Delayed neuronal death and delayed neuronal recovery in the human brain following global ischemia.

The understanding of delayed hippocampal death as a therapeutic window for post-ischemic treatment of the brain has led to numerous investigations focusing upon underlying cellular mechanisms and pharmacological potentials in gerbils and rats. Nevertheless, studies on the occurrence of delayed neuronal death in the human brain have been singular and dealt with only small files of patients. To complement these limited data, in the present study 26 adult patients with a history of a single cardiac arrest were included. Following successful resuscitation, individual survival ranged from less than 1 h to 186 days (mean = 11 days). The severity of the resultant ischemic injury in hippocampus CA1, among Purkinje cells, or in frontal neocortex, respectively, was quantified by direct counting of necrotic neurons. Additionally, hippocampal specimens were immunostained for neuron-specific enolase. The data obtained demonstrate the occurrence of delayed neuronal death in human hippocampus and, in a minor form, in cerebellar Purkinje cells. This is in contrasts to the immediate manifestation of ischemic neuronal necrosis in the neocortex. Unlike previous findings in experimental animals and in humans, the delay of CA1 cell death could be defined as lasting about 7 days following cardiac arrest. Moreover, the immunohistochemical results indicate delayed neuronal recovery in CA1, which in the time course reciprocally corresponds to delayed manifestation of hippocampal neuronal death. Interpretation of the results must consider the lack of information about the exact individual duration of cardiac arrest and resuscitation, as well as missing data concerning pre-ischemic physiological variables.


Desmin and vimentin as markers of regeneration in muscle diseases.

Localization and distribution of desmin and vimentin have been studied in different neuromuscular disorders using monoclonal antibodies. We have demonstrated that vimentin, although virtually absent in normal human muscle fibers, is expressed in regenerating fibers in different neuromuscular disorders. Moreover, these fibers showed a strong positivity with desmin antibodies. In normal muscle fibers desmin is only localized at Z-line level. These results suggest that desmin and vimentin may be over-expressed during muscle regeneration processes, probably because of their importance in the structural organization of the sarcomere.


Histopathological effects of intracerebral injections of human recombinant tumor necrosis factor-alpha in the rat.

Human recombinant tumor necrosis factor-alpha (rTNF-alpha) was administered to normal Fischer 344 rats by stereotaxic intracerebral (IC) injection. Animals received a single injection of either 6 x 10(4) U rTNF-alpha or excipient in their right parietal lobe. Others received three consecutive daily injections of either 6 x 10(4) U rTNF-alpha or excipient to examine effects of higher accumulative doses. Histological examination of the brain revealed that both single and multiple IC injections of rTNF-alpha triggered an immigration of circulating leukocytes into the site of TNF-alpha injection. After one injection, this cell population was composed mainly of macrophages and neutrophils. Maximal leukocytic influx occurred by 48 h and was composed mostly of neutrophils which were limited to the injection site and perivascular space. Quantitation of the inflammatory reaction by measurement of tissue myeloperoxidase levels supported these histological observations. One day after multiple rTNF-alpha injections, leukocytic adhesion to endothelium, vascular cuffing and leukocytic infiltration into the neuropil was observed at levels comparable to those seen 3 days following a single rTNF-alpha injection. We conclude that while one or more IC injection(s) of 6 x 10(4) U rTNF-alpha was well tolerated in normal rats, at this dose the cytokine triggers a pronounced leukocytic infiltration at the site of injection. These results support a role for TNF-alpha as a mediator in inflammatory responses within the central nervous system.


The inhibition of lymphocyte blastogenesis by asparaginase: critical role of glutamine in both T and B lymphocyte transformation.

L-Asparaginase has long been used in the treatment of acute lymphoblastic leukemia or malignant lymphoma in childhood. To determine cell type specific sensitivity to this drug, the L-asparaginase-mediated inhibition of blastogenesis of human peripheral T or B lymphocytes was compared. The rate of incorporation of [3H]-thymidine into the DNA of either T lymphocytes due to phytohemagglutinin (PHA) or B lymphocytes due to Staphylococcus aureus Cowan I (SAC) was measured by the addition of Escherichia coli L-asparaginase in the medium. The blastogenic response of either T or B lymphocytes was also determined in medium depleted of exogenous asparagine and/or glutamine, both of which are hydrolyzed by this enzyme. The in vitro blastogenesis of either human T lymphocytes due to PHA or B lymphocytes due to SAC was inhibited by the inclusion of asparaginase in the medium. The deprivation of exogenous asparagine did not have any inhibitory effect on the blastogenic response of both T and B lymphocytes to each mitogen. On the other hand, the glutamine concentration in the culture medium provided a critical influence on the proliferative response of T and B lymphocytes. The rate of incorporation of [3H]-thymidine into DNA was increased markedly as the concentration of glutamine was increased from 2(-7)-2 mmol/l. It is concluded that the mechanism of inhibition of PHA- or SAC-stimulated lymphocyte blastogenesis by L-asparaginase is not asparagine deprivation but glutamine deprivation. Glutamine, which is the most abundant amino acid, is thought to have an important role in the immune response of lymphocytes.


Treatment of Kawasaki disease using the intravenous aspirin anti-inflammatory effect of salicylate.

Serum salicylate concentrations were measured in 60 patients with acute phase Kawasaki disease (KD), who were treated with intravenous aspirin (IVASP), to evaluate its anti-inflammatory effect in the treatment of KD. Patients with serum salicylate concentrations > or = 150 micrograms/ml showed shorter durations of fever (7.1 +/- 2.0 vs 10.4 +/- 6.6 days; P < 0.05), shorter durations of positive serum C-reactive protein (14.6 +/- 4.5 vs 22.3 +/- 10.6 days; P < 0.01) and lower incidences of coronary arterial involvements (0/10 vs 6/24; P < 0.05) than did patients with serum salicylate concentrations < 150 micrograms/ml. Significant linear correlations were recognized between daily IVASP dosage and serum salicylate concentrations (r = 0.73; P < 0.01), and between serum salicylate concentrations and serum free salicylate concentrations (r = 0.82; P < 0.01). These correlations did not differ between the presence and absence of coronary arterial involvements. Based on these findings we concluded that a beneficial anti-inflammatory effect in the treatment of KD is achieved when the serum salicylate concentration is > or = 150 micrograms/ml, and that such concentrations could be achieved by increasing the daily IVASP dosage to 100 mg/kg per day or more.


Disodium cromoglycate in the treatment of bronchopulmonary dysplasia.

Bronchopulmonary dysplasia (BPD) has become the most common form of chronic lung disease in the neonate. Recently, we have experienced a severe case of BPD and examined the effect of disodium cromoglycate (DSCG) on BPD. The gestational age and birthweight of the patient were 27 weeks and 1,000 g, respectively. Although RDS subsided after surfactant replacement therapy, the arterial-alveolar oxygen tension ratio (a/APO2) gradually decreased and FiO2 increased with age, respectively, and pure oxygen supplementation was eventually required after 67 days of life. The DSCG treatment was commenced at 80 days of life. After 6 days of the inhalation therapy, a/APO2 gradually increased. After 10 days of the treatment, the baby was extubated. While the baby was intubated, intratracheal lavage fluid samples were obtained. Eosinophilic cationic protein (ECP) and polymorphonuclear (PMN) elastase concentrations were determined. ECP and PMN elastase concentrations of intratracheal lavage fluids gradually decreased with the DSCG treatment. These results may indicate that DSCG has led to an improvement of pulmonary function and facilitated weaning from mechanical ventilation in an infant with BPD.


The 11q- syndrome with mosaic partial deletion of 11q.

A female child with mosaic partial deletion of 11q is reported. At 1 month of age she was presented with cogenital glaucoma, trigonocephaly and multiple minor anomalies. She exhibited growth retardation and the typical phenotype of 11q- syndrome. G-banding analysis failed to show any abnormality, although subsequent high resolution banding revealed the abnormal karyotype 46,XX,del(11)(q23.3 q24.2)/46,XX,del(11)(q23.3 q25). This case is a second case of mosaic 11q- syndrome and her karyotype suggests that the region of 11q23.3-11q24.2 is critical in 11q-syndrome. Congenital glaucoma has never been reported as a complication of 11q- syndrome.


Successful collection of peripheral blood stem cells from an infant with acute lymphoblastic leukemia using the Haemonetics V50.

Peripheral blood stem cells (PBSC) were collected using the Haemonetics V50 from an 8 month old infant weighing 7.8 kg suffering from acute lymphoblastic leukemia in the first complete remission. Leukapheresis was performed according to an exchange transfusion procedure by the two arm method using only a single lumen Broviac catheter. No problem occurred in the patient during this procedure except for a reduction (by half) of the initial platelet count. This method enables one to collect PBSC very safely, even from infants, in a manner that is painless for patients.


Two children with bromate intoxication due to ingestion of the second preparation for permanent hair waving.

We report two children who suffered from sodium bromate intoxication due to ingestion of the second preparation for permanent hair waving (the second permanent preparation). One child suffered from gastrointestinal symptoms only. The other exhibited slight acute renal insufficiency. Results of the histological examination of the kidney in the sick child with acute renal insufficiency showed sporadic epithelial separation of the proximal tubuli under light microscopy. In addition, we could demonstrate more clearly epithelial separation and unbroken tubular basement membranes under electron microscopy (EM). To our knowledge, this is the first report of EM findings in this disease. The mechanism of epithelial injuries by bromate is not clear.


Neonatal adrenal hemorrhage detected antenatally.

This report describes two cases of neonatal adrenal mass detected antenatally by routine ultrasound (US) examination of pregnant women. Case 1 was recognized by the fetal US at 31 weeks gestation. The mass, located near the right upper pole of the kidney, was echolucent on US examination. A serial US of the mass showed changes of the internal echoes from a cystic lesion to a mixed lesion, and finally to a hyperechogenic lesion due to a neonatal adrenal hemorrhage (NAH). At 33 days, laparotomy was performed, and the pathological finding revealed an NAH owing to the mass bleeding into the adrenal cyst. Case 2 was also detected by fetal US just before birth. The mass of the right upper pole of the kidney was hyperechogenic on US examination. The baby clinically deteriorated after birth because of hypovolemia owing to NAH. A serial US of the mass showed the change from a hyperechogenic to a cystic lesion. Four months later, the mass spontaneously resolved. From the US spectrum, the mass was diagnosed as NAH. These are the second known cases of NAH detected before birth in Japan.


Survival rate of extremely low birthweight infants and its effect on the amendment of the Eugenic Protection Act in Japan.

Because of the increasing survival rate of extremely low birthweight infants in recent years, the viability limit in the Eugenic Protection Act in Japan was amended from 24 to 22 completed weeks of gestation. The Japan Pediatric Society's survey on the outcome of infants born in 1990 focused on infants born before 24 weeks gestation and less than 500 g. The survival rates of infants born in 23, 22 and before 22 weeks gestation overall at 511 hospitals throughout Japan were 43/118 (36%), 3/36 (8%) and 0/8 (0%), respectively. Of 16 infants, none weighing less than 400 g at birth survived but 16 (12%) of 50 infants between 400 and 499 g survived. Up-to-date statistical data is essential to the amendment of the concept of viability and subsequent ethical decision-making on extremely low birthweight infants.


Surfactant replacement therapy in premature babies with respiratory distress syndrome: factors affecting the response to surfactant and comparison of outcome from 1982-86 and 1987-91.

The impact of surfactant therapy on chronic lung disease remains uncertain. During the past decade (1982-91), over 300 babies with respiratory distress syndrome (RDS) weighing 501-2,500 g at birth were consecutively treated with surfactant-TA at our neonatal intensive care unit. Data on 95 RDS babies treated in the first 5 year period (Period 1, 1982-86) were compared with those on 158 RDS babies treated in the second 5 year period (Period 2, 1987-91). Overall respiratory improvement was better in Period 2 than in Period 1. In Period 2, surfactant therapy converted 98% of the babies with moderate/severe RDS to those with 'near normal' lung by 72 hr post-treatment. In Period 2, 95% of the surfactant-treated babies weighing 501-1,750 g at birth survived, 97% of which required no supplemental oxygen at 40 weeks corrected gestational age. Increased survival rate in the surfactant-treated babies during the past decade has not been followed by a parallel increase in chronic lung disease. The severity of the initial pulmonary disease per se was not the significant risk factor for chronic lung disease. Several other variables affecting the response to surfactant therapy and outcome have been identified by stepwise logistic regression analysis and include factors related to perinatal events such as birth asphyxia and infection, and other complications of prematurity.


High frequency oscillation.

The current state of high frequency oscillation (HFO) in Japan is reviewed. The discussion is focused on the following: (i) the repeated application of short duration SI (sustained inflation) is effective in recruiting lung volume and increasing PaO2; (ii) HFO can prevent the formation of granulocytes related to lung injury; and (iii) HFO does not increase the risk of severe complications such as air leaks, bronchopulmonary dysplasia or intraventricular hemorrhage.


Pulmonary surfactant apoprotein-A in neonates with different respiratory disorders.

A serial determination of pulmonary surfactant apoprotein-A (SP-A) was made on tracheal aspirates from seven intubated infants with different types of respiratory failure in the first week of life. A two-site immunoassay with monoclonal antibodies was adopted to determine the SP-A concentration. The concentrations of albumin in the same samples were also assayed, and these data were expressed as the ratio of SP-A to albumin (SP-A/albumin ratio), and evaluated against clinical data such as the arterial-alveolar oxygen tension ratio (a/APO2) or ventilatory index. In infants with respiratory distress syndrome, the SP-A/albumin ratio was initially low, and increased gradually in the first few days of life with the improvement of a/APO2 and ventilatory index. The complication of pulmonary hemorrhage due to patent ductus arteriosus (PDA) resulted in a temporary decrease in the ratio. The infant with transient tachypnea of the newborn showed higher concentration from the first day of life and, in the course of PDA without pulmonary hemorrhage, the ratio did not decrease. The cases of congenital pneumonia showed the SP-A/albumin ratio remaining low while the infection was evident. These data suggest that the SP-A/albumin ratio of the tracheal aspirate can be used for the quantitative and qualitative evaluation of endogenous pulmonary surfactant in newborn infants with different respiratory disorders.


Determination of serum unbound bilirubin for prediction of kernicterus in low birthweight infants.

Serum unbound bilirubin concentrations (UBC) and serum total bilirubin concentrations (TBC) were measured serially in 138 low birthweight (LBW) infants treated with phototherapy for non-hemolytic hyperbilirubinemia. We attempted to assign the suitable critical UBC levels for predicting bilirubin encephalopathy into two different birthweight groups: a very low birthweight (VLBW) group (birthweight < 1,500 g) and an LBW group (birthweight between 1,500 g and 2,499 g). Twelve infants were diagnosed as 'at risk' for kernicterus, of whom 11 had signs of acute bilirubin encephalopathy and received exchange transfusion. One VLBW infant had neurological sequelae at a 3 year follow-up, although exchange transfusion was not carried out because of low TBC. Sensitivity and specificity for predicting kernicterus were calculated at different UBC levels between 0.6 microgram/dl and 1.5 micrograms/dl and TBC levels between 8 mg/dl and 26 mg/dl. The receiver-operating characteristic (ROC) curves plotted for UBC as a predictor of kernicterus were clearly shifted up and to the left compared with the curves for TBC in the VLBW and LBW groups. Thus, the UBC measurement may well provide a more rational basis for evaluating the risk of kernicterus in LBW infants. The optimal cut-off points were derived from these curves. In the VLBW group, the sensitivity was 100% and the specificity was 96% for a UBC of 0.8 microgram/dl, and 80% and 64% for a TBC of 11 mg/dl. In the LBW group, the sensitivity was 100% and the specificity was 98% for a UBC of 1.0 microgram/dl and 71% and 78% for a TBC of 16 mg/dl.(ABSTRACT TRUNCATED AT 250 WORDS)


Postnatal growth curves of very low birthweight Japanese infants.

To construct standard growth curves for Japanese infants of very low birthweight, longitudinal data provided by 47 neonatal centers in Japan were reviewed. Data were collected on the growth of infants admitted to those units during 1986 and 1987 and who survived beyond 3 years of age. A total of 379 singleton infants, who were free of neurological sequelae and appropriate for gestational age, were enrolled. Those whose birthweights were more than 600 g and less than 1,500 g were grouped into nine weight categories separated by increments of 100 g. Data on the increase in weight and head circumference were compiled and analyzed until more than half the infants in each weight category had been discharged from each site. Growth curves of bodyweight and head circumference in the nine groups were constructed using polynomial regression analysis to define the curve of best fit. With increasing prematurity, significant trends of greater weight loss (P < 0.05), longer time to reach the lowest weight (P < 0.01) and a longer time to regain birthweight (P < 0.01) were observed. In addition, there was a significantly higher incidence of chronic lung disease in such groups (P < 0.0001). Growth curves were characterized by the average clinical profiles in each of the nine groups. We believe that these data will be useful in evaluating the growth of very low birthweight infants being cared for in modern neonatal intensive care units in Japan.


Prevention of perinatal transmission of hepatitis B virus carrier state.

By means of passive and active immunization with hepatitis B immunoglobulin and hepatitis B vaccine, 396 of 407 babies born to hepatitis B antigen-positive carrier mothers, were protected from establishing the hepatitis B virus (HBV) carrier state during a follow-up period of 12 months or longer. Four infants developed the HBV carrier state before the completion of the immunoprophylaxis schedule, and another seven developed the state after the completion of the schedule. Seroconversion of anti-HBc was observed in 26.8% of the successfully protected infants. In Japan a nationwide program to prevent the vertical transmission of HBV with these procedures was established in 1986, and so liver diseases due to HBV are expected to be eliminated in the near future.


Oxygen and reduced umbilical blood flow trigger the first breath of human neonates.

The mechanism triggering the first breath of human neonates is still unclear. In order to investigate the role of oxygen and umbilical blood flow in the onset of the first breath, a total of 20 rat and rabbit fetuses were studied. All five rat fetuses delivered in a nitrogen chamber did not commence breathing of their own accord, whereas all five rabbit fetuses delivered in oxygenated fluorocarbon fluid commenced their own breathing, suggesting that contact with oxygen rather than release from submergence is more crucial in the initiation of the first breath.


Epidemiology of neonatal chronic lung disease in Japan.

A nationwide survey on the epidemiology of chronic lung disease (CLD) of the newborn was conducted. Questionnaires were sent to 391 level II and III neonatal centers in Japan and the registration of infants born in 1990 with chronic lung disease was requested. CLD was defined as an oxygen requirement greater than that obtainable in room air at 28 days after birth, with symptoms of persistent respiratory distress and a hazy or emphysematous and fibrous appearance on chest X-ray. A total of 301 neonatal centers (77.0%) responded and 50,290 infants at these centers were registered. Of these, 97% survived the first month and 1,135 of 48,762 neonatal survivors developed CLD. The mortality of infants with CLD was 6.2%. Survival rates at 28 days of age increased consistently with birthweight. Survival at 28 days of age in infants below 1,000 g at birth was 73.7%, but the rate was 93.9% in infants weighing 1,000-1,499 g. The incidence of CLD was inversely proportional to birthweight. Approximately one quarter of neonatal survivors with a birthweight below 1,500 g and approximately half of extremely small infants ( < 1,000 g) developed CLD. The analysis of CLD infants showed that 28.2% of them had a history of respiratory distress syndrome (RDS) and a typical fibrous appearance on chest X-ray (Type I), while 29.3% also had a history of RDS but had an atypical X-ray appearance (Type II).(ABSTRACT TRUNCATED AT 250 WORDS)


Effect of mean airway pressure on bronchial mucosal blood flow in rabbits with oleic acid-induced injury.

The effects of mean airway pressure (MAP) on bronchial mucosal blood flow at the carina in nine anesthetized adult rabbits undergoing high frequency ventilation were studied. The animals were given oleic acid to diminish lung compliance and to exclude the influences of increasing MAP on systemic venous return. Mucosal blood flow decreased significantly when MAP exceeded 14 cmH2O. Mucosal blood velocity tended to decrease as higher levels of MAP were applied. Mucosal blood volume decreased significantly when MAP exceeded 20 cmH2O. Hemodynamics, arterial blood gas values and pH were not changed significantly. Our data demonstrate that bronchial mucosal blood flow decreases at high levels of MAP even if cardiac output remains constant. Hence this decrease of bronchial mucosal blood flow may be due to the transmission of pressure to submucosal bronchial capillaries.


[13C] breath test of medium-chain triglycerides and oligosaccharides in neonates.

It is suitable to examine the utilization of carbohydrates and fats using stable isotope-labelled substrates in neonates because of their non-radioactivity. Administering medium-chain triglycerides (MCT) and oligosaccharides is of use in enteral nutrition for a patient with a limited water intake such as a neonate. In this study, the oxidation of MCT and maltose administered orally as an energy supplement in neonates has been examined using a stable isotope-labelled breath test. Five normal term neonates and five growing preterm infants were given [13C]-trioctanoin orally and three growing preterm infants were given [13C]-glucose and [13C]-maltose orally. The [13C] enrichment in carbon dioxide was analyzed by isotope ratio mass spectrometry, and oxidation rates over 6 hr and 12 hr respectively, were calculated. The oxidation rates for [13C]-octanoin after 6 hr were 46.2 +/- 3.6% in preterm infants and 53.5 +/- 13.8% in normal neonates, respectively (no significant difference), and 58.4 +/- 9.4% and 52.8 +/- 6.0% for [13C]-glucose and [13C]-maltose, respectively (not significant). The results demonstrate that orally administered MCT and maltose are oxidized sufficiently in preterm infants.


[Renal angiomyolipoma: study of 39 patients and general review].

Between 1969 and 1991, 39 patients totalling 48 renal units with renal angiomyolipoma (RAMP) were diagnosed and treated in the Urology Service of the Hospital La Paz. In 5 patients, RAMP was part of a tuberous sclerosis, and was isolated in the remaining ones. RAMP was symptomatic in 32 cases (32/48 = 66.6%), 10 with Wundrelich's syndrome, and in 24 cases (24/48 = 50%) was larger than 4 cm. In the first cases of our series, clinical diagnosis through renal arteriography was achieved in 33% (5/14) cases; later, with the arrival of ultrasound and CAT, pre-operative diagnosis was possible in 88% (30/40) of cases. There was also 2 periods with regard to treatment, the initial one with predominance of radical surgery and the present one of observation and/or conservative surgery depending on size as well as signs and symptoms. Overall, 23 nephrectomies, 2 partial nephrectomies and 6 tumorectomies were performed, while there has been 17 cases (with no histological confirmation) treated with conservative approach and followed-up with ultrasound and CAT. With an average follow up of 8.4 years (range: 0.5-20 years), there has been no local or metastatic relapse of RAMP. There was one case of lymphatic affection which was explained as evidence of RAMP's multifocal condition and not as an indication of malignancy. In 3 patients, histological examination revealed coexistence of RAMP and renal carcinoma; 2 of these patients who underwent nephrectomy are free of disease; the third patient, treated with conservative surgery (tumorectomy), showed renal carcinoma relapsed after 2 years and had it removed. RAMP's incidence, histogenesis, diagnostic methods and treatment criteria are discussed.


[Urologic complications in renal transplantation: our experience with 200 cases].

Urinary tract complications continue to be a major cause of morbidity in renal transplant patients. This paper is a review of the urological complications developed in in 200 renal transplants performed in our service over a 10-year period, from January 1980 to December 1989, with a follow-up of at least 1 year. We include a total of 29.5% urological complications, subdivided in two sections each corresponding to a distinct period during which different procedures were used in the renal transplantation unit. The report includes an analysis of the complications' etiopathogenic, diagnostic and therapeutic factors.


[Epidemiology of urologic pediatric emergencies in our hospital, 1990].

The article's objective is to study the epidemiological patterns which define the paediatric urological emergencies within the area of influence of our hospital. To this end, 187 protocols of the paediatric emergencies attended by the urologist in 1990 were retrospectively reviewed. The most frequently observed pathologies were balanitis-phimosis, acute scrotum and genito-urinary injuries. A clear relationship of the type of disease to the patient's age and treatment, as well as some time-related variations were observed. About 40% of all cases could had been treated at a non-emergency outpatient clinic.


[Cystolysis. Supratrigonal denervation].

CI is an entity with obscure etiopathogenesis and difficult to manage. This essay contributes three cases, out of a series of 25, were cytolisis was performed. Results after six months follow-up are very encouraging, since pain has disappeared in all cases and pollakiuria has been radically reduced.


[Endourologic treatment of tumor of the upper urothelium: results and clinical course].

Presentation of 31 patients with suspected diagnosis of upper urothelium tumour seen between 1986 and 1991. In agreement with our study protocol and the endourological treatment followed in this type of tumours, there were eight false positive, which were excluded. Five cases were treated by retrograde ureterorenoscopy while in the remaining 18 cases the anterograde percutaneous approach was used. A review of both the aspects of endourological treatment and the evolution of these patients during that period is included.


[Supernumerary kidney with ectopic ureteral opening to the vagina associated with horseshoe kidney].

Contribution of one case of supernumerary kidney with ureter ectopically opened to vagina associated to horseshoe kidney. Supernumerary kidneys are extremely unusual entities, there being only about 70 cases described in the international literature. This is the first case where it is found associated to horseshoe kidney.


[Seminal vesicle cyst and ipsilateral renal agenesis: frequent association].

Presentation of a new case of cyst of the seminal vesicle in one patient with ipsilateral renal agenesis, stressing the frequency of this association. The cyst become evident following confirmation of renal agenesis, and presented an unusual communication to the bladder due to previous surgery (transurethral resection). This diagnosis was only suspected in the computerized tomography and cystoscopy and later confirmed by deferentovesiculography. The relevance of exploring any possible dysplasia of the seminal tract in the presence of renal agenesis is stressed. From an embryological point of view, the close relationship during development of both urinary and reproductive systems appear to explain the coexistence of these two anomalies. The primary symptoms of the condition, including the unspecific ones, as in the present cases, are discussed. Differential diagnosis from other deep pelvic cysts is referred. Following a literature review and based in our personal experience, already published, our views on the different embryological, clinical, diagnostic and therapeutic considerations are established.


[Bladder endometriosis].

Endometriosis is the ectopic location of the endometrium. It is quite unusual to find endometrium foci within the vesical cavity, this experience representing only 1-2% of all possible locations. This paper contributes one vesical endometriosis in a 35 year old woman endoscopically diagnosed because of a solid tumour with surface bluish bullae or cysts. We used Gestrima, in dosage of 2.5 mg twice weekly, as adjuvant treatment to endoscopic surgery with complete objective response.


[Paravesical tumor of adrenal gland residues].

Presentation of one case of ectopic suprarenal tissue residues' tumour found at paravesical level. The singularity of this diagnosis, unless hormonally active, or when very large in size, as well as its various locations is recalled. Ultrasound, CAT and hormone characterization are the mainstays to achieve clinical diagnosis. Surgery is always the course adopted. Only when such an option is unsuitable, drugs are used to block the steroidogenesis.


[Subcapsular hematoma after ESWL].

Contribution of 2 cases of post-ESWL subcapsular haematoma in patients with HBP. One of them underwent surgical drainage. In the second case a more conservative attitude was followed. Review of related literature.


[Prostatic syndrome as presentation form of non-Hodgkin's lymphoma].

Description of one case of a 66 years old patient who developed prostatic syndrome with obstructive renal insufficiency. The ultrasound study showed the existence of a large prostatic mass diagnosed by means of a biopsy as a non-Hodgkin lymphoma. The thoraco-abdominal computerized tomography ruled out the presence of distant adenopathy while bone marrow biopsy did not show lymphoma infiltration. Subsequently, the patient was given polichemotherapy following a CHOP scheme. After 6 cycles, a second CT was performed that showed disappearance of the previously described prostatic mass. Chlorambucil was given as maintenance therapy. The patient remains asymptomatic and disease-free nine months after discontinuing the polichemotherapy.


[Renal angiomyolipoma in childhood: a clinical case].

The renal angiomyolipomas are unusual benign tumors which more than 50 per cent, are associated with tuberous sclerosis or intestinal linphangiomatosis. They can be discovered in a radiologic study by chance or to be associated with flank and abdominal pain and hematuria. The ultrasonographic imagen is characteristic and its management is conservative.


[Post-natal development of interstitial Leydig cells in rat testicle].

The existence of different stages of postnatal activities in Leydig's cells, as demonstrated in hormone studies, appears to be fully admitted. Such occurrence should have repercussions on the population of those elements primarily entrusted with their production, either in the number of elements or their activities. The present article studies Leydig's cells rate in Wistar rats over the postnatal stage, from birth to adulthood. During this postnatal stage, Leydig's cells population does not actually disappear. There is a decrease immediately after birth and up to the age of 21 days when gonadal drop occurs in this species, and from there on a considerable increase takes place for in a two-month period they multiply by ten. On the other hand, it is highly surprising the great speed of testicle growth up to the age of 60 days, reaching maximum size at 90 days. The increase is due to the growth of the tubular compartment.


Users' perceptions of mail-service pharmacy.

This survey studied the satisfaction of university employees with the mail-service pharmacy option of their major health insurance provider. Nearly 92% reported good or excellent satisfaction with the mail order service. Of the 76.5% who reported receiving drug information brochures with some or all of their prescriptions, 91.5% rated the information excellent or good. When asked what sources they used to get additional information, 31.2% used a mail service pharmacist. These data suggest that mail order pharmacies, which have increased volume 50% per year since 1981, can expect to maintain and expand their market share. All pharmacy sectors should use this information to determine ways to enhance their competitive position.


Prospects for controlled-delivery systems.

Americans seem to view medical progress as a citizen's entitlement. They expect, and researchers expect to seek, cures for acquired immunodeficiency syndrome (AIDS), Alzheimer's disease, cancer, and other deadly or incapacitating diseases. Both the public and researchers also seem undaunted by the cost. CDS technologies and biotechnology drugs are making this expectation possible. Still, CDSs may not dispel public resentment over the high cost--and profit--of discovering otherwise welcomed new healing molecules. As noted by 1988 Nobel laureate in medicine, Sir James Black: "I think both the press and industry have failed to communicate to the public that behind every little pill is a vast amount of high technology...." With increasing use of and satisfaction from CDSs, more of these mechanisms, covering a broadening spectrum of uses, will be marketed. Because these products are taken less often, patient compliance is expected to increase. As more CDSs are introduced, dispensing frequency will decline and the complexity of prescription drugs will increase. Pharmacists can take advantage of this trend by expanding their activities in the management their patients' medication use.


Tricholemmal cysts of the head and neck.

Tricholemmal cysts, sometimes termed pilomatrixomas, are benign skin neoplasms. This study was undertaken to evaluate the clinical experience with management of pilomatrixomas at a large, referral-based university hospital. The records of patients treated at the UCLA Medical Center were reviewed retrospectively. Patients treated during the years 1966 to 1991 inclusive were reviewed for details of the clinical course. All pathology slides were confirmed histologically. Pilomatrixoma was confirmed in 53 patients. Of these, 29 patients (55%) had pilomatrixoma isolated to the head and neck region. All were treated with surgical excision. One patient (3%) experienced recurrence due to inadequate initial excision. Subsequent re-excision resulted in a cure. Tricholemmal cysts present as solitary, painless, slow-growing cutaneous nodules often resulting in discoloration of the overlying skin. Simple excision cures this benign neoplasm, and recurrences are rare. Fine-needle aspiration biopsy may aid in the diagnostic workup.


Water precautions in children with tympanostomy tubes.

The necessity and effectiveness of taking precautions around water with children who have tympanostomy tubes is a source of some controversy among otolaryngologists. This study was undertaken to survey the practice standards of otolaryngologists treating these children. A total of 1,266 board-certified otolaryngologists practicing (mean 14.8 years in practice) in the southern and eastern United States were surveyed to determine current recommendations. Among those surveyed, 13.1% forbid children with tympanostomy tubes from swimming, whereas 3.1% feel that no water precautions are needed. Limitations are placed in the depth of swimming by 68% and the type of swimming water by 18%. The most commonly recommended form of protection is the use of ear plugs, which is favored by 53.4%. Liberalization of recommendations concerning the need for water precautions was noted by 79% of respondents who cited personal experience as the single most influential factor. An overwhelming percentage of respondents indicated they would be willing to alter their current practice based on new information generated from a clinical trial. This survey demonstrates that diversity of opinion does exist among otolaryngologists relative to their recommendations for water precautions after placement of tympanostomy tubes. This survey demonstrates the need for a prospective randomized clinical trial designed to address this issue.


Lipid and volume analysis of neck drainage in patients undergoing neck dissection.

We seek to establish normative values for the volume of postoperative neck drainage from patients undergoing ablative oncologic procedures that include a neck dissection and to analyze neck drainage for lipid content to establish guidelines that may be helpful in identifying chylous fistula when this diagnosis is not clinically straightforward. Neck drainage obtained through continuous suction percutaneous drainage catheters was evaluated following 23 neck dissections performed on 19 patients. In every case, either radicle or modified type I neck dissection was performed. The volume of drainage was quantitated on a day-to-day basis. In a separate group of 27 patients undergoing neck dissection, neck drainage was compared with serum levels of triglyceride, cholesterol, and chylomicron content. The mean duration of neck drainage was 5 days. Maximum drainage (160 mL) was noted on the first day and dropped daily to less than 10 mL by the fifth postoperative day. A statistically significant difference between serum and neck drainage triglyceride and cholesterol content was observed in nearly all cases. Neck drainage fat content was lower than that noted in serum in nearly all cases. Chylomicron content of 4% was encountered in neck drainage. This study provides normative data on lipid content of neck drainage. With only a rare exception, the triglyceride and cholesterol levels are higher in the serum than in the neck drainage. A triglyceride level of 100 mg/dL seems to be the upper limit of normal (mean plus 1 standard deviation). A low level of chylomicron (> 4%) is consistent with normal healing and may be due to breakdown of fatty tissue.


IgE levels in faecal extracts of patients with food allergy.

IgE levels in faecal extracts (Copro-IgE levels) were investigated in food allergy (FA) patients before and after the challenge test administration of food allergens. IgE levels were measured by time-resolved fluoroimmunometric assay. In addition, the effects of administration of oral sodium cromoglycate (SCG) on the Copro-IgE levels were studied. Copro-IgE levels in patients with FA, who were placed on an elimination diet, did not differ from those of healthy children. After a challenge test immediate symptoms of urticaria and wheezing were observed in all FA patients. Copro-IgE levels in each patient increased markedly within 24 h of the challenge test. Moreover, FA patients treated orally with SCG showed neither the increase in Copro-IgE levels nor any remarkable symptoms after the challenge. Our results suggest that the increased Copro-IgE levels may be a specific consequence of the local immune response to food allergen stimulation in the gut mucosa.


Reduced nonspecific bronchial reactivity and decreased airway response to antigen challenge in atopic asthmatic patients treated with the inhaled leukotriene D4 antagonist, L-648,051.

We studied the effect of the inhaled leukotriene D4 antagonist, L-648,051, on antigen-induced bronchoconstriction and nonspecific bronchial reactivity. Ten males with mild atopic asthma completed a double-blind, randomized, two-period, placebo-controlled cross-over study. For a 7-day period patients inhaled either placebo or 6 mg of L-648,051 four times daily. Bronchial reactivity to methacholine was measured at base line (day 1) and after 6 days, treatment (day 7). On day 8, after inhaling 6 mg of the antagonist (or placebo), the patients were challenged by inhaled antigen; they received an additional 6 mg of the antagonist (or placebo) 3 h later. Pulmonary function (forced expiratory volume in 1 s, FEV1) was measured serially through an 8-h post-antigen challenge. Nonspecific airway reactivity was again measured on day 9. Compared to placebo, L-648,051 treatment diminished the methacholine reactivity, on both day 7 (NS) and on day 9 (P < 0.05). In addition, the immediate and late bronchial responses to antigen challenge on day 8 were attenuated in the patients when treated with L-648,051. In the immediate phase (0-3 h postchallenge), the airway response was significantly reduced at all recordings between 20 min and 1 h postchallenge. In the late phase (3-8 h postchallenge), the pulmonary response was also reduced. However, the reduction was statistically significant only at the 5-h recording. The results suggest that sulfidopeptide leukotrienes are of importance for nonspecific airway reactivity, and that leukotriene D4 is a significant mediator in the immediate asthmatic reaction.


Histamine-induced inhibition of neutrophil chemotaxis and T-lymphocyte proliferation in man.

Histamine inhibits in vitro human neutrophil chemotaxis and T-lymphocyte proliferation via H2 receptors. The aim of this study was to verify these inhibitory effects of histamine in man in vivo. Healthy volunteers were challenged with histamine by intravenous (1 mg), subcutaneous (1 mg) and inhalatory (2.4 mg) routes. Venous blood was taken before and at different times after challenge. Neutrophil chemotaxis was studied by the Boyden assay and T-lymphocyte proliferation by counting H3-thymidine incorporation in cultured mononuclear cells. Plasma histamine was measured by radioimmunoassay. Histamine infusion caused transient systemic symptoms as well as a significant decrease of neutrophil chemotaxis (mean - 26% +/- 6) and of PHA-pulsed T-lymphocyte proliferation (mean - 16% +/- 6) 4 h after histamine challenge. Subcutaneous injection of histamine caused only a significant decrease of neutrophil chemotaxis (mean - 24% +/- 15) 4 h after injection. Histamine inhalation was well tolerated and caused a significant depression of neutrophil chemotaxis (mean - 40% +/- 15) and of T-lymphocyte proliferation (mean - 27% +/- 6) 2 and 4 h after the challenge. Histamine challenges were always accompanied by a rapid and transient rise in plasma histamine. Inhalation of an H2 agonist (impromidine) but not of an H1 agonist (betahistine) caused a decrease of neutrophil chemotaxis and of T-lymphocyte proliferation. Oral pretreatment with an H2 antagonist (cimetidine) before histamine inhalation prevented histamine-induced decrease of neutrophil chemotaxis and T-lymphocyte proliferation, whereas astemizole, an H1 antagonist, had no effect. In conclusion, during the few hours following administration, exogenous histamine in man causes a depression of neutrophil chemotaxis and T-lymphocyte proliferation via H2 receptors.(ABSTRACT TRUNCATED AT 250 WORDS)


Elevated levels of peripheral-blood, naturally occurring aliphatic polyamines in bronchial asthmatic patients with active symptoms.

The levels of peripheral-blood, naturally occurring aliphatic polyamines, such as putrescine, spermidine, and spermine, from 21 bronchial asthmatic patients (11 atopics and 10 nonatopics) were measured by postcolumn derivatization high-performance liquid chromatography analysis. None of the patients, except the 44-year-old woman in the case report below, were given prednisolone, and they were instructed to take only regular medication during the tests. Blood was drawn from the patients in a fasting state, and the polyamine levels were compared between the times when they were free of asthmatic symptoms and when they had mild spontaneous attacks. Nine (5 atopics and 4 nonatopics), 6 (3 atopics and 3 nonatopics), and 4 (3 atopics and 1 nonatopic) out of 20 patients, when they had relatively mild asthmatic attacks, showed higher putrescine, spermidine, and spermine levels, respectively, than those of normal healthy control subjects. The levels of peripheral blood polyamines from a 44-year-old atopic bronchial asthmatic woman, who was admitted to the hospital with severe asthmatic attacks, were measured serially, and the putrescine and spermidine levels were found to be elevated during the asthmatic attacks, returning to normal levels in parallel with the clinical course. These data may suggest a role for naturally occurring aliphatic polyamines in bronchial asthma.


Diurnal variation of urinary histamine and 1-methylhistamine excretion in healthy children.

In order to establish a noninvasive method of monitoring immediate hypersensitivity reactions in children, we studied the diurnal variation of urinary histamine and 1-methylhistamine excretion and the influence of food intake in a group of 14 healthy nonatopic children (aged 2-16 years). Histamine and 1-methylhistamine in spontaneous urine samples were determined by radioimmunoassay. Mean variation of 2-h intervals was much higher for urinary histamine than for 1-methylhistamine (45% of base-line level versus 24%). There was no circadian rhythm or influence of food intake. The short half-life of histamine released into blood circulation may be the main reason for the higher variation of histamine excretion. In children, urinary 1-methylhistamine is less influenced by diurnal variation and is therefore more suited to monitor immediate hypersensitivity reactions than urinary histamine itself.


Clinical atopy and associated factors in primary-school pupils.

To investigate potential risk factors for clinical atopy in childhood, we obtained cross-sectional data from a cohort of 1376 8-year-old pupils. Parental atopy (hay fever, asthma, eczema), gestational age, maternal smoking habits, and the child's history of asthma, hay fever, and eczema were ascertained by questionnaire. Combining the history and the result of a skin prick test using seven aeroallergens, we defined the child's atopic diseases. Of the population evaluated, 25.4% were categorized as atopic (10.2% allergic asthma, 17.3% eczema, 6.9% hay fever). As compared with the clear nonatopics (40.2%), parental atopic diseases were more prevalent in each of the atopic groups. Significant associations of the parents' and child's disease were obvious for eczema and hay fever. Low gestational age (LGA) was more frequent in children with any atopy or with an allergic asthma (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.02-2.97; OR 2.8; 95% CI 1.5-5.4). Hay fever and allergic asthma occurred less frequently in girls (OR 0.5; 95% confidence interval 0.3-0.8; OR 0.6; 95% CI 0.4-0.9). In conclusion, our data underline the importance of parental atopy for the clinical outcome in the offspring. In addition, LGA appears to be a risk factor for allergic asthma and for general atopy in later life.


Occupational asthma in a hairdresser caused by persulphate salts.

Persulphate salts, which are common constituents of hair bleaches, have occasionally been reported to cause occupational asthma in hairdressers. We describe the clinical and immunological studies carried out in a hairdresser who developed cutaneous and respiratory symptoms, about 1 year after being employed in a hairdressing salon. Skin prick tests with 1:5 w/v potassium and sodium persulphate extracts were positive in our patient at 15 min and negative in control subjects. The European standard contactans (ECDRG) and a battery of hairdressing agents were patch tested with positive result to KATHON CG (isothiazolinone). The methacholine-inhalation test showed airway hyperresponsiveness. Bronchial provocation test with a 1:50 w/v potassium persulphate extract elicited a nonimmediate asthmatic reaction, followed by recurrent nocturnal fall in FEV1 lasting up to 3 days after the test. Plethysmography results revealed air trapping caused by a marked increase of airway resistance 3 h after the specific bronchial challenge. Histamine release test was not conclusive, and the determinations of specific IgA, IgM, IgG and IgG subclasses by EIA and IgE by RAST against persulphate salts were negative.


Micellar catalysis in flow injection systems: the nitrosation reaction.

The use of aqueous micellar carrier streams in flow injection is shown to catalyse on-line reactions and thereby improve the sensitivity relative to non-micellar systems. The effect of several different micellar systems on the nitrosation reaction of N,N-diethylaniline in acidic solution was investigated. The mechanism of the micellar enhancement is discussed and the sensitivities of the method in both aqueous and micellar media are compared. The presence of the cationic surfactant, cetyltrimethylammonium bromide, is shown to improve the sensitivity of the analysis. The effect of the micellar solution on the dispersion characteristics of the system was also studied. The greater viscosity of the micellar phase increases dispersion for non-reacting systems, but when monitoring a reaction product the increased reaction rate can counteract this and the micellar carrier can show less over-all dispersion than the aqueous carrier.


Determination of thiocyanate in human saliva and urine by ion chromatography.

A simple ion-chromatographic method has been developed for the determination of trace amounts of thiocyanate in human saliva and urine. Thiocyanate separation and detection were carried out on an ODS column coated with cetyldimethylamine and by an ultraviolet detector, respectively. Citrate solution (1 mmol l-1) was used as the mobile phase. Thiocyanate was clearly separated from many organic and inorganic anions found in saliva and urine samples. The analytical results obtained by the proposed method agreed with those of the Fe(3+)-thiocyanate spectrophotometric method. Thiocyanate concentrations in the saliva and urine of smokers were found to be significantly higher than those of non-smokers.


High-performance liquid chromatographic determination of fatty acid binding proteins in rat liver with fluorescence detection.

A highly sensitive, simple and reproducible method for the quantitative determination of fatty acid binding protein in rat liver by post-column high-performance liquid chromatography with fluorescence detection is presented. Fatty acid binding protein in rat liver cytosols is separated by gel-permeation column chromatography, which is followed by fluorescence detection. The detection makes use of the fluorescence enhancement observed when a fluorescent fatty acid probe, dansylundecanoic acid, binds to fatty acid binding protein. The method is rapid, simple to perform and highly sensitive. The method was applied to the determination of fatty acid binding protein in liver from control and hypolipidaemic drug treated rats.


Determination of femtomole concentrations of catecholamines by high-performance liquid chromatography with peroxyoxalate chemiluminescence detection.

A highly sensitive method for determination of the plasma catecholamines, norepinephrine (NE), epinephrine (E) and dopamine (DA) is described. The method consists of the extraction of the catecholamines, using 3,4-dihydroxybenzylamine as internal standard, from plasma with alumina (5 mg), followed by a reversed-phase column separation, on-column fluorogenic derivatization with ethylenediamine (ED) and post-column peroxyoxalate chemiluminescent reaction detection utilizing bis[4-nitro-2-(3,6,9-trioxadecyl-oxycarbonyl)phenyl] oxalate (TDPO) and hydrogen peroxide. In order to optimize the reaction conditions for high-performance liquid chromatography to obtain highly sensitive detection, the effects of changing reagent compositions on the chemiluminescence yield were investigated. The following are the optimized conditions. Eluent, a mixture of 50 mmol l-1 potassium acetate (pH 3.20)-50 mmol l-1 potassium phosphate (pH 3.20)-acetonitrile (90.15 + 4.85 + 3 v/v/v) containing 1 mmol l-1 sodium hexanesulfonate (40 degrees C) and flow rate, 0.5 ml min-1. Fluorogenic reagent solution, 105 mmol l-1 ED and 175 mmol l-1 imidazole in acetonitrile-ethanol (90 + 10 v/v) and flow rate, 0.25 ml min-1. Reaction coil (15 m x 0.5 mm i.d.) heated at 80 degrees C. Chemiluminogenic reagent solution, 0.25 mmol l-1 TDPO, 150 mmol l-1 hydrogen peroxide and 110 mmol l-1 trifluoroacetic acid in dioxane-ethyl acetate (50:50 v/v) and flow rate, 1.4 ml min-1. The detection limits for all the catecholamines were 1 fmol (signal-to-noise ratio at 2). The standard deviations of the method for the determination of NE, E and DA added to rat plasma (2.5 nM) were 3, 3 and 4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of multiple arteriovenous fistulae in a postphlebitic syndrome of longterm evolution].

Authors report a case of a 77-years-old man who, after an accident of traffic on 1968, presented a left ileo-femoral deep venous thrombosis. Consequently, the patient suffered and important postphlebitic syndrome, with several varicose packs which were treated by surgical procedure in other centre. During several years, patient presented severe trophic diseases. Seventeen years after the beginning of his pathology, and during an angiologic examination, multiple arteriovenous fistulas at the left ileofemoral area have been shown. An skeletalization was impossible because of the severe ulcerations of the leg; so a left iliac arterial ligature and a Dacron Banding in primitive iliac artery, reducing a 50% the diameter, were made. The postoperative result was excellent, with an spectacular reduction of the fistulous communications and a complete remission of the cutaneous ulcerations.


[Intraoperative iliac angioplasty and distal revascularization: is it an efficacious method in the high-risk patient?].

The fact that iliac femoro-popliteal areas are both simultaneously interested in some high risk patients, frequently is cause of several problems in the indication of the surgical treatment. So, we have decided to practice an iliac Angioplasty peroperatively as a method of iliac revascularization in association with the surgical repairment of the femoro-popliteal area. Results of 20 patients with 23 surgical procedures during a period of two years is reported.


[Arterial embolisms in the upper and lower limbs: a clinical review].

A clinical review about the subjects is made. Percentages and comparisons between lower and upper limbs were established. Correlation with statistics from other authors are presented.


[Hemodynamic bases for the automated quantification of the degree of obstruction in the peripheral arteries of diabetic patients].

In order to improve in the early diagnosis of an arterial occlusion, we proposed the bases of an automatized system that allows to recognize the hemodynamic features of diabetic patients in different stadiums of their disease. Fifty-four patients with type-II diabetes were studied. We recorded the arterial flow curves in the bilateral femoral, popliteal, pedia and tibial-posterior arteries from all of our patients. In the distal arteries from patients with hemodynamics disturbances, we found normal values of the variants measured: maximal systolic speed flow (Max A), maximal diastolic speed flow (Max D), Peurcelot's resistance (RP), pulsatility index (PI) and spectral band (SB).


[The functional effect of internal carotid TEA on ocular hemodynamics].

Fifteen patients with a stenosis of the internal carotid artery superior than a 70% were studied in order to analyze the effects of TEA on the ocular hemodynamics. Analysis was made by ophthalmodynamography and electrofunctional studies. An improvement of the ocular hemodynamics was found, particularly by ophthalmodynamography and visual evoked potentials.


[Cleavage fragments of C3 and of dermo-epidermal junction of normal human skin].

Recently, we have demonstrated the presence of C3dg deposits, a cleavage fragment of the third component of complement, on the basement membrane zone (MB) of normal human skin. These C3dg deposits are specific, isolated and not restricted to stratified squamous epithelia. Their origin is not thought to be due to passive incorporation of circulating C3dg within selected MB. Conversely, human keratinocytes are able to synthesize and secrete C3 and could represent a local source for these C3dg deposits. In situ production of C3 by epidermal cells could play a role in local inflammatory reactions. Similarly, a C3dg binding site(s) in selected basement membrane may account for the accumulation of C3-containing immune complexes in such tissues in pathological conditions.


[Physical capacity and some determining factors in the patient with the postphlebitic syndrome].

40 limbs from normal persons and 32 limbs from patients with postphlebitic syndrome were studied. The latter group was classified according to the phlebography in partial and total recanalized postphlebitic groups. The research was carried out with a strain gauge plethysmograph and an ergometric bicycle. The patients showed the greater values of the venous volume, the maximal venous outflow and the rate of venous refilling, specially, the patients with total recanalized postphlebitic syndrome; this suggest a greater degree of venous valve insufficiency and a loss of the viscoelastic properties of venous vascular wall. The peripheral resistance was greater in the postphlebitic groups and it suggests a higher sympathetic nervous tone. The physical working capacity was lower in the postphlebitic patients and no relation was observed between it and the plethysmographic parameters.


[Chronicity and diagnostic doubts of Melkersson-Rosenthal syndrome. Analysis of developing ways in 5 cases].

In order to demonstrate the variability of the muco-cutaneous and neurovegetative signs and symptoms of Melkersson-Rosenthal syndrome (MRS), we report the cases of five out of 80 patients suffering from this complex oro-facial syndrome. In the majority of our patients the major symptoms, and in particular recurrent labial or intraoral swellings and/or facial palsy, did not occur simultaneously, which delayed the definite diagnosis of either complete or incomplete type of MRS. However, more than 80 p. 100 of our patients complained of various relapsing cranio-facial neurovegetative troubles that constitute the so-called minor symptoms of MRS, whereas a history or sequelae of facial palsy were found in only 35 p. 100 of our patients followed up for years or decades. In patients with solitary facial palsy or oro-facial oedemas as the initial symptom of putative MRS, the uncovering of concomitant minor symptoms proves to be helpful for substantiating the recognition of incomplete MRS. Thus, in questionable cases of MRS attention should be paid to seemingly incidental disturbances of the cranio-facial neurovegetative system (e. g., relapsing disorders of lacrimation, sweating, migraine-like headache) forming minor but characteristic hints to incomplete or unusual cases of MRS.


[Narrow-band UVB phototherapy (Philips TL01 lamps) in psoriasis].

The authors report the results of an open study conducted on 53 patients with psoriasis treated by narrow-band UVB phototherapy, using Philips' TL01 lamp. With a simple procedure which did not require MED determination this treatment gave satisfactory results in 92 p. 100 of the cases, with mild burns in only 9 p. 100. The morphological type of psoriasis (patchy, guttate or nummular) had no influence on the therapeutic result, but the degree of infiltration of the lesions and their location on the lower limbs proved to be a factor of relative resistance. In most patients the results were obtained in 20 sessions with a mean cumulative dose of 20.19 +/- 2.7 J/cm2. Some patients had an additional treatment of 6 sessions. The results obtained with Philips' TL01 lamp were as satisfactory as those obtained with the conventional UVB lamps, but the TL01 lamp seemed to be easier to handle and better tolerated, which gives them some advantages over the latter.


[Cutis marmorata telangiectatica congenita: crossed limb dimelia].

We report a case of localized cutis marmorata telangiectatica congenita involving the right upper limb and the left lower limb. This is a rare distribution, with only one case in the literature. The patient, a 22-month old boy, showed no other abnormality.


[Superficial disseminated porokeratosis with dermal amyloidosis].

A case of non-actinic disseminated superficial porokeratosis with dermal amyloid deposits in a 53 year-old-man is reported. The lesions of the trunk and arms were typical, but annular lesions of the ankles were lichenoid. The amyloid deposits were present under the cornoid lamella in the typical lesions and absent in the annular lesions. The different clinical variants of porokeratosis are discussed. The origin of amyloidosis is debated; it seems to be epidermic, due to degeneration of the keratinocytes. The secondary cutaneous amyloidosis is usually described in association with epithelial tumors or psoriasis, but exceptionally with porokeratosis.


[Calcifying panniculitis].

We report a case of calcifying panniculitis which occurred in a 67-year old woman suffering from chronic renal failure and primarily involved anticoagulant injection sites. Calcifying panniculitis is a rare condition belonging to the spectrum of calciphylaxis first described by Selye in 1962. This disease seems to imply necessarily a specific morbid background including renal failure together with calcium-phosphate metabolism impairment. Following the action of a so-called "challenger" (in the present case calcium heparinate [Calciparine], a subcutaneously administered anticoagulant drug), the lesions start as painful subcutaneous nodules soon turning into plaques of necrosis. The area involved mainly includes the abdomen and thighs, due to the preferential distribution of fat and the classical use of such regions for subcutaneous injections. In our patients, histological examination disclosed an initial involvement of subcutaneous fat vessels mimicking mediacalcosis, soon followed by calcium-phosphate deposits within interadipocyte spaces. An electron microscopy study confirmed the presence of calcium crystals within the cytoplasms of some connective tissue cells and the extracellular matrix. From a review of the literature, it seems reasonable to normalize the calcium-phosphate product by reducing hyperparathyroidism as a first therapeutic step. Then, wide surgical excision of the necrotic areas should be performed to rule out any possibility of self worsening of the lesions and provide the best chance of healing without superinfection. The use of diphosphonates on pathophysiological grounds is discussed.


[Erythroderma induced by teicoplanin].

We report the case of a 38-year old man who developed erythroderma during treatment with teicoplanin for staphylococcal septicaemia. The clinical symptoms, which included high fever, shock and erythroderma, were suggestive of staphylococcal toxic shock. After teicoplanin was withdrawn and replaced by vancomycin the disease followed a favourable course. The reintroduction test was positive. This case illustrates the problems associated with the diagnosis of erythroderma in intensive care patients and confirms that it is possible to prescribe vancomycin in cases with allergic reaction to teicoplanin.


[Donor-recipient lung volume matching in double lung transplantation. Value of left lower lobe graft].

For double lung transplantation, lung volume matching is easier comparing the predicted total lung capacities of the donor and recipient and the recipient's true TLC. The major concern in the inability to close the chest when the donor lungs are too large. The technique reported of left lower lobe implantation during bilateral single lung transplantation might be of great value in patients with small lung volume.


[Establishment of a bank of cryopreserved valve homografts and clinical use in ninety-two patients].

Good long-term results obtained with homologous valve grafts, specially for correction of congenital cardiac defects, prompted us to create a local cryopreserved homograft bank. A 5-year experience is described, including indications for harvesting, techniques of preparation, cryopreservation and thawing. During this period, 195 homografts entered the bank and 92 were used. Among these 92 clinical cases, 74 consisted of right ventricular outflow tract reconstruction (47 valved conduit and 27 monocusp bearing patch) and 17 were left ventricular outflow tract reconstructions (11 free hand aortic valve and 6 aortic root replacement). Only one case was a tricuspid replacement with a stented homograft. Short-term results, with these homografts, are satisfactory and are compared with long-term results reported in the literature. The authors insist on using very thorough techniques and constant quality control. New developments should include viability control and immunological studies.


[The internal mammary artery binds more 125I-albumin than the aorta].

The internal mammary artery is currently the arterial replacement of choice for coronary artery bypass grafts. The authors studied the permeability of the vessel wall of the internal mammary artery and the ascending aorta in 12 patients undergoing coronary artery bypass grafts by comparing the 125I-albumin binding profiles. Their results suggest that albumin crosses the internal mammary artery more easily than in the aorta.


[Traumatic rupture of the aortic isthmus revealed by acute obstruction of the descending thoracic aorta].

A traumatic transection of the upper descending thoracic aorta, undiagnosed, was complicated on the tenth day by an acute obstruction of the descending thoracic aorta. The upper body hypertension resulted in generalised convulsions and cardiac failure with pulmonary oedema. The lower body ischemia resulted in paraplegia, acute ischemia of the lower limbs, liver failure and anuria. An emergency revascularisation of the lower body was achieved by axillary-bifemoral bypass. The improvement of the clinical status allowed complete repair of the aortic transection two days after the extra-anatomic revascularisation. This case emphasizes the severity of the cases with impaired blood flow to the lower body and the benefit of the extra-anatomic bypass in pathology of the upper descending thoracic aorta when complete repair of the aortic transection is associated with an extremely high risk.


[Traumatic double rupture of the isthmic aorta. Apropos of an unrecognised case successfully treated by two-stage surgery].

The authors report the case of a 33 year old patient, who underwent an emergency repair of a traumatic tear of the thoracic aorta, after a car accident. This operation was carried out with femoro-femoral cardiopulmonary bypass support. Associated lesions were traumatic tear of the left diaphragm repaired through left thoracotomy during repair of the aorta, rupture of the liver and multiple fractures of the left superior limb. Postoperative course was marked by liver hemorrhage and septicemia. Orthopedic treatment of the various fractures was performed. The course of thoracic lesions was uneventful. An aneurysm of the aortic isthmus was revealed during venous digital subtraction angiography routinely performed 60 days after surgery. The patient was reoperated with femoro-femoral bypass support. A second incomplete tear of the aorta, missed during the first operation was discovered 3 cm above the suture of the first one. This lesion was easily repaired and the post-operative course was uneventful. The value of systematic control angiography after aortic traumatic repair is emphasised.


[Postoperative acute aortic dissection. Apropos of two cases].

Aortic dissection after cardiac surgery is a rare complication. The prognosis is often poor: 33-78% of mortality. The study of two cases out of 2100 patients operated upon during the last three years, and the review of the literature, allows to recall the mechanism, the anatomic origin and the different surgical techniques. Early diagnosis is essential. Some preventive techniques may reduce the incidence of the iatrogenic dissections.


[Total anomalous pulmonary venous return in a 61 year-old adult].

The authors report a case of total anomalous pulmonary venous return successfully treated by surgery in a 61 year-old man. This case is unusual because of the late discovery of this congenital malformation which is usually rapidly fatal in the absence of surgical correction. This prolonged survival can be explained by the large atrial septal defect and the absence of obstruction, to pulmonary venous return and associated malformations. Surgical repair is essential to prevent the development of irreversible lesions of the right side of the heat and the pulmonary arterial bed.


[Radiation-induced sternal tumors: value of myocutaneous flap of the latissimus dorsi].

Two patients treated by radiotherapy, one 13 years previously for Hodgkin's thymoma and the other 10 years previously for breast cancer, presented with a radiation-induced sternal tumour. The first case had undergone manubriectomy for fibrosarcoma complicated by dehiscence of the skin wound one year prior to referral to our unit: she presented with a haemorrhagic ulcerated recurrence. The lesions were widely excised (skin defect: 13 x 13 cm). The second patient underwent "en bloc" cutaneo-osteomyopericardectomy with omentoplasty onto the pericardium and sternal prosthesis (skin defect: 12 x 7 cm). These tumours are rare, but the radiation-induced skin damage requires wide excision. In both cases, the skin defect was easily repaired by means of a latissimus dorsi myocutaneous flap.


[Lobectomy extended to the main bronchus in the treatment of bronchial cancer (seventy-three cases)].

Sleeve allow excision of bronchial carcinoma in patients not able to functionally tolerate pneumonectomy. Our series consists of 73 patients operated over the last thirty years. Implantation of the bronchus was treated either by wedge resection or by complete resection followed by reimplantation. This procedure was performed for respiratory functional reasons in 39 cases (53%), on principle in 27 cases (37%) and in palliative indications in 7 cases (10%). The high perioperative mortality (6.8%) and morbidity (20%) were related to bronchovascular complications which were eliminated over the last decade. Local recurrences (23%) were more frequent than following conventional resections. On the other hand, the survival, 80% at one year, 62% at 2 years, 54% at 3 years and 39% at 5 years, related more to metastatic dissemination than to local recurrence, was comparable to that of the control group of pneumonectomised patients. This procedure gave identical results in terms of survival, but should be reserved for patients with respiratory failure due to the increased risk of local recurrence.


[Non-malignant esophagotracheal fistulas in adults. Experience with 35 cases].

Esophagotracheal fistula always constitutes a serious, life-threatening complication. Fistulae occurring during medical intensive care with mechanical ventilation are currently the most frequent. Their diagnosis was strongly suspected by clinical examination of the patient, but was always confirmed by endoscopy which revealed their exact site in relation to the vocal cords or carina, essential information for the choice of incision when it is decided to perform surgery. Twenty-five patients were treated medically. Treatment was always combined with gastrointestinal resting, control of gastro-oesophageal reflux and broad-spectrum systemic antibiotics. There were 19 deaths and 6 fistulae closed spontaneously. Three of these 6 patients developed a secondary tracheal stenosis, 2 of which were treated surgically by resection-anastomosis. Ten fistulae were closed surgically with a good long-term result. The indication for surgery was essentially based on the patients general and infectious status and on his or her respiratory autonomy. Technically, we always combined direct suture of the two organs with interposition of muscular or pleural tissue.


[Endobronchial neurogenic tumors].

Endobronchial neurogenic tumours are exceptional and little known. The authors report two cases of such tumours: a neurofibroma of the right main bronchus in a 32 year old man and a schwannoma of the left main bronchus in a 10 year old child. Pneumonectomy was necessary in both cases due to destruction of the pulmonary parenchyma distal to the obstruction. The incidence of this type of tumour is estimated to be between 0.2 and 4%. They may be either schwannomas or neurofibromas, the discovery of which always raises the problem of the possible association of von Recklinghausen's disease malignant forms, neurogenic sarcomas or malignant schwannomas may also be encountered. The diagnosis is based on endoscopy which reveals the tumour and allows biopsy. Treatment of these essentially benign tumours should be conservative, provided the diagnosis is made early, prior to parenchymal destruction. The prognosis is poor in the malignant forms and chemotherapy may be useful in malignant schwannomas.


[Pseudotumoral thoracic actinomycosis with lung and brain metastases. Apropos of a case. Review of hundred thirty one cases in the literature].

One particular case of thoracic actinomycosis is reported. The patient presented with a neurological picture mimicking a metastasis, as chest radiogram and CT-Scan indicated a primary pulmonary tumor. Diagnosis of actinomycosis was overlooked and final diagnosis was based on direct microscopy of lung tumor, which required a thoracotomy, without any resection. Antibiotic treatment with penicillin was successful as the cerebral lesion was completely cured within 2 months and the thoracic lesion reduced 2/3rd volume within the same delay. The importance of correct handling of tissue specimens and adequate informations to the microbiologist are emphasized. Another point of interest is that good clinical results can be expected from prolonged antibiotic treatment. Surgery must be reserved for diagnosis if no other means has been effective, for failure of medical treatment or for acute complications.


[Injection of collagen in recurrent paralysis after thoracic surgery].

The author describes a new technique of treatment of recurrent laryngeal nerve paralysis by intra-cordal injection of collagen after thoracic surgery. After description of the collagen used and the technique of injection, the author presents the results. It is a new method, simple, efficient, well tolerated, giving patients a voice, and treating their swallowing troubles.


[Value of limited resections in the surgical treatment of lung cancers].

From 1969 to 1990, 88 limited lung resections were performed for the treatment of malignant lung tumours. These operations consisted of 73 typical resections (29 segmentectomies, 15 bisegmentectomies, 23 middle lobectomies, 6 lingulectomies) and 15 atypical resections. In 15 cases, they were completed by lymph node dissection. These operations were performed in patients with a mean age of 55.8 years (range: 24 to 76). The ventilatory functional status contraindicated wider resection in only 7 cases. The immediate postoperative mortality (7 cases, i.e. 8%) and the postoperative complications observed in 29.6% of cases were higher than those observed after wide resections, but do not constitute a specific argument in the indication for partial resection. Histological examination of the operative specimens revealed 80 primary lung cancers (42 squamous carcinomas, 28 adenocarcinomas, 8 anaplastic and unclassifiable tumours, 1 bronchiolo-alveolar tumour and 1 malignant carcinoid tumour). The primary nature of the tumour could not be definitely confirmed in the other 8 patients (history of head and neck neoplasm in 7 cases and bladder carcinoma in 1 case). The survival according to TNM stage, histological nature of the tumour, positivity of the resection margins and intraoperative tumour effraction was identical to that associated with lobectomies.


[Forgotten mediastinal goiter: seven cases].

The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.


[Cystic tumor of the mediastinum of digestive origin. Apropos of a new case. Diagnostic and pathogenic hypotheses].

An incidental discovery of a posterior and inferior mediastinal cyst-like opacity allowed us to diagnose a pulmonary sequestration in a 45-year old woman. The operative findings showed an hour-glass tumor of the inferior mediastinum with an abdominal prolongation attached by a stalk onto the top of the stomach. These findings made us change our diagnosis in favour of an abdomino-thoracic gastric duplication. This new hypothesis was not confirmed by the results of the pathological report which revealed two kinds of tissue; intestinal in the abdomen and broncho-pulmonary in the chest. Two diagnoses where then proposed: complex hamartoma or mediastinal bronchogenic cyst. The pathogenic interpretation in such cases is still very controversial. English authors are prone to classify them as broncho-pulmonary foregut malformations. Macroscopic and microscopic data of the specimen led us to consider our case-report to be a foregut malformation.


[Early hospital discharge after uncomplicated myocardial infarction: strategies].

Considerable advances have been seen in recent years in the diagnostic and therapeutic management of myocardial infarction. Furthermore, approximately 50% of patients hospitalised for a myocardial infarction have shown no evidence of any complication by the 3rd day of the disease. With this in mind, the authors show that early discharge from hospital at the end of the first week is possible in perfect safety for the majority of these patients, most often treated by thrombolysis, based upon precise knowledge of the severity of arterial disease and of left ventricular function, and the detection of any residual ischemia or possible rhythm disturbances. Only patients with three vessel disease have a higher risk of residual angina and should theoretically be excluded from such programmes. Ambulatory rehabilitation is an essential adjuvant, contributing to a faster return to work and a decrease in health care costs.


[Left ventricular relaxation and hypertension. Effect of captopril on gamma-angiographic parameters].

In order to evaluate the action of captopril on left ventricular filling in hypertension, 14 hypertension (158 +/- 10/101 +/- 5 mmHg) patients aged 51 +/- 6 years were investigated by Technetium 99m gamma-angiography. The time/activity curve was used to determine the maximum filling rate (MFR) and maximum filling time (MFT) of the ventricle before and after treatment with captopril (mean dose : 44 +/- 26 mg/day for 7 months). Blood pressure was significantly lowered by treatment and there was a decrease in left ventricular mass from 128 +/- 17 to 118 +/- 15 g/m2 (p = 0.07). Maximum filling rate was accelerated by treatment from 2.27 +/- 0.57 to 2.57 +/- 0.43 VTD . s-1, p = 0.005). This variation was due essentially to half of the patients, suggesting an "all or nothing" type response. Maximum filling time did not vary. The basic question raised by this type of study is to know whether the improvement in the available relaxation parameter, MFR, was associated with actual improvement in filling, which is the true aim. Although the explanations offered for the observed findings are hypothetical, taking into account of all the trial data together with the morphological data provided by echocardiography suggests that captopril does have an actual and hemodynamically significant action on filling.


[Slow ventricular tachycardia caused by naftidrofuryl overdose (naftidrofuryl and ventricular tachycardia)].

Treatment with intravenous naftidrofuryl may be complicated by ventricular arrhythmias. A case of slow ventricular tachycardia occurring in a 65-year-old man with a dilated cardiomyopathy following an accidental overdose of naftidrofuryl (2 x 200 mg ampules in 250 ml of 5% glucose solution in 2 hours) prescribed for complicated arterial disease of the lower limbs is reported. This sustained ventricular tachycardia converted spontaneously after several hours. This case emphasises the risk of arrhythmogenic effects of this drug and indicates the need for careful monitoring when it is used intravenously in patients with underlying heart disease.


[Primary leiomyosarcoma of the pulmonary artery. Apropos of a case. Review of the literature].

A 59-year-old woman hospitalised because of dyspnea and a heart murmur in a context of pyrexia was found to have evidence of obstruction of the pulmonary arterial system, clearly defined by ultrasonography, catheterisation and angiography and Imatron scan. The particular feature of this fifth reported case of pulmonary artery leiomyosarcoma is its documentation by transesophageal ultrasonography and tumor biopsy during catheterisation. Surgery with partial excision of the tumor was followed by survival for 6 months, bearing in mind the absence of chemo- or radiosensitivity of this type of tumor. Cases from the literature are reviewed.


[Cerebral abscess disclosing congenital heart disease].

Cerebrovascular accidents and brain abscesses are the most worrisome complications of cyanogenic cardiac lesions in infants and young children, but remain rare in the adult. The authors report the case of a brain abscess which led to the subsequent discovery of a congenital cardiac malformation consisting of a ventricular septal defect and moderate pulmonary valve stenosis. Complete correction of the cardiac lesions was carried out three months after neurosurgical treatment (needle biopsy/drainage).


[False aneurysm of the left ventricle during the acute phase of myocardial infarction: diagnosis by transesophageal echocardiography].

The authors report a case of myocardial infarction complicated by a false aneurysm of the posterior wall of the left ventricle, the diagnosis of which was confirmed, for the first time, by transesophageal echocardiography (TEE) which provided better definition of the anatomical features of the lesion: visualisation of the particularly wide neck (5 cm) and the site of rupture of the myocardium; demonstration of the presence in the false aneurysm with a thin pericardial wall of a large thrombus of different acoustic density, itself overlain by swirling whorls. Colour Doppler combined with TEE clearly showed the acceleration of flow at the neck and its slowing in the newly formed cavity. Once the diagnosis was made, the patient rapidly underwent surgery with a successful outcome. The quality of the images obtained without risk by TEE suggests the important role which this investigation could play in the future in the diagnosis of certain mechanical complications of myocardial infarction.


[Arteriovenous fistula following surgery of intervertebral disk].

Vascular damage during intervertebral disc surgery is uncommon. It sometimes leads to the formation of an arteriovenous fistula and about one hundred cases have been reported in the literature. The diagnosis is often early, with signs of venous hypertension predominating. The authors report a case of arteriovenous fistula presenting late as apparently primary congestive cardiac failure. The mechanisms of this condition were demonstrated during preoperative instrumental manoeuvres. Surgical correction is the only treatment alternative. Repair must be arterial and venous, most often using prosthetic material. This generally enables total and permanent recovery, but overall mortality in pathology of this type is not nil.


[Right ventricular dysplasia].

Arrhythmogenic right ventricular dysplasia is responsible for ventricular tachycardia affecting an apparently healthy heart. It can sometimes lead to sudden death, which may be the presenting symptomatology of the disease. It results from fibro-adipose infiltration of the free wall of the right ventricle, and sometimes of the septum, possibly secondary to myocarditis. The prognosis depends upon the quality of the left ventricle. If it is healthy, the only risk is that of arrhythmia. Treatment using anti-arrhythmic drugs is most often effective and, with proper management, the prognosis is good and the risk of sudden death eliminated. If the left ventricle is abnormal, there is the risk that dysplasia associated with arrhythmia will progress to right then congestive cardiac failure in the context of a dilated idiopathic cardiomyopathy with ventricular tachycardias originating on the right side. Arrhythmogenic right ventricular dysplasia is a notable cause of sudden death in athletes. Routine screening of such individuals is justified, as is that of those with high risk occupations (locomotive and vehicle drivers, etc.).


[Combination of oral administration of cibenzoline and digoxin in patients with supraventricular arrhythmia].

Chronic co-administration of digoxin and several antiarrhythmic drugs increases digoxin plasma levels. To determine the effects of the administration of oral cibenzoline on digoxin plasma levels and its effects on clinical and electrocardiographic parameters, we conducted a prospective multicenter study in 22 cardiac patients with a mean age of 66 +/- 12 years (39-85), who were on long term digoxin therapy (0.25 mg once daily for at least 2 weeks) and who required oral cibenzoline therapy in the prevention of recurrence of symptomatic atrial tachyarrhythmias. Cibenzoline was given for 4 weeks at a dose of 130 mg twice daily in patients aged less than 70 years (group I, n = 15) and this dosage was reduced by half in patients over 70 years of age (group II, n = 7). Evaluation of the effects of this combination on clinical and electrocardiographic tolerability as well as the drawing of blood samples for assay of cibenzoline and digoxin took place before and after 4 weeks treatment with cibenzoline. The digoxin plasma levels were (mean +/- sem) 0.96 +/- 0.1 ng.ml-1 before cibenzoline administration and remained unchanged after 4 weeks of combination therapy (1.0 +/- 0.1 ng.ml-1), p > 0.05. Digoxin plasma levels in group I varied from respectively 0.8 +/- 0.1 ng.ml-1 (0.5-1.7) to 0.8 +/- 0.1 ng.ml-1 (0.4-1.5) and in group II from 1.2 +/- 0.2 ng.ml-1 (0.6-2) to 1.4 +/- 0.3 ng.ml-1 (0.7-2.5). This therapy was well tolerated in 16 patients out of 21 evaluable patients (76%) and there was no significant change in vital signs during the study.(ABSTRACT TRUNCATED AT 250 WORDS)


[Efficacy and tolerance of propafenone in the prevention after a year of recurrent atrial arrhythmia. Results of a multicenter study of 114 patients].

One hundred and fourteen patients were included in an open multicenter trial of the prevention of atrial arrhythmias by propafenone and of the tolerability of this anti-arrhythmic agent after a year. The study population was divided into two groups: group I of 45 patients with only runs of arrhythmias and group II of 69 patients with a stable arrhythmia. Patients were seen again after 2 weeks, 3 and 6 months and 1 year. Holter records were obtained routinely in group I and at 6 months in group II. Treatment was stopped for inefficacy in 30 patients (10 of group I, 20 of group II), for intolerance in 10 patients (5 in each group) and for both in 3 patients (1 in group I, 2 in group II). Propafenone was considered to be effective and well tolerated in 55 per cent of patients, this success rate being identical in the two groups. Effectiveness persisted in a stable fashion at 1 year in those patients who responded initially.


[Findings of bile duct ultrasonography in 100 patients with AIDS in black Africa].

A systematic study of bile ducts by abdominal echotomography on 100 African patients affected by AIDS disease has showed 11 bile ducts abnormalities (7 alithiasic cholecystitis and 6 inflammatory cholangitis, associated in 2 cases). The patients studies showed several associated infections, particularly a pulmonary tuberculosis and/or extra-pulmonary. The etiology of bile ducts attack has not been formally specified: lack of Cryptosporidium at the stools parasitologic exam, but presence of several opportunistic germs, or no, in the several samples (blood, cerebrospinal fluid, stools, expectoration).


[Exudative enteropathy in disseminated lupus erythematosus].

We present the case of a young woman with a protein-losing enteropathy occurring in the context of systemic lupus erythematosus. This rare complication has limited gastro-intestinal manifestations and must be systematically looked for when hypoalbuminemia occurs in the absence of a lupus nephritis. High dose corticosteroids therapy (> or = 1 mg/kg/day of prednisone) usually leads to recovery, and should be the first treatment attempted. If this treatment is ineffective, bolus injections of methylprednisolone (1 g/day for three days) may be recommended. Immunosuppressive therapy should be given only if the above treatments are ineffective, or in case of cortico-dependency.


[Bacterial ecology of the digestive tract and defense of the body].

The indigenous microflora of the upper digestive tract is poorly developed and consists of microorganisms in transit, originating in the oro-pharynx. Aerobic bacteria, mainly streptococci, predominate. In the normohydrochloric stomach, the mean fasting bacterial concentration is 10(3)-10(4)/ml gastric juice. In the small intestine, levels of up to 10(5) bacteria/ml contents are reached. The essential mechanism which maintains this relative sterility of the upper digestive tract is the gastro-intestinal transit and in particular the interdigestive migrating motor complex. In the terminal ileum, a zone subject to relative stasis, the intraluminal bacterial population rises to 10(8)/ml in one third of subjects, with the appearance of enterobacter and strict anaerobes. In the colon, a zone of physiological stasis, the number of microorganisms per ml of contents is 10(8)-10(9) on the right side and 10(10)-10(12) on the left side. The dominant flora is strictly anaerobic and the subdominant flora optionally aero-anaerobic, consist mainly of Enterobacter, Streptococci and Lactobacilli. The balance between the species of microorganisms in the colonic ecosystem and its stability results primarily from microbial antagonisms. The barrier flora, consisting of groups of anaerobes, either prevent the implantation of exogenous microorganisms (drastic barrier) or limit it to the subdominant flora (permissive barrier). The repression of the subdominant flora by the dominant flora prevents the subdominant flora from spreading to the mesenteric ganglia and then the whole body. Rupture of the barrier flora by a wide-spectrum antibiotic may permit the local multiplication of a pathogenic organism (C. difficile, Salmonella), or the spread of an opportunist organism (Klebsiella pneumoniae).


[Food poisoning outbreaks: an epidemiological study].

The occurrence of foodborne disease outbreaks (FDO) is increasing in industrialized countries. Most of these outbreaks (2/3) are notified from restaurants and other commercial establishments but more and more from households. Salmonella is the major agent of FDO, especially S. enteritidis for five years. However, its role may be overestimated because inadequate microbiological techniques routinely performed. Despite recent progress, several outbreaks still go unnoticed. Every outbreak should be early investigated, with methodical collection of clinical, bacteriological and food data, followed by statistical analysis. Once identified the responsible pathogen, the contaminated food, the source of contamination and the bacterial growth enhancing factors, rapid control measures can prevent further epidemics. Compulsory notification of all FDO to the public health services is the condition for the reliability of a national surveillance programme.


[Should travelers' diarrhea be prevented and/or treated?].

The prevention of traveller's diarrhea should be limited to the evaluation of drinking water, the avoidance of certain foods and careful hygiene of the hands. Although their efficacy is somewhat controversial in this context, these precautions at any event reduce the risk of acquiring other feco-orally transmitted diseases. Because of the increasing resistance of the bacteria responsible and their multiplicity, early treatment of any actual case of traveller's diarrhea is preferable to prophylactic antibiotics. Therapeutic indications vary according to the severity of traveller's diarrhea and the general condition of the patient. Travellers must be aware of these considerations before their departure.


The Lipomycetaceae, a model family for phylogenetic studies.

The Lipomycetaceae (Endomycetales) are known from the genera Dipodascopsis, Lipomyces and Zygozyma with budding anamorphic states in Myxozyma. The family is easily recognized culturally and physiologically but is phenotypically and ecologically extremely diverse. This natural taxon is phylogenetically distinct from the Saccharomycetaceae, but probably related to the Dipodascaceae. The possible evolution of the lipomycetaceous anamorphs is discussed.


Evidence for, and taxonomic value of, an arachidonic acid cascade in the Lipomycetaceae.

By using specific inhibitors of the lipoxygenase and cyclo-oxygenase pathways, arachidonic acid metabolites with similar sensitivities towards these inhibitors as in humans, were detected in Dipodascopsis uninucleata. The taxonomic value of aspirin sensitive arachidonic acid metabolites in the Lipomycetaceae was next assessed. No metabolites of which the production is inhibited by aspirin were detected in strains representing the following species: Lipomyces starkeyi, Lipomyces kononenkoae, Lipomyces tetrasporus, Myxozyma melibiosi, Myxozyma mucilagina, Myxozyma kluyveri, Waltomyces lipofer, Zygozyma oligophaga and Zygozyma arxii. The detection of such aspirin sensitive arachidonic acid metabolites in representative strains of Lipomyces anomalus and the genus Dipodascopsis, emphasises the isolated position of these taxa in the genus Lipomyces and the family Lipomycetaceae, respectively. Finally using long chain fatty acid analyses, electrophoretic karyotyping and other phenotypic characters, a phylogenetic scheme is proposed for some genera in the Lipomycetaceae.


[The intraluminal transport of vitamin B12].

Since the existence of vitamin B12 was suggested by Castle in the first few decades of this century, vitamin B12 has been the subject of many studies which have proved the high complexity of its assimilation by the organism. Over the last few years the marked progress in functional digestive exploration methods and the physical and the chemical characteristics of biological molecules have revived the established idea of the vitamin's intraluminal transit. Our recent studies have been concentrated on the bilio-duodenopancreatic stage of the vitamin B12 transport. In nature, vitamin B12 is only exceptionally met in its free form, it is always associated with a binder. Like a ball being passed from one player to another it moves between binders. Alimentary vitamin B12 released from its protein complexes by culinary preparation and gastric secretions, is combined with haptocorrin. In the duodenum the transfer of B12 on intrinsic factor is due to partial degradation of haptocorrin by pancreatic enzymes and intraluminal pH balance. Then combined with intrinsic factor the vitamin can be caught by the ileal receptor. The partial degradation haptocorrin joins vitamin B12 analogs from excreted bile or synthesized by the intestinal microorganisms.


Myxozyma neotropica sp. nov. (Candidaceae)--a new yeast species from Costa Rica.

Two strains of an undescribed, soil-borne species of the genus Myxozyma were recovered. They differ from other accepted species of this genus in their carbon assimilation pattern, mol% G+C and low extent of DNA complementary. A description of the new species, Myxozyma neotropica, and a key to the species accepted in the genus are given.