Transfer, expression, and inheritance of salmonid growth hormone genes in channel catfish, Ictalurus punctatus, and effects on performance traits.

We examined expression and inheritance of salmonid growth hormone genes RSVLTR-rtGH1 cDNA and RSVLTR-csGH cDNA, transferred to channel catfish (Ictalurus punctatus) by microinjection. One to 9 copies of the foreign DNA were inserted in either head-to-tail tandem array at single insertion sites or single copies at multiple insertion sites. All P1 transgenic catfish evaluated produced salmonid growth hormone regardless of the construct. Five P1 x P1 matings were accomplished. The spawning rate and fertility of these P1 transgenics in artificial spawning conditions were comparable to those of normal channel catfish. In two of three years, 100% spawning and 100% hatch were obtained. Percent transgenic progeny observed in the five matings were 20, 52, 7, 47, and 0%, which was lower (P < 0.001, chi 2) than the 75% inheritance expected assuming the P1 brood stock had at least one copy of the foreign gene integrated and were not mosaics in the germ line. At least 7 of 10 P1 were mosaics, and a minimum of 2 of 10 P1 did not possess the salmonid growth hormone genes in their germ line. P1 transgenics grew at the same rate as their nontransgenic full siblings, which is not surprising because the P1 were mosaics. F1 transgenic progeny in two families possessing RSVLTR-csGH cDNA grew 26% faster, to 40 to 50 gm, than their nontransgenic full siblings when evaluated communally. One F1 progeny group produced by RSVLTR-rtGH1 cDNA x RSVLTR-csGH cDNA mating and one F1 progeny group (parents either RSVLTR-rtGH1 cDNA or RSVLTR-csGH cDNA) grew at the same rate as normal full siblings when grown communally to 25 gm and 60 mg, respectively. In families where F1 progeny grew faster than controls, the range in body weight and coefficient of variation for the transgenic full siblings were less than those for controls. In families where F1 progeny grew at the same rate as controls, range in body weight and coefficient of variation were similar for transgenic and normal individuals. The percent deformities observed in P1 transgenics (13.6%) was higher (P < 0.05) than in microinjected P1 nontransgenics (5.1%). Percent deformities in transgenics and control F1 channel catfish was not different (p > 0.05; 0.5 and 2.8%, respectively).


Transfusion-associated graft-versus-host disease in patients with Hodgkin's disease and T cell lymphoma.

Two patients, one with Hodgkin's disease and one with peripheral T cell lymphoma, developed transfusion-associated graft-versus-host disease 16 and 8 days after transfusion of red cell and platelet concentrates. Fever and skin rash were followed rapidly by an elevation of liver enzymes and the onset of diarrhoea and pancytopenia. Despite treatment with high-dose methylprednisolone and anti-lymphocyte globulin, commenced within 7 and 2 days of the onset of rash, grade IV GvHD persisted and both patients died with severe pancytopenia. HLA types of peripheral lymphocytes of the patient with Hodgkin's disease were inconsistent with those of her parents and siblings, but HLA typing of her fibroblasts revealed that her true type was consistent with those of her parents and that her circulating lymphocytes were not genetically her own. The HLA types of the patient with T-cell lymphoma were inconsistent with those of her siblings which suggests, but, in the absence of other evidence, does not prove, chimaerism.


Platelet counting using plasma platelet concentrate samples.

Platelet counting using samples of plasma from platelet concentrates prepared for transfusion was assessed. The methods employed included a manual phase-contrast method, and counting with Coulter S Plus and Sysmex E-2500 counters. All methods were reproducible (mean CV of 4.9, 2.2 and 1.4%, respectively). However, neat samples of platelet concentrates analysed by Coulter counter were inaccurate (mean count of 863.8 x 10(9)/l compared to 1018.9 x 10(9)/l counted manually). Moreover, the Coulter platelet counts were non-linear above 900 x 10(9)/l, whereas the E-2500 platelet counts were linear to 2700 x 10(9)/l. A one-in-three pre-dilution was required to obtain accurate, linear counts with the Coulter counter, whereas the E-2500 was accurate without pre-dilution (mean count of 1030.2 x 10(9)/l compared to 1018.9 x 10(9)/l counted manually). In conclusion, the method of platelet counting may affect true platelet yields.


Immunomodulatory activity of different blood products on the mitogen-induced human lymphocyte transformation.

Blood transfusions have an immunosuppressive effect on the recipient and induce changes in several immunological parameters. We studied the effect of homologous and autologous fresh plasma (FP), fresh frozen plasma (FFP), heparinized plasma, as well as the influence of red blood cells (RBC), CPDA-1, CPD, heparin, PAGGS-mannitol, SAG-mannitol and ADSOL on mitogen-induced lymphocyte transformation. Both homologous and autologous FP and FFP decreased the PHA and ConA response of human lymphocytes (P < 0.05). The PWM response was reduced by FP (P < 0.05). The mean t1/2 of plasma-induced suppression was approximately 38 h. Dose-dependent suppression rates were observed with pure CPDA-1 and CPD solutions. In contrast, heparinized plasma showed an elevated PHA- and ConA-induced transformation rate (P < 0.025), whereas PWM induction was unaffected. In addition, washed RBC, pure PAGGS-M, SAG-M and ADSOL solutions revealed no effect on the PHA response. Freezing, heating or recalcification of plasma resulted in an increase in the PHA response. Adenine was not immunosuppressive in vitro. We conclude that, in addition to unspecific mechanisms by CPDA-1 or CPD, an unknown plasma factor, which is susceptible to changes in temperature or storage conditions, suppresses the PHA-, PWM- or ConA-induced T-cell immune response. Further clinical studies are needed to correlate these observations with clinical phenomena.


Development, optimization and use of an enzyme linked immunosorbent assay (ELISA) to measure factor VIII antigen utilizing monoclonal antibodies.

An enzyme linked immunosorbent assay (ELISA) has been developed to measure VIII:Ag in plasma and concentrates. The assay utilizes two commercially available monoclonal antibodies to VIII:Ag and provides an alternative to the established immunoradiometric assay (IRMA). It has the advantage of not requiring the use of radioactive material and human antibodies. The assay sensitivity is 0.006 u/ml and the interassay coefficient of variation is 6.3%. Forty-eight samples with VIII:Ag levels ranging from 0.006 to 1.5 u/ml were assayed by both ELISA and IRMA. The coefficient of correlation between the two assays was 0.89. In addition to measuring human VIII:Ag, it is also possible to detect antigen in several animal plasma and sera.


Audit of the use of packed red blood cells in association with seven common surgical procedures.

The risks and costs associated with the transfusion of blood and its components have led to increasing demands for evidence of the appropriate use of blood components. We have examined the use of packed red blood cells (PRBC) in association with seven common, surgical procedures performed in 1987 and 1988 to establish patterns of use. The information has formed the basis for surgical blood order schedules and autologous donation targets for these procedures. It has also been used to determine appropriate audit 'triggers' and the results of an audit using these 'triggers' are reported.


A survey of cold-growing gram-negative organisms isolated from the skin of prospective blood donors.

The skin of the antecubital fossae of 90 subjects, chosen at random but eligible to be blood donors, was sampled using sterile swabs. This sampling was done prior to disinfection. The swabs were inoculated into a selective culture medium and 'incubated' at blood bank refrigerator temperature for a total of 6 weeks. The results show that there were a number of cold-growing Gram-negative bacilli (GNB) on the skin tested. One of the GNB carriers found was subjected to frequent testing both before and after skin disinfection. The routine skin disinfection regime for blood donors was used in an attempt to establish its effectiveness. Despite regularly being able to culture Pseudomonas fluorescens prior to swabbing, no swabs taken after disinfection showed growth. This volunteer was subjected to a skin biopsy to establish whether the skin disinfection might be simply superficial. No growth occurred in the medium into which biopsy tissue, after disinfection, was inoculated. We conclude that although GNB may be present on donors' skin, the disinfection procedure, as used by us prior to donation, was effective.


Pulmonary embolism in Ibadan, Nigeria: five years autopsy report.

The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante-mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti-coagulant therapy in high risk patients.


The effects of Cassia abbreviata on rat blood pressure.

The effects of a crude extract of the stem bark of Cassia abbreviata on mean arterial pressure in anaesthetized rats were investigated. Bolus injections of the stem bark elicited a transitory fall in blood pressure which was dose-dependent. The depressor response was not blocked by atropine nor propranolol thus indicating that muscarinic and beta 2 receptors are not involved. However it was partially blocked by diphenhydramine, and H1 antagonist. The latter also partially blocked the depressor response to histamine which is mediated partially through both H1 and H2 receptors. It is concluded that the stem bark of C. abbreviata contains histamine or a chemically related substance and that it is this component which is responsible for lowering the blood pressure.


Cutaneous squamous cell carcinoma in Tanzania.

The Tanzania Cancer Registry at Muhimbili Medical Centre, Dar es Salaam, Tanzania was reviewed for squamous cell carcinoma of the skin in non-albino African subjects. The data was analysed for age, sex, site and predisposing factors. Our results were then compared with studies previously carried out in Tanzania, elsewhere in Africa and also on Blacks in America. Squamous cell carcinoma of the skin was found to be a common malignancy, and the commonest skin cancer. Its peak was in the 40-49 years age group though it could occur in children under five years of age. The most affected site was the lower limb, followed by the head and the neck. The penis in the male and the vulva in the female were the third most affected sites. The scalp and the lip were more affected in females than males. Chronic trauma, chronic ulcers, and scars were the main predisposing risk factors to the lower limb and the scalp, while ultra violet radiation to the head and neck, and smegma of the uncircumcised penis were thought to be predisposing risk factors.


Seasonal vulnerability to depression. Implications for etiology and treatment.

The risk for depression increases at two opposite times of the year--late spring/early summer and late fall/early winter. In 15% of patients with recurrent major depression, depressive episodes regularly recur on an annual basis in one of the two seasonal risk periods. Thus, there are primarily two forms of seasonal affective disorder: recurrent fall-winter depression and recurrent spring-summer depression. The opposite seasonal types of depression tend to have opposite vegetative symptoms. Sleep, appetite and weight increase in winter depression and decrease in summer depression. An important implication of the seasonality of depression is that some type of depression may be caused by changes in the physical environment and that manipulations of the physical environment may be used as treatments. There is now extensive evidence that exposure to bright artificial light is an effective treatment of recurrent winter depression. A corollary is that seasonal deficiency of natural light probably induces winter depression. There have been considerable efforts to elucidate the biological mechanisms of winter depression and its response to phototherapy. Although no single system has been shown to be responsible for the syndrome, there is evidence that the indole hormone melatonin, the indole neurotransmitter serotonin, and the peptide neurohormone corticotropin releasing hormone (CRH) play roles in the pathophysiology and phototherapy of winter depression.


[The depressive patient before depression].

This paper describes five prototypes of depression which develop from different temperamental substrates: timid-inhibited, dysthymic, hyperthymic, cyclothymic and irritable. They correspond, respectively, to anxious depressions, double depressions, anergic depressions, rapid-cycling depressions, and hostile depressions. The author argues that, despite a certain degree of overlap in pharmacologic response, each prototype has a relatively unique profile, including benzodiazepines, MAOIs, SSRIs, TCAs, lithium, low dose neuroleptics and anti-epileptic agents.


[Time and the depressive subject].

Dealing with the diseased man means dealing with man, and whether his disease be organic or psychic, this disease is, first and foremost, a human affliction imposed by life. Any attempt at understanding this affliction should first answer the question of what "being a man" signifies. When Nietzsche writes that man is an animal "not yet established", "an afflicted animal", one may understand that man is afflicted by himself and that he is not a man in the way a thing is a thing. Our approach is based on a phenomenology of existence which focuses on the style of existence of the concrete individual rather than on the supra-individual features of psychopathological syndromes. Actually, depressive conditions exist in all cultures and at all ages; this reality is as intimate to man as is his relation with time. In the common experience of our "good" and "bad" days, we are often unaware of time that passes or, on the contrary, we feel that time is sluggish and we discover two things. First, as shown by E. Straus, we experience two forms of time: a time of the Ego moving along with our own history and a time of the world which is a time we share with other men and with things. Depression has its roots in the discrepancy between these two forms of time. Besides, this experience shows that everything we do during our daily life can be withdrawn. We experience a loss, not of an object that disappears but of our feeling, of our contact with the ambient world.(ABSTRACT TRUNCATED AT 250 WORDS)


[Time and depression in children and adolescents].

The existence of depression in young individuals has often been denied or at least underestimated particularly during adolescence, to the benefit of such other concepts as morosity, inherent in this period of life, and from which depression should be differentiated. Recent epidemiological investigations in the general population have revealed an approximate 2% and 10% prevalence of depression in the child and the adolescent, respectively. This considerable increase in morbidity is associated with a modification of the sex ratio: more boys are affected before puberty, more girls after puberty. In the present work we shall first deal with the semiology and comorbidity of depression as related with the developmental changes occurring in the child and the adolescent. Thus, several studies have shown that the DSM III criteria for affective disorders are consistently applicable to pre-puberty children and adolescents as well. However, depression in the pre-puberty children may be more ostentatious, manifesting itself by psychomotor agitation, somatic complaints and anxiety comorbidity of the type: Separation Anxiety Disorder and phobias. Depressed adolescents may exhibit more anhedonia, more depressive cognition, hypersomnia, weight variations, more alcohol or drug abuse and suicide attempts, and, in one third of them, greater coexistence of anxiety disorders or behavioural disorders. The course of depression at this age is now known, owing to catamnestic studies that proved methodologically satisfactory (we personally managed the follow-up of 75 depressed adolescents over an average 45 months). Depression in the child and the adolescent is not a benign affection, it is a long-lived, recurrent and disabling illness.(ABSTRACT TRUNCATED AT 250 WORDS)


[Depression in middle age patient].

"Middle age of life" should be considered more as a psychological concept than a chronological one. It may be defined very roughly as the forties but the limits are variable within the age range 35-50 years. This period is often one of existential crisis marking the access to the age of maturity. This "transition", or "maturescence", confirms or modifies life orientations previously selected by the subject according to modalities that are sometimes difficult to live and assume, hence the frequency of depressions. Among internal modifications, there is an important change in the way time is lived; from then on, the subject becomes clearly aware of his past lifetime and of his remaining lifetime. Time has come for him to draw a balance, which involves looking at himself from a distance, interrogating himself about his previous choices, a feeling of confinement, often a relative degree of disillusion. The subject must discover for himself a new form of presence in the world. In parallel, the members of his family environment also change: parents become old, adolescents develop their social autonomy, husband or wife follows his/her own existential route in an individual mode. All such modifications often promote a loss of the subject's usual landmarks, a relative degree of puzzlement, sometimes even a destruction of pre-existing harmony that may impair the psychological balance of the subject. Promoted by anxiogenic conflicts due to changes, depressions frequently occur in the middle-age group, depending on the above fragilizing factors, the particular circumstances, and the subject's background.(ABSTRACT TRUNCATED AT 250 WORDS)


[Depression and aging].

Old age is a qualitative state during which depression frequently occurs. This illness presents particular features which should be considered in the course of both normal ageing and senility. Viewed as an existential crisis, ageing may be considered as a depression promoting factor. Rich in depression promoting factors, this period of life is a sequence of crises which result in reorganizations heavily dependent on the adaptive capabilities of the aged person. During ageing, depression exhibits particular features that one should be able to recognize and distinguish from the consequences of deficits that are the normal adjuncts of the ageing process. The same is true of alterations occurring in the cognitive sphere and which might result from demential alteration. During ageing, depression should be identified among the other decompensation patterns occurring in the aged patient by viewing the situation in terms of overhelmed mechanisms. Depression exhibits a pattern whereby it relates closely with the risk of dementia. Therapeutic management should take into account such a perspective, that one might call transnosographic, when considering the depressiveness of aged patients as a high-risk situation requiring long-term follow-up of their biological, psychodynamic, social and cognitive functions.


[Duration of antidepressive treatments].

In spite of the considerable amount of research undertaken in the field of biological psychiatry, there is currently no reliable guide allowing us to predict with accuracy the response of a patient to an antidepressant treatment. Moreover, owing to the heterogeneity of the spectrum of affective disorders, to the importance of eliminating the various factors involved in an apparent resistance to an antidepressant therapy, it seems aleatory, particularly for an individual patient, to foresee precisely the length of an antidepressant treatment, except may be in unipolar disorders. The quality of the physician-patient therapeutic relationship should never be neglected. The recent hypotheses pertaining to the etiopathogenesis of affective disorders, the advent of new psychotropic agents such as the specific serotonin uptake inhibitors, or other agents not acting through this mechanism and the MAOI, type A, as well as the utilization of corticosuppressor drugs, may pave the way to new therapeutic avenues that could, in the future, modify the prognosis and the duration of the treatment of the depressive affective disorders.


Features of recurrent brief depression.

Recurrent brief depression, characterised by frequently occurring brief depressive episodes, lasting less than two weeks, is now recognised as a common and disabling illness with a chronic relapsing course and a significant suicide risk. The episodes have a mean duration of 3 days, but otherwise fulfill the symptomatic criteria for DSM III-R major depression. Some two thirds of episodes satisfy severity criteria for at least moderate depression and about a third for severe depression. They recur erratically with a mean period of 18 days between the start of one episode and the next. Because of the frequency of the episodes patients may report longer continuous periods of depression than was the case and may be mistakenly perceived as dysthymia as major depression. It is important to identify these patients as treatment response appears to differ. The episodes are too short to be able to assume efficacy with conventional antidepressants; it is necessary to adopt a prophylactic strategy for treatment aiming to reduce the severity, the frequency, or the duration of episodes.


In vitro inhibition of alkaline phosphatase activities from intestine, bone, liver, and kidney by phenobarbital.

A kinetic study of the inhibition of several alkaline phosphatase (AP isoenzyme activities by phenobarbital was carried out using p-nitrophenylphosphate (10 mM) as a substrate at pH 9.8 in a 300-mM Hepes buffer. AP from bovine kidney, calf intestine, bovine liver, and rat bone was used. Over a phenobarbital concentration range of 20-400 mM, all these isoenzymes were inhibited in an uncompetitive manner with a Ki of 200 mM for intestinal AP, and in a linear mixed-type manner for all the other isoenzymes tested. The Ki values were 10, 40 and 55 mM for kidney, bone and liver AP, respectively. The use of 15 mM carbonate-bicarbonate or 400 mM diethanolamine buffer did not modify the degree of inhibition of intestinal AP activity. Dixon plots of the reciprocal of reaction velocity versus inhibitor concentration either at different substrate concentration or at different DEA concentration indicate uncompetitive inhibition for the intestinal enzyme. This in vitro inhibitory effect of phenobarbital is in contrast to its in vivo stimulating action on AP. However, in the whole animal, the effects of phenobarbital administration probably represent the sum of multiple effects.


Alkaline phosphatase and phosphotyrosine phosphatase activities of cultured amniotic cells with trisomy 18.

In cultured amniotic cells from fetuses with Edward's syndrome (trisomy 18), the activities of two protein phosphatases, alkaline phosphatase and phosphotyrosine phosphatase, were measured. Comparison with normal fetal cells showed a different behavior for each enzyme. Alkaline phosphatase was significantly lowered while phosphotyrosine phosphatase remained at normal levels. The interest of these enzyme assays in the screening procedure of this severe chromosome defect is discussed.


Purification and characterization of 6-pyruvoyl tetrahydropterin synthase from human pituitary gland.

6-Pyruvoyl tetrahydropterin synthase, the enzyme that catalyses the conversion of 7,8-dihydroneopterin triphosphate to 6-pyruvoyl tetrahydropterin, was purified 3,330-fold from human pituitary gland with an overall recovery of 30%. The native enzyme has a molecular mass of 68 kD and consists of four identical subunits of 16.5 kD. The pH optimum of the enzyme in Tris/HCl buffer is 7.5. The enzyme is dependent on Mg2+ and NADPH and has a Michaelis-Menten constant of 10 microM for its natural substrate, 7,8-dihydroneopterin triphosphate. The isoelectric point of the human enzyme is 4.3-4.6. The human pituitary gland enzyme is heat instable in contrast to the enzymes from human, rat and salmon liver, and Drosophila head. The amino acid composition showed remarkably high content of acidic amino acids Asp and Glu. The N-terminus was found to be blocked.


A new continuous optical assay for maltase and sucrase.

A new method for the assay of maltase and sucrase is reported. The method makes use of mutarotase, hexokinase and glucose 6-phosphate dehydrogenase as ancillary enzymes. The reaction is linear at least up to a delta E/min of 0.13.


Pathological release of urinary endopeptidase 24.11 early after renal transplantation.

Endopeptidase 24.11 (EC 3.4.24.11) enzymatic activity was spectrofluorimetrically measured in human urine, using a synthetic peptidic substrate. Urinary endopeptidase 24.11 output (Uendo) was determined in 24-hour urine samples of 10 kidney transplant recipients during the first 2 weeks after surgery. In 9 patients, a large increase in Uendo levels was noted during the 1st and/or the 2nd postoperative days (mean +/- SEM of peak Uendo 624 +/- 122 micrograms/24 h, p = 0.0003 as compared to 239 +/- 20 micrograms/24 h in a healthy control population). This occurred whether patients received OKT3 (n = 6) or cyclosporine A (n = 3) as primary immunosuppression. Uendo returned to normal between the 3rd and the 5th postoperative day. We conclude that renal transplantation is associated with an early and marked release of endopeptidase 24.11 in urine. This could be due to the potentially toxic effects of ischemia and/or immunosuppressive drugs on the proximal tubular epithelium. The clinical usefulness of urinary endopeptidase 24.11 as a marker of tubular injury remains to be assessed.


Sex and age dependence of rat kidney sialidase.

Rat kidney sialidase levels have been reported to be markedly altered in pathological states such as diabetes. This was associated with a modification of sialic acid levels. Therefore, it was interesting to study the variations of kidney sialidase and sialyltransferase activities and sialic acid content according to sex and age. This was carried out from birth to 210 days of age. The substrates used were sialyl alpha(2-3)[3H]-lactitol for sialidase activity, asialofetuin and [14C]-CMPNeu5Ac for sialyltransferase activity. In males sialidase activity increased until 32 days then slightly declined. In females, the activity increased and leveled off at 135 days of age. Higher sialidase activity was observed in females than in males from 56 days of age. Gonadectomy had no effect on this activity. In both sexes, sialyltransferase activity decreased markedly with age. This activity was higher in females than in males, whereas sialic acid levels varied only moderately with age and were slightly higher in females.


Urinary cholinesterase activity is increased in insulin-dependent diabetics: further evidence of diabetic tubular dysfunction.

We measured the cholinesterase activity in morning urines from 63 insulin-dependent diabetics and 27 controls. The total esterase (TotE) activity (Ellman's method) has been divided into aliesterase (AliE), pseudocholinesterase and acetylcholinesterase by means of two inhibitors, eserine and quinidine. Diabetics were divided in 2 groups according to the urinary albumin/creatinine ratio (mg/mmol, < 2 in group 1, > 2 in group 2). The urinary cholinesterase behavior was correlated with that of a known tubular lysosomal hydrolase, N-acetyl-beta-D-glucosaminidase (NAG). Compared to normals, in addition to a significant increase in urinary NAG in diabetes (in group 2 more than in group 1), TotE and AliE were also significantly raised (+36% and 109% of the controls, in group 1 as much as in group 2).


Essential fructosuria: increased levels of fructose 3-phosphate in erythrocytes.

Erythrocytes of 3 adult siblings with essential fructosuria contained 45-200 mumol/l fructose 3-phosphate (Fru-3-P), i.e. 3-15 times the concentration in normal controls. Sorbitol 3-phosphate was also increased, but to a lesser degree. An oral load with 50 g of fructose produced an additional 40 mumol/l increase of erythrocyte Fru-3-P after 5 h. The rate of Fru-3-P formation by red cells in vitro was normal. HbA1 and HbA1c were normal. The suspected pathogenetic role of Fru-3-P in diabetic complications is questioned.


[Problem of controlling current mental capacity in operators].

The industrial means to control and forecast the current mental capacity of operators are absent nowadays in spite of its level connected with about 2/3 of accidents through the personnel's fault. Results of 10 year-experience show how the computerized self-educating adaptable systems of current individual mental capacity monitoring in power engineering operators were created. The systems to control the mental capacity in operators before and over the course of the shift let also improve the reliability and economy in exploitation of huge technological enterprises and preserve the operator's health.


[Characteristics of work intensity and fatigue in proof-readers in the polygraphic industry].

A group of proof-readers showed the elective resistance to fatigue from visual work by the end of working shift. Changed near point, decreased power and hardiness of the hand, aggravated self appraisal were more significant than altered achromatic visual stability, time of motor response to the light and critical flicker fusion frequency. The studied parameters were compared making use of Derevianko's index.


[Health status and prevention of disorders in people performing intensive visual work].

Electronic industry workers, whose work involves visual strain were examined. The work appeared to be characterized by a plenty of unfavourable factors: high visual and emotional intensity, considerable strain of the locomotor apparatus in supporting a fixed sitting posture. The micromountain workers were exposed to poor ionized and ozonized air conditions combined with high bacterial contamination and lack of the UV rays in the air. Examinees showed markedly changed health and functional status of the main body systems. A complex of hygienic, prophylactic, physiological, technological and medical measures yielded remarkable results. Working conditions of electron industry workers are to be regulated.


[Changes of functional state of the human body and the dynamics of its recovery in hard physical work in protective devices in various air temperatures].

Effect of the hard manual work on humans using the individual protective means in temperature conditions from 17 to 30 degrees C was studied. The investigation revealed the altered thermoregulatory, circulatory, central nervous systems and the acid-base status. The changes were found depending on the environmental temperature. The recovery period (one-hour rest and shower) did not normalize the disordered functions, so further correction of the functional status is necessary.


[ Dynamics of NAD-dependent isocitrate dehydrogenase activity in homogenized rat liver exposed to toxic products of the phosphorus industry].

Dynamic studies showed that the combined action of phosphine and hydrofluoric acid damages the Krebs cycle reactions, dehydrogenization of isocitrate and synthesis of citrate in homogenized rat liver. Yellow phosphorus harmed the citrate synthetic reaction of citric acid cycle in homogenized rat liver as well. That activated the alternative action principles in the cycle. The main cause of such disorders in the Krebs cycle in likely to be the abnormal fat metabolism induced by toxic products of phosphorus industry.


[The making of the industrial physician].

A total of 259 questionnaires distributed among physicians working at plant shops were analysed. The formation of such specialist turned out to be difficult because of inadequate training in occupational pathology and hygiene at the medical institute.


[The main principles in the combined action of metals and their significance for hygiene].

Features of metal's co-action according to the results of toxico inetic studies concerning the binary elemental combinations infused into the body are discussed. The investigations revealed that the stoichiometric laws of metals' co-action depended on the way the metals were infused by and the scheme of their combined action, on their qualitative and quantitative composition. The quantitative changes in the metabolism of metals during their co-action were found the most important. These changes may serve to evaluate and forecast the combined action of metals. The role of individual metallic qualities in their metabolic co-action was proved to be important.


[Role of psychological studies in clinics for occupational diseases].

The authors emphasize the significance of psychological studies in patients with occupational diseases. Foreign and home investigations of the problem are reported. The programme and prospects for the introduction of the methods into practical medicine are presented.


[Health disorders in workers of the fish processing industry].

The contributors propose a study of the labour conditions (microclimate, work load and intensity) in processing of dried yellowfin fish, describe results of the psycho-physiological and clinical studies, including medical examinations, epicutaneous testing, ventilation capacity of the lungs and peripheral blood laboratory studies. It was established that the technological processes of drying yellowfin fish exhibited exposure to the biological factors causing irritations and sensibilization of the skin fraught with occupational diseases (dermatitis) and respiratory disorders (allergic rhinopathy and the pre-asthma syndrome).


[Occupational morbidity of oil industry workers on the mainland and continental shelf].

Data of occupational morbidity in oil industry workers of Azerbaidjan are compared with the mean data in the country. Oil industry workers of mainland and shelf turned out to have different levels of occupational morbidity, depending also on the age and length of service.


[Principles and methods of evaluating tension of the functional systems in the body during work].

Grounded and worded concept stresses that the intensity of regulating mechanisms must be taken into account in evaluating the difficulty and intensity of work, criteria of intensity are suggested. Growth of intensity index, centralized administration or considerable number of correlations (above the average on the whole industry) and more synchronized functions during the work improve the intensity of work by one step above the results of the simple physiological evaluation of work intensity.


The cementless PCA primary total hip system. Medium-term follow-up of 235 cases.

The Porous Coated total hip Arthroplasty (PCA), used by the authors since August 1984, represents a considerable advancement in the field of prosthetic replacement. Its original design and biological fixation give it long-lasting stability not only in young patients, but also patients with initial osteoporosis. Its use in cases of advanced osteoporosis, however, is more controversial. The 8-year results are quite satisfactory from both a clinical and radiographic standpoint, confirming, as other authors have reported, that the medium and long-term results of cementless total hip replacement tend to stabilize because there is a lack of late reactions, which are more common in cemented implants.


Correction of lower limb deformity using external fixation.

The authors report their experience in treating angular and rotational deformities of the lower limb by an original method consisting of corticotomy and gradual distraction with an external fixator on the opposite side of the limb as the deformity. The Castaman angular and Monticelli-Spinelli circular external fixators were employed (Castaman, 1983; Monticelli and Spinelli, 1983, 1986, 1987).


CT arthrography and arthroscopy in chronic glenohumeral joint instability.

The authors evaluate the value of CT arthrography in glenohumeral joint instability. A study was conducted on a group of 16 patients with recurrent dislocation of the shoulder. All patients underwent CT arthrography and arthroscopy. The diagnostic accuracy of CT arthrography was rated for different types of lesions on the basis of arthroscopic confirmation of its findings. Our results, which include a statistical analysis, showed a diagnostic accuracy of 97.3% in Bankart lesions and 100% in Hill-Sachs lesions and loose bodies. Dilation of the subscapular bursa and injury of the glenoid labrum-IGHL complex were often identified, while chondritis and synovitis were less frequently diagnosed. The authors therefore conclude that CT arthrography may be considered an extremely reliable diagnostic test for obtaining an overall picture of injuries due to instability. Arthroscopy, on the other hand, should be reserved for cases in which surgery may be performed in the same stage as diagnosis.


Ultrastructural analysis of the adaptation of articular cartilage to mechanical stimulation.

Ultrastructural analysis was conducted on samples of articular cartilage taken from both load-bearing and non-load-bearing areas with the aim of evaluating the morphologic adaptation of the articular cartilage to mechanical stimulation and identifying the mechanisms of interaction of the chondrocyte and the matrix. Through this analysis we were able to better define the adaptation process of the cartilage as well as the modalities of mechanical stress transmission. We believe that the complex formed by the chondrocyte, the pericellular matrix, and the pericellular capsule constitutes the biomechanical unit of the articular cartilage which serves as the sensor and transducer of mechanical stress. The arrangement of the collagen fibers and the proteoglycans which make up the pericellular capsule and membrane around the chondrocyte can be compared, from a mechanical standpoint, to a dynamic structure constructed in order to absorb the load stresses and protect the internal environment. From a biological standpoint, these are comparable to an extracellular-scaffold constructed with the aim of mediating the interaction between the chondrocyte and the territorial and inter-territorial compartments.


Radial head fracture treated by resection. Long-term results.

Thirty-one patients who underwent resection of the radial head for fracture of the radial head were reviewed after an average of 17 years. These patients were divided into three groups according to the type of fracture and treatment: group 1 had undergone complete resection due to isolated radial head fracture, group 2 partial resection due to isolated fracture, and group 3 complete resection due to radial head fracture associated with other lesions in the same arm. The clinical results were satisfactory in 72% of the group 1 patients, none of the group 2 patients, and 60% of the group 3 patients. In 55% of the patients an increase in the valgus angulation of the elbow was observed, modest in most instances. In almost half of the patients, all of which had full range of elbow motion, a new radial head had formed. Eighty percent of the patients had clinically asymptomatic distal subluxation of the radioulnar joint. In most cases of isolated radial head fracture, complete resection yields satisfactory long-term results. Partial resection, on the other hand, has a high incidence of failure. The presence of other osteoarticular lesions in the same arm significantly reduces the chances of success.


Emission spectrophotometric analysis of titanium, aluminum, and vanadium levels in the blood, urine, and hair of patients with total hip arthroplasties.

Emission spectrophotometry was used to measure the levels of titanium, aluminum, and vanadium in the blood, urine, and hair of 30 patients with total hip arthroplasties. The patients were divided into three groups of ten; one group was studied two years after total hip replacement, one at four years, and one at six years. High levels of titanium and aluminum were found in the hair, especially in the group studied six years after implantation, while the levels of the three ions in the blood and urine were not significant.


The Elmslie-Trillat procedure for recurrent subluxation of the patella. One to five year follow-up.

Thirty-four patients who had undergone the Elmslie-Trillat procedure from 1985 to 1989 were examined in order to evaluate the effectiveness of this operation in the treatment of recurrent subluxation of the patella. The result of an increased Q angle accompanied by patella alta, femoral sulcus dysplasia, or vastus medialus obliquus dysplasia was also studied. Only those patients with recurrent subluxation of the patella took part in this study; cases of habitual or permanent dislocation, potential instability, traumatic dislocation, and degenerative arthritis were excluded. The patients were reviewed both clinically and radiographically, and the A.R.P.E.G.E. scoring system was used to evaluate the results. The follow-up period ranged from 1 year to 5 years and 4 months, with an average of 3 years. The overall results were excellent or good in 77% of the cases, as was the subjective knee stability rating in 87% of the cases and the pain rating in 82% of the cases. Recurrence of the subluxation was observed in only one instance. The results were not significantly different when the groups of patients with patella alta and type 1 femoral sulcus dysplasia were considered separately. The results were also excellent in the patients who underwent the Elmslie-Trillat procedure with reconstruction of the vastus medialis obliquus. In conclusion, surgical realignment of the anterior tibial tubercle confirmed its reliability in the treatment of recurrent subluxation of the patella. In cases of patella alta, the authors recommend lowering the anterior tibial tubercle only when the Insall-Burstein index is greater than 1.3. Femoral sulcus-plasty should be performed in cases of type 3 sulcus dysplasia.


Atraumatic patellofemoral joint disorders. Long-term results of surgery.

Clinical and radiographic follow-up was done on a group of patients with atraumatic patellofemoral joint disorders who had been treated surgically by realignment of the extensor apparatus at the authors' institution from 1985 to 1989. The preoperative radiographic examination in the 65 patients treated (for a total of 74 realignments) evaluated the following parameters: sulcus angle, Insall-Salvati index, and congruence angle. The 46 patients who returned for follow-up (after an average of 2 years and 3 months) were evaluated clinically according to a classification system proposed by the authors which is based on objective clinical data and a multi-factorial assessment of pain. Moreover, radiographic follow-up of the same 46 patients made it possible to quantify the degree of realignment achieved with each type of surgical technique. The clinical and radiographic data made it possible to determine more precise indications for each type of surgical procedure in relation to the disease involved, using a correct diagnostic approach and making a thorough evaluation of the clinical, anatomical and pathological features.


Torsional tibia vara.

Infantile tibial torsion and tibia vara are common childhood deformities with controversial methods of measurement and treatment. The authors believe that the two deformities are different manifestations of the same entity for which the term "torsional tibia vara" is adopted. A practical method of measurement and a decisive method of conservative treatment are presented for this disorder. The concept as well as the methods of measurement and treatment have been successfully practiced by the senior author (H.Z.) for the past 20 years.


Clinical and radiographic evaluation of the Codivilla method of surgical correction of congenital club foot. Medium-term follow-up of 235 cases.

The authors review 30 patients with congenital club foot (CCF) who were treated surgically by a slightly modified Codivilla technique. Clinical morphologic, and functional follow-up was performed an average of 10 years later, and the findings were compared to the radiographic features. The final outcome was rated good in 41% of the cases, fair in 29%, and unsatisfactory in 30%. The authors found a close correlation between the grade of the initial deformity and the final outcome. Some sign of the deformity always remained, even when the functional outcome was excellent.


The effect of chemotherapy on osteosarcoma.

The aim of this study was to evaluate the effect of chemotherapy on osteosarcoma by comparing the histologic pattern of primary tumors with that of their metastases. Therefore the primary tumors and metastases in 11 patients were macroscopically and histologically classified according to the Enneking and Broder systems as well as our own method. Three of 11 patients developed metastases with a less malignant pattern, 8 patients developed metastases which were as malignant as the primary tumor. The chemotherapeutics used had either an insubstantial effect or none at all on the differentiation of immature tumorous structures in the metastases and treatment did not lead to the expected improvement. Only the patients in whom, according to our own system, the primary tumors were classified as less malignant, are still alive.


A fourth type of brachial plexus injury: middle lesion (C7).

The authors describe a fourth type of traumatic brachial plexus lesion which was found in 11% of injuries to the spinal nerve roots, trunks and cords. This lesion consists of isolated or predominant lesion of the middle elements. While high lesions are caused by shoulder trauma in a downward direction and low lesions by trauma in abduction, middle lesions are produced by trauma in an anteroposterior direction. The high incidence of this type of lesion led the authors to propose the following new classification: high lesions (C5, C6)(Duchenne-Erb); middle lesions (C7); low lesions (C8, T1) (Dejerine-Klumpke); complete lesions.


Influence of an in-patient exercise program on scoliotic curve.

In 107 patients with idiopathic scoliosis radiographs were performed under standard conditions immediately before and immediately after a 4-6 week in-patient exercise program at the Katharina-Schroth Hospital. The average angle of curvature as measured by the Cobb technique was 43.06 degrees (standard deviation = 22.87) before treatment and 38.96 degrees (SD = 23.00) after treatment. An improvement in the curve of 5 degrees or more was found in 43.93% of the patients, 53.27% were unchanged and in 2.8% the curve increased by 5 degrees or more. Altogether the improvements in curvature were highly significant. These results show that even in severe scoliosis the magnitude of the curve can be reduced by a specific rehabilitation program of physiotherapy.


Allergy to components of total hip arthroplasty before and after surgery.

Sensitivity to a series of haptens was studied in two groups of patients by means of patch tests. The first group was made up of 66 patients with total hip replacements, 12 of whom had aseptic loosening of the implant. The second group, which was used as a control, consisted of 41 patients scheduled to undergo total hip replacement. Ten patients (15.1%) in the first group tested positive; one of these had aseptic loosening. In the control group, two patients (4.8%) tested positive. The theory that an allergy may be the cause of loosening has a biologic foundation, but it can only be used to explain a few cases. However, since considerable vanadium sensitivity was found, we suggest that this material be used as little as possible in the manufacturing of prosthetic components.


Severely displaced fracture of the thoracic spine without neurologic lesion. A case report.

The author reports a case of severely displaced fracture of the thoracic spine without neurologic damage in a 27-year-old man. The lesion was treated by open reduction, internal fixation, and posterolateral spinal fusion. A precise description of the clinical, radiographic, and CT features of the lesion is provided in order to facilitate proper classification and treatment.


Entrapment of the flexor digitorum profundus of the ring finger at the site of an ulnar fracture. A case report.

Entrapment of the ring finger flexor digitorum in the ulna following fracture of both forearm bones is very rare. Only three cases have been reported previously (Jeffrey, 1976; Rayan and Hayes, 1986). We report another case of such entrapment in an 8-year-old boy.


Intratendinous ganglion and carpometacarpal boss. A report of two cases.

Two cases of intratendinous ganglion which developed over the underlying carpometacarpal boss, the dorsal osteoarthritic spur at the second or third carpometacarpal joint, are presented. The intratendinous ganglion, which may predispose the affected tendon to spontaneous rupture, must be differentiated from carpometacarpal ganglion and bursitis, which are usually asymptomatic. When the intratendinous ganglion associated with underlying carpometacarpal boss is removed, this bony prominence at the carpometacarpal joint which is the cause of irritation leading to mucoid degeneration and ganglion formation should also be excised.


Gestational diabetes in a rural setting.

Women who are already diabetic and become pregnant, as well as women who develop gestational diabetes, have increased risks of complications to both fetus and mother. These risks in gestational diabetes mellitus (GDM) can be reduced to near that of a non-diabetic mother by normalizing the blood sugar. The current recommended standards are reviewed. Utilizing a team approach, care was provided to patients with GDM in a rural primary care setting in order to attempt to normalize the blood sugar to the recommended level. Review of the outcomes of these pregnancies supports the conclusion that acceptable care for patients with GDM can be provided away from the tertiary care centers and in the primary care setting.


[Evaluation of 1st semester activity of the Algiers Poison Center].

The Poisons Center located in Bab el Oued University Hospital of Algiers has been opened to the public since January 2, 1991. The staff is made of public health physicians and pharmacists residents trained in toxicology. Phone calls are a new means for obtaining advice on poisonings and the public must be informed on the modalities of use. The number of calls shows that people are willing to use this fast and effective medium. A specific data sheet was created. The analysis of calls includes the origin of call, the nature of products used, the age range the clinical condition of patients, the recommended treatment and the outcome when known.


[Acute amoxapine poisoning with rhabdomyolysis and acute renal insufficiency].

Acute renal failure and rhabdomyolysis are reported in a 33 year old man who had taken 6 g of amoxapine. Different possible levels for the toxic action of amoxapine are discussed and compared with literature data.


[Comparative urinary elimination of caffeine in sedentary and sportsmen after administration of Guronsan].

The authors present the results of a study on urinary excretion of caffeine, after a single oral intake of 100 mg of caffeine, in two populations of students at rest and during exercise. Whether expressed in mg/l or mg/g creatinine no significant difference in urinary excretion of caffeine was observed between the two populations and it proves to be lower than the limit level authorized by the IOC (12 mg/l).


Relationship between enterotoxigenic Escherichia coli and diarrhea among children in Buenos Aires.

The incidence of enterotoxigenic Escherichia coli (ETEC) has been studied in 85 children with acute diarrhea in patients in the Hospital de Niños Pedro de Elizalde, Buenos Aires, and in 38 healthy children. All of them were up to four years old and none had received antibiotic treatment within 7 days before sampling. ETEC was recovered in 9 out of 85 (10.6%) children with diarrhea. From these positive cases, 6 were associated with heat-stable (ST), 1 with heat-labile (LT) and 2 with both LT and ST enterotoxins. Only one case (2.6%) of LT-producing ETEC was detected in the control group. In 5 out of 9 ETEC diarrhea cases (55.5%) the isolated strains expressed human colonization factor antigens (CFA); four of them were CFA/I and one CFA/II. The characteristics of the CFA, biotype, serotype and antibiotic sensitivity pattern were studied in 23 E. coli isolates from 10 ETEC positive children. Of the 12 ST only strains, 5 (41.7%) expressed CFA/I and 2 (16.7%) CFA/II (CS2 + CS3). One out of 2 LT/ST strains expressed CFA/I. CFAs were not detected in the ETEC-LT nor in the toxin negative E. coli strains. From the ETEC isolated, 82.4% were resistant to 4 or more antibiotics, whereas only 50% of simultaneously isolated toxin-negative E. coli presented this sensitivity pattern. The different ETEC strains belonged to several different serotypes, some of them rarely observed in other countries. None of these serotypes correlated either with the toxin profile or with the sugar fermentation pattern.(ABSTRACT TRUNCATED AT 250 WORDS)


[Clinical and biochemical study of 9 patients with hereditary elliptocytosis].

Using clinical, functional and biochemical criteria, we studied the red blood cell membrane of nine caucasic patients from four families with hereditary elliptocytosis (HE). From a clinical point of view, seven cases were classified as compensated mild HE in whom anemia and splenomegaly are absent and reticulocytosis is slightly elevated or normal. Two cases were uncompensated mild HE with anemia, reticulocytosis, splenomegaly and erythrocytic fragmentation. (Table 1). Three individuals from one family displayed a significant reduction of protein 4.1 by polyacrylamide gel electrophoresis; one of them was uncompensated HE. The patterns of limited tryptic digestion and dimer/tetramer proportion of spectrin were normal. The study of red cell deformability by ectacytometry revealed that the cell deformability under isotonic conditions was decreased in all HE patients and the curve obtained had trapezoidal shape (Fig. 3). We found that the deformability index correlated well with the degree of anemia, but no correlation was observed between clinical findings, morphological phenotype and specific molecular etiology. According to our knowledge, this is the first report on molecular and functional studies in HE in Argentina.


[Definition of hypertension based on a prevalence study of 1,423 young adults].

The prevalence of arterial hypertension (AH) was studied in 1423 individuals (702 males and 721 females) aged 21 years (Fig. 1, Table 1). Systolic (SBP) and diastolic (DBP) blood pressures and heart rate (HR) were measured three times on two different occasions separated by at least one week. Three different criteria were used to define AH (Table 3): 1) World Health Organization (WHO) [PAD > or = 95 mmHg in one casual determination]; Joint National Committee IV (JNC-4) [PAD > or = 90 mmHg on two different occasions]; and 3) Statistical [PAD > percentile 95 of the respective distribution]. BP was distributed normally in both males and females (Fig. 4). DBP decreased progressively along the six measurements (Fig. 2, Table 2), with the average of DBP determinations 4-6 being significantly lower than the average of determinations 1-3 (p < 0.05). SBP behaved in the same way (Fig. 2, Table 2), but in this case the 2nd and 3rd determinations within each occasion (2-3 and 5-6) were significantly lower than determinations 1 and 4, respectively (p < 0.05). As a result, the percentage of individuals of either sex with DBP > 90 mmHg was 14.7% based on the 1st determination (Fig. 5), but if the averages of determinations 1 to 3 or 1 to 6 were considered, these percentages decreased to 8.7% and 4% respectively (Fig. 5). With the WHO criterion (PAD > or = 160/95 mmHg based on the first determination) there were 3.3% of individuals with AH. With the statistical criterion the prevalence of AH was always 5%, but the actual value of percentile 95 was progressively lower as we took into account the 1st. determination, the average of 1-3 or the average of 1-6: 100, 95 and 90 mmHg in males and 90, 88 and 84 mmHg in females, respectively (Fig. 6). With the JNC-4 criterion there were 1.6% of individuals with AH (Fig. 5). These low figures were caused by the lack of repeatability of DBP readings in the second determination, since 79% of the individuals with DBP > or = 90 mmHg on the first occasion were normotensive on the second one, whereas more than 95% of those being initially normotensive remained in that category on the second visit (Fig. 7). The FC did not show important changes (Fig. 8), and the percentage of individuals with systolic AH was low (Table 4).(ABSTRACT TRUNCATED AT 250 WORDS)


[Phenotypic expression variation of isovaleric acidemia in Argentinian patients. A long term follow-up].

In this paper we discuss the first five Argentinean patients presenting isovaleric acidemia (IVA), an alteration of leucine catabolism due to a genetic defect of isovaleryl-CoA dehydrogenase. Belonging to unrelated families, one from native (H. Fam.) and the other from Italian ancestry (M. Fam.); the patients presented the clinical pattern highly suggestive of the disease: they were siblings, had disease-free intervals, vomiting, ketoacidosis crises, "sweaty feet" odor and progression of the neurologic involvement from somnolence and stupor to profound coma. In the four children of H. Fam. the disease had a late but severe beginning; one of the girls died (N.H.). The boy from M. Fam. presented a neonatal form of clearly benign course. The disease was confirmed by gas-chromatography (GC) of volatile acids in serum and also by the typical urinary acid GC-profiles (Fig. 1, A and B); the isovalerylglycine quantitative evaluation in urinary samples collected during crises is shown in Table 1. The morphological findings in liver and brain of N.H. showed at the ultrastructural study, an extensive fatty degeneration and greatly marked mitochondrial alterations in the liver and edema, neuronal karyorrhexis and karyolysis in the brain (Fig. 2). The therapeutic protocol based on a low leucine or low protein diet and use of glycine is described. The evolutionary follow up, more than 10 years for the first case, showed a normal mental development in three of them and retardation in the first child of H. Fam., who had a late diagnosis. IVA is still valuable as a paradigm in the acquisition of a highly clinical suspicion and for its introduction in the study of genetic organic acidemias.


[Neuropsychologic evaluation in Parkinson disease].

For decades Parkinson's disease has been considered to be limited to disturbed motor functions and its association with a cognitive deterioration is very recent. The frequency of cognitive decline varies according to the authors between 3% and 93% depending on the different criteria of evaluation. Owing to the discrepancy among the previous studies our object has been to determine the existence of cognitive changes of statistical significance, since even nowadays the relation between neuropsychology and physiopathology has been misunderstood. A total of 50 patients between 52 and 85 years old with Parkinson's disease have been neurological and neuropsychologically evaluated and the results correlated with 50 healthy controls. Patients, who presented clinical signs of demence according to the criteria of DSM III or any other neurological or general disease were excluded because of possible side effects on the motor cognitive phase. For the neuropsychological study Signoret's Battery of Cognitive Efficiency test (BEC 96) was used, it evaluates: the attention, orientation, thinking, memory, recognition, serial learning, fluency, naming and constructional functions. It was observed that all the patients with Parkinson's disease performed these tests worse than the controls, except for attention. From the statistical point of view the differences are highly significant (p < 0.001) for serial learning and constructional tests and significant (p < 0.05) for orientation, thinking fluency and naming. In the area of mnesic functions the patients with Parkinson's disease show an alteration that predominates significantly on serial learning, however, it is less important for logical memory. All the alterations correspond to the long term memory.(ABSTRACT TRUNCATED AT 250 WORDS)


[Prevalence of high normal blood pressure and progression to hypertension in a population sample of La Plata].

In 1985 we investigated the prevalence of high normal blood pressure in 6387 inhabitants (range 15-75 years old) of the city of La Plata and its progression to arterial hypertension after four years. High normal blood pressure was defined as a systolic blood pressure (BP) < 140 mmHg and diastolic BP between 85-89 mmHg (average value of two measurements) on one occasion. Arterial hypertension was defined as a systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, both as an average of two measurements on two occasions. High normal BP prevalence was 6.62%, being higher in men than in women (p < 0.0005, Table 1). General progression to hypertension was 41.79%, being higher in the older individuals (p < 0.0005). Of the 423 individuals with high normal BP (Table 2), 268 (63.36%) were found in 1989 (Table 3). They had an incidence of hypertension of 10.45% per year, also higher in older subjects (Table 4). There were no differences between sexes. Subjects with high normal BP who subsequently developed hypertension had higher systolic BP in 1985 than those who remained normotensive (p < 0.001, Table 5). Most of them progressed to mild diastolic hypertension (29.48%) or borderline isolated systolic hypertension (6.72%, Fig. 1). In this study, progression to arterial hypertension was higher than that reported in similar studies for general population in other countries.


Effect of glucose infusion in dogs on blood sugar, insulinemia and serum free fatty acid responses.

A glucose dose-response study, in normal dogs, was performed in vivo. Glucose doses: a) priming 700 mg/kg body wt, i.v.; b) intravenous infusions: 20 (Group I), 28 (Group II), 44 (Group III) and 100 mg/kg body wt/min (Group IV) for 60 min. The following responses were studied: blood sugar, serum immunoreactive insulin and serum free fatty acids. There were significant effects of the dose of infused glucose on blood sugar and serum insulin integrated responses; the integrated serum free fatty acid response was not influenced. Mean integrated blood sugar responses in groups I, II and III coincided, while that observed in Group IV was increased. Mean integrated serum insulin response in group III was above those found in I, II and IV; the response in II was below the one detected in IV. In groups I and II, there was a linear inverse relationship of blood sugar to serum insulin integrated responses; this relationship vanished as data from groups III and IV were also included in the calculation of respective product-moment correlation coefficient. There was a significant effect of the dose of infused glucose on the insulinogenic index during glucose test. Mean insulinogenic indices in groups II and IV were below that of group III. A small unique peak of insulin response in group I during glucose infusion test was observed. A typical biphasic insulin response in systemic venous blood of animals of group II, was found.(ABSTRACT TRUNCATED AT 250 WORDS)


[Massive proteinuria and HELLP syndrome].

HELLP syndrome continues to be a clinical entity of difficult diagnosis. Weinstein first defined it in 1982 giving the practicing obstetrician a sequence of useful initials (H = hemolysis; EL = elevated liver enzymes; LP = low platelets). Since then a lot has been written and it has become clear that the syndrome is a form of severe preeclampsia. The American College of Obstetrics and Gynecology does not include HELLP in the description of severe pre-eclampsia as such but does accept each of its components as being part of severe pre-eclampsia. The case presented deals with a 33 year old white female, admitted at 27 weeks gestation with nausea, epigastric pain resembling acute abdomen, nose bleeding and mild hypertension. The analysis revealed an abnormal liver profile with elevated GOT, GPT and LDH, heavy proteinuria (14.4 g/day), decreased platelet count (92000/mm3) and elevated total bilirubin. Pregnancy was terminated by cesarean section 24 hours after admission because the patient's condition was deteriorating. Obviously in pre-eclampsia/eclampsia there is a systematic injury to all tissues. Proof of this is the hypertension as a consequence of vascular spasm and proteinuria due to glomerular injury. In HELLP the sequence of events is probably altered; hepatic injury precedes vascular and renal injury of conventional preeclampsia. The syndrome results from many clinical and pathological symptoms derived from endothelial microvascular injury which determine a rapid platelet activation causing vascular spasm, platelet aggregation and further endothelial injury through a feedback mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)


[Rapid correction of acute hyperkalemia with nebulized salbutamol].

Fifteen patients on chronic hemodialysis received twenty-two treatments with 20 mg nebulized salbutamol (4 ml of 0.6 g% in 4 ml of saline), to control an episode of acute hyperkalemia, (6.58 +/- 0.14 range: 5.7-7.9 mEq/l) and as a previous step before dialysis. Plasma potassium concentration at 20, 40, 60, 90 and 180 min post-salbutamol, were: 5.85 +/- 0.21, 5.58 +/- 0.21, 5.48 +/- 0.27, 5.46 +/- 0.17 and 5.57 +/- 0.34 mEq/l, respectively. (Fig. 1). The decrease of plasma potassium was significant at 40' and maximal at 90': 1.12 +/- 0.10 mEq/l, and persisted for at least 3 hours (in 3 patients up to 6 hours). No correlation was found between the grade of hyperkalemia and the magnitude of plasma potassium decrease after therapy. The systolic and diastolic blood pressure decreased significantly at 60 and 80 min post-treatment: 134 +/- 6.45 vs 119 +/- 6.79 and 74 +/- 4.12 vs 64.66 +/- 3.88 mmHg (p < 0.02 and p < 0.001). The heart rate and respiratory frequency increased significantly at 60-80 and 20 min respectively (90 +/- 4.45 vs 113 +/- 4.55 beats/min and 19.57 +/- 0.98 vs 23.42 +/- 1.24 resp/min) (p < 0.001) (Table 1). The secondary effects of the administration of the drug, such as sinus tachycardia, fine tremor and anxiety in 6, 4 and 1 patient respectively, were moderate and well tolerated. It is concluded that, due to its technical feasibility, promptness of action, duration of hypokalemic effect, few side effects and repeatability, nebulized salbutamol can be considered a first choice in the treatment of acute hyperkalemia.


[Quantitative computerized tomography in the study of osteoporosis. Our experience].

In the diagnosis of osteoporosis there are, today, several techniques for investigating bone mineral density. In this work the authors evaluate the sensitivity of Computed Tomography in the diagnosis of this metabolic disease, because of the built-in competence of this method in determining the density of the anatomical tissues. In a randomised study the Authors performed Single Energy Quantitative Computed Tomography (SEQCT) in estimating the bone mineral density of lumbar vertebrae in 44 female patients. The data obtained were correlated, using the Student "t" test, to the measurements acquired, in the same group of patients, employing Dual Energy X-ray Absorptiometry (DEXA), 27 patients, and Total Body DEXA, 17 patients. Results revealed a good correlation between SEQCT and DEXA (R = 0.89) and statistical significance (p < 0.001). On the contrary there is not a good correlation (R = 0.58) if SEQCT is compared to Total Body DEXA. According to our experience Quantitative Computed Tomography is useful in diagnosis osteoporosis and it should be performed in all post-menopausal patients. This method, which has a high level of precision, is cheap and easily adaptable to every Computed Tomography. Because of the high X-ray dose rate, only DEXA should be performed in monitoring patients undergoing therapy.


[Gamma-ray bone densitometry and evaluation of the patient at risk for osteoporosis].

After having briefly illustrated the main theories of photonic ray bone densitometry, the authors describe the various techniques used to evaluate bone mass and bone mineral density as accurately and precisely as possible both at an appendicular level and at lumbar and femoral sites. Since these data only provide a static measurement and are unable to provide information regarding bone mass evolution in time, a method is illustrated which is theoretically capable of identifying high risk subjects, namely those who, on the basis of simple blood and urine tests for some biochemical parameters, are likely to undergo a significant reduction in bone mass in the future. Lastly, the paper reports the preliminary results of a study carried out in immediately post-menopausal women in whom rapid loss of bone mass was followed by a greater reduction in bone mineral density measured at an appendicular level.


[The diagnosis of metabolic bone diseases].

Physical semeiotics, the laboratory, radiology and histology represent the diagnostic tools for metabolic bone diseases. Past medical history and a full objective examination form the basis for every type of diagnostic and therapeutic approach. Familial patterns, the range of drugs used by the patient, the concomitance of diseases affecting mineral metabolism, and the presence of deformities or typical characteristics of some clinical conditions allow the clinician to orientate his diagnosis. Some laboratory tests (serum calcium and phosphate, calciuria) are useful for screening, whereas others (parathyroid hormone and other calciotrophic hormones, biochemical parameters of bone remodeling) must be carried out only for precise diagnostic purposes. In addition to highlighting and characterizing fractures, plane radiology is indicated for the differential diagnosis of focal bone diseases. In the latter diagnosis is facilitated by bone scintigraphy which reveals areas of accelerated bone remodelling. The quantitative evaluation of bone mass using non-invasive methods is of fundamental importance in osteopenic syndromes. Of all the techniques evolved in the past, only quantitative computerized tomography and X-ray computerized mineralometry are used today in the diagnosis and management of osteoporotic patients. The choice of one or other technique should be based on the clinical necessity and on their respective accuracy and reproducibility. Histomorphometric bone biopsy is indicated only in cases of rapid bone loss with uncertain biochemical conditions and for the diagnosis of mineralization disorders.


Hypothesis: impaired immunity as a factor which contributes to the spread of drug-resistance.

Evidence has accrued to indicate that host defence mechanisms enhance the efficacy of many of the drugs used to treat infectious diseases. Because of this, and also because of the likelihood of increased pathogen loads in immunoincompetent hosts, some infections are less likely to be completely cured by normal regimens of chemotherapy in individuals with drastically impaired immune responsiveness. In such circumstances natural selection could result in the accelerated emergence of drug-resistance pathogens.


[Methodological basis and clinical applications of total-body densitometry].

With the advent of dual-energy x-ray absorptiometry (DXA) total body scans can be done in only 10-20 minutes rather than the 60-80 minutes required by dual-photon absorptiometry (DPA). The DXA approach replace the Gd153 radionuclide source of DPA and provides substantially greater output intensity. The higher radiation flux achievable provides several advantages over conventional DPA: this makes total body scans routinely accessible. The measures of the entire skeleton and its major subregions cut down the problems of representativeness and relocation. The short term precision (coefficient of variation) was 0.5% for total body-bone mineral density (BMD) and about 1% for regional-BMD. We studied 885 women; study cohort consisted of 161 healthy postmenopausal women, 357 healthy postmenopausal women and 367 osteoporotic women with one or more vertebral crushes. The results indicate that bone mass begin decreasing during the last period of the premenopausal phase; the advent of menopause brings about a dramatic reduction of both total body and single area BMD: this phenomenon is particularly marked in subjects with osteoporosis. The single most important factor in determining BMD changes, is years since menopause. In order to assess the ability of DXA total body to distinguish women with postmenopausal osteoporosis of variable radiological degress from healthy postmenopausal women, we studied 330 postmenopausal females aged 42-85 years. There were 63 healthy women who were considered controls (Group 1).(ABSTRACT TRUNCATED AT 250 WORDS)


[Effect of cyclosporin A, azathioprine, and methylprednisolone on plasma levels and heart atrial content of atrial natriuretic peptide in the rat].

In Wistar normotense male rats of six months old the effect of Cyclosporine A (Cys A), azathioprine (AZA) and methyl prednisolone (M-Pred), alone or associated, on the plasmatic levels and atrial content of the atrial natriuretic peptide (PNA) have been studied. The values of creatinine, urea, sodium a potassium were also measured in serum. This treatment was maintained for 30 consecutive days at these doses: Cys A (5.00 mg/kg b.w./day), AZA (2.50 mg/kg b.w/day) and M-Pred (20.00 mg/kg b.w./day), being the peritoneal the way of administration. Eight groups were organized: control, vehicle, Cys A, AZA, M-Pred, Cys A + M-Pred, AZA + M-Pred, Cys A + AZA + M-Pred. All the above parameters were estimated at 24 hours after respective injections. No changes are found after Cys A or AZA in the plasmatic and atria contents of PNA. Nevertheless, m-Pred alone or in association determines high increases of PNA in plasma and tissue. The other parameters are unchanged. The data reveal the beneficial use of M-Pred, glucocorticoid of the low mineral activity, in the therapy of rejection in cardiac transplantation. On the other hand, Cys A and AZA appear not to be important in the secretion and atrial synthesis of PNA.


Cyclosporin A: antiparasite drug, modulator of the host-parasite relationship and immunosuppressant.

Cyclosporin A (CsA), a cyclic undecapeptide with powerful properties of immunosuppression, acts on parasitic infections in laboratory animals in various ways. The outcome of drug administration in vivo varies with timing of treatment relative to infection, route of administration, dose and number of treatments applied. CsA is clearly antiparasitic against malaria, schistosomes, adult tapeworms, metacestodes and filarial nematodes. By contrast, it acts as an immunomodulator against trypanosomes and Giardia, by exacerbating infection; in the case of Leishmania spp. the drug acts variously. In some other infections CsA acts both as an antiparasite drug and as an immunosuppressant (Toxoplasma, avian coccidiosis and gastrointestinal nematodes). This range of activities is reviewed and possible modes of action discussed in the light of emerging data on in vitro drug activity and on putative receptor binding. The potential value of a non-immunosuppressive analogue of CsA in the control of parasitic infections of humans and domestic animals is considered but this paper lays particular stress on the seminal role of CsA as a laboratory tool.


[Ultrasonography techniques in the evaluation of the osteoporotic patient].

Previous studies have shown a significant but weak correlation between speed of sound (SOS) and broadband ultrasound attenuation (BUA) in bone, and densitometric bone measurements. These findings indicate that these techniques reflect different properties of bone. We measured SOS and BUA in the os calcis (Achilles, Lunar Corp.) and bone mineral density of the lumbar spine (BMS-LS; by DEXA) and of the ultradistal radius (BMD-UDR; by DPA) in 60 postmenopausal women (age range 50-65): 30 were osteoporotic women (OP) and 30 were age-matched normal postmenopausal women (N). Mean values of SOS and BUA resulted significantly lower in OP group (p < 0.001). SOS and BUA measurements significantly correlated with DEXA of the lumbar spine (r = 0.52 p < 0.001, r = 0.56 p < 0.001, respectively) and DPA of ultradistal radius (r = 0.60 p < 0.001 and r = 0.62 p < 0.001, respectively). In conclusion, these techniques show good correlations with absorptiometric techniques. The best correlation has been found between BUA and DPA of ultradistal radius. Furthermore, US techniques are able to separate a normal from an osteoporotic population. Therefore, US techniques seem to be a useful tool for screening of osteoporotic disease.


Immune-dependent chemotherapy of schistosomiasis.

Host immune responses have been shown to enhance the efficacy of several schistosomicidal drugs. The evidence derives mainly from experiments on Schistosoma mansoni infections in the mouse with their immune status variously modulated; this review emphasises praziquantel (PZQ), which is now the main drug used for treatment of human schistosomiasis. Electron microscopy and indirect immunofluorescence indicate that PZQ disrupts the integrity of the surface membranes of S. mansoni, particularly those covering the dorsal tubercles of adult male worms, and this causes antigens which are the targets of antibody attack to be revealed. We review the evidence that two S. mansoni antigens in particular are implicated in the immune-dependent action of PZQ: a 200 kDa glycoprotein and a 27 kDa antigen with non-specific esterase activity. Consistent with the involvement of the latter antigen, increased non-specific esterase activity was demonstrated histochemically on the surface of intact PZQ-treated male worms, and we describe a chromogenic substrate assay for quantifying the amount of esterase activity that is exposed after drug treatment. The potential relevance of these observations for enhancing the efficacy of drugs currently used to treat human schistosomiasis, and for devising novel therapeutic strategies, is discussed.


[Long-term treatment of central diabetes insipidus with oral DDAVP].

Clinical use of the DDAVP (1-Deamino-8-D-Arginine Vasopressin) is now the first choice in treatment of Central Diabetes Insipidus. It is an analogue of Vasopressin with a higher antidiuretic potency, less vasopressor activity, and a longer duration of action. This drug still presents some problems of administration route. A lot of studies were published about different administration routes of DDAVP: sublingual tablets, parenteral solution, nose spray and suction de-epithelialized skin. Some authors have utilized the oral route (solution or tablets) with good results in short-term treatment. We think the formulation in tablets of DDAVP is an efficacious support of the therapy in this disease also for long-treatment. In our study 3 patients with Central Diabetes Insipidus (aged 22-56; 2 idiopathic and 1 post-surgery) previously treated with DDAVP nasal solution (10 micrograms/day; 36-156 months), have been submitted to a chronic treatment with DDAVP tablets for a period of 24-36 months. The DDAVP tables were administered at the dosage of 400-600 micrograms/day in 2-3 administrations. The patients were studied at intervals of 3-6 months, and on each occasion full blood count, glucose, azotaemia, creatinine, liver function tests, electrolytes, urine volume, density and osmolality were estimated. The long-treatment with oral DDAVP was able to keep a good control of the disease in all patients. In case 1 we had a significant reduction of urine volume (p < 0.01) and a significant increase (p < 0.01) of urine osmolality in comparison with previous treatment with nasal solution; in case 2 and 3 no significant changes were observed. No side effects were noted during this study. The drug has been well tolerated and the compliance of patients was better during oral DDAVP than nasal solution. In our opinion the oral DDAVP is an effective and safe solution for the treatment of Central Diabetes Insipidus, and give to the patients a better quality of life in comparison to the nasal solution.


Diethylcarbamazine (DEC): immunopharmacological interactions of an anti-filarial drug.

Anti-parasitic drugs may achieve their therapeutic effect either by direct activity against the pathogenic organism, or by altering host factors which lead to parasite killing. In this review, we discuss the evidence for an indirect mode of action for one major anti-filarial drug, diethylcarbamazine (DEC). The interpretation most consistent with existing data is that DEC alters arachidonic acid metabolism in microfilariae and in host endothelial cells. These changes may result in vasoconstriction and amplified endothelial adhesion leading to immobilization of microfilarial parasites, enhanced adherence and cytotoxic activity by host platelets and granulocytes. These events would represent activation of the innate, non-specific immune system, independent of the adaptive, antigen-specific, immune response. This model explains the paradox between rapid clearance in vivo and the lack of an in vitro effect, as well as the efficacy of DEC in non-immune animals. It may also account for the inconsistencies in the effects of DEC against different filariae in different host species. In addition, we discuss the significant side-effects often associated with treatment of heavily infected patients, and the longer-term changes in T-cell reactivity and the host-parasite relationship which follow successful treatment with DEC.


Immunomodulatory agents in the laboratory and clinic.

This paper reviews naturally occurring and synthetic compounds that either enhance immune defences or lower both natural and acquired immunity. Immunomodulatory agents used both for laboratory study and clinically for the management of immunologically based diseases are considered.


Interactions between immunity and chemotherapy in the treatment of the trypanosomiases and leishmaniases.

The immune status of a host infected with Trypanosoma spp. or Leishmania spp. can play an important role in successful chemotherapy. In animal models, treatment of African trypanosomiasis with difluoromethylornithine or melarsoprol requires an appropriate antibody-mediated immune response. An intact immune system is also necessary for rapid clearance of trypanosomes from the bloodstream following treatment with suramin or quinapyramine. Similarly, an efficient cell-mediated immune responses is required for maximal efficacy of pentavalent antimonials in the treatment of leishmaniasis. However, the potential relationship between parasite-induced or acquired immunosuppression and effective chemotherapy has been poorly studied. Macrophages which have been activated by bacterial cell wall components or gamma-interferon are known to display increased activity against Leishmania donovani or Trypanosoma cruzi. In experimental and clinical visceral leishmaniasis, use of macrophage activators together with pentavalent antimonials has lowered the dose of antimony required to cure the infection.


Interactions between chemotherapy and immunity in bovine theileriosis.

In bovine theileriosis the use of chemotherapy to control an infection sufficiently long to permit the establishment of a solid protective immune response has been developed as a routine vaccination procedure. Infections with Theileria parva and T. annulata can be prevented by the administration of carefully controlled numbers of sporozoites simultaneously with a long acting tetracycline and this form of immunization has been widely used for the control of East Coast fever in Africa with considerable success. In this review, the nature of the chemotherapy, the immune response and the interactions between chemotherapy and immunity in the development of infection-and-treatment immunization procedures are discussed.


Chemotherapy and immunity in opportunistic parasitic infections in AIDS.

Parasitic diseases are endemic in parts of the tropics, but there is no convincing evidence that their prevalence or incidence is increasing due to the HIV epidemic. Available scientific data on parasitic infections in patients with the Acquired Immunodeficiency Syndrome (AIDS) suggests a predominance of Pneumocystis carinii, Toxoplasma gondii and Cryptosporidium spp. For reasons which are unclear, parasitic infections such as Plasmodium falciparum, Strongyloides stercoralis and Entamoeba histolytica, where cell-mediated immune responses are also thought to be significant, do not appear to be opportunists of importance. It is being increasingly recognized that chemotherapy for parasitic diseases has a host-dependent component, although scientific data on this subject remain scanty. The management of opportunistic parasitic infections in patients infected with HIV is dogged by failures and relapses, aptly illustrating the notion of the relationship between chemotherapy and the immune response. This review discusses the immunity and chemotherapy of opportunistic parasite infections in patients infected with the Human Immunodeficiency Virus (HIV).


[The evolution of chronic chagasic cardiopathy. I. The influence of parasitemia].

During eight years (1982-1990) the evolution of chronic chagasic cardiopathy and its relation to parasitemia was evaluated in 279 patients, 85 men and 194 women, studied by resting electrocardiography and xenodiagnosis. All patients were residents in Virgem da Lapa, State of Minas Gerais, Brazil and their ages varied from 7 to 76 years (average 42.6 y). According to the results of the electrocardiograms the evolution of chagasic cardiopathy was classified as a) unchanged--when there was no change of the initial pattern off the ECG, b) progressive--when there was deterioration of the ECG pattern and c) regressive-when there was normalization or regression of the ECG alterations. Regarding xenodiagnosis 120 were considered with positive parasitemia, one or more xenodiagnoses positive, and 159 with negative parasitemia--all xenodiagnoses negative. The results showed: a) chagasic cardiopathy unchanged in 172 (61.6%) patients, b) progressive in 99 (35.5%) patients and c) regressive in 8 (2.9%). There was no relation between the evolution of chagasic cardiopathy and parasitemia. Independent from parasitemia, the cardiopathy was progressive according to the age of the patients and significantly greater in males. In conclusion we can state that evolution of chronic chagasic cardiopathy is associated with the age and with the male sex, but not with parasitemia, and this may suggest that parasitemia is not related to the development of the chronic chagasic cardiopathy.


[The assessment of parasitemia in women who are carriers of Trypanosoma cruzi infection during and after pregnancy].

This paper presents an evaluation of the parasitemic profiles of 119 women chronically infected with T. cruzi. Xenodiagnosis (xenos) were applied during (465 xenos) and after pregnancy (363 xenos) in order to detect possible variations in parasitemia in these periods. The frequency of positive xenos was greater during than after gestation. Otherwise, the frequency of infected triatomines was wore elevated during pregnancy, indicating higher parasitemic levels in this period. Only 17% of the studied women had two or more positive xenos during pregnancy. In these mothers the difference between the frequencies of positive xenos during and after gestation was high, suggesting the occurrence of exacerbation of infection at least in some women.


[The current status of diffuse cutaneous leishmaniasis (DCL) in the state of Maranhão. II. The epidemiological and clinico-evolutionary aspects].

The authors describe a retrospective and prospective study of 6 patients with diffuse cutaneous leishmaniasis observed in the state of Maranhão, since 1974. The patients come from different rural regions of the state and in all of them Leishmania (Leishmania) amazonensis was the cause five of the patients initiated their disease in the first decade of life. All the patients first had a solitary, nodular lesion, that after a variable period of time, disseminated and acquired other aspects. Sequentially the patients presented multiple nodular and ulcerative lesions, negative Leishmania skin tests and a refractory response to the therapeutic schedules used up to the present.


Human immune responses during schistosomiasis mansoni.

Studies of immune responses as they occur in patients with schistosomiasis appear to progress relative to cUrrent technological advances, and to advance despite the understandable inability to pursue in vivo manipulations in this host/parasite system. Emphasis is most often placed on making immunological comparisons between such patient groups as reinfected/non-reinfected, intestinal/hepatosplenic, high/low intensities of infection, infected/uninfected within endemic areas, and those born of infected/uninfected mothers. Based on these types of comparisons, reasonable conjectures can be made regarding the immunological occurrences during this chronic exposure condition. Some consideration is now being given to the immune mechanisms of some of the observations made, and while some of these must then be carried back to experimental models for further manipulation-based analysis, new technological developments continue to assist in the field/bench ability to ask questions that might assist our understanding to a point where this knowledge can be applied to shaping developmental approaches to vaccine development and the goal of alleviating morbidity.


[Sodoku--a case report].

Rat-bite fever results from an infection with the organism Spirillum minus. The authors report a symptomatic patient with fever, malaise, and ulcer in forehead after a rodent exposure. The organism was identified in darkfield examination of the ulcer exudate. Penicillin was the drug used with clinical improvement of symptoms.


[The neuropathological findings in the acquired immunodeficiency syndrome (AIDS): a review of 138 cases].

This is an autopsy study performed in a retrospective fashion to determine the incidence of diseases that could affect the central nervous system in AIDS. For this purpose, 138 autopsies of patients with AIDS performed at the "Hospital de Clínicas de Porto Alegre", Brazil, between January/85 and December/90 were studied. All the brains were evaluated macroscopically and microscopically mainly through hematoxylin-eosin staining and if necessary special techniques like PAS, Grocott, Giemsa and Ziehl-Nielsen were done. Results have revealed 29 (21%) cases with cerebral toxoplasmosis; cryptococcosis in 17 (12%); tuberculosis in two (1%) and one case (0.7%) of candidiasis. Besides these inflammatory lesions, 15 (10%) presented vascular lesion; 8 (6%) had gliosis and 7 (5%) cases had suggestive findings of HIV encephalopathy. We can conclude that the CNS is a important target affected by AIDS and that cerebral toxoplasmosis is the principal disease in the CNS in AIDS patients.


Fulminant hepatitis with microvesicular steatosis (a histologic comparison of cases occurring in Brazil--Labrea hepatitis--and in central Africa--Bangui hepatitis).

A similar histopathologic picture of fatal hepatitis associated with widespread acute fatty changes in hepatocytes and single-cell necrosis was seen in epidemic cases occurring in two distinct equatorial areas having high prevalences of HBV and HDV infections. The cases were previously considered to be two different entities; Labrea hepatitis in Brazil, and Bangui hepatitis in the Central African Republic. However, the histopathologic findings suggest that they are pathogenetically and etiologically related to HBV and HDV infections, probably modified by some as yet unknown factor(s) present in equatorial forest zones.


[The use of sodium azide as a fecal preservative for studying the eggs of Schistosoma mansoni and of other helminths by the Kato-Katz method: a study in an endemic area].

In two aliquots of 208 samples of stool, tests have been made by the Kato-Katz method, one being made after the use of 0.2mg of sodic azide for 200mg, and the other without the aforesaid conservant. The resulted percentages with or without the conservant were, respectively, for Ancylostomideos: 12.5 and 25.9; for Ascaris lumbricoides: 71.6 and 72.5; for Schistosoma mansoni: 7.6 and 17.7, and for Trichuris trichiura: 86 and 85. The count of the eggs with and without the conservant was, respectively, 264 and 539 for Ancylostomideos, 13186 and 33751 for A. lumbricoides, 55.5 and 63.5 for S. mansoni, and 1345 and 2068 for T. trichiura. The authors did not confirm the advantage of using sodic azide for study in endemic areas. They suggest that the exsiccation of the stool and the low intensity of infections can explain the unfavourable results of the present clinical trial.


[Candidiasis in AIDS patients].

A total of 35 in patients admitted at Emilio Ribas Hospital--São Paulo, Brazil, with digestive candidiasis and AIDS clinical diagnostic were evaluated 10 month later, being 29 male and 6 female; white outnumbering black with age ranged from 30 to 50 years old. Agar Sabouraud culture and tube germinative tests identified 28 (80%) Candida albicans out 35 strains. Minimum inhibitory concentration (MIC) 50% was against azoles (ketoconazole = 2.2 micrograms/ml; itraconazole = 21.0 micrograms/ml and fluconazole = 19.0 micrograms/ml); polyenes (nystatin = 50.0 micrograms/ml and amphotericin B = 0.12 micrograms/ml) and 5 fluorocytosine = 1.6 micrograms/ml. Siegel tests showed significant Candida albicans proportions in strains isolated from 35 AIDS patients. There was no significant relation between AMB doses and early or late death. candidiasis in AIDS patients showed high MIC 50% to azoles and nystatin and significant Candida albicans proportion in all strains isolated from AIDS patients. Previous amphotericin B therapy had no influence in early or late death in 30 patients. Previous therapy possibly explained MIC 50% increases in Candida strains.


[The clinical parameters relevant for the differential diagnosis between mucocutaneous leishmaniasis and paracoccidioidomycosis].

We retrospectively evaluated the medical records of 15 patients diagnosed with leishmaniasis and of 28 patients diagnosed with paracoccidioidomycosis presenting with involvement of the oral-nasal-pharyngeal mucosa seen at Escola Paulista de Medicina from 1986 through 1990. These patients were compared in regard to the following variables: sex, age, time since disease onset, location of lesion, and clinical complaints. Sex, time since disease onset, lesion at the nasal septum, palate, tongue, and lips, and history of oral pain, dysphagia/odynophagia, and nasal obstruction were significantly different in the two groups of patients. The authors point out to the relevance of these findings in the differential clinical diagnosis of leishmaniasis and paracoccidioidomycosis.


[The prevalence, infection indices and feeding habits of the Triatominae captured in an area of epidemiological surveillance].

Prevalence of triatomines and their infection by Trypanosoma cruzi, were studied during 1974-1981, in the Administrative Region of Campinas, São Paulo, Brazil. This investigation was continued (1982-1986), blood meal tests with bird, marsupial, rodent and human antisera having been added. Panstrongylus megistus, predominant in the region, whose winged instars are often found infected by T. cruzi in inhabited houses, displayed and alimentary eclecticism. From a sample of 7,785, 14.78 percent reacted positively with human antisera. A similar, but less marked behaviour was observed in Rhodnius neglectus. Triatoma sordida, the second most important species in the Region, was neither demonstrated to be feeding on humans nor to be infected by T. cruzi. Changes in their natural habitat probably caused sharp rises in T. arthurneivai populations in the human dwellings. The capture of three specimens of Microtriatoma borbai marks the first occurrence of this species in the State São Paulo. "Focus investigation" in areas in the surveillance phase can detect triatomines in the process of domiciliation.


[The prevalence of intestinal parasitoses among the users of the Health Center of Sousas District, Campinas, São Paulo (1986-1990)].

The prevalence of intestinal parasites was carried on users of the Health Center of Sousas District, Campinas, SP (1986-1990). From 770 observed medical records we verify 114 positive cases (14.8%) for protozoa, helminths and commensals. Ascaris lumbricoides (48.2%), Giardia lamblia (30.7%), Trichuris trichiura (18.4%) and Enterobius vermicularis (9.6%) were more prevalent in preschool children. The adults, what are the most numerous class, appeared few parasitised. The other parasites and commensals appeared with a prevalence like the traditional brazilian population surveys, except for the absence of tenids and low prevalence of Ancylostomatoidea. We propose the realization of routine stool parasitological examinations among the preschool children and the use of the primary health care data in parasitological survey.