[Vital recognition of complete occlusion of the left main coronary artery].

Left main coronary artery occlusion is found in about 0.05% of all coronary arteriograms. In this case report left main occlusion was associated with a dominant right coronary artery and good collaterals to the circumflex and left anterior descending coronary arteries, which seems to be essential for survival in this lesion. Our case belongs to the minority of patients who have survived a myocardial infarction in the presence of left main occlusion.


X-linked pyruvate dehydrogenase E1 alpha subunit deficiency in heterozygous females: variable manifestation of the same mutation.

Three female patients are described with pyruvate dehydrogenase (PDH) deficiency as a result of mutation in the X-linked gene for the E1 alpha subunit of the complex. Two of these patients illustrate typical presentations of PDH E1 alpha deficiency, with severe neurological dysfunction, degenerative changes and developmental anomalies in the brain, together with variable lactic acidosis. The third patient extends the known spectrum of the condition to include mild to moderate mental retardation and seizures in an adult. All three patients have the same mutation in the PDH E1 alpha gene. This mutation, a C-to-T substitution in a CpG dinucleotide in amino acid codon 302 (designated R302C), results in the replacement of arginine by cysteine at this position. The mildly affected adult was the mother of one of the other patient, making this the first described instance of mother-to-daughter transmission of a mutation causing PDH E1 alpha deficiency. The genetic basis of the variable expression of X-linked PDH E1 alpha deficiency in heterozygous females is discussed.


Hypertrophic obstructive cardiomyopathy in a neonate with the carbohydrate-deficient glycoprotein syndrome.

The carbohydrate-deficient glycoprotein (CDG) syndrome in its most severe form (neonatal olivopontocerebellar atrophy) is a life-threatening multisystem disease. We report a neonate who was referred for cardiological assessment because of respiratory distress, a murmur and episodes of desaturation. After initial spontaneous improvement he presented at 9 weeks with evidence of a severe hypertrophic obstructive cardiomyopathy (HOCM). The diagnosis of CDG syndrome was suggested by the characteristic dysmorphic features, hypotonia, visual inattention and severe failure to thrive; it was confirmed by electrophoresis of serum transferrin. HOCM can be a feature of the CDG syndrome, in addition to the (previously reported) pericardial effusions.


Isolated biotin-resistant deficiency of 3-methylcrotonyl-CoA carboxylase presenting as a clinically severe form in a newborn with fatal outcome.

The son of Kurdish, consanguineous parents (cousin marriage) presented from the first day of life with initially focal and later generalized attacks of epileptic seizures and a severe generalized muscular hypotonia. Urinary excretion of 3-hydroxyisovalerate and of 3-methylcrotonylglycine was persistently increased. Diagnosis of isolated biotin-resistant 3-methylcrotonyl-CoA carboxylase deficiency was confirmed in cultured fibroblasts. Psychomotor retardation was progressive, seizures and marked EEG abnormalities persisted. Treatment with leucine and protein-resistricted diet under hospital control did not significantly improve these conditions. The patient died from a cardiac and circulatory failure after a prolonged epileptic attack, with bronchial aspiration. The non-responsiveness of our patient to therapy and the fatal outcome indicate the existence of a severe neonatal variant of this otherwise rather benign genetic enzyme deficiency.


Glycogen debranching enzyme deficiency: long-term study of serum enzyme activities and clinical features.

In glycogen storage disease type III (glycogen debranching enzyme (DE) deficiency), the activities of serum alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase may be strikingly elevated during childhood but are low during adult life. To determine the pattern of the elevated serum enzyme activities in relationship to diet, the biochemical subtype and clinical symptoms, 13 patients with DE deficiency were studied. Activities of serum aspartate and alanine transaminases, lactate dehydrogenase, and alkaline phosphatase were markedly elevated during infancy. Continued elevation of enzyme activities during childhood appeared to be related to DE deficiency in liver, but unrelated to DE deficiency in muscle. Activity elevations correlated inconsistently with diet and poorly with childhood growth rate or the presence of hypoglycaemia. The serum enzyme activities declined around puberty concomitantly with a decrease in liver size. Although periportal fibrosis and micronodular cirrhosis indicated the presence of hepatocellular damage during childhood, the decline in serum enzyme activities with age and the absence of overt hepatic dysfunction suggest that the fibrotic process may not always progress.


Differential diagnosis of hydroxydicarboxylic aciduria based on release of 3H2O from [9,10-3H]myristic and [9,10-3H]palmitic acids by intact cultured fibroblasts.

Intact cultured fibroblasts from patients with deficiency of long-chain 3-hydroxyacyl-CoA dehydrogenase release 3H2O from [9,10-3H]myristic acid and [9,10-3H]palmitic acid more slowly than normal. The ratio of activity (palmitate/myristate) is also low and the expression (rate with palmitate2/(rate with myristate) gives good differentiation between affected and unaffected cells. In some patients who have shown hydroxydicarboxylic aciduria when unwell there is reduced 3H2O production from [9,10-3H]myristic and [9,10-3H]palmitic acids by intact cultured fibroblasts but normal 3-hydroxyacyl-CoA dehydrogenase activities in disrupted cells. The palmitate/myristate ratio is higher than in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. The basic defect in these patients is still unknown but it is suggested that caution be used over the administration of medium-chain triglyceride.


Long-term effects of bone marrow transplantation on lysosomal enzyme replacement in beta-glucuronidase-deficient mice.

This study uses bone marrow transplantation (BMT) between congenic strains of mice as an experimental model to examine enzyme replacement therapy of lysosomal storage diseases. Bone marrow cells from donor mice which have normal levels of the lysosomal enzyme beta-glucuronidase (Gus), which is heat-stable, rapidly repopulated the haematopoietic compartment of irradiated recipient mice which have only low levels of a thermolabile form of this enzyme. Gus activity was found to increase progressively in the tissues of the recipients, including the liver, heart and skeletal muscle. Elevated levels were also observed in the kidney and brain. The increase in enzyme activity in the host tissues was not due to the presence of contaminating blood cells, but rather to the acquisition of new, heat-stable enzyme from the donor bone marrow cells. High levels of Gus activity persisted for at least 72 weeks, showing the potential therapeutic value of BMT for enzyme deficiency diseases.


Bone marrow transplantation for Sanfilippo disease type B.

Allogeneic bone marrow transplantation was performed on twins with Sanfilippo B disease. They were the first two patients with this disorder to undergo the procedure. There was definite evidence of engraftment as shown by conversion to donor blood group antigen and tissue type, and increased leukocyte alpha-glucosaminidase activity. Nine years post transplant, neither twin is as handicapped as her untreated brothers were at the same age, although in one twin hyperactivity and behavioural problems, characteristic of the disorder, are present. Details of the twins' intellectual development and growth, their alpha-glucosaminidase activity and urinary glycosaminoglycan excretion are reported.


Bone marrow transplantation for Niemann-Pick type IA disease.

Bone marrow transplantation has been undertaken with encouraging results as therapy for a wide variety of lysosomal storage diseases. We report a case of Niemann-Pick disease Type IA in which, despite the presence of only mild hypotonia with depressed reflexes, the clinical course of the disease appeared to be only slightly modified by this procedure, which was performed at the earliest practical opportunity. The patient was diagnosed early when asymptomatic, because of a family history of an affected sibling who died at 14 months. He received a bone marrow transplant from an HLA-identical, MLC non-reactive sibling donor, whose leukocyte sphingomyelinase activity was in the homozygote normal range. There was adequate engraftment as evidenced by persistently normal leukocyte sphingomyelinase activities, and there was no evidence of graft-versus-host disease. Visceral storage and neurological impairment were less rapidly progressive than in his untreated sibling but he eventually died at 30 months. Autopsy confirmed that this was essentially due to the effects of the underlying Niemann-Pick disease. We conclude that despite some success in other neurovisceral lysosomal storage disorders, bone marrow transplantation is not likely to be an adequate treatment for Niemann-Pick disease Type IA.


Urinary screening for alpha-OH triazolam by FPIA and EIA with confirmation by GC/MS.

Triazolam is a very short-acting triazolobenzodiazepine with sedative-hypnotic properties. Approximately 2% of an oral dose is excreted unchanged in the urine. The major urinary metabolite is alpha-hydroxytriazolam glucuronide (70% of the dose). The objective of this study was to characterize the reactivity of alpha-hydroxytriazolam in the urine benzodiazepine assay by fluorescence polarization immunoassay (FPIA; Abbott TDx) in comparison with enzyme immunoassay (EIA; Syva EMIT d.a.u. benzodiazepine assay). alpha-OH triazolam at 300 ng/mL gave a response equivalent to the 200-ng/mL nordiazepam Abbott calibrator. In the EMIT assay, alpha-OH triazolam gave a response equivalent to the 300-ng/mL calibrator (Syva) at 100-200 ng/mL. Both immunoassays gave positive results in 9 out of 9 urine specimens collected from individuals receiving triazolam. Confirmation was performed by analyzing for alpha-OH triazolam after enzymatic hydrolysis and formation of a TMS derivative for GC/MS. All urine specimens were positive for alpha-OH triazolam. In conclusion, both the FPIA and EIA immunoassay screening assays are acceptable for detecting the presence of alpha-OH triazolam in the urine of patients receiving therapeutic doses of triazolam.


Isolation of acidic, neutral, and basic drugs from whole blood using a single mixed-mode solid-phase extraction column.

A solid-phase extraction procedure was developed for the isolation of acidic, neutral, and basic drugs from whole blood. A blood sample was sonicated, diluted with phosphate buffer, and the drugs were extracted on a mixed-mode bonded-phase silica column at pH 6.0. The extraction system was adjusted to pH 3.3 with acetic acid. After column drying, the drugs were selectively eluted from the column by two different eluates, which were collected separately. Acidic, neutral, and weakly basic drugs with lower pKa values (e.g., benzodiazepines) were present in the first acetone-chloroform (1:1) fraction. The other basic drugs were present in the second fraction (basic ethyl acetate). The drugs with pKa's close to the pH of the extraction system (pH 3.3) appeared in both fractions. The two fractions were evaporated until approximately 100 microL of solvent remained in the tube and were then analyzed on a gas chromatograph equipped with a wide-bore capillary column and flame ionization detector. The absolute recoveries of all tested drugs exceeded 81% at a concentration of 2 micrograms/mL.


Gas chromatographic determination of propylene glycol dinitrate in rodent skin.

A gas chromatographic (GC) method was developed for the detection of propylene glycol dinitrate (PGDN) in rodent skin following extraction with ethyl acetate. Known quantities of PGDN contained in the torpedo fuel Otto Fuel II were added to homogenates of rat skin, which were subsequently extracted with two 10-mL portions of ethyl acetate. An aliquot of each extract was analyzed by GC with a flame ionization detector. With this method, concentrations ranging from 0.0042 to 11.2 mg/mL were determined by comparison with a standard curve. The extraction efficiencies ranged from 85.7% for the lowest concentration to 101% for the highest concentration.


Quantitation of cinnamaldehyde and cinnamic acid in blood by HPLC.

A rapid and sensitive high performance liquid chromatographic (HPLC) method is described for the quantitation of cinnamaldehyde (CNMA) in rat blood at concentrations of 0.1-100 micrograms/mL. One of the metabolites of CNMA, cinnamic acid, can also be quantified simultaneously. CNMA is unstable in rat blood, probably because of rapid oxidation to cinnamic acid by enzymatic catalysis and nonenzymatic Schiff base formation with free amine groups of blood proteins. The disappearance of CNMA from rat blood follows first-order reaction kinetics with a half-life of 9 min at room temperature. The current analysis method involves the addition of an agent that will prevent CNMA degradation by denaturing protein and competitively blocking nucleophilic addition reactions, resulting in the nearly complete recovery of CNMA from blood. Recovery of cinnamic acid was approximately 80% at concentrations of 1-10 micrograms/mL.


Confirmation of low concentrations of urinary benzodiazepines, including alprazolam and triazolam, by GC/MS: an extractive alkylation procedure.

Urine samples containing diazolo- and triazolobenzodiazepines and metabolites were hydrolyzed with beta-glucuronidase and extracted with methylene chloride. The extracts were treated with methyl iodide, methylene chloride, and tetrahexylammonium hydrogen sulfate in basic solution to form the methyl derivatives of the drugs and metabolites. GC/MS analysis resulted in the following test characteristics: day-to-day precision at 360 ng/mL (120 ng/mL for the triazolobenzodiazepine metabolites) was 2.4 to 5.5% CV; calibration curves were linear to 6000 ng/mL (1000 ng/mL for the triazolobenzodiazepine metabolites), and operational limits of quantitation were in the range 13-25 ng/mL.


Emit ETS plus ethyl alcohol assay for the determination of ethanol in human serum and urine.

We evaluated the enzymatic Emit ETS Plus Ethyl Alcohol Assay (Emit) intended for the quantitative analysis of ethanol in human urine, serum, and plasma. The assay had been designed for use with the new Syva ETS Plus analyzer. The assay had a linear range up to 6.5 g/L and a low detection limit of 0.1 g/L. Assay within-run precision in serum with ethanol added to 0.25, 0.40, 1.00, 3.00, and 5.00 g/L yielded CVs (n = 32) of 6.1, 5.8, 3.7, 3.5, and 4.5%, respectively. Within-run precision of the assay using with ethanol added to 0.25, 0.40, 1.00, 3.00, and 5.00 g/L yielded CVs (n = 32) of 4.9, 5.0, 4.3, 3.3, and 5.0%, respectively. Between-run precision of aqueous controls yielded 0.41 +/- 0.02 g/L ethanol (target value, 0.40 g/L), CV = 4.5% (n = 31) and 3.05 +/- 0.06 g/L ethanol (target value, 3.00 g/L) CV = 2.1% (n = 31). Absolute recovery of the assay with 0.40 to 6.00 g/L ethanol added to serum and urine yielded mean recovery values of 105.5 and 101.5%, respectively. Results of the analysis of patient serum and urine specimens for ethanol by the Emit assay correlated well with those obtained by other methods. The Emit assay was found to be rapid, precise, and accurate for the determination of ethanol in clinical specimens. It was also found to be free of interferences from small molecular weight alcohols, aldehydes, ketones, and glycols. The Emit assay's linear range of up to 6.50 g/L ethanol was a major advantage over the ADx and aca assays; these assays were only linear to 3.00 g/L.


Morphine determination by gas chromatography/mass spectroscopy in human vitreous humor and comparison with radioimmunoassay.

A gas chromatographic-mass spectroscopic method (GC/MS) for morphine determination in human vitreous humor was developed. Reversed-phase solid-liquid extraction gave better sample purification compared with liquid-liquid or normal-phase solid-liquid extractions. In 10 real cases of death by heroin overdose, the correlation between the results obtained by GC/MS and by radioimmunoassay (RIA) was studied.


Application of gas chromatographic determination of organotin compounds to basic research on the metabolism of triphenyltin chloride in rats.

This paper describes the application of gas chromatographic determination of organotin compounds to basic research on the metabolism of triphenyltin chloride in rats. Phenyltin compounds were extracted (as chloride) from rat-liver homogenates and subcellular fractions with hydrochloric acid and n-hexane-benzene (3:2, containing 0.05% tropolone). These organotin compounds were pentylated with a Grignard reagent prior to capillary gas chromatography. The absolute detection limits were in the range of 3.6 to 4.4 pg as tin. The absolute recoveries of phenyltin compounds added to homogenized whole liver and each subcellular fraction sample ranged from 73.9 to 97.4%. The intracellular distribution of triphenyltin and its metabolites in the liver was observed for 72 h after a single oral dose of triphenyltin chloride was given to rats. The tri-, di-, and monophenyltin compounds in the fractions reached maximal amounts about 6, 48, and 72 h after administration, respectively. Also, the concentrations of monophenyltin compounds in the liver were typically lower than to those of di- and triphenyltin compounds. The highest contents of di- and triphenyltin compounds per protein were found in the microsomal fractions.


Modification of Emit assay reagents for improved sensitivity and cost effectiveness in the analysis of hemolyzed whole blood.

This report describes an improved method for the direct detection of a broad spectrum of drugs of abuse in hemolyzed whole blood by means of Syva Emit enzyme immunoassay. Improvements include a 1.5 to 10 fold increase in Emit assay sensitivity along with a 2 to 4 times increase in the normal number of assays per kit. This was accomplished by enzyme substrate and cofactor supplementation with a commercially available product (Raichem), assay reagent dilution, and extension of the absorbance measure time. The Emit drug abuse in urine (d.a.u.) assays used in this study included amphetamine, barbiturate, methadone, methaqualone, opiate, benzodiazepine metabolite, phencyclidine, and propoxyphene. The Emit serum assays used were the benzodiazepine and the tricyclic antidepressant assays. The within-run coefficients of variation ranged from 0.25 to 0.66%, and the between-run coefficients of variation ranged from 0.45 to 1.00%. The proposed method allows for the analysis of hemolyzed whole blood using both Emit d.a.u. and serum assays. It is sensitive and can detect therapeutic or subtherapeutic concentrations of drugs in all assays tested. The method is simple, rapid, and allows for the direct analysis of a methanolic extract of whole blood without lengthy sample concentration steps. The method allows for the detection of highly potent drugs and for long-term monitoring of drug metabolites and conjugates. This could be beneficial for therapeutic drug monitoring, assessing patient compliance, and detection of previous drug use.


Serial capillary gas chromatography/Fourier transform infrared spectrometry/mass spectrometry (GC/IR/MS): qualitative and quantitative analysis of amphetamine, methamphetamine, and related analogues in human urine.

A method using serial capillary gas chromatography/Fourier transform infrared spectroscopy/mass spectrometry (GC/IR/MS) for the analysis of derivatized amphetamine, methamphetamine, and related analogues was developed. The GC/IR/MS was configured and optimized with a Hewlett-Packard (HP) 5890A gas chromatograph with a 12-m x 0.32-mm i.d. HP-5 capillary column serially interfaced through an HP 5965A infrared detector to an HP 5970 mass selective detector with a fused-silica 1.2-m x 0.10-mm i.d. column. Urine samples are extracted and derivatized as heptafluorobutyryl (HFBA) derivatives. For quantitation GC/MS in the selected ion monitoring (SIM) mode was used, with D,L-amphetamine-D5 as the internal standard. Gas chromatography/Fourier transform infrared spectrometry (GC/FT-IR) quantitation uses a selected wavelength chromatogram, spectral subtraction, double internal standard method using both D,L-amphetamine-D5 and 4-phenyl butylamine. Sensitivity for the combined GC/MS and GC/FT-IR system for amphetamine and methamphetamine shows limits of linearity of 100 to 5000 ng/mL, a limit of detection of 25 ng/mL, and a limit of quantitation of 98 ng/mL. The overall recovery for amphetamine and related analogues was greater than 85%. Precision studies for concentrations over the range of 200 to 1500 ng/mL showed coefficients of variations ranging from 2.8 to 13.0%. Correlation studies for quantitative GC/MS SIM and GC/FT-IR are greater than 0.98 for amphetamine, methamphetamine, and related analogues. Each analysis includes GC/MS SIM and GC/FT-IR quantitation, qualitative nonselective full spectra GC/FT-IR, and GC/MS scans of HFBA derivatives cross-referenced with an internal drug library, which provides high confidence and a means for the surveillance of amphetamine-like chemical analogues.


Toxicological findings in a fatal case of acebutolol self-poisoning.

A fatal case of acebutolol self-poisoning is presented. After single-step liquid-liquid alkaline extraction, acebutolol was identified by using an HPLC/DAD screening procedure. By means of a specific HPLC method, acebutolol was then quantified in a large range of postmortem samples. The blood acebutolol concentration was 34.7 micrograms/mL. The tissue distribution of the drug is discussed in the light of the existing literature.


Coping strategies among police recruits in a high-stress training environment.

The use and impact of coping strategies were explored in a setting of environmental stress. The sample consisted of 180 police recruits subjected to training stress in a U.S. police academy. Measures of coping, personal distress, and life stressors were used. Recruits who scored high on personal distress tended to use more coping strategies than those who had lower distress scores. These findings suggest that the magnitude of personal distress may be an important factor in determining which array of coping techniques is used. In terms of effectiveness, the coping strategies of distancing and planful problem solving significantly reduced distress. Escape/avoidance and self-control coping did not appear to work in the police situation and significantly increased distress.


Ethnic group preferences and the evaluation of ethnic identity among adolescents in The Netherlands.

The relationship between the evaluation of ethnic identity and ethnic group preferences among Dutch and that among ethnic minority adolescents was examined. It was predicted that a more positive attitude toward one's own ethnic identity would be associated with a higher level of ingroup preference. This prediction was confirmed, and this led to the question of how inter-ethnic relations and a positive ethnic identity could be stimulated simultaneously. Not only the ingroup aspect of ethnic group relations was studied but also the outgroup aspect. As members of the high-status group, the Dutch subjects showed a higher level of ingroup preference, compared with ethnic minorities. Also, own-group identification and own-group-oriented patterns of preferences among the Dutch subjects were found to be accompanied by the rejection of minority groups. No such tendency was found among adolescents from ethnic minorities.


Investigation of circadian rhythms in anaerobic power and capacity of the legs.

Previous work has demonstrated that exercise performance varies with time of day. The aim of this study was to investigate the influence of time of day on measures of anaerobic power and anaerobic capacity. Twelve male subjects, aged 18-22 years, performed a stair run test, a standing broad jump and the Wingate Anaerobic Test on twelve separate occasions. These were at 02:00, 06:00, 10:00, 14:00, 18:00 and 22:00 hours, duplicate measurements being obtained at each time point. Subjects' diet and activity prior to exercise and the laboratory temperature were controlled. Pre-exercise rectal temperature was measured on each occasion. The rectal temperature data conformed to a cosine function: its peak occurred at 18:11 hours and the peak to trough variation was 0.76 degrees C (p < 0.001). There was a rhythm in performance on the stair run and the broad jump tests, in phase with the curve in rectal temperature. Results for peak power and mean power production on the Wingate test did not display a significant circadian rhythm. The stair run and broad jump tests seem to be more sensitive to circadian rhythmicity than does the Wingate Anaerobic Test.


Effect of time of day on adaptive response to a 4-week aerobic exercise program.

The circadian effects of an aerobic training program were studied in 3 groups of men who exercised at different times of day. Twelve healthy sedentary men were assigned to morning (9:00-9:30), afternoon (15:00-15:30) or evening (20:00-20:30) exercise groups. Each group performed a 30-minute 60% VO2max cycle ergometer exercise 4 days per week over a 4-week period. Maximal oxygen uptake (VO2max) was estimated and adaptive responses of heart rate and blood lactate levels to the training program were measured. After 4 weeks, the afternoon group showed a significant increase in estimated VO2max. A significant decrease in heart rate and blood lactate responses occurred in the afternoon and morning groups and the afternoon and evening groups, respectively. These results suggest that aerobic training is most effective in the afternoon.


Isometric and isokinetic knee joint performance in Japanese alpine ski racers.

Isometric and isokinetic (concentric and eccentric, strength of alpine skiers with different performance levels were measured. Nine national (elite, EG) and 10 collegiate (trained, TG) female alpine skiers (16 to 23 years of age) performed maximal voluntary knee extension and flexion. Peak torque was measured at an angular velocity of 30 deg.s-1. The cross-sectional area (CSA) of thigh muscles (quadriceps and hamstring muscles) was determined by an ultrasonic method. No significant differences in anthropometric variables and CSA were observed between EG and TG. EG had significantly greater (p < 0.01 for extensors and p < 0.05 for flexors) eccentric knee extensor and flexor strength than that of TG whereas no significant differences were noted in isometric and concentric strength. Eccentric strength/CSA ratio was also higher for EG than for TG. It was suggested that knee extension and flexion strength during eccentric muscle action might be related to the performance level of alpine skiers.


Force and power of preferred and non-preferred leg in young soccer players.

The purpose of this study was to assess the effects of soccer training on strength and power of leg extensor muscles in preadolescent boys and their possible influence in developing a muscular lateral dominance. Twenty male children (mean age 9.6 yr), ten soccer players and ten untrained subjects, participated in this study. Force and power were measured at five constant cranking velocities on an isokinetic bicycle dinamometer. Each isokinetic load was given after each trial. Force and power outputs were calculated for each limb. Soccer players always showed higher and statistically significant differences (p < 0.05) for force and power values for all considered pedal frequencies. No significant differences were observed for force and power values between preferred and non preferred limb. The results demonstrate the effect of soccer training on the increase of force and power of both legs regardless of lateral dominance.


The relative contribution of strength and physique to running and jumping performance of boys 7-11.

The purpose of this study was to determine the association of static strength with motor performance of 7 through 11 year old boys (N = 60) after accounting for differences in physique, i.e., body size, shape, and composition. Static strength measures included thigh extension, leg extension and plantar flexion measured by electronic transducer and back lift, leg lift, and right and left grips measured by spring dynamometer. Measures of body composition consisted of fat estimated from triceps, subscapsular and calf skinfolds, and fat-free body weight estimated from potassium-40 measurements. Body structure consisted of skeletal widths, and segment girths, lengths and volumes. The dependent variables were vertical jump, standing broad jump, 50-yard dash, 600-yard run and mile run. The measures of strength increased the variance accounted for from 10 to 23% over that when body size, composition and structure were used without strength. An exception was vertical jump where no increase in the variance accounted for was found with the addition of strength variables. The regression equations determined for the sample of 60 boys rendered multiple R's ranging from 0.64 (mile run) to 0.75 (50-yard dash). It was concluded that strength has a significant relation to motor performance and that its contribution can be better assessed after accounting for differences in body size, shape, and composition.


The heart rate VO2 relationship of aerobic dance: a comparison of target heart rate methods.

The purpose of this study was to examine the relationship between heart rate (HR) and oxygen consumption (VO2) for aerobic dance exercise. Therefore, eleven females completed 20 minutes of aerobic dance with continuous monitoring of HR and VO2. These physiological responses were analyzed with correlation/regression techniques. The results showed that for aerobic dance to produce a response in excess of 50% of VO2 max, the target HR must be approximately 80% of the age-predicted HR max or greater. In contrast, previously reported data for treadmill running shows that 50% of VO2 max is achieved at approximately 65% of age-predicted HR max in females. The maximum heart rate reserve (Karvonen) method was also found to underestimate the actual VO2 of AD. With the Karvonen method, the target heart rate must approximate 65% of maximum HR reserve in order to elicit a VO2 response which is representative of 50% of VO2 max. These data support recent research which illustrates that target heart rate prescriptions derived from treadmill testing may fail to accurately place AD participants in the recommended training zone.


Factors enhancing cardiac output in resting subjects during cold exposure in air environment.

Six young males, in semi-nude conditions, resting in dorsal reclining position, were exposed successively to a thermoneutral environment (30 min), a cold environment (1 degree C) (Cold) or thermoneutrality (Control) (120 min), and during 60 min recovery in thermoneutral conditions. Cardiac output has been measured using a Dual Beam Doppler. During cold stress a significant increase of heart rate (66.4 +/- 6.4 to 91.0 +/- 14.9 beats.min-1), systolic blood pressure (119.5 +/- 7.8 to 218.7 +/- 18.7 mmHg), diastolic blood pressure (68.1 +/- 11.7 to 114.3 +/- 28.3 mmHg) and cardiac output (5.42 +/- 0.96 to 8.08 +/- 1.28 l.min-1) were observed. On the contrary initial systolic aorta flow acceleration is significantly lowered (1130 +/- 120 to 840 +/- 170 cm.s-2). Systolic ejection volume remained unchanged throughout the whole experiment. Increase in cardiac output during cold air (1 degree C) exposure is thus only imputed to the higher heart rate partly due to hypersecretion of catecholamines. The diminution of the blood flow acceleration could be related to a lesser arterial compliance and/or to the cold induced hemoconcentration. Enhanced heart's mechanical work due to sympathetic stimulation, seems thus to be absorbed by the increase in the peripheral resistance.


Body composition of university students by hydrostatic weighing and skinfold measurement.

The body composition of 124 male and 70 female Tartu University students was measured by three different methods: hydrostatic weighing by maximal expiration, hydrostatic weighing by maximal inspiration and subcutaneous fat thickness measurements. Our results show that the proposed body density measuring method by maximal expiration is simple, reliable and applicable not only in indoor swimming pools but in field conditions as well. The second new hydrostatic weighing apparatus is more comfortable for the subjects where the body density is measured at maximal inspiration. The mean body density of males was somewhat higher when measured by the maximal inspiration (1.066 +/- 0.012 g.ml-1) than when measured by the maximal expiration (1.063 +/- 0.009 g.ml-1, p < 0.05). For females, on the contrary, the maximal expiration method (1.044 +/- 0.010 g.ml-1) yielded a higher body density value than when measured by the maximal inspiration (1.040 +/- 0.011 g.ml-1, p > 0.05). The body fat percentage measured by skinfold thickness correlated significantly with the body fat percentage calculated by body density by maximal expiration (males r = 0.420, females r = 0.531) and inspiration (males r = 0.507, females r = 0.663). We must conclude that the presented two methods of measuring body density offer new possibilities for densitometric analysis without the need for expensive laboratory equipment.


Effect of middle-intensity exercise on carnitine and beta-hydroxybutyrate plasmatic concentration in men and women.

The purpose of this study is to describe the dynamics of carnitine, its esters and beta-hydroxybutyrate, during a prolonged moderate-intensity physical exercise, as the literature data (Angelini 1986, Carlin 1986, Lennon 1984) up to date reported were not uniform. In our study twenty-two untrained subjects (11 males, 11 females) performed a test exercise on a motor-driven treadmill for 90 min at 50-60% of VO2 max. Blood samples were obtained at rest, at 20, 40, 60 and 90 min during the exercise and after 30 min of recovery. Men show an increase over rest values in short chain acyl carnitine after 90 min of exercise higher than women (M 157%, F 80%), while women have a more elevated relative increase in beta-hydroxybutyrate (M 201%, F 233%); Total carnitine in both sexes is not significantly modified.


Little effect of long-term, self-monitored exercise on serum lipid levels in middle-aged women.

To study the effect of long-term, self-monitored exercise on physical fitness and serum lipid levels of middle-aged, nonsmoking females, a controlled study was conducted in 33 sedentary Swiss women. Seventeen women were randomly allocated to jog 2h/wk for 4 months on an individually prescribed and heart rate controlled base, whereas 16 women served as controls. Although leisure-time physical activity increased significantly in exercisers compared to controls, the average running distance of 10.9 km/wk was somewhat less than expected. The "net decrease" (4-month change in exercisers minus 4-month change in controls) in the sum of four skin-folds was -4.85 mm (p < 0.05). Four-month changes in serum lipids were generally small and nonsignificant. For example, the net decrease in total triglycerides was -0.2 mmol/l (p = 0.13). Correlational analyses revealed significant associations between changes in the waist-hip ratio and changes in total cholesterol (total-C) or the HDL/total-C ratio (r = 0.44, p < 0.01 and r = -0.29, p < 0.05, respectively). An increase in endurance capacity was associated with an increase in the HDL2-subfraction and in the ratio of HDL/total-C (r = 0.46, p < 0.05 and r = 0.52, p < 0.01). Multivariate linear regression analyses confirmed a change in endurance capacity as the statistically strongest positive predictor of changes in HDL, HDL2 and the HDL/total-C ratio. However, women who used oral contraceptives did not show any favourable lipid changes despite a considerable improvement in endurance capacity. The present training study in healthy, habitually sedentary middle-aged women was not able to show the same beneficial changes in serum HDL concentration as seen in male counterparts, when analyzed according to the principle of intention-to-treat. Exploratory analyses revealed that a too low jogging activity as well as a confounding effect of oral contraceptive use may partially account for the lack of significant changes in serum lipid levels after training.


The effect of exhaustive exercise on salivary immunoglobulin A.

The purpose of this study was to examine salivary immunoglobulin A (s-IgA) responses to exhaustive exercise. Twenty-nine, college age (means +/- SD = 21.45 +/- 3.1 yrs; range 18-29 yrs) moderately active males (running < 10 miles per week) performed an incremental treadmill test to exhaustion. Unstimulated salivary samples, collected before as well as immediately and one hour following the test, were analyzed for s-IgA using an enzyme-linked immunosorbent assay (ELISA). Mean s-IgA levels decreased significantly (24.4%, p < 0.05) immediately following the maximal test, and remained depressed (16.9%) one hour after the test. Of the 29 subjects, five exhibited an increase (range = 1.3 to 53.3%) in s-IgA following the exercise bout. The results of this study suggest that exhaustive exercise may temporarily reduce salivary IgA levels.


Strengthening physical self-perceptions through exercise.

Two studies examined the effects of physical activity/exercise on physical self-perceptions, self-efficacy, body satisfaction, fitness and relationships among these variables. In study 1, 34 female undergraduates participated in a 10-week exercise/activity program. Participants were selected from existing classes forming a weight training, aerobic exercise and activity control group. Results revealed changes in physical self-perceptions, strength, and body composition over the 10-weeks. Improvements in physical self-perceptions and fitness occurred independent of exercise/activity group. Groups differed in the perceived importance attached to physical self-perceptions. Correlations among the measures revealed relationships among physical self-perceptions, body satisfaction, global self-esteem, and fitness. In study 2, we hypothesized that weight training would have a greater effect on physical self-perceptions and body image perceptions than physical education activity classes. Thirty-seven males and 28 females were selected from existing classes forming a weight training and activity group. Results revealed no significant changes in physical self-perceptions, body image, or global self-esteem over the 10-week program, while strength and physical self-efficacy improved. Correlations among measures from both studies offer preliminary support for Sonstroem and Morgan's model for the examination of self-esteem in exercise settings.


The fates of Czechoslovak contestants in Olympic games.

Since the Second Olympic Games of the new era up to the Games in 1988 on the whole 2031 Czechoslovak competitors participated in both Summer and Winter Games. The author succeeded in compiling items on the length of life and causes of decease of 265 Olympic participants who died up to the end of 1989. The study of those items revealed that the length of living of those athletes who died in the period 1950 till 1989 was 67.4 years. That indice may be compared with men in population with a mean length of life 67.7 years in 1988. It is however necessary to take into consideration that the studied sample of Olympic competitors represents a certain selection of men. The causes of natural death of Olympic competitors do not differ in principle from natural deceases of other former Czechoslovak athletes and also no expressive differences were found in comparison with natural causes of death of men in population.


Lymph, lymph glands, and homeostasis.

Under aerobic conditions every respiring cell in the human body normally consumes oxygen to burn food and produce stoichiometric quantities of water which dissolves carbon dioxide and less soluble cell products. The effluent water and solutes appear in the form of lymph in the interstices between cells. The lymph effluent from all respiring cells flows to become the circulating lymph and blood plasma which coordinately sustain a steady state of homeostasis throughout the internal milieu. As a result, every living cell served by the vascular system has equal opportunity to partake of water and solutes emanating from or absorbed by remaining cells. Solute quantities available depend on cell location, regional plasma flow, local vascular permeability, molecular size, configuration, solubility and concentration, as well as avid cell receptors. Proportional to oxygen consumption, organized lymph glands develop in environments of relatively high oxygen tension around regional arteries to filter and process lymph coming from regional cells, and to produce effluent lymph rich in soluble globulins extruded by local mononuclear cells (especially macrophages, plasmacytes, lymphocytes), along with suspended small cytoplasm-poor lymphocytes. In turn, such dissolved globulins and remarkably motile small lymphocytes help feed, regulate growth and provide immunity to remaining cells. The lymph effluent from lymph glands and residua from capillary filtrates, along with newly absorbed solvent water, join the blood circulation during pulmonary inspiration in volumes proportional to the volume of air inspired with each breath.


Use of tonometry to assess lower extremity lymphedema.

Tissue tonometry was used to assess the outcome of microwave hyperthermia in treatment of 9 patients with lower extremity lymphedema. After microwave treatment, tissue tonicity of the lymphedematous leg returned toward normal. This improvement correlated with a reduction of leg volume and circumference, decrease in "inflammation" in the edematous subcutaneous tissue and clinical episodes of cellulitis. Possible factors involved in this shift in tissue tonicity toward normal include mobilization of excess fluid and plasma proteins from the interstitium, reduction in microvascular cellular infiltrate and changes in the elastic and viscoelastic properties of matrix collagen, elastin and ground substance following hyperthermia.


A comparative study of acetylcholinesterase activity in bovine (S. cervi) and human (B. malayi, W. bancrofti) filaria.

Setaria cervi, a bovine filarial parasite, contains a significant amount of acetylcholinesterase (AChE) activity with microfilaria having five to ten times more AChE activity than female and male adult worms, respectively. Because AChE shows substrate specificity and hydrolyzes acetylthiocholine but not butrylthiocholine, this parasitic enzyme is likely a true acetylcholinesterase. The latter also resembles an AChE enzyme in the human filarial parasite B. malayi which hydrolyzes acetylthiocholine iodide three times faster than butrylthiocholine iodide. The S. cervi AChE, like its counterpart, also exhibit inhibition with eserine, a specific inhibitor of this enzyme. Subcellular localization of AChE in adult female worms shows enzyme activity both in the mitochondrial and post-mitochondrial fraction. However, enzyme activity in the soluble fraction is twenty-seven times greater than in the mitochondrial fraction.


Dermal lymphatics in myotonic dystrophy.

Myotonic dystrophy is an hereditary disorder of several organ systems. Skeletal muscle is a principal target organ, but abnormalities also occur in the peripheral microcirculation. Because morphological and functional changes in the dermal blood microcirculation may affect interstitial fluid drainage of the skin, we examined dermal lymphatic morphology in adult patients with myotonic dystrophy. Skin biopsies were taken from the big toe from patients with myotonic dystrophy (age 18-50 years) and subjected to light and electron microscopy; five healthy subjects served as controls. The salient findings in myotonic dystrophy were ultrastructural changes of the lymphatic endothelial cells and the fibrillar elements that surround the lymphatic wall. These abnormal lymphatic findings are interpreted in light of changes in the blood microvasculature and loose connective tissue in this disorder.


Enzyme-histochemical identification of the human lymphatic capillary by adenylate cyclase.

This investigation was performed in order to establish a new histochemical method for the identification of lymphatic capillaries. The microvasculature in specimens from human foreskin was examined for adenylate cyclase and alkaline phosphatase activity by light and electron microscopy. Lymphatic capillaries showed positive adenylate cyclase reactivity and negative alkaline phosphatase reactivity whereas the blood capillaries showed a positive reaction for alkaline phosphatase and a negative one for adenylate cyclase. The presence of adenylate cyclase activity in the endothelium of the lymphatic capillary may relate to microvascular function including the transcapillary exchange of water and solutes.


Review of neural network applications in medical imaging and signal processing.

The current applications of neural networks to in vivo medical imaging and signal processing are reviewed. As is evident from the literature neural networks have already been used for a wide variety of tasks within medicine. As this trend is expected to continue this review contains a description of recent studies to provide an appreciation of the problems associated with implementing neural networks for medical imaging and signal processing.


Fundamental characteristics of human limb electrical impedance for biodynamic analysis.

The paper describes the use of human-limb impedance for biodynamic analysis. The change of human-limb impedance during movement was measured, and was found to be related to kinematic and kinetic parameters. Strong relationships were found between the velocity of change of the forearm impedance and the angular velocity of the elbow joint (correlation coefficient r = -0.97), between the the change of forearm impedance and the velocity of a human limb (r = 0.79). A change of upper-limb impedance was caused by a change in a sectional area of muscular tissue in the measured part and a change of blood volume during movement of an upper limb. In tennis, there was a strong relationship between a change of forearm impedance and ball velocity (r = 0.87). Impedance waveforms were useful for analysis of the movement pattern and the stability of movement in tennis. This method has the following characteristics: (a) it does not have a spatial and temporal limitation for measurement; (b) the subject is scarcely restricted in movement; (c) the data processing can be handled easily and quickly; (d) impedance waveforms inherently show magnitude, form and stability of movement.


Simulation method for cardiac stroke volume estimation by intracardiac electrical impedance measurement.

Using the electrical impedance measurement technique to investigate stroke volume estimation, three models of the ventricle were simulated. A four-electrode impedance catheter was used; two electrodes to set up an electric field in the model and the other two to measure the potential difference. A new approach, itself an application of the quasi-static case of a method used to solve electromagnetic field problems, was used to solve the electric field in the model. The behaviour of the estimation is examined with respect to the electrode configuration on the catheter and to catheter location with respect to the ventricle walls. Cardiac stroke volume estimation was found to be robust to catheter location generating a 10 per cent error for an offset of 40 per cent of the catheter from the chamber axis and rotation of 20 degrees with respect to the axis. The electrode configuration has a dominant effect on the sensitivity and accuracy of the estimation. Certain configurations gave high accuracy, whereas in others high sensitivity was found with lower accuracy. This led to the conclusion that the electrode configuration should be carefully chosen according to the desired criteria.


Cellular automation model of ventricular conduction.

A computer simulation of ventricular conduction is presented with a discrete element ventricular conduction model. The model is shown to be capable of demonstrating normal ventricular rhythm, including QRS and T-waves, plus a variety of rhythm disturbances including missed beats, electrical alternans and self-sustaining instability with arrhythmias. The morphology of the range of alternans produced bears a strong resemblance to certain clinically recognised arrhythmias.


Pupillometer for clinical applications using dual 256-element linear CCD arrays.

A new pupillometer for measuring the size of the pupil of the human eye is described. It uses two inexpensive 256-element charge coupled device (CCD) arrays in an orthogonal configuration. The system is controlled and data are analysed by means of a Z80A microcomputer. Software allows the position and diameter of the pupil to be displayed on a monochrome video monitor. Infra-red diodes irradiate the eye so that measurements can be made in darkness. The accuracy is better than +/- 0.1 mm, over the range 3.2-9.5 mm. Dynamic measurements of the pupil light reflex response can be made with sampling periods as short as 20 ms.


Effect of mains interference on time coherent averaging.

The paper deals with the influence of mains interference on time coherent averaging using an internal trigger. The general distribution of the time jitter is derived and applied to a simplified signal. The authors prove that no amount of averaging can do away with this type of interference. Finally, the deformation this type of jitter has on a step signal is computed.


Optimal time-window duration for computing time/frequency representations of normal phonocardiograms in dogs.

The optimal duration of the time-window used to compute the time-frequency representation (spectrogram) of the phonocardiogram was studied in four dogs by using intracardiac and thoracic measurements of the PCG. The power and cross-spectrograms of the intracardiac and thoracic PCGs were computed using a fast Fourier transform algorithm and a sine-cosine window with 10 per cent decaying functions. A coherence spectrogram was also computed for each dog to study the linear relationship between the two signals and determine the optimal time-window duration. Results show that the optimal range of the time-window duration is between 16 and 32 ms. A time-window shorter than 16 ms spreads out low-frequency components into the higher frequencies and generates a spectrographic representation with poor frequency resolution (> or = 62.5 Hz). A window larger than 32 ms increases the frequency resolution but smears the spectrographic representation of the signal in the time domain and thus cannot correctly reflect the time-varying properties of the signal. In both cases, the amplitude of the coherence function computed between the left ventricular and the thoracic phonocardiograms is overestimated.


New method of automated sleep quantification.

Since its discovery some 50 years ago, the electro-encephalogram (EEG) has formed the basis for classification of sleep into several stages, either laboriously performed by visual examination of the EEG and related signals or, more recently, by automated techniques. Both visual scoring and most automated analyses are highly subjective and rely on application of a predefined set of rules. A method of analysing the EEG which requires no such application of rules and aims to give some indication of the dynamics of sleep in humans is proposed in the paper.


Impedance plethysmography for blood flow measurements in human limbs. Part 2. Influence of limb cross-sectional area.

The cross-sectional area of a limb varies along the extremity. This is of great importance when impedance plethysmography is used for limb blood flow studies. The actual measurement site, as well as the interelectrode distance, must be carefully selected to avoid underestimation of the blood flow value. The distance between the potential electrodes should be less than 10 cm for an adult subject.


Mathematical model for the exchange of gases in the lungs with special reference to carbon monoxide.

A mathematical model has been formulated for the simultaneous exchange of gases O2, CO2, CO and N2 in the lungs. The model takes into account the physiological parameters, such as ventilation rate, diffusing capacity of the lungs, cardiac output, total volume of blood in the body and the interaction of gases in the blood. The nonlinear functions for representing O2, CO2 and CO dissociation curves have been used. The results predicted from the model are in good agreement with those based on the ventilation/perfusion relationships. The COHb build-up in the blood, computed from the model as a function of exposure time, is in good agreement with the experimental values. The consideration of capillary blood pO2 as a constant value, instead of an independent variable, is shown to introduce a maximum error of 0.25 per cent in the blood COHb. The model is applied to analyse the COHb levels at high altitude.


Monitoring of respiratory and heart rates using a fibre-optic sensor.

A new method, which uses a fibre-optic probe to monitor respiratory and heart rates simultaneously, has been developed and evaluated. The results provide evidence that it is possible to monitor respiratory and heart rates using the reflection mode of photoplethysmography (PPG). The fibre-optic probe makes it possible to monitor from different sites on the patient, and the method is convenient to use. In addition, the probe is X-ray transparent, insensitive to electromagnetic interference (e.g. during MRI investigation) and may be made very light and small. Therefore the method is suitable for the observation of both adults and neonates, in hospitals as well as in other environments.


Faradic resistance of the electrode/electrolyte interface.

A new method is used to measure the direct-current (Faradic) resistance of a single electrode/electrolyte interface. The method employs a constant-current pulse and a potential-sensing electrode. By choosing a sufficiently long pulse duration, the voltage between the test and potential-sensing electrode exhibits a three-phase response. In the steady-state phase, the voltage measured is equal to the current flowing through the electrode Faradic resistance and the resistance of the electrolyte between the test and potential-sensing electrode. By measuring this latter resistance with a high-frequency sinusoidal alternating current, the voltage drop in the electrolyte is calculated and subtracted from the voltage measured between the test and potential-sensing electrode, thereby allowing calculation of the Faradic resistance. By plotting the reciprocal of the Faradic resistance against current density and fitting the data points to a third-order polynomial, it is possible to determine the zero-current density (Faradic) resistance. This technique was used to determine the Faradic resistance of electrodes (0.1 cm2) of stainless-steel, platinum, platinum-iridium and rhodium in 0.9 per cent NaCl at 25 degrees. The zero current Faradic resistance is lowest for platinum (30.3 k omega), slightly higher for platinum-iridium (47.6k omega), much higher for rhodium (111k omega) and highest for type 316 stainless-steel (345k omega). In all cases, the Faradic resistance decreases dramatically with increasing current density.


Teachers at a British medical school.

Clinical teachers' attributes, beliefs and attitudes to teaching were measured by mailing a questionnaire to a 50% sample of staff at a British medical school. This paper describes the attributes of the 80% who responded. The majority (83%) were male and females were particularly under-represented in the upper echelons of academia. Most (57%) taught at least once weekly, though 20% taught less often than once a month. The 41% who were primarily NHS employees were as active in teaching as those employed by the University. Small group teaching was most frequently undertaken by 73%, though 17% (who were more likely to be University employees) most often lectured. Only 19% of teachers had attended a course in medical education in the previous 5 years--these were more likely to have qualified relatively recently and to be University employees. Few (9%) teachers claimed membership of a medical education society. It is hoped that these findings will stimulate debate on how medical school teachers are selected, how they can be helped to improve their teaching performance and how their enthusiasm for teaching can be fostered.


Ten statements on the motivation of medical teachers to teach.

Not only high number of students, increasing disintegration of curricula, lack of resources or hindering state regulations and laws seem to be the crucial problem in medical education worldwide but in particular substantially reduced interest and poor commitment in educational matters. Ten statements on possible reasons for the teachers' lack of motivation to teach are given and proposals for promoting their commitment are made.


Bulletin boards for faculty development.

Within the faculty development program of a Department of Family Medicine at a major research university, bulletin boards offer an alternative method for communicating new information, reinforcing knowledge previously acquired, and stimulating faculty to think about new ideas. This paper describes a five-step strategy for integrating bulletin boards into a faculty development program.


Faculty development in the health professions: conclusions and recommendations.

This report summarizes recent literature reviews and resource books on faculty development in the health professions and describes findings from articles not previously reviewed. Nine conclusions about faculty development in the health professions are drawn: (1) the concept of faculty development is evolving and expanding; (2) research skills are becoming a major focus of faculty development; (3) teaching skills are still a prominent aspect of faculty development; (4) fellowships are being used effectively to recruit and train new faculty; (5) the institutional environment has become a focus of faculty development; (6) faculty evaluation is an effective approach to faculty development; (7) the efficacy of faculty development needs better research documentation; (8) model curricula have been developed for different types of faculty; and (9) comprehensive faculty development centers are gaining in popularity. A set of recommendations based on the conclusions drawn is offered for those planning faculty development interventions.


Faculty mentors for medical students: a critical review.

New concern about the psychosocial development of medical students has resulted in a call for closer relationships between faculty and medical students. This review examines the literature on advising programs in medical schools and on mentoring generally to develop a better understanding of how faculty and students might interact. Innovative advising programs are discussed within the context of current thought about the value and structure of mentoring relationships.


Changes in personal health behaviors of medical students.

Physicians, including medical students, seem to lead healthier lives than the general public. Whether their favorable health behavior is learned through medical education is not known. This study uses a standardized health risk assessment to compare the personal health behaviors of a single class of medical students before and after completing their clinical rotations. Our findings confirm that medical students exhibit healthier lifestyle behaviors than that of the general population, and that changes in health behaviors may evolve with training.


Professional attitudes of doctors and medical teaching.

The attitude of doctors towards the profession influences to a large extent a number of aspects of clinical competence. Their attitude towards the patient is particularly important as it determines the quality of communication. There is reason to believe that a certain number of practising clinicians have not acquired the appropriate attitude to their patients and the skills in communicating that this entails in spite of specific undergraduate education programmes. This would warrant more and different attention to this subject by medical schools than is actually the case. The recently introduced scale of attitudes between doctor-centred, disease-oriented and patient-centred, problem-oriented could provide a basis for studying, teaching and evaluating individual attitudes of students.


Time involvement in journal reading and a suggested facilitation.

In the field of continuing postgraduate education, the reading of professional journals is an accepted method of keeping informed in regard to new developments and contemporary thought on different philosophies of treatment. Not only is such reading realized as being an efficient educational vehicle, but there is now a growing awareness of the actual necessity for any clinician to set aside specific time to the exercise. It is not always readily apparent, however, how great the time commitment can be, even when the reading is limited to selected articles. This paper sets out to indicate in quantitative terms the time that could be expected to be utilized by both general dental practitioners and academic teachers if a thorough and conscientious perusal of the journals were to be undertaken. A practical strategy for facilitating at least part of the problem is put forward in the hope of reaching a helpful compromise.


A tutorial/essay project to expand the learning experience in undergraduate medical pharmacology.

To lessen fact overload and to enhance the teaching of pharmacologic principles in an undergraduate course we introduced a tutorial/essay project into our traditional lecture-based course. Under the guidance of a faculty tutor, each student researched an assigned topic, developed a paper incorporating the results of the literature review and his or her own attitudes and formally discussed and answered questions on the topic with the tutor. Students and tutors were enthusiastic about this learning experience especially in that it required independent student-centred activity, provided opportunity for useful student/tutor interaction and helped students to learn to integrate scientific information with their own thoughts and ideas.


A review of the oncology curriculum at Dalhousie medical school.

The teaching of oncology at Dalhousie medical school is currently left to the discretion of the 30 university departments. There is no central coordination. This organization leaves no monitoring of curriculum content to see that what should be covered is indeed covered, nor does it provide teaching from the perspective of oncology rather than the perspective of the other individual disciplines. Following an inventory of the oncology curriculum and a survey of interns graduating from Dalhousie in 1991, we recognize deficiencies in the clinical portion of the curriculum that could be rectified with a small number of hours designed to teach the various aspects of the management of cancer patients in case-scenario, student participation sessions.


Student assessment of clinical experience in general surgery.

Forty-two students kept a log diary of all activities during their general surgical firms at a main university hospital in London. The students saw on average 35 patients per week on whom physical aspects were discussed by the consultant with the student after the consultation in 58%, psychological aspects in 4% and social aspects in 1.6%. Students spent an average of 11.2 hours per week with patients. In outpatients students spent most of their time as passive observers, but there were opportunities for more active involvement on the wards. Here the students spent on average 1.5 hours per week personally examining patients and 1 hour per week taking histories. Each student performed on average two short and one long examination per week and 0.5 short and 2.25 long histories per week. The students received on average 2.9 hours per week of consultant teaching in small groups, junior medical staff teaching at 2.2 hours and non-medical staff teaching of 1.1 hour per week. Students spent almost 4 hours per week attending formal traditional lectures in large groups. Some areas identified for improvement were: the relatively little feedback and supervision students received when personally examining patients and taking histories; the passive involvement of students in most educational settings; the small amount of time devoted to discussing social and psychologically relevant factors in the history; the few practical procedures personally performed by students; the relatively large amount of time students reported as unproductive and the small amount of time spent on self-education.(ABSTRACT TRUNCATED AT 250 WORDS)


Establishing goals and priorities in a surgery department.

Limitation of resources necessitates prioritization in the planning of goals for a clinical discipline such as surgery. Private practitioners and academic surgeons have their own priorities which reflect their specific, often conflicting, interests. We describe a model (modification of Davies & Morgan, 1983) for establishing goals and priorities with input from both private practitioners and academic full-time surgeons in a large Department of Surgery. The model consists of four phases each of which is divided into input, process and output stages. During the input stage general large group discussion allows identification of disparate views. This is followed by refinement of these ideas in small group discussions (process) which results in the formulation of a report (output). Application of this model resulted in a clear definition of goals and priorities by consensus and placed education first on this list of priorities in spite of a department in which there is a predominance of private practitioners whose major area of activity is in the realm of patient care.


Teaching statistics to health professionals: the legal analogy.

Despite the importance of statistical concepts to health professionals, the teaching of statistics to students from this field has generally been unrewarding. We feel that a few central concepts are crucial to all statistical thinking and that, for most health professionals, the communication of these is more important than learning about complex mathematical models. A device for demonstrating the parallels between a criminal legal trial and statistical hypothesis testing is presented. We feel that it can facilitate the learning of this central statistical concept.


Anatomy of the upper limb: a partnership in learning and assessment.

Specific rehabilitation of the upper limb by the Occupational Therapist requires a sound working knowledge of the anatomy of the pectoral girdle, arm, forearm and hand. To aid the learning process the Liverpool occupational therapy students are given their assessment topics at the beginning of the course. They find a conductive partner with whom to work and practice, and together they prepare for the oral demonstration which forms the assessment test at the end of the second term. Each student completes a questionnaire at the end of the fourth term. This is designed to ascertain how confident the student felt, and how well they retain their anatomical theory of the upper limb for clinical work.


A new approach in training pre-clinical medical undergraduates in community medicine in Pondicherry, South India.

Pre-clinical medical undergraduates are taught Community Medicine using a variety of teaching methods keeping the didactic lectures to the minimum in conformity with the latest recommendations of Medical Council of India. Five of the total twelve topics were taught using group discussion during 1988-89. The present paper gives the details of lesson plans for two topics. Evaluation was done based on the results of the written test, opinions expressed by the students and on the spot observation by the faculty members. Suggestions given by the students to improve the sessions have also been highlighted.


Audit of oral examinations in psychiatry.

This study describes a simple set of statistical parameters for assessing the reliability and validity of oral examinations (OE). Traditional feedback to examiners tends to categorize them as 'hawks' or 'doves' on the basis of whether their personal mean mark is above or below the group mean. Our study shows that the mean OE mark on its own is not a good measure of examiner performance. We suggest that inter-rater reliability between examiner pairs is a more satisfactory indicator of reliability and face validity. The correlation between the OE marks given by an examiner and the student's subtotal from written parts of the exam (SUBTOT) is suggested as a useful indicator of OE validity. These measures, as applied to our own student exam results, suggest that our OE examiners are performing at an acceptable standard of agreement (Cohen's Kappa for pass/fail 0.74, p < 0.0001), and support the use of the OE as a method of student assessment.


[Heterogeneity of lung ventilation as an indicator of early occupational exposure effects on the respiratory system].

The homogeneity of lung ventilation was evaluated in 148 male workers without any evident symptoms of impaired lung ventilation who were employed as miners (94 persons) and processors (52 persons) of PbS ore. The V2:V1 factor was calculated from the resultant of the maximum flow and volume. In the group of miners, significant increase of homogeneity was found to occur in elder workers (over 35 years of age) and in those employed for a longer period of time (above 10 years). Ventilation heterogeneity in that group was also intensified by simultaneous occurrence of chronic bronchitis. In the group of the floatation plant workers, there was a similar relationship between the ventilation heterogeneity and their age as well as employment period. As no effect of tobacco smoking on the discussed parameter was detected, it can be presumed that the effect of the working environment factors was predominant.


[Neurobehavioral effects of chronic occupational exposure to mixtures of solvents used in furniture varnishing. Part I--Psychological examination].

The study aimed at detecting psychological effects of chronic occupational exposure to the mixtures of solvents used in furniture varnishing. 36 exposed workers and 34 controls selected so as to account for age, education level and the nature work were examined. The following tests were used in the examinations: the Neurobehavioral Core Test Battery, Orebro Symptom Questionnaire, Perceived Stress Scale. A slow-down of perceptive and motor activities, which intensified with the duration of exposure, was the only observed adverse effect of the exposure. The workers employed for periods longer than 15 years more often reported symptoms of psychic function disturbances and deterioration of their health condition.


[Neurobehavioral effects of chronic occupational exposure to mixtures of solvents used in furniture varnishing. Part II--Testing of visual evoked potentials].

The study involved a group of 40 workers chronically exposed to mixtures of organic solvents. The exposure did not exceed the allowed hygienic standard. Organic changes in the central and/or peripheral nervous system were not detected. Irregular visual evoked potentials were found in 9 (22.5%) of the exposed workers. The irregularities related primarily to the latency of some components of visual evoked potentials. Those changes occurred primarily within the group of workers employed for longer periods of time (16 years and longer).


[Biological evaluation of experiments in rats of Australian and Italian talc aggressiveness].

In order to evaluate biological effects of Austrian and Italian talc, pulmonary and hemolytic tests as well as pathomorphological examinations were performed. 120 Wistar rats divided into 5 groups were given intratracheally 50 mg of the examined talc dust suspended in 0.5 ml of 0.9 NaCl. The control group received one 0.5 ml dose of NaCl. The observation periods were 6 and 9 months. Then the biochemical tests for hydroxyproline content in the lung were carried out along with patho-morphologic tests to evaluate the fibrogenic activity of the talcs examined. In animals the intratracheal insufflation of talc dust causes inflammatory changes within the bronchi and lungs. On the basis of biochemical examination of lung homogenates, the differences in the hydroxyproline content were determined. After 6 months the symptoms of chronic inflammation and cellular modules developed. Within another 3 months the symptoms of chronic atrophic inflammation in the bronchi were observed and cellular modules containing dust particles were detected in the lung. Hemolytic test revealed a slightly higher degree of aggressiveness of the Austrian talc.


[Effect of an occupational environment containing manganese on granulocyte adherence].

Workers employed in the manufacture of iron/manganese alloys were exposed primarily to manganese, but also to noise and other factors. Neutrophilic erythrocytes of those workers displayed significantly higher adherence compared to that determined in the control group. Duration of employment, occurrence of chronic bronchitis and the intensity of tobacco smoking did not affect the adhesive properties of neutrophilic granulocytes in peripheral blood.


[Participation of mental workload in circulatory system reaction to occupational work].

The aim of the study was to determine the degree to which the heart rate during and after work of variable physical and mental load was affected by the mental workload of moderate intensity. The subjects were 150 women aged 17-57. 24-hour recordings of their heart rates during work, leisure and sleep were taken using the Medilog recording-analysing system. Mental workload was determined in two ways: by the AET method, which enabled objective evaluation of the load, and by a method which involved subjective evaluation of work requirements and the ability to cope with them. Using the multiple regression analysis, the degree to which concurrent elements of mental and physical workload an serve as predictors of heart rate during work, leisure and sleep. The results show that physical workload is the more essential factor affecting the reaction of the circulatory system under the circumstances of concurrent mental and physical workload. By extending the measurements to involve off-duty hours, it was possible to determine that the consequences of mental workload manifested also after the work. The prolonged effect of mental workload on the heart rate was evident only when the subjective method of workload estimation was used. This points to the individual character of mental workload. The findings indicate on one hand that the share of mental workload should not be neglected during evaluation of the effects of occupational workload on the physiological reactions and, on the other, that the heart rate measurement is a useful tool for indicating essential elements of workload.


[The effect of social support on women's perception of global stress and health status].

Social support is considered to be an essential factor in the perception of global stress, as it reduces the impact of the stressors (and thereby protects against excessive stress), a well as reduces the detrimental effects of stress. The purpose of the study was to determine the level of social support received by women in two essential areas: family life and occupational work, and to estimate the relationships between the support level and stress perception by women and the condition of their health (estimated with the use of the Goldberg General Health Questionnaire). The APGAR questionnaire designed by G. Smilkstein was used to estimate the support. This was the first instance of the application of the method in a Polish study--with prior written consent of the author of the method. The study involved 98 women in four occupational groups (physicians, nurses, spinning machine operators, and employees of financial department of an industrial plant). The results of the study indicate that the situation of the women in respect of the received social support differs, to a statistically significant degree depending on the occupational group to which they belong. The evaluations of the support are also, significant correlated with the evaluations of global stress in the whole population test--higher results with respect to the support are correlated with the lower degree of stress. The support from the family shows higher degree of correlation with the level of the perceived stress than the support received at the place of employment.(ABSTRACT TRUNCATED AT 250 WORDS)


[Effect of combined exposure (noise, dust, nitrogen oxides) on health status of metal workers in heavy industry. Evaluation of erythrocyte metabolism].

This paper presents the effects of combined exposure (noise, dust, nitrogen oxides) on the health condition of industrial workers, with special regard to red blood cell metabolism. 208 male industrial plant workers of the average age of 38.5 +/- 8.27 years and the average work period of 14.7 +/- 8.22 years were examined. The statistically significant increase of methemoglobin level was detected as well as some changes in erythrocyte metabolism in terms of increased activity of glucose-6-phosphate dehydrogenase, pyruvate kinase and in vitro production of lactic acid in erythrocytes. The observed changes indicate the influence of exposure to nitrogen oxides and the resulting cellular adaptation to unfavourable working conditions (activation of the pentose cycle and of the final stage of anaerobic glycolysis cycle).


[Acetylation phenotype as a biomarker of sensitivity to the carcinogenic effect of aromatic amines].

The feasibility of genetic screening used for the determination of the acetylation phenotype in workers exposed to carcinogenic aromatic amines seems to be well-grounded. A conclusion like that is supported by numerous epidemiologic observations which show that the slow acetylators are more prone to bladder cancer under the conditions of exposure to aromatic amines than the fast acetylators. The significance of the acetylation phenotype for the processes which start the transformation of the normal bladder epithelium cells into the neoplasm was explained by studying the metabolism of the carcinogenic amines in the cells of mammals, including humans. Further tests are required to explain to what degree the genetic inclination is associated with the occurrence of the slow acetylation phenotype dependent on the tobacco smoking and on other factors, such as diseases, past or present.


[Carpal tunnel syndrome of occupational etiology--new problems in diagnosis and certification].

The work is based on the author's own experience during her employment as an expert at the Institute of Occupational Medicine, Lódź, and on the literature on diagnosing and certification of occupational etiology of the carpal tunnel syndrome. The paper also discusses the applicability of the electrophysiological tests for occupational certification, as well as the significance of having adequate information about the workplace of the examined people and the problem of expected difficulties in evaluating exposure to the due variable structure of production and services.


[Health protection in the workplace in Germany (former Federal Republic of Germany) in 1973-1990].

1. In Germany health protection against injuries at work is distinctly separated from the general health care of the population. 2. Health protection at work includes: recognition, prevention, treatment and rehabilitation connected with occupational diseases as well as prevention of accidents at work. The total cost of this system including accident indemnities is covered by the employer. 3. The system of health care and safety at work within the enterprise comprises a coordinated activity of the physician inspector and a representative of the enterprise and the owner. 4. In big enterprises there is another system operating parallel to the one mentioned above: this system provide comprehensive health care. The costs are covered by contributions both on the paid of the employers and the employees.


Testicular organization and spermatogenesis in Tegula (Chlorostoma) tridentata (Potiez and Michaud, 1838) (Mollusca: Archaeogastropoda: Trochidae).

The basic environment for the generation of spermatozoa in the gastropods is a gametogenic compartment resulting from somatic and germ cells interaction. In arachaeogastropods however, such association has not been characterized. In this study at the light and transmission electron microscopy level, evidences are given that in T. (C.) tridentata, spermatogenesis is centrifugal and occurs around seminiferous tubules surrounding the lumen that is a blood vessel. This basic organization presents somatic cells interacting with germ cells. There are three types of spermatogonia: primary spermatocytes with proacrosomic granules, and spermatids that undergo the following spermiohistogenic events: 1. Nuclear chromatin condensation to form a short cylindrical nucleus with an anterior invagination containing the base of the axial rod and a posterior invagination containing the proximal centriole. 2. Polarization of mitochondria attached to the posterior nuclear membrane to integrate the midpiece. 3. Coalescence of proacrosomic granules in one acrosomic vesicle, polarization of the acrosomic vesicle in the anterior nuclear region and transformation of the acrosomic vesicle in the conical acrosomic complex with a subacrosomic cavity containing the axial rod. 4. Tail formation from the distal centriole. Apparently the supporting cells do not associate closely with the spermatids. Therefore, they would not perform a mechanical role in the generation of spermatozoa shape that is characteristic of the Trochidae and other archaeogastropod families. This spermatozoon is peculiar due to its prominent acrosome larger than the nucleus.


Leaf ruminal digestion in Sorghum bicolor cultivars as influenced by water deficit.

A study was carried out on the effects of water deficit upon the specific leaf digestion of two sorghum cultivars: Novillero and Leoti Red. Using scanning electron microscopy it was established that after ruminal incubation, losses of structural integrity increased when the plants were submitted to drought conditions. This increase was marked in cv. Novillero after 48 h of digestion. For both cultivars, the phloem, mesophyll, parenchyma and epidermis were the most susceptible tissues to bacterial attack. The alterations in tissue disappearance during digestion, could partially explain the effects of water deficit upon the improvement in the nutritional quality of the two cultivars studied.


Dehydroleucodine prevents ethanol-induced necrosis in the rat gastric mucosa. A histological study.

The aerial part of Artemisia douglasiana Besser (6) has been used in folk medicine as a cytoprotective agent against the development of peptic ulcer. The dehydroleucodine (DhL), its active principle, significantly prevents the formation of gastric lesions induced by the exposure of the rats to absolute ethanol orally administered. The stomachs of control and experimental rats (after ethanol and pretreated with DhL) were removed, opened along the greater curvature and studied under stereo microscope and with light and scanning electron microscope. Absolute ethanol produced focal visible hemorrhagic lesions, extensive hyperemia, vascular stasis, cell disruption, and necrosis of the mucosa. Abundant mass of mucus was observed with scanning. The stomachs of rats pretreated with DhL showed a reduction of lesions. No hemorrhage and hyperemia were observed. The epithelia of the mucosa had a cobblestone appearance, similar to control rats and was covered by a fine layer of mucus. The mechanism of the protective action of DhL is unknown although it seems to be related to endogenous prostaglandins (PG).


A light- and electron-microscopic study of the pineal complex of the ammocoete larva of the southern lamprey Geotria australis.

The pineal complex of larval Geotria australis lampreys has been examined by light- and electron-microscopy. The complex consists of a pineal organ and a smaller parapineal organ, the former being situated dorsal to the latter. It is concluded that the pineal organ is a functioning photoreceptor, with neural and endocrine output. The parapineal appears to be a more basic neuroendocrine organ without photosensory capability. Day-night comparisons of the pineal complex show no obvious differences in ultrastructure; this could be related to the chronobiological role of the complex as a constant monitor of ambient light levels, rather than a mere visual receptor that changes its sensitivity at night.


Crystals in supporting cells of pineal organ in larval lamprey not likely to be pure guanine.

Spectrophotometry of larval pineal organs, digested in either 1 M HCl or 1 M NaOH, revealed peak absorbances at 253 nm and 268 nm, respectively. This result is not consistent with the view that the crystals found in lamprey pineals are chemically made of guanine.


[The chitinases of aerobic sporulating bacteria isolated from different ecological sources].

The chitinolytic activity of 171 strains of 15 species of spore-forming aerobic bacteria isolated from different ecological sources has been studied. 85 strains of the studied bacilli (50%) hydrolyzed colloidal chitin in a different degree. Among the cultures isolated from human and animal organism 60% of strains were characterized by the presence of extracellular chinases, among the collection strains--37%, among those isolated from soil and from insects--40 and 43%, respectively. The cultures of Bacillus subtilis as well as B. coagulans, B. megaterium and some other possessed the highest activity on the liquid medium. Some strains have been chosen for further research aimed at their possible use for biotechnology.


[The lysogeny of Vibrio parahaemolyticus of serovar O4:K12].

Lysogeny has been first established in strains of parahemolytic vibrios of serovar O4:K12. Moderate phages belonged to morphological group IV by home A. S. Tikhonenko's classification and were presented by one serological type. No correlation has been revealed between sensitivity to moderate phages of parahemolytic vibrios and specificity of "O"- or "K"-serotypes.


Polymerase chain reaction: relevance for oral pathology.

The polymerase chain reaction (PCR) is a recent innovation in biotechnology for amplifying specific nucleic acid sequences by use of repeated cycles of DNA synthesis. Application of PCR has been extended to a wide variety of biological and medical disciplines; fields of application include molecular genetics, pathology, microbiology, forensic medicine, and infectious diseases. Because of its speed and powerful sensitivity, PCR has become a highly valuable method for detecting small amounts of target nucleic acid sequence with the caveat that it has certain limitations. Importantly, false-positive reactions can result from the amplification of contaminating DNA whereas false-negative reactions can result from introduction of inadequate numbers of primer sequences. The application of PCR in the context of oral pathology is presented along with a discussion of the utility of this technique to aid in the elucidation of the etiology of oral disease.


[A method for determining the toxigenicity of micromycetes].

A method is suggested to determine toxigenicity of microscopic fungi from genera Aspergillus, Penicillium, Fusarium, etc. which contaminate fodder, food products and environment objects. The method is based on the property of micromycetes isolated from fodder, food products and environment objects to produce mycotoxins under optimal conditions of their cultivation on the nutrient media. Their further extraction by the organic solvent, evaporation and emulsification of the extract and its peroral introduction to young female rats cause a disease and death of animals. The suggested method may be used for recognizing and preventing mycotoxicoses of farm animals and poultry.


[Problems for discussion on the creation and use of bacterial preparations for the correction of the microflora of warm-blooded animals].

Different aspects of interrelation between macro- and microorganisms are considered in the paper. The phenomenon of rapid translocation of the exogenic microflora into blood and organs of the hot-blood animals opened by the authors is analyzed in detail. Strategy and tactics of application of biopreparations from living microbiol cultures are discussed as based on the authors' experimental data as well as on numerous data from literature.


[The first isolation of Torulopsis glabrata (Anderson) Lodder from dental granulomas].

Three Torulopsis have been isolated from two hundred or so dental granulomas. Torulopsis glabrata has been observed in cases of ophthalmopathy, infections of the oral cavity, lung infections, endocarditis and septicaemia. Apical lesions due to Torulopsis glabrata are not typical of mycosis but are generic of dental granulomas. The histological granulomatous character prevails. Experimental infections have been obtained from this fungus. Human infections by Torulopsis glabrata have been described. These infections are induced particularly in subjects with their immunity systems depressed by prolonged cortisone therapy. Their systematic position and morphology in optical microscopy have been examined in accordance with current views.


[In vivo and in vitro experimentation with the effects of chlorhexidine in patients who have undergone a periodontal intervention].

The periodontal pack is often used to cover the surgical site after surgery, even when associated with local applications of preparations containing chlorexidine, in order to obtain an antiseptic protection. However many people question whether the drug effectively succeeds in penetrating the pack, or if the presence of the pack itself doesn't obstruct the action of the medication. The aim of this work is to evaluate the efficiency of the clorexidine in the surgical area with and without a periodontal pack. In a first stage, a case was chosen and contemporary operated on in two different but anatomically similar sites at the same time. One of the two sites was covered with a chlorexidine gel for the following week, whilst the other was left without medication. After seven days the stitches removed from the two different sites were placed in culture mediums to number and classify the bacterial strains present. In the second stage of the experiment, another eight patients were operated on in the same way, and the two sites covered with periodontal packs. In one of the two sites a layer of chlorexidine gel was positioned under the pack, and the chlorexidine above and on the sides of the pack was continually renewed throughout the week following the operation. The other site was not treated. The results obtained show that the pack partially reduces the action of the drug medication, probably because an insufficient amount reaches the site. The activity and efficiency of chlorexidine against the strains of bacteria found in vivo were tested in vitro. The chlorexidine destroyed all of them.(ABSTRACT TRUNCATED AT 250 WORDS)


[The action on bacterial plaque of the mastication of a sorbitol chewing gum].

The authors made a clinical evaluation of mastication of sorbitol chewing gum and its interference on plaque accumulation on teeth in 14 volunteers, 10 men and 4 women with an age average of 27 y.o., who joined both control and gum groups for 1 or 2 or 3 days. Both groups, after perfectly cleaning their teeth, were requested to avoid any measure of oral hygiene for the whole time of the study and the gum group was advised to chew one sorbitol chewing gum immediately after every assumption of solid food for unless than 30' minutes with a minimum of 4 pieces a day (after breakfast, after lunch, during the afternoon, after dinner). They were supplied with one of two most diffused sorbitol chewing gums in Italy: Vivident in 8 and Happydent in 6 cases. The choice of sorbitol was made because it can be considered a non-cariogenic sweetener and because in our country it is the most used in the so called "senza zucchero" gums and sweets. Plaque extension was evaluated by Quigley-Hein plaque index with the same procedure of the original work and taken as a parametric value in order to apply parametric tests as media, normal distribution, standard deviation, variance, Student's tests, etc. These evaluations were made on Ramfjord's teeth: 1.6, 2.1, 2.4, 3.6, 4.1, 4.4 each one divided in two half. Results, so processed, showed a significant reduction (-0.96%; p < 0.01) of plaque index for 1 day with best effect on vestibular half of frontal teeth (p between < 0.01 and < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)


[A scanning electron microscope assessment of the changes induced by wear on subsonic endodontic instruments].

The aim of the present work was to study the wear of a special kind of subsonic instruments with usage. We have examined with scanning electron microscope new and used instruments: the first to estimate the features and degree of final touches; the second to examine how they wear after 1, 3 and 5 minutes. We tested for each period 3 instruments per size. In all we controlled 72 instruments. The results of the study show that after 5 minutes the instruments are very worn.


[Anatomicosurgical comments on the importance of the spinal accessory nerve].

The preserved integrity of the spinal accessory nerve plays an extremely important role in cervico-facial surgery since the majority of surgical approaches involve this nervous structure. Following a short historical outline of the surgical method, the Authors illustrate the anatomo-topographical aspects and anatomo-surgical problems. A number of points emerge from a review of the literature which are vital to isolate the spinal accessory nerve: 1) the transversal apophysis of the atlas is particularly prominent in the retrostyloid space and lies half-way across an imaginary horizontal segment connecting the mastoid process with the angle of the mandible; 2) the posterior edge of the sternocleidomastoid muscle at approximately six centimetres from the mastoid process; 3) the nervous point of Erb located at the point where the superficial branches of the cervical plexus emerge from the posterior edge of the sternocleidomastoid muscle (the nerve generally emerges from the posterior edge of the sternocleidomastoid muscle two centimetres above this point and two centimetres below it the nerve meets the anterior edge of the trapezius). This is followed by an analysis of the possible complications deriving from lesions to this vital nervous structure. The resection of the spinal accessory nerve leads to the so-called "shoulder syndrome" mainly due to the denervation of the trapezius. This syndrome is characterised by the onset of regional pain, the typical deformation of the shoulder joint and functional deficit. The deformation is provoked by the decreased muscular strength of the superior and middle portion of the trapezius manifested as the rocking of the shoulder and a higher superointernal angle.(ABSTRACT TRUNCATED AT 250 WORDS)


[Primary reconstruction of the anterior sublingual sulcus with a nasolabial flap after the resection of a malignant neoplasm].

The reconstruction of the loss of substance from the oral floor following demolitive cancer surgery aims to guarantee adequate tongue movement and the consequent preservation of phonatory and swallowing functions, as well as the possibility of using prosthetic rehabilitation. Large defects are resolved using musculocutaneous or free vascularised flaps, whereas smaller defects may be closed by first intention using alveolo-lingual suture. There are a number of drawbacks to this method: occurrence of fistulas immediately after surgery and secondary ankyloglossia. It is then necessary to resort to a second operation using dermoepidermic graft and plastic surgery of the oral floor to liberate the tongue. These problems may be resolved using a nasolabial flap. The flap can be prepared using either an upper or lower peduncle, it is relatively simple to perform and does not significantly prolong operating times. The contemporary dissection of the neck with ligature of the facial artery does not in our experience significantly influence flap vascularisation. The main drawback is the limited size of the flap (on average it is 6-7 cm long with a maximum width of 3-4 cm at the base. The upper edge is equally placed 7-10 mm from the medial side). The flap must be sufficiently thick to ensure an adequate blood supply to subcutaneous tissue, but the dissection plane must be sufficiently near the surface to preserve the facial nerve. It is important to prepare the graft bed so as to avoid creating tension after suture.(ABSTRACT TRUNCATED AT 250 WORDS)


[The orthosurgical correction of 2 cases of Angle class II div I].

An orthosurgical technique comprising maxillary expansion using Burstone screws associated with multiple corticotomy, repositioning of the bone basis and pre- and postoperative orthodontics was used to correct two cases of Angle's class dysgnathia with involvement of both the bone basis and alveolodental component. The outcome was satisfactory in that a good esthetic result was achieved together with normal and functional occlusion which was stable over time.


From diet to DNA: dietary patterning of gene expression.

The role of molecular biology in understanding structure/function relationships as well as the influence of metabolic processes on host nutrition is becoming increasingly important. Not only is this field having a major effect in elucidating the detailed structure of nutritionally important enzymes but it is also allowing the nutrition scientist to study metabolic function and the significance of different pathways in whole animals. In this review, the use of gene transfer studies, in particular, the creation of transgenic animals to study mechanisms in which nutrients may regulate gene expression is discussed. Although these studies are presently quite specific, it is envisioned that these studies will ultimately lead to a better understanding of dietary host interactions, which may lead to the ability of the clinician to optimize dietary intake in order to more favorably modify metabolic disorders.