The proboscis in human cyclopia: an anatomical study in two dimensions.

A 2-dimensional anatomical study has been undertaken of the proboscis and its contribution to the roof of the median orbit in human cyclopia. The cyclops material consists of 4 sectioned fetal heads and a dried cyclops skull. The skeleton of the proboscis is formed by the nasal capsule. The base of the proboscis lies in the floor of the anterior cranial fossa filling an extended ethmoidal notch and contributing to the roof of the median orbit anterior to the fused lesser wings of sphenoid. The cavity of the proboscis is lined with squamous epithelium, respiratory and olfactory mucosa. Olfactory fibres pass from the proboscis into the extradural space of the ethmoidal notch forming a collection of tissue similar to the inferior layer of the normal olfactory bulb. The data indicate that the proboscis represents the anterosuperior part of the normal nasal cavity developed in the absence of median components. It is suggested that the cyclops face constitutes a model for the study of the development of the normal face.


A further study of the high incidence of the median artery of the forearm in Southern Africa.

Sixty-two forearms from 36 cadavers of South Africans of European extraction were dissected. The frequency of the median artery per forearm was 27.4%. There was neither bilateral difference nor sexual dimorphism in the incidence of the artery. These findings compare well with a previous study of black South Africans (Henneberg & George, 1992) where frequency per forearm was 27.1%. Our findings are much higher than those of earlier studies. This discrepancy may be explained either by differences in the thoroughness of the observations or regional variation, or by the occurrence of a secular trend in the development of vasculature.


Significance of the innervation pattern of the human abductor pollicis longus muscle.

The abductor pollicis longus muscle (APL) can be separated into 2 divisions, deep and superficial. The deep division has more bellies, each of which has its own site of insertion. The superficial division is situated on top of the deep tendon. Each division is innervated by a separate branch of the radial nerve. This pattern of innervation may indicate independent actions by individual muscle parts. The deep division, inserting around the carpometacarpal joint of the thumb, has a nerve supply that reaches each separate muscle belly. This division should have a stabilising action on the joint. The superficial division, together with the extensor pollicis brevis, is innervated from the ulnar side by a terminal branch of the radial nerve. This division should, in cooperation with the extensor pollicis brevis and longus muscles and the thenar muscles, act to move the thumb in various directions.


Neuropeptide accretions in the endoplasmic reticulum of oxytocinergic neurons in cats, monkeys and rabbits: a widespread phenomenon.

Light microscopic observations using Nomarski optics on the aldehyde-fixed hypothalamus of normal adult cats, monkeys and rabbits revealed the presence of cells in the supraoptic, paraventricular and periventricular nuclei which possessed yellow birefringent inclusions. Immunogold labelling showed that in each species the cells displayed oxytocin-like immunoreactivity, both in electron-dense inclusions within some (but not all) cisterns of rough endoplasmic reticulum and in secretory granules. The cells in cats and rabbits were in all respects indistinguishable from the homologous 'birefringent' cells previously described in rats, but in monkeys, cells frequently contained additional inclusions in cisterns of rough endoplasmic reticulum which did not display oxytocin or vasopressin-like immunoreactivity, even after trypsin, pepsin or chymotrypsin treatment of sections. Observations on cats and rabbits using fluorescence microscopy revealed that the birefringent cells possessed bright autofluorescence which facilitated the identification of more cells than were seen using Nomarski optics alone. Autofluorescence was abolished when sections were mounted in glycerol, or when exposed to light for protracted periods of time. Attempts to label for monoamines in these cells were not successful, suggesting that the fluorescence is not due to aldehyde-induced amine fluorescence. It is not clear why neuropeptides are retained in some rough endoplasmic reticulum cisterns. It is possible that these birefringent cells contain a peptide, or peptides, which are abnormal in some manner, or which may be other members of the oxytocin gene family. Alternatively, the processing of neuropeptides to permit their export to the Golgi apparatus may be deficient. Acetylcholinesterase (AChE) histochemistry revealed that, unlike other oxytocin neurons, cells with intracellular accretions lacked detectable acetyl cholinesterase. As AChE is a known peptidase, it may be involved in regulating peptide export from the rough endoplasmic reticulum.


A permeability barrier to lanthanum and the presence of collagen between odontoblasts in pig molars.

Previous experiments in rat incisors indicate that the odontoblasts form an impermeable barrier which prevents fluid movement between pulp and dentine. The permeability of the odontoblast layer has now been investigated in pig molars which are more analogous to human teeth. The heads and necks of anesthetised piglets were perfused intra-arterially with lanthanum nitrate in Ringer's solution or with Ringer's solution alone. Molar tooth germs were removed, sliced, fixed by immersion and embedded in resin. Ultrathin sections including pulp and dentine were examined by transmission electron microscopy. Fenestrated capillaries were permeable to the electron dense lanthanum which thus entered the extracellular space between the odontoblast cell bodies. The lanthanum was excluded from predentine indicating that a barrier to permeability is present. In the above specimens and in others from 2 animals which were fixed by perfusion fixation, longitudinally oriented bundles of collagen fibrils were found passing from dentine through predentine into the odontoblast layer. Longitudinal collagen was also present between odontoblast cell bodies and entering the pulp at their basal ends. This suggests that classical von Korff fibres are present during primary circumpulpal dentinogenesis. In some sections longitudinally oriented collagen was absent. The junctions showed features of classical tight junctions but open tight junctions containing longitudinal collagen were also observed, suggesting that the junctions may modulate. Despite a trace of evidence that lanthanum can leak through adjacent to longitudinally penetrating collagen we concluded that the biological permeability barrier is maintained. The presence of the barrier indicates that other than the longitudinal collagen fibrils of which the source is unknown, all molecules incorporated into dentine are deposited there by the odontoblasts. An advantage of the barrier may be that it provides a closed environment for the orderly process of matrix deposition and mineralisation of dentine.


Pericapillary collagen in the human thymus: implications for the concept of the 'blood-thymus' barrier.

The deposition of collagen in the walls of capillary-size blood vessels was studied in 95 human thymuses with respect to the site of deposition, extent of the change and relation to age and degree of involution. When examined by electron microscopy the collagen was found to be situated between the 2 basement membranes of the so-called 'double-layered' capillaries characteristic of the thymus of many species. This results in the formation of substantial 'collars' of collagen around a proportion of the blood vessels examined. Few such collars are seen before birth, but their number and thickness increase markedly during the 1st year of life. The relationship of these changes to the degree of involution is less apparent. The significance of these changes to thymic structure and function is discussed in relation to cell traffic through the thymus and the postulated 'blood-thymus barrier', the existence of which is seen to be in some doubt.


Changes in fibronectin, laminin and type IV collagen distribution relate to basement membrane restructuring during the rat vibrissa follicle hair growth cycle.

Hair growth in adult mammals involves continuous dermal-epidermal interaction across the follicular basement membrane, and repeated reorganisation of lower follicle structure during the hair growth cycle. The immunolocalisation of 3 extracellular matrix components, fibronectin, laminin and type IV collagen was investigated during the course of the rat vibrissa follicle growth cycle, and their distribution correlated with changes in cellular and extracellular ultrastructure, particularly around the basement membrane zone. Laminin and type IV collagen were omnipresent at the follicular dermal-epidermal junction, but were also seen in granular extracellular form within the inner dermal component of the follicle, the dermal papilla. Both the inner papilla-epidermal junction and the thick specialised outer basement membrane (the glassy membrane) revealed labelling by these 2 antibodies around telogen (the period of nonfibre production). By contrast, fibronectin was abundant within the anagen dermal papilla but at telogen stained the dermal-epidermal junction heterogeneously, when it disappeared from the inner papilla-epidermal interface but intensified externally. These changes to extracellular matrix distribution coincided with a modification of basement membrane ultrastructure from a relatively uniform line at anagen, to one which became much broader and multilayered at telogen with a loss of definite structure within the papilla. This shows that the lower part of the vibrissa follicle retains the capacity for very rapid basement membrane modification and remodelling, and implies that it is part of the biological process which enables dermal-epidermal signalling, rather than a secondary product of physical changes to the appendage. The work supports the idea that dermal papilla cells could contribute to basement membrane formation, and also that fibronectin may be involved in regulating cellular activities within the follicle. In the vibrissa follicle, dynamic cellular activity clearly takes place throughout the duration of the hair cycle.


Quantitative analysis of factors contributing to expansion of microvillous surface area in the coprodaeum of hens transferred to a low NaCl diet.

A stereological study of the lower intestine (coprodaeum) of the domestic hen was undertaken using combined light and electron microscopy. Numbers of columnar absorptive epithelial cells and the dimensions and numbers of microvilli were estimated. The aim was to identify the main factors contributing to an increase in microvillous surface area following transfer of hens from a high to a low NaCl diet on which they were kept for at least 3 wk. The principal contributor to observed changes between organs was cell number. Birds adapted to the low NaCl diet had 57% more cells than high NaCl controls. The average cell had a larger microvillous surface (55%) and this could be explained by the presence of longer (34%) and more densely packed (38%) microvilli. The total number of microvilli per coprodaeum doubled (from 35 x 10(9) on the high NaCl to 71 x 10(9) on the low NaCl diet). The increase in cell number accounted for 67% of the change in surface area and 78% of the change in number of microvilli per organ. These findings emphasise that, when assessing the form and function of a whole organ, it is important to monitor cell populations as well as single cells. This is especially true when studying renewing and expanding (rather than static) populations.


Distribution of anionic sites on the perineurium.

The distribution of anionic sites on the perineurial basal lamina (BL) and plasmalemma of dorsal root ganglia and sciatic nerves was determined using cationic ferritin (CF) and cationic gold (CCG). The probes were applied to the tissue before and after resin embedding and visualised by electron microscopy. There were no apparent differences in charge distribution between the 2 tissues. At physiological pH a strong anionic charge was distributed evenly over the BL as demonstrated by pre-embedding labelling with CF; the plasmalemma was only moderately anionic. A similar application of CCG at pH 2.0 revealed a quasi-regular distribution of anionic sites (presumably due to acidic carbohydrate moieties) on the BL, whilst CCG-labelling of L. R. White sections indicated a differential distribution of these moieties on the BL of the inner and outer perineurial lamellae. Cationic ferritin (12 nm diameter) crossed the BL and entered perineurial caveolae, but CCG (effective diameter of 15 nm) did not, suggesting that the BL is a size-restrictive filter. These results are discussed with regard to the ultrastructure and function of the BL of other tissues and the possible role of perineurial BL charge as a determinant of perineurial permeability.


Microangioarchitecture of the guinea pig gallbladder and bile duct as studied by scanning electron microscopy of vascular corrosion casts.

The microvasculature of the gallbladder, the common bile duct, and the duodenal papilla was investigated in 20 albino guinea pigs (Cavia porcellus) using microvascular corrosion casting and scanning electron microscopy (SEM). Main supplying and draining vessels (first-order vessels) approach the gallbladder along the cystic duct. From the latter, penetrating vessels (second-order vessels) arise which pierce the muscular coat of the gallbladder body to form the plexus of third-order vessels between the muscle coat and the mucosa. Third-order vessels finally branch to supply the subepithelial capillaries, which show a honeycomb arrangement, corresponding to the gallbladder pits. At the areas bordering mucosal pits and beneath the tunicae plicae mucosae, the capillaries form glomera. These structures make the mucosal vasculature suitable for adapting to gallbladder wall distension caused by volume changes. The mucosal capillary glomera may also be involved in absorption of substances from bile, or they could act as buffer zones, counteracting the pressure which develops as the gallbladder volume increases. Venous sphincters occurring at the junction of mucosal vessels with the subjacent third-order veins may regulate blood flow in the mucosal glomera. The neck region as well as bile ducts consist of 2 vascular layers: an inner capillary layer and an outer one containing arterioles and venules. The duodenal papilla has a hemispheric shape and is interposed in the transition zone between the stomach and the duodenum. On the most luminal aspect, the capillaries of the papilla have a ring-shaped arrangement, as do the capillaries of the stomach, surrounding the mucosal glands; the remainder of the papilla is covered by duodenal villi capillaries.


MR features of intracranial hemangioblastomas.

The contribution of MR in 10 patients with surgically proven intracranial hemangioblastomas was retrospectively evaluated and correlated with the computed tomographic findings. Angiography was obtained in eight cases. Multiple lesions were shown in only two patients, but none proved to have von Hippel-Lindau disease. In six patients the tumor typically appeared as a cystic lesion with an intensely enhancing mural nodule at the pial surface of the cyst; three patients presented with a solid lesion with a central cyst and one with a solid lesion only. Thirteen tumors were located in the posterior fossa, with one in the brain stem extending towards the spinal cord. A supratentorial localization was found in two patients. Abnormal serpiginous vessels supplying or draining the mural nodule or solid lesion were not visualized on contrast-enhanced computed tomography, but were easily identified as flow voids on MR in five patients. Calcification or hemorrhage were not seen in the entire series. Because of the multiplanar imaging capability and the lack of streak artifacts from the petrous bone, MR provides better localization than CT. MR is more accurate in predicting the number, extension and vascularity of hemangioblastomas, and provides a sound basis for further diagnostic and therapeutic procedures.


Portal vein thrombosis after acute pancreatitis: diagnostic confirmation with computed tomography during arterial portography.

Portal vein thrombosis is a rare complication of pancreatic inflammatory disease. Usually, the radiologic diagnosis is made either by ultrasonography, contrast-enhanced CT or angiography. Moreover, MRI seems a very promising method. CT during arterial portography (CTAP) focused on portal system proved to have a place in the evaluation of portal vein thrombosis in a particular case.


Postoperative imaging of labyrinthine fistulae in cholesteatomas.

We evaluated the morphology of three operatively closed labyrinthine fistulae which were due to acquired middle ear cholesteatoma in three patients. In all three cases the fistula location was in the horizontal semicircular canal. The fistulae were closed by a mixture of bone powder and Tissucol. The layer closing the fistula was in all cases indistinguishable from the bony otic capsule on the postoperative CT.


Arthro-CT in detecting sideways displacement of the temporomandibular joint disk.

One of the major disadvantages of sagittal arthrotomography of the temporomandibular joint is its limited capability to detect sideways (medial or lateral) disk displacement. Several arthrographic signs, suggesting sideways disk displacement have been described in recent reports. The most important one is the edge sign. In doubtful cases, arthro-CT can be used for depiction of medial or lateral disk displacement.


Spontaneous rupture of the bladder: an uncommon finding on excretory urography.

A case of recurrent intraperitoneal bladder rupture is reported. Tearing occurred after minor trauma in a woman who had suffered a fracture of the pelvic rim 6 years earlier. Spontaneous rupture of the bladder is rare. The symptoms of an intraperitoneal bladder rupture may suggest intestinal disease and intravenous urography may be misleading. A retrograde cystogram is required to obtain the diagnosis.


Chronic focal fibrosing pancreatitis: detection by MRI.

The study of a 70-year-old woman with fibrosing pancreatitis, an uncommon variety of chronic pancreatitis, presenting as a discrete solid mass in the head of the pancreas, is reported. CT and US were non-diagnostic while ERCP and MR detected a focal anomaly. This case report stresses the sensitivity of MR in some pancreatic pathologies.


Congenital intrahepatic porto-systemic shunt.

An asymptomatic case of intrahepatic shunt between a portal and hepatic vein is presented. Ultrasound examination combined with Doppler sonography showed a communication between a dilated portal vein and a hepatic vein. Computed tomography and angiography confirmed the findings. Porto-hepatic venous shunting is very rare and has previously been reported in association with cirrhosis. The vascular malformation we present is believed to be a congenital anomaly, as no signs of cirrhosis or trauma were found.


[Stomach adenocarcinoma: what form of gastrectomy?].

Three hundred and sixty consecutive cases of gastric adenocarcinoma were studied retrospectively between 1976 and 1987. Surgery was curative in 195 patients: 91 had a subtotal gastrectomy 83 a total gastrectomy and 21 a proximal gastrectomy. Subtotal and total gastrectomy were compared within this group in terms of postoperative morbidity and mortality, abdominal comfort and 5-year actuarial survival: Postoperative mortality was greater after total gastrectomy (9.6 vs 2.2%, p = 0.04), as were anastomotic leaks (19 vs 2%, p = 0.0009). Mean weight loss was greater after total gastrectomy (p = 0.005). Comparison of patients with similar tumor staging and localization did not show any significant difference in 5-year actuarial survival. If subtotal gastrectomy is certainly justified for distal gastric cancer, it should be considered for some proximal localization.


[Surgical silicone prostheses in the treatment of biliary tract cancers: long prostheses or short prostheses? Results apropos of 500 cases].

The interest of surgical prostheses in the palliative treatment of biliary tract cancer is well established, on the basis of their good tolerance, the more than 15 year follow up experience and the number of patients operated upon. After exeresis, they allow re-establishment of continuity, either by use of a prosthesis in Y when the right and let ducts can be dissected, or by using two prostheses, a multiperforated long prosthesis reimplanted in the duodenum and a short prosthesis reimplanted in the common bile duct without attaining the sphincter of Oddi. Of the 1000 cases treated, 500 were the object of a statistical analysis, 46 being operated upon by the author, in 60% of cases for biliary tract cancer, either primary or as an extension from the gallbladder. One-third of the patients had advanced lesions and a short survival of less than 3 months. Two-thirds a median survival of 9 months. In 10%, a radical exeresis was performed with survival of more than one year without recurrence of jaundice. Failure of treatment with persistence of jaundice was due to advanced disease for which surgery is unsatisfactory. Essential complications were premature bile leaks (5%) without serious consequences if sufficient drainage was maintained, since it stopped spontaneously, and angiocholitis (6%), the result of territory exclusion or reflux. Recurrence of jaundice was related to extension of the neoplasm to the secondary bile ducts, and to hepatic metastases. Obstruction of the prosthesis before two months was rare (6%) and was preceded by angiocholitis. In the absence of recurrence of the cancer the prosthesis can be replaced surgically without difficulty.


[Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases].

Management of abdominal wounds is presently the subject of discussion between the partisans of routine laparotomy and those preferring "armed" surveillance. Results of study of a series of 176 abdominal wounds subjected to surgical dogma showed: that the diagnosis of non penetrating wounds (17.6%) was not always evident, due either to their anatomical localization (frontier region wounds) or to insufficient local exploration in urgent cases (6.6% of false-negatives), that the existence of serious clinical signs (50 cases) was always associated with one or more visceral lesions, requiring urgent laparotomy with a morbidity of 20% and a mortality of 8% (4 cases), that in the case of asymptomatic penetrating wounds (96 cases), routine laparotomy did nevertheless allow the diagnosis of visceral lesions in 50 cases (including 23 major lesions) but was of no utility in 46 cases (31.5% of blind laparotomies for the total series). The elevated proportion of useless laparotomies (30% in the literature), the result of a dogmatic attitude, or the risk of a delayed intervention (5 to 8%) in the series practising the selective method, led to a modification in the authors' attitude. The existence of serious signs should obviously result in a laparotomy. In their absence, and when confronted with a penetrating or doubtful (frontier region) wound, an exploratory celioscopy is proposed to ensure complete abdominal exploration, to confirm the presence or absence of penetration, to treat minimal lesions and to perform a classical laparotomy in case of evident necessity.


[Paraplegia after surgery of the suprarenal aorta (26 cases reported during a national survey)].

Although their frequency is probably underestimated, medullary complications of abdominal aorta surgery are rare but serious, and may be the cause of medico-legal actions. Referral of a patient allowed the collection of 26 unpublished cases: 18 with aneurysms, including 6 ruptured lesions and 12 undergoing cold surgery, and 8 with aorto-iliac occlusion, these 26 cases representing 0.16% of abdominal aorta interventions performed during the same period. Mortality (6 cases) was due principally to neurological complications, total in 4 cases, partial in 3 and persistent in 13. Risk factors were perioperative collapse (explaining the elevated frequency in ruptured aneurysms) and the occlusion of the internal iliac arteries. Duration of clamping was not significant. No certain method of prevention could be elucidated, either by a literature review or by analysis of the personal series.


[The aorto-esophageal fistula. A rare cause of digestive hemorrhage].

The authors report a new case of aortoesophageal fistula caused by a giant ulcer of the esophagus. Success of the surgical treatment during the bleeding period couldn't occult the seriousness of this fistula which is almost fatal. Only an early diagnosis permitting a surgical treatment in better conditions could improve the prognosis of this condition.


[Surgical treatment of ruptures of the achilles tendon in athletes. 31 cases operated on with an average follow up of 4 years].

The authors analyze a series of 31 tendo achillis ruptures occurring after sport accident. All were treated surgically. The actual follow up being of 4 years (1 to 12 years). In nearly one third of the cases, either a change in the training methods or intensive activity was noted. 80% of cases showed an causal violent trauma. Tendinopathy preceded the rupture in 20% of the cases, without being an important prognosis factor. In 70% of cases, diagnosis was made within the 24 following hours, and later (more than 8 days after) in one patient out of ten. Type of the surgical procedure does not seem to make any change in the long term prognosis. Each time a severe post op. complication occurred, the final result was bad. In one third of cases pre op. and post op. tendon lengths were not identical, this detail not seeming to bother the patients. In 60% of cases, same sport level was reached. In 80% of cases the final results were good or excellent.


[Metacarpophalangeal luxation of the thumb. Apropos of 30 cases].

A retrospective study of a series of 30 cases of metacarpo-phalangeal luxation of thumb (18 dorsal and 12 palmar) showed the relatively high frequency of the palmar variety both in adults and children. Prognosis was better for dorsal than for palmar luxations, the latter being associated with other lesions; cutaneous, tendinous and/or bony, these constituting the severity factor.


[Osteosynthesis of fractures of thr proximal end of the humerus by the screw-pin technique].

Both fascicular pinning as described by Appril and palmate pinning are inconvenient in that the pins can perforate the articular cartilage of the humeral head and provoke premature unpinning because of insufficient fixing in an osteoporotic bone. A new osteosynthesis material has been developed to reduce these inconveniences: the screw-pin. This ensures initial stability in the humeral head and allows immediate postoperative re-education of displaced fractures of the upper end of humerus. Results are presented of the use of this new material since 1988 in 26 fractures of upper end of humerus.


[Surgical treatment of carcinoid tumors of the intestine].

Carcinoid tumours arise from the neuroendocrine system and present a characteristic morphological picture. They occur in almost every organ, predilected sites are the appendix and the small intestine. Prognosis depends on the primary localization and tumour size. Carcinoids of the appendix and rectum are mostly small and thus have a good prognosis. Growth of bronchial, stomach and small intestinal carcinoids is aggressive and implicates a high percentage of metastatic disease. First choice therapy is the surgical removal of the tumour. Depending on tumour size surgical treatment includes fulguration, local excision and oncologic radical resection up to extended organ extirpation. Reoperation and repeated surgery have good chances to be successful concerning tumour remission and improvement of the carcinoid syndrome. Additive treatment comprises in particular somatostatin therapy and, in some cases, chemotherapy.


[Chronic Corynebacterium endophthalmitis. Apropos of 3 cases].

Only a few isolated cases of endophthalmitis have Corynebacterium been implicated as etiology. This diphtheroid, which has been considered for a long time as a nonpathogenic contaminant from the conjunctival flora, may produce systemic diseases usually in immuno-deficient patients. Keratitis and endophthalmitis cases have been reported in the literature. We report three cases of chronic endophthalmitis after extracapsular extraction with intraocular chamber posterior lens which are characterized by many subacute iridocyclitis and vitritis attacks treated by topical steroids. These endophthalmitis are characterized by decrease of visual acuity, hypopion, white plaque on posterior capsule and vitritis. In the first case, Corynebacterium has been isolated from the culture of vitreous and in the second and third cases from the culture of aqueous humor. These bacteria are often very slow growing, 8 to 14 days in the 3 cases. Colonies may not become visible on culture plates before one week or more. Corynebacterium grow well on ordinary media (blood and chocolate agar). The major difficulty is not to discard organism frequently considered contaminants. The treatment associated systemic antibiotherapy with steroids or not, central capsulotomy and vitrectomy with intraocular injection of antibiotic with or without steroids. Antibiotics sensitivities among diphteroids vary greatly. Quinolones, penicillins, vancomycin, cyclines and aminosides are often a good choice. However, individual sensitivities determined by the antibiogram must be used for an appropriate treatment.


[Photorefractive keratectomy following undercorrected myopic epikeratoplasties].

Five eyes had a delayed refractive regression following myopic epikeratoplasty; the undercorrection ranged between -8.00 and -10.00 diopters. Four of the 5 eyes had a loss of best spectacle visual acuity of two Snellen lines or more. Excimer laser photorefractive keratectomy was performed to achieve a full refractive correction. A dense subepithelial haze was observed in the 5 eyes. The 3 months postoperative refraction ranged between -1.00 D and +2.50 D but the spectacle corrected visual acuity reached only 0.1 to 0.2. Because of the poor visual acuity results, the five epikeratoplasty lenticles were removed, resulting in restoration of best preoperative spectacle visual acuity in 4 of the 5 eyes. Excimer laser photorefractive keratectomy was not a helpful means of correcting residual high myopia after myopic epikeratoplasty. The poor results may be explained by the preexisting stromal abnormalities.


[Evaluation of the efficacy of antimicrobial drugs in ophthalmic solutions].

The antimicrobial efficacy of preservatives in ophthalmic solutions was tested. Five strains were used as challenge organisms. They represented bacteria, yeasts and molds. Sixty per cent of the ophthalmic solutions showed a good preservation against S. aureus ATCC 6538, according to the standards and in 40% of cases, the bacteria disappeared on the second week. Against E. coli ATCC 8739, 90% of the samples were well preserved and in 10% the bacteria disappeared by the second week. Against Ps. aeruginosa ATCC 9027, C. Albicans ATCC 10231 and Asp. niger ATCC 16404, the ophthalmic solutions showed a 100% preservation. The majority of the products showed a satisfactory preservation. They contained declared preservatives and sometimes combinations of two antimicrobial agents.


[Values and limitations of radioimmunoscintigraphy with MoAb 225-28S in the diagnosis of posterior uveal melanoma].

When evaluating a clinical situation in which a posterior uveal melanoma (PUM) is suspected, we have to use all available diagnostic procedures because it may be difficult to distinguish between amelanotic tumours and/or small melanomas. Early diagnosis of a small lesion is mandatory for successful conservative therapy. Radioimmunoscintigraphy (RIS) of malignant melanoma has become an encouraging tool in Nuclear Medicine. 99mTc labelled F (ab')2 fragments of MoAb 225-28S raised against cutaneous melanoma were used. Nine patients were examined: the clinical diagnosis was PUM in 7 cases and choroidal metastases in 2 cases. Due to the size and/or site of the tumor, six eyes were enucleated. In all of these cases histopathology revealed a malignant melanoma. One patient died with disseminated hepatic metastases, 2 months after observation. RIS was positive in 5 of 7 PUM (71.4%) and a false negative result was obtained in 2 patients. Two true negative scintigraphies were observed in the patients with breast carcinomas and choroidal metastases. On the basis of these results, RIS may be valuable to diagnose ocular malignant melanoma, but specificity of MoAb 225-28S needs to be assessed.


[Results of trabeculectomy in congenital glaucoma].

Congenital glaucoma has a very serious prognosis. It represents the first cause of blindness in Tunisian children. Trabeculectomy introduced by Cairns in 1968, was initially proposed as second-line treatment in congenital glaucoma surgery. It has now become more frequently used as first-line treatment in this indication. We have already used this technique directly in 35 children suffering from congenital glaucoma with a total of 54 eyes. Forty four eyes underwent a single operation, ten eyes underwent two to four trabeculectomies. Then study of these cases with a mean follow up of 24 months shows an overall success rate of 64% after one trabeculectomy, with or without additional medical treatment. The study of tonometric diagrams shows that the successful results obtained after 3 months persisted in the long term. Trabeculectomy gives better results in congenital glaucoma with intraocular pressure greater than 40 mmHg. Repeated operations are sometimes necessary. In these cases, postoperative subconjunctival 5 fluorouracil (SFU) did not improve the surgical outcome.


[The visual field of patients with pseudophakia using kinetic and automated perimetry].

One of the major benefits of pseudophakia is to maintain a good visual field. Visual field was therefore studied in 40 pseudophakic eyes using: 1. kinetic perimetry according to Goldmann using 3 tests: I1, I2, I4; 2. Automated perimetry. Insertion of a posterior chamber intraocular lens was performed in 85% of cases whereas the remaining 15% received an anterior chamber intraocular lens. Visual acuity was > 5/10 P2-P4 in all patients. The results showed a 15% reduction in the visual field compared to normal values. This reduction was concentric and harmonious but was more marked in internal isopters. This reduction was less marked with posterior chamber intraocular lenses. On the other hand, automated perimetry showed that global retinal sensitivity was decreased in pseudophakia, and this deficiency was more pronounced in the periphery.


[Prognostic factors of choroidal melanoma: an anatomo-clinical retrospective and statistical study of 76 enucleated cases].

The authors report the results of a retrospective study of 76 patients enucleated for a choroidal melanoma, in whom prognostic factors of survival were studied. The presence of metastasis at the time of diagnosis, the size of the tumor and the epithelioid cellular type are the most pejorative factors (though statistically not significant). A peak mortality can be observed between the second and the fourth year after enucleation. A predominance of the liver metastases is clearly established (75% of the metastases observed in our sample). We observed a majority of small tumors (40%) of spindle cell type (50%).


[Unusual uses of liquid perfluorocarbons].

Since the use of low viscosity perfluorocarbon liquids by Chang in 1987, many applications in vitreoretinal surgery have become possible owing to their physical properties (density, viscosity and refraction index). Perfluorocarbon liquids are used exclusively when a vitrectomy is necessary. The main indications are drainage of subretinal fluid by peripheral dehiscence, to facilitate dissection of vitreo retinal proliferation, in retinal detachment by giant tear and in posterior lens dislocation. The authors report three cases illustrating two new indications for perfluorocarbon liquids. Confirming the presence or absence of a peripheral dehiscence in a total retinal detachment if vitrectomy is necessary, subretinal fluid is displaced and escapes via a possible dehiscence. Treatment of vitreretinal incarcerations in a sclerotomic orifice during a vitrectomy is simplified. Easier treatment of this complication is made possible by the injection of perfluorocarbon liquids into the "non-incarcerated" orifice. Despite the more frequent use of perfluorocarbon liquids in vitreoretinal surgery, the possible specific complications which may occur with these products mean that they should be used with caution.


[Goldenhar syndrome. Surgical emergency apropos of a case].

We report a case of Goldenhar syndrome in a six week old infant. This patient had bilateral peribulbar choristoma, bilateral pre-auricular appendix and left superior palpebral coloboma with severe exposure keratitis. This condition necessitated an emergency surgical eyelid repair. The authors discuss the different clinical manifestations of this syndrome and therapeutic modalities, particularly the surgical treatment of choristoma and palpebral coloboma.


[Eye manifestations and treatment of brain chordoma. Apropos of a case].

We report a case of intracranial chordoma revealed by an isolated abducent nerve palsy in a 4 years old boy. We discuss the possible symptoms of intracranial chordomas and their clinical, radiological and histological diagnosis as well as differential diagnosis. We summarize the available therapeutic modalities and we emphasize the future advantages of proton beam therapy in these lesions.


[Bilateral hidrocystoma of the median canthus. Apropos of a case].

Cystic lesions of the eyelids are not uncommon and are variable in nature. A case report of a 42-year-old male patient is detailed. A bilateral cystic lesion was clearly visible at both medial canthuses. Surgical resection was performed under local anesthesia, followed by histopathological study of the specimens. This revealed that these lesions were hidrocystomas, of probable eccrine origin. As many different cystic lesions may be encountered on the eyelids (dermoid cysts, epidermic cysts, cystic basal cell carcinomas...), routine histopathological study of surgically removed cystic specimens is mandatory to obtain an accurate diagnosis.


[Local treatment by epidermal growth factor after epikeratoplasty. A double-blind clinical trial].

Epidermal growth factor is a protein which stimulates epithelial cell growth. We conducted a randomized double blind study between patients treated with PHZ102 (Inpharzam SA, Cadempino, Switzerland) containing EGF, and placebo eyedrops as topical treatment following epikeratoplasty, to evaluate the effect of EGF on corneal reepithelialization. The patients of the EGF group recovered earlier (1 to 4 days) than the patients in the placebo group (3 to 15 days). Therefore, the results obtained confirmed that EGF may reduce the time normally required for complete reepithelialization of the cornea.


[Is vitrectomy cataractogenic? Study of changes of the crystalline lens after surgery of retinal detachment].

In order to assess the relationships between vitrectomy and postoperative crystalline lens changes we reviewed the records of 298 selected cases of operated retinal detachments in phakic eyes. We compared two groups: 155 eyes were operated with cryotherapy, vitrectomy and gas injection. 143 eyes received cryotherapy and retro-hyaloid fluid-gas exchange. Follow-up of at least 12 months and detailed description of the lens were available in 90 cases and 82 cases of the two groups respectively. Postoperative lens changes were as follows: nuclear sclerosis occurred in 63% of the vitrectomised eyes, mild in 14%, moderate in 16%, severe in 32%. In contrast, nuclear sclerosis occurred in only 4% of the non vitrectomised eyes, all these cases were noted as moderate. Posterior subcapsular opacities occurred in 4.5% of the vitrectomised eyes versus 2.4% of the non vitrectomised eyes. Nuclear sclerotic changes were correlated with vitrectomy and longer follow-up. Posterior subcapsular cataract was correlated with vitrectomy and larger intraocular gas bubble.


[Ultrasonic treatment of hypertonia caused by intraocular silicone oil].

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.


[Trabeculoretraction by argon laser. 5 and 8-year results].

To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)


[Prevalence of eye diseases in Basedow disease. Apropos of a prospective study with 85 cases].

The authors report the results of a prospective study, conducted between March 1990 and March 1991, on 85 patients suffering from Graves' disease, who were systematically examined to evaluate the prevalence of ophthalmopathy in Graves' disease. They were graded according to the Nospecs classification: 32 patients had no ophthalmopathy; 21 had only eyelid retraction (grade I in the Nospecs); 32 had a real ophthalmopathy (Grade II) or more in the Nospecs: 27 patients had signs of inflammation (grade II), that were often minor, 14 patients a moderate or intermediate exophtalmos (grade III), 4 patients had corneal injuries (grade V). The authors discuss the problems caused by this classification.


[Developmental aspects of diabetic retinopathy during pregnancy].

The course of diabetic retinopathy (DR) was studied in 93 pregnant patients. Results were compared with data from 98 diabetic non pregnant women. Worsening of initial retinal lesions was observed in 16% of the pregnant group whereas only 6% of the control group showed a similar aggravation. The difference between the two groups was statistically significant (p < 0.05). Argon laser panretinal photocoagulation of pre-proliferative and proliferative DR resulted in no subsequent DR-induced complications. On the other hand, the risk of appearance of DR and/or its worsening during pregnancy depends on initial network but mostly on the duration of diabetes mellitus. In conclusion, regular ophthalmologic examination of diabetic patients especially during pregnancy seems crucial for the early screening of any worsening. Furthermore, the importance of pregnancy planning is emphasized.


[Multifocal and monofocal implant. Comparative functional results (contrast sensitivity and dynamic visual acuity)].

The functional results (contrast sensitivity and dynamic visual acuity) of 19 multifocal (3 M design) and 14 monofocal intraocular (IOL) were compared. Best corrected visual acuity was > or = 8/10 P 2. Major differences of functional performance in favour of monofocal IOL's were found under standard conditions of vision (low contrast and illumination levels). Dynamic visual acuity allowed accurate evaluation of the difference of performance between these two models of implant. The indications for multifocal IOLs were reconsidered in the light of these results.


[Should accommodative strabismus be operated on?].

Hypermetropia is probably not the real cause of accommodative squint. The arguments for this view are the absence of binocular vision in more than half and of the presence of a vertical deviation in about one third of cases of accommodative strabismus. Furthermore, after reduction of this vertical deviation by means of simultaneous surgery upon the horizontal and oblique muscles, binocular vision recovers spontaneously, the accommodative component of the squint disappears and visual acuity improves without glasses. Recent neurophysiologic research explains the beneficial effect of simultaneous surgery. According to these investigations there are two systems of accommodation and convergence; a quick phasic one, where accommodation is linked with convergence and a slow tonic one without interaction. The tonic system is responsible for the neutralization of the excess of convergence induced by hyperaccommodation. Tonic vergence depends on fixation disparity which is eliminated by a vertical deviation and restored by the surgical reduction of this vertical deviation. The fact of wearing positive correction produces and consolidates a hypo-accommodation, revealing a latent hypermetropia which could compromise emmetropisation. Furthermore, this correction being associated with squint, is a source of psychological complexes and the cost of an optical treatment is high, considering that spectacles need to be renewed frequently and many times during lifetime. On the other hand, simultaneous surgery removes an important obstacle to fusion and makes the patient independent of spectacles, not only regarding the squint, but also visual acuity.


[Anterior lenticonus, suggesting Alport syndrome. Apropos of a first case in Zaire].

Anterior lenticonus is a rare condition, in which there is a conical or spherical protrusion of the anterior surface into the anterior chamber. This is demonstrated by this case report, which has not been previously described in the Black African or Zairian ophthalmological literature. The patient was 28 years old and complained of gradual deterioration of vision over several years. The visual acuity was 20/200. The slit lamp biomicroscope showed an anterior lenticonus with microopacities of the lens. On fundus examination, a fundus albipunctatus-like appearance with midperipheral retinal flecks and macular hole were found. The presence of associated ocular abnormalities, deafness and hematuria, is suggestive of Alport's syndrome.


[Idiopathic and secondary chorioretinal folds].

Chorioretinal folds may be observed in many choroidal or retinal diseases. In age-related macular degeneration, they are usually associated with retraction of a neovascular membrane and a typically radial pattern of the folds can be seen. In this disease, pigment epithelium folds were recently described. Their clinical and angiographical characteristics are different from chorioretinal folds and the two diseases should not be confused. A 74-old patient presented, in the left eye, with sub foveal new vessels situated at the center of a pigment epithelial detachment (PED). Radial chorioretinal folds surrounded the PED, as frequently observed during follow-up in subretinal neovascular membranes. Nevertheless, right eye fundus examination revealed roughly horizontal, regular and parallel chorioretinal folds. Ultrasonography demonstrated characteristics of idiopathic chorioretinal folds: flattening and thickening of the posterior sclera and choroid. No sign of posterior scleritis was found. These ultrasonographic elements were observed in the left eye away from the central neovascular membrane. The chorioretinal folds therefore seemed to be idiopathic, in a hyperopic patient. The shape of the folds was modified in one eye by a subfoveal neovascular membrane. Chorioretinal folds may occur in different retinal diseases. The associations with many different aetiologies with modification of the shape of the folds, as described in this clinical case, should be emphasized.


Significant anti-HIV activity of new modified polyanionic polymers in vitro.

The anti-HIV activities of two new polyanionic polymers (AM 242 and AM 612) were investigated in cell culture-based and biochemical antiviral assays. These compounds inhibited the reverse transcriptases from HIV-1 and HIV-2, using enzyme purified from virions and either a ribosomal RNA or gapped duplex DNA as the template. With the ribosomal RNA template, AM 242 and AM 612 had ID50 values of 1.1 and 0.10 micrograms/ml against the HIV-1 reverse transcriptase. In vitro cell based assays determined that both compounds significantly inhibited both the cytopathic effects associated with HIV-1 infection and the replication of virus in infected cells. AM 242 had an IC50 of approximately 1.0 micrograms/ml, while that of AM 612 was 0.19 micrograms/ml. These two active polyanionic polymers were effective in inhibiting the growth of a panel of HIV-1 isolates and were also active against HIV-2. Although the compounds were toxic at high concentration, they had antiviral activity over a wide range of nontoxic concentrations, yielding a high selectivity index. AM 612 was 100% protective for CEM cells from 320 ng/ml to 1 microgram/ml. Both compounds caused a significant increase in cellular proliferation as determined by the concentration-dependent increase in incorporation of radioactive precursors into cellular macromolecules.


Effect of metals on interleukin-6 (IL-6) mitogenic stimulation of murine hybridoma cells.

The effect of several divalent metal cations (Co, Cu, Zn, Hg and Pb) on the proliferative response of B9 hybridoma cells to IL-6 has been investigated. At concentrations which are not cytotoxic all the metals inhibited proliferation. The inhibition by Cd and Pb was dependent on both time of addition of the metal and IL-6 concentration. Cd (10 microM) and Pb (50 microM) added at the same time as IL-6 were inhibitory but added 24h later had no effect. Increasing the concentration of IL-6 overcame the inhibitory effect of Cd (10 microM) and Pb (50 microM). Inhibition caused by the other metals was independent of either time of addition or IL-6 concentration. IL-6 did not stimulate an increased intracellular concentration of metallothionein suggesting that the protective effect of IL-6 is not mediated via induction of metallothionein. The results suggest that there are at least two distinct metal sensitive events in B9 proliferation, i) IL-6 reversible inhibition by Cd and Pb ii) IL-6 independent inhibition by Co, Cu and Hg.


Pidotimod stimulates natural killer cell activity and inhibits thymocyte cell death.

Experiments were performed to analyze the possible effect of the immunomodulating agent Pidotimod (3-L-pyroglutamyl-L-thiazolidine-4-carboxylic acid) on mouse Natural Killer (NK) cell activity and glucocorticoid hormone(GCH)-induced thymocyte apoptosis. The results indicate that in vivo treatment with Pidotimod (200 mg/Kg ip for 5 days) causes a significant increase in NK activity and in vitro treatment produces a significant reduction of dexamethasone-induced thymocyte apoptosis. This inhibition appears to be dose-dependent and is also evident against TPA or Ca(++)ionophore-induced apoptosis.


A short incubation with PGE2 affects the proliferative response of T lymphocytes to PWM.

In this study we have investigated the role of PGE2 in the activation of human T lymphocytes by PWM. A preincubation of these cells with molar concentrations of the prostaglandin ranging from 10(-9) M to 10(-4) M is able to reduce the expression of IL-2R and CD71 on T lymphocyte membrane during the first days of culture, while the DR molecule which is expressed later in the same experimental conditions is not affected by the treatment of T lymphocytes with PGE2. The PGE2-induced inhibition of IL-2R and CD71 well correlates with the reduction of 3H-thymidine incorporation by T cells, indicating that a preincubation of T lymphocytes with PGE2 profoundly affects the proliferative apparatus of these cells when they are stimulated by PWM.


Antimicrobial agents induce monocytes to release IL-1 alpha, IL-6, and TNF, and induce lymphocytes to release IL-4 and TNF tau.

Evaluation was carried out on the action of different antibiotics on the release of cytokines. Experiments were done in vitro on monocytes and on human lymphocytes. Results show that the majority of the antibiotics tested are able to induce the release of one or more cytokines from their respective producing cells. Among the beta-lactams the most active were the cephalosporins (cephalexin, cefamandol, ceftazidin, and a sulbactam-ampicillin combination) in inducing the release of TNF, IL-1 alpha, and IL-6 from monocytes, and releasing IL-4 and IFN-tau from lymphocytes. The sulbactam-ampicillin combination and cefamandole were extremely active in the production of IFN-tau. Among the lincosamides, clindamycine notably stimulated the release of TNF and IL-6, while lincomycine induced a notable increment of IL-4 from monocytes. Teicoplanin is a very strong inducer of TNF, IL-1 alpha and IL-6.


Regulation of murine T-lymphocyte function by spleen cell-derived and exogenous serotonin.

The modulatory effects of serotonin on T-cell activity were investigated. T-cell blastogenesis of normal spleen cells was slightly stimulated by the addition of low doses (1 and 10 ng/ml) of the inducer of serotonin release, fenfluramine. In contrast to the stimulatory effects of low doses of fenfluramine, high doses of fenfluramine (1 and 10 ug/ml) or of exogenously added serotonin (> or = 0.1 ug/ml) inhibited T-cell activation. Both the stimulation by low dose fenfluramine and the inhibition by high dose fenfluramine were accentuated by pretreating mice with tryptophan to heighten intracellular stores of serotonin and then inducing serotonin release. Pretreatment of mice with the serotonin inhibitor p-chlorophenylalanine (PCPA) abolished the fenfluramine inhibition of T-cell activation indicating that the fenfluramine inhibitory effect was mediated via endogenous spleen cell-derived serotonin. However, the PCPA treatment diminished T-cell activation. These results suggest that endogenous serotonin causes a biphasic dose-response effect on T-cell activity with serotonin being required for optimal T-cell function, low doses being immune stimulatory and higher doses being suppressive.


beta-Lactam antibiotic modulation of murine neutrophil cytokinesis.

Fourteen cephalosporins, 11 penicillins and 1 monobactam were evaluated for their in vitro modulation of murine neutrophil cytokinesis. As a result, the beta-lactam antibiotics were placed into 6 groups based on their effect on random (R) and FMLP-directed (D) migration [Group 1 (no effect): cephalosporin C; Group 2 (R-->D decreases): cloxacillin, cefotaxime, ceftazadime, cefuroxime, cephalothin, cephapirin, cephadine, nafcillin, piperacillin, ticarcillin, ampicillin, oxacillin, aztreonam; Group 3 (R increases D-->): cephaloridine; Group 4 (R increases D increases): cefsulodin; Group 5 (R increases D decreases): cefoperazone, cefoxitin, ceftriaxone, 6-amino-penicillanic acid; Group 6 (R decreases D decreases): cefadroxil, cefazolin, penicillin G, methicillin]. Trypan blue exclusion studies showed that inhibition of R and D by Group 6 beta-lactam antibiotics is not due to overt cytotoxicity. beta-lactam antibiotics inhibiting D also increased neutrophil adherence to plastic at a concentration of 1000 microM. Finally, the [Ca++] inhibitor chlorpromazine significantly abrogates beta-lactam- and FMLP-directed migration at a test concentration of 1 microM.


Preventive effect of a synthetic immunomodulator, 2-carboxyethylgermanium sesquioxide, on the generation of suppressor macrophages in mice immunized with allogeneic lymphocytes.

The effect of 2-carboxyethylgermanium sesquioxide (Ge-132) on the generation of splenic suppressor macrophages (S-M phi) in C3H/He mice (H-2k) immunized with allogeneic spleen cells from C57Bl/6 mice (H-2b) was investigated. We have previously demonstrated that S-M phi expressing I-J antigen, which appeared during alloimmunization, inhibited cytotoxic T lymphocyte (CTL) generation in the MLR and the elimination of these S-M phi before subjection to the MLR resulted in more effective generation of CTL. The CTL activity, which was determined in vivo by the Winn's test, was markedly enhanced when immunized mice received a 100 mg/kg dose of Ge-132. The compound was found to be the most efficacious when injected simultaneously with the immunization. The activity of allospecific CTL co-cultured with M phi fractions obtained from immunized mice in a 4-h 51Cr-release assay was shown to be 31% lysis of the target cells as compared with 90% lysis of the target cells in effector cells co-cultured with normal M phi fractions. In contrast, effector cells co-cultured with M phi fractions from Ge-132-treated immunized mice lysed 95% of the target cells. Analysis of the level of I-J antigen expression on macrophages (M phi) obtained from mice 7 days after immunization revealed a > 2.5-fold increase, whereas I-A antigen expression remained constant when compared with splenic M phi from naive mice. In contrast, the opposite effect on I-J and I-A antigen expression was observed in splenic M phi from alloimmunized mice treated with Ge-132. These results suggest that Ge-132 could regulate CTL generation in alloimmunized mice by preventing the generation of I-J+ S-M phi.


Antitumor activity evaluation of bromine-substituted analogues of ifosfamide. I. Stereodifferentiation of biological effects and selection of the most potent compounds.

The series of 9 compounds, including 3 racemates and 6 enantiomers of bromine-substituted analogues of ifosfamide (bromo-, chlorobromo- and dibromofosfamides) have been evaluated for antitumor activity against L1210 leukemia, Lewis lung carcinoma and B16 melanoma in mice. Effective and curative doses of tested compounds were estimated on the basis of computer-assisted elaboration of the dose-effect curves obtained from experimental data. Two oxazaphosphorine drugs, ifosfamide and its congener cyclophosphamide, were used as referentials. Elementary toxicity studies were conducted in parallel in healthy animals and lethal doses were determined. Selection of the most potent compounds was based on the comparison of their therapeutic indices, calculated from the ratio of lethal to effective doses. In effect four compounds which have been shown therapeutically more effective than both referential drugs, were selected for further evaluation in mice bearing advanced tumours. Stereodifferentiation of evaluated biologic effects favouring S(-) isomers was observed in all three groups of compounds. Preliminary observation was also made indicating significant lethality reduction after per os administration of selected agents, which was not paralleled by diminution of their antitumor effectivity.


Decreased immunological responses by wortmannin-containing rice culture of Fusarium oxysporum and by purified wortmannin in avian species.

Immunological assays were performed in young chicken and duck after they had been fed wortmannin-containing culture of Fusarium oxysporum or purified wortmannin for 2 weeks. The culture significantly decreased humoral response to sheep red blood cell, cell-mediated cutaneous hypersensitivity to phytohemagglutinin and phagocytic activity in isolated peritoneal exudate adherent cells, but only when the concentration was high enough to cause concurrent reduction in body weight gain and hematocrit. Increased dietary metabolizable energy and protein did not affect the toxicity of the culture. On the other hand, purified wortmannin (1 mg/kg diet) significantly inhibited the aforementioned immunological responses prior to the adverse effects on body growth and hematocrit. The data strongly indicate that wortmannin is an immunotoxic substance. The possibility that macrophage is the primary target cell type is discussed.


The effects of perfluorodecanoic acid (PFDA) on humoral, cellular, and innate immunity in Fischer 344 rats.

The in vivo effects of perfluorodecanoic acid (PFDA) exposure on antibody production, delayed type hypersensitivity (DTH), and natural killer (NK) cell activity were determined. Fischer 344 rats were injected with PFDA (20 mg/kg or 50 mg/kg, 8 days or 30 days prior to sacrifice) and were immunized with keyhole limpet hemocyanin (KLH). Pair-fed and ad libitum-fed control rats were included to evaluate effects of PFDA-induced anorexia. KLH-specific IgG2a production was significantly decreased (p < 0.05) in PFDA-treated rats when compared to ad libitum-fed and pair-fed controls at 8 days but not at 30 days following PFDA treatment. The DTH response of PFDA-treated rats was decreased 8 days and 30 days after PFDA treatment when compared to ad libitum-fed and pair-fed controls, however, the decrease was not statistically significant. NK activity 30 days after PFDA treatment was significantly elevated (p < 0.05) when compared to ad libitum-fed controls, but pair-fed controls had similarly elevated NK activity. NK activity at 8 days after PFDA treatment was not significantly altered. In conclusion, PFDA has been demonstrated to have immunomodulatory effects, some of which may be associated with drug-induced anorexia.


The effect of Lasso herbicide on human immune function as measured by in vitro assays.

Using in vitro assays, this study was undertaken to determine whether the components of Lasso herbicide formulation had an effect on the human immune system. Mononuclear cells from human peripheral blood were exposed to analytical alachlor, alachlor conjugated to human serum albumin or Lasso formulation over a concentration range from .01 microM-1.0 microM. The effects of the test materials on the following immunological functions were determined: lymphocyte proliferation induced by mitogen or antigen; antibody synthesis of IgG and IgM isotypes in pokeweed stimulated mononuclear cell cultures; cytotoxic T cell proliferation; lysis of target cells by natural killer cells and lymphokine activated killer cells. The data demonstrated that the test compounds had no significant, dose related effect on the function of immunocompetent cells. Hence, the data suggest that the components of the Lasso formulation have no effect on the human immune system.


Crohn's disease and the Jews.

Several epidemiologic studies of Crohn's Disease (CD) from the northern hemisphere show high rates of the disease among Jews. Israel has absorbed many Jews from those countries and the rates of CD in Israel are lower than in their place of birth. Important, too, among immigrants from the middle east Mediterranean countries, the rates appear to be higher than those in their countries of origin, where the disease is rare. CD has a genetic predisposition, but we physicians cannot ignore the environmental factors.


Diversion colitis--20 years a-growing.

During the last decade, clinical and pathologic studies of diversion colitis have led to a better understanding of its nature. The clinical features are well described, and the endoscopic appearances, and gross and microscopic pathology are now defined. Thus, firm diagnosis and distinction from other colitides, notably ulcerative colitis and Crohn's disease, are possible in most cases. Restoration of the fecal stream cures diversion colitis, which in some cases may be successfully treated with short-chain fatty acid enemas, although the efficacy of this method remains to be substantiated. An understanding of the pathogenesis of diversion colitis (currently unknown) may lead to better methods of prevention and treatment.


Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome. Characterization and treatment with corticosteroids.

Study objectives were to characterize the clinical syndrome of chronic idiopathic esophageal ulceration in patients with acquired immunodeficiency syndrome (AIDS), to determine the extent of local human immunodeficiency virus (HIV) infection, and to evaluate the effect of corticosteroid therapy upon symptoms and healing. Twelve AIDS patients with chronic esophageal ulcers whose etiology remained unknown after clinical evaluation were the subjects. All patients complained of severe odynophagia, chest pain, and weight loss. Barium radiography and endoscopy demonstrated large, undermined ulcers with severe acute inflammation. No evidence of herpes simplex viruses I or II, cytomegalovirus, fungi, or tumors were found histologically. Evidence of HIV was found in all ulcers using a combination of RNA in situ hybridization, immunohistochemistry, and quantitative antigen capture enzyme-linked immunosorbent assay of tissue homogenates. Steroid therapy by the oral or intravenous routes or by direct intralesional injection resulted in pain relief, weight gain in 10 patients, and ulcer healing in five patients. A characteristic clinical syndrome of chronic idiopathic esophageal ulceration may occur in patients with AIDS, related to local HIV infection in the esophagus. Corticosteroids relieve symptoms and may promote healing of the ulcer.


Healing and relapse of duodenal ulcer during ranitidine therapy in the elderly. The RUDER Study Group.

A total of 2,109 outpatients with active duodenal ulcer (DU) entered an open, prospective study in order to investigate factors influencing healing and relapse during 2 years of ranitidine therapy (300 mg daily for healing, 150 mg as maintenance treatment). In a retrospective analysis, we evaluated the influence of age. Symptoms related to DU in 1,899 evaluable cases in patients over 65 years of age (n = 185) were identical to those of DU patients younger than 65 years old (n = 1,714). Rapid healing within 2 weeks of ranitidine therapy was less frequent in the elderly (32.5%) than in younger patients (40.7%) though identical healing rates (94.1%) in each group were achieved by continuation of ranitidine therapy for 8 weeks. Cumulative recurrence rates during the 2 years of long-term therapy were lower (17.3%) in old age than in patients under 65 years of age (23.3%). Adverse events were rare in both age groups. We conclude that DU healing during ranitidine is delayed in old age. Additional differences in relapse rates in favor of the elderly suggest that DU disease has a different course in the elderly.


Low prevalence of gastric metaplasia in the duodenal mucosa in Peru.

We compared the prevalence of gastric metaplasia of the duodenal mucosa (GM) and its characteristics in 204 Peruvian patients from a low socioeconomic level with the corresponding prevalence reported in dyspeptic patients from a developed country, the United Kingdom. Gastric metaplasia was significantly less prevalent in the Peruvian than in the United Kingdom series. However, when present, GM was not significantly different in extent or frequency of colonization by Helicobacter pylori or association with active duodenitis, despite a higher prevalence of H. pylori-associated gastritis. Hypochlorhydria was markedly more frequent in the Peruvian than in the United Kingdom series. The finding of a low prevalence of H. pylori-colonized GM in patients with previously reported low prevalence of duodenal ulcer gives further support to a pathogenic link between both conditions.


Early gastric cancer in southern Taiwan.

Between January 1986 and November 1990, 231 patients underwent resection for primary gastric adenocarcinoma at Chang Gung Memorial Hospital in southern Taiwan. Thirty-nine (17%) of these patients had early gastric cancer (limited to the mucosa or submucosa regardless of nodal metastases). Epigastric pain was the most frequent symptom (71.8%). The lesions were located in the lower third of the stomach in 84.6% of the patients and in the middle third in 15.4%. A preoperative diagnosis of gastric cancer was achieved in 94% of patients by endoscopic examination with biopsies. All of the patients underwent distal subtotal gastrectomy without mortality. Macroscopically, 84.6% of cases were included in types IIc, III, and IIc-III. One patient died of multiple liver metastases 3.2 years after operation. The cumulative survival rate at 5 years is 92.9%. We comment on these matters and place early gastric cancer in Taiwan into a more global context.


Preoperative clues to Crohn's disease in suspected, acute appendicitis. Report of 12 cases and review of the literature.

Twelve patients who underwent laparotomy for suspected acute appendicitis were found to have Crohn's disease of the terminal ileum. Appendectomy was performed in all although in only four patients was the appendix grossly inflamed. Postoperative complications, either abscess or fistula, developed in four patients (33%). Careful investigation of the records revealed some preoperative diagnostic clues: a history of recurrent abdominal pain and/or diarrhea (83%), physical examination revealing normal temperature (50%), and laboratory results compatible with a chronic process such as microcytic anemia (33%) and hypoproteinemia/hypoalbuminemia/hypocholesterolemia (50%). As the differential diagnosis between Crohn's disease and appendicitis is difficult and the surgical approach to the appendix in the presence of Crohn's disease is controversial, we illuminate some practical points in the preoperative evaluation of these patients and deal with the question of whether appendectomy should be performed in these patients.


Ki-67 antibody labeling index in colorectal carcinoma.

Ki-67 labeling index of 58 colorectal carcinomas and 10 normal colonic mucosa samples was determined by the use of an immunohistochemical staining technique. The Ki-67 labeling index in colorectal carcinomas ranged from 15.7 to 63.6% (mean +/- SD of 38.5 +/- 10.5) and was significantly higher than the index for normal colon mucosa (mean +/- SD of 14.1 +/- 2.8). The mean Ki-67 labeling index was significantly higher in Dukes' B and Dukes' C tumors than in Dukes' A tumors, but the index did not correlate with the size of the tumor. There was no correlation between the Ki-67 labeling index of the tumor and lymph node involvement. The present study disclosed that the Ki-67 labeling index correlated with local invasion of colorectal carcinoma, but not with metastasis of the tumor.


The effect of loperamide on anorectal function in normal healthy men.

Loperamide improves anorectal functioning in patients with diarrhea and incontinence. Loperamide reduces sensitivity of the recto-anal inhibitory reflex and increases internal anal sphincter tone. Additionally, it has an effect on rectal compliance in incontinent patients with diarrhea. We studied the effect of loperamide versus placebo at different distances from the anal verge in 18 healthy male volunteers, using standard anorectal manometry was a double-blind, two-factorial design. We found that the recto-anal inhibitory reflex is most pronounced when stimulated in regions close to the anal canal and that distention stimuli are also perceived best in that region. Both effects are counteracted by loperamide. We found no effect on internal sphincter tone or rectal compliance. These results imply a gradient of sensitivity for rectal perception and the recto-anal inhibitory reflex in healthy volunteers. Loperamide action on both mechanisms suggests a common mediator for both effects.


Diagnosis of the acute abdomen in the neurologically stable spinal cord-injured patient. A case study.

The diagnosis of the acute abdomen in the spinal cord injured patient is difficult. Diagnoses are often so delayed that approximately 10% of these patients die of acute abdominal problems. The presentation also varies with the level and duration of injury. An understanding of the functional neuroanatomy of the abdominal wall and viscera aids in timely diagnosis. I present an illustrative case and describe the pertinent functional neuroanatomy.


Injection sclerotherapy as a cause of Klebsiella pneumoniae peritonitis.

We report a case of Klebsiella pneumoniae peritonitis after endoscopic sclerotherapy and discuss its pathogenesis and risk factors. We also review previous cases in the literature and make recommendations for prophylactic therapy. Endoscopists should be aware of peritonitis as a possible complication of endoscopic sclerotherapy.


A cecal diaphragm associated with the use of nonsteroidal anti-inflammatory drugs.

In the small intestine, strictures and diaphragms causing obstructive symptoms are well known to occur in patients using nonsteroidal anti-inflammatory drugs. Recently, two cases of nonsteroidal anti-inflammatory drug (NSAID)-associated diaphragm-like colonic stricture were reported as unexpected findings in patients being investigated for iron-deficiency anemia. We present a third such case that occurred in the cecum in a 49-year-old woman with rheumatoid arthritis who had been taking NSAIDs for 5 years.


Pancreatitis in ulcerative colitis.

A 19-year-old man without apparent predisposing factors was found to have chronic pancreatitis and 6 months later developed ulcerative colitis. Is there a real association between pancreatitis and inflammatory bowel disease? We discuss previous reports.


Endoscopic diagnosis and treatment of Mirizzi's syndrome.

Mirizzi's syndrome is the name given to common bile duct obstruction secondary to a stone in the cystic duct. The cause of the biliary obstruction is often difficult to establish before operation. We report two cases of Mirizzi's syndrome, diagnosed endoscopically and treated without surgery. One of the patients was treated by drainage of both the common bile duct and the gallbladder associated with monooctanoin dissolution of the gallstone. The other was treated by common bile duct stenting.


Colonoscopy: a prospective report of complications.

Patients (N = 2,097) undergoing ambulatory office colonoscopy were followed to determine the incidence of endoscopic complications. In this group, 1,320 patients had diagnostic colonoscopy with or without biopsy; 777 patients had 2,019 polyps removed. Three of 2,097 patients (0.1%) had transient hypotension requiring i.v. fluid resuscitation and oxygen administration. All patients went home without sequelae. Acute postpolypectomy bleeding occurred in 11 of 777 patients (1%) requiring acute management; bleeding was controlled during colonoscopy in all. Postpolypectomy syndrome occurred in 9 of 777 patients (1%). All patients were treated medically. Late postpolypectomy bleeding occurred in 15 of 777 patients (2%). Perforation occurred in two of 777 patients (0.3%), at 1 and 9 days postpolypectomy. Both patients underwent surgery with uneventful recoveries. We conclude that office colonoscopy including polypectomy is safe. The overall complication rate for therapeutic ambulatory colonoscopy was 5%, with major events requiring hospitalization in 2% of patients.


[Characteristics of group A streptococci isolated from children with non-suppurative complication or severe infection].

We determined the characteristics of group A streptococci isolated from 29 sporadic cases with non-suppurative complication or severe infection during a 15-year period from 1977 to 1991. The clinical diagnoses of children included 4 patients with rheumatic fever, 2 with reactive arthritis, 2 with central nervous system complication, 5 with glomerulonephritis, 11 with Honoch-Schölein purpura, 4 with sepsis and 1 with empyema. Twenty-four strains were isolated from throat swabs, 4 from blood specimens and one from pleural fluid. M/T-serotypes and the number of isolates were as follows; 1/1:10, 3/3:1, 3.3R/3:3, 4/4:7, 5/NT:1, 12/12:3, 18/18:2, 62/12:1, NT/13:1. All 29 isolates had productivity for at least one of streptococcal pyrogenic exotoxins (SPEs) A, B and C. Two strains were positive for A, 2 for A and B, 3 for A, B and C, 9 for B and 13 for B and C. Of 11 isolates from patients with Henoch-Schönlein purpura, 7 and 2 strains were serotyped in M1 and M4, respectively, but none was in M12. Ten of 11 isolates were positive for SPE B or SPEs B and C.


[Identification of strains on recurrent Haemophilus influenzae infections in patients with chronic respiratory tract infections].

Nontypable Haemophilus influenzae is one of the most important pathogenic bacteria in respiratory tract infections. H. influenzae is most frequently associated with recurrent infections in chronic respiratory tract infections (CRTIs). It is known that H. influenzae often reemerges after the antibiotic treatment has been stopped. We analyzed serotype, biotype, and the OMP patterns of H. influenzae isolates from sputum of CRTIs patients to determine whether an exacerbation is caused by an identical H. influenzae strain, or by a new H. influenzae strain. One hundred eighty nine strains of H. influenzae were obtained from 124 exacerbation from 24 patients. The first and second isolates were identical in 23 out of 33 exacerbations (< or = 15-days interval between each exacerbation) and also in 22 out of 34 exacerbations (15 < days but < or = 30-days interval between each exacerbation). This is called early recurrence. In contrast, the first and second isolates were different in 28 out of 34 exacerbations (> 30-days interval between each exacerbation). This is called late recurrence. These results suggest that early recurrence and late recurrence of recurrent H. influenzae infections occur in a different mechanism.


[Culture-positive Legionella pneumonia in Japan, 1980-1990. Working Party for Legionellosis, Japanese Ministry of Health and Welfare].

The Working Party for Legionellosis headed by the Japanese Ministry of Health and Welfare processed to standardize the diagnostic procedures for Legionella pneumonia, as the first step to clarify the actual occurrence of patients with this respiratory disease. All the clinical data were collected and analysed on the 28 culture-confirmed patients in Japan during the past 11 years, from 1980 through 1990. The 28 patients were distributed throughout Japan, from Hokkaido to Kyushu. Out of 28 patients, 18 were community-acquired and 10 were nosocomially infected. In 8 of 18 community-acquired patients, any significant underlying disease was not observed. Though it was dominant in the age group in their 60s & 70s, victims were distributed in adults over 20 years of age and even in a new born baby. Only 5 out of 28 patients recovered successfully. From the autopsy findings, in 5 out of the remaining 23 expired patients, Legionella pneumonia seemed to be successfully treated, but other disease or other bacterial pneumonia put an end to the patients. The results of clinical laboratory tests and the efficacy of antibiotics to Legionella pneumonia were essentially the same as those reported in the literature.


[Typing system for Clostridium difficile by western blotting using antisera against ten different serogroup strains].

Western blotting using antisera against each of reference ten serogroups was evaluated as a typing system for Clostridium difficile. A total of 164 isolates of C. difficile (114 epidemiologically unrelated and 50 isolates from a hospital outbreak in New York) were tested. Blotting patterns for the ten reference strains showed serogroup-specific bands located in the 30-60 kDa when each homologous antiserum was used. At greater than 60 kDa, variations in each serogroups were observed; these variations were used for subserogrouping the isolates. Serogroup A, G, H, and K were most frequently recovered in the group of epidemiologically unrelated isolates. Subserogroup G-1 strains of serogroup G was isolated from 28 of 36 patients (78%) of the hospital outbreak. The result suggested that the subserogroup G-1 strain was the major cause of infection in the hospital outbreak. A total of 46 of the 114 unrelated isolates (40.4%) and 9 of 50 outbreak isolates (18%) did not react with any of reference antisera and classified as nontypable. The western blotting was found to be useful not only as an epidemiological tool but as a typing system for C. difficile.


[Relationship between hand-washing activity of disinfectants and in vitro bactericidal activity in the presence of peptone].

A study was made on the relation between in vitro bactericidal activity against Staphylococcus epidermidis which is the main bacterial flora of skin and the disinfecting activity of hand-washing with povidone-iodine, sodium hydrochloride, chloramin-T, chlorhexidine gluconate and benzalkonium-chloride. Although the bactericidal activity of povidone-iodine and sodium hydrochloride was significantly high as compared with those of the other three disinfectants, both povidone-iodine and sodium hydrochloride showed no or a little hand-washing effects. In vitro the bactericidal activity of both povidone-iodine and sodium chloride were significantly retarded by the addition of peptone in the reaction mixture. On the other hand, chloramin-T, chlorhexidine gluconate and benzalkonium chloride showed a high disinfecting activity in hand washing in spite of low in vitro bactericidal activity. Moreover, the bactericidal activity of these three disinfectants were not suppressed by the addition of peptone in the reaction mixture. These results strongly suggested that hand washing effect of disinfectant is affected by the protein on the hand and that hand-washing activity of disinfectant should be determined by in vitro bactericidal activity in the presence of peptone.


[Enteroadherent Escherichia coli exhibiting localized pattern of adherence among infants with diarrhoea in Brazil--incidence and prevalence of serotypes].

The incidence of enteroadherent Escheridhia coli exhibiting localized adherence to HeLa cells was investigated using the EAF probe (Nataro et al., J. Infect. Dis., 152:560-563, 1985) among 126 infants below 3 years of age along with 126 age-matched healthy controls in Brazil. The EAF probe proved to be sensitive and specific in detection of enteroadherent E. coli. EAF-probe positive E. coli was isolated from 23.0% of the infants with acute diarrhoea while the corresponding rate of isolation from healthy controls was 11.9%. EAF-probe positive E. coli strains belonging to the classical enteropathogenic E. coli (EPEC) serogroups were more often associated with diarrheal cases (18.3%) than with strains isolated from control healthy infants (5.6%). The predominant EAF-probe positive E. coli serotypes were O55:H-, O111:H2 and O119:H6. These serotypes, especially O111:H2, were mainly isolated from cases with diarrhoea suggesting a strong causal association. Among the EAF positive non-EPEC serotypes, the most prevalent serotype was O88:H25 and this represents a, hitherto, unrecognized diarrheagenic E. coli serotype.


[Epidemiological study of Staphylococcus aureus isolated from the Japanese National University and Medical College Hospitals with coagulase typing, and production of enterotoxins and toxic shock syndrome toxin-1].

Coagulase typing, staphylococcus enterotoxins (SE) A to E or toxic shock syndrome toxin-1 (TSST = 1) production, and susceptibility to Oxacillin (MPIPC) were examined in 430 strains of S. aureus, which were isolated from clinical specimen of 43 Japanese National University or Medical College Hospitals during the one month period of August in 1990. Methicillin-resistant Staphylococcus aureus (MRSA): more than 4 mmg/ml of minimum inhibitory concentration for MPIPC in Mueller-Hinton broth containing 2% NaCl, occupied 58.6% of all the S. aureus, and more than 60% of the strains from admitted patients in all the areas of Japan except Hokkaidoh. Coagulase type II, SEC and TSST-1 producing strains were most frequently detected, 34.5% of all the MRSA. This kind of strain was distributed mainly in the eastern part of the Honshyu island, and showed high percentage especially in the Tohhoku and the Chyubu area. The second most frequent kind of MRSA was coagulase type II, no SE nor TSST-1 producing one, 15.4%, which was distributed mainly in the western part of Japan. Coagulase type IV, SEA producing MRSA strains and Coagulase type II, SEA, SEC and TSST-1 producing strains were detected in relatively high incidence, 10.3% and 8.7% respectively. Coagulase type III, no SE nor TSST-1 producing MRSAs demonstrated characteristic distribution, and were detected only in the western part of Japan, presenting the highest incidence in the Shikoku Island.


[Detection of mycobacteria by DNA amplification].

Polymerase Chain Reaction (PCR) was used to detect and to identify Mycobacterium species. In this study, 13 out of 14 Mycobacterium species were detected by using six pairs of oligonucleotide primers. The PCR product was detected by non-isotopic southern blot hybridization even when as little as 10 fg of purified M. tuberculosis DNA was used. And 8 mycobacterial species were identified by PCR-Restriction Fragment Length Polymorphism (RFLP) using two kinds of endonuclease.


[Mycoplasma pneumoniae respiratory tract infection prevailing among infants at a nursery school].

Mycoplasma pneumoniae (M. pneumoniae) infection in infants had been considered to be very rare, but recently some clinical cases have been reported. We experienced an epidemic of M. pneumoniae infection in a nursery school, and compared M. pneumoniae infection in infants with that in preschool and school children to investigate the features of infantile M. pneumoniae infection. We obtained the following clinical findings in 15 infantile patients with M. pneumoniae infection: The maximum body temperature scarcely increased to 38.5 degrees C or more and the period of high temperature and cough was shorter in infant patients than in preschool and school aged patients. Stridor occurred in 4 patients but skin disorder was not observed. In the laboratory findings, the white blood cell count tended to increase with no changes in neutrophil/lymphocyte ratio and CRP increased slightly. M. pneumoniae antibody was negative in all the patients except 3 and old hemagglutination tests were positive in only 4 patients. The chest X-ray examinations showed a mild increase in the hilar shadow. However, the sequentially located homogeneous shadow which is commonly seen in preschool and school aged patients was not detected. M. pneumoniae antibody scarcely increased in infantile patients but M. pneumoniae was isolated by throat culture from 14 of the 15 patients who were diagnosed as having M. pneumoniae infection.


[Changes in serotypes of clinical isolates of Pseudomonas aeruginosa by anti-pseudomonal drugs].

Forty-two isolates of P. aeruginosa from various infections were each incubated in Mueller-Hinton broth including piperacillin, cefsulodin, ceftazidime, imipenem, gentamicin or norfloxacin (1MIC-4MIC) at 35 degrees C for 18 hours, and serotyped using monoclonal antibodies. Serotypes of 4 (9.5%)-8 (19.0%) of the 42 isolates each changed to different groups after incubation. No relationship was found between serotypes of the formed variants and anti-pseudomonal drugs used. When P. aeruginosa TA-2 was exposed to cefsulodin at different concentrations (1MIC and 2MIC) under the above conditions, the distinct variants different in serotypes were formed according to the drug concentrations. Furthermore, P. aeruginosa TA-2 and TA-13 were incubated in Mueller-Hinton broth including cefsulodin (1/2 or 2MIC) and gentamicin (1/2MIC), respectively, and the growth curves of parent and variant cells were determined. In the experiments, the variants appeared 6 hours after onset of the incubation and grew with the parents. The present results may explain our findings previously reported; coexistence of colonies different in serotype of P. aeruginosa isolated from some individual patients. The results indicate the possibility that alteration in bacterial surfaces in association with changes in serotypes might occur in vivo in these patients infected with P. aeruginosa and treated with anti-pseudomonal drugs.


[Analysis of chest radiographs of culture positive Legionella pneumonia in Japan, 1980-1990. Working Party for Legionellosis, Japanese Ministry of Health and Welfare].

We analyzed the initial and follow-up chest radiographs of 28 patients with culture-positive Legionella pneumonia, and developed a scoring system to quantitate the severity of radiological findings for pneumonia. Intrapulmonary shadows were observed on the initial chest radiograph in 26 patients, but pleural effusion was noted in only one. In one patient the initial chest radiograph had probably been obtained too early to reveal any pulmonary change. Alveolar shadows were noted on the initial radiograph in 21 (81%) patients, and interstitial shadows in 5 (19%). In ten (38%) patients shadows were present in both lung fields. Shadows were prominent in the middle and lower lung fields. A cavity was noted in only one patient, and pleural effusion was also noted at some time during the clinical course in 19 (70%). A large amount of pleural effusion was observed in four patients. The average pneumonia severity score was 3.3 in the 9 patients who survived, and 5.1 in the 17 who died (p > 0.05). The mortality rate was 53% in the 17 patients with pneumonia severity score of 5 or less and 89% in the 9 patients with a score of 6 or more (p > 0.05). Twelve patients died within one week after the initial chest radiograph was obtained. There were no differences among patients with community-acquired infection with or without underlying disease and those with nosocomial infection in characteristic and extension of shadow, presence of pleural effusion, or pneumonia score. The chest radiograph of Legionella pneumonia include bilateral shadow findings characteristic, pleural effusion and rapid progression of shadow, and are clinically useful for diagnosis.


[A case of perinatal transmission of human immunodeficiency virus--diagnosis of HIV infection by culture and PCR].

A child born from a mother with HIV infection was reported. We have followed the patient from 3 month old of age. Her HIV antibody disappeared at 7 month by EIA, and at 10 month by WR. But we confirmed her HIV infection by PCR and HIV culture, repeatedly at those times, PCR and HIV culture are thought to be necessary for sero-negative infants born from mothers positive for HIV antibody.


[A case of chronic myelogenous leukemia with pulmonary aspergillosis diagnosed by the detection of circulating Aspergillus antigen].

Immunocompromised hosts usually develop invasive mycotic disease. Among many pathogenic fungi. Aspergillus spp, is the most common pathogen of respiratory infection. Early diagnosis of invasive type pulmonary aspergillosis is still difficult, and the treatment is usually difficult. Many investigations have recently suggested that detection of Aspergillus antigen from sera of the patients is useful for early diagnosis to save their lives. We have experienced a case diagnosed by the detection of circulating Aspergillus antigen by Pastorex Aspergillus, who was a 64-year-old female with the blastic crisis chronic myelogenous leukemia. After anti-leukemic chemotherapy, she suffered from pneumoniae with pleural effusions and severe hypoxia, which did not respond to antibiotics. At this point, her serum sample showed positive Aspergillus antigen by Pastorex Aspergillus. She was treated by intensive antifungal chemotherapy, and thereafter improved quickly. Titers of Pastorex Aspergillus were well correlated with her clinical course. The sensitivity of the test requires further improvement, but the specificity of the test is considered to be high enough for clinical use.


[Studies on risk factors influencing delayed resolution of pneumonia].

Among 61 patients admitted to our hospital because of bacterial pneumonia during the last six years, we investigated several risk factors influencing delayed resolution of pneumonia shadows, such as age, extent of the lesion, period of fever and sputum production after antibiotic therapy, WBC, CRP and PaO2 values on admission, the period of increased values of WBC and CRP, the presence or absence of etiological pathogens, the period from the appearance of symptoms to admission, and the period of drug therapy. In our series, the period from appearance of symptoms to admission (r = 0.62) and that of increased WBC (r = 0.35) significantly correlated with the period of pneumonia shadows to the time of their resolution. Similar results were obtained from the multiple variate analysis of various factors. These results suggest that the duration period (nontherapy period) of inflammation closely associated with leukocytosis plays a crucial role in the delayed resolution of pneumonia shadows.


[Kinetics of the complement subcomponent C1q production of peritoneal macrophages in NZB/W F1 female mice].

To clarify the role of local production (exohepatic) of complement on primary host defense mechanisms against microbial infections in the host who decreased the amount of complement in serum, the kinetics of the complement production by the complement-producing cells in exohepatic tissue was examined by measuring the amount of C1q, subcomponent of the first complement component, in cultured supernatant of the monolayer of peritoneal macrophages (PM phi) collected from 5, 15, 35, and 48 weeks-old female mice of NZB/W F1 (B/W F1). The C1q production of PM phi in B/W F1 mice showed remarkable decrease at 15 weeks-old. After that, however, the C1q producibility of PM phi recovered gradually and, at mice 48 weeks old, the complement produced finally exceeded the amount observed in mice 5 weeks-old, contrariwise the C1q values in serum were significantly lowering in the same aged mice. The increased production of C1q of PM phi was observed in both 35 and 48 weeks-old mice, of which the value corresponded with increase of anti-nuclear antibody titer in serum and of the amount of protein in urine. On female mice of ddY (control), the amount of C1q production of PM phi in 5 weeks-old mice was two-fold higher than that of 5 weeks-old B/WF1 mice. But at 15 weeks, the production showed a 1/2 decrease in that of mice 5 weeks-old and the decreased values were kept to 35 weeks-old.(ABSTRACT TRUNCATED AT 250 WORDS)


[Analysis of urinary tract infections in hospitalized elderly patients, with particular reference to the use of diapers].

We investigated the clinical and laboratory data of 215 hospitalized patients (mean age were 76.9 +/- 12.1) to analyze both the characteristics of senile UTI and the influence of the way of urination. UTI was present in 121 of 1897 patients (6.4%), 95 of whom (78.5%) were female. Comparison of the parameters between non-infected and infected patients were as follows: body temperature was 36.57 +/- 0.64 degrees C vs. 37.49 +/- 0.77 degree C; WBC, 5410 +/- 2040/microliters vs. 7260 +/- 3230/microliters; CRP, 1.2 +/- 2.4 mg/dl vs. 3.5 +/- 3.4 mg/dl; mean class of urinary RBC, 0-1/hpf vs. 3-5/hpf; and mean class of urinary WBC, 5-10/hpf vs. 30-50/hpf. All parameters were significantly elevated (p < 0.001) in the patients with UTI. The rate of detection of causative bacteria was 88.7%; with 14.8% Escherichia coli, 12.8% Providencia species, 9.6% Enterococci, and 8.7% Pseudomonas aeruginosa. Patients with UTI were divided into three groups according to their method of urination: normal urination, use of diapers and catheterization. Body temperature (> or = 37.5 degrees C) was 2.8%, 10.1% and 34.9%; WBC (> or = 9.000), 2.7%, 6.1%, and 14.3%; CRP, 16.9%, 36.1% and 51.1%; urine RBC (> or = 6-10/hpf), 8.4%, 7.1% and 36.1%; urine WBC (> or = 15-30/hpf), 20.4%, 44.4% and 76.9%, respectively. There was a significant difference (p < 0.05-0.001) between all parameters except for urine RBC between the normal-urination patients and diaper using patients. This investigation suggested that the use of diapers was a risk factor for UTI in elderly patients.


[Detection of Ureaplasma urealyticum by polymerase chain reaction].

A polymerase chain reaction (PCR) procedure for detection of Ureaplasma urealyticum was developed. A set of oligonucreotides based on sequences within the 16S ribosomal RNA gene from U. urealyticum were used as extension primers for the PCR. A DNA fragment of 397 bp was amplified by the PCR, when U. urealyticum DNA was template for the PCR. No amplified product was detected from other bacterial DNA including those of Mycoplasma genus. The amplified DNA fragment of 397 bp was detected on agarose gel electrophoresis, when DNA of > or = 10(2) cells of U. urealyticum per PCR was used as template for the PCR. Thus, the PCR procedure was shown to be a simple, rapid and specific method for detection of U. urealyticum and could be applied to detection of U. urealyticum from clinical specimens.