbeat per embryo) was high (26%-27%) in both arms of the trial, probably as a result of selective zona drilling of low prognosis embryos with thick zonae. A method is presented for quantifying zona hardening in human embryos. The exposure to acidic Tyrode's solution of each embryo was expressed as a function of the duration to pierce the zona and the diameter of the needle. Preliminary findings suggested that embryonic viability is correlated with zona hardening. In order to test the hypothesis that extracellular fragments may affect embryonic viability, small amounts of fragments were removed from embryos during assisted hatching. The pregnancy rate in 36 patients with extracted fragments was relatively high (41%) considering the poor morphology of the embryos involved.


Human ampullary co-cultures for blastocyst transfer in assisted reproduction.

Although the assisted reproductive techniques (ART) have contributed significantly over the last decade in alleviating subfertility in the childless couple, the implantation and take-home baby rates have been stubbornly low. A major cause for such low success rates has been the reduced viability of replaced embryos perhaps induced by the suboptimal in vitro conditions used in ART laboratories. One approach to improving embryo viability is to provide the growing embryo with a simulated in vivo environment by replicating the conditions existing in the human fallopian tube in vitro. This requires either the maintenance of an intact fallopian tube in vitro or establishment and maintenance of tubal epithelial cell-lines which could be used as feeder layers for early embryonic growth. The concomitant growth of cells with embryos in vitro has been referred to as co-culture. This paper discusses the in vitro behaviour of human tubal epithelial cells, the fertilisation and growth of embryos in ampullary co-culture, the specificity of co-cultures, the mechanism of action of co-cultures and the methods of screening the human ampullary co-culture system for microbes. The pregnancy and implantation results on 50 patients enrolled for a co-culture clinical trial are presented and the future use of this system discussed.


Understanding the fundamentals of embryology in assisted reproductive technology.

This paper emphasises the need to understand the fundamentals of embryology in relation to in vitro fertilisation (IVF) and associated assisted reproductive technologies (ART). It introduces the reproductive technologist and others involved in such programmes to the events that occur during early embryogenesis, which have led to recent developments in IVF/ART. It also covers some of the contributions made by IVF/ART in understanding early events of development, particularly during the first week of human life. The reader is referred to some of the widely used embryology texts and audio-visual aids and also to selected reviews and papers published recently that would help toward a better understanding of early development and ART.


Ethical issues in assisted reproduction.

Since the birth of Louise Brown in 1978, no other area in clinical practice and medical research has held the public interest to the same extent as the assisted reproductive technologies. This has led to the formation of committees of enquiry, guidelines from professional bodies, the passage of legislation, and the formation of legislative bodies. The ethical issues which arise in the clinical practice of assisted reproduction, the donation of gametes and embryos, and their cryopreservation, surrogacy, and human embryo research are reviewed.


[Post-streptococcal immunity in the child in acute articular rheumatism (R.A.A.) or recurrent sore throats].

It concerns comparative studies between two children groups: One group who had previous RAA. A second group who had anginas only. This work shows the interest to associate two streptococcal serologic tests (ASLO, ASD) in order to increase the number of recent diagnostic streptococcal infectious. The remaining immunity is missing in children less than 5 years old; more than 50% of above 10 years an antistreptococcal answer although they have not streptococcus infections presently.


[Prospective study of Listeria in humans and animals].

During 1967 to 1985, three cases of listeriosis were reported in Algeria; at that time Listeria monocytogenes caused several thousand cases of meningitis and sepsis in the world. In order to determine the frequency and bacteriologic characteristics of strain isolated in Algeria, a prospective investigation was carried from 1985 to 1989 in humans and animals samples. Sensitivity tests to antibiotics (MIC) point out that all isolates strains are resistant to cephalosporins (first and third generation), but are susceptible to Ampicillin and Gentamicin which ought to constitute the treatment basis of listeriosis.


[Listeria serotyping].

Serotyping of Listeria has contributed to bring to light on the origin of outbreaks listeriosis; on the other hand, it is also an additional expression for the identification of Listeria genus. In order to get better in this field, we have produced five factors sera: I, I/II, V/VI, VI, VII.


[Preliminary epidemiological study of carriers of Clostridium difficile].

171 samples have been taken from stools of sick persons in three departments of university and hospital centres of Algiers (C.H.U.A.): the department of maternity (C.H.U Parnet), the department of breast diseases (CPMC), the department of women's surgery (CPMC), 13 samples of C. difficile have been isolated with a frequency of 7.6 per 100 of cases. The rate of conveyance seems more important in adults in hospitals and often concerns sick persons enduring digestive cancer (10.25 per 100) or newborn with a frequency of 8.73 per 100.


[1st isolation of Yersinia enterocolitica in Algeria].

Yersinia enterocolitica has been researched in 200 samples of human stools, 40 animals excrements, 38 specimens of soils and 46 of water; the microorganism has been recovered in respectively 3.5%, 10%, 10.5% and 26% out of the total of samples examined; the strains isolated belong to different Wauter's biotype scheme but the biotype 1 is the most predominant except in soil samples. None of biotype 2 and 4, admitted to be adapted to man, has been isolated from human stools. We think that the notion of adaptation of a given biotype to a given host must be reviewed. These data, although they demonstrate the existence of yersinia enterocolitica in Algeria, because of the small number of samples examined, do not reflect exactly the real incidence of the infection caused by this microorganism.


[Production of a vaccine against enterotoxemia from Clostridium perfringens strains isolated in the field].

We have isolated eight strains of C. perfringens from cases of enterotoxaemia. Five of these strains have revealed themselves toxic with respective types (type "A":2, type "C":2, type "D":1). In order to produce anti-enterotoxaemia vaccine, we have proceeded at the cultivation in fermenter of isolated strains and reference strains CWA 35, CWC and CWD AF. At the end of fermentation, we have evaluated the two following parameters: obtained biomass, and toxin titers. With the two classes of strains we reached an important biomass but toxins titers relatively weak comparatively to that which is usually required. It will be necessary then, to demonstrate the immunogen value of the produced vaccines by testing their efficacity.


[Newcastle disease in Algeria. Study of the pathogenic properties of Newcastle disease virus strains isolated in Algeria].

The Newcastle disease in Algeria: Study of pathogenic properties of the Newcastle disease viral strains isolated in Algeria. The study of pathogenic characters of 14 strains of Newcastle disease virus isolated from 1972 to 1982 was carried out: The following testS were realized: the mean lethal time for the chicken embryo, the pathogenic power index by intravenous way, the pathogenic power index by intracerebral way, the hemagglutination spectrum and the thermal stability of the hemagglutination. In short we can say that these isolated 14 strains are fast-growing.


[Result of the refinement of a technique for the isolation and identification of Campylobacter from food commodities].

Campylobacter jejuni has been researched in raw milk, skin and excrement of chicken. All milk samples are negatives but 66% of chicken skin and 12% of chicken excrements are positives. An enrichment phase using brucella broth added with horse blood and antibiotics is necessary.


[Bacteriologic quality of the prepared dishes in cafeterias].

In this work, we reports results of bacteriologic analysis of 352 cooked meals (vegetables, meats, desserts). Although, 32% of analysed samples are bacteriologically good, 68% are contamined either by S.P.C but potentially dangerous either by pathogenic bacteria involved in food-born infections.


[Visceral leishmaniasis in Algeria. Evolution of visceral leishmaniasis in the Grande Kabylie area (1985-1990)].

The authors report 285 cases of visceral leishmaniasis recorded over a 6 year-period from 1985-1990 in the Wilaya of Tizi-Ouzou (Grande Kabylie). The authors report a resurgence of this disease during the last years, with a 5 human cases per 100,000 annual prevalence and a 6 per cent of rate death, the most active part of mediterranean area appears to be the region of Grand-Kabylie. A control program in the Wilaya of Tizi-Ouzou is proposed.


[Various isolation and enrichment media for isolating Yersinia enterocolitica].

Study of different isolation and enrichment media for recovering Yersinia enterocolitica has been carried out. The best data have been obtained after enrichment in phosphate buffer with sorbitol and bile salts, followed by a decontamination with Aulisio's KOH and streaking into Hectoen medium.


[Visceral larva migrans syndromes: reflections on various cases of toxocariasis].

The authors selected among 5 diagnosed cases of larva migrans. In this study, the authors reported a review of this disease.


[Production of monoclonal antibodies against a wild strain of rabies virus].

Production of monoclonal antibodies against a wild strain of rabies virus. Cell fusion of SP 2/O, a murine myeloma against a wild strain of rabies virus has originated five monoclonal antibodies (M.A.) specific for virus nucleocapsid , one M.A. specific for virus glycoprotein and one M.A. specific for a viral membrane protein.


[Rapid micromethod for CH50 determination using an algorithm].

The titration of haemolytic complement in biological liquid cause inconvenient in calculating concentration, it was long and fastidious. We report a fast technic based on measure of hemolysis in microplate++ method, which exploitation of results, it does with an appropriate algorithm.


[Comparative activities in vitro of 4 quinolones (nalidixic acid, pefloxacin, norfloxacin, ofloxacin) on 13 bacterial species].

Nalidixic acid and three fluoroquinolones were tested on 389 strains belonging to 13 bacterial species, all isolated in Algeria. Ofloxacin, norfloxacin and pefloxacin have the same activities on E. coli, Acinetobacter and S. aureus. Norfloxacin has the best activity on Proteus, Enterobacter, Shigella and Klebsiella. Norfloxacin and ofloxacin have the same activities on S. typhi, Salmonella and choleric Vibrio. Norfloxacin has the same activity than pefloxacin on P. aeruginosa. It is necessary to prescribe a quinolone in the right way and to consider the pharmacokinetic properties.


[Resistance to new quinolones among the enterobacteria].

We report the isolation of 10 strains of enterobacteriaceae with a new quinolone's resistance. This resistance was detected by a diminution of inhibition's diameter around the disk of pefloxacin , and confirmed by the determination of Minimal Inhibiting Concentrations (M.I.C.). These strains, moreover multiresistant to multiple antibiotics, were isolated from patient's urines with repetitive urinary tract infections (paraplegics, lithiasic patients). None of this patients was treated by new quinolones. The incorrect use of old quinolones is probably responsible for the selection of this new quinolone's resistance.