[The causes of longitudinal fracture of the upper complete denture base].

Laying the strain gauge on the design areas of palatal base and frenum labiorum of complete dentures and simulating the different shapes of notch of frenums by the photoelastic mould. The test of the base condition under static and dynamic load by electrical measurement method was carried out. The longitudinal breaking line on the front part of the palatal base was first observed. The causes of breaking may be due to: the weak effect of notch of frenum labiorum; stress concentration on the front part of the base; material fatigue caused by the repeated alternate force and the strength of base material reduced by unsuitable processing.


[The distribution of glycosaminoglycans in the temporomandibular ligament].

The distribution of glycosaminoglycans (GAGs) in the adult dog's Temporomandibular ligament (TML) was studied by histochemical methods. Two staining methods were used, Alcian blue/PAS and Alcian blue with different concentration of MgCl2 (the Critical electrolyte concentration (CEC) method). It was found that GAGs were mainly localized in the TML, especially in the ligamental midsubstance and condylar attachment area, rather than in the capsule. Various GAGs distributed differently between the TML and capsule and they were also different among the different parts of the TML, although the majority of the CEC values was found corresponded to those of Chondroitin/Dematan Sulfate. It was suggested that the different topographical distribution of GAGs between the TML and capsule was probably related to their structure and function.


[The application of nasometer on the analysis of normal and cleft palate speech].

This paper reports the use of for assessment of speech by oronasal acoustic measures. Nasal energy during speech is reflected by nasolance value and graph pattern. The degree of velopharyngeal closure and the situation and movement of other speech organs can be demonstrated. The speech of 120 normal children and 60 preoperation cleft palate patients are studied. The scales of normal value and graph pattern are recorded. Comparing with normal speech, the scale of nasolance value and characteristics of graph pattern of cleft palate speech are obviously changed and may be assessed by this apparatus. The treatment and speech therapy plan can be made with the results obtained by this method as the basis.


[The experimental research on the changes in the amount of prostaglandins in rat alveolar bone during tooth movement].

In this paper, the author observed that in different time the changes of the amount of endogenous prostaglandins in rat alveolar bone under continuous orthodontic force, and confirmed that there are certain amount of PGE1. PGE2 in the rat alveolar bone even without orthodontic force, and the amount is no difference between right and left side. After several hours when the orthodontic force was applied the amount of PGE1 and PGE2 in rat alveolar bone rose significantly. But it is transient and does not last 24 hours.


[Clinical application of positioner and its fabrication].

Positioner is one type of removable appliances made of elastic material. This material, which is a kind of high polymer and has recoverable ability, may be as a new type of orthodontic material used not only in orthodontic treatment of various kind of malocclusions but also in retention in later stage of treatment. It is not same to the stainless steel wire of traditional removable appliances which must be activated every time to produce a little tooth movement. The advantages of positioner are to reduce the visit frequency and to shorten the duration of treatment. According to our clinical experiences, the indications are: simple individual malocclusion; treatment and retention in later stage of various kind of malocclusions; and patients who couldn't come to clinic regularly.


[The effect of berberine in sterilizing infective root canal of deciduous teeth].

This investigation introduces the effect of sterilizing infective deciduous root canal with Chinese traditional herb berberine. Through the bacterial test, animal test, clinical practice, and comparing with the dental root disinfectant for mocresol (FC) and comphorphenol (CP) it indicates that berberine Chinese traditional herb is a excellent disinfectant for infective deciduous root canal.


[Electrophysiological effects of intravenous propafenone for treating atrial-ventricular nodal dual pathways reentrant tachycardia].

The acute electrophysiological effects of intravenous propafenone were studied through programmed electrical stimulation in 9 patients with atrio-ventricular nodal dual pathways reentrant tachycardia (AVNDP-RT). The results showed that propafenone prolonged significantly the effective refractory period of atrial ventricular nodal fast pathway (AVN-FP) in retrograde conduction and might further terminate the paroxysmal supraventricular tachycardia (PSVT). It is an effective drug for treating AVNDP-RT. Neither blood pressure dropping nor other side effects were observed.


[A comparative study of coronary arteriography and myocardial emission computed tomography in the diagnosis of coronary heart disease].

Both coronary arteriography (CAG) and myocardial emission computed tomography (ECT) were performed in 58 patients. According to CAG findings and clinical manifestations, 47 patients were diagnosed as coronary heart disease (CHD), while 11 not. CAG was abnormal in 39 patients of the 47. The sensitivity and specificity of CAG were 83% and 100% respectively. The diagnosis of CHD was made without any doubt in patients with abnormal CAG. The sensitivity of ECT was 97.9%, the specificity only 45.5%, and the predictive value of negative ECT 83.3%. Therefore, abnormal ECT should be closely related to the clinical manifestations in order to evaluate its significance and a normal ECT may rule out CHD with more reliability.


[Noninvasive estimation of the pulmonary artery pressures in patent ductus arteriosus with continuous-wave Doppler echocardiography].

To develop a new method for noninvasive measuring of the pulmonary artery pressure (PAP) in patient ductus arteriosus (PDA), left and right heart catheterization (Cath) and continuous-wave Doppler echocardiography (CWD) were performed simultaneously in 30 cases with PDA. The results showed that there was high correlation of the systolic peak pressure gradient (delta pp), the end-diastolic pressure gradient (delta Pd) and the mean pressure gradient (delta Pm), across PDA measured with the two techniques (r = 0.99, 0.96 and 0.98, respectively). The CWD-derived pulmonary artery systolic (PASP), diastolic (PADP) and mean (PAMP) pressure, which were estimated by subtracting delta Pp, delta Pd and delta Pm from the brachial artery systolic, diastolic and mean pressure, correlated well with the corresponding PAP measured with Cath (r = 0.92, 0.89 and 0.94, respectively). It is concluded that CWD offers a reliable technique for estimating shunt pressure gradients and PAP in patients with PDA.


[Potentiated polarized liquid therapy and heart emergency].

Kalium and Magnesium ions are important cations in human body, both of them take part in many processes of metabolism in coordination. Injection of Kalii L-aspartatis and Magnesii L-aspartatis added to polarized liquid (GIK-Glucose, Insulin, Kalii Chlorid) might potentiate its effect and reduce carbon dioxide and ammonia in blood. 72 patients with various heart emergencies and other critical diseases were treated with potentiated polarized liquid (GIKL) with remarkable efficacy. A preliminary study on its clinical use and mechanism was carried out.


[Obstructive sleep apnea syndrome and essential hypertension: diurnal variation of urinary catecholamines].

30 subjects of old and middle age (28 male, 2 female) with obstructive sleep apnea syndrome (OSAS) and 20 normal subjects with matchable age and body weight (14 male, 6 female) as control were studied with nocturnal polysomnography for at least 7 hours. Right arm blood pressure was determined in supine position before and after sleep. Meantime, three 8-hour urine specimens, two collected while awake and one during sleep were examined for urinary levels of epinephrine (E) and norepinephrine (NE) with fluorometric method. All OSAS subjects (mean apnea index 42.9) had significant arterial oxygen desaturation (mean 63.9%). 12/30 OSAS subjects had definit history of essential hypertension. They described that hypertension appeared months or years after the onset of sleep disorders. Before sleep the blood pressure in OSAS subjects was higher than that in controls (mean 133/90 mmHg versus 118/77 mmHg P < 0.001). After 7 hours of sleep with apnea events, the blood pressure rose to 149/100 mmHg (P < 0.001). whereas in the controls there was no change of statistic significance (mean 115/77 mmHg). A diurnal rhythm in free catecholamines excretion was apparent for both NE and E (P < 0.05) in the controls, while in OSAS there was no normal diurnal rhythm. 24-hour values of NE were remarkably higher than those in controls. It is known that up to 40% of OSAS subjects is in the population of essential hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)


[Measurement of gastric emptying in non-ulcer dyspepsia].

Using real-time ultrasonography, we monitored gastric emptying indirectly in 26 cases of non-ulcer dyspepsia (NUD) and 13 healthy adults by determining the anteroposterior gastric measurement of a single section of the stomach in the corpus fundus immediately after drinking 500 ml water and then every 10 min. for five times. The average time for 50% gastric emptying in NUD patients (36.46 +/- 13.13, x +/- s) was longer than that in healthy adults (23.54 +/- 5.93), but the half time of gastric emptying in male with NUD was not significantly different as compared with that in male controls and female patients of NUD.


[Hepatocyte stimulatory peptide and its clinical significance in viral hepatitis].

Hepatocyte stimulator peptide (HSP) is a new hepatic stimulator substance. Its monoclonal antibodies have been obtained in our laboratory. In this study, HSP was determined in the sera of 315 subjects including patients with various forms of hepatitis and healthy persons with enzyme-linked immunosorbent assay (sandwich method). It is shown that HSP level in the sera of patients with fulminant hepatitis was high and correlated with the level of tumour necrosis factor (TNF), serum bilirubin (SB) or prothrombin time (PT). It is suggested that level of HSP in the sera of the patients reflected the degree of hepatocyte injury. A formula was recommended to predict the outcome of the patients with fulminant hepatitis.


[Hepatitis B virus DNA in the serum of anti-HBs positive persons].

In order to investigate the significance of HBV DNA in the serum of anti-HBs positive persons, the serum of 76 anti-HBs positive persons was studied for HBV DNA by means of polymerase chain reaction (PCR). The results showed that 21 (32.2%) out of 65 cases without hepatitis B vaccination were positive for HBV DNA detected with PCR (PCR-HBV DNA), but no one was positive for PCR-HBV DNA in 11 cases inoculated against hepatitis B. It was also found that 6 cases were positive for HBsAg-Ab immunocomplex in those positive for PCR-HBV DNA and the liver tissue in 2 of the 5 cases with liver-biopsy were positive for HBVAg determined with immunohistologic ABC method. We believed that persons, who acquired anti-HBs after HBV infection were different from those who were vaccinated, might carry HBV which come from the HBsAg-Ab immunocomplex and HBVAg positive hepatocytes. In addition, the study also proved that the PCR-HBV DNA positive rate correlated significantly with the anti-HBe and or anti-HBc positive rate and with the abnormal rate of liver function in the anti-HBs positive persons. It was suggested that persistent presence of HBV DNA in the bodies should be responsible for the persistent presence of anti-HBe and anti-HBc in the serum and also for the liver damage.


[Factors related with stroke recovery].

81 patients with an average of 61 who had a hemispheric stroke for the first time and survived more than 12 months were followed in order to study the factors related with recovery. The results are: (1). The severity of the initial attack and the presence of depression and other complications in recovery period are the main relating factors with both the quality of life and recovery of neurological deficits. (2). The size of the lesion shown in CT is the main relating factor with the recovery of neurological deficits. (3). function of affected hand is a main relating factor with the quality of life. According to these results, it is essential to have a preliminary consideration to facilitate recovery at the initial stage of stroke and to organize the rehabilitation programs for the patients.


[Application of serum somatomedin C level to assess the disease activity in patients with acromegaly].

Serum SMC level was measured in acromegalic patients with different disease activity. The serum SMC level of 10 untreated and 15 treated patients with active disease was 30.5 +/- 17.6 and 23.8 +/- 16.3 KU/L respectively. These levels were significantly higher than the value 2.7 +/- 2.8 KU/L in 7 patients during remitting state. The serum SMC level correlated with the basal and the nadir GH level and the area under the GH curve in glucose suppression test. The serum SMC levels in 6 patients with prolactinoma, 10 patients with Grave's disease and 8 patients with renal failure were all in normal range, but in 10 patients with liver cirrhosis it was 0.36 +/- 0.39 KU/L, which was significantly lower than the normal value. We concluded that serum SMC level is a good criterion for assessment of disease activity of acromegaly for it does not require a dynamic test and it does not increase in other diseases.


[Molecular pathology of inherited Glanzmann's thrombasthenia. Report of 11 cases].

Glycoprotein IIb-IIIa (GPIIb-IIIa) concentration was studied in 11 patients with Glanzmann's thrombasthenia (GT) with sensitive Western blotting technique. 7 patients with severe GPIIb-IIIa deficiency (less than 10% of the normal) were designated as type I (64% of patients), 2 patients with moderate GPIIb-IIIa deficiency (10-25% of the normal) as type II (18%) and 2 patients with GPIIb-IIIa 40-100% of the normal as variants (18%). Southern Blotting was used to analyze the GPIIb and GPIIIa genes in the 11 patients. The results showed that there were no major deletions or insertions in either the GPIIb or GPIIIa genes. However, a small change in GPIIb gene was demonstrated in two sibling patients and the abnormality of GPIIIa gene was found in another two patients. These observations combined with those from literature provide a basis for discussing the molecular pathology of Glanzmann's thrombasthenia.


[Analysis of the therapeutic effect of radial keratotomy].

666 cases (1,302 eyes) of myopia were performed radial keratotomy and 738 eyes were followed up for 6-9 months. Before surgery, the mean spherical refraction was -6.65D and the mean keratometry was 44.17D with uncorrected visual acuity of 0.03-0.4. 6-9 months after operation, the mean spherical refraction decreased by 4.76D, or an average decrement of 2.69D for mild myopia, 4.07D for moderate myopia, 5.28D for high myopia, and 6.00D for very high myopia. The percentages of eyes with postoperative uncorrected visual acuity > or = 0.5 were 100%, 84.86%, 58.01% and 20.59% for mild, moderate, high and very high myopia respectively, and the corresponding figures for postoperative uncorrected visual acuity > or = 1.0 were 89.29%, 55.71%, 17.79% and 3.92% respectively. Complications were few.


[Radial keratotomy for the treatment of myopia].

210 eyes were performed radial keratotomy for treatment of myopia of mean -5.65D. The central clear zone was 3mm-4mm in diameter, and 4, 6, 8 or 12 incisions were made. The depth of cut was estimated at 90%-95% of the corneal thickness. After a mean follow-up of 15.4 months, myopia was reduced by an average 4.99D, keratometric corneal refractive power by 3.91D, and 42.4% of the eyes became emmetropic. The complications included corneal microperforation in 4.3%, visual fluctuation in 36.2%, glare in 11.9%, overcorrection from +0.75 to +1.50D in 3.8%, and undercorrection from -1.00 to -5.25D in 20.0% of the eyes. The rate of endothelial loss averaged 5.9% in the central and 6.0% in the peripheral area of the cornea.


[An analysis of the causes of glaucomatous visual function damage by computed multifactorial stepwise regression].

Computed multifactorial stepwise regression analysis of quantitative visual field deterioration in relation to 28 factors showed that only the hemorheological indices entered the multiplex regression equations, especially accurately for POAG patients with severe visual damages. Besides, the patients might also have lower antioxidant capability in the red cell membrane protein. Based on the present results and data abroad, POAG might pertain to the blood hyperviscosity syndrome, and with elevated intraocular pressure and decreased ocular arterial pressure, the visual function damage would be aggravated.


[Quantitative computerized image analysis of the relationship between neovascularization and nonperfusion area in branch retinal vein occlusion].

Quantitative computerized image analysis of composite fluorescein angiograms of 62 eyes with branch retinal vein occlusion (BRVO) found 33 eyes with newly formed blood vessels. Determination of the ratio of the retinal capillary nonperfusion area to the disk area revealed that the ratio was positively correlated with the incidence of neovascularization, in that 10.0% of the cases with the ratio under 10 and 63.2% of the cases with the ratio between 10-30 had neovascularization, and the incidence of the latter increased to 82.6% among cases with the ratio over 30. The calibres of 344 retinal arteries and veins in normal subjects and in the affected and unaffected eyes of BRVO patients were measured to find that both vessels were narrowed in late patients of retinal vein occlusion.


[Contrast sensitivity in the fellow eye of unilateral age-related macular degeneration].

The VCTS 6000 Contrast Sensitivity Test System was used in testing the fellow eyes of 20 cases of unilateral age-related macular degeneration (ARMD), with age-matched normal controls. Among the patients, 25% of the fellow eyes showed minor contrast sensitivity reduction at medium and high spatial frequencies. This test may be useful in the diagnosis of subclinical ARMD.


[Strabismus and stereopsis in children].

43 strabismus children 5-12 years old were successfully corrected with surgery plus synoptoscope functional training before and after the operation. They were followed up for an average 2 years: 38 cases (88.4%) obtained qualitative stereopsis with the synoptoscope, and 14 cases (32.6%) obtained central stereoacuity with Yan's stereoscopic test charts. The results indicated that early surgical intervention plus functional training before and after the operation was an effective means to raise the functional cure rate of strabismus in children. The two methods of synoptoscope and Yan's stereoscopic test charts and their clinical significance were discussed.


[An analysis of 12 cases of ocular acanthoma].

The series of 12 cases of acanthoma comprised 6 males and 6 females, aged 29-62 years, averaging 45 years. The duration of disease was 1-4 months, and the lesions were located on the upper lid (3 cases), the lower lid (4 cases), the inner canthus (1 case), the corneal limbus (2 cases), and the palpebral or bulbar conjunctiva (1 case each). 9 lesions grew to be masses, with central umbilication or ulceration in 3 cases each. After local excision, 7 cases were followed up 2 months to 9.5 years and none relapsed.


[A clinical study of primary lipoma and liposarcoma of the orbit].

3 cases of primary lipoma and 2 cases of liposarcoma originating from the orbit were confirmed histopathologically. The clinical features, pathologic findings, ultrasonography, computed tomography, and nuclear magnetic resonance imaging of the tumours and the differential diagnoses were discussed.


[Microbiology of soft contact lens-related keratitis].

Among 385 specimens of presumed microbial keratitis cultured at Beijing Institute of Ophthalmology from April 1988 to December 1990, 21(6%) were associated with extended-wear contact lenses. Of the latter, 10(48%) were cultured bacterio-positive, including 8(80%) of gram-negative and 2(20%) of gram-positive bacteria. Pseudomonas aeruginosa was found in 6 specimens, accounting for 60% of the bacterio-positive cultures. In the meantime, among the 364 specimens not associated with contact lens wear, 87(24%) were cultured positive, including 27(31%) of gram-negative bacteria, 32(37%) of gram-positive bacteria and 20(23%) of fungi, while mixed cultures and nocardia each accounted for 4(5%). 9 contact lens containers and all cleaning solutions of 11 cases of pseudomonas corneal ulcers were cultured to find them 100% positive of P. aeruginosa.


[Analysis of 7 elements in the serum and lens of senile cataract patients].

The contents of Fe, Al, Cu, Zn, Ca, Mg and P in the serum and lens of senile cataract patients were determined with inductively coupled plasma (ICP) spectrometry to find that (1) the Fe, Al, Zn and Ca levels in senile cataractous lenses were significantly higher, and the P level lower than those in normal subjects; however, the serum levels of Fe, Al, Zn and Ca were significantly lower, and the level of P higher than those in normal subjects; (2) the serum levels of Cu and Zn varied with the duration of cataract, which could explain the inconsistency among authors with regard to these parameters; (3) the relation between Fe and Al and the development of cataract remained to be elucidated; (4) the Ca/P ratio in senile cataractous lenses was 50 times (1:0.02) that in clear lenses; these 2 elements were regarded to have close relation with cataractogenesis; and (5) Cu and Mg were not related to cataractogenesis, a finding in agreement with most reports.


[Uveitis and immune complexes].

The mean level of circulating immune complexes (CIC) in 24 uveitic patients determined by PEG deposition with the biochemical analyzor was found to be 28.458 +/- 7.796, in contrast to the value of 14.499 +/- 6.194 in the control group. The CIC level in acute iridocyclitis and panuveitis was significantly elevated compared with those in other types of uveitis. The results again demonstrated that most cases of uveitis, especially those of unknown origin, were related with immune complexes, and changes in the level of CIC could also be an indicator of therapeutic effects.


[A study on the diametric growth of the cornea in Chinese children].

The horizontal and vertical diameters of both eyes were measured with Wissly's keratometer in 65 children under 3 1/2 years of age and in 65 normal adults. The results showed that the human cornea continued to grow after birth until end of the 3rd year.


[An epidemiological survey of blindness and low vision in Shandong Province].

An epidemiological survey of blindness and low vision was carried out in a sample population of 115 167 in Shandong Province to find that the prevalence of binocular blindness was 0.34%, that of unilateral blindness 0.65%, that of binocular low vision 0.46%, and that of unilateral low vision 0.64%. The prevalence rates increased with age and the leading causes of blindness, in order of importance, were cataract, corneal diseases and glaucoma in urban areas, and cataract, corneal diseases and retinal diseases in rural areas.


Disc and field damage in patients with unilateral visual field loss from primary open-angle glaucoma.

To assess the temporal relationship between field and disc change in early glaucoma, 24 patients with unilateral visual field loss from primary open angle glaucoma were identified for planimetric optic disc measurements. Cross-sectional analysis of disc rim area was performed and compared to 25 age-matched normal controls. The mean (+/- SD) disc rim area in eyes with normal visual fields (1.10 +/- 0.31 mm2) was slightly larger than that of eyes with visual field loss (0.90 +/- 0.33 mm2). The mean disc rim area in the control group (1.49 +/- 0.19 mm2) was significantly different from both sets of eyes in the asymmetric primary open angle glaucoma patients (p = 0.000). These findings support the hypothesis that loss of the optic disc rim can be detected before perimetric abnormalities develop in patients with glaucoma.


Monitoring in vivo lens changes. A comparative study with biochemical analysis of protein aggregation.

In this study the AA attempted to evaluate the relationship between lens optical density and lens fluorescence determined in vivo, with some specific (in vitro) biochemical changes occurring during cataract development. Special attention has been given to the comparison between diabetic and non diabetic cataracts. Prior to surgery all lenses were analysed by Scheimpflug photography to evaluate the topography of opacities and fluorescence distribution. Individual lenses were separated into cortex and nucleus and the amount of high molecular weight (HMW) protein aggregates was determined by FPLC (Fast Performance Liquid Chromatography). The results found in this study have shown that, as it would be expected, diabetic cataractous lenses present higher fluorescence levels than senile cataracts. It has also been shown that the increase in lens optical density, determined by Scheimpflug photography is clearly related to the increase in the amount of HMW-aggregates. Furthermore, in diabetic cataracts, a good correlation between protein aggregation and lens fluorescence determined in vivo has been found. Thus, it seems that in diabetic cataracts chemical or metabolic mechanisms leading to the production of fluorescent chromophores may be related to protein aggregation and therefore to the major processes involved in cataract development.


Simulating age-related optical changes in the human eye.

The decline in visual function observed in older adults has been attributed to a deterioration in optical quality, decreased neural function, or a combination of both of these factors. One way of separating their contribution is to design a simulation of the optics of the elderly eye and examine its effect on the visual performance of younger observers. The age-related reduction in pupil size was simulated by the administration of an ophthalmic miotic drug, whilst a neutral density filter was included to account for the increased absorption of the ocular media. An optical cell containing a critical concentration of 500 nm diameter polystyrene microspheres in suspension was used to simulate light scatter. The spatiotemporal contrast sensitivity of an older group of observers was then compared with that of a younger group with and without the optical simulation. The contrast sensitivity of the younger group was consistently better than that of the older, and the presence of the optical simulation produced no significant effect on performance. This suggests that, under normal viewing conditions, it is primarily neural factors which underlie the deterioration in visual quality experienced by older observers.


Field loss after pan retinal photocoagulation with diode and argon lasers.

Argon and diode laser pan retinal photocoagulation are used in diabetic proliferative retinopathy. This is a prospective study of the effects of each laser type on peripheral field loss. It shows that diabetics have significantly reduced peripheral field prior to laser compared to normals (p = 0.006). With identical pan retinal photocoagulation with either argon or diode laser there is no difference in field loss.


Effect of the application of acetazolamide soaked contact lenses on intraocular pressure of rabbits.

Topical application of acetazolamide has no known effect on intraocular pressure (IOP). We tried to detect the hypotensive effect on IOP of acetazolamide soaked onto soft contact lenses (CL). We applied CLs soaked in either 1%, 3%, or 5% acetazolamide solution onto one eye of 29 rabbits while the contralateral eye served as a control. There was an average 32% reduction of IOP amongst all acetazolamide applied eyes, and an average 19% reduction of IOP amongst all control eyes. Amongst the 1% acetazolamide-CL applied eyes there was a mean 37% reduction of IOP, amongst the 3% acetazolamide-CL applied eyes a mean 36% reduction, amongst the 5% acetazolamide-CL applied a mean 30% reduction, and a mean 19% reduction in control eyes. The longest period of IOP reduction followed the application of 1% acetazolamide-CLs, probably owing to improved drug corneal penetration at this concentration. Our results reveal that the application of acetazolamide soaked soft CLs has a significant hypotensive effect on IOP in both the applied and contralateral control eyes of rabbits.


Results of extracapsular cataract extraction with lens implant. A review of 1625 cases.

We studied the results and complications of extracapsular cataract extraction with lens implantation. A one year follow-up of 1625 cases is described.


Induced astigmatism following small incision cataract surgery combined with trabeculectomy.

The combination of phacoemulsification and implantation of foldable intraocular lenses through a small incision with a trabeculectomy is increasingly preferred in glaucoma patients with coexisting cataract. Small incisions induce less astigmatism and thereby enhance visual recovery. This study should clarify if this benefit of small incision cataract surgery is preserved when combined with a trabeculectomy. Thirty-five eyes were included in this study. Preoperative astigmatism measurements were compared with those obtained one month and one year postoperatively. Vector analysis was performed. A series of 30 cases which underwent small incision cataract surgery alone were used as a control group. One month postoperatively the eyes undergoing the combined procedure showed about the same with-the-rule astigmatic peak (mean: +0.32 dpt.) as the control group eyes (mean: +0.26 dpt.; p > 0.05). One year postoperatively both groups showed the same against-the-rule astigmatic shift (mean: -0.28 dpt.; p > 0.05). In conclusion, patients undergoing small incision cataract surgery combined with trabeculectomy showed a small amount of surgically induced astigmatism. When compared with patients which underwent small incision cataract surgery alone, the difference in astigmatic changes was found to be statistically not significant.


Visual impairment in hysteria.

We have reviewed the charts of 45 neuro-ophthamological patients diagnosed with 79 monocular visual field or visual acuity losses secondary to non-organic etiology. Our aim was to determine the percentage of patients that have improvement in vision. As part of the protocol, all patients had magnetic resonance images, pattern visual evoked potentials, and flash electroretinography in addition to complete neuro-ophthalmological examinations. A single physician performed both the initial and follow-up examinations of all patients. Thirty-three percent of these patients had visual field defects only, 62% had both visual field defects and visual acuity defects, and 5% had only visual acuity defects. After organic disease was ruled out, all were given a timetable for recovery and clear reassurance regarding their prognoses for visual recovery. Seventy-eight percent of these patients showed improvement or were normal, while 22% showed no improvement. Younger patients without obvious psychiatric disorder had better prognoses than older patients.


Eighteen-month course of two patients with grafts of fetal dopamine neurons for severe Parkinson's disease.

Two patients with advanced Parkinson's disease were followed for 6 months before, and 18 months after, receiving stereotaxic grafts of fetal mesencephalic tissue from aborted human fetuses. Parameters studied included a series of standardized tests of movement, response to levodopa, electrophysiological recording of the motor readiness potential, and positron emission tomography (PET) with ligands based upon levodopa and upon the dopamine reuptake inhibitor nomifensine. The patients each received stereotaxic implantation of ventral mesencephalic tissue containing midbrain dopamine neurons from aborted human fetuses of 8 to 10 weeks gestational age into the caudate and putamen of one hemisphere. Throughout their 18-month course, the patients were treated with cyclosporine, azathioprine, and glucocorticoids to minimize the risk of graft rejection. There were no significant complications from the procedure, but there was also no major change in their assessment of impairment on the Hoehn and Yahr scale. However, significant changes were observed in clinical, electrophysiological, and PET measures. Changes in these parameters, apparent at 6 months postoperatively, were described in detail in a previous report. The purpose of this present report is to provide follow-up data from the subsequent year with an emphasis on longitudinal evaluation methodology. Standardized clinical testing showed a small but long-term improvement in the first of the two patients. Following the operation, she was able to walk in "off" periods, which she had not been able to do preoperatively. This improvement was accompanied by increased walking speed and reduction in the time necessary to perform a series of pronation and supination movements using both hands. Although these improvements have continued throughout the postoperative period, they have not alleviated her basic neurological impairment. The second patient showed similar improvement during the first 6 months; she then reverted to her preoperative status at the end of the 18-month follow-up period. The electrophysiological recordings were consistent with the clinical findings. Both patients had significant changes in the motor readiness (bereitschafts) potential amplitude, which was greatest 5 to 7 months postoperation. The amplitude of the potential declined subsequently for both patients, but remained significantly elevated over the preoperative baseline for patient 1. The analysis of the PET scans was somewhat compromised by technical problems in the preoperative scans. However, they are also consistent with the clinical data. In comparisons of the operated and the unoperated sides, fluoro-dopa showed increased uptake in the caudate nucleus of patient 1 at 6 months and at 13 months.(ABSTRACT TRUNCATED AT 400 WORDS)


Regional expression of fos-like immunoreactivity following seizures induced by pentylenetetrazole and maximal electroshock.

The expression of fos-like immunoreactivity (FLI) has been used widely as a marker of neural activation following the induction of seizures in several experimental models of epilepsy. The purpose of the present study was to provide a more detailed regional analysis of FLI expression following the induction of seizures by maximal electroshock (MES) and pentylenetetrazole (PTZ). Tonic-clonic seizures, matched for duration, were induced by MES applied by earclips (40 mA, 1 s) and intraperitoneal injections of PTZ (60 mg/kg); tonic hindlimb extension was present only after MES. Two hours after the induction of seizures brain tissue was processed for FLI. High levels of FLI were induced by both convulsion-inducing processes in a range of structures, including the dentate gyrus, the caudal amygdala, parts of the cerebral cortex, the bed nucleus of stria terminalis, various thalamic nuclei, the lateral parabranchial nucleus, and the nucleus of the solitary tract. In other structures, such as the medial and rostral amygdala, the ventromedial hypothalamic nucleus, the peripeduncular area, the central gray, and parts of the pretectum and superior colliculus, significantly greater FLI was induced by MES. Only in relatively few structures, such as the reticular thalamic nucleus and arcuate nucleus of the hypothalamus, did PTZ cause a much larger expression of FLI than MES. Insofar as the c-fos technique reflects neuronal activation, the present data reveal potentially important differences in the circuitry underlying the seizures induced in two major experimental models of epilepsy.


Immunochemical studies of extracellular glycoproteins (X-GPs) of goldfish brain.

Exoglycoproteins (X-GPs) are a family of soluble glycoproteins which are the most prominent constituent of the extracellular compartment of goldfish brain. On conventional two-dimensional polyacrylamide gels they typically display two primary molecular weight forms, averaging about 33 and 38 kDa, each appearing as a row of five to seven individual spots. When X-GP antibodies were applied by Western blotting, gels of goldfish brain extract prepared without a reducing agent showed, in addition to the primary molecular weight groups, at least one row of spots of slightly lower molecular weight and a major array of spots in the range of 45-60 kDa. The latter presumably represent dimers of the primary X-GP forms since they gave rise to the primary forms upon treatment with a reducing agent. However, on gradient gels prepared without detergents or reducing agents, X-GPs identified by immunostaining appeared only at 200 kDa and above, indicating that these proteins naturally occur in the form of large particles. Deglycosylation of the brain extract by N-glycosidase F reduced the molecular weight of each primary X-GP form by about 5 kDa, but did not abolish the microheterogeneity, which is at least partly due to minor differences in primary structure among the proteins in individual spots. Both rows of spots in the deglycosylated sample showed a coordinated shift toward the basic side of the gel, and a prominent new spot appeared on the basic end of the lower molecular weight group, which probably represents the fully deglycosylated form of the most abundant X-GP isoform.(ABSTRACT TRUNCATED AT 250 WORDS)


Reinnervation of denervated skeletal muscles by grafted dorsal root ganglion.

We examined whether or not the cervical dorsal root ganglion (DRG) of the rat, when isografted and connected to the distal stump of the severed common peroneal nerve, could survive, project axons to the denervated leg muscles, and exert beneficial influences to delay the degeneration of the denervated muscles. Rats in which the muscles were similarly denervated but no DRG was grafted served as the control. After a postoperative period of 72 to 286 days, histological study showed that nerve cells at the superficial part of the grafted DRG survived. Indirect electrical stimulation via the distal stump of the common peroneal nerve produced no contraction of the muscles, indicating that no functional neuromuscular contacts had been reestablished. Direct stimulation of the denervated muscles did elicit contraction, and the isometric twitch and tetanic tensions were significantly much higher in the experimental rats with a grafted DRG than in the control rats. Cholinesterase-silver staining indicated the presence of axons in the denervated muscles, but the axons did not terminate on endplates. Compared with the control muscles, the experimental muscles had significantly more axons, and had atrophied less as indicated by muscle wet weight and histological appearance. These results indicate that the sensory axons can delay the weakening and atrophy of muscles after denervation. We suggest that the sensory axons may exert certain trophic influence on the denervated muscle fibers, though the actual mechanism is unknown.


Neurotoxic components in normal serum.

Serum neurotoxicity was studied by adding whole or fractionated serum (adult human, adult horse, or newborn calf) to neuron-rich cultures prepared from various regions of embryonic (Days 14-15) rat brain, including spinal cord, ventral mesencephalon, cerebellum, septum, and striatum. Effects of serum were also tested on several types of embryonic non-neuronal cells (skeletal muscle myotubes, cardiac muscle myocytes, and fibroblasts from skin and lung). Serum concentrations of 50% or more killed more than 95% of all neurons within 3 days. Serum concentrations as low as 10% also killed some neurons, especially those from cerebellum. Septal, cerebellar, and spinal cord neurons were more sensitive than striatal or mesencephalic neurons. All the tested non-neuronal cells survived much better than neurons at serum concentrations of 20% or more. Neurotoxicity was present in both fresh (human) and previously frozen (human and animal) sera, and affected both young (4 days in vitro) and older (42 days in vitro) cultures. Neurotoxicity was greatly diminished by heating the serum to 56 degrees C for 30 min. Experiments indicated that serum toxicity was not due to lipoprotein, complement, or tumor necrosis factor. All serum neurotoxicity was retained by an ultrafilter with a nominal molecular weight cutoff of 10 kDa. The profile of neurotoxicity following gel filtration at neutral pH was variable, with high toxicity most consistently observed in fractions with apparent molecular weights exceeding 100 kDa, and variable degrees of toxicity at lower molecular weights.


CGRP-immunoreactive primary afferent nerve fibers in the rat urinary bladder: effects of dorsal rhizotomy and MK-801.

A transection lesion of the suprasacral spinal cord results in a decreased density of calcitonin gene-related peptide (CGRP)-immunoreactive (I) primary afferent nerve fibers in the rat urinary bladder. The fiber density can be restored by postsurgical treatment with the N-methyl-D-aspartate receptor antagonist MK-801. We are attempting to determine the level of the primary afferent neuron at which MK-801 might have a restorative effect on CGRP immunostaining. Thus, the purpose of this study was to determine if MK-801 had a similar restorative effect on immunostaining for CGRP in bladder nerves after a direct lesion of the sacral afferent system, i.e., rhizotomy of the L6 and S1 dorsal roots. To assess the effect of the lesion, the mean length and number of bladder CGRP-I nerve fibers, as well as the number of CGRP-I perikarya in the L6 and S1 dorsal root ganglia (DRG), were measured following bilateral L6 and S1 dorsal rhizotomies. Both the mean length and the numbers of CGRP-I bladder fibers were significantly decreased by the lesion. However, the number of CGRP-I primary afferent perikarya in the L6 and S1 DRG was unchanged from control values. Rats which received rhizotomies and subsequent treatment with MK-801 did not exhibit restoration of the density of CGRP-I bladder fibers nor an alteration in the number of CGRP-I primary afferent perikarya. These data suggest that MK-801-induced restoration of bladder CGRP-I primary afferent nerve fibers may rely on an intact central process.


Amyloid precursor protein mRNA encoding the Kunitz protease inhibitor domain is increased by kainic acid-induced seizures in rat hippocampus.

A 168-nucleotide exon, found in alternatively spliced amyloid precursor protein (APP) mRNAs, encodes a Kunitz protease inhibitor (KPI) domain. Kainic acid (ip) caused a selective increase of KPI mRNA in rat hippocampus. By in situ hybridization, KPI mRNA was induced in the neuronal layers of the hippocampus 11-12 h after the onset of kainate-induced seizures. The kainate-induced elevation of the KPI-containing APP-770 mRNA was blocked by pretreatment with the anticonvulsant pentobarbital. These data suggest that kainate-induced seizures cause alterations in APP RNA stability and/or processing in rat hippocampal neurons.


Changes in glutamic acid decarboxylase mRNA in the pallidum of the rat following unilateral damage of the striatum and overlying cortex.

The messenger RNA encoding glutamic acid decarboxylase (GAD) has been examined in the pallidum of the rat using in situ hybridization histochemistry following damage of the striatum and overlying frontal neocortex of one side. Following a postoperative survival time of 5 weeks, ipsilateral shrunken pallidal neurons showed significant decrease in GAD mRNA. The mRNA for GAD is significantly increased in neurons of the contralateral pallidum. These neurons are also significantly enlarged. These findings may be related to pathological changes in pallidal neurons in Huntington's disease.


[Survey and treatment of the blind in Xinhui, Guangdong, China].

Co-operating with Helen Keller International (HKI) in 1987 and 1988, Zhongshan Ophthalmic Center made a large scale prevalent survey of the blind in Xinhui, Guangdong, China. Three screening methods were used in the project. The first was a house-to-house visit by ophthalmologists. The second was performed initially by trained country health workers and then checked by ophthalmologists. In the third one, the blind people were asked to come together to be examined by ophthalmologists. The second method was found to be the most effective. The survey revealed that the prevalent rate of blindness was 0.24% in the county. Of all the blind, 89% were over 50 years old, 73% were females. Cataract accounted for 47% of the blindness. Thirty percent of the blind from cataract received surgical treatment. The postoperative re-examination half a year later showed that the corrected visual acuity in 86% of the patients was more than 0.05.


[The experimental studies of the effect of Forskolin on the lowering of intraocular pressure].

The effect of the domestic Forskolin on lowering the intraocular pressure (IOP) of rabbits was studied. The results showed that the Forskolin significantly lowered the normal IOP of rabbits and blocked the ocular hypertension induced by water load in rabbits (p < 0.01). The maximum decrease value of 2%, 1% and 0.5% of the Forskolin was 0.59. 0.36 and 0.19 kPa (1 kPa = 7.5 mmHg), which showed the noticeable dose-effect relationship. Topical ocular application of Forskolin lowered IOP in 1/2 hour, reached to a peak in 2-3 hours and remained significantly for 10 hours. The pupillary diameter did not change when IOP were reduced. Furthermore, the Forskolin had potent stimulative properties to adenylate cyclase (AC). The greater the ability of the Forskolin to stimulate AC, the stronger the effect of IOP lowering.


[Glaucomatous hemodynamic changes in central retinal artery and ocular artery].

The hemodynamics of ocular artery (OA) and central retinal artery (CRA) in 100 eyes of 50 normal subjects and 61 eyes of 39 patients with glaucoma were studied with colour doppler image technique. The results showed the hemodynamic characteristics about normal and glaucomatous eyes and that the ischemic change of CRA was one of the high risk factors in glaucomatous visual functional damages. We propose a new classification of glaucomatous hemodynamics and the clinical application of hemodynamic parameters in glaucoma diagnosis. We also, for the first time, make use of hydrodynamic pressure to calculate the retinal perfusion pressure, which explain the phenomena of intraocular pressure increasing with blood flow decreasing and the effect of hyperviscosity as well as cardiovascular disease on glaucoma. A new approach to the research of glaucoma is presented.


[The operation treatment for the age-related macular degeneration wet-type eyes and its complications].

Age-related macular degeneration (AMD) is one of the important causes for blindness in elderly population. The effect of the treatments by laser and vitrectomy in AMD wet-type eyes, which subretinal neovascularization is existed in or have vitreous hemorrhage, is reported and discussed. Using laser photocoagulation, 65% of the affected eyes had marked cicatrization and 31% were partially improved. Among the 4 AMD eyes with vitreous hemorrhage, three cases were successful after vitrectomy. It has a certain significance for rescuing the vision and controlling the development in AMD wet-type eyes.


[Vitrectomy combined with intravitreal injection of drugs for the management of advanced suppurative endophthalmitis].

Sixty cases (60 eyes) of advanced suppurative endophthalmitis treated by a combination of vitrectomy and intravitreal injection of drugs (antibiotics or/and corticosteroids) were investigated perspectively. Of the 60 cases, 43 were infected after trauma, 12 were infected after surgical procedures, while the others were of unknown causes. During the follow-up period of 1/2-5 years, 57 cases (95%) retained functioning eyes, the postoperative visual acuity of 34 eyes (57%) being 0.05 or better and the postoperative visual acuity of 17 eyes (28%) 0.4 to 1.0. The advantages of the therapeutic regimen are analyzed. We believe that it is the most effective therapy for suppurative endophthalmitis. The timing of the operation and the factors influencing the results are discussed. This report also presents our clinical experiences in the management of advanced suppurative endophthalmitis.


[Endogenous uveitis in senior patients].

Forty-seven cases of endogenous uveitis aged 60 and above were analyzed in the retrospective study. The result shows males are more than females (1.2:1). Among the 47 cases, 28 cases (59.57%) are anterior uveitis, 18 cases (38.30%) are panuveitis. Only 1 case (2.13%) is posterior uveitis. Immediated-type uveitis is not found. Besides, 34 cases are non-granulomatosis type, more than the cases with granulomatosis type (13 cases). The major complications are secondary glaucoma (22 cases) and complicated cataract (16 cases). Immunological tests to the patients showed the unbalance of immune-regulation was mostly complicated by immune-related sickness. The cure rate was 40.58%. The invalid and deteriorative rate was 17.39%. 62.32% of the patients had the vision acuity lower than 0.3 after the treatment.


[Refractive error and amblyopia in children].

The refractive status of 3,099 children was analyzed. The result showed that the incidence and degree of hyperopia decreased gradually and those of myopia increased along with the growing up of children in ametropia. In binocular refractive amblyopia, high and medium hyperopia and myopia in severe and medium amblyopia were significantly more than those in mild amblyopia. In monocular refractive amblyopia, high and medium hyperopia and high myopia in the amblyopic eyes were more than those in the nonamblyopic eyes. The refractive status of binocular esotropic amblyopia had no significant difference in various ages and degrees of amblyopia. There was also no significant difference between the refractive status of the amblyopic and nonamblyopic eyes in monocular esotropic amblyopia. It was considered that refractive amblyopia was closely related to high ametropia and the deviation of the eye might be the main cause of strabismic amblyopia.


[Measuring the threshold of stereopsis for 111 children with amblyopia].

The threshold of stereopsis was measured by static stereopter for 111 children with amblyopia aged from 4 to 13 years. They were divided into three groups: 38 cases ranging in age from 4 to 5 years, 43 cases 6 to 7 and 30 cases 8 to 13. Fifty six cases were unilateral and 55 bilateral amblyopia. The average threshold of stereopsis was 149.64 second angle for the 4-5 group, 66.69 for the 6-7 and 48.48 for the 8-13. The average threshold for unilateral amblyopia was 65.3, in which mild type was 38.6 and under moderate type was 88.84, whereas the average threshold for bilateral cases was 115.81, in which mild type was 44.09 and under moderate type was 175.44. The distribution of stereopsis for different age groups, the threshold of stereopsis influenced by different types of amblyopia and the comparison of amblyopia between bilateral and unilateral are also discussed.


[Computerized image analysis for retinal nerve fiber layer: a preliminary report].

The principle and method for analysing the white-black photographs of retinal nerve fiber layer (RNFL) by using the technique of computerized image analysis were introduced. An objective and quantitative result of RNFL on the white-black photograph was initially obtained, and using the technique of fulse colour, each of the RNFL could be showed, which seem to have more advantages than observing RNFL on a white-black photograph.


[A software design for standard grayscale printout of China-made automatic static quantitative TBC visual field analyser].

A method of "TBC GRAPH" software design for standard grayscale printout of TBC static quantitative perimetry is introduced. The software is operated in IBM PC/XT or PC/AT compatible computer, using Chinese Character Disk Operating System (CCDOS) which has widespread users in China. Symbols were established by using CCDOS word--make function, and sectoral as well as symbolic matrix were made, which realized the standard grayscale printout. The software is recommended for use in ophthalmic clinic and education.


[Hurler syndrome (a case report)].

A case of Hurler syndrome diagnosed by clinical and laboratory examination is reported. The patient's roentgenograms showed the dystrophies of bones, lace-shaped ribs, boat-shaped cranium, fishhook-shaped forefront protrusion of silla trucica. Corneal opacities and high ocular pressure were found in both eyes. VEP measurement suggested the defects of optic nerve. The authors emphasized that visual electric physiological examinations should be used to estimate the visual functions when the patient's refractive medium is opqaue. The differential diagnosis was also briefly discussed.


The role of calcium in DNA synthesis and development of mouse preimplantation embryos in vitro.

The effect of calcium upon embryonic growth was studied using cultured mouse preimplantation embryos. Both morphological development of the embryos and embryo DNA synthesis were shown to be dependent on the Ca2+ concentration in the medium in which the embryos were grown. Reduction of the calcium concentration below 10(-5) M completely blocked cell division and blastocyst formation in the cultured embryos, but only moderately inhibited embryo DNA synthesis. Trifluoperazine, a calmodulin antagonist, strongly inhibited the Ca(2+)-dependent DNA synthesis in the embryos. On the other hand, the drug only slightly affected the morphological development of the embryos. These results demonstrate that calcium independently affects two different aspects of the embryo development, i.e. DNA synthesis and cell division. It is suggested that the former effect is calmodulin-dependent, while the latter involves the calcium-dependence of metabolite transport through the cell membranes.


Toxicity of Fastac 10 EC, a pyrethroid insecticide, to Paramecium primaurelia and Tubifex sp.

The pyrethroide, Fastac 10 EC was tested on the paramecia and Tubifex sp. The results showed that both tests are valid for estimation of the toxicity of the pesticide. However, the Paramecium test is more sensitive when one is investigating the direct toxicity of the compound. The great validity of the Tubifex test lies in the possibility of tracing the teratogenic effects of the pesticides.


Species of the Paramecium aurelia complex in the middle Sudeten of Czecho-Slovakia.

On the investigated territory three species of the complex were identified, namely Paramecium biaurelia, P. triaurelia, and P. novaurelia. P. novaurelia dominated over the other species with regard to the number of clones established from nature as well as to habitats.


Effect of the immature cytoplasm on the duration of the interautogamous interval (IAI) in Paramecium tetraurelia.

Cytoplasm in the quantity of about 5% of the cell volume was transferred from young clonal age donors into older recipients. The experimental post-transplantation clones showed statistically significant prolongation of the IAIs as compared with those stemming from the original recipients or donors. This suggests that the cytoplasm of young postautogamous cells contains a component retarding the expression of the autogamy-inducing gene(s).


Cell proliferation in the germinal layer of the lateral brain ventricles in normal adult mice and under some experimental conditions.

Histological and autoradiographic studies revealed mitotic activity in the subependymal germinal layer in the brains of adult mice. The number of mitoses observed was higher in animals subjected to administration of haematoporphyrin and selenourea.


Circadian rhythm in the pineal organ of the yellow-bellied toad, Bombina variegata (L.), under laboratory conditions.

A circadian morphological rhythm of the pineal organ, as judged by changes in the nuclear volume of the photoreceptor cells, was found in sexually mature male Yellow-bellied toads (Bombina variegata) maintained continuously at 26 degrees C and on a 17L/7D illumination cycle. The greatest nuclear volume occurred at the photophase (16.00 h), and the lowest at the end of the scotophase (4.00 h).


Studies on the biology of Argas (A.) reflexus (Fabricius, 1794) (Acari: Ixodida: Argasidae). 2. Effect of alternating temperatures on embryonic development and egg hatch.

The paper presents the results of observations on the effect of temperature alterations between 9 degrees C and 30 degrees C every 6 and 12 hours, respectively, on the embryonic development and egg hatch of Argas (A.) reflexus. No effect of the frequency of temperature changes on the percentage of egg mortality, embryo mortality, abnormal egg hatching, or egg hatching into morphologically normal larvae was observed. The experiments showed that in changes temperature have a particularly detrimental effect on the eggs prior to blastulation.


Assessment of insulin resistance in vivo: application to the study of type 2 diabetes.

Besides insulin secretion, insulin sensitivity plays a key role in the feedback glucose-insulin closed loop. It can be altered in numerous physiological, pathological and pharmacological conditions. It can be estimated in vivo using methods that open the feedback loop (insulin suppression test, glucose clamp) or that analyze the closed loop by employing mathematical models of glucose kinetics. The most popular method is the euglycemic hyperinsulinemic glucose clamp. This test should be ideally coupled with a priming-constant infusion of a glucose tracer together with indirect calorimetry. This combination allows to study the glucose kinetics (Ra and Rd, and thus endogenous-mainly hepatic-glucose production) and its metabolism (oxidation or storage as glycogen), respectively. One alternative approach is the frequently sampled intravenous glucose tolerance test where the dynamic changes in plasma insulin and glucose levels are analyzed using the so-called 'minimal model' method. Noninsulin-dependent or type 2 diabetes is characterized by a significant defect in both insulin secretion and action. The insulin resistance is located at the liver site (increased glucose production) and at the peripheral tissues (decreased oxidation and, even more, defective storage of glucose in the muscles). This insulin resistance, which predominates at the postreceptor level, seems to be genetically determined but is worsened by weight excess and by hyperglycemia itself. This contributes to a vicious circle which aggravates progressively the severity of the disease.


The syndrome of insulin resistance.

It is well known that excessive weight is associated with resistance to insulin-mediated glucose uptake and predisposition to the development of type II diabetes. It has been shown more recently that excessive weight and insulin resistance tend to be associated to android fat distribution, arterial hypertension, elevated levels of triglycerides, low concentration of HDL cholesterol and defective fibrinolysis. The terms syndrome of insulin resistance, metabolic syndrome or syndrome X have been proposed to describe this cluster of abnormalities. The pathophysiological mechanisms which could explain the interrelations between these different parameters are still only partly understood. Epidemiological prospective studies have demonstrated that the metabolic syndrome is a risk factor for coronary heart disease and type II diabetes. The mechanisms involved in the development of diabetes are relatively well established, but those which are implicated in the atherothrombotic process are far from being clearly described. Anyway, sufficient presumption exists to attempt at decreasing insulin resistance when it exists. Physical training and, if indicated, weight reduction are the simplest means.


Hyperinsulinemia, insulin resistance and essential hypertension.

Glucose intolerance and noninsulin-dependent diabetes are commonly associated with hypertension. Epidemiological data suggest that this association is independent of age and obesity. Much evidence indicates that the link between diabetes and essential hypertension is hyperinsulinemia. When hypertensive patients whether obese or of normal weight are compared with matched normotensive control subjects, an increased plasma insulin response to a glucose challenge is consistently observed. Studies using insulin glucose clamp techniques in combination with tracer glucose infusion and indirect calorimetry have demonstrated that the insulin resistance in hypertensive subjects is located in muscles and restricted to glycogen synthesis. The relations between hyperinsulinemia and blood pressure do not prove that the relationship is a causal one. However, at least four mechanisms may link hyperinsulinemia with hypertension: Na+ retention, sympathetic nervous system overactivity, disturbed membrane ion transport and proliferation of vascular smooth muscle cells. Diuretics and beta-blockers may enhance insulin resistance, which is not affected by calcium antagonists, but decreased by the ACE inhibitor captopril. Weight reduction and regular physical exercise can improve insulin sensitivity and decrease blood pressure values. These nonpharmacological interventions should be more strongly recommended to diabetic and nondiabetic hypertensive patients.


Hypertriglyceridemia: cause or consequence of insulin resistance?

An overproduction of VLDL by the liver and a slower clearance of these lipoproteins are usually seen in diabetic patients. There is correlation between insulin resistance and plasma triglyceride concentration. Triglyceride may influence an early step in the insulin action pathway and alternatively, insulin resistance may cause hypertriglyceridemia. Hyperinsulinemia and/or hypertriglyceridemia may play a strong role in the cardiovascular risk of patients with type II diabetes. There is an important need to conduct trials to define therapy that can reduce the risk of cardiovascular complications.


Insulin resistance and polycystic ovarian syndrome.

Insulin resistance (IR) and polycystic ovarian syndrome (PCOS) appear as linked phenomena, although this is not easy to obviate in common forms of PCOS while it is evident in the rare cases of extreme IR and hyperinsulinism (HI). Experimental data indicate that insulin could interfere with the local insulin-like growth factor systems in ovaries, and presumably in adrenals and in the hypothalamic pituitary system. The female puberty system offers a physiological model to explain the gonadotropic action of insulin. In patients with IR, HI could induce a state of hyperpuberty, leading to the constitution of PCOS during adolescence.


Age-related insulin resistance: a review.

Impaired glucose tolerance occurs with age. This impairment is multifactorial including a decrease in insulin-mediated glucose uptake by peripheral tissues and a delay in insulin-induced suppression of hepatic glucose output. A post-binding defect in insulin action such as a reduced capacity to transcribe more glucose transporter mRNA and/or a reduced translocation of preformed glucose transporters to plasma membrane is incriminated. However, insulin resistance with age is not a constant finding and other mechanism(s) has (have) to be involved in old individuals with impaired glucose tolerance and normal tissue insulin sensitivity.


Molecular basis of insulin resistance.

The recent application of recombinant DNA technology to clinical investigation now allows the identification of the molecular alterations responsible for insulin resistance. In this review, the recent knowledge concerning these investigations is reported. Genetic mutations of the insulin gene as the source of insulin resistance have been reported for a long time. More recently a series of mutations of the insulin receptor gene have been identified as the cause of the extreme insulin resistance, observed in rare syndromes, such as type A insulin resistance or leprechaunism. However, it is probable that the majority of the molecular defects causing insulin resistance occur at the postreceptor level. The key proteins involved in the different intracellular signalling pathways of insulin are only partly identified. A better understanding of the mechanisms of insulin action is essential for the identification of corresponding genetic alterations. The investigations concerning the glucose transporter GLUT4 and glucokinase genes are good examples of complex but promising research, which has recently started. Elucidation of the genetic and molecular basis of diseases such as type II diabetes or other states associated with insulin resistance, is the long-term goal.


Pharmacological approach in the treatment of insulin resistance.

Insulin resistance syndromes are heterogeneous in either severity or mechanism. Many drugs have been shown to counteract various elements of insulin resistance. Some of them, by normalization of metabolic parameters, decrease insulin resistance induced by chronic hyperglycemia in diabetes. Insulin and, to some extent, sulfonylureas are in this group, but these drugs are not stricto sensu medication of insulin resistance. Some drugs sensitize peripheral tissues to the action of insulin. For instance, biguanides and thiazolidine-dione facilitate translocation to the membrane of glucose transporter in presence of insulin. Other compounds as vanadate or IGF-1 mimic some peripheral action of insulin. Finally, blockade of FFA oxidation by specific inhibitors (methylpalmoxyrate) can limit insulin resistance. In 1992, among these compounds, specific of insulin resistance, biguanides are mostly used. However, the efficacy of these drugs is moderate and limited to type 2 diabetes.


The thyroid hormone receptors: molecular basis of thyroid hormone resistance.

Major progress has been achieved in the mechanism of action of thyroid hormones thanks to the identification of the T3 receptor as the product of the proto-oncogene c-erbA. Recognition of subsets of receptors with and without T3-binding properties and of the interaction of different receptors with each other leads to new insights in cell regulation and development. In thyroid hormone resistance, distinct mutations in the T3-binding domain of thyroid hormone receptor (TR)beta have been identified in unrelated families. No correlation between the type of mutation and tissue resistance has been established. Mutant TRs bind to thyroid hormone response elements (TREs) on both negative or positive T3-controlled genes. Subjects with heterozygous TR beta gene deletion are not affected, supporting the hypothesis that mutant TRs act through a dominant negative effect. In generalized thyroid hormone resistance, mutated TR beta may interfere through competition for TREs and/or formation of inactive dimers. Finally, deficiency in T3 receptor auxiliary protein or other accessory proteins or competition between mutant and normal TRs for these factors is not excluded.


Thyroid hormone generalized resistance.

The syndromes of thyroid hormone resistance may affect overall or only some tissues. The generalized resistance is an inherited disease which involves a familial eumetabolic or hypometabolic goiter, increased free thyroid hormones with normal or elevated plasma TSH levels; children may present mental retardation, deafness, short stature and delayed bone age. The disease is frequently misdiagnosed. In vivo and in vitro tests may be used to assess the diagnosis. The defect of increment of sex hormone-binding globulin after administration of T3 may be useful in the demonstration of the disease. Therapy uses high T4 or T3 doses in hypometabolic patients. The generalized thyroid hormone resistance could be linked to abnormalities at the T3 receptor and c-erb A gene level, as a consequence of different point mutations or deletions involving the hormone-binding domain.


Pituitary resistance to thyroid hormones.

Pituitary thyroid hormone resistance (PRTH) refers to a particular form of thyroid hormone refractoriness that is accompanied by peripheral hyperthyroidism, as only the TSH-secreting pituitary cells appear to be resistant to the effects of thyroid hormones. The presence of PRTH is suspected and diagnosed on the basis of the finding of high free thyroid hormone levels along with unsuppressed TSH, clinical signs and symptoms of hyperthyroidism and values of at least one of the parameters evaluating peripheral thyroid hormone action in the hyperthyroid range. However, most patients with PRTH present with clinical signs and symptoms of thyroid dysfunction, particularly goiter and tachycardia, overlapping those recorded in patients with generalized thyroid hormone resistance (GRTH), i.e. refractoriness to thyroid hormones at both pituitary and peripheral tissue level. Moreover, most of them display normal values of other parameters evaluating the peripheral effects of thyroid hormones and bear mutations in the gene encoding for T3 nuclear receptors similar to those found in patients with GRTH. These findings are questioning the existence of PRTH as a separate clinical entity and support the view that the various forms of thyroid hormone resistance may be part of a spectrum of disease with variable expression in different issues.


Differential initiation of translation of a single estrogen receptor mRNA could explain some estradiol resistance cases.

Cell response to steroid stimulation is generally acknowledged to be mediated by an intracellular protein known as a receptor. Response intensity is related to the affinity of the receptor and to the number of sites occupied by its specific ligand. Although verified in the majority of experimental and clinical studies, certain phenomena of steroid hormone resistance would seem to challenge this assertion. Application of gene molecular biology to determine the action mechanisms of steroid hormones has partially explained cell resistance in terms of genetic modifications. The work presented here shows that in certain cases, estrogen resistance could be explained by regulation of translation of the single messenger RNA coding for the receptor.


D2 dopaminergic receptors: normal and abnormal transduction mechanisms.

Dopamine receptors of D2 type present on lactotroph cells are coupled to a large series of transduction mechanisms. Beside their negative coupling with adenylate cyclase, they are also coupled with potassium and calcium channels, leading to a decreased intracellular calcium concentration. In addition, D2 dopamine receptors also modulate phospholipase activities. Dopamine inhibits inositol phosphate production, through two distinct mechanisms. One of them could represent a direct negative coupling with phospholipase C. All these transduction mechanisms of the D2 dopamine receptors implicate G proteins sensitive to pertussis toxin. In contrast, these receptors are negatively coupled to phospholipase A2 through G proteins insensitive to this toxin. Both isoforms of the D2 dopamine receptor, generated by alternate splicing of a single gene, are present in lactotroph cells. After transfection in CH4C1 cells the two isoforms are coupled with adenylate cyclase while only the shortest isoform appears negatively coupled to phospholipase C. Functional D2 dopamine receptors are present in human prolactinomas. Resistance to bromocriptine therapy is associated with a decreased density of these receptors in the tumor. In addition, the ratio of the two receptor isoforms (measured by PCR) is different in responsive and resistant tumors. Furthermore, the activity of Gi/Go proteins coupled to adenylate cyclase appears also affected in resistant tumors. Resistance to bromocriptine therapy appears thus to involve multiple changes at the different levels of the multiple mechanisms of action of dopamine on lactotroph cells.


Prolactinomas and resistance to dopamine agonists.

Among 288 patients with prolactinoma (aged 12-62 years; 242 women), 27 were diagnosed as resistant to bromocriptine as their plasma prolactin (PRL) levels remained elevated despite long-term (3 months or more) treatment at high doses (> or = 15 mg daily). These 18 women and 9 men, aged 29 +/- 9 years (mean +/- SD, range 13-50), followed-up for 8 +/- 4 years, had microadenomas (n = 6) or macroadenomas. They were treated by dopamine agonists alone (n = 6) or associated with surgical or radiation therapy. In 8 cases repetitive surgical treatments were necessary. Among the 24 patients who were treated with the nonergot dopamine agonist CV 205-502 after unsuccessful bromocriptine treatment, half of them (9 women, 3 men) resumed normal PRL levels on doses ranging from 0.15 to 0.45 mg/day. Despite daily doses of CV 205-502 from 0.3 to 0.525 mg, the remaining patients were not normalized by this drug which did not prevent tumor growth in 4 of them. Two patients died from invasive cerebral extensions of their tumor and a third had vertebral metastases with positive anti-PRL immunostaining. It is concluded that bromocriptine-resistant prolactinomas represent the most severe aspect of this disease and that a more powerful dopamine agonist like CV 205-502 is effective in only a fraction of these patients.


G-protein oncogenes in acromegaly.

G-proteins belong to a family of proteins which share the common properties of GTP binding and hydrolysis. Heterotrimeric G-proteins are composed of alpha-, beta- and gamma-subunits. The alpha-subunit which differs from one G-protein to another contains the GDP/GTP binding site and has intrinsic GTPase activity. The receptor occupancy causes displacement of bound GDP by GTP, dissociation of free beta gamma-dimer and alpha-GTP complex, interaction of the activated alpha-GTP complex with intracellular effectors, such as enzymes and ion channels. The turn off of the reaction is due to the GTPase activity which causes the hydrolysis of GTP to GDP. G-proteins are essential for transferring hormonal signals from cell surface receptors to intracellular effectors. Since G-proteins generate intracellular effectors involved in cell growth, G-protein genes have the propensity to be converted into oncogenes. In fact, mutations in the alpha-subunit of Gs (the G-protein involved in the activation of adenylyl cyclase) have been demonstrated in 40% of human GH secreting pituitary adenomas. Single amino acid substitutions replacing Arg 201 with either Cys or His or Gln 227 with either Arg or Leu cause constitutive activation of adenylyl cyclase by inhibiting GTPase (gsp oncogene). The same mutations were identified in about 10% of thyroid adenomas and in the McCune-Albright syndrome.


Resistance to somatostatin (SRIH) analog therapy in acromegaly. Re-evaluation of the correlation between the SRIH receptor status of the pituitary tumor and the in vivo inhibition of GH secretion in response to SRIH analog.

The development of a long-acting somatostatin (SRIH) analog (octreotide, Sandoz) has been a major breakthrough in the treatment of acromegaly. However, in 20-30% of the patients, growth hormone (GH) plasma levels remain elevated (> 10 micrograms/l) despite treatment with octreotide. This raised the concept of resistance to SRIH analog therapy in acromegaly. Indeed, in vivo response to SRIH analogs varies greatly among acromegalic patients. According to the reviews in the literature and our own autoradiographic data, no direct correlation can be established between the GH response to octreotide and the number or affinity of the SRIH receptors located on the tumor. In our series a greater density of SRIH receptors is present on tumors from patients very sensitive to the SRIH agonist. A subset of patients resistant to octreotide could result from a very low density of SRIH receptor although this type of GH-secreting tumor constitutes certainly a rare case. A subset of GH-secreting pituitary tumors can be characterized by a mutation on the alpha subunit of the guanine nucleotide-dependent protein coupled to the stimulation of adenylate cyclase (G alpha s). This mutation results in a high basal adenylate cyclase activity and a low GHRH-stimulated activity. However, when the adenomas are separated according to their basal adenylate cyclase activity, SRIH is able to decrease cAMP levels in both types of tumor. In addition, in our series no direct correlation is observed between the SRIH inhibition of adenylate cyclase and the amount of SRIH-binding sites.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of high and low dietary fat and indomethacin on tumour growth, hormone receptor status and growth factor expression in DMBA-induced rat breast cancer.

The effects of high and low dietary fat (20% vs. 0.5% corn oil), and of the prostaglandin synthetase inhibitor indomethacin (0.005% w/w), on tumour incidence, tumour growth, hormone-receptor status and growth-factor expression were examined in dimethylbenzanthracene (DMBA)-induced rat breast cancer. The high dietary-fat group showed a significantly higher tumour incidence, larger tumour size and larger number of bromodeoxyuridine(BrdU)-positive cells of tumours as compared with those in the low dietary-fat group. Indomethacin reduced tumour incidence significantly, but conversely increased the tumour size and the number of BrdU-positive cells in both the high and the low dietary-fat groups. No significant difference was noted in the hormone-receptor status of the tumours. Growth factors (TGF-alpha and IGF-II) were somewhat highly expressed in the high dietary-fat group as compared with the low dietary-fat group, but indomethacin rather reduced the growth-factor expression. It is concluded that high dietary fat stimulates tumour incidence and tumour proliferation, while indomethacin has dual effects: a stimulating effect on tumour proliferation, but an inhibiting effect on tumour incidence. It is also suggested that hormone-receptor status and growth-factor expression do not play an important role in their stimulating effects on tumour proliferation.


Indomethacin-induced intestinal ulcers are associated with an increased number of peripheral T lymphocytes in the rat.

Indomethacin (8 mg/kg per os) induced small-intestinal ulcers which were associated with an increased percentage of total number and T-helper peripheral lymphocytes. An increase in intestinal flora and a decrease in mucosal permeability due to indomethacin treatment are among the factors which favour the cytotoxic T-cell reactions and the resulting increase in lymphocytes.


Effect of ethanol chronic use on hepatotoxicity in rats exposed to tetrachloroethylene.

Tetrachloroethylene, an industrial halogenated solvent, shows several toxic effects. Also at hepatic level this substance can induce a damage but this effect is present only after high exposure, but such high levels have not been found in work environments. Using Wistar rats, we wanted to check whether the chronic administration of ethyl alcohol can modify the action of tetrachloroethylene. Tetrachloroethylene was administered by aerosol and alcohol at the concentration of 15% in drinking water. We observed an increase in plasma triglycerides, and evident histological alteration as a result of steatosis, in rats drinking alcohol as compared to a control group; the administration of tetrachloroethylene to rat drinkers of alcohol did not cause an increase in plasma triglycerides and steatosis as compared to rat drinkers of alcohol, but on the contrary we observed a decrease in alcohol-induced liver damage.


Activation of bladder mast cells in interstitial cystitis.

Interstitial cystitis (IC) is a sterile, inflammatory bladder condition characterized by urinary frequency and urgency, as well as burning and suprapubic pain, which occurs more frequently in women who may suffer for years before diagnosis. An increased number of mast cells have been associated with IC, but the published reports are inconclusive and often conflicting. Human bladder biopsies were analysed blindly for the degree of activation of mast cells in control and IC patients. It was found that mast cells from IC patients averaged as high as 34 cells/mm2 as compared to less than 16/mm2 in controls. Electron microscopy revealed that over 90% of mast cells from IC patients were activated to various degrees. It is concluded that mast cell activation is a pathologic characteristic for IC.


[Activity of selected enzymes of the anti-oxidase system in the vitreous body, aqueous humor and lens after subconjunctival ozone in experiments].

The influence of ozone on the activity of enzymes of the antioxydation system in selected structures of the eye were checked. Ozone given topically in weak concentrations acts stimulating, increasing the activity of the enzymes of the antioxydation system, instead in high concentrations causes a significant reduction of activity of the enzymes of the mentioned system.


[Value of gentamycin concentration in aqueous humor of a rabbit's eye depending on the method of application. Summary of a doctoral thesis].

Pharmacokinetics of gentamycin in the primary and secondary rabbit's aqueous was examined by using a new experimental method of subconjunctival application (without breaking the continuity of the conjunctiva). It was established that after subconjunctival application one cannot obtain any therapeutical concentrations in the primary or secondary aqueous. Presented are conditions which have to be fulfilled to obtain a therapeutical concentration of gentamycin in the secondary aqueous.


[Evaluation of the macula which was not involved in retinal detachment after surgical treatment of retinal detachment using scleral indentation. Summary of a doctoral thesis].

The goal of the study was the evaluation of the influence of the nowadays most frequently used surgical methods in cases of retinal detachment on the macula not involved in the detachment. The study takes into account surgical interventions which have the same indications and principles of action. They are based on an extra-scleral indentation--temporary or permanent one--by means of a Lincoff-Kreissig balloon and a meridional silicone sponge implant. The examinations comprised 54 patients. They were divided into 2 groups: 1st group (24 patients) was treated by cryopexy and a Lincoff-Kreissig balloon, the 2nd group (30 patients) by cryopexy and a meridional silicone sponge implant. In all the patients of both groups the retina reattached. During the 5-years observation of patients of the 1st group no macular changes were detected; one did not observe metamorphopsia or disturbances of the color vision. In the 2nd group instead 17 patients claimed metamorphopsia, 20 patients showed disturbances of the color vision and angiography changes involving the macular region (13 patients).


[Retinal changes accompanying acute pancreatitis].

Observed were 12 patients with acute pancreatitis claiming to suffer various kinds of visual disturbances. All the examined patients exhibited changes in the eye fundus localized mainly in the area of the posterior pole. As the general condition was improving the fundus changes slowly receded.


[Various clonidine drops in treatment of glaucoma].

Seventeen patients with glaucoma were given bilaterally a single drop of Isoglaucon (Clonidine hydrochloride) of various volume (15 microliters and 40 microliters) and various concentrations of the drug (0.125%, 0.25%, 0.50%) according to the principle of a double blind trial. In comparison with placebo all sorts of Isoglaucon drops cause a statistically important reduction of intraocular pressure; an essential lowering of the general systolic and diastolic pressure (a side effect of the treatment) appeared after application of a larger drop (40 microliters) of a 0.5% concentration. By reducing the content of the drug in the drop or reducing its volume one can avoid the fall in the general blood pressure.


[Naclof and dexamethasone in topical application after trabeculectomy].

Evaluated was the topically applied solution of natrium salt of diclofenac--Naclof (22 eyes) and a 0.1% solution of dexamethasone phosphate (23 eyes) on the healing of postoperative wounds after trabeculectomy in a clinical examination in patients with simple glaucoma. After the filtering operation the authors observed in the group of patients treated by dexamethasone a longer and more pronounced flattening of the anterior chamber (up to 14 days) a greater hypotensive effect and a more increased facility of the outflow (in an observation period of 6 months). In the case of a considerable flattening of the anterior chamber after trabeculectomy application of Naclof gives a better prognosis than of dexamethasone.


[Surgical treatment of low pressure glaucoma].

Eyes with non-controlled--in spite of a conservative treatment--bilateral low-tension glaucoma with a decreased facility of outflow (10 patients, 20 eyes) were subjected to antiglaucoma operations. Trabeculectomy was performed in one eye, a filtering operation in the second one. During the observation period of 1.5 years it showed that in the low-tension glaucoma the visual function undergoes more frequently stabilization after a more radical glaucomatous procedure (of filtration type) when the postoperative fall in the intraocular pressure exceeds 20% and its daily oscillations are considerably reduced.


[Inter-capsular technique of cataract extraction with implantation of intraocular disc lenses--own material].

The authors present personal results and complications of surgery with application of intraocular disc lenses. Evaluation of this model of intraocular lenses is positive. The authors are encouraging to their use.


[Significance of anterior and posterior lens capsule in inter-capsular cataract surgery].

Anterior as well as posterior lens capsule are nowadays the object of interest because of their importance. Discussing the cataract surgery the author presents the role of the lens capsule in the process of the inter-capsular technique of cataract extraction and in the postoperative course.


[Methods of preventing opacification in the posterior lens capsule after extracapsular cataract extraction].

The methods of extracapsular cataract extraction generated some problems connected with postoperative opacification of the posterior capsule. The authors present clinical and experimental methods applied nowadays, intended to prevent these opacifications from forming.


[Late results of stomatologic and ophthalmologic treatment of injuries involving the central part of the face].

The authors present an analysis of the results of treatment of patients with injury of the central fragment of the face, who have been hospitalized in the 2nd Department of the Maxillofacial surgery in Silesian Academy of Medicine. In the period 1980-1987 there were 447 patients with an injury of the central fragment of the face. Among this group 60 (13.4 p.c.) patients showed disturbances of the visual system. The most frequent causes of the injury were: assault (61.5 p.c.), traffic accidents (20.1 p.c.), occupational injuries (8.8 p.c.). Deformation of the face was the most frequent pathology observed in the course of a control stomatological check-up (32.0 p.c.). The most important ocular pathology were the posttraumatic atrophy of the eye (3.3 p.c.) and optic atrophy. Palpebral scars (33 p.c.) and diplopia (7.6 p.c.) were the most frequent ocular signs.


[Principle and technique of magnetic resonance tomography in ophthalmology].

The phenomenon of the magnetic resonance and methods of its representation are described. A standard technique of spin echo used in ophthalmology is presented.


[Assessment of clinical course of myocardial infarction complicated by atrioventricular conduction disorders].

The aim of the study was to assess the clinical course of myocardial infarction complicated by atrioventricular conduction disorders. The patient group consisted of 155 subjects, 117 men and 38 women, aged 31-91 (mean = 61 years). Analysis included the type and frequency of AV conduction disorders with respect to the infarct site and size, the presence of complications, therapy used with particular consideration of temporary electrical stimulation. AV conduction disorders were found in 15.8% of patients with myocardial infarction. They were found significantly more frequently in those with the inferior myocardial infarction. The patients with the infarction complicated by AV conduction disorders showed more extensive myocardial necrosis, with the degree of the block correlating with the infarct size, more frequent occurrence of such complications as cardiogenic shock, pulmonary edema. Despite the use of electrical stimulation the mortality rate in the myocardial infarction complicated by complete AV block was high, reaching 50.7%.


[Estimation of renal tubular function after uropoline administration in certain disease states].

24 h urinary excretion of beta-microglobulin (beta 2M) and Tamm-Horsfall protein (THP) before and after administration 40 ml of 75% Uropoline were assessed, as a specific markers of proximal and distal tubular dysfunction respectively. 22 patients without renal diseases and hypertension (C), 22 hypertensive patients (HP), 14 patients with renal stone disease (RSD) and 16 patients with pyelonephritis (PN) were examined. Administration of Uropoline did not change beta 2M and THP urinary excretion in C, but increased beta 2M excretion in HP and decreased THP urinary excretion in patients with RSD. It is concluded, that Uropoline shows a noxious effect on the proximal tubule in HP and on the distal tubule in patients with RSD.


[Examination of cortisol and insulin levels in serum of patients with primary hyperlipoproteinemia and phenotype IIa and IIb during lovastatin treatment].

Serum cortisol and insulin concentrations were determined in 30 patients with primary hyperlipoproteinemia (HLP) phenotype IIa (20 persons) and IIb (10 persons) during treatment with lovastatin. Lovastatin dosage varied from 20-80 mg daily. Serum insulin concentration did not change significantly after lovastatin treatment. Serum cortisol concentration significantly increased after 12 weeks of treatment. Cortisol concentration changes were different in HLP IIa and IIb patients. In HLP IIa cortisol concentration increased from 21.9 micrograms/dl to 28.1 micrograms/dl after 12 weeks of treatment, in HLP IIb cortisol level decreased from 31.3 to 24.1 micrograms/dl after 4 weeks of treatment and increased to 32.3 micrograms/dl after 12 weeks of therapy. Mean cortisol concentration was significantly higher in HLP IIa than HLP IIb patients. LDL-cholesterol concentrations changes after treatment correlated significantly with baseline cortisol concentration in HLP IIa group (r = -.34), changes in HDL-cholesterol concentration with baseline insulin levels in HLP IIb patients (r = -.54).


["White coat hypertension" syndrome in resistant essential hypertension].

The study population included 51 patients, aged 34-67 years with essential arterial hypertension treated with 3-5 hypotensive drugs at the Outpatient Antihypertensive Department. Based upon frequent measurements of elevated arterial blood pressure values they were found to be therapy resistant. 24-h ambulatory blood pressure monitoring recorded at one hour intervals (Space Labs) excluded 8 patients (15.7%) from the resistant hypertension group as the number of values > 140/90 mm Hg did not exceed 25% of the measurements. In these patients white coat hypertension was the reason for diagnosing resistance. In 18 patients (35.3%) the initial diagnosis was confirmed as the number of increased values was 80-100%. The severity of eye fundus changes, higher blood pressure values and male predominance characterized the resistant group. The use of long-term noninvasive automatic blood pressure recording helps us to exclude pseudo-resistance and avoid further intensification of treatment.


[Levels of beta-endorphin in serum of patients with chronic renal failure on conservative treatment during insulin-induced hypoglycemia stimulation testing].

beta-endorphin (BE) and other opioid peptides participate significantly in the development of the uremic syndrome. In patients with chronic renal failure (CRF) an elevated serum BE level and lack of a twenty-four-hour BE-secretory pattern were found. In 14 patients with CRF on conservative treatment with serum creatinine above 500 mumol/l and in 14 healthy subjects serum BE was evaluated after intravenous insulin injection. An adequate hypoglycemia was obtained in every subject. Basel serum BE concentration was significantly higher in patients with CRF than in healthy subjects and correlation positively with creatinine. After 60 min. from insulin injection in both groups the peak BE level was observed here after 120 min. it returned to the initial values. The curve of BE concentration in patients with CRF ran significantly higher than in healthy subjects. A total secretory answer of the pituitary measured by the area over basel value of BE was similar in both groups. It seems that BE secretion by the corticotropic cells of the pituitary is unchanged in patients with CRF. Impaired BE elimination by the kidneys is probably responsible for hyper-beta-endorphin levels in those patients.


[Experimental study of external fixation of femoral fractures. Mechanical properties of different kinds of fixation. Clinical implications].

An in vitro assessment of the mechanical performance of 10 types of external femoral stabilization allowed the amplitudes of fracture site displacements during the initial loading phase of a comminuted fracture treated by external fixation to be established. The largest displacement to load ratios were observed in the sagittal plane for all tested configurations. The highest fixator stiffnesses were obtained by using large diameter tubes and pins. The most rigid fixators have a derigidification system which creates the problem of choosing the ideal time to change the rigidity.


[Femoral and tibial bone torsions associated with internal femoro-tibial osteoarthritis. Index of cumulative torsions].

Among the hypothesis about pathogenesis of medial knee osteoarthritis, the participation of modifications of the alignment of the limb in the frontal plane is known. The participation of the femoral and tibial torsions had been assessed by a few authors. In this study, the torsions have been measured by computerized tomodensitometry. The global torsional morphology of the limb has been defined by the measure of the Index of Cumulated Torsions. The values of torsions have been compared with the angle deformities measured in the frontal plane. The effects of the bone torsions on the position of the lower limb during the weight-bearing phase of the gait and the consequences about the knee have been studied.


[Total knee replacement after valgus tibial osteotomy. Technical problems].

Forty total knee replacements following valgus tibial osteotomy were analysed. There were 38 patients (10 men and 28 women) with a mean age of 72 years at the time of the joint replacement, at a mean of 8.5 years after osteotomy. Mean follow-up was 3 years (1 to 5 years). Performing a total knee replacement after valgus tibial osteotomy posed some specific problems due to asymmetrical bone cuts, residual ligament laxity, loss of bone at the tibial plateau, and especially when there was a malunion of the previous osteotomy. The functional results were good. A group of 208 patients with total knee replacements for untreated osteoarthritis acted as a control for comparison. In the group with an osteotomy the results were worse in respect of the walking distance and flexion angle achieved after joint replacement compared with primary replacement (p < 0.001). However the GUEPAR and HSS score 77.2 +/- 2.3 were very similar. Using unilateral weight-bearing X-rays, 18.8p. 100 demonstrated opening from ligament laxity and 40.6p. 100 had radiolucent lines under the components, which was the same as in the control group. The tibio-femoral mechanical axis using long-leg films had a mean varus angle of 0.7 degrees.


[Post-operative iatrogenic hallux varus. Surgical treatment. Apropos of 19 cases].

The post operative iatrogenic hallux varus associates varus, big toe's dorsal flexion and supination. The pathogeny is dominated by musculo-tendinous lack of balance created by the initial operation and excessive exostosectomy. The authors have nineteen times surgically corrected this deformation. The procedure included in all cases, a medial arthrolysis; five times associated with a screwed capito-metatarsal osseous shelf (or graft) (when there was a metatarsal's head maiming); thirteen times associated with a metatarso-phalangeal arthrodesis (in cases of impaired joint surfaces). The authors analyse, besides, without excluding them the other surgical procedures for hallux varus, and particularly tendinous transfers. The results show the necessity of a perfect etiopathogenic analysis of the deformation.


[Old fractures of the lateral humeral condyle (lateralis capitellum humeri) in children].

The authors report their experience of 19 cases of non recent fractures of the lateral humeral condyle in children. The delay from the initial trauma to the first clinic was: minimum, 45 days (this delay defines a non recent fracture), maximum 7 years. 18 patients sustained an operation, 15 non-unions and 3 malunions; 1 patient was not operated on. The mean follow-up was about 5 years. The authors have determined two groups of patients according to the delay of treatment, less or more than 6 months. In the first group, 13 procedures out 14 allowed fusion of the condyle without necrosis. In the second group, the severe malalignments of the elbow required a varus or a valgus osteotomy.