[The production of hydrogen peroxide by neutrophilic polymorphonuclear leukocytes in patients with non-insulin dependent diabetes mellitus].

The production of hydrogen peroxide (H2O2) by neutrophilic polymorphonuclear leukocytes (PMN) after stimulation with PMA, FMLP, aggregated IgG and phagocytosis were determined in 36 patients with non-insulin dependent diabetes mellitus (NIDDM). The H2O2 production of PMN after the stimulation was measured using by flow cytometry. The patients were divided into four stages as follows: (1) non-microalbuminuric stage, (2) microalbuminuric stage, (3) proteinuric stage without impairment of renal function (less than 1.2 mg/dl of serum creatinine) and (4) proteinuric stage with impairment of renal function (more than 1.3mg/dl of serum creatinine). The H2O2 production after stimulation with PMA or phagocytosis was significantly higher in patients with NIDDM than normal controls. And also, there is the tendency of an increase in the H2O2 production after stimulation with FMLP or aggregated IgG. This increase of the H2O2 production was observed in all four stages of NIDDM patients after the stimulation, especially in patients with renal failure associated with diabetic nephropathy. These results suggest that reactive oxygen species produced by PMN after stimulation under various conditions may play an important role in the progression and exacerbation of diabetic nephropathy.


[A case of acute interstitial nephritis and nonoliguria acute renal failure induced by cimetidine].

Cimetidine is a histamine H2-receptor antagonist. Widely it is prescribed, and then various side effects have been increasingly recognized. Acute renal failure as a result of acute interstitial nephritis is one of the most important adverse effect. We report a case of biopsy-proven acute interstitial nephritis following cimetidine therapy. Farther more, we review other reported cases of cimetidine-induced acute interstitial nephritis, and discuss the clinical features and a role of immunological mechanisms of these cimetidine-induced disorders. A 52-year-old woman was admitted because of fever and protenuria. A month before admission, she developed gastric ulcer and was given cimetidine 600mg orally a day by a near physician. Laboratory data on admission included the following: white blood cell count, 14700/microliters; eosinophils, 6%; BUN, 50.7mg/dl; Cr, 7.6mg/dl; CRP, 34.0mg/dl. All drugs were discontinued because we suspected drug-induced acute renal failure, especially by cimetidine. Renal biopsy performed on day 3 showed interstitial nephritis with lymphocyte infiltration which was composed mainly of T cell. T4/T8 ratio was determined to be 1. There was neither predominance of helper nor cytotoxic cells in T cell subpopulation. We reviewed 22 cases reported and discussed the features of cimetidine-induced interstitial nephritis. The most important thing is to monitor renal function periodically with the suspicion of this disorder. On the detection of abnormality of laboratory data, cimetidine should be discontinued.


[A successfully treated case of acute renal failure due to acute immune hemolytic anemia and nontraumatic rhabdomyolysis induced by streptomycin reinjection].

A case of acute immune hemolytic anemia associated with non-traumatic rhabdomyolysis (NTR) induced by streptomycin (SM) reinjection, which developed acute renal failure, has been reported. A 70-year-old female was admitted to our hospital because of sudden macroscopic hematuria after reinjection of 1g. SM. Laboratory findings on admission were as follows; hemoglobin and myoglobin were positive in urine. RBC 129 x 10(4)/microliters, Hb 4.9g/dl, Ht 11.1%, reticulocytes 52/1000, serum indirect billirubin 3.8g/dl, LDH 9, 230 WU, BUN 149mg/dl, Cr 7.9mg/dl, myoglobin 1, 400ng/ml and haptoglobin 10.6mg/dl. The drug lymphocyte stimulating test of SM was positive (215%). A direct antiglobulin test was also positive. An indirect antiglobulin test was negative, but became positive after incubation with SM. These observations made the diagnosis of SM-induced hemolytic anemia associated with NTR. On the second hospital day she developed anuria, and was put on hemodialysis treatment. Two months after the acute hemolytic episode and acute renal failure she recovered and is presently in good health without recurrence.


[Tuberculosis in young generation: a report from six general hospitals].

We investigated epidemiologic and clinical aspects of tuberculosis in young generation and pointed out problems in ambulatory treatment. In six general hospitals in Tokyo, 418 cases of tuberculosis (285 males and 133 females) were diagnosed between 1983 and 1991. They were divided into three groups; 1) young group, 10 to 29 yr (62 cases), 2) middle age group, 30 to 69 yr (255 cases), 3) elderly group, above 70 yr (101 cases). And the risk of clinical breakdown, method of case finding, radiological findings, extra-pulmonary lesions, method of diagnosis, relationship with epidemics, patient's delay, doctor's delay, drug regimens and patient's compliance in each group were investigated. In addition, after completion of therapy we sent them survey questions about relapse and attack of tuberculosis among their families. Results were followings. 1) Estimated risk of clinical breakdown by age was calculated as follows, (the number of patients)/(the population of Tokyo)/(estimated incidence of infection). This was extremely high in young group. 2) Sixteen percent of patients in young group were related with epidemics and another eight percent with familial outbreaks. 3) Although many patients in young group showed focal lesions in chest radiographies, the rate of symptomatic patients was 61% and that was almost same as in other groups. 4) The rate of patients showing atypical radiographic findings, extra-thoracic lymphadenopathy and idiopathic pleuritis were relatively high in young and elderly group. 5) Results of survey questions showed no relapse among ambulatory treated patients. Familial outbreaks (three cases) were thought to be caused by long patient's delay and not by ambulatory treatment of smear-positive patients.(ABSTRACT TRUNCATED AT 250 WORDS)


[Case study of interleukin-1 beta, tumor necrosis factor alpha and interleukin-6 production peripheral blood monocytes in patients with diabetes mellitus complicated by pulmonary tuberculosis].

Patients with diabetes mellitus (DM) show an increased susceptibility to bacterial infections due to the presence of neutrophil dysfunction. Susceptibility to tuberculosis has also been reported in such patients, however, the reason remains unclear. This study measured the production of interleukin-1 beta (IL-1 beta), tumor necrosis factor alpha (TNF alpha) and interleukin-6 (IL-6) by the peripheral monocytes of patients diagnosed with pulmonary tuberculosis accompanied by DM (TB+DM) and patients without DM complications (TB) using age-matched, healthy control subjects for comparison. Also examined was the relationship between cytokine production and DM control. The results were as follows: (1) The production of IL-1 beta, TNF alpha and IL-6 in TB patients was significantly higher than that observed in the healthy control subjects. (2) The production of IL-1 beta, TNF alpha and IL-6 in TB+DM patients was significantly lower than that observed in the TB patients. (3) The production of IL-1 beta and TNF alpha in TB+DM patients with poor control was significantly lower than that observed in the patients with good control. (4) The TNF alpha production had a significant inverse correlation to HbA1c in the TB+DM patients. This study demonstrated that the production of cytokines is impaired in TB+DM patients and suggests a close correlation between tuberculosis immunity and DM.


[Three cases of young adults advanced pulmonary tuberculosis due to patient's and doctor's delay].

Three young adults advanced pulmonary tuberculosis due to delay of therapy were reported. In case 1 and 3, their delays resulted from difficulty in diagnosis, in case 2, from neglecting medical counseling. Each cases revealed bilateral diffuse shadows on chest roentgenograms on admission, which were typical shadows of advanced pulmonary tuberculosis. Malnutrition might contribute to the development of the diseases, which were improved by anti-tuberculosis therapy and hyperalimentation therapy. These cases were suggested some clinical problems characteristic of pulmonary tuberculosis of young adults.


[Diagnostic role of fiberoptic bronchoscopy for mycobacterial diseases].

From 1981 to 1991, 5,572 patients underwent bronchoscopic examination, in this series 3,754 patient's samples were sent for determination of mycobacterial isolation. In the 506 samples, mycobacterial bacilli were detected with smear or culture. In the low tuberculous incidence area like northern part of America, many reporters supported the opinion that routine bronchial aspirate detection for tuberculosis was not cost-effective. Inversely, in the high tuberculous incidence area like Hong Kong, M. lp et al. claimed the usefulness of routine bronchial aspirate examination for mycobacterial bacilli. Japan was regarded as moderate tuberculous incidence area. We review a ten-year experience with fiberoptic bronchoscopy for mycobacterial isolation. Our results suggest that in an area with a moderate prevalence of tuberculosis, bronchoscopic examination for mycobacterial disease is useful in the selected hospitals for the selected cases. In Japan, the smear positive prevalence has been on the increase from 1982. We estimate that the Japanese popularization of fiberoptic bronchoscopy may influence a part of the Japanese epidemic statistical analysis of mycobacteriosis.


[Diagnostic role of fiberoptic bronchoscopy for mycobacterial diseases--serological diagnosis].

Detection of IgG antibodies against purified cord factor (trehalose-6, 6'-dimycolate) prepared from Mycobacterium tuberculosis H37Rv was carried out by the method of enzyme-linked immunosorbent assay (ELISA) and its diagnostic usefulness was also evaluated in this study. Sera from 65 patients with active pulmonary tuberculosis, 58 patients with inactive pulmonary tuberculosis, 36 patients with diseases other than tuberculosis and 66 healthy adults were examined. Patients with active pulmonary tuberculosis showed significantly higher titers of IgG antibodies against cord factor than other groups (p < 0.001). Patients with inactive pulmonary tuberculosis also showed significantly higher titers of IgG antibodies against cord factor than patients with diseases other than tuberculosis and healthy adults (p < 0.001). An antibody titers of greater than 0.29 were established as a positive ELISA test. For patients with active pulmonary tuberculosis, the ELISA had a sensitivity of 85% and a specificity of 96%. From these results, it is concluded that the detection of IgG antibodies against cord factor is useful for the serodiagnosis of active or inactive pulmonary tuberculosis.


[Comparison of MB-Check, BACTEC, and egg-based media for recovery of mycobacteria].

The rate of recovery and time to the detection of mycobacteria from clinical specimens were measured for biphasic and radiometric liquid-based culture systems and egg-based media (3% Ogawa and Ogawa K). From the 245 sputum specimens processed, a total of 86 (35.1%) mycobacterial isolates were detected. Of these, 81 (94.2%) and 80 (93.0%) isolates were detected with the MB-Check and BACTEC systems, respectively, and 65 (75.6%) isolates were detected with the 3% Ogawa egg method. The difference in the percentages of positive cultures between the two systems based on liquid media and the 3% Ogawa egg method was significant (P < 0.01). This difference was even greater among smear-negative specimens. The detection time was shorter with the liquid-based systems. The mean times to the detection of the Mycobacterium tuberculosis complex were 19.1 days with the MB-Check system, 13.4 days with the BACTEC system, and 21.7 days with the 3% Ogawa egg method. These results indicate that both the MB-Check and the BACTEC systems, based on liquid media, are efficient for the recovery of mycobacteria.


[Polymerase chain reaction for identification of Mycobacterium in sputa].

Polymerase chain reaction was applied to the diagnosis of mycobacterial infections. This reaction could detect bacteria in clinical specimens within a few hours. Sensitivities of the five primer systems reported in 1990 were compared. It was proved that the primer system reported by Eisenach et al. was as sensitive as culture on Ogawa's medium for the detection of Mycobacterium tuberculosis in sputa. Other systems were found to be less sensitive than this system, and the nested PCR should be applied to make these systems highly sensitive. For the practical application of PCR method, we should improve the detection system to fit for the practice in clinical laboratory. High cost of PCR system could be another barrier for the practical application.


[DNA probe and polymerase chain reaction for detection and identification of mycobacteria].

The DNA probe and polymerase chain reaction (PCR) technique for detection and identification of mycobacteria were compared with the conventional smear and culture method. The results of identification by DNA probe agreed well with those of the biochemical method. Moreover, six percent of Mycobacterium avium complex (MAC) were revealed to be mycobacteria other than MAC by DNA probe. The nested PCR for detection of gene coding protein antigen b of Mycobacterium tuberculosis complex showed excellent specificity and sensitivity. Then we applied this technique to rapid detection of M. tuberculosis in 222 clinical samples. The agreement between nested PCR and the biochemical method was excellent, and 17 cases were diagnosed by only nested PCR in spite of negative results by smear and culture. These cases were unlikely to have yielded false positive results since their clinical features were compatible to tuberculosis. From these data, it was considered that the DNA probe and PCR technique were extremely useful strategies and would contribute to rapid diagnosis of mycobacterial infectious diseases.


[Rapid genetic identification system of mycobacteria].

Rapid colorimetric hybridization method was applied for the identification of mycobacteria and phylogenetic detection and identification system of mycobacteria of polymerase chain reaction method was designed. Quantitative DNA-DNA hybridization in microdilution plate was used to identify 22 mycobacterial species. This method could identify 90% (178 among 194 trials) of clinical isolates within 3 hr. Ten percent of clinical isolates did not belong to any of the established 22 species. Through this work, we found Mycobacterium abscessus is genetically independent from M. chelonae and proposed M. abscessus as a distinct species. M. pregrinum had been classified as M. fortuitum, however, it was also found as a independent species. Thus the name M. peregrinum was officially revived and acquired the taxonomic position. Highly sensitive genetic detection system of mycobacteria was designed by using polymerase chain reaction (PCR) method. Common mycobacterial sequence of 16S ribosomal RNA gene was first amplified by a single pair of PCR primers from staining negative sputum and the amplified DNA was identified by species specific DNA probe because the amplified fragment contained species specific sequence.


[The treatment of intestinal invagination in children].

The work discusses the results of analysis of clinical diagnostics of intestinal intussusception in 197 children and their treatment. Age peculiarities of the clinical course of intussusception were revealed. The characteristic pathomorphological changes of the walls of the invaginated portion of the intestine were studied according to the duration of the disease and the type of intussusception. The causes of the inefficacy of nonoperative correction of the invagination are identified. The tactics of intussusception management and the indications for operative treatment were elaborated on the basis of these data. The author suggests his own method for desinvagination. Operations were conducted on 62 children. Nonoperative treatment by the method developed by the clinic was applied in 169 (85.7%) children, the invaginated portion was reduced in 139 (82.2%) children and the treatment proved ineffective in 30 (17.8%) children. The author recommends the method for reduction developed at the clinic as the method of choice in the management of intestinal intussusception in children.


[Fecal incontinence in Hirschsprung's disease in children].

Among the criteria of evaluation of the results of operative treatment of Hirschsprung's disease in children, along with the absence of constipation is the function of defecation control. The authors examined 27 patients with fecal incontinence after Duhamel's operation. It was established that fecal incontinence in children after operative treatment of Hirschsprung's disease may be caused not only by affection of the external sphincter muscle of the anus, the nerve plexuses, and adaptation of the rectum to the new conditions after the pull-through operation, but also by trauma inflicted to the levator ani muscle. In children with severe damage to the levator group of muscles consequent upon operative treatment of Hirschsprung's disease, operative intervention for creating the anorectal angle is indicated.


[The diagnosis of motor disorders of the small intestine in peritonitis in children and the rationale for pathogenetic methods of correction].

The work deals with the results of experimental (200 animals) and clinical (20 patients) study into the role of the efferent link of the autonomic nervous system in regulating motor activity of the small intestine and the possibility of using direct electroenteromyography in the diagnosis of the stages of paresis and the degree of motor disorders in peritonitis. The pathogenetic methods of treatment of intestinal paresis are substantiated. Medicamentous stimulation of the cholinergic nervous system in peritonitis is effective only when intactness of the intramural ganglia is maintained, in which case the electroenteromyographic test with neostigmine methylsulfate or cerucal may be conducted. The pathogenetic method of treatment in all other cases is medicamentous blockade of the adrenergic nervous system.


[Changes in the respiratory coefficient during the intravenous administration of energy substrates in the early postoperative period in children].

Changes of the respiratory coefficient in the early period after operation on the abdominal organs were studied in 18 children during intravenous infusion of the main energy-producing substrates glucose and fat for 60 minutes. Their doses were in proportion to the age daily requirements and constant for each child during the whole period of study. The mean respiratory coefficient before infusion of the substrates was 0.84 +/- 0.005 on the first postoperative day, 0.857 +/- 0.009 on the second, and increased further to 0.888 +/- 0.008 and 0.909 +/- 0.023 on the third and fourth days, respectively. During infusion of energy-producing substrates the mean value of the respiratory coefficient reduced significantly (p < 0.001). It was 0.702 +/- 0.005 on the 60 th minute of the first day, 0.726 +/- 0.004 on the second day, and then increased to 0.761 +/- 0.009 and 0.778 +/- 0.01 on the third and fifth days, respectively. Before infusion of the substrates, the relative amounts of energy produced due to oxidation of fast and glucose were, respectively. 54.6% and 45.4% on the first day after operation. Later the share of fat decreased and that of glucose increased to 31.1% and 68.9%, respectively by the fifth day. During infusion of the substrates the relative amount of energy obtained at the expense of fat grew to 100% on the 60th minute of the first day and was 93.5% on the second day, the amount of glucose was 6.5%. The respective figures were 81.6% and 18.4% on the third day and 75.8% and 24.2% on the fifth day.(ABSTRACT TRUNCATED AT 250 WORDS)


[The late examination results in children with pylorospasm and dyskinesia of the proximal sections of the small intestine].

The article analyses the late-term results of examination of 46 children with neurogenous dyskinesias of the gastrointestinal tract which were recognised in infancy for the first time. The author believes that the functional, motor-evacuation, and sphincter disorders of the proximal parts of the digestive tube lead to the development of organic noninfectious diseases of the gastroduodenal system.


[Computed tomography of the pelvis in pediatric proctology].

The article shows the wide possibilities of computed tomography (CT) diagnosis of the topography of muscles forming the external sphincter of the anus (ESA) in patients with developmental anorectal anomalies and in trauma and rupture of the perineum. It is shown that in anorectal anomalies with fistulas opening into the urinary system the puborectal muscular sling is "drawn up" ventrally in relation to the external sphincter elements lying closer to the surface. Analysis of the results of CT examination of the pelvic floor in 16 children with anorectal anomalies showed that the degree of development of the sphincter muscles does not always correspond to the level of atresia. For instance, the mass of the ESA muscles is manifested more in some forms of cloacal atresia than in "tubular" stenoses of the rectum (anorectal stenosis--Curravino-triad component) (G. Curravino, 1981). CT examination of children with this complex of caudal anomalies allowed the authors to reveal a fourth constant component: dysplasia of the pelvic floor and a specific developmental anomaly of the anal sphincter. CT is the method of choice in the examination of children with this pathological condition because it makes it possible to recognise the presence of presacral masses. The use of CT in traumas and ruptures of the perineum allows the depth and extension of ruptures of the ESA muscles to be authentically determined.


[The treatment procedure in vesicoureteral reflux in young children].

A group of 54 children with vesicoureteral reflux recognized in the first 3 years of life was analysed. All of them received adequate nonoperative treatment including prolonged antibacterial therapy and management of cystitis and urodynamic disorders of the lower urinary tract. According to the degree of vesicoureteral reflux (VUR), the children were divided into two groups. Group 1 consisted of 29 children with Degrees I-II VUR in 37 ureters. Nonoperative treatment was effective in 75% of cases. Retrospective appraisal of urograms revealed no signs of cicatricial-sclerotic changes in the parenchyma of the kidneys. In five children with Degree II VUR of long duration the kidneys were smaller than the normal size of their age. Group 2 was made up of 24 patients with Degrees III-V VUR into 34 ureters. No changes were found in the renal parenchyma on urograms made during the first examination. During follow-up, however, signs of reflux-nephropathy (RN) were detected, which according to the recommendations of the International group for reflux study were evaluated as Degree I RN--10 cases, Degree II RN--12 cases, Degree III RN--8 cases, and Degree IV RN--4 cases. The authors believe nonoperative treatment of children with Degrees I-II VUR to be justified, patients with Degrees III-V VUR call for active surgical intervention from the moment that the reflux is recognized.


[The clinical significance of membrane-destructive processes and their correction in children with suppurative surgical infection].

The results of examination of 101 patients with purulent surgical infection provide evidence of considerable disorders of cell membrane metabolism which correspond to the severity of the disease. Three states of the antioxidant defence system were distinguished: compensated, subcompensated, and decompensated. It is suggested that antioxidant and membrane-stimulating treatment should be applied with consideration for the types of the course followed by the metabolic processes (metabolically latent, lipoperoxidatative, and peroxidative). The clinical effect of the use of antioxidants in 38 patients is shown.


[The efficacy of specific plasma in the therapy of newborn infants with a Pseudomonas aeruginosa surgical infection].

141 newborn with purulent surgical infection were under observation. In 73 the inflammatory process was not induced by Pseudomonas aeruginosa in 68 the infection was caused by the blue pus bacillus. Bacteriological and immunological examination was conducted, including that with the use of enzyme immunoassay, to monitor the optical density of anti-pyocyanea antibodies during the course of the disease. It was found that the serum of a healthy newborn baby contains antibodies to Pseudomonas pyocyanea and did no differ from that of healthy older children in the level of anti-pyocyanea antibodies. The increase of the level of anti-pyocyanea antibodies in response to infection with Pseudomonas pyocyanea is twice less in newborns than older children with this infection. The use of specific plasma is much more effective than the administration of nonhyperimmune plasma. The efficacy of treatment with anti-pyocyanea plasma is determined by the level of anti-pyocyanea antibodies produced in the patient as a result of plasmatherapy rather than the volume of the dose given for the course.


[The diagnosis of obstructive cholangiopathy in newborn infants].

To establish an early diagnosis of obstruction of the extrahepatic bile ducts in 12 newborn infants with jaundice the authors applied hepatobiliary scintigraphy and transcutaneous cholecystocholangiography under control of laparoscopy (2 patients). Atresia of the bile ducts was diagnosed in 4 children, which was confirmed during the operation; in one of these patients scintigraphy undertaken 3 weeks after the intervention showed restoration of the flow of bile into the intestine. In 5 cases a mechanical component of jaundice was not found and in 2 newborn infants the results of scintigraphy proved to be poorly informative. Transcutaneous cholecystocholangiography under control of laparoscopy in 2 cases made it possible to avoid laparotomy in suspected atresia of the bile ducts.


[The immune status of children with extrahepatic portal hypertension following splenectomy].

The purpose of the work was to study the immune status and some nonspecific defense factors in children with extrarenal portal hypertension after splenectomy. Seventy-one children were examined. It was found that the T-lymphocyte count before and in the early periods after the operation in children with extrahepatic portal hypertension did not differ from that in the control group. At the same time, the changes in serum immunoglobulins depended on the stage of the examination. Study of other links of immunity also revealed the time course of changes in their values.


[The results of the surgical treatment of thyroid diseases in children].

The results of surgical treatment of various forms of diseases of the thyroid gland in 254 children are analysed in follow-up periods of 12 months to 20 years. Functional compensation of the thyroid occurred in all patients with nodular forms of goiter who were subjected to operation which did not exceed hemithyroidectomy in volume. The analysis showed that operative treatment of children with the diffuse toxic form of goiter attended by the autoimmune component lead to hypothyroidism in 76.6% of patients, whatever the activity of the thyroid tissue, and a recurrence developed in 11.7% of those who were operated on. In children without the autoimmune component postoperative hypothyroidism was found in 48.6% of those examined, a recurrence was found in 3.2% of cases. The indications for operative treatment are specified, measures for the prevention of postoperative complications are listed.


[The surgeon's procedure in dystrophic bone cysts in children].

The authors set apart childhood dystrophic cyst as a separate nosological unit. The underlying factor of the development of a bone cyst is dysplasia of vessels filling the bone-marrow canal and a concomitant dystrophic process in the surrounding bone tissue. The nonneoplastic nature of the cysts led to the search for sparing methods of treatment, namely, the puncture method. The administration of demineralized bone shavings during therapeutic puncture (after osteoperforation of the wall, scraping off the fibrous membrane) produces good results. The clinical material consists of 46 cases. There were 8 cases of aneurysmal bone cyst, 23 with active and 15 with passive bone cysts. In 44 cases treatment by two or three punctures led to recovery in 2-4 months. In 2 patients with aneurysmal bone cysts three punctures proved ineffective and an operative intervention was undertaken. It is concluded that treatment by puncture is indicated in dystrophic bone cysts. Operation is indicated in poor outcomes of puncture treatment in patients with aneurysmal bone cysts.


[The conservative treatment of acute hematogenous osteomyelitis in children].

Radioisotopes were used to study the water spaces of the bone and bone marrow in 47 dogs with a created model of acute osteomyelitis. By the 3rd-5th day of experimental osteomyelitis sharp hyperhydration of the bone marrow and bone proper was revealed which was caused by a 2.5-2.8-fold increase of the volume of intercellular fluid in the zone of the affection, leading to circulatory disorders and necrosis. Dehydration of the tissues is accomplished by inflicting numerous percutaneous osteoperforations (NPO) with Kirschner's wire. The osteoperforations are made not at random but in a regular manner through both walls of the bone in two interperpendicular planes. Circulation in the zone of the affection is restored in this case and osteonecrosis in prevented. Conservative methods of treatment of acute hematogenous osteomyelitis were developed according to the stage of its development and were applied in 168 patients whose ages ranged from 20 days to 14 years; in 75% of patients who were admitted in the early stages of AHO the disease took and abrupt course. In patients with neglected forms of AHO three-fourfold infliction of NPO in the subacute stage produced a stimulating effect on reparative regeneration in the zones of osteonecrosis and the forming sequestra.


[The treatment of intestinal fistulae in children by applying a by-pass anastomosis using magnetic devices].

A new method is suggested for the exclusion of intestinal fistulas by the formation of by-pass anastomoses by means of a permanent magnet. The variants of the techniques of magnet by-pass anastomoses are discussed. The results of treatment of 46 children with external intestinal fistulas are shown. With the formation of a by-pass compression anastomosis the mortality rate among children with intestinal fistulas reduced from 31 to 13%.


Enzymatic properties of ubiquitously expressed delta-subspecies of protein kinase C differing from other members of protein kinase C family.

The delta-subspecies of protein kinase C (PKC) was purified to near homogeneity from the Triton X-100 extract of the rat brain particulate fraction by successive chromatographies on S-Sepharose Fast Flow, Phenyl 5PW, Heparin 5PW, hydroxyapatite, and Mono Q columns. The purified enzyme was doublet with molecular weight of 78 kDa and 76 kDa on SDS-PAGE. This doublet proteins were separated partially by Mono Q column chromatography, both of which were recognized by the antibodies raised against synthetic oligopeptides, parts of the deduced amino acid sequence of the rat delta PKC. Protein phosphatase 2A treatment suggested that the 78 kDa protein was a phosphorylated form of the 76 kDa protein. To confirm the structural and genetic identity of the doublet proteins, delta PKC was expressed in COS 7 cells by transfecting its cDNA-constructed plasmid, and was purified for comparison. This recombinant enzyme was also doublet. The enzymes isolated from the brain and COS 7 cells showed identical reactivities with delta PKC-specific antibodies, chromatographic behaviors, and V8 protease peptide mapping. In addition, these the enzyme preparations were indistinguishable from each other in their responses to phosphatidylserine, diacylglycerol, phorbol esters, free fatty acids, and Ca2+. Comparison was also made between the enzymological properties of delta PKC and alpha PKC, such as activation kinetics, sensitivity to protein kinase inhibitors and substrate specificity which were distinctly different from each other.


Susceptibility of Aedes albopictus mosquitoes (Oahu strain) to infection with Dirofilaria immitis.

The susceptibility of the Oahu strain of Aedes albopictus mosquitoes to infection with Dirofilaria immitis was examined to study the development of larvae in detail. Most of the developing larvae were found in the Malpighian tubules and infective larvae in the labium, indicating that Aedes albopictus Oahu strain is susceptible to the infection with D. immitis. New different patterns of development from those reported by earlier studies were observed: (i) the second-stage larvae in the thorax muscles of the mosquitoes and (ii) a small projection from the head of the sausage-form first-stage larvae.


Protein kinase C subspecies in rat brain synapses and phosphorylation of growth-associated protein.

Synaptosomes isolated from rat hippocampus contained the alpha- and beta-subspecies of protein kinase C (PKC), but not the gamma-subspecies, whereas postsynaptic pyramidal cells contained all these three subspecies. The PKC enzymes were activated synergistically by diacylglycerol and cis-unsaturated fatty acids including docosahexaenoic acid which is abundant in brain phospholipids. The phosphorylation of a PKC-specific substrate, growth-associated protein (GAP-43), which is associated predominantly with presynaptic membranes, was also protein (GAP-43), which is associated predominantly with presynaptic membranes, was also stimulated by diacylglycerol and cis-unsaturated fatty acids, particularly at the micromolar range of Ca2+ concentrations. The results presented suggest that cis-unsaturated fatty acids together with diacyglycerol may take part in the phosphorylation of GAP-43 in presynaptic membranes presumably by the alpha- or beta-subspecies of PKC even after the Ca2+ concentrations return to the basal level.


[The characteristics of cardiomyopathy in different geographical regions].

Region-specific characteristics of hypertrophic cardiomyopathy (HC) and dilated cardiomyopathy (DC) were compared for 108 relevant patients living in Dubai (United Arab Emirates) and Moscow (Russia). Out of 49 citizens of Dubai 17 had HC, 32 DC, and 59 Moscow patients had HC in 23, DC in 36 cases. It was found that HC in Dubai tends to run a silent latent course, involving mainly basal septum and right ventricle. Apical lesions were more typical for Moscow citizens who also display more severe myocardial impairment. DC in Dubai produces weaker cardiac insufficiency and arrhythmia. Incidence of idiopathic and periportal DC proved higher in Dubai, while alcohol and virus infection underlie DC more frequently in Moscow.


[The clinical efficacy of plasmosorption in stenocardia].

Follow-up examinations of 52 anginal patients who have received combined treatment involving plasma sorption indicate a good response in 77%, satisfactory in 11.5% and no response in 11.5% of the examinees. Exercise tolerance and performance increased by 34.3 and 52.1%, respectively. The scope of chemotherapy was related to the initial severity of the disease. Clinical remission after plasma sorption lasted 8.4 +/- 0.7 months.


[Treatment experience with rheumatoid arthritis patients during remission].

94 rheumatoid arthritis (RA) patients were observed for 4-5 years to evaluate the effect of basic treatment and opportunities for prolonged remission. A regimen of combined treatment has been tested which allows for psychologic status of the patient, corrects weak points in the regulatory systems, affects mechanisms of nonspecific resistance. The combined treatment administered during RA remission has resulted in complete responses (remissions) more frequently, prolonged their duration. Destructive processes in the joints still present in remission were seen to slow down.


[The diagnosis and endoscopic removal of foreign bodies obstructing the esophageal lumen].

The authors present a sequence of diagnostic (the patients' complaints, case history, clinical, x-ray and endoscopic evidence) and therapeutic (endoscopic treatment) measures to be taken in order to remove foreign bodies responsible for esophageal obstruction. The policy proposed allows the physicians to avoid misdiagnosis and to clear away foreign bodies from the esophagus with minimal complications in 96% of the cases.


[The surgical procedure in patients with hemorrhaging perforating gastroduodenal ulcers].

The paper presented the results of surgical treatment of 277 patients with bleeding penetrating gastroduodenal ulcers. Gastric location of the ulcer was revealed in 52 patients and duodenal location in 225 ones. More commonly used resections of the stomach according to a Billroth-I method or suprapyloric resections versus the resection of the stomach according to method Billroth-II when used in the patients with gastric location of the ulcers helped to reduce the mortality from 23.1 to 0%. The wide usage of organ-sparing operations combined with vagotomy reduced the lethal outcomes of the disease from 13 to 5.5% versus the resection of the stomach. The rate of bleeding relapses in the early postoperative period which followed the suture of penetrating gastroduodenal ulcers was 25.9%. The dissection of ulcers or their elimination from the alimentary tract could be regarded as the methods of choice in case of palliative treatment. Surgical treatment of penetrating gastroduodenal ulcers should be performed prior to bleedings. Planned operative intervention should be performed in patients with deep gastric ulcer with diameter of 1.5 cm and more and pyloroduodenal ulcers with diameter of more than 1 cm.


[The computerized evaluation of the signs of duodenal peptic ulcer].

A mathematical analysis of the data bank collected on duodenal ulcer patients has been performed using adapted to computer processing coded disease histories. Most informative signs of ulcerogenesis, diagnostic indicators of peptic ulcer have been selected and ranged. The review of peptic ulcer diagnostic criteria is presented.


[Acute cholecystitis in the clinical picture of acute food poisonings].

The authors followed up 215 patients with acute cholecystitis who were hospitalized with an erroneous diagnosis of food poisoning and 346 food poisoning patients who developed acute cholecystitis in the course of the disease mentioned. Symptoms for differential diagnosis of acute cholecystitis and food poisoning were considered.


[A new approach to the antibacterial therapy of chronic antral gastritis associated with Helicobacter pylori].

The authors proposed an original method of treatment for antral gastritis associated with Helicobacter pylori and combined with duodenal ulcer. The principle of the method consists in a successive gastric lavage with alkaline and antibacterial (metronidazole) solutions twice a week for a fortnight. Three groups of patients were under observation (37 examinees with chronic antral gastritis associated with Helicobacter pylori and combined with duodenal ulcer). Ten persons who were enlisted into the first group were treated with the lavage only, the second group persons (n = 12) were treated with lavages and histodyl in a dose of 400 mg per night, the third group (n = 15) were orally treated with metronidazole (0.25 g three times a day) for 15 days. A total elimination of Helicobacter pylori was observed in the half of the first group, 2/3 of the second and in 1/3 of the third group. Epithelialization of duodenal ulcers was observed in all those enlisted in the first and second group. Cicatrization of ulcers was observed in half of the patients from the third group.


[The transport of sodium, water and active osmotic substances in different parts of the nephron of patients with chronic glomerulonephritis and hypertension].

The lithium test was conducted to evaluate transport of water, sodium and osmotic active substances in 46 chronic glomerulonephritis (CG) patients. Sixteen CG patients entered group 1. All of them had secondary hypertension (SH). Twelve CG patients with SH symptoms of moderate reduction of endogenic creatinine clearance were assigned to group 2. Twelve patients of group 3 had CG and isolated urinary syndrome. Group 4 consisted of 6 patients with essential hypertension. As shown by the test, association of SH and CG is not an essential factor for renal transport of sodium, water and electrolytes. Some shifts in the transport in group 2 are attributed to reduced number of functioning nephrons. The tendency to enhanced lithium clearance was registered in group 4. This may reflect an increased supply of sodium, water and osmotic active substances to the uriniferous tubules.


Identification and quantitation of cocaine and its metabolites, benzoylecgonine and ecgonine methyl ester, in hair of Bolivian coca chewers by gas chromatography/mass spectrometry.

Twenty hair samples obtained from Bolivian mine workers who chewed 3-8 g of coca leaves daily for several years were analyzed for cocaine and its main metabolites, benzoylecgonine (BZE) and ecgonine methyl ester (EME). A new method was developed for the detection and quantitation of cocaine and its metabolites, BZE and EME, from hair in a single procedure. The hair samples were washed, cut into 56 segments (2-cm length), pulverized, and incubated with phosphate buffer and the enzyme beta-glucuronidase-arylsulfatase. After solid phase extraction and derivatization with pentafluoropropionic anhydride/pentafluoropropanol, the drugs were identified and measured by gas chromatography/mass spectrometry (GC/MS) using deuterated cocaine, BZE, and EME as internal standards. The method is reproducible (cocaine, CV = 8%; BZE, CV = 14%) and the detection limit for cocaine and BZE was 0.1 ng/mg, for EME 1 ng/mg. In the different hair segments, cocaine was found to be present in concentrations between 1.4 to 50.6 ng/mg, benzoylecgonine from 0.4 to 17.6 ng/mg, and ecgonine methyl ester traces below the calibration curve of approximately 12.9 ng/mg. In 95% of the cases cocaine exceeded BZE and EME in concentration.


Concentration of cocaine and metabolites in plasma of humans following intravenous administration and smoking of cocaine.

Plasma was obtained from 10 human subjects at various intervals after administration of two rapid doses of cocaine, either intravenously or by smoking, and multiple doses by smoking and intravenously. The plasma was analyzed for COC and its metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME). Plasma concentrations of COC were found to be dose-dependent. For patients receiving two successive doses of COC intravenously (IV) or by smoking (SM), the average half-life of COC was found to be between 38 and 39 minutes, regardless of the dose or route of administration. Considerable interindividual variation was observed. Multiple doses of both SM and IV COC were administered to three patients in a manner consistent with COC abuse. The maximum COC concentration observed was 1.2 mg/L following a total administration of 316 mg of COC over 90 min. Analysis of BE and EME confirmed that BE is the principle metabolite of COC in blood. All COC was accounted for by BE. EME, when present, did not exceed 5% of the BE concentration.


The role of ecgonine methyl ester in the interpretation of cocaine concentrations in postmortem blood.

A study of the metabolism of in vivo cocaine (COC) and the stability of in vitro COC suggests that the presence of benzoylecgonine (BE) in unpreserved blood arises from in vivo COC metabolism and that ecgonine methyl ester (EME) in unpreserved blood arises from in vitro COC hydrolysis. Postmortem cases positive for COC were studied to determine if molar concentrations of EME in unpreserved blood could be used to estimate the blood COC concentration at the time of death when added to the molar COC concentrations. COC was analyzed in 10 postmortem blood specimens between 1 and 8 days following death and again 10 to 70 days after further storage. The COC lost was accounted for by its hydrolysis to EME. Good correlation (r = 0.9677, p < 0.001) was observed when the blood COC concentrations in postmortem cases were compared to blood COC concentrations predicted by the addition of blood COC and EME concentrations; hence, analysis for EME and estimation of perimortem COC concentrations can assist in defining deaths associated with COC use.


A simplified procedure for the determination of free codeine, free morphine, and 6-acetylmorphine in urine.

A procedure for detection and quantification of free codeine, free morphine, and 6-acetylmorphine in urine is presented. The analytes were extracted at neutral pH by solid-phase extraction prior to derivatization to their trifluoroacetyl derivatives. The derivatized extracts were analyzed by gas chromatography/mass spectrometry in the electron impact mode. Confirmation of the analytes was accomplished by comparing the ion abundance ratios of the analytes to those of a previously analyzed standard. The qualitative ion abundance ratios were required to be within 20% of those of the standard for acceptance. Quantification was based on the tri-deuterated analogs of the analytes. Linearity was obtained in the range of 10 to 1000 ng/mL, with correlation coefficients of all analytes exceeding 0.999. Percent recoveries were 90% for codeine, 88% for morphine, and 85% for 6-acetylmorphine. No hydrolysis of 6-acetylmorphine occurs during the extraction procedure. The authors also studied the stability of 6-acetylmorphine at various storage conditions of pH, temperature, and chemical preservation. 6-Acetylmorphine was found to be stable for 12 weeks when stored at -17 degrees C.


Field performance of current generation breath-alcohol simulators.

The between-run accuracy and reproducibility of vapor-alcohol control tests associated with quantitative evidential breath-alcohol testing in the field were evaluated. Control samples were generated at six separate sites with 34 degrees C TOXITEST II breath-alcohol simulators and analyzed by infrared spectrometry with Model 5000-D intoxilyzers in the recirculation mode. Control test results at target alcohol concentrations of 0.060, 0.080, 0.090, 0.100, 0.110, and 0.120 g/210 L (n = 779) were combined and analyzed by standard statistical methods. Results were correlated with target values, and the signed and absolute differences were calculated and analyzed. Data treatment included ANOVA, linear regression analysis, t statistics, and relative and cumulative frequency distributions of the differences. We found the performance of these current generation simulators in the field to be similarly satisfactory to that obtained in our laboratory evaluation. We further found that vapor-alcohol control samples generated with these devices conformed to established formal requirements and that they can serve as an effective quality assurance measure in evidential breath-alcohol analysis.


Detection of cocaine and its metabolites in human amniotic fluid.

The dramatic rise in maternal drug abuse and the incidence of positive drug findings during neonatal testing has increased the need for prenatal toxicological testing for drugs of abuse. Human amniotic fluid samples collected after 13-39 weeks of pregnancy were screened for cocaine metabolite (benzoylecgonine) by fluorescence polarization immunoassay (FPIA). All positive samples, as well as any accompanying maternal serum, were confirmed by gas chromatography/mass spectrometry (GC/MS) for cocaine and its metabolites. Five samples out of 450 were positive for cocaine, benzoylecgonine, and ecgonine methyl ester by GC/MS. In addition, one sample was also positive for cocaethylene. Two maternal serum samples were positive for benzoylecgonine and ecgonine methyl ester. The presence of cocaine, benzoylecgonine, ecgonine methyl ester, and cocaethylene in the amniotic fluid suggests that the fetus is exposed to cocaine and its metabolites through maternal circulation. The impact of this exposure on the health of the newborn is unknown.


Feasibility of using GC/FT-IR for drug analysis in the forensic toxicology laboratory.

New developments in cryogenic sample deposition for gas chromatography/Fourier transform infrared (GC/FT-IR) spectroscopy have increased the sensitivity of the technique 100-1000-fold, to match or surpass that of gas chromatography/mass spectrometry (GC/MS). The current methods of GC/MS have led to some false positive identifications in drug testing labs. New methods employing GC/FT-IR will provide absolute identification through infrared fingerprinting with routine detection in the ppb range. GC/FT-IR methods are being developed which indicate low picogram amounts of material are detectable. Some preliminary data have shown that reference-quality spectra can be obtained from samples containing 200 ng/mL of amphetamines, and spectra from samples below the 25 ng/mL level for amphetamines can be obtained for identification purposes. These and other applications will be addressed along with limit of detection (LOD), limit of quantitation (LOQ), and linearity in comparison to commonly used techniques.


Solid phase extraction of phencyclidine from urine followed by capillary gas chromatography/mass spectrometry.

This communication describes a method for the solid phase extraction of phencyclidine (PCP) from urine, followed by GC/MS analysis. The method is linear over the range 5-1000 ng/mL and consistently produces cleaner chromatograms than can be obtained by liquid-liquid extraction. The limits of detection and quantitation are 0.47 and 1.38 ng/mL, respectively. Extraction efficiency, or recovery, was found to be 100.8 +/- 6.5%, and the between-run precision was 3.5% (25 ng/mL, n = 51). This solid phase method for extraction of PCP from urine has several advantages over liquid-liquid extraction for laboratories of any size.


Whole blood deproteinization for drug screening using automatic pipettors.

Automating the initial screening of postmortem blood and other tissues for drugs of abuse requires a pipetting procedure that is compatible with immunoassay screening tests. The deproteinization procedure uses a zinc sulfate-5-sulfosalicylic acid reagent to precipitate blood proteins. This procedure for deproteinization of whole blood and tissue homogenates is compatible with coated tube radioimmunoassays (RIA) and can therefore be used in automating the initial screening step.


Group selection, individual selection, and the evolution of genetic drift.

In a subdivided population, genetic drift affects variation between groups, and thus it can have an important effect on the outcome of evolution (Wright, 1978). The rate of genetic drift is determined, in part, by the behaviour of population members. This paper presents three mathematical models in which behavioural traits that affect the rate of genetic drift are allowed to coevolve with traits that are under selection at the group and individual levels. The results show that if group selection is strong relative to individual selection, then behavioural traits that enhance the rate of genetic drift will tend to increase in frequency. The strength of this effect depends, in part, on the way in which vacant sites are colonized.


On the origin of the transfer RNA molecule.

Data and arguments are given in favour of the hypothesis that the primitive tRNA molecule may have originated from a direct duplication event involving one of the two halves of the tRNA molecule. It seems that a molecule capable of assuming a hairpin structure was involved as a precursor in this duplication. The two halves of the present tRNAs could, therefore, be considered as paralogous.


Tissue distribution of bupropion in a fatal overdose.

A fatality resulting from the ingestion of bupropion is reported. Quantitation of bupropion and its metabolites was accomplished by gas chromatography. The distribution of bupropion and its metabolites, along with analytical details, is presented.


The evolution of regeneration: adaptive or inherent?

If regeneration were adaptive, it would have arisen autonomously by natural selection from non-regenerative antecedents. Unless each episode coincidentally reinvented the same method of regeneration independently, one would expect the various lineages to differ basically from each other, which they do not. On the other hand, if regeneration were inherent to metazoan life, a derivative of embryogenesis, its various expressions should be as much like each other as they resemble the development of embryonic appendage buds, which they do. It follows that the uneven distribution of regeneration must have been due to its extinction here and there, not as a negative adaptation by natural selection but as a pleiotropic epiphenomenon linked to more useful adaptations with which it was incompatible. In vertebrate evolution, these adaptations have included the transition from aquatic to terrestrial habitats and the modification of poikilothermic to homeothermic metabolism. The former advance rendered the regeneration of weight-bearing limbs impractical; the latter favored rapid wound healing and scar formation which effectively precluded blastema formation. If the latent capacity for regeneration persists in non-regenerative appendages, as would seem to be the case, then the restoration of its overt expression should be possible if the mechanisms of its inhibition could be discovered and eventually rendered ineffectual.


Relationships between chromosome segregation, cell shape and temperature in Escherichia coli.

The partitioning of chromosomes into daughter cells during the division of Escherichia coli is non-random. As a result, the chromosome containing the older template DNA strand has a higher probability of segregating toward the old cell pole than toward the new cell pole. The numerical value of this probability is a function of the incubation temperature. It is shown here that a recent model for explaining the physiological basis for non-random chromosome segregation also explains the temperature dependence of the segregation process.


Modification of a consumer digital audio tape (DAT) for analog data recording.

A modification of a commercially available digital-audio tape (DAT) for DC recordings such as those used in patch clamp and other electrophysiological experiments is introduced. The modified DAT can record data from 2 channels plus a separate trigger signal for up to 2 h. The bandwidth ranges from direct current to 21 kHz; the signal-to-noise ratio is above 90 dB and the A-D resolution is 16 bit. A 120-min cassette yields a storage capacity of 1.4 Gbytes. The trigger is 'hidden' on 1 channel as a burst of 1-ms duration, thus minimizing interference with the recorded data. The modified DAT offers a low-cost yet high quality solution to most analog data storage needs.


Hyperthermia-induced damage to rat sciatic nerve assessed in vivo with functional methods and with electrophysiology.

A 5-mm segment of the rat sciatic nerve was treated in vivo with hyperthermia (43-45 degrees C) for different times using a brass thermode. The effect of this local heat treatment on the nerve was assessed with electrophysiology and using two functional assays. Hyperthermia led to a dose-dependent decrease of motor and sensory function. Electrophysiological examination showed a decrease in amplitude of motor and reflex responses rather than a decrease in conduction velocities. Calculated ED50 values were not significantly different for the two functional and for the electrophysiological methods. Functional recovery from nerve damage took place in all cases. Measured at the same level of damage, i.e., 50% function loss, it took 14 days to recover from complete sensory function loss and 20 days from complete motor function loss. Although both motor and sensory functions were restored, 30 days after hyperthermia no responses could be detected with electrophysiology, this as a result of the thin myelin sheaths that occur upon recovery.


Detection of complement protein mRNA in human astrocytes by the polymerase chain reaction.

Primer sets specific for complement proteins, C3, factor B and factor I, were designed and used to amplify cDNA from cultured human astrocyte mRNA by the polymerase chain reaction. Appropriately sized PCR products of 506 bp, 885 bp and 146 bp, respectively, were generated and specificity was confirmed with Southern blotting using an enhanced chemiluminescence detection system. The sensitivity of detection was high, with amplified product from cDNA of approximately 6250 cells readily visualized. C3 and factor B have previously been reported to be produced by murine astrocytes; however, this is the first report indicating synthesis of C3, factor B and factor I by human astrocytes. These results indicate that PCR is a simple and sensitive technique to detect mRNA transcripts for proteins of the alternative pathway of complement in human astrocytes.


Computer-assisted alignment of standard serial sections without use of artificial landmarks. A practical approach to the utilization of incomplete information in 3-D reconstruction of the hippocampal region.

An algorithm for the alignment of stained serial sections without the support of artificial landmarks is described. Four-hundred-thirty serial sections of the rabbit hippocampal region were digitized, and computer-based alignment was performed without use of artificial markers, resulting in a consistent matrix. Following proper filtration, artificial sections were cut through the matrix. In a second experiment every second image was deleted and reconstructed by interpolation with a minor loss of biological information. In a third experiment every second image was deleted and the rest of the images were 'disordered', realigned and the missing planes reconstructed by interpolation. Under these circumstances the matrix was reconstructed with some loss of information. These results may widen the limits of 3-dimensional (3-D) reconstruction, as routine histological preparations normally include only every second or every third section without artificial landmarks.


New transducers for measuring muscle length in unrestrained animals.

Muscle length in unrestrained, chronically implanted animals is conventionally measured with gauges consisting of a compliant silicone rubber tube filled with either hypertonic saline or mercury, the measurement principle being a continuous change in the electrical resistance of the fluid column inside the tubing with stretch. These gauges have two major disadvantages: (1) changes in resistance that are not related to changes in length, such as those produced by changes in temperature or osmotic dilution of the hypertonic saline, cause the measurements to drift, and (2) there is no direct and accurate way to calibrate the measurements. In this communication two new types of muscle length gauge are described that eliminate both problems. Both types make use of the principle of sonomicrometry, i.e., the measurement of distances with pulsed ultrasound. Both types have been successfully used to measure the length of the medial gastrocnemius muscle in chronically implanted cats during treadmill locomotion.


Species differences in platelet aggregation induced by platelet-activating factor (PAF).

Species differences in platelet aggregation induced by platelet-activating factor (PAF) were investigated by using the same procedure of platelet preparation and biological assay. Washed platelets of six different species (horses, dogs, rats, rabbits, sheep and guinea pigs) were prepared employing the same method and platelet aggregation was induced by C16-PAF. Horse platelets were most sensitive to PAF (8.0 x 10(-12) M) and rabbit platelets activated by 5.0 x 10(-11) M PAF were also sensitive enough to detect PAF in clinical samples.


Histamine leukocytosis. I. Effect of histamine on peripheral leukocyte counts.

The effect of chronic administration of histamine on the number of cells in peripheral blood of dogs, rabbits and guinea pigs was tested by single and consecutive intramuscular injections of histamine in a beeswax-sesame oil mixture. Leukocytosis due to increased numbers of neutrophils occurred in all animals after single injections of histamine in beeswax, although erythrocytes and hematocrit values were unaffected in all species. When injection of histamine was repeated on consecutive days, the extent of leukocytosis subsided in some cases; however, the simultaneous administration of aminoguanidine restored leukocytosis. Single or daily injections of the beeswax-sesame oil mixture without histamine had none of these effects in any animals tested. Although simultaneous injections of histamine and H1 receptor antagonists did not alter histamine effects, the combined administrations of histamine and H2 receptor blocking agents suppressed histamine-induced leukocytosis.


The effect of naloxone on restraint-induced antinociception in mice.

Restraint for a period from 15-60 min induced significant antinociceptive effect in both male and female mice. The restraint animals all showed an increase in response time to the hot plate test at 55 degrees C. The antinociceptive activity was still apparent one hour after restraint. In the male animals, prior administration of naloxone s.c. 15 min before restraint for 60 min did not affect the degree of antinociceptive activity induced by restraint. In addition, naloxone administered s.c. immediately after restraint for 60 min also did not affect the degree of antinociceptive activity in male mice. These findings indicate that in male animals the endogenous opioid mechanism is most likely not involved in the restraint-induced antinociception. However, for the female mice naloxone administered s.c. either before or immediately after restraint for 60 min dose-dependently suppressed the antinociceptive activity induced by restraint. It is concluded that restraint can induce antinociceptive activity in mice; however, different mechanisms may be involved in the antinociception observed. In male mice the endogenous opioid systems do not seem to play a significant role in restraint-induced antinociception, while for female animals blockade of opioid receptors would greatly diminish the antinociception observed after restraint.


The single-pass perfused rabbit ear as a model for studying percutaneous absorption of clonazepam. I. General characteristics.

A single-pass perfused rabbit ear was employed as the model for studying percutaneous absorption of clonazepam in an open perfusion system. Clonazepam at 1.5% concentration (w/w) was suspended in a gel containing 1% (w/w) neutralized Carbopol 934 vehicled by a 50% water solution of propylene glycol and applied to the skin, in a thermostatically controlled chamber, after 10 min pretreatment with a lauryl alcohol enhancer. At 32 degrees C, the amount of clonazepam which diffused into the effluent after a 3 h lag phase was constant for 3 h and the flux averaged 0.486 mcg/h/cm2, whereas at 25 degrees C, the flux averaged 0.424 mcg/h/cm2. The amount of drug diffusing into the effluent was a function of the contact surface area and was independent of the rate of perfusion up to values of 1 ml/min. The apparent diffusion coefficient, Ds, and the partition coefficient, KM, were 2.75/10(6)/cm/h and 5.21, respectively.


Serum histamine in Alzheimer's disease and multi-infarct dementia.

Recent data indicate that a neuroimmune reaction might be responsible in part for neuronal death and cognitive deterioration in senile dementia. The potential involvement of brain histamine (HA) and interleukin-1 (IL-1) in this process has been previously documented. We have studied the concentration of serum HA in patients with Alzheimer's disease (AD) or multi-infarct dementia (MID) and in age-matched control subjects. Serum HA levels were significantly higher in AD (10.935 +/- 5.692 nM) and MID (8.521 +/- 3.44 nM) than in controls (5.533 +/- 2.567 nM) and correlated with mental performance as evaluated with the Mini-Mental State Examination (MMSE) (r = +0.493, p < 0.009). No correlation was found with cardiovascular parameters, cerebrovascular risk factors or age. Hyperactivation of the histaminergic system in AD at central and peripheral levels might reflect a neuroimmune reaction to brain tissue damage, a neurotrophic response, and/or a reactive process to regulate the IL-1 induced amyloid precursor protein (APP) overproduction.


Investigation of the pharmacokinetic behavior of barucainide in man during an early phase I study.

The pharmacokinetic behavior of the class Ib antiarrhythmic drug barucainide was investigated in a phase I study in a group of 6 healthy male volunteers after oral administration of an initial single dose of 20 mg and incremental doses between 30 and 70 mg barucainide hydrochloride. After a lag time of about 1 h, median plasma concentration peaked at ca. 48 ng/ml barucainide hydrochloride 2.5 h after administration of 20 mg. The drug was finally distributed in a total volume of VB/f of about 630 l. With a terminal half-life of ca. 12.5 h (8-26 h) it was eliminated rather slowly. Elimination was predominantly due to metabolic processes; however, a median of 21% of the dose (7-28%) was recovered unchanged in the urine. Barucainide, in the dose range studied, was not subject to any appreciable first-pass effect; its metabolism apparently depended on the hydroxylation capacity of the volunteers. The doses administered were well tolerated. There were no changes in the cardiovascular parameters investigated, no adverse effects and no impairment of general well-being.


Shi-quan-da-bu-tang (ten significant tonic decoction), SQT. A potent Chinese biological response modifier in cancer immunotherapy, potentiation and detoxification of anticancer drugs.

Shi-Quan-Da-Bu-Tang (Ten Significant Tonic Decoction), or SQT (Juzentaihoto, TJ-48) was formulated by Taiping Hui-Min Ju (Public Welfare Pharmacy Bureau) in Chinese Song Dynasty in AD 1200. It is prepared by extracting a mixture of ten medical herbs (Rehmannia glutinosa, Paeonia lactiflora, Liqusticum wallichii, Angelica sinesis, Glycyrrhiza uralensis, Poria cocos, Atractylodes macrocephala, Panax ginseng. Astragalus membranaceus and Cinnamomum cassia) that tone the blood and vital energy, and strengthen health and immunity. This potent and popular prescription has traditionally been used against anemia, anorexia, extreme exhaustion, fatigue, kidney and spleen insufficiency and general weakness, particularly after illness. In order to restore immunity in cancer patients, potentiate the therapeutic effect and ameliorate adverse toxicity of anticancer agents, 116 Chinese herbal formularies (Kampo) have been screened and evaluated. Fifteen compounds were found to have such actions. Among these, SQT was selected as the most effective as a potent biological response modifier. During the last eight years, animal models and clinical studies have revealed that SQT demonstrates extremely low toxicity (LD50 > 15 g/kg op murine), self-regulatory and synergistic actions of its components in immunomodulatory and immunopotentiating effects (by stimulating hemopoietic factors and interleukins production in association with NK cells, etc.), potentiates therapeutic activity in chemotherapy (mitomycin, cisplatin, cyclophosphamide and fluorouracil) and radiotherapy, inhibits the recurrence of malignancies, prolongs survival, as well as ameliorate and/or prevents adverse toxicities (GI disturbances such as anorexia, nausea, vomiting, hematotoxicity, immunosuppression, leukopenia, thrombocytopenia, anemia and nephropathy, etc.) of many anticancer drugs. The application and mechanistic studies of SQT in future development have potential importance in basic and clinical research of the traditional Chinese therapeutic approach of "toning the blood and strengthening Qi (vital energy)" in cancer immunotherapy.


Biocultural synthesis in medical anthropology.

Medical anthropology has developed distinct and separate biological and cultural approaches to the study of health and disease in human populations. Within cultural anthropology a major focus has been the ethnomedical perspective that analyzes the process of defining disease and describing the social response to disease. In biological anthropology, an ecological perspective considers the interaction of the population, the insult and the environment at the core of the disease process. There has been limited success in integrating the cultural and biological perspective. Some cultural anthropologists claim that the ecological perspective relies on a biomedical model and therefore is not useful in studying non-Western societies. Others are critical of the adaptivist perspective that they believe fails to consider political economic factors that affect the disease process. The lack of a biocultural integration has hindered the systematic analysis of health and disease in contemporary traditional and non-Western groups. An ecological model that addresses these problems will provide a biocultural integration of the disease process.


Toward an ecology of women's reproductive health.

Medical ecology has been one of the dominant theoretical strands in medical anthropology since the 1960s. It has come to be identified with a rather narrow range of research issues, concerning such matters as adaptation to climate and infectious disease, and has dealt with small-scale foraging societies. An ecological model has potential for dealing broadly with other health issues, in the case explored here, women's reproductive health, a topic that has frequently been approached from either a cultural or biological standpoint rather than the integrated one advocated here.


Postischemic breakdown in hippocampal protein synthesis and mnesic deficits in rats: pharmacological improvement by curative naftidrofuryl treatment.

This work was designed to investigate the effects of brain ischemia on mnesic retention in the model of unilateral microsphere embolization in rats. Using various radioactive tracers as well as a learning/memory test, we could correlate following parameters: regional blood flow, protein synthesis and memory retention. All were severely impaired by the hemispheric multi-infarction. A curative treatment with naftidrofuryl (15 mg/kg i.p.) for 3 consecutive days strongly improved the mnesic capacities of the animals, and this effect was corroborated by a marked protective drug action on protein synthesis in the hippocampus. Indeed, studies on valine incorporation into proteins revealed that, despite having no quantitative effect on regional blood flow, naftidrofuryl allowed an almost normal functioning of protein synthesis. As naftidrofuryl had also no direct effect on protein synthesis in the intact contralateral hemisphere, this effect was consequently attributed to the metabolic and/or antiserotoninergic effects of the drug.


Astrocyte volume regulation and ATP and phosphocreatine concentrations after exposure to salicylate, ammonium, and fatty acids.

Cellular volume regulation following swelling in hypo-osmotic phosphate-buffered saline (PBS) and ATP and phosphocreatine concentrations of cells incubated in iso-osmotic or hypo-osmotic PBS were measured in primary cultured rat cerebral astrocytes exposed for 30 min to NH4Cl, salicylate, hexanoate, octanoate, and/or dodecanoate. These compounds have been implicated in the pathogenesis of cerebral edema in Reye's Syndrome. NH4Cl (0.10 - 10 mM) had no effect on astrocyte volume regulation or ATP concentration. Salicylate significantly reduced ATP concentrations at 3.0 mM and 10 mM but had no effect on volume regulation. Hexanoate (10 mM and 30 mM) decreased astrocyte ATP content by over 80% while octanoate (10 mM) reduced ATP content by more than 50%. Concentrations of these fatty acids at or below 3.0 mM had no effect on ATP content. Volume regulation was inhibited by 3.0 mM hexanoate and 3.0 mM octanoate but not lower concentrations. Dodecanoate (0.1-3.0 mM) decreased cellular ATP content by 33-51% in iso-osmotic PBS solutions. Phosphocreatine content was reduced by exposure to salicylate or octanoate at concentrations which had no effect on ATP content. These results indicate that astrocyte energy metabolism and volume regulation may be compromised by agents associated with cerebral edema in Reye's Syndrome. Analysis of the dose-dependence of these effects suggests that inhibition of astrocyte energy metabolism is not sufficient to affect volume regulation.


Effects of variations in the duration of diffusible-tracer infusions on calculated values of global and local cerebral blood flow.

Using dual tracer quantitative digital autoradiography and iodoantipyrine (IAP), we compared local cerebral blood flow (LCBF) measurements using two different infusion times within the same animal. Rats were given concurrent infusions of 14C-IAP and 123I-IAP; one tracer was administered over 20 seconds and the other over 40 seconds. Pairs of autoradiograms, one representing predominantly 123I and the other 14C, were then produced from 20 micron-thick brain sections and images from each section were digitized and processed to produce pairs of digital images of LCBF. The corresponding LCBF images were compared quantitatively on a pixel-by-pixel basis. Global LCBF values were greater (28%) at 20 seconds compared to 40 seconds, consistent with the previously reported "falling flow" phenomenon. Perhaps more importantly, the actual pattern of LCBF differed in certain regions such as the cortex, hippocampus, thalamus, and cerebellum between the two time points. In other words, the quantitative patterns of calculated LCBF values were dependent upon the duration of tracer infusion, even when the infusion times were kept below recommended limits (45 seconds). Thus, errors in LCBF measurements may occur in certain structures even in brief experiments. Because these errors are spatially dependent rather than blood flow dependent, there is presently no model which can be globally applied to the brain to correct them.


[Immunological phenomena in pulpal-periapical lesions].

Based on an extensive review of the literature, the authors examine immunological reactions in pulpal and periapical lesions. Although it has been known for some time that bacterial infection causes this pathology, attention has been recently focused on immunological factors in the ambit of the phlogistic process. The present study examines the correlation between the latter and the type of extent of antigenic response, focusing attention on their important role in the phenomena of osteoclastic activation and inhibition of bone repair. From a physiological point of view there are few inflammatory cells in dental pulp, like macrophages and T lymphocytes. When the pulp comes into contact with the antigenic substance it activates a specific and aspecific immune response: the form through the activation of B and T lymphocytes, and the latter through the action of LPS, PMN and complement. An important role in the immune response is played by the cytokines which are able to regulate the intensity and duration of the immune response against potential pathogenic agents. It was initially thought that these were only produced by lymphocytes and as a result they were known as lymphokines. Later it was observed that other cell populations were also able to produce them. Phlogosis of the periapex starts before the pulp is fully necrotic. Tissue detritus and products of bacterial derivation escape through the numerous endoparadontal communication pathways and stimulate an inflammatory response by the vascular system of the parodontal ligament. The concomitant immune reaction occurs due to the tendency to block and restrict the inflammation to the radicular channels, thus preventing its diffusion.(ABSTRACT TRUNCATED AT 250 WORDS)


[Tubular sclerosis].

Tubular sclerosis is a pulp-dentin complex defensive response to several physiologic and pathologic stimuli; it leads to an increasing tubular obliteration which enormously reduces dentinal permeability. Its typical structural features are either increased peritubular dentin thickness or "caries crystals". Pathogenesis is a much debated question: some authors assert that peritubular dentin thickening is the main liable for sclerosis while others support a centrifugal theory. Another point of view considers its pathogenesis the result of many integrated mechanism.


[The clinical and microbiological evaluation of the efficacy of oral irrigation on the periodontal tissues of patients wearing fixed orthodontic appliances].

The aim of the present study has been the evaluation of the effectiveness of oral irrigation with or without toothbrushing and dental flossing, in individuals treated with fixed orthodontic appliances, on controlling the development of dental plaque and, hence, of gingivitis. Eight individuals with a good general and oral status have been chosen. Before the experimental period, they received instructions about oral hygiene with toothbrushing and dental flossing and then they have been monitored to verify they were doing well. At the time T0, the upper tooth have been banded, three Periodontal Indexes (Plaque Index according to Silness and Loe, Modified Gingival Index according to Lobene and Gingival Bleeding Index according to Ainamo and Bay) registered and subgingival plaque samples from the premolars' gingival sulcus collected in order to point out the total anaerobes bacterial counts, the rates of motile bacteria, spirochetes, Gram positive and Gram negative cocci and bacteria, by means of optical and dark field microscopy and of cultural methods. For their oral hygiene, the patients had to use, in the right side toothbrush and dental floss (Control 1), in the left side the oral irrigator alone (Test 1). One month later (time T1), the lower teeth have been banded, too. In the right side the patients had to use toothbrush and dental floss (Control 2), while in the left one they used the same devices as Control 2 plus the oral irrigator (Test 2). At the time T1 Periodontal Indexes and Microbiological analyses have been extended to all the four quadrants.(ABSTRACT TRUNCATED AT 250 WORDS)


[Oral symptoms in the climacteric. A prevalence study].

The female climacteric is attributed to physiological ovarian failure with the consequent decrease in the secretions of oestrogen, progestones and androgens. Numerous metabolic, psychological and physical changes have been associated with this event. Oral discomfort, including the burning mouth syndrome and the dry mouth syndrome, has been described as a menopausal symptom. However, the relationship between the hormonal changes related to climacteric and the onset of oral discomfort is still controversial. The purpose of the present study was to evaluate the prevalence of oral symptoms, with particular regard to burning sensation, xerostomia, altered taste and recurrent oral ulcerations. The relationship between oral and climacteric symptoms and psychological status of the patients was also evaluated. A questionnaire was administered to 136 women (mean age: 51.2 years, range 40-62) being consecutively referred to the University Hospital Menopause Clinic from October 1991 to March 1992. The questionnaire included informations regarding menopausal state, oral symptoms, drug assumption, wearing of partial or total dentures, parafunctions (lip and cheek biting, bruxism, tongue thrusting). Climacteric symptoms including flushes/sweats, palpitations, headache, arthralgia/myalgia, vaginal dryness, decreased concentration, tiredness, decreased libido, insomnia, vertigo were evaluated. Visual analogue scale (VAS) was used where appropriate. Information regarding the alteration of the psychological status was collected by means of the Hospital Anxiety and Depression Scale Statistical analysis was performed by chi 2 test or Fisher's Exact Probability Test and Mann-Whitney U-test. The level of significance accepted was 5%. The subjects in this study were divided into two groups on the basis of their answers to the questionnaire: group I (no. 39), premenopausal women; group II (no. 97), menopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)


[An update on nonsurgical periodontal therapy. A review of the literature].

In this review the authors examine the currently accepted nonsurgical treatment modalities, the role of pharmacotherapeutics in the prevention and treatment of periodontal disease and in the maintenance of the results. They also consider the utility of nonsurgical treatment for cases of advanced periodontal disease and the future direction of clinical practice and research.


[Lipoma of the parotid gland. Comments on a case].

The authors present a case of parotid gland lipoma. They underline the clinical features, the unusual finding of it in the parotid lodge and the relationship with the surrounding tissues. After having shown the nosologic pattern of this neoplasm they underline the importance of the instrumental investigations by means of ET, TC and RM, that lead to a nearly sure pre-surgery diagnosis.


[Mucopolysaccharidosis. A case report of Morquio's type-A disease (MPS IV-A)].

The mucopolysaccharidosis represent a broad spectrum of disorders due to the deficiency of one of a group of enzymes which degrade three classes of mucopolysaccharides: heparan sulfate, dermatan-sulfate and keratan sulfate. The general phenotype includes coarse facies, corneal clouding, hepatosplenomegaly, joint stiffness, hernias, dysostosis multiplex, mucopolysaccharides excretion in the urine and metachromatic staining in peripheral leukocytes and bone marrow. Various components of the MPS phenotype are also found in the mucolipidoses, glycoprotein storage diseases. Detailed clinical and radiologic evaluation and identification of the type of MPS excreted in the urine help to narrow the diagnosis possibilities. Definitive diagnosis requires assay of specific enzymes in various tissues such as cultured skin fibroblasts. For the moment there are 14 types of known mucopolysaccharidoses, including several subtypes. They are classified into Hurler's syndrome (MPS I-H); Scheie's syndrome (MPS I-S); Hurler-Scheie's syndrome (MPS I-H/S); Hunter's syndrome A, B (MPS II-A, B); Sanfilippo's syndrome A,B,C,D (MPS II-A,B,C,D); Morquio's syndrome A,B,C (MSP IV-A,B,C); Maroteaux-Lamy's syndrome (MPS VI) and Sly's syndrome MPS VII). The mucopolysaccharidosis incidence is around 0.04-0.3% of the newborn and they are 1.5% of all congenital disorders. All mucopolysaccharidosis are autosomal recessive disorders, except for Hunter's syndrome that is X-linked and recessive. Patient suffering of MPS, usually, don't show clinical sign from their birth in fact they develop later their characteristics. The average surviving of this patients is around 20-30 years old, and the exitus is due to cardiac failure or to infections to the gastrointestinal tract or to instability of atlantoaxial joint.(ABSTRACT TRUNCATED AT 250 WORDS)


[Hypertrophy of the masseter: a rare case associated with hypertrophic cardiomyopathy].

Masseteric hypertrophy is a rare, monolateral or bilateral lesion. The aetiology is often unknown and both congenital and acquired forms are reported in the literature. The authors report a case of masseteric hypertrophy associated with hypertrophic cardiomyopathy. Family history shows two brothers suffering from the same cardiac disease. Echography, computed tomography, EMG test and aspiration biopsy of masseteric muscle were performed. Echocardiography and HLA, B and C antigens of 16 relatives were also performed. In the report case the authors hypothesized a multifactorial background on a genetic basis.


Nutrition support in inflammatory bowel disease.

Many patients with the inflammatory bowel diseases, Crohn's disease, or ulcerative colitis have significant protein-calorie malnutrition and micronutrient deficiencies. Factors that contribute to these nutritional deficits include inadequate nutrient intake, malabsorption, excessive nutrient secretion across the diseased gastrointestinal tract, drug-nutrient interactions, and increased nutrient requirements. In this review, the use of enteral and parenteral nutrition support as primary therapy for active Crohn's disease and ulcerative colitis is discussed. Other roles for nutrition support in patients with inflammatory bowel disease, including preoperative nutrition support, nutritional treatment of intestinal fistulas and growth retardation, and home parenteral nutrition for gut failure, are also reviewed.


Home hyperalimentation for inflammatory bowel disease.

Total parenteral nutrition (TPN) has become a useful tool in the management of patients with inflammatory bowel disease (IBD). In the past, it was felt that TPN would have a therapeutic role in IBD, but experience has shown that it functions more as an adjunct to other therapeutic interventions. The specific roles of TPN in IBD include: (1) nutritional maintenance in the short bowel syndrome, (2) TPN as adjunctive therapy in jejunoileitis of Crohn's disease, (3) home TPN (HTPN) in Crohn's colitis, and (4) preoperative repletion of significantly depleted patients going to surgery. The adaptation of hospital techniques to the home situation has allowed patients to carry out long-term TPN therapy at home. Patients with IBD on HTPN are subject to the same mechanical and metabolic problems as are other patients on HTPN and, in addition, have a higher infection rate. When carried out appropriately, however, HTPN is a valuable technique in the management of patients with IBD and may provide an improved quality of life.


Ten-year survival of a Broviac catheter.

We report a patient with regional enteritis and short bowel syndrome who has been treated with home parenteral nutrition for 19 years, during 10 of which he used a single Broviac central venous catheter. The catheter finally required replacement because of progressive lumen occlusion, which was presumed to be caused by thrombosis. At the time of replacement, the catheter was found to be friable and embedded in a hard sheath that made it adherent to the wall of the internal jugular vein and prevented complete removal. At some time during the ensuing 16 months, the retained fragment embolized asymptomatically to the pulmonary artery. During the first 2 months after the placement of a new Hickman catheter, progressive flow resistance developed, probably because of calcium phosphate precipitation, although no change had been made in the parenteral formulation. It resolved immediately upon the instillation of hydrochloric acid into the catheter.


Glutamine content of whole proteins: implications for enteral formulas.

In two recent clinical trials in surgical patients, supplementation of total parenteral nutrition with daily doses of 12 or 20 g of glutamine resulted in a diminished loss of free glutamine in skeletal muscle tissue. Studies in animals exploring the use of both enteral and parenteral glutamine supplementation suggest that glutamine may be an essential nutrient in the maintenance of gut structure and function during critical illness. These findings have led to heightened interest in the glutamine content of enteral formulas. This article describes a method for estimating the glutamine content of whole-protein enteral formulas. The average amount of glutamine in selected, whole-protein formulas ranges from a minimum of 3.55 g/4200 kJ to a maximum of 5.15 g/4200 kJ. Although it is still too early to define the safest and most effective dose of glutamine, there are two points regarding glutamine supplementation that clearly merit further investigation: no clinical trials have been conducted to assess the potential benefits of glutamine supplementation of an enteral diet or to assess the effects of using diets containing protein-bound glutamine rather than free glutamine.


Selenium deficiency in long-term total parenteral nutrition.

Although selenium is an essential trace element, it is often not routinely added to total parenteral nutrition (TPN) formulations. When selenium is not added, patients are at risk for selenium deficiency. This report describes such a patient. He had several operations for colon cancer, including a massive resection of the small bowel that resulted in a short bowel and a fistula. TPN was started after his last operation. After he was discharged, he had a normal, active lifestyle, except that he limited oral intake to water and an occasional soft drink. After 3 years of almost exclusive nourishment by TPN, he developed whitened nail beds. Investigation for possible trace element deficiency resulted in a finding that he had very low levels of selenium in his blood. He did not have any of the cardiac or skeletal muscle abnormalities that have been associated with selenium deficiency. After supplementation with selenium, his blood levels of selenium rose and the nail bed changes were reversed.


The essential fatty acids.

In animal and human tissues, there are four families of fatty acids that are derived from the precursors palmitoleic, oleic, linoleic, and linolenic acids. Of these, linoleic and linolenic acids are essential dietary elements for humans and all higher animals. The four precursor fatty acids are metabolized (through desaturation and chain elongation) to form the long-chain polyunsaturated fatty acids. The principal fatty acids derived from linoleic acid are arachidonic acid, which contains four double bonds (tetraene) and dihomogamma linolenic acid, whereas products formed from linolenic acid are eicosapentaenoic acid and docosahexaenoic acid. The major products from palmitoleic and oleic acids are the 20 carbon fatty acids with three double bonds (triene). In the presence of adequate dietary amounts of essential fatty acids, tetraene products predominate in plasma. When the intakes of both linoleic and linolenic acids are low, triene formation is high and hence the triene/tetraene ratio in plasma is used to assess the index of essential fatty acid deficiency. The polyunsaturated fatty acids derived from essential fatty acids serve as cellular membrane phospholipid components which can influence the physicochemical characteristics of the lipid bilayer. Changes in membrane lipids can modify the mobility and function of a variety of membrane proteins which may result in altered cell/organ functions. Linoleic acid is specifically required in the skin to maintain the integrity of epidermal water barrier. The dihomogamma linolenic acid, arachidonic acid, and eicosapentaenoic acid are the precursors of eicosanoids which influence many cell processes and organ functions.(ABSTRACT TRUNCATED AT 250 WORDS)


Intravenous fat emulsions in clinical practice.

The use of intravenous fat emulsions has become an integral part of the provision of parenteral nutrition. In the past, this was achieved by the administration of lipids separately from the dextrose-amino acid base solution. More recently, lipids have been admixed along with the dextrose-amino acid formula as a total nutrient admixture (TNA). This article discusses the advantages and disadvantages of TNAs, the factors that affect the stability of emulsions, the potential for microbial growth in TNAs, and guidelines for the compounding of TNAs.


Lithium treatment and memory assessment: methodology.

Clinical observations have suggested that lithium may exert adverse effects on memory. The difficulty in achieving empirical consensus regarding this issue has reflected several methodological problems: diversity of research designs, heterogeneous samples, lack of control groups and the possible confounding of memory test scores by variables such as depression, other acute psychopathologies, organicity, treatment duration, and age. The diversity of memory tests in terms of the complexity and modality of the stimuli as well as the types of memory assessed (immediate, short- and long-term, logical, visuo-practic) has further complicated the comparison of results across studies. Furthermore, the administration of test batteries has been limited by patients' fatigue and the severity of their illness, and by the time required to complete testing. Hence, the use of test norms may be restricted. Suggestions are made for the selection of appropriate memory tests, patients sampling and data analysis. The authors discuss the difficulties inherent in blind studies and in matched-group designs examining the effects of lithium on memory. Conclusions point to the advantages of prospective within-subject designs with repeated testing in which patients serve as their own controls.


Widespread reduction of regional cerebral blood flow during hyperventilation-induced EEG slowing ('buildup'). Observation from subtraction of brain imaging with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime.

To study the pathophysiological mechanisms of hyperventilation-induced EEG showing, i.e., the so-called 'buildup' phenomenon, changes in regional cerebral blood flow (rCBF) were investigated before and during the phenomenon in a 16-year-old woman with headache, thought to be of neurotic origin, by subtraction technique of brain images with single photon emission computed tomography using technetium-99m hexamethyl-propyleneamine oxime (99mTc-HMPAO). The tracer uptake during buildup decreased by 31-42% as compared to baseline values at rest before buildup in all of the measured regions, reflecting a widespread reduction in rCBF. Gas analyses of arterial blood collected during buildup showed a decrease in PaCO2, and increases in PaO2 and pH with a slight decrease in blood pressure and an increase in pulse rate. These results directly demonstrate a close correlation between the hyperventilation-induced EEG and rCBF changes, suggesting that the buildup phenomenon results from cerebral ischemic change, presumably due to cerebral vasoconstriction caused by the PaCO2 decrease.


EEG and evoked potentials in episodic-dyscontrol syndrome.

The neurophysiologic correlates of explosive rage and violence are uncertain and controversial. We recorded 17-channel electroencephalograms (EEGs), brainstem auditory-evoked potentials (BAEPs), and long-latency auditory-event-related potentials (AEPs) in 23 patients with impulsive, aggressive and violent behavior satisfying criteria for episodic-dyscontrol syndrome. Most patients also satisfied criteria for intermittent explosive disorder, although some had had conduct disorders in childhood or had previously used psychoactive substances. Sixteen of 23 patients had normal EEGs, while 7 had diffuse or focal slowing not ascribable to drowsiness or the effects of medication. They differed significantly from 20 age-matched patients with headaches, of whom 1 had an abnormal EEG (chi 2 = 4.68, p < 0.05), and from 24 depressed patients, all of whose EEGs were normal (chi 2 = 4.83, p < 0.05). Patients and normal control subjects did not differ in BAEP latencies. N100 and P160 AEP amplitudes were lower in episodic-dyscontrol patients than in control, but the difference was not significant. These findings suggest that non-specific cerebral dysfunction and EEG changes may be associated with disordered impulse or behavior control. Episodic dyscontrol may be associated with other evidence of minimal brain dysfunction.


Exploring the connections between platelet monoamine oxidase activity and behavior. II. Impulsive personality without neuropsychological signs of disinhibition in air force pilot recruits.

Platelet monoamine oxidase (MAO) activity and serum levels of the adrenal androgen metabolite dehydroepiandrosterone sulfate (DHAS) were measured in 18 male air force pilot recruits and 19 randomly selected male conscripts. Personality scales from three inventories were given, and computerized neuropsychological tests were performed: finger tapping and alternation, reaction time, perceptual maze, perspective fluctuation and lexical decision. The pilot recruits had higher scores in sensation-seeking-related scales suggesting disinhibited behavior in the social sphere, interest in sports and activities involving some danger, and a need for change. They also had higher scores on an impulsivity scale which comprises sensation-seeking content. In the neuropsychological tasks, the pilot recruits were faster in finger-tapping alternation and performed more efficiently in the perceptual-maze test than the conscripts. In a linear discriminant analysis, neuropsychological-task performance discriminated significantly between the pilot and conscript groups. In the biochemical measures, the pilot recruits had higher DHAS levels but similar MAO activity levels compared to the conscripts, which is in contrast to what has been found in other sensation-seeking groups in comparison to controls. This result is in accordance with the normal scores in one of the impulsivity scales in the pilot recruits, and with the absence of signs of disinhibition in neuropsychological tasks. It is proposed that only some aspects of the impulsivity concept might be critical for the association with low MAO activity.