[Electrocardiography in pediatrics. 1: Critical considerations of methods and experimental findings].

The results of experimental cardiology are reported on the basis of the electrophysiology of the heart. The QRS complex of the ECG, representing the spread of excitation through the ventricles, is used as an example to reflect the physiological and pathological events of the heart. The limitations of this example arise from the uncorrected recordings of the potential differences from the body surface. The need to use corrected lead systems is pointed out. The most commonly used FRANK lead system is extremely sensitive to the inaccurate positioning of lead points on the thorax. Evidence for this drawback is given by experimental findings in infantile and juvenile rats. It is clear that inaccurate positioning of electrodes is especially crucial in small subjects. A fundamental criticism of the FRANK lead system used in growing subjects is the impossibility of eliminating the errors caused by the changing geometry of the thorax of children of different ages. Improvement of the physical correction of ECG recordings in children for the purpose of reliable diagnostics is vital.


[Help for behaviorally disordered children and their families].

1. A comprehensive survey is given on the divergence of opinions on child education in this century. 2. The aim of this survey is to find out the causes of children's behavioral disorders using psychoanalytical methods. 3. The factors of behavioral disorders occurring in families today are discussed. 4. Conclusions for psychoprophylaxis and -therapy of behavioral disorders of children are drawn. They describe the important roles of parents, pediatricians and psychologists and the social responsibilities of the family of a child suffering from a behavioral disorder.


[Electrocardiography in pediatrics. 2: Recommendations for a newly introduced recording and evaluation procedure].

ECG recordings were made by means of a modified NELSON-lead system in a total of 100 children aged between 2 weeks and 59 months. Software developed by ourselves served for on-line calculations of the dipole moment D which is graphically represented by vector loops in three projection planes, horizontal, frontal and sagittal. In addition, the maximum spatial vector Dmax and the mean vector A are calculated by the program. The examination of one child including positioning of 20 electrodes and production of a hard-copy of the results takes no longer than 15 minutes. The children were unsedated and awake when the ECGs were recorded. The results show the continuously growing dipole moment and its gradually changing direction from the right posterior or left anterior to the left posterior quadrant in parallel with the growth of the body and the heart, respectively. The smallest vector magnitudes and smallest vector loops of the dipole moment are measured in the youngest infants (0-2 months) while very high voltages in conventional ECGs of infants are regularly seen, predominantly in the precordial region. Two examples of pathological NELSON-ECGs are reported. One case is a boy aged 4 years 10 months with aortic supravalvular stenosis, the other one is a girl aged 4 years 3 months with pulmonic valve stenosis. These cases demonstrate the excellent suitability of this noninvasive method as a diagnostic tool for pediatric cardiology.


[Circumcision for prevention of penis and cervix cancer? Results of a parent survey].

Results of questioning young parents--582 by direct questioning and 624 by questionnaires--about their knowledge of male circumcision are presented. 61% of those directly questioned and 24% of parents polled by questionnaire did not know what circumcision means. The older the parent and the higher their professional qualifications, the greater their knowledge. Reasons for circumcision were divided into four categories: surgical, hygienic, prophylaxis of cancer and cosmetic. Health education about genital hygiene and circumcision is necessary.


[Congenital syphilis].

Four infants with Lues connata, three with the early stage of the disease (patients 1-3), are reported. Diagnosis was made after exclusion of other diseases. Initially an infectious disease was expected, since anemia, leucocytosis, thrombocytopenia, hepatomegaly and/or splenomegaly and a bad condition were found. In two patients bone structure was abnormal. Elevated serum concentrations of liver enzymes (ALAT, ASAT) were the indication for liver biopsy in one patient, in whom an accompanying hepatitis was diagnosed. Treatment was performed with penicillin, no JARISCH-HERXHEIMER reaction was observed. The Lues tests were negative during pregnancy but a displacental transfer of pathogenic agents could be assumed. Patient 4 was diagnosed at 9 months of age. Infection of the mother probably occurred in the last 6 weeks of pregnancy. It can not be decided if the baby has a connatal or acquired Lues. The titer decrease of the CMT-test after the end of the penicillin therapy is a marker for a successful treatment. If treatment was started at 2 years of age a total clinical recovery can be expected. The case reports demonstrate that negative Lues test during pregnancy do not exclude Lues connata in newborns. The Lues diagnosis should be considered if an infectious disease in a newborn can not be diagnosed. A general Lues serodiagnostic test is recommended in all newborns before they leave the obstetrics department.


Transepithelial potential difference in the bronchial system of children with chronic bronchitis and bronchial asthma.

In 45 children with chronic non-specific respiratory diseases (CNSRD), 18 with bronchial asthma and 27 with relapsing or chronic bronchitis, the transepithelial potential difference (tpd) was measured in the tracheobronchial system (bronchoscopy under general anaesthesia). The statistical variation in the tpds was highly significant. In asthmatics with significant eosinophilia in the bronchial secretions of the main bronchus we found a tpd of 26.5 (+/- 8.5) mV and in bronchitics a tpd of 18.2 (+/- 6.3) mV. This suggests that the presence or absence of eosinophils in the secretions, the products of intermediate cell metabolism or different pathogenetic processes, could be responsible for the variety of change in the tpd measured in the respiratory tract.


[Results of studies with the Meyer-Probst Encephalopathy Questionnaire in children with normal behavior].

To diagnose encephalitis the 'Encephalitis-Fragebogen (E-F)' by Meyer-Probst is a valid instrument. The authors tested a large number of children without unadaptive or neurotic behaviour (4.5 to 11.9 years) with this instrument to define new standards. Parts of the results are presented. There are very significant differences between boys and girls. Considering the age, different standards are necessary only for boys. Using these new standards it is possible to avoid misinterpretation.


[Differential evaluation of a study of children with normal behavior with the Meyer-Probst Encephalopathy Questionnaire].

To define new standards for the 'Enzephalopathie-Fragebogen' by Meyer-Probst the authors tested a large number of children (n = 2841) without unadaptive or neurotic behaviour (4.5 to 11.9 years). The results of the total scale were published in an earlier article. The findings of the specific scales prove significant differences between boys and girls with respect to the scales hyperactivity, social adaption, emotional instability and educability. Considering the age, different standards are necessary for boys only. The results published here differ from those of Meyer-Probst.


[Diagnostic and therapeutic aspects of cerebral seizures caused by pseudohypoparathyroidism].

The knowledge of the pseudohypoparathyroidism is of great importance since the consequence of inadequate treatment may be serious. The most important features of the pseudohypoparathyroidism are the hypocalcemia and seizures. The following case concerns a patient with pseudohypoparathyroidism; the clinical symptoms and treatment of this disorder will be discussed.


Experience in management of diminished growth in adolescent Turner's syndrome patients.

The aim in the management of patients with Turner's syndrome, besides substitution of sexual steroids, is the attempt to improve their final height. The data allow therapeutic recommendations, which, however, realize only the first intention. The final height, indeed, cannot be improved by traditional methods. Further two alternatives remain to be tested: long time low dose estrogen therapy, and high dosed HGH application.


The effect of N-acetyl-cysteine (Mucosolvin) on the transmural potential difference of the mucosa in children.

The mucosa of the respiratory and gastrointestinal tract produces an active transepithelial (or transmural) electric potential difference (tpd), which can be measured (in millivolts, mV). In CF-children receiving oral N-acetyl-cysteine treatment, the tpd of the buccal mucosa is largely the same as that in non-CF-children; the tpd of the nasal mucosa is significantly higher in CF-children. Given orally, N-acetyl-cysteine also provokes a significant decrease in the rectal mucosa tpd in CF-children. We suggest the effect is caused either by an osmotic effect of N-acetyl-cysteine (local), and/or by alteration of the factors regulating basal electrolyte transport/conductance of epithelia (chloride secretion? leaky junction?).


Indirect composite resin crowns as an esthetic approach to treating ectodermal dysplasia: a case report.

This article presents a case report describing the indirect fabrication of composite resin crowns for the restoration of primary anterior teeth. A 3-year-old with a confirmed diagnosis of hypohidrotic ectodermal dysplasia was provided with composite resin crowns that were both esthetic and functional. The indirect method decreases clinical time, provides a durable restoration, and allows treatment of patients who lack the cooperative ability to endure prolonged direct bonding appointments. The indirect technique may be feasible for the restoration of carious teeth as well as the presented case.


Glass-ionomer-silver-cermet interim Class I restorations for permanent teeth.

Glass-ionomer-silver-cermet cement has proved to be a worthy alternative to silver amalgam for restoring certain Class I lesions in primary teeth. Such restorations are now known to last up to 8 years without need for repair or replacement. Cermet cement has also been used for interim restoration of permanent teeth in special cases, with ideal results. The procedure for placing a glass-ionomer-silver-cermet cement Class I restoration is described.


Disocclusion time-reduction therapy with immediate complete anterior guidance development to treat chronic myofascial pain-dysfunction syndrome.

Successful treatment of chronic myofascial pain-dysfunction syndrome by disocclusion time-reduction therapy has been shown to be effective in 1 to 3 months, with the major muscular changes occurring in the first 30 to 40 days following initial therapy. Disocclusion time reductions have been previously reported to quickly reduce or eliminate numerous symptoms of chronic myofascial pain-dysfunction syndrome. Proper modification of an existing occlusal scheme from one that contains lengthy disocclusion time to one with short disocclusion time can be accomplished by implementing the method of occlusal adjustment known as immediate complete anterior guidance development. This paper describes the proper clinical occlusal adjustment methodology using a computerized device that shows the measurement and subsequent reduction of excessive disocclusion time. This directly lessens elevated contractile muscle activity, which leads to rapid muscular recovery of the involved dysfunctional muscle groups.


Clinical procedures in fabricating post and core restorations: case reports.

In this series of case reports, unusual clinical procedures in the implementation of post and core restorations are demonstrated and their difficulties are discussed. First a method for preparing an immediate post and amalgam core, while utilizing the provisional self-curing acrylic resin crown as a matrix for the condensation of amalgam, is presented. The second technique is the fabrication of a cast post and core restoration that fits an abutment root as well as the existing crown of a four-unit fixed restoration. The third case illustrates the clinical procedures involved in preparing an immediate post and core restoration through an opening in the crown, when the extended fixed restoration cannot be removed.


Intentional replantation: report of a successful case.

Irreversible iatrogenic damage sometimes occurs during dental treatment. In certain cases, intentional extraction, repair, and replantation can be used to save the damaged tooth. This case report describes the successful replantation of a premolar that had sustained a large root perforation.


A 3-year clinical study of a hybrid composite resin as fissure sealant and as restorative material for Class I restorations.

After 3 years, 78.0% of 64 reexamined fissure restorations (extended sealants) and small occlusal restorations were clinically acceptable or excellent, and 21.9% had to be repaired or replaced because they had fractured (6.3%) or were no longer clinically acceptable by some other criterion (15.6%). The conservative preventive resin restoration seems to be an effective treatment for small occlusal defects. Meticulous dental hygiene by the patient and regular examinations by the dentist are mandatory.


Restoration quality in relation to wedge-mediated light channeling.

Thirty large mesio-occlusodistal cavities with their margins totally in enamel were restored using the three-sited light-curing technique in five different ways: group 1 = Mark I version of a light-reflecting wedge; groups 2 and 3 = interproximal curing with transparent, nonreflecting wedges; groups 4 and 5, Mark II version of the light-reflecting wedge with increased resiliency. In groups 3 and 5, the light that was not conducted by the transparent wedges was shielded by a piece of aluminum foil. It was found that, when used directly and unshielded, both Mark I and Mark II versions of the light-reflecting wedge induced significantly better marginal adaptation than the transparent, nonreflecting wedge, especially gingiovproximally. With both the nonreflecting and reflecting wedges, the shielding had no effect on the overall percentage of excellent margin. However, gingivoproximally, the shielding significantly improved the marginal quality in the nonreflecting wedge groups, leading to the conclusion that the first increment should be cured as thoroughly as possible from a gingivoproximal direction, preferably indirectly via light-conducting wedges. Direct irradiation from a lingual or buccal direction is less favorable.


Effect of peroxide bleaches on resin-enamel bonds.

Human third molar teeth were divided into three groups: untreated control; enamel treated with 35% hydrogen peroxide for 2 hours; and enamel treated with 10% carbamide peroxide gel for 14 days. All teeth were ground to present a flat enamel surface, to which cylinders of light-cured composite resin were bonded. Shear bond strengths were determined for each specimen. The mean shear bond strengths of resin-enamel bonds after pretreatment with both 35% hydrogen peroxide and 10% carbamide peroxide were significantly lower than those for untreated controls. External bleaching with these materials prior to resin bonding procedures may reduce the quality of resin-enamel bonds.


Biocompatibility of an enamel-dentin adhesive.

To assess the biocompatibility of a third-generation dentinal adhesive that uses a smear layer conditioner (Scotchbond 2), Class V cavities were prepared and restored in vivo, following a standardized protocol, in 32 human premolars to be extracted for orthodontic reasons. Histologic observation showed seven slight, five moderate, and one severe reaction short term, while 11 slight and three moderate reactions were observed long term. It appeared that the intensity of the reactions decreased with time. Bacteria were observed on only five teeth, and no correlation could be established between the presence of bacteria and the intensity of the reactions. It seemed that the conditioning of the smear layer, although it might have rendered the residual dentin more permeable, limited percolation phenomena by increasing adhesion. Although only one severe reaction was observed, it is mandatory in a clinical setting to place a protective lining near the pulp.


Dentinogenesis imperfecta: a case report.

Dentinogenesis imperfecta is a localized form of mesodermal dysplasia of the dentin affecting both the primary and permanent dentitions. Most previous reports on dentinogenesis imperfecta describe treatment with overdentures, which have several disadvantages. The present report describes a case of dentinogenesis imperfecta in an 11-year-old girl. A combination of restorative, prosthetic, and surgical treatment was used to resolve the condition.


Oral amalgam pigmentations (tattoos): a retrospective study.

Oral amalgam tattoos are typically asymptomatic, benign, solitary or multiple clinical lesions produced by inadvertent placement of dental silver amalgam restorative material into the oral soft tissues. Diffuse lesions often display a grayish brown discoloration while other tattoos present a darker blue-black contrast. One hundred sixty-eight biopsy reports that confirmed the diagnosis of amalgam tattoo were analyzed to find age, sex, and race of the patients and size, location, and duration of occurrence of the lesions. Among the 168 cases, 235 individual tissue specimens were identified. A majority of the specimens were taken from the buccal mucosa, gingiva, and alveolar mucosa. The most common site for the lesion was the mandibular arch. The size of the individual specimens ranged from 0.10 cm to 1.50 cm. Almost two thirds of the specimens were 0.40 cm or less.


Atraumatic surgical technique and implant bed preparation.

The issues of bone necrosis and implant bed congruency are both central to the success or failure of endosseous dental implants to achieve osseointegration. Use of internally irrigated drilling instruments has been postulated to minimize bone necrosis. The ability of the cutting instruments to produce a smooth, congruent implant bed and retain fine bone structures is also critical to achieving primary integration. In the experiment conducted, the use of internally cooled instruments reduced the likelihood of thermal bone damage, particularly when trephine mills were used. Trephine mills were able to retain the fine bone structures of the walls of the implant bed site. No visible degradation occurred from multiple uses of the instruments.


Emergency repair followed by complete-coronal restoration of a fractured mandibular incisor.

Severely fractured anterior teeth often require immediate repair, while long-term restoration is delayed until a healing period is completed. This paper details a technique of immediate emergency repair of a fractured mandibular incisor followed by placement of a bonded composite resin complete-coronal restoration months later. Careful diagnosis, gentle handling of the freshly traumatized tooth and surrounding tissues, and ideal selection and use of the respective bonding materials are necessary to ensure eventual replication of form, function, and tooth shade when the long-term restoration is placed.


Prerestorative bleaching: effect on microleakage of Class V cavities.

The effect of bleaching extracted teeth on the microleakage of subsequently placed Class V composite resin restorations was evaluated. Ten extracted premolars were stored in water at 37 degrees C to serve as controls. Ten premolars were exposed to a carbamide peroxide gel for three 2-hour periods per day for 9 days. These specimens were stored in water at 37 degrees C except during treatment periods. Class V cavity preparations were then placed at the cementoenamel junction of the facial and lingual surfaces of all teeth. Half of the teeth of each group were restored with Scotchbond 2/Silux Plus and half were restored with Prisma Universal Bond 3/AP.H. After 24 hours of storage in 37 degrees C water, the teeth were thermally stressed for 100 cycles. Microleakage was assessed by dye penetration. The results demonstrated that prerestorative bleaching did not affect the marginal seal of subsequently placed restorations.


Cariostatic and ultraconservative sealed restorations: six-year results.

The objective of this clinical study was to determine the ability of an ultraconservative, sealed composite resin restoration, without a traditional cavity preparation and without the removal of the carious lesion, to arrest Class I caries. Tooth preparation was limited to placing a bevel in the enamel. These restorations were compared, over 6 years, with (1) ultraconservative, localized, sealed amalgam restorations with no extension for prevention and (2) traditional, unsealed amalgam restorations with the usual extension for prevention outline form. Caries was arrested by the ultraconservative, sealed composite resin restorations for 6 years. Complete sealant retention on the sealed amalgam restorations was somewhat lower than that on the sealed composite resin restorations; conversely, partial sealant retention was higher for the sealed amalgam group. The marginal integrity of the sealed amalgam restorations was significantly superior to that of the unsealed amalgam restorations. The sealant also protected Class I posterior composite resin restorations against wear.


Effect of eugenol-containing endodontic sealer on retention of prefabricated posts luted with adhesive composite resin cement.

Reported studies have implicated eugenol in the reduction in retention of restorations luted with chemically cured composite resin cement. This study investigated the effect of residual eugenol in the root canal on the retention of ParaPost dowels cemented with Panavia EX composite resin. An attempt was also made to identify and to determine the most effective cleansing procedure. Findings of this study demonstrated a substantial decrease in retention of posts luted with Panavia composite resin cement in the presence of eugenol. Irrigation with ethyl alcohol (ethanol) or etching with 37% phosphoric acid gel was found to be effective in restoring the resistance to dislodgment of the posts, but alcohol produced the most consistent and reliable results.


Resistance to fracture of ceramic jacket crowns.

The resistance to fracture of jacket crowns, fabricated of cast glass-ceramic and five traditional ceramics, was evaluated. Four identical jacket crowns of each type were constructed on absolutely equal dental abutments in epoxy resin, obtained from a primary mandibular molar. An increasing load was then applied to the mesiobuccal cusp of each of the 24 crowns. Although the glass-ceramic proved to have the highest fracture resistance, it was not significantly stronger than three other traditional ceramics; neither did it seem to be suitable for constructing jacket crowns on posterior teeth.


[Cleft lip and cleft palate: cephalometric characteristics of affected individuals, their relatives and a control population].

Eight cephalometric parameters were determined in individuals affected with cleft lip and cleft palate, their parents and siblings and a sample of normal individuals. No differences were found in males in any group. In contrast, affected females had lower measurements than their female relatives, and these lower latter in turn had measurements than control females. Although differences between groups were significant enough overlap existed and therefore genetic counseling based on these measurements would be uncertain.


[Concentration of trace elements in children from northern Chile].

Industrial processes may lead to severe alterations of environment affecting the health and quality of life of neighbouring communities. The present study reports the concentrations of Cu, As, Br, Na, K, Se, Hg, Cr, Co, Zn, Fe and Sb in samples of hair from children 6 years of age living in Antofagasta, Chuquicamata, María Elena, Calama and San Pedro de Atacama. Results were compared to those obtained in children of the same age living in Santiago. Samples were obtained according to recommendations from the International Nuclear Energy Organization and were analyzed by the neutron activation method at facilities of the Chilean Nuclear Energy Commission. Values for Cu (38.8 ppm), Cr (4.29 ppm) and As (19.2 ppm) in children from Chuquicamata are considered dangerous according to international standards.


[Treatment of non-variceal upper digestive hemorrhage with endoscopic thermocoagulation].

Over a year period, 60 of 172 patients presenting with upper gastrointestinal bleeding were treated by endoscopic thermocoagulation. Entry criteria included active bleeding (pulsatile or oozing), a visible vessel, sentinel clot or the presence of a pigmented protuberance at the ulcer crater. Hemostatic therapy was performed using the heat probe. The physical status and risk of the patients was estimated according to the ASA classification. Hemostasis was obtained in 17 of 21 patients with pulsatile bleeding (81%), 30 of 30 patients with oozing (100%) and 18 of 18 patients with a visible vessel or a pigmented protuberance in the lesion (100%). Three patients, older than 70 years of age, died. All had pulsatile bleeding from a deep ulcer located at the posterior-inferior wall of the duodenal bulb. They were classified as ASA III (n = 1) or IV (n = 2) with significant concomitant illness. These results suggest that endoscopic thermocoagulation is an effective treatment of active upper gastrointestinal bleeding, especially useful in a group of high risk patients.


[Benign polypoid lesions of the gallbladder. Their relation to gallbladder adenocarcinoma].

Out of 12,153 cholecystectomies performed over a period of 10 years, 114 polypoid lesions were found in 81 removed gallbladders (0.7%). 225 adenocarcinomas of the gallbladder were found in the same population (1.85%). The mean age of patients with polypoid lesions was 46 years, with a male to female ratio of 1:2.7. 94% of lesions measured less than 10 mm and only 9.6% were adenomas. Among these, dysplastic alterations were found in all and one had evidence of early adenocarcinoma. The mean age of patients with adenocarcinoma was 62 years with a male to female ratio of 1:6. Residual adenomas were found in 2 cases and multiple adenomas coexisted in another case. Thus, polypoid lesions of the gallbladder are less frequent than adenocarcinoma. Only adenomas show a potential to evolve to malignant lesions, but their low incidence makes them an unimportant precursor of gallbladder carcinoma.


[Clinical course characteristics of gastric cancer 1958-1990].

The clinical, surgical and histopathologic characteristics of patients with gastric cancer were compared among 3 consecutive periods from 1958 to 1990. A significant increase in the frequency of location at the upper third of the stomach, a greater proportion of resectable lesions, an increasing tendency towards extended total gastrectomy and a significant increase in the frequency of undifferentiated or diffuse carcinoma were observed. A change in pathogenetic factors along the years may be involved in the differences described.


[Simultaneous digestive and cardiological studies in asymptomatic chagasic patients].

Prognosis in patients with Chagas disease is related to systemic involvement. 43 asymptomatic chagasic subjects, 28 males and 15 females aged 28 to 85 years, were subjected to electrocardiograms and upper and lower gastrointestinal radiological studies. 23 patients (53%) had evidence of involvement of at least one organ. Multiple involvement was demonstrated in 5 individuals (12%): one patient had megaesophagus, megacolon and abnormal EKG; 2 had megaesophagus and abnormal EKG; 1 had megaesophagus and dolicocolon and 1 had dolicocolon and abnormal EKG. Dilated esophagus was found in 6 patients (14%), dolico or megacolon in 13 (20%) and abnormal EKG, mostly bifascicular block in 10 (23%). Thus, isolated or multiple organ involvement is frequent in asymptomatic chagasic subjects. Routine screening of this population is advisable for early diagnosis and prevention of complications.


[Echotomographic findings in gastric cancer].

Echotomographic studies were performed in 163 patients with gastric cancer from 1984 to 1990. The technical aspects of the examination and the images obtained in different lesions are described. Emphasis is placed on local or diffuse wall infiltration, ulcerations, vegetations or stenotic lesions. Consideration of these aspects during routine echotomographic exploration of the abdomen may help improve to the detection of gastric cancer.


[Gastric cancer: epidermal growth factor and epidermal growth factor receptor].

In 19 patients with advanced gastric cancer the expression of epidermal growth factor receptor and epidermal growth factor (EGF) were studied using immunohistochemical techniques. There were 12 males and the mean age of the group was 54.8 years. Most cases belonged in Borrmann's types III or IV. Tumoral cells were positive for EGF receptor in 9 patients (47%), with a strong reaction in 6. Thirteen of 18 subjects were positive for EGF. The reaction for EGF receptor was positive in 20% of 12 patients with intestinal type tumors and in 67% of 7 patients with diffuse tumors. Reaction for EGF was positive in 80% of intestinal type tumors and 64% of diffuse tumors. Simultaneous positive reactions for both antigens was observed in 5 of 18 patients, all with diffuse type tumors. Signet ring cell tumors showed less positivity than less differentiated ones. Thus, the expression of EGF and EGF receptor was higher in our patients with advanced gastric cancer than reported elsewhere.


[Etodolac versus piroxicam in the treatment of acute lumbago. Double-blind study].

To evaluate the efficacy of the nonsteroidal anti-inflammatory drug etodolac, a comparative, double-blind study versus piroxicam was carried out. Two homogenous groups (in terms of age, sex, time since last crisis and duration of present episode) of patients suffering from acute lumbar pain were treated during one week with either etodolaco, 300 mg b.i.d. (n = 30) or piroxicam 20 mg/day plus placebo (n = 31). Diagnosis was confirmed by history, physical examination, and Rx studies. Several clinical parameters were assessed prior and after treatment. All 61 patients completed the study. Adverse drug reactions were evaluated in the final visit. No significant differences were established between groups in relation to efficacy. Compared to baseline, statistically significant relief of symptoms was achieved in both groups, for pain intensity (p < 0.005); sleep quality (p < 0.005); paravertebral muscles spasm (p < 0.005) and spinal range of motion (p < 0.005). Patients treated with etodolac exhibited significantly less adverse reactions than those on piroxicam (p < 0.025).


[Convulsive electrotherapy in Parkinson disease. Presentation of a clinical case].

Electroshock therapy was performed in a patient with Parkinson disease who had shown intolerance to treatment with levodopa. Evaluation at 1 and 6 months post therapy revealed mild and short lived antiparkinsonian effects. The theoretical basis for this therapy are discussed.


[Fatal infectious endocarditis in a patient with annulo-aortic ectasia and predominant bicuspid valve aortic stenosis. Anatomoclinical case].

A 25 year old female with bicuspid aortic valve and aortic stenosis developed infectious endocarditis due to beta hemolytic streptococcus. Specific antibiotic therapy was not successful, the patient developed multiple embolic episodes and platelet dysfunction that prevented surgery. The patient died 5 weeks after admission. Necropsy showed aortic annulo-ectasia, cystic medial necrosis and localized dissection of the proximal aorta. There were multiple aortic valve vegetations and evidence of inflammatory myocardial involvement, coronary embolization and myocardial infarction. Aortic annulo-ectasia should be investigated in patients with aortic valve endocarditis and early surgery would be advised to prevent aortic dissection.


[Treatment of anorexia nervosa].

Treatment of anorexia nervosa integrates psychiatric and medical aspects. Elements of analytically oriented (not true psychoanalysis) and behavioral forms of psychotherapy are utilized. Emphasis should be placed in the setting, patient-therapist relation, and alliance with the family. Weight gain is the gauge and one of the goals of the therapy, having in mind that as it increases anxiety may be generated. From a behavioral point some restrictions are indicated. Antipsychotic (or neuroleptic) and antidepressant drugs should be used. Haloperidol is the drug of choice among antipsychotics while amitriptyline is usually preferred as antidepressant. General medical measures include adequate nutritional support, limitation of physical activity, eventual supplementation with iron, folic acid and vitamin B12. Estrogen therapy associated to progestins, calcium and vitamin D should be considered to prevent osteopenia.


[Basis for changes in medical education].

Medicine and medical education are going through a critical period due to a series of factors. Amongst them the explosion of knowledge and the progress in technology, and on the other hand the inefficiency of traditional medicine to cope with frequent and important health problems. We propose a medical education model based on a wider traditional model that incorporates social and psychological aspects of medicine emphasizing on prevention of disease and promotion of health. This model offers new methodological alternatives centered in the identification of problems, the acquisition of information and decision making, rather than in the storage of information.


[Workers exposed to styrene: application of a neuropsychological evaluation computer system].

The purpose of this study was to adapt and apply a battery of neuropsychological tests administered by computer. The study comprised three phases: 1) An existing system (NES-2) was revised and adapted (mainly in its Spanish version, since the structure and time intervals were the same). 2) A pilot group of 18 subjects was administered the five selected tests. 3) A comparative study of 36 exposed workers with 40 unexposed controls was undertaken. It was concluded that computer-administered tests are acceptable and economic. No significant differences were found between exposed. The possible reasons for the negative findings are discussed, as well as the types of future studies that need to be carried out.


[Andres Bello and the origins of the University of Chile].

During colonial times the Royal University of San Felipe was founded in 1738. The first plan for medical studies was outlined in 1779. During the Independence, the National Institute created in 1813 took over higher education. The first Course of Medicine was dictated there in 1833. The University of San Felipe was replaced by the University of Chile in 1842. Andrés Bello, its first Rector, developed the constituting laws of the University.


Influence of cloprostenol in the experimentally induced ulcer in rats.

We have tested the action of cloprostenol a relatively stable analogue of PGF2 alpha in experimentally induced gastric ulcer in rats by contention stress or indomethacin. Our results show that CIPG, administered at higher doses than those inducing an luteolytic effect, has a gastroprotective effect both in the contention stress-induced ulcer (2.30 + 0.26 in series III as compared to 3.80 +/- 0.73 in series III, p < 0.01) and in indomethacin-induced ulcer (2.69 +/- 0.38 in series V as compared to 3.61 +/- 0.34 in series IV, p < 0.01).


An overview of oncogenesis.

The paper reviews the actual knowledge in the field of oncogenesis, according to the oncogene theory of cancer. The main actions of proto-oncogenes during cellular proliferation are outlined and oncogenes are classified to their specific roles. The relationships between proto-, viral-, and cellular oncogenes are analyzed and the several steps of the evolution of a p-onc towards a c-onc are described. Several examples of better known oncogenes are presented to illustrate the interrelations between the families of genes and their interactions during oncogenesis are evoked. As the implication of each c-onc in distinct neoplasia can be suspected according to the most frequent genomic alteration of each type of cancer, information about the chromosomal localization of oncogenes is comprised. The oncogenes' products, their weight and cellular position are also presented. The onco-suppressor genes, oncogenes' counterparts are also described, their localization being deduced from analysis of frequent breakpoints or mutation site/s in cancers. Finally, future perspectives of oncogene research are also outlined.


[Polycystic kidney disease with autosomal dominant transmission].

Autosomal dominant polycystic kidney disease affect adults starting the 5th decade of life. It is caused by at least two different gene defects, one gene being located on the short arm of chromosome 16. It's more frequent at women and clinically, near renal cysts, appear others systemic manifestations as hepatic cysts, intracranial aneurysms, cardiac valvular lesions or diverticula. The diagnosis is set up on urography and ultrasonography and the treatment attempt to slow down the evolution to renal failure and to prevent the complications as infections, obstructions and hypertension, that may aggravate the prognosis. Lately there are discussions about a preventive treatment consisting in genetic counseling.


Meigs' syndrome. A case report and review of literature.

A 31-year-old woman, with primary infertility associated with cervico-vaginal defect, presented with intermittent breathlessness often correlated by the patient with menses, cough and chest pain. The symptoms had lasted for 6 months, and were attributed to a pleurisy, which was confirmed at roentgenology and treated by frequent thoracentesis, evacuating in all over 15 liters of fluid. Several aetiologies were excluded, such as: viral, TB, L.E., neoplasia, liver disfunction. A gynecological ultrasonography finally diagnosed a solid extensive ovarian tumour. Right oophorectomy has completely stopped pleural effusion relapse. We consider this case representative for the importance of a serious consideration of Meigs' syndrome in any recurrent pleurisy. We also believe our case to support the hypothesis of a hormone implication in Meigs' syndrome cause, as the symptoms correlated with menses, and especially as the morphopathological diagnosis was ovarian fibroma with myxoid areas, which could be incriminated for the patient's primary infertility, but it was not properly investigated.


Effect of glyceryl trinitrate on proximal stomach musculature in normal volunteers.

The effect of GTN on stomach is unknown although there is evidence that nitric oxide, the active component of GTN have a mediator role in the upper gastrointestinal tract. By the use of a newly developed barostat technique it was investigated the effect of GTN on gastric fundal tone and contractions. measurements were done 1 hour before an 1 hour after the administration of either 500 micrograms sublingual GTN and 5 mg buccal GTN or a placebo in 7 healthy individuals (14 experiments) by recording variations in the volume of air within an intragastric bag that was maintained at a constant pressure of 12 mmHg by the barostat. a significant increase in intrabag volume of 99.74 +/- 28.34 ml (mean +/- SEM) (p < 0.01) was recorded after GTN administration; a not significant (p > 0.01) increase in volume of 24.34 +/- 16.23 ml was after placebo. There was no significant difference between the frequency of contractions before and after drug or placebo administration. after systemic and constant administration of GTN a constant reduction in gastric fundal tone is produced with no change of fundal contractions.


Effect of age on fattening and body condition of draught oxen fed teff straw (Eragrostis teff) based diets.

Twenty-four Ethiopian Highland Zebu (Bos indicus) oxen were allocated to 6 groups of 4 animals each on the basis of liveweight, age and body condition according to a completely randomised block design. The animals were group-fed an experimental diet consisting of (g/kg) 551 g concentrate and 449 g teff straw, at the rate of 2.5 kg per 100 kg of liveweight for 18 weeks. They were weighed and condition scored weekly. Feeding levels were adjusted weekly. The daily liveweight gain of each animal was estimated using regression analysis and changes in condition score evaluated. Age significantly affected the liveweight gains and body condition score changes of the oxen. There was a significant (P < 0.001) linear effect of age on average liveweight gain. The average daily gains were 0.62, 0.51 and 0.41 kg/day for animals aged 4 to 5, 7 to 8 and 10 to 11 years respectively. Age exhibited a significant (P < 0.05) quadratic effect on body condition changes. The results are discussed in terms of benefits from traction and fattening and farm system implications of fattening younger animals for reproduction and improved feeding.


Liveweight estimation of cattle by scale and by tape, a method comparison study.

The repeatability of weight estimation of cattle by scale and by tape and the agreement of weight estimates obtained by the 2 methods were evaluated. The within-subject standard deviation of replicates was used as a measure of repeatability while the agreement of the 2 methods was evaluated by analysis of the differences in weight estimates. In young cattle, the measurement error of the tape was about twice that of the scale while in adult cattle it was more than 4 times as great. Although weight estimates by the 2 methods were highly correlated, considerable differences occurred in individual cattle. The same was true for estimates of weight gain. It does not appear advisable to use the tape in trials where weight is an independent variable whereas the use of the tape can be justified in experiments where weight is the dependent variable.


Copper status of Najdi sheep in eastern Saudi Arabia under penned and grazing conditions.

Concentrations of serum copper were significantly lower in penned Najdi sheep (zero grazed) than in grazing sheep in eastern Saudi Arabia. Soil-plant-animal interrelationships studies suggest that this could be attributed to the low copper to molybdenum ratio in the forages (berseem and Rhodes grass) fed to the penned sheep as compared to pasture plants. This was in line with the status of these minerals in the soils.


Louse and mite infestation in domestic animals in northern Nigeria.

Records of domestic animals brought to the Veterinary Entomology Laboratory for diagnosis of suspected lice and mite infestation over a 10 year period were analysed. From a total of 794 suspected cases, 137 (17.3%) and 247 (31.1%) were positive for lice and mange mites respectively. The most common lice species recorded were Linognathus vituli (66.7%) on cattle, L. ovillus (83.3%) on sheep, Haematopinus suis (100%) on pigs and Menacanthus stramineus (54.5%) on poultry. Other lice species recorded included Haematopinus bovis and Solenopotes capillatus on cattle, Damalinia ovis on sheep, Linognathus stenopsis and Menacanthus stramineus on goats, Goniocotes sp. on a horse, Linognathus setosus and Menacanthus stramineus on dogs, Goniodes gigas, Lipeurus caponis, Menopon gallinae and Chelopistes meleagrides on poultry. The most common mite species were Demodex folliculorum on cattle (96.9%) and on dogs (80.8%), Sarcoptes scabiei on pigs (100%) and Notoedres cati (80.3%) on rabbits. Other mite species included Psoroptes communis, Cheyletiella parasitivorax, Ornithonyssus gallinae and Dermanyssus gallinae.


Isolation of drug-resistant strains of Trypanosoma congolense from the lower Shabelle region of southern Somalia.

Drug resistance by pathogenic trypanosomes in Somali livestock has been suspected for some time but there have been few attempts to examine this problem in detail. Field isolations from two areas in the Lower Shabelle Region were obtained by injecting blood from trypanosome infected cattle into a recipient calf. Once the calf became parasitaemic it was treated with a standard dose of isometamidium chloride (Samorin, RMB) at 0.5 mg/kg. When a subsequent relapse infection developed, indicative of drug resistance, blood was taken and injected into groups of cattle and mice and these were treated with a range of doses of isometamidium chloride and diminazene aceturate (Berenil, Hoechst AC) to determine the degree of drug resistance. Both isolates showed remarkably high levels of drug resistance to both isometamidium chloride and diminazene aceturate, with minimum curative doses in cattle of > 2.0 mg/kg and 7.5 mg/kg for the two drugs respectively. Minimum curative doses in mice were approximately ten-fold those in cattle. Fortunately there have been a very few reports from Africa of such high levels of resistance of Trypanosoma congolense to this normal "sanative pair" of drugs. The results indicate that drug resistance could be an important constraint on the use of trypanocidal drugs to control trypanosomosis in Somalia.


Indigenous and crossbred cattle--a comparison of resistance to ticks and implications for their strategic control in Zimbabwe.

A comparison of the tick resistance of indigenous Mashona and crossbred Afrikander x Sussex oxen following natural tick infestation indicated that significantly more African blue ticks Boophilus decoloratus were found on the crossbred than the indigenous cattle (P < 0.05). The two groups of cattle were exposed to Babesia bigemina and Theileria taurotragi as indicated by high antibody titres on the indirect fluorescent antibody test, but no antibodies could be demonstrated to Anaplasma marginale and T. parva bovis despite the presence of their vectors. Rhipicephalus appendiculatus, Hyalomma truncatum and H. marginatum rufipes showed a seasonal distribution. The implications of the findings in terms of strategic tick control are discussed.


Cattle production systems in the derived Savannah and southern Guinea Savannah regions of Oyo State, southern Nigeria.

A single visit questionnaire survey was undertaken on 50 cattle owners in Oyo State, south-western Nigeria. Data were collected on grazing patterns, calving dates, calf mortalities and attitudes to the N'Dama breed and its crosses with Bunaji cattle. All cattle herds had similar grazing patterns, using natural pasture from April to November, crop residues in December, pasture regrowth after burning plus crop residues in January and regrowth and browse in February and March. The conception pattern was unimodal, reaching a peak in July after the new grass growth from the first rains. Calf mortalities were highest between 2 to 4 months of age during the early rainy season, but were significantly lower in mixed N'Dama/Bunaji herds than in the Bunaji herds. Most cattle owners were interested in purchasing N'Dama breeding stock, believing them to be more productive. This is a move away from the traditional pastoralist practice of keeping only Bos indicus breeds.


Livestock development policy in The Gambia: a reassessment.

This paper examines the historical development of policy in The Gambia through an analysis of 3 recurring themes: the motivation for keeping livestock, growth of the cattle population and the resulting feed deficit, and the need to develop a mixed farming system. The paper argues that there are major discrepancies between the common understanding which emerges from these themes and the realities of livestock ownership and production. It is suggested that it is because of these discrepancies, that livestock policies and programmes, other than mass disease control, have seldom had their desired impacts.


An outbreak of haemorrhagic septicaemia (septicaemic pasteurellosis) in cattle in Zimbabwe.

An outbreak of haemorrhagic septicaemia caused by Pasteurella multocida in beef cattle in Zimbabwe grazing effluent-irrigated pastures, is described. The outbreak occurred during the wet summer months and predisposing stress factors included excessive rainfall and unusual cold weather during the preceding month. History, clinical features and post-mortem findings were consistent with reports of the disease from other countries, except that meningitis was also a constant feature. Morbidity approached 77% and mortality 5 per cent. Prophylactic treatment and vaccination with a killed bacterin together with a return of warmer and drier weather were probably important in halting the outbreak.


Isolation and characterisation of Newcastle disease virus strain in a feral dove (Stigmatopelia senegalensis) in Nigeria.

An isolate of Newcastle disease virus (NDV) was obtained from a feral dove, (Stigmatopelia senegalensis). The isolate was shown to have a mean-death-time of 96 h and an intracerebral pathogenicity index of 0.10. It was immunogenic but not pathogenic for 6-week old chicks on experimental infection. Based on these observations the isolate was classified as a lentogenic strain. The role of such isolates of NDV from wild birds on the Nigerian poultry industry is discussed.


Seasonal influences on gonadal and extragonadal sperm reserves in Small East African zebu (Bos indicus) bulls in Ethiopia.

Body weight and scrotal circumference (SC) data were taken ante mortem and genitalia collected after slaughter from Small East African zebu (SEAZ) bulls slaughtered during the wet (n = 46) and the dry (n = 53) seasons. Bulls slaughtered during the wet season were significantly heavier (47 kg) and had significantly larger SC measurements (3.3 cm) than those slaughtered during the dry season. Mean (+/- s.e.m.) paired testes weights were 233.7 +/- 13.8 and 292.8 +/- 11.3 g and epididymal weights 26.8 +/- 0.9 and 35.9 +/- 1.1 g in bulls slaughtered during the dry and wet seasons, respectively. Daily sperm production rates and epididymal sperm reserves were 2.2 +/- 0.1 x 10(9) and 3.0 +/- 0.1 x 10(9); and 16.1 +/- 0.3 x 10(9) and 17.6 +/- 0.4 x 10(9) in bulls slaughtered during the dry and wet seasons, respectively. These differences were significant. It was concluded that season affected reproductive capacity of zebu bulls probably due to variations in the quality and quantity of nutrition. However, the confounding effects of ambient temperature and nutrition on reproductive capacity of zebu bulls in tropical regions need further examinations.


Genetic and environmental variation in reproductive and lactational performance of Jersey cattle in the coastal lowland semi-humid tropics.

Reproductive and lactational performances, including length of productive life, were evaluated from records for 1960 to 1988 for a Jersey herd in coastal lowland semi-humid Kenya. The herd grazed natural pastures and until the mid 1970s received supplementary feeding. Mean performance included 31 months age at first calving, lactation milk yield (MY) of 1,788 kg in 3.3 lactations and a calving interval (CI) of 408 days. Mean milk yields declined from over 2,200 kg in the 1960s to about 1,500 kg in the 1980s with concomitant changes in calving interval, length of productive life and infertility. While annual genetic components of change in MY and CI were not significantly different from zero, the environmental components were large and significant (P < 0.01) showing that the declines in performance probably resulted from decreased feed availability and less efficient disease control. Estimates of genetic parameters were consistent with those in the literature. With good management purebred Jersey cows in coastal lowland semi-humid Kenya were productive, but animal and herd productivity were highly dependent on management level which had a major effect on both milk yield and reproductive wastage.


Season and location effects on serum and liver mineral concentrations of Senepol cattle on St Croix, Virgin Islands.

Serum and liver concentrations of selected macro- and trace minerals were determined in Senepol cattle at 8 sites (4 each in a high and low rainfall region) during the dry and wet season on St Croix. At each site an average of 15 mature, lactating cows, grazing native grass/legume pastures without supplementation were blood sampled each season. Liver samples were collected (n = 51) at slaughter from mature animals originating from the same sites. A preliminary analysis indicated no differences in serum mineral concentrations between mature lactating cows and growing heifers. There were differences between sites for serum magnesium (Mg) (P < 0.001), copper (Cu) (P < 0.05) selenium (Se) (P < 0.001) and zinc (Zn) (P < 0.01) in the dry season, and for Cu (P < 0.01), iron (Fe) (P < 0.001) and Zn (P < 0.01) in the wet season. Higher (P < 0.001) serum concentrations of Mg, Cu, Fe and Zn were observed in the dry season, while Se was higher (P < 0.01) in the wet season. Liver concentrations of Cu and Fe were lower (P < 0.01) and liver molybdenum (Mo) (P < 0.001) and Se (P < 0.05) higher during the dry season. The seasonal differences in serum Cu, Se and Zn concentrations have not been observed in other studies in the Central American region. More than 50% of serum samples were deficient in phosphorus (P) regardless of season, and in Cu and Zn during the wet season. Mineral supplementation should be considered.


Plasma progesterone concentrations during pregnancy and pseudopregnancy and onset of ovarian activity post partum in indigenous goats in Zimbabwe.

Eight pregnant does were housed individually and fed a hay and concentrate diet throughout pregnancy and lactation. The mean gestation period was 146.7 +/- 3.0 days, with a twinning rate of 75 per cent. Mean body condition scores improved from 2.4 +/- 0.2 to 2.8 +/- 0.2 over the first 80 days of gestation and were maintained at 2.8 until 45 days before kidding. From then until kidding, mean scores fell to 2.2 +/- 0.2. Plasma progesterone concentrations during pregnancy rose significantly from 3.91 +/- 0.51 ng/ml on day 40 to 5.96 +/- 0.51 ng/ml on day 60 (P < 0.05) and remained high until 5 days before kidding. Three pseudopregnant does had similar progesterone profiles to pregnant does over the first 80 days, but the rise around day 35 to 40 was not significant and progesterone concentrations returned gradually to basal levels after day 100. The same 8 does, together with an additional 4 does which had been brought inside 60 to 70 days before kidding, were used to study onset of ovarian activity post partum. The twinning percentage was 83 per cent. Mean body condition score at parturition was 2.2 +/- 0.1. By day 35 post partum, mean condition scores had fallen to 1.9 +/- 0.1, and mean weights from 36.9 +/- 1.9 kg at kidding to 32.1 +/- 2.0 kg. Ovarian cyclicity was resumed just before mean scores and weights started to improve. The mean interval from kidding to onset of oestrous cycles was 97.3 +/- 9.5 days. This coincided with mean time to weaning which was 99.5 +/- 5.5 days.(ABSTRACT TRUNCATED AT 250 WORDS)


Pelagic whole fish (Rastriobola argenteus) as a protein source for pigs.

Two trials were carried out to investigate the potential of small pelagic fish (Rastriobola argenteus) locally referred to as omena, as a protein supplement for pigs. In trial one, 12 growing pigs were fed on diets containing either soyabean meal or omena for 30 days. The average daily gains, daily feed intakes and feed to gain ratios were 814 g, 2.01 kg, 2.47 and 831 g, 1.98 kg, 2.38 for the soyabean meal and omena diets respectively. All these performance indicators were similar between the 2 dietary treatments. In the digestibility study involving weanling rats, the digestibility of dry matter was not affected by diet but that of protein and ash were different between the 2 diets (P < 0.05). The digestibilities of dry matter, crude protein and ash were 75.8, 66.0, 56.9 and 77.6, 71.3, 39.2 for soyabean meal and omena diets respectively. Rastriobola argenteus (omena) is a potential protein supplement for pigs.


[Epidemiology of alcohol and drug abuse in Paraguay].

The results of a prevalence study on use- and abuse- of psychoactive substances, among a population aged 12 to 45 in Paraguay are presented. Presence of the depressive syndrome as well as attitudes and beliefs related to the use of psychoactive substances were also investigated. A bilingual questionnaire was drafted--i.e. a Spanish version and a Guarani version due to the Paraguayans' bilingual characteristic--that yielded acceptable validity and reliability levels. A stratified random sample was applied, with a total of 2,504 questionnaires filled out. Weighted data are shown here as studied by sex, age-group, socio-economic level, and presence of the depressive syndrome. Substance/alcohol use patterns were found out to be widely tolerant about abusing legal substances such as alcohol, tobacco, and psychotropic drugs. As regards illicit substances use, inhalants head the list followed by marijuana at a close range.


[Primary prevention in mental health programs. Possible or impossible? Now or later?].

The point in discussion is: Does any possibility exist of having primary prevention actions included in mental health plans and programs of the countries pertaining to the Latin-American and Caribbean region? On the one hand, such actions are becoming more and more necessary if the higher mental health demands are taken into account--which exceed the offer of services at a secondary preventive level. On the other hand, recent literature has been accumulating scientific evidence bringing rational basis for interventions at a primary preventive level. Mental health workers--if adequately trained--may find a fruitful field for action in assistance and research as well.


[Creative moments during analytical processes].

Examples from his clinical work are used by the author to illustrate creative instances during analysis. First, there appear a dis-idealization and a threat of chaos, followed by mourning, reparation and sublimation. The creative function originates in a patient's attempt to objectify his or her ego in different ways--which involves a phantasy of being re-born in order to love someone and be loved in turn. It represents a triumph of life over death, of health over madness. In other words, the creative function means putting psychic chaos into order with pre-existing elements by means of original, new, better-integrated changes.


[Changes in psychiatric care. Reform or revolution? The experience of the Swedish model].

Reforms to psychiatric practice in Sweden are discussed, expecting that the Scandinavian experience be of assistance as regards changes that are being implemented for a re-structuration of psychiatric care in Latin America. The following points are enhanced: (a) epidemiological studies as an important basis for planning and action in mental health; (b) a progressive closing of mental hospitals while, at the same time, more institutionalization capacities are being created at general health services, and (c) organizing non-hospital care by sectors with community mental health teams being in charge of. As far as negative aspects are concerned, a tendency towards a "psychologization" so to speak of social issues, and a certain lack of attention of patients with severer disorders are pointed out.


[Functional dysphonia: relation with personality and ICD-10 criteria].

The International Classification of Diseases, 10th. revision (ICD-10) in the category F45 defines the somatoform disorder as a mental disease characterized by the reiterative presentation of somatic symptoms in absence of an organic disease, or the somatic pathology being insufficient to explain the intensity of the symptoms as well as the discomfort and preoccupation of the patient. Fifteen female teachers with functional dysphonia were studied by means of a semistructured interview and psychometric evaluations. Considering dysphonia as the principal symptom, the most frequent diagnosis, in accordance with ICD-10 was "Other somatoform disorder" (F-45.8)(9/15). Five patients were diagnosed as motor dissociative disorder (F-44.4). All the patients had some abnormality of personality (5 with personality disorder and 10 with exacerbation of personality traits). The criteria of ICD-10 to classify the functional dysphonia as Somatoform disorder are discussed. It is suggested that certain personality traits are facilitators for somatization.


[Interdisciplinary ambulatory care in patients with chronic mental disease].

The experience of an ambulatory treatment for mental chronic outpatients is presented. A trans-disciplinary group (including a psychiatrist, an occupational therapist, a social worker, a nurse, and a psychologist) worked during a 3-year period. Five specific clinics were created: Organic Mental Syndrome, Schizophrenia, Mood Disorders, Neurosis, and Psychoactive Substance Users. Results of the treatment are presented, showing the benefits such a clinical envisioning meant not only for the patients involved but also for their family, the hospital management, and the members of the therapeutic group as well.


[Evaluating the efficacy of psychotherapy: follow-ups].

The results of psychotherapeutic treatments administered at a private institution of the city of Buenos Aires--over a 200-case total--by means of a telephone calls follow-up procedure are discussed. A comparison is thus possible between the results achieved by the above mentioned institution's working team, and results as described in literature. At the same time, an important subgroup has been determined: Namely, patients who feel better after an only admission interview--a fact likely to make you think over people's mental resources.


[Stress of teachers and students' violence].

A training program for secondary school teachers, by the name of Stress inoculation, is presented. It is aimed at coping with conflictive situations likely to arise in a classroom. Adapted from D. Menchembaum's model, this program has been developed, and assessed at three secondary schools of the city of Buenos Aires: It is the author's contention that it lives up to her expectations. Teachers are trained to develop resources enabling them to: (a) recognize alarm signals arising in their relationships with students (i.e., signals advising that such relationships are in jeopardy), (b) cut sequences leading initial situations to burst out in violent behavior, and (c) incorporate coping alternatives when facing violent situations so that both teaching, and teacher-students relationship are preserved--as well as teacher's and students' mental health.


[Psychopathology and psychosocial functioning of adults with epilepsy. Preliminary evaluation].

To examine the relationship between psychosocial functioning and psychopathology in epilepsy, a total 37-outpatient sample was assessed by means of both the Washington Psychosocial Seizure Inventory (WPSI) and the Minnesota Multiphasic Personality Inventory (MMPI). Patients came from an epilepsy program of the Hospital psiquiátrico, Chile. Disorders in several areas pertaining to psychosocial functioning and psychopathology were observed: Their distribution was quite similar to disorders previously reported when using both instruments. The WPSI scales showed a positive correlation with the MMPI's--a relevant correlation as far as the Overall Psychosocial Functioning, and Emotional adjustment sub-scales are concerned. The relationship between psychopathology and psychosocial functioning in epilepsy is discussed as well as the usefulness of the WPSI as a screening-test for the psychosocial assessment of epileptic subjects.


[Is it possible to build up an algorithm of the human soul?].

The possibility of constructing a computer programmable algorithm able to generate behaviors indistinguishable from human behaviors is envisioned. First, a concept of algorithm is offered, this proposal is discussed, and, lastly, limitations to such a project are considered.


[Obesity and feeding behavior: diagnostic and psychometric aspects].

Obesity is regarded in its triple connotation of symptom, risk factor and homeostatic organization, stressing the inadequacy of traditional formulations about psychological causation. Psychological factors most frequently associated to obesity are excessive intake, complications of dieting and alterations of body image. The predictive role of psychophysiological dimensions of Restraint, Disinhibition and Hunger is discussed on the basis of empirical information. ICD-10 formulations are considered a positive advance in the taxonomy of syndromes with alterations of body weight.


[Gender role and anorexia nervosa].

The gender role is defined; its physiognomy, adopted by women since the occurrence of the Industrial Revolution, and the intricate status that characterizes the present feminine role are described. Finally, a psychosocial approach of anorexia nervosa is made. This disorder is considered as a paradigm of the present ambiguity of the femininity concept likely to become a transactional phenomenon between sexual identities.


[Insufficient sex education in medicine].

The present paper--actually a synthesis of the author's thesis for M.D. degree--aims at pointing out the need there is for an MD-oriented education in normal and pathological sexuality to be implemented. A 228-medical student/175-physician sample was administered the well-known SKAT test altogether with a questionnaire dealing with sexual personal experience, contraception procedures, and self-evaluation on knowledge, training, and personal attitude toward sex-related matters. Results showed mistakes and misinterpretations in the area of knowledge of both groups: Personal experience appears to be a physician's sole guideline. Doctors' reluctance to approaching sexual matters when writing clinical records was also observed, an aspect confirming physicians' limitations--in connection not only with knowledge per se but also with inhibitions shared by both a professional and his or her patient. Thus, the convenience of implementing sexual education as another subject in curriculum is suggested.


[Psychosocial intervention in hospitalization due to alcoholism].

This paper presents a descriptive-type research on the findings of a 1-year follow-up experiment on a 72-inpatient at the Instituto sobre Alcoholismo y Fármacodependencia of the city of San José, Costa Rica. Information wa obtained from a 59-question instrument aimed at exploring: Sociodemographic aspects, alcohol ingestion-abstention patterns; interpersonal, family and labor relationships, autodiagnosis, and evaluation of the treatment program. During the 3-week inpatient treatment, a psychosocial treatment was administered to all subjects. Owing to the substantial changes patients evidenced in the above mentioned areas, findings suggest that the objectives were fulfilled satisfactorily enough.


[Stereotype, self-stereotype and metaperception of men and women].

Male and female self-stereotype, and metaperception were studied in a 613-University student sample (291 men, 322 women). Seventy-nine bipolar items from the Factorial Scales of Self-concept were used as a measure. Factor analyses of items were independently calculated for their application to both men and women. The principal findings were as follows: 1) Male stereotype basically includes instrumental characteristics while female stereotype includes expressive as well as instrumental attributes; 2) Male and female self-stereotypes are in accordance with their respective stereotypes; 3) Men as well as women have a fairly accurate idea of how they are perceived by the opposite sex.


[Colored matrices test (special scale): how to evaluate and interpret it in our milieu].

Raven's "Colored Matrixes" (Special scale) were specially adapted for 5- to 11-years-old children by their author. The present paper analyzes: 1) The importance of taking into account wrong responses to the matrixes since they are likely to occur at a higher (5/6) probability level than correct responses (Burnbaum, 1968; Bock, 1972); 2) The proposal of considering the Colored Matrixes as a test with cultural reduced influences. The findings of a research carried out with 790 preschool- and schoolchildren (ranging 4- to 11.5-years-old) in Argentina are presented: Total scoring, and series scoring are shown. By means of a multiple variance analysis it has been found out that both age and series, as well as the interaction between both have a statistically significant influences on score variations. Besides, new evaluation guidelines are presented.


[Use of the perceptive stimulative model (PSM, Romano, 1979) as an individual and/or group diagnostic test].

MEP (Spanish acronym for Perceptive-stimulative Model) is a visual test whose nimble and simple administration is apt for both individual and group studies. As a diagnosis complementary instrument, its design has been arranged so that the perceptive material (i.e. geometric outlines) offers information on the degree of integration of ego functions, an analysis of which allows perspectives applicable to diagnosis, prognosis, and therapeutical orientation. At the same time, such analysis enables hypotheses related to the interaction potential of patients involved to be advanced.


[The surgical therapy of liver trauma].

The different therapeutic patterns of liver trauma are presented; they should be chosen on the basis of both clinical assessment, particularly looking for hemodynamic impairment and associated bowel lesions, and CT scan data. Surgical abstention should be considered for a great number of blunt liver trauma; open or severe blunt trauma should be preferably treated by elective hemostasis and biliostasis, with only rare use of hepatic resection "à la demande", on partially sectioned or devitalized tissues. Cavo-suprahepatic wounds remain the most important technical problem and continue to worse the prognosis in liver trauma.


Blunt and penetrating liver trauma: surgical strategies.

From our own experience with 104 patients with liver trauma treated by laparotomy we confirmed the present trends in treating blunt liver trauma, i.e. conservative therapy of minor lesions under closed observation with imaging procedures (US and CT-scan); minor local measures in superficial liver injuries when laparotomy is performed for other reasons; generous use of the Pringle maneuver in primary hemostasis; temporary or final treatment by perihepatic packing in all parenchymal fractures with predominant venous bleeding; direct suture or ligation of arterial bleeding; liver resection only for the debridement of destroyed tissue. With primary packing the patient can be transferred to an experienced center. The overall mortality is more dependent on combined lesions from polytrauma. The early and efficient hemostasis of liver trauma may, however, stabilize the border-line patient and give him a better chance. This is underlined by the experience, that isolated liver injuries have a much better prognosis except central lesions of the retrohepatic vena cava and large central hepatic veins.


Clinical evaluation of hepatic lesions: guidelines for diagnostic protocols and injury severity scores.

The standardisation of diagnostic procedures according to an adequate sequence is a mandatory in determining the therapeutic strategy in liver traumas. In a series of 26 consecutive cases of trauma of the liver, 3 of them penetrating, we adopted a diagnostic algorithm based on the extensive use of sonography and "Injury Severity Scores" in addition to the standard clinical procedures. The treatment of the lesions was surgical in 21 cases (81%) and conservative in 5 (19%); post operative mortality was 14% and overall mortality 11.5%. None of the cases treated by conservative approach had to be submitted to surgery during the follow-up period. Sonography, carried out by surgical staff within 30' from observation and at definitive intervals, allowed a correct surgical approach in all cases; a similar sensitivity was obtained by sonography also in the cases treated conservatively and submitted to C.T. evaluation. The absolute correlation between Revised Trauma Score, Injury Severity Scale, classes of severity of the lesions and subsequent surgical survey suggest that this scoring system could be adopted in the first triage of traumatic lesions of the liver. Sonography could be preferred to diagnostic peritoneal lavage in the screening of cases with circulatory instability; furthermore, it could be a valid alternative to C.T. in hemodynamically stable patients.


[The risk factors for liver and kidney complications in general surgery: the results of a prospective multicenter study].

A method for preoperative assessment of surgical risk, in function of several risk factors, was developed using the multiple logistic function, as a model of multivariate statistical analysis. This model has the advantage to express the two considered outcomes (perioperative complications and death) in numerical terms of probability. The data were obtained from 1182 consecutive patients, 14 yrs or more, admitted to six centres in various regions of Italy. Stepwise logistic regression model was applied to a set of preoperative and operative factors, three of which were found to significantly correlate with postoperative hepatic failure: compromission hepatic function time of surgical operation > 120' and nutritional status. The factors significantly correlate with postoperative renal failure were: compromission renal function, bacterial contamination during surgery, time of surgical operation > 120'.


[Latent pathology of the thyroid: an epidemiological and statistical study of thyroids sampled during 507 consecutive autopsies].

In order to highlight the occult pathology of the thyroid in the aged, the authors examined all the glands withdrawn from 507 consecutive autopsies on subjects of 67.10 years of median age. In 10 tables there are weight and measurements of the thyroids, macro and microscopic details and pathologic appearances. Adenomas were found in 17.1% of cases and histologically besides the known cases referred also to the Hürtle cells type, 4 clear cells adenomas and 5 adenolipomas were found. In 27.42% the subjects were affected or were dead for a malignant extrathyroidal neoplasm, and in 26% of these there was a metastasis in the thyroid. Never a primitive thyroid carcinoma, macroscopically and clinically evident, but in 53 thyroid glands, 54 occult carcinomas (OC) were found, particularly 37 papillary and 17 medullary. IN 57% of 165 histologically treated thyroids, to evidence C-cells, hyperplasia of these cells was found associated with various pathologic conditions, more in aged subjects. In 147 glands were found 170 nodules of various number of cells, at times positive for calcitonin. These solid cellular nodes (SCN) were evaluated as nodular C-cells hyperplasia. Besides isolated cases of acute thyroiditis (also the mycotic type), of tubercular thyroiditis and Hashimoto's, in 12% of the glands a lymphocytic chronic thyroiditis was found, frequently with Hürtle cells. Others observations were: basophilic thickening of colloid also with calcium oxalate crystals, lipoid degeneration of follicular cells and fat interfollicular and interlobular infiltration, thyroid amyloidosis, inner and media elastic calcification of thyroid arteries, presence of cysts with squamous cells coating, parathyroid glands and cartilage intrathyroidal plaques.


[Conservative meso-pancreatectomy for cystic papillary tumor: apropos a case report].

A case of papillary-cystic neoplasm of the pancreas is reported in a 22-year-old woman. The only symptom was a palpable pulsating mass in her upper left abdomen. A conservative surgical treatment was adopted, consisting of pancreatic body resection (meso-pancreatectomy) and pancreaticojejunostomy to distal pancreatic stump. These neoplasms are quite uncommon, and can be difficult to differentiate from other cystic lesions of the pancreas. Surgical excision is curative in these tumors and is the treatment of choice due to its low morbidity and good long-term survival.


[Perforations of the colon].

Perforations of the colon are a difficult problem for any surgeon, due the emergency they represent and the multiple clinical and pathological findings. Personal cases are revised and the opportunity of a case-by-case evaluation and of an eclectic surgical choice are stressed.


Transcultural nursing considerations of child abuse/maltreatment in American Samoa and the Federated States of Micronesia.

A conceptual analysis focuses on defining child maltreatment from the perspective of two Island nations in the Pacific Basin, American Samoa and the Federated States of Micronesia. Based on a review of the literature on child maltreatment laws and cultural factors in each region, a range definition is proposed. The range definition is comprised of defining features and borderline features for child maltreatment as it exists across these cultures in the Pacific Basin. Defining features were derived from evaluation of child abuse and neglect laws in each specified population. Borderline features were derived from cultural factors in American Samoa and the Federated States of Micronesia. While these Island nations already have child abuse and neglect laws, they are adapted from the United States. The degree at which unreasonable harm becomes abuse is culturally dictated, hence, these territories of the Pacific Basin are seeking culturally specific terminology when defining child maltreatment. The findings of this analysis indicate the significance of transcultural knowledge in nursing practice and the legal accountability nurses hold on the issue of child maltreatment.


[Nutritional treatment in the therapeutic strategy in benign esophageal stenosis].

Oesophageal strictures prevent a normal alimentation, and in chronic and more prolonged cases are the cause of severe denutrition. Many organs then undergo changes reflected on ultrastructural morphology, that in most severe and lasting cases can demonstrate irreversible. The functional aspect of such changes correspond to a hindered performance of the damaged organs with possible sudden cardiovascular accidents, which are particularly meaningful in the surgical steps of reconstruction, that is heavy for the patient not only in the perioperative period but also during the recovery when higher are the caloric energetic requirements. For the positive outcome of the surgical therapy of these strictures it is therefore necessary to preventively restore an acceptable nutritional status of the patient by the use of one or more of the nowadays available techniques of artificial nutrition. A particular topic of the need of a efficacious nutritional treatment can be pointed in the cases of oesophageal caustic burns, where the caloric requirements is high since the beginning to meet the catabolic effects of the traumatic condition, while malnutrition represents one of the negative factors in prolonging connettival and fibroblastic proliferation, cause of most severe strictures and recurrences. After a general survey of the whole problem, the characteristics of the various artificial nutrition techniques are discussed, with the identification of an optimal scheme of global and nutritional treatment in oesophageal caustic burns.


[Extensive lymphadenectomy in the therapy of cancer of the left colon and rectum: an analysis of the anatomicopathological data].

In the last 12 years in our surgical service, radical resection was performed in 142 patients with cancer of left colon and in 145 patients with rectal cancer. Extended lymphadenectomy was always realized: preaortocaval lymphadenectomy in colonic cancer; preartocaval and pelvic lymphadenectomy in rectal cancer. The incidence of C stage was 40.14% in cancer of left colon and 40.68% in rectal cancer. Neoplastic diffusion in preaortocaval lymph nodes was only in a patient with colonic cancer, never in patients with rectal cancer. The incidence of neoplastic diffusion in pelvic nodes was 3.12% (0 in superior rectum; 6.25% in medium rectum; 2.4% in inferior rectum). In 1 of 90 patients with tumour of medium or inferior rectum, we relieved tumoural involvement of pelvic nodes without neoplastic diffusion in regional nodes. These anatomo-pathological data subline: a) the low incidence of neoplastic diffusion in preaortocaval nodes in cancer of left colon and rectum; b) the importance of pelvic lymphadenectomy in cancer of medium and inferior rectum.


[Allergic conjunctivitis].

The eye reacts to foreign substances through a variety of specific and non-specific defense mechanisms. Constantly exposed to a great variety of microorganisms, the eye is capable of protecting itself without altering its own structure and function. Its resistance relies upon anatomic and physiological properties of its external components (eyelids, tears, conjunctiva and cornea). Most of the times, the conjunctiva becomes affected, resulting in a clinical picture of conjunctivitis where allergy predominates, expressed as allergic rhinoconjunctivitis, allergic conjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis and flictenular conjunctivitis. The physiopathology is considered to be of type I reaction (IgE mediated). Frequent complains often associated with other allergic diseases are: pruritus, tearing, photofobia and ocular redness. The diagnosis of allergic conjunctivitis in done by means of a throughout clinical history, conjunctival citology and evaluation of specific IgE with immediate skin tests. Treatment is symptomatic (antihistamines, antibiotics and/or topic steroids), but prevention (environmental control and sodium cromoglycate) and specific immunotherapy must be considered.


[Malignant peritoneal mesothelioma: apropos a new case].

Prognosis for patients with malignant peritoneal mesothelioma is very poor, and most patients are beyond cure by the time the diagnosis has been made. The pathogenesis of this uncommon neoplasm seems to be related to asbestos and radiation exposure. The authors report a case of diffuse peritoneal mesothelioma in a 33-year-old man. Since the patient complained of aspecific symptoms and both biochemical and "imaging" studies did not provide useful informations for a definitive diagnosis, an exploratory laparotomy was performed. Intraoperative histological findings demonstrated the presence of a malignant peritoneal mesothelioma which had spread all over the omentum; considering the inoperability assessment of this case, the operation was completed and the patient was dismissed with an adjuvant chemo-therapy. Five weeks later the patient died.


[Treatment of congenital facial paralysis with crossed innervation of facial nerve and electric field stimulation].

Congenital facial palsy is a devastating deformity. At present time there are no reports of the early treatment of this disorder. The treatment may be to supply contralateral auto reinnervation to the affected muscles through a sural-facial nerve graft enhanced by electric field stimulation. The purpose of this paper is to report 5 cases of congenital facial palsy treated by a crossed sural-facial nerve graft, enhanced by electric field stimulation. One year after surgery, clinical and electrodiagnostic examinations indicate appropriate reinnervation activity in all the patients.


[Neurological development disorders in very low birth weight newborns].

Thirty very low birth weight newborns (less than 1,500 g) were evaluated at term from the neurological point of view, and were followed-up during the first 2 years of life by a multidisciplinary team, in order to detect long term sequelaes. There were 3 patients with major neurological disorders, and one third presented minor alterations. Neurological evaluation at term was a good sequelae predictor. No significative differences were found in perinatal variables: birthweight, gestational age, Apgar's score, ventilotherapy and with presence of intraventricular hemorrhage when normal outcome prematures were compared with those with neurological disorders. Blindness or deafness were not detected. It's important to continue the follow-up study up to the school age.


[Indomethacin in the prevention of subependymal-intraventricular hemorrhage in preterm newborns with conventional mechanical ventilation].

The results of a double blind study to evaluate the efficiency of prophylactic endovenous indomethacin versus placebo for prevention of intraventricular hemorrhage (IVH) in newborn infants between 28 to 36 weeks of age who were intubated at the delivery room and required mechanical ventilation in NICU are presented. Fourty six patients required mechanical ventilation, but 14 neonates had IVH evaluated by ultrasound when were admitted to the Unit. At least 32 infants were studied, 16 for each group. There were no differences between the groups in weight, gestational age, sex and delivery way. The mobility was the same in relation to hialine membrane disease, sepsis, pneumonie and pneumotorax. The placebo group had more frequency of PDA and mortality (P < 0.5). There were no differences in mean airway pressure and arterial gases, also in glucose, platelets and urinary volume. The indomethacin group had mayor urinary density and FeNa but the results were always in normal ranges. The IVH was the same in both groups. We concluded that the indomethacin at the levels used did not produced alterations, and if the IVH is not prevented, were observed lesser severity of the same and the frequency of PDA and mortality are lesser. But still is necessary more number of cases for best conclusions.


[Multisystemic impact in the full-term newborn with perinatal asphyxia].

We studied 30 full-term newborn infants, admitted to the newborn intensive care unit of "Manuel Gea González" General Hospital between January 1, 1989 and December 31, 1990. All infants had 5-minute Apgar score of 5 or less. The disturbances related to: brain, heart, liver, bowel, coagulation system, calcium and glucose homeostasis were investigate in all cases. Of the 30 infants, 29 (97%) had developed 1 to 7 abnormalities in the systems studied. Most of them had from 2 to 5 abnormalities (77%). The commonest disturbance was brain involvement in 22 cases (73%); metabolic and coagulation changes had also been observed, while heart disturbances were less common. There was no significant difference between the intensity and number of systemic abnormalities observed in these infants and the alterations seen during pregnancy, labor, delivery, administration of anesthesia and Apgar score. These observations suggest a striking relationship between asphyxia in the newborn infant and the development of systemic disturbances.


[The VATER association].

The clinical, radiologic, and anatomic features of 53 patients with VATER association were reviewed. The vertebral, anorrectal, tracheoesophageal, radial, and renal congenital defects included in the association are similar to those described by other authors. In this report genital anomalies are very frequent and should be included as a diagnostic criteria for this association. Encephalic, facial, and cranial congenital defects are common and can affect prognosis; 17 patients have other malformations patterns, and they can belong to a different group of malformations.


[Intrahospital infections at a neonatal service].

This study is about the importance and mechanisms of the nosocomial infections, specially in newborn babies of the "Hospital General del Centro Médico La Raza del IMSS". We studied 461 newborns of which 53 (11.49%) developed one or more intrahospitalary infections. The rate of intra-hospital infections was 18.40%, mainly due by septicemia, infections of the surgical wounds, and respiratory tract infections. The gramnegative bacterias were predominant. Also were found Staphylococcus aureus and Staphylococcus epidermidis frequently. We give some preventive advice.


[Barotrauma in newborns. Study of 81 cases at a neonatal intensive care unit of a province].

We present 81 patients with diagnosis of air leaks in a Neonatal Intensive Care Unit (NICU). During 6 and a half year period. Air leaks were present in a 7.3% of overall admissions and in 18% in those whom received mechanical ventilation. We observed pneumothorax in all the patients, accompanied by pneumomediastinum in 12% and with interstitial emphysema in 7%. Other forms of air leak were present only rarely. Eighty percent of our patients were managed with intrapleural drainage. Almost 40% of events happened after resuscitation of tracheal aspiration management. The concomitant disease most often seen was respiratory distress syndrome (RDS) during it's convalescent period. Most of them had been previously placed in mechanical ventilation. We had a very high death rate, most significant in the group with weight less than 2,500 g in which 80% died. An analysis between our findings and those in literature was made.


[Aneurysm of the Galeno's vein: report of a case].

Some aspects of pathophysiology, diagnosis and treatment of gastroesophageal reflux (GER) in children are presented. There is considered a multifactorial syndrome. The objective of this review is present new trends in etiology, diagnostic methods, in a practical point of view, specially in places without sophisticated equipment. Finally it is presented rational therapeutical basis en GER management.


Simple in vivo bioassay without radioisotopes for recombinant human erythropoietins.

A simple in vivo bioassay suitable for routine testing of quality control of recombinant human erythropoietin (rHuEPO) analogues was developed. The assay took four days, normal mice were used and radioactive compounds were not needed. EPO activity was measured by the increased number of some part of reticulocytes which increased specifically and dose-dependently by the injection of rHuEPO. They were considered to be mostly immature reticulocytes and were counted as the residual particles from blood cells after treatment with a hemolysing reagent. These particles could be counted by conventional automated microcell counters. The assay procedure was simple and easy. The sensitivity, reliability and reproducibility of this method were acceptable for routine in vivo bioassay of rHuEPOs. This method was economical, and can be used instead of the existing bioassays for rHuEPOs.


In vivo biological activities of recombinant human erythropoietin analogues produced by CHO cells, BHK cells and C127 cells.

The in vivo biological activity of four pharmaceutical preparations of recombinant human erythropoietin was compared. Two of the erythropoietins were produced by Chinese hamster ovary cells, CHO-K1, and the others were produced by mouse mammary cells, C127, and baby hamster kidney cells, BHK-21. The activities of the analogues were estimated by a simple cell counting method with conventional automated microcell counters. The amounts of these analogues gave straight logarithmic dose-response curves when plotted against the count of particles resistant to hemolysing reagent, which particles were mostly immature reticulocytes. The lines from the four analogues were parallel to each other. The relative activities of these analogues were 1.02, 1.19 and 1.21 when one of the analogues was arbitrarily used as the standard. These differences in the extent of the activity were not significant. Thus, the four recombinant human erythropoietin analogues, produced by four different mammalian cell lines, expressed the same biological potencies in vivo corresponding to their units, and the units used up to now by the manufacturers are equivalent. These results also draw the conclusion that the new simple in vivo bioassay can replace the existing accepted assay methods.


Assay for measuring relative potency of leptospiral bacterins containing serovar pomona.

An enzyme-linked immunosorbent assay (ELISA) was developed for the quantitation of leptospiral antigen in bacterins containing Leptospira interrogans serovar pomona type kennewicki. A monoclonal antibody (MAb), 2D7, which is directed against a surface antigen on whole cells of L. interrogans serovar pomona type kennewicki, was used in the assay. The capture of antigen in bacterins by a polyclonal antiserum was followed by the addition of the 2D7 ascites fluid, an anti-mouse conjugate and substrate. Biologicals evaluated with this system included preparations containing type kennewicki antigen (homologous) and those not containing type kennewicki antigen (heterologous). Heterologous bacterins gave optical density (OD) values comparable to those of blank wells. Homologous bacterins yielded OD values equal to or greater than those of the National Veterinary Services Laboratories (NVSL) reference pomona bacterin. The relative potencies (RP) of 84 licensed commercial Leptospira pomona bacterin serials were evaluated against the NVSL reference pomona bacterin using the NVSL Relative Potency computer program. Random samples of 1, 2, 3 and 5 ml dose products were selected for evaluation with this system. All products tested passed the hamster potency assay required for leptospiral bacterins. This ELISA system enables detection of antigen in bacterins containing L. interrogans serovar pomona type kennewicki and demonstrates the potential for in vitro testing of leptospiral bacterins.


Swedish inactivated polio vaccine: laboratory standardization and clinical experience over a 30-year period.

Swedish inactivated polio vaccines have contained per single human dose a mean amount of viral antigen equivalent to 1 x 10(7.5) CCID50 of type 1, 1 x 10(7.4) of type 2 and 1 x 10(7.8) of type 3 produced on primary monkey kidney cells. Potency tests were made in comparison with an equivalent amount of live virus suspension of all three types. Validation of tests has been based on the response to type 1 only. Based on clinical experience with vaccine lots from 1957 and the establishment of the second live reference virus suspension in 1966, the minimum limit of immune response in guinea-pigs--expressed in extinction values--was decided as 1.5 for type 1 and type 3, and 1.0 for type 2. The potency test method used since 1959 in Sweden was two subcutaneous injections 2 weeks apart using 10 guinea-pigs per dilution and blood collected 1 week thereafter. Potency tests made according to European Pharmacopoeia revealed a somewhat lower value for type 2. D-antigen content in Swedish vaccines was low, however, the Swedish vaccine has protected against many episodes or outbreaks of wild virus in Sweden and immunized individuals elsewhere in the world. For the Swedish population a clear-cut clinical motivation for requiring a higher potency for type 2 as required in the European Pharmacopoeia or increased levels of D-antigen in the final product has not been presented. It was concluded that the European Pharmacopoeia method did not distinguish between doses of 0.5-1.0 ml. The minimum limit extinction value for type 2, i.e. 2.0 seemed to high.(ABSTRACT TRUNCATED AT 250 WORDS)


The modified leukocytosis promoting factor (LPF)-test: a valuable supplement to the mouse weight gain (MWG)-test in toxicity control of whole cell pertussis vaccine.

For the safety testing of pertussis vaccine, many in vivo assays have been developed, but none of these assays, except the Mouse Weight Gain (MWG)-test, are obligatory. Leukocytosis Promoting Factor (LPF) test, performed in mice, is one of the tests to examine the toxicity. However, due to lack of standardization, this test has not been implemented in the regular safety testing of the vaccine. Our investigations demonstrate that the LPF-test becomes more reproducible and sensitive if preparations are administered subcutaneously on day 0 and and counting of the leukocytes are done on day 6. Therefore, it is suggested to include the revised LPF-test in the quality control panel for the assessment of the toxicity of whole-cell pertussis vaccine.


Rabies neutralizing antibody in serum of children compared to adults following post-exposure prophylaxis.

Rabies neutralizing antibody concentrations in serum (SRNA) elicited by experimental post-exposure prophylaxis (PEP) regimens are used to assess their potential clinical efficacy. Although PEP with human rabies immunoglobulin (HRIG) plus human diploid-cell culture vaccine (HDCV) is almost completely protective, the limited availability of these components has stimulated the search for alternative regimens. Since 33% to over 60% of PEP is administered to children, a need exists for data on the SRNA response to HRIG plus HDCV in children, to be used to assess the potential value of alternative PEP treatments. We measured SRNA by the rapid fluorescent focus inhibition test on days 0, 1, 3, 7, 14, 28, 56 and 90 after initiation of PEP with HRIG (20 IU/kg) and HDCV (1.0 ml on day 0, 3, 7, 14, 28) in 10 children [8 +/- 4 (mean +/- SD) years of age] and 32 adult control patients (38 +/- 16 years of age). Early, uniform appearance of SRNA was observed with no differences between groups. These data are consistent with the demonstrated efficacy of PEP with HRIG plus HDCV in children as in adults and provide results that can be used for initial evaluation of experimental pediatric PEP regimens in the future.