[Focal junctional tachycardia in adults. Anatomo-electrophysiological aspects apropos of a case].

The authors report the case of a 65 year old patient with focal junctional tachycardia complicating infectious myocarditis which had a fatal outcome. The ECG recordings showed episodes of tachycardia alternating with junctional rhythm at 90/min. There were signs of retrograde conduction. The anatomopathological findings were typical of acquired myocarditic lesions in the lower part of the atrioventricular node with congenital abnormalities, in particular a bifid node and His bundle with an accessory paraseptal atrioventricular bundle. This is the first description, to the best of the authors's knowledge, of junctional tachycardia associated with a latent pre-excitation.


[Right atrioventricular metastasis of myxoid liposarcoma. Prolonged course after repeated surgery and chemotherapy].

The authors report a case of cardiac metastasis of a myxoid liposarcoma of the thigh in a 54 year old woman. The treatment associated repeated surgical ablation and chemotherapy. The drugs used induced some cardiotoxicity which limited their prescription but nevertheless, the patient survived 5 years. Previous reported cases do not describe survival lasting more than 2 years and associated chemotherapy would therefore seem to be a valuable adjuvant, increasing the life expectancy of such patients.


[Coronary accelerated arteriosclerosis and vasospasm in the transplanted heart].

Accelerated atherosclerosis of cardiac grafts is one of the factors limiting long-term survival after cardiac transplantation. The authors report the case of a patient who had a cardiac arrest associated with severe atherosclerosis 18 months after transplantation. The severity of the coronary lesions was underestimated by coronary angiography. An ergometrine test induced coronary spasm, a phenomenon which has only rarely been observed in transplanted hearts. The patient died one month later despite calcium inhibitor therapy. Autopsy revealed very severe triple vessel disease. This case illustrates the possible rapid evolution of coronary artery disease in cardiac transplant recipients, the difficulty in evaluating the severity of the lesions by coronary angiography and the additional possibility of observing coronary spasm in these cases.


Single-dose toxicokinetics of aluminum in the rat.

The toxicokinetics of aluminum (Al) in male Wistar rats was studied after single intragastric (IG) doses of 1000 and 12,000 micrograms Al/kg and intravenous (IV) doses of 10, 100, 1000, and 12,000 micrograms Al/kg. Serial blood samples, daily samples of urine and feces as well as brain, liver, kidney, spleen, quadriceps muscle, and femur samples were collected. Al was measured by atomic absorption spectrometry. Al blood profiles after IV doses were adequately described by a two-compartment open model. Al toxicokinetics was dose dependent and appeared to plateau at 12,000 micrograms/kg. At IV doses between 10 and 1000 micrograms/kg the terminal half-life of elimination from whole blood (t1/2 beta) increased from 29.9 +/- 7.8 to 209.3 +/- 32.6 min, and the total body clearance (CL) decreased from 2.45 +/- 0.64 to 0.28 +/- 0.03 ml min-1 kg-1. Following an IV bolus of 10 and 100 micrograms/kg the administered Al was recovered completely from urine (94.4% +/- 9.9% and 98.5% +/- 3.2%). Twenty-nine days after the IV dose of 1000 micrograms/kg daily renal excretion decreased to baseline values while only 55.1% +/- 8.0% of the dose was excreted. Nineteen days after the single IV dose of 1000 micrograms/kg Al accumulated in liver (28.1 +/- 7.7 versus 1.7 +/- 0.5 micrograms/g of control rats) and spleen (72.5 +/- 21.1 versus < 0.4 microgram/g). After the single 1000 micrograms/kg IG dose no absorption of Al was detectable. The IG dose of 12,000 micrograms/kg resulted in a maximum blood Al level of 47.9 +/- 12.4 micrograms/l after 50 min.(ABSTRACT TRUNCATED AT 250 WORDS)


Influence of short-term aluminum exposure on demineralized bone matrix induced bone formation.

The effects of aluminum exposure on bone formation employing the demineralized bone matrix (DBM) induced bone development model were studied using 4-week-old Sprague-Dawley rats injected with a saline (control) or an aluminum chloride (experimental) solution. After 2 weeks of aluminum treatment, 20-mg portions of rat DBM were implanted subcutaneously on each side in the thoracic region of the control and experimental rats. Animals were killed 7, 12, or 21 days after implantation of the DBM and the developing plaques removed. No morphological, histochemical, or biochemical differences were apparent between plaques from day 7 control and experimental rats. Plaques from day 12 control and experimental rats exhibited cartilage formation and alkaline phosphatase activity localized in osteochondrogenic cells, chondrocytes, osteoblasts, and extracellular matrix. Unlike the plaques from control rats that contained many osteoblastic mineralizing fronts, the plaques from the 12-day experimental group had a preponderance of cartilaginous tissue, no evidence of mineralization, increased levels of alkaline phosphatase activity, and a reduced calcium content. Plaques developing for 21 days in control animals demonstrated extensive new bone formation and bone marrow development, while those in the experimental rats demonstrated unmineralized osteoid-like matrix with poorly developed bone marrow. Alkaline phosphatase activity of the plaques continued to remain high on day 21 for the control and experimental groups. Calcium levels were significantly reduced in the experimental group. These biochemical changes correlated with histochemical reductions in bone calcification.(ABSTRACT TRUNCATED AT 250 WORDS)


N-benzyl-N-lactyl dithiocarbamate treatment of mice after chronic cadmium administration.

Administration of N-benzyl-N-lactyl dithiocarbamate (BLDTC) to mice after chronic cadmium (Cd) administration evoked a prompt, dose-dependent reduction of the whole body burden; 75% of the retained Cd was mobilized and excreted after 20 i.p. injections of BLDTC at 1.0 mmol/kg/injection. This same dose regimen produced 71% and 98% reductions of the renal and hepatic Cd concentrations, respectively. There was no reduction by BLDTC of the endogenous level of any of seven other metals measured: iron, magnesium, selenium, copper, calcium, zinc, and manganese. Renal proximal tubular damage in mice which received Cd followed by BLDTC was much less than that observed in kidneys from mice which received Cd alone. Chronic Cd administration led to substantial epithelial vacuolar damage to renal distal tubules, and this process was not apparently reversed or antagonized by BLDTC treatment to the extent observed in proximal tubules.


Ongoing hepatocellular regeneration and resiliency toward galactosamine hepatotoxicity.

In previous studies, we reported that the age-dependent hepatotoxicity of galactosamine (GalN) was evident in hepatocytes maintained in primary cultures. Cellular proliferation and tissue repair are not manifested in response to injury in this in vitro system. Neonatal (5-day) rats have ongoing hepatocellular proliferation in contrast to adult (5-month) rats, and should be therefore resilient to GalN toxicity. Liver injury was assessed by serum transaminases (ALT, AST), 3H-thymidine (3H-T) incorporation into nuclear DNA, and content of hepatocellular nuclear DNA. While the dose of 400 mg/kg did not cause any significant liver injury in the neonates, it did produce significant liver injury in adult rats. At a dose of 800 mg/kg, GalN produced significant injury in the neonates. Because 400 mg/kg causes clearly demonstrable liver injury in the adult and no injury in the neonates, this dose was used for further studies. In addition to the above measures of injury, uracil nucleotides (UTP, UDP, and UMP), glycogen, histopathology, and autoradiographic examination of liver sections were used to assess the liver injury in neonatal and adult rats. In a time-course study, all of the above were measured at 0, 12, 24, 36, 48 and 72 h after GalN administration. Serum enzyme elevations as well as the appearance of necrotic and swollen hepatocytes were maximal at 24 h in the adults rats. In contrast to these observations in the adult rats, none of these measurements indicated significant liver injury in the neonates. 3H-T incorporation into nuclear DNA was much higher in the neonatal liver in comparison to the adults reflecting the difference in regeneration. Hepatocellular nuclear DNA was also higher in the neonate and was significantly decreased due to GalN treatment. In the adult rats, the quiescent normal level of 3H-T incorporation and nuclear DNA content were further decreased at 12 h, increased at 48 h and returned to normal low, quiescent levels at 72 h. In the neonates mitotic activity of hepatocytes was higher than in the adult rats. In the adult rats, mitotic activity was increased at 48 h after GalN administration and returned to normal at 72 h. In the neonates GalN did not alter the mitotic activity significantly. These findings demonstrate that in the presence of hepatocellular regeneration, galactosamine toxicity is minimal while in the absence of it, clear toxicity is manifested. In conclusion, while perturbation in uracil nucleotides and related biochemical events may explain the infliction of liver injury by GalN in an age-dependent fashion, the extent of tissue repair impacts decisively on the final outcome of injury.


Cell death and lipid peroxidation in isolated hepatocytes incubated in the presence of hydrogen peroxide and iron salts.

The incubation of isolated hepatocytes in the presence of glucose plus glucose oxidase, a H2O2-generating system, resulted in extensive loss of cell viability, as expressed by the release of lactate dehydrogenase (LDH). Disturbance of metabolic functions such as glycogen and protein synthesis was also caused by H2O2, but in no case was malondialdehyde (MDA)-like products detected. The lytic effect of H2O2 was significantly enhanced by incubating hepatocytes in the presence of iron salts. Under these conditions, MDA-like products were detected, but lipid peroxidation and cell injury did not correlate. Iron chelators modulated the cytotoxicity of H2O2 in different (and opposite) ways: when iron was complexed with ADP, increased cell lysis was observed compared to uncomplexed iron plus H2O2. Iron-DTPA, on the contrary, decreased such a lytic effect. The preincubation of hepatocytes with desferrioxamine mesylate (Desferal; a strong iron chelator) abolished the cytolytic effects produced by the association of iron salts and H2O2, as well as the membrane oxidative injury due to H2O2 alone, thus suggesting the existence of an intracellular source of iron. This kind of mechanism (metal chelation rather than radical scavenging) is supported by the absence of any protective effect by some free radical scavengers against the oxidative injury induced by the association iron H2O2. Nevertheless, the glycogenolytic effects observed in the presence of H2O2 were not modified by Desferal. In our opinion, the cytotoxicity of the association H2O2 plus iron salts involves at least two different and independent mechanisms.


Acute and subacute inhalation toxicity of silane 1000 ppm in mice.

Male ICR mice were exposed to silane 1000 ppm, a concentration 200 or 2000 times higher than the recommended occupational exposure limits by many countries and academic associations, for 1, 2, 4, and 8 h (phase I study) and for 6 h/day, 5 days/week, over 2 and 4 weeks (phase II study). Hematological and biochemical studies were performed, and the animals were examined for histopathological lesions of the cornea, nasal cavity, respiratory tract, lung, liver, kidney, spleen, pancreas, thymus, thyroid, bone marrow, salivary glands, esophagus, and testis. All mice in both studies survived until they were sacrificed. In the phase I study, no exposure-related changes were found as a result of the hematological, biochemical, or histopathological examinations. In the phase II study, hematological and biochemical examinations failed to reveal any exposure-related changes, but mild irritation, manifested in the form of a small amount of exudate (eight out of ten animals), and inflammatory cells and/or necrotic cells on the nasal mucosa (six out of ten animals) was observed in the mice exposed to silane for 4 weeks. These findings suggest that silane toxicity and irritation are not severe.


[Elevated production of GM-CSF by peripheral blood mononuclear cells stimulated with mite antigens in children with bronchial asthma].

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a cytokine which can stimulate the proliferation and functions of eosinophils and neutrophils. We have studied whether peripheral blood mononuclear cells (PBMC), obtained from children with stable asthma, can produce GM-CSF through stimulation with crude Dermatophagoides farinae (Df) antigen in vitro. The patients had strongly positive RAST results for house dust mite Df. Levels of GM-CSF in PBMC culture supernatant were assayed by an enzyme immunoassay. When stimulated with Df antigen, patient's PBMC released significantly increased levels of GM-CSF compared with unstimulated ones. PBMC of non-allergic controls, however, did not. The addition of polymyxin B, an inactivator of endotoxin, did not suppress the Df-antigen-induced production of GM-CSF. Levels of GM-CSF produced by PBMC stimulated with Df antigens were significantly higher in the patients than in the controls. These results indicate that PBMC of children with Df-allergic asthma, unlike those of non-allergic children, can produce elevated levels of GM-CSF by stimulation with Df antigens.


[Increased granulocyte/macrophage colony stimulating factor production by mononuclear cells from patients with bronchial asthma].

The in vitro production of granulocyte/macrophage colony stimulating factor (GM-CSF) by mononuclear cells from the peripheral blood of patients with bronchial asthma (BA) was examined by enzyme-linked immunosorbent assay (ELISA). In 3 of 12 cases studied, mononuclear cells from BA patients produced GM-CSF without stimulation. And in 5 of 12 cases studied, mononuclear cells from BA patients produced GM-CSF in response to IL-2. Mononuclear cells from patients with other diseases (n = 13) and healthy volunteers (n = 6) did not release any detectable (> or = 7.5 pg/ml) GM-CSF. The culture media of mononuclear cells from BA patients showed activities for stimulating the proliferation and survival of eosinophils, and these activities were partially inhibited by anti-GM-CSF antibodies. GM-CSF production by mononuclear cells from BA patients treated with prednisolone was lower than that of mononuclear cells from untreated BA patients. And prednisolone showed a reduction in the GM-CSF production from mononuclear cells in response to IL-2. These results suggest that GM-CSF production by mononuclear cells may play a role in the pathogenesis of BA.


[Serum eosinophil cationic protein (ECP) and major basic protein (MBP) levels in patients prepared for asthma attack].

Serum ECP levels, serum MBP levels and blood eosinophil counts (Eo) were studied in patients prepared for asthma attack. Five severely asthmatic children were studied. Samples were taken just before their 33 times of home stay loading test. Serum ECP levels were significantly higher in the patients who suffered asthma attacks during their home-stay period than in those who did not. In addition, serum ECP levels were higher in the patients whose asthma attack started less than 12 hours after they returned home. However, there was no significant correlation either in serum MBP levels or peripheral eosinophil counts between these groups. These findings suggested that serum ECP levels increased in patients prepared for asthma attack.


[Clinical manifestation and prognosis of respiratory syncytial virus infection in infants].

To evaluate the clinical features of respiratory syncytial virus (RSV) infection and relation with bronchial asthma, 233 infants hospitalized for lower respiratory tract infection during winters from 1988 to 1990 were enrolled in this study. RSV antigen was detected from half of them by immunofluorescent antibody test. Children with RSV infection showed the characteristic findings as follows; wheeze (71.6%), elevated serum 2-5 AS activity, a marker for viral infection, low level of acute phase reactants. Patients whose family members with major allergy experienced more frequent episodes of wheeze. Since the initial RSV infection could cause wheeze among infants from atopic families and recurrent wheezy infants could be recognized as in the pre-stage of infantile asthma, we should follow these infants with RSV infection closely.


[A new steroid therapy for difficult asthmatics--an induction and maintenance, two-step therapy].

Beclomethasone dipropionate (BDP) administered by inhaler is a very useful drug for the treatment of bronchial asthma. In this therapy, it is very important to use steroids systematically to induce a complete remission of asthma attack (first step) and then begin to use BDP a dose of more than 800 micrograms to maintain remission (second step). We treated 27 difficult asthmatics with this therapy and found this new method very useful. The characteristics of asthmatics were as follows. 1) The age ranged from 37 to 82, and the mean age (+/- S.E.) was 58.9 (+/- 2.6) years old. 2) The onset age ranged from 27 to 74 with a mean age (+/- S.E.) of 46.9 (+/- 2.6) year old. 3) The number of non-atopy was 22 cases. 4) The follow-up duration ranged from 5 to 45 months with a mean (+/- S.E.) of 15 (+/- 2.0) months. The results were as follows. 1) The complete remission rate was 48%, partial remission 37% and unchanged 15%. 2) There was a significant increase only in %VC. 3) The peripheral eosinophil count was decreased significantly. 4) The log value of PC20 concentration by acetylcholine increased significantly by a factor of 2.94 to 3.28. 5) After this therapy, the mean serum cortisol level at 9:00 a.m. was 10.1 (+/- 3.8, S.E.) micrograms/ml. There were only 2 cases whose cortisol level were under the normal. 6) There were many oral side effects, namely stomatitis with 5 cases and hoarseness with 8.


[Clinical significance of IgG4 antibody determination in children against egg white, milk, soybean and Dermatophagoides farinae].

The measurement of IgE and IgG4 antibodies against egg white, milk, soybean and Dermatophagoides farinae was performed by FAST (fluorescence allergosorbent test) using 21 serum samples obtained from non-allergic children and 160 serum samples from atopic children with bronchial asthma and/or atopic dermatitis. Their antibody levels were evaluated for any association with disease severity and for clinical significance in establishing diagnosis. It was found that children with bronchial asthma showed lower levels of IgE antibodies against egg white, milk and soybean and higher levels of IgE antibodies against Dermatophagoides farinae compared with those of children with atopic dermatitis, while both groups showed higher levels of egg white and milk-specific IgG4 antibodies compared with non-allergic children. These IgE and IgG4 antibody levels revealed a tendency to correlate with disease severity in patients with atopic dermatitis, while this was not observed in patients with bronchial asthma. The contribution percentages of IgG4 antibody determination, together with IgE antibody determination, in retrieving causal allergens were 71% for egg white, 70% for milk and 48% for soybean allergy, implying their diagnostic value in establishing clinical diagnosis.


[Protein phosphorylations in granulocyte/macrophage colony-stimulating factor-stimulated human peripheral blood eosinophils].

Peripheral blood eosinophils from normal healthy subjects were isolated on a Percoll gradient and were incubated with [32P] orthophosphoric acid. 32P-labeled eosinophils were washed and stimulated with GM-CSF under different conditions. After reaction was stopped, SDS/PAG electrophoresis was performed along with autoradiographs to determine the incorporation of 32P into proteins. GM-CSF-stimulated eosinophils produced an increase of 32P incorporation into the bands in the 31 kDa and 35 kDa areas after 30 sec and 1 min of stimulation. The increase of 32P incorporation was dependent on Mg2+ concentration and temperature, suggesting that proteins in the eosinophils with apparent molecular weights of 31 kDa and 35 kDa can be phosphorylated with the stimulation of GM-CSF.


[The signal transduction of serotonin secretion involves protein tyrosine phosphorylation in rat basophilic leukemia cells].

We investigated the signal transduction of serotonin secretion by stimulation with DNP-Ascaris antigen or ionomycin in rat basophilic leukemia cells (RBL-2H3). The modes of action of antigen and ionomycin for serotonin secretion were shown to be similar. The treatment of cells with antigen resulted in increased tyrosine phosphorylation of 105 and 72 KDa proteins, in particular, the tyrosine phosphorylation of 72 KDa protein seemed to correlate with serotonin secretion. Furthermore, we observed that antigen stimulation caused a marked increase in inositol polyphosphates production, which derived from the tyrosine phosphorylation of phospholipase C-gamma in RBL-2H3 cells. On the other hand, treatment with ionomycin also resulted in an increase in tyrosine phosphorylation of 72 KDa protein, but did not induce inositol polyphosphates production. These results suggested that the activation of tyrosine kinase may be related to serotonin secretion, and that intracellular Ca2+ increase may also play an important role in this activation.


[Studies on IFN-gamma production by peripheral blood mononuclear cells cultured with Candida antigen in asthmatics].

T-cell-derived lymphokine, IFN-gamma, has potent effects on B-cell differentiation and leukotriene C4 production in leukocytes, and inhibits the effect of IL-4 on IgE production. To investigate the role of IFN-gamma in the pathogenesis of bronchial asthma, we examined IFN-gamma production by peripheral blood mononuclear cells cultured with Candida antigen and serum Candida specific IgG1 antibody from 20 asthmatics. The results were as follows: 1) IFN-gamma production in non-atopic severe asthmatics was significantly higher than in healthy subjects, atopic mild and moderate asthmatics, and atopic severe asthmatics (p < 0.05). 2) There was a significant correlation between IFN-gamma production induced by Candida antigen and serum Candida specific IgG1 antibody (r = 0.72, p < 0.01). These results suggest that IFN-gamma may play an important role in the pathogenesis of non-atopic severe bronchial asthma.


[Allergy among Japanese patients with chronic fatigue syndrome].

Allergy is a common feature of patients with chronic fatigue syndrome (CFS). Because of this strong association, we attempted to explore the prevalence of allergies among Japanese patients with CFS. Of the present 18 patients, 78% had allergies during their premorbid and/or postmorbid conditions. Their allergies were mainly cutaneous reactions including drug allergies and 43% of the patients had 2 or more allergic reactions. In the case of a premorbid condition, allergies improved spontaneously after onset of CFS. Clinical manifestations of CFS, however, became worse during the period of an association with allergies. Immunologic tests, including peripheral blood lymphocyte-subsets, blastogenesis, natural killer-cell functions and cytokine-assays, were not any correlation between both patients with and without allergies.


The right to procreate: intellectual disability and the law.

The common law recognizes the right of every woman to bear a child and will not contravene that right unless there are compelling reasons for doing so. The issue of the right of intellectually disabled girls, below the age of 18 years, to ultimately bear a child has now been removed to the courts. Following a recent High Court decision, surgery resulting in the sterilisation of intellectually disabled minors cannot be performed without the sanction of the Family Court. Intellectually disabled women differ in that they are legally adults once they reach the age of majority with presumed full adult rights to consent to medical treatment. Other legal mechanisms are require when they lack this capacity. This article discusses the High Court case and others that have been heard in Australia recently.


What effect will the Nurses Act 1991 have on maternity care?

The NSW Nurses' Act 1991 has far-reaching implications for midwifery and for childbearing families. There are several issues that cause concern. The primary issue is the potential employment of non-midwives in maternity care. This would be dangerous to the women being cared for because of the specialised knowledge required to practice midwifery. In some ways the act undermines the independence of midwifery from nursing and the value of midwifery care. Implementation of the act may also cause some role conflict in maternity units.


The Royal Women's Hospital Family Birth Centre: the first 10 years reviewed.

In reviewing the first 10 years experience of the Royal Women's Hospital Family Birth Centre (FBC), we examined the outcomes of pregnancy and labour in a group of women who requested alternative birthing care and who were identified antenatally as being a 'low-risk' population. This study is a retrospective analysis of 5,365 women booked with the birth centre between 1980 and 1989. Over 16% of women developed antenatal complications precluding further care there, while a further 16% developed complications in labour requiring transfer out to conventional labour wards. Thus 67% of those originally booked delivered in the FBC. The instrumental delivery rate was 11%, and the Caesarean section rate was 4%. Of the women who delivered in the FBC, 3.1% had a postpartum haemorrhage and 1.8% required manual removal of placenta. Approximately 4% of babies born in the FBC required some resuscitation, and 0.8% needed admission to the neonatal nursery. Two perinatal deaths occurred in women admitted in labour to the FBC with a live baby, whilst 2 other women presented in labour with a fetal death in utero (perinatal mortality 0.89 per 1,000).


Organization and early results of a shared antenatal care programme.

The organization and function of a public hospital based shared antenatal care programme is described. The programme has proved to be popular with pregnant women and local practitioners and currently 24% of public antenatal patients attending the hospital are cared for in this way. The study presents the results of management of 1,000 consecutive low risk patients whose antenatal care was shared between hospital doctors at the Royal Women's Hospital, Melbourne and local practitioners. Two hundred and twenty patients did not complete the programme because of social factors, medical diseases or pregnancy complications. The 780 patients who did complete the programme had a lower Caesarean section rate than the overall hospital population (8.3% compared with 18.5%) and a lower perinatal mortality rate (6.4 compared with 20.5 per 1,000 births). It is essential that patients are carefully assessed at their hospital booking visit before embarking on such a programme. Equally, careful assessment by local practitioners is important as abnormalities such as essential hypertension may be overlooked at the initial hospital assessment or may arise between the hospital visits.


Shared obstetric care: the general practitioner's perspective.

Shared obstetric care between hospital and general practitioner (GP) is being developed in several States in Australia as an alternative model of care for pregnant women in the public hospital system. The aim of this study was to determine the attitudes of participating GPs to the shared obstetric care programme at the Royal Women's Hospital, Melbourne. Fifty GPs were randomly selected, and face to face individual interviews were conducted using qualitative methods. GPs feel that the continuity of care they can provide during pregnancy and the postpartum is a very important and valuable aspect of their role as shared care providers. They are generally satisfied with the programme at the Royal Women's Hospital but some suggest that communication between the hospital and the GP should be improved. There was significant interest in being involved in deliveries in shared care programmes in the future and GPs question the appropriateness of the diploma of obstetrics as the only acceptable qualification for shared care.


The demographic characteristics of early and late attenders for antenatal care.

In the Royal New Zealand Plunket Society's 1990-91 Cohort study, 581 of 4,286 women questioned (13.7%) had not initiated antenatal care until after the first trimester. These late attenders were more likely to be non-European or of high parity; 42.9% of Pacific Islander mothers and 28.9% of Maori mothers did not initiate antenatal care until after the first trimester. Late attenders were also more likely to be unmarried, of lower socioeconomic status, young or with lower educational attainment. The reason for delayed antenatal care needs to be investigated and mothers who are high parity and non-European need to be particularly targeted to encourage them to attend for antenatal care early.


Perinatal mortality in a tertiary obstetric institution.

At the Royal Women's Hospital, Melbourne in the 3 years 1987-1989 analysis of the records of 13,347 public patients revealed an overall perinatal wastage of 20.8 per 1,000 births. This seemingly high figure resulted from the fact that 45% of losses occurred in nonbooked and emergency admissions. Many patients were referred with major complications of pregnancy, especially gross prematurity, lethal congenital malformations and intrauterine deaths. During the 3-year period 74% of perinatal losses occurred before 33 weeks' gestation and only 10% were after 37 weeks. By comparison at a Victorian State level, 47% of perinatal deaths occurred before 33 weeks and more than 35% after 37 weeks' gestation. The major causes of perinatal wastage in both groups were similar. At the Royal Women's Hospital in the 3-year period lethal congenital abnormalities accounted for 19.1% of fetal wastage, premature labour, premature rupture of the membranes and cervical incompetence 16.2%, multiple pregnancy 14.7%, antepartum haemorrhage 14.0% and hypertensive disorders 9.7%. During the 3-year period 7.7% of hospital stillbirths were intrapartum compared to 27% for the State of Victoria. The stillbirth rate in Victoria has declined over the past decade, but to a lesser extent than the neonatal death rate. Over the 3-year period 1987-1989 the ratio of stillbirths to neonatal deaths was 3 to 2, and in 1989 there were nearly twice as many stillbirths as neonatal deaths (424 versus 240). Furthermore, 55% of stillborn infants in Victoria had birth-weights of more than 1,500 g compared to the Royal Women's Hospital figure of 36%.(ABSTRACT TRUNCATED AT 250 WORDS)


The timing of delivery in diabetic pregnancy: a 10-year review.

The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.


Excessive birth weight and maternal glucose tolerance--a 19-year review.

The incidence of birth-weight of 4,540 g (10 lb) or more rose from 0.87% in the years 1971 to 1977 to 1.16% in the 12 years from 1978 to 1989 with a concomitant increase in hyperglycaemia in our antenatal population. The relationship between excessive birth-weight and maternal glucose tolerance was investigated in the light of these observations. The results from glucose tolerance tests performed routinely during the pregnancies of 510 women who delivered infants with a birth-weight of 4,540 g or more were compared with those from a control series of 5,003 women with consecutively tested pregnancies. Glucose tolerance in subsequent pregnancies was also compared with the control series, and in 1991 the study group women were investigated for emergence of permanent diabetes mellitus. Excessive birth-weight was associated with maternal hyperglycaemia (p < 0.05) but not with gestational diabetes; 79% of infants with birth-weight > or = 4,540 g were born to mothers who were not hyperglycaemic. There was no increase in glucose intolerance in subsequent pregnancies in the study group and only 2 of 49 women with follow-up testing had diabetes mellitus. Birth-weight > or = 4,540 g occurred in 1.1% of the total population and 1.1% of women with gestational diabetes, and was related to maternal hyperglycaemia in about 1 in 5 cases. The increased incidence of excessive birth-weight infants was not related to the increased incidence of gestational diabetes in our pregnant population. Birth-weight > or = 4,540 g had a poor association with later development of diabetes.


Gestational diabetes in twin pregnancy: prevalence and long-term implications.

During the period 1971-1991 at the Mercy Hospital for Women, gestational diabetes (GDM) was diagnosed in 3,447 of 61,914 tested singleton pregnancies (5.6%) and 59 of 798 tested twin pregnancies (7.4%, p = 0.025). A difference was apparent in the period 1971-1980, when the prevalences of GDM in singleton and twin pregnancies were 3.0% and 5.6% respectively (p = 0.012), but not in the period 1981-1991 when the corresponding prevalences were 7.4% and 8.4% (p = 0.36). Of the 59 patients in whom a diagnosis of GDM in a twin pregnancy was made, 27 attended the follow-up programme. These patients were matched to a control group of 27 patients who had GDM in a singleton pregnancy with similar characteristics for known risk factors for the development of permanent diabetes mellitus. On WHO criteria diabetes mellitus occurred in 5 (18.5%) of the subjects and 2 (7.4%) of the controls (p = 0.21). The difference in prevalence of GDM in twin and singleton pregnancies is less now that the overall prevalence of the disease has more than doubled (1971-1980 versus 1981-1991). Although the increased rate of permanent diabetes mellitus after twin pregnancy is not statistically significant, it would seem wise to make a special effort to enroll these women in the follow-up programme.


Antiphospholipid antibodies in pregnancy.

We assessed the relationship between antiphospholipid antibodies and recurrent miscarriage, fetal deaths, and the pregnancy complications--placental abruption, fetal growth retardation and preeclampsia. The subjects were 81 women with a history of 3 or more miscarriages, 62 with a history of fetal death in the index pregnancy, 105 with a poor obstetric history or pregnancy complications and 13 with systemic lupus erythematosus. Antiphospholipid antibodies were found in 41% of women with a history of recurrent miscarriages, 29% with a history of recent intermediate fetal death or stillbirth, 19% with a poor obstetric history and 69% with systemic lupus erythematosus. There is a high incidence of antiphospholipid antibodies in complicated pregnancies. Patients presenting with the above pregnancy disorders should be tested for antiphospholipid antibodies because of the risk conferred on a fetus by their presence and to expand the treatment options.


Neonatal herpes simplex: Royal Women's Hospital 10-year experience with management guidelines for herpes in pregnancy.

In the 10-year period 1982-1991 inclusive, 6 cases of neonatal herpes simplex were diagnosed at the Royal Women's Hospital, Melbourne (1 disseminated, 1 pneumonitis, 4 cutaneous [1 with central nervous system involvement]), resulting in an incidence of 1 in 11,000 livebirths for this population. Three cases were due to HSV 1 and 3 to HSV 2. In no case did the mother have a recent or past history of overt genital herpes infection. Two cases were acquired in utero, an uncommonly recognized form of infection. A favourable long-term outcome occurred in 2 of 4 cases in which diagnosis was prompt and antiviral therapy was instituted rapidly. Routine antenatal screening in the last trimester of pregnant women with a history of genital herpes before pregnancy is not advised, because the results have been shown to be unreliable in predicting viral shedding and hence the infants' risk of exposure to virus at delivery. A protocol for management of herpes in pregnancy is included.


Antihypertensive drug effects on placental flow velocity waveforms in pregnant women with severe hypertension.

Doppler studies of the uterine and umbilical arteries were performed in 24 acutely hypertensive pregnant women. Women were divided into 2 groups: Group 1 (diastolic blood pressure (DBP) > 110 mm Hg) received placebo (n = 6) or 10 mg oral nifedipine (n = 9); Group 2 (DBP > or = 110 mm Hg) received 10 mg oral nifedipine (n = 5) or 10 mg intravenous hydralazine (n = 4). Treatment allocations were random within groups and the investigator and patient were blind to the treatments. Baseline flow velocity waveforms (FVW) and posttreatment FVW's at 30, 60 and 120 minutes were recorded. There was no significant difference between baseline and posttreatment FVW indices within or between groups. Placebo was as effective as nifedipine in lowering blood pressure over 2 hours of study. There were no significant adverse effects of treatment.


Expected gain in body mass and onset of the menarche.

Fertility is dependent on sexual maturity, which is associated with a number of factors, including body mass. In this study the Body Mass Index (BMI) was used to estimate body fat in a large sample of 13-year-old New Zealand girls. Nearly half of the subjects (46%) had experienced the menarche. Expected gain in body mass was calculated from growth rates at earlier ages and used to examine whether deviation from the expected gain was associated with the onset of the menarche. In general, the results show an association between the menarche and gain in body mass. However, many girls who failed to achieve their expected gain had experienced the menarche (18%), indicating that the relationship between body weight and the menarche may not be causal or is mediated by other factors.


Risk factors and a risk scoring system for the prediction of malignancy in ovarian cysts.

A retrospective study was carried out on 396 patients who presented with ovarian masses. Sixty five (16%) patients were found to have ovarian malignancy while the rest either had benign ovarian tumours (n = 159), endometriotic cysts (n = 130), physiological cysts (n = 20) or inflammatory masses (n = 7). The relative risk for ovarian malignancy among these patients increased significantly (p < 0.001) after the age of 40 years. The presence of ascites, abdominal distension, urinary complaints and loss of appetite and weight were significant individual risk factors for malignancy. Ultrasound image of a complex cyst is also associated with increased risk of malignancy in an ovarian mass. None of the individual risk factors was discriminatory between a benign and malignant cyst. However, these factors can be combined to form a 20-point risk scoring system. The risk of malignancy in an ovarian cyst increased with increasing scores. In this study, the median scores were 3 for benign cyst, 7 for borderline malignancy and 12 for malignant cysts. Using a total score of 7 as a cut off point, one can detect 75% of malignant cysts with a specificity of 84.1%, a positive predictive value of 47.5% and a negative predictive value of 94.6%. It is concluded that the majority of malignant ovarian cysts can be identified preoperatively to allow arrangement and planning of an optimal surgery.


Danazol in the treatment of menorrhagia: the effect of a 1 month induction dose (200 mg) and 2 month's maintenance therapy (200 mg, 100 mg, 50 mg or placebo).

This paper highlights the difficulties of recruiting subjects to objective menstrual blood loss (MBL) studies. Such difficulties may explain the relative paucity of such studies in the literature. Eleven women with objectively assessed evidence of menorrhagia were treated for 1 month with an induction dose of 200 mg of danazol (Danocrine). Subsequently the women were randomly assigned to receive 50, 100 or 200 mg of danazol or placebo for 2 months of maintenance dosing. Follow-up with objective assessment of MBL was continued for 3 months after cessation of maintenance dosing. Danazol 200 mg as an induction dose significantly reduced MBL. The maintenance dose of 200 mg during the following 2 months produced a further decrease in MBL and in some cases amenorrhoea. The lower maintenance dosages of 50 mg and 100 mg were associated with a variable response. The study was unable to determine whether any beneficial effect of the maintenance dosages of danazol could be maintained following cessation of therapy since the study numbers had become too small. It appears, however, that there is unlikely to be any persisting benefit once therapy has ceased.


Stress management and infertility.

The author through personal experience has gained knowledge in the area of infertility and stress management. Her professional background supports the experiences, emotions and management techniques encountered with sound theoretical knowledge. This article deals with some of the procedures confronting a couple who experience infertility problems. It aims to explain and qualify common emotional responses experienced by couples and offers stress management strategies to improve their coping ability.


Uterine perforation associated with endometrial ablation.

Three cases of uterine perforation associated with endometrial ablation are presented. Possible predisposing factors in 2 cases were previous Caesarean section and difficulty in cervical dilatation. Adequate training for gynaecologists in hysteroscopy is essential before undertaking any type of operative hysteroscopy.


Laparoscopic adnexectomy--indications, technique and results.

Laparoscopic adnexectomy was performed successfully in 38 patients in whom the procedure was attempted. Failure may result from inexperience of the surgeon or when preliminary dissection near bowel suggests trauma is likely. The duration of the operation was between 15 and 105 minutes, blood loss was minimal and all but 2 patients were discharged within 24 hours of surgery. Pain was relieved in 33 of 35 patients in whom this was the dominant symptom. In 1 patient a small ovarian remnant implanted on the bladder was removed at subsequent laparoscopy. Preliminary experience of this procedure suggest it may be preferable to laparotomy because of the reduced risk of wound complications, pain, time in hospital and duration of convalescence.


Laparoscopic salpingostomy with electrocautery in the management of tubal pregnancy.

From August, 1990 to May, 1991, all cases of tubal pregnancy presenting to King George V Hospital for Mothers and Infants were considered for laparoscopic salpingostomy. This procedure involved opening the affected Fallopian tube with diathermy, removal of ectopic tissue via the laparoscope, achieving haemostasis and leaving the tubal incision to heal by secondary intention. The procedure was undertaken in 35 patients and was successfully performed in 31 patients with an average operating time of 66.4 minutes (+/- 20.1 minutes). Average hospital stay was 2.1 days (+/- 1.3). This paper examines the technique and results of the initial learning curve for laparoscopic salpingostomy and finds that with knowledge of potential hazards and care in surgery, this operation can be safely carried out in a selected group of patients.


Ultrasound diagnosis and laparoscopic excision of an interstitial ectopic pregnancy.

Interstitial tubal pregnancy occurs in about 5% of ectopic tubal pregnancies and is associated with an increased risk of severe haemorrhage (1). Diagnosis prior to rupture of the pregnancy into the peritoneal cavity is very important to avoid haemorrhage. Its presence has been considered to be a contraindication to laparoscopic surgery (2), although most ectopic pregnancies can be managed laparoscopically by an experienced endoscopist. We report the diagnosis of an interstitial pregnancy by ultrasound before rupture and treatment by laparoscopic excision of the pregnancy.


Outpatient hysteroscopy: a comparison of 2 methods of local analgesia.

A prospective, randomized study was undertaken to objectively compare pain tolerance of 2 methods of local analgesia for outpatient hysteroscopy. Patients in group 1 received a paracervical block using 20 ml of 1% lignocaine. Patients in group 2 received a uterosacral block using 2 ml of 2% lignocaine. There was no statistical difference between the 2 groups (p = < 0.65) in efficacy of pain relief. The method used for patients in group 2 reduces time and costs for outpatient hysteroscopy.


Placenta praevia percreta invading the urinary bladder.

A case of placenta praevia percreta involving the urinary bladder is presented. A classical Caesarean section was performed at 35 weeks' gestation but the placenta was left in situ and an elective hysterectomy was successfully performed 2 weeks postpartum.


Delayed fetal death following electrical injury in the first trimester.

A case of possible delayed fetal death following electrical shock in the first trimester is reported. Evidence from the literature of delayed effects of electrical injury later in pregnancy is presented, suggesting that delayed as well as immediate detrimental effects in the first trimester should not be discounted. Perhaps the spectrum of effects of electrical shock on the fetus could be investigated in animal experiments to elucidate the pathogenesis of such injury to the fetus. Electric fences are a possible hazard to pregnant women in rural areas.


Topical application of honey in treatment of abdominal wound disruption.

The usefulness of honey application as an alternative method of managing abdominal wound disruption was assessed. Fifteen patients whose wound disrupted after Caesarean section were treated with honey application and wound approximation by micropore tape instead of the traditional method of wound dressing with subsequent resuturing. We achieved excellent results in all the cases with complete healing within 2 weeks. Honey application is inexpensive, effective and avoids the need to resuture which also requires general anaesthesia.


Recombinant-inbred strains: general methodological considerations relevant to the study of complex characters.

If appropriately determined, recombinant-inbred (RI) strain means provide an excellent method for determining genetic correlations among complex characters. However, little systematic attention has been paid to important environmental influences on strain means such as random effects due to litter membership or systematic maternal influences, which are inevitably confounded with genetic effects. It is suggested that users of RI strains would do well to control for litter effects by sampling appropriately from many litters and assessing the potential role of maternal influences by appropriate fostering procedures. Concern for these and other environmental sources of variation has caused reliability of strain means to emerge as an important issue in studies with RIs which focus on complex characters. Examples of estimating the reliability of RI strain means are provided to draw attention to the value of this kind of information in both gene-mapping studies and genetic correlational analyses. In addition, particularly in the case of behavioral tests which are susceptible to considerable day-to-day variation, repeated testing of the same animals can serve to diminish the influence of extreme deviations which are due to random variations in the manner in which the test is conducted on any given day. The advantages of RIs for gene mapping are well established. However, via the power of genetic correlational analysis, the RI methodology is emerging as a major alternative method, e.g., as distinct from lesion studies, pharmacological interventions, etc., in the bio-behavioral sciences to explore relationships between different domains of inquiry. Via its cumulative and integrative power, it is likely to make a major contribution to investigations of relationships between complex characters at various levels of and this application which should be considered separately from its application to gene mapping.


Chromosome mapping of Soa, a gene influencing gustatory sensitivity to sucrose octaacetate in mice.

Strain distribution patterns among recombinant inbred strains suggested that a locus influencing taste sensitivity to sucrose octaacetate was on chromosome 6. A location for Soa was established by linkage analysis of behavioral and electrophoretic data from outbred and congenic strains and from test-cross progeny. Haplotyping of 41 outbred CFW-Cr animals with a cDNA probe showed perfect cosegregation of Soa and Prp, a gene for salivary proline-rich proteins. Five of twelve B6.SW-Soaa strains were found to retain Ldr-1, lactate dehydrogenase regulator-1, on chromosome 6 as an allelic passenger from the SWR/J donor strain (source of the Soaa Taster allele). Centimorgan distance was estimated using the ABP/Le linkage-testing strain (non-Taster, Soab) and the SWR/J strain (Taster, Soaa) in a testcross breeding system. The data are consistent with a position for the Soa locus on mouse chromosome 6, 62 cM from the centromere.


Inference in linkage analysis of multifactorial traits using recombinant inbred strains of mice.

Recombinant inbred strains have been shown to be important tools for segregation and linkage analysis of multifactorial traits. Tests of association have been used as robust methods of linkage detection, however, guidelines for forming inferences from significance levels have not been generally available. In this paper, lessons learned from a Bayesian statistical approach to linkage analysis of Mendelian traits have been applied to studies of multifactorial traits. Criteria for detection of linkage based on Bonferroni's correction for multiple testing are also discussed.


Empirical estimates of Bonferroni corrections for use in chromosome mapping studies with the BXD recombinant inbred strains.

Most chromosome mapping efforts with the BXD recombinant inbred (RI) strains involve comparisons between a trait of interest and each of a large number of marker loci for evidence of linkage. Such multiple tests or comparisons greatly increase the Type I error rate compared to the single-test situation. Perhaps the most direct way to obtain multiple-test error rates is to employ a Bonferroni correction, where the single-test alpha is multiplied by the number of independent (nonredundant) comparisons (k) to yield a multiple-test alpha that protects against even one fortuitous association with any of the markers. Several empirical estimates of k are discussed for the published BXD marker set of 142 mapped loci and the newer unpublished marker set (October 1991) comprised of 352 marker loci. Reasonable estimates of k appear to be roughly 40 and 65 for these two marker sets, respectively.


Recombinant congenic strains of mice from B10.D2 and DBA/2: their contribution to behavior genetic research and application to audiogenic seizures.

Recombinant congenic strains (RCS) represent a series of related strains, each of which carries a small fraction of the genome of one strain ("donor" strain) on the genetic background of another strain ("background" strain). Recombinant inbred strains (RIS) are commonly used to identify major gene segregation and linkage and associations between behavior and quantitative trait loci, whereas recombinant congenic strains (RCS) open other complementary leads. The variability in the reactivity of RCS to a trait is thus the expression of few minor-effect genes originating from the donor strain, because the probability that major genes are present in any one RCS is low. Unlike RIS in which minor-effect genes are often masked by major genes, RCS enable the effects of minor genes to be studied. With our method, for a given trait, an estimate can be made of the gene strength distribution as well as an estimate of the minimal number of genes involved having a certain strength.


Free radical generation in hydroperoxide-treated erythrocytes monitored continuously by luminol-amplified chemiluminescence.

Organic hydroperoxides induce oxidative damage to mammalian cells. We describe how luminol-amplified chemiluminescence can be used to monitor free radical generation (following treatment of erythrocytes in vitro with organic hydroperoxides) throughout the entire time-course of oxidative stress. Enrichment of erythrocyte alpha-tocopherol levels increased the induction time by 25% and led peak chemiluminescence fall of 30%. Furthermore, ascorbate loading reduced the signal four-fold during the induction period. The catalytic role of haemoglobin was shown by the abolition of chemiluminescence by azide and a low (but detectable) signal in haemoglobin-depleted erythrocyte ghosts. Luminol-amplified chemiluminescence enables the kinetics of free radical generation to be monitored continuously. Furthermore, it may enable features of the mechanism of interaction between cellular antioxidants and antioxidant enzymes to be elucidated.


Expression of salivary mucin bacterial aggregating activity: difference with caries.

The low and high molecular weight mucin forms were isolated from saliva of individuals with different caries status and assessed for their bacterial aggregating potential towards S. mutans and S. sanguis. The high molecular weight mucin from both groups exhibited similar protein and carbohydrate content, but the level of covalently bound fatty acids was lower in the caries-resistant group. The mucin from caries-resistant group showed only a weak inhibitory potential, while no inhibitory activity was observed with the mucin of caries-susceptible group. The low molecular weight mucins from both groups, while displaying compositional similarities, showed a marked variation in the bacterial aggregating activity, and the titer of the mucin from caries-resistant group was at least 128-fold greater than that of caries-susceptible group. The results demonstrate that the bacterial aggregating epitope of salivary mucins is expressed to a greater extent in caries-resistant individuals, and that this epitope is apparently more accessible to bacteria in the low molecular weight mucin form.


Alterations in the methylation of membrane phospholipids in the uterus and post-implantation embryo following exposure to teratogenic doses of alcohol.

The intragastric administration of alcohol to pregnant mice at 3.0 g/kg body weight, but not at 0.5 or 1.5 g/kg body weight, adversely influenced embryonic growth and increased the rate of methyl group incorporation from S-adenosyl-L-[methyl-3H]methionine into uterine endometrial plasma membrane phospholipids. These changes involved phosphatidylcholine, phosphatidyldimethylethanolamine, and phosphatidylmonomethylethanolamine when the alcohol was acutely administered, but only phosphatidylcholine when the drug was given in a semi-chronic regime. Similar alterations were not detected in post-implantation embryos exposed to alcohol either in vitro or in vivo. The results suggest that maternal exposure to alcohol during early post-implantation pregnancy can alter the pattern of phospholipid methylation in the uterus, but not in the embryo, which may facilitate biochemical changes that adversely influence the ability of the maternal system to support embryonic development.


Comparison of supernatant-and ribosome-bound rat liver tRNA.

Transfer RNAs were separated into a ribosome bound fraction and a supernatant (cytoplasmic) fraction. The nucleoside composition, 2-dimensional PAGE pattern and in vivo labeling were compared. 12 minor nucleosides were identified by HPLC. In general, the minor nucleosides, especially N2-methyl-guanidine and ribothymidine, were higher in the ribosome-bound fraction. The PAGE patterns were similar but there were quantitative and qualitative differences among the smaller spots. In vivo labeling by 32P showed that new tRNA goes preferentially to the ribosome but mixing does occur. The results suggest the existence of two compartments of tRNA.


The stimulatory and inhibitory effects of glycyrrhizin and a glycyrrhetinic acid derivative on phosphorylation of lipocortin I by A-kinase in vitro.

The effects of GL and oGA on the activity (phosphorylation of lipocortin I) by A-kinase were investigated in vitro. It was found that (i) phosphorylation of the 35-36 kDa polypeptide by A-kinase was inhibited selectively when the partially purified kinase fraction from EAT cells was incubated with [gamma-32P]ATP in the presence of 60 microM oGA; (ii) the marked polypeptide was identified as a lipocortin I; and (iii) the activity of the kinase was stimulated about 4-fold by 5 microM oGA, but it was inhibited at doses above 25 microM. The drug-induced inhibition of phosphorylation of lipocortin I by A-kinase may be implicated in the anti-inflammatory effect of the drugs.


Cytotoxicity of human beta-interferon produced in human glioma cells transfected with its gene by means of liposomes.

The cytotoxicity of human beta-interferon (HuIFN-beta) produced in human glioma cells was examined by use of our liposomes entrapping two plasmids, pSV2neo and pSVMTV-IFN-beta. After the cells had been transfected with these genes by means of the liposomes, neomycin-resistant cells were selected. When the selected cells were subjected to a single exposure to dexamethasone, all of the cells were found to produce HuIFN-beta and were eliminated by 8 days. Accordingly, the effect of HuIFN-beta produced in human glioma cells is considered to be cytocidal.


DNA polymerase alpha, beta, and gamma activities in human lymphocytes stimulated by Tora-mame (Phaseolus vulgaris) lectin.

We measured the levels of the DNA polymerases alpha, beta, and gamma in human peripheral lymphocyte cells stimulated with Tora-mame lectin (TM-lectin) and the induction patterns were compared to those with other plant lectins, i.e., phytohemagglutinin (PHA) and pokeweed mitogen (PWM). The maximum activity of DNA polymerase alpha in lymphocytes was achieved at the concentration of 10 micrograms/ml with TM lectin and the dose response curve of TM lectin showed a sharp peak in contrast to that of PWM. During prolonged stimulation for 10 days, the time course of DNA polymerase alpha induction was different among these three lectins. A peak of alpha-enzyme was correlated with maximal incorporation of [3H]thymidine and was observed on the fourth day with TM lectin, on the third day with PHA, and sixth day with PWM. DNA polymerase beta in lymphocytes was also activated by the addition of these proteins. Two different peaks were observed during a 10-day period with every lectin, and TM lectin was most potent stimulator among them. The activity of DNA polymerase gamma in lymphocytes was at a very low but detectable level which increased slightly in response to TM lectin treatment. Although some variability of gamma-enzyme activity was observed after the seventh day, the pattern in the course of 7 days was similar among the lectins.


Crosslinking of proteins in acetylcholine receptor-rich membranes from Torpedo californica: relation of 43-kD protein and Torpedo dystrophin to acetylcholine receptor.

We examined the spatial relation of 43-kD protein and Torpedo dystrophin, which are cytoplasmic peripheral membrane proteins in the nicotinic acetylcholine receptor (AChR)-rich membranes, to AChR. We used three kinds of the heterobifunctional crosslinking reagents to crosslink proteins in the AChR-rich membranes. Products crosslinked by SMPB (14.5 A span) including 43-kD protein and Torpedo dystrophin appeared at the tops of the stacking gels at the concentrations of 8.89 x 10(-5)M to 8.89 x 10(-3)M SMPB. High molecular weight materials (crosslinked products) increased with increasing concentrations of the crosslinker. On the other hand, band intensity of alpha, beta, and delta subunits of AChR remained unchanged up to a concentration of 2.67 x 10(-3)M SMPB, while the band of gamma subunit diminished at the same concentrations as did that of the 43-kD protein. Torpedo dystrophin was also crosslinked at the same concentrations as were effective for the 43-kD protein and gamma subunit. On the basis of these results, we conclude that the 43-kD protein is intimately associated with the gamma subunit of AChR and Torpedo dystrophin.


Acidic alpha-D-mannosidase in phenotypically different leukemic lymphoid cells.

The activity of acid alpha-mannosidase in phenotypically characterized lymphoid cells, isolated from peripheral blood, spleen and lymph nodes of patients with various lymphoproliferative disorders has been studied. Cells with different immunophenotypes were shown to have different alpha-mannosidase activity levels. The lowest alpha-mannosidase activity was observed in cells phenotypically corresponding to early B cells obtained from B-CLL patients. The highest activity was determined in cells with phenotypes of activated, CD11c-expressing B cells from B-NHL and HCL patients. There were considerable differences in alpha-mannosidase activity between peripheral blood and spleen lymphoid cells of B-NHL patients with spleen damage. The data obtained may be used in classification, primary diagnosis and staging of hematopoietic malignancies.


Role of alkaline metal ions in the H(+)-ATPase activity of various yeast species.

Saccharomyces cerevisiae, Schizosaccharomyces pombe, Endomyces magnussi, Lodderomyces elongisporus and Rhodotorula gracilis, yeast species ranging from a glycolytic type to a strictly aerobic one, were tested for the activity of their plasma membrane H(+)-ATPase and the effect of alkaline metal cations thereon. The ATP-hydrolyzing activity of membranes from glucose-activated cells ranged from 456 to 932 mumol inorganic phosphate released per min per 1 g membrane protein. The effect of 0.2 M Li+, Na+, K+, Rb+ and Cs+ never exceeded the statistical range of error. In contrast, acidification after glucose addition ranged from 0.15 (for R. gracilis) to 14.8 nmol H+ per min per mg dry weight (for S. cerevisiae) and it was markedly influenced by the presence of alkaline metal chlorides, the highest effect observed being a seven-fold increase by K+ in a S. cerevisiae suspension. The effects were additive to those observed without ions in solution and are ascribed to the operation of independent channels and/or exchange systems for H+ with a clear selectivity toward K+. The separate nature of the ion-triggered extracellular acidification is supported by a different ratio of titration to pH-derived acidity with and without K+.


Lentil seedling amine oxidase: interaction with carbonyl reagents.

Carbonyl reagents containing a primary amino group were covalently bound by lentil seedling amine oxidase to resolve conflicting data for both the number of functional active sites in the dimeric enzyme. Active site titration of highly purified enzyme samples with all the carbonyl reagents extrapolates to 1 mol of inhibitor/mol of enzyme subunit indicating the presence of a cofactor at each enzyme subunit. This result is at variance with numerous previous reports of only one functional cofactor for enzyme dimer in copper amine oxidase.


Oxidation of cystathionamine and lanthionamine by lentil seedlings amine oxidase.

Cystathionamine and lanthionamine are good substrates for lentil seedlings amine oxidase. One mole of hydrogen peroxide and one mole of ammonia per mole of substrate are produced, indicating that only one amino group is oxidized to aldehyde. The aminoaldehydes so originated undergo cyclization by intramolecular Schiff base formation. The pH optimum for the oxidation of either cystathionamine or lanthionamine is 7.0 in potassium phosphate buffer. The Km values are 0.61 and 0.84 mM respectively, similar to that for cystamine (0.8 mM).


On the anomalous behaviour on gel-filtration and SDS-electrophoresis of prothymosin-alpha.

The regulator of T-cell proliferation prothymosin alpha, is a protein with a relative molecular mass of 12 KDa as calculated from its amino acid sequence. This immunoregulator exhibits anomalous behaviour on gel-filtration and SDS-PAGE electrophoresis appearing as oligomers which are 5 or 2 fold larger than the corresponding polypeptide. These results suggest that a dimeric form of prothymosin alpha is stable to dissociation by SDS and reduction by beta-mercapto ethanol.


Complexes involving gossypol, DNA and Cu(II).

Gossypol, a polyphenolic binaphthyl dialdehyde found in cotton seeds, is a dietary mutagen and a potential male contraceptive. We have earlier shown that in the presence of Cu(II) gossypol causes strand breakage in double stranded DNA and that active oxygen species are involved in this reaction. In this paper we present experiments to suggest that gossypol may be oxidised by Cu(II) to a gossypol radical that may directly react with DNA. Changes in absorption spectrum and fluorescence emission spectrum of gossypol indicated that it binds to both double stranded and single stranded DNA. Gossypol and Cu(II) were shown to form a charge transfer complex that decayed in an oxygen independent reaction. The rate of DNA degradation by gossypol-Cu(II) complex was found to be the same both in the presence and absence of molecular oxygen.


Dual hormonal involvement in the regulation of rat uterine collagenase activity.

Hormonal control of rat uterine collagenase activities which use collagen types I, III, and V as the substrates has been studied. The collagenases are shown to be regulated in general by estradiol as well as by progesterone. However, the enzyme activity that uses type III collagen as the substrate appears to have a preferential response to progesterone over estradiol.


Downregulation of saturated fatty acid and upregulation of unsaturated fatty acid by 13-cis-retinoic acid in human prostate cancer cells.

Retinoids play a major role in regulation of epithelial cell growth and cellular differentiation, but their mechanism(s) of action are still unclear. In the present study, we examined the effects of 13-cis-retinoic acid (13-cis-RA) on cytotoxicity, growth properties, morphology, neutral lipids, phospholipids and fatty acids in cultured human prostate cancer cell lines. The results of these experiments suggest that 13-cis-RA (10 microM) inhibits the DNA synthesis and nude mice tumorigenicity by 2- to 3-fold, compared to control. Electron microscopy revealed more differentiated phenotypes after 13-cis-RA treatment. There was a significant increase in phosphatidylcholine and decrease in sphingomyelin in 13-cis-RA treated cells compared to control. The saturated fatty acids significantly decreased whereas unsaturated fatty acids were increased after 13-cis-RA treatment in prostate cancer cells. This study demonstrates for the first time that retinoic acid mediated downregulation of saturated fatty acids and upregulation of unsaturated fatty acid in human prostate cancer cells.


Gonadotropin bioactivities in mouse, hamster, rat and guinea pig pituitaries are largely adsorbed on concanavalin A-sepharose.

The pituitaries of mice, hamsters, guinea pigs and rats were extracted with Tris-Cl buffer and the extracts were chromatographed on Concanavalin A (ConA)-Sepharose into unadsorbed ConA I and adsorbed ConA II fractions. The ConA I fraction was subjected to gel filtration on Sephadex G-100 and fractionated into an unretarded peak and several retarded peaks. The peak with a molecular weight of approximately 40,000 (designated ConAI Sephadex fraction II) was then subjected to ion exchange chromatography on CM-cellulose and fractionated into an unadsorbed CM I and an adsorbed CM II fraction. The ConA II fraction was fractionated by ion exchange chromatography on CM-cellulose into CM I and CM II fractions. The ConA II CM II fraction was the chromatographic fraction which exhibited the highest potency in stimulating testosterone production by isolated rat Leydig cells. Its activity was much higher than the corresponding ConA I Sephadex fraction II CM II fraction which differed chromatographically only by non-adsorption on ConA-Sepharose. The ConA II CM II fraction manifested cross reactivity in a rat luteinizing hormone (LH) radioimmunoassay. The guinea pig pituitary ConA II CM II fraction also cross-reacted in a rat thyroid stimulating hormone radioimmunoassay. The ConA II fractions of hamster and guinea pig pituitary extracts demonstrated follicle stimulating hormone (FSH) activity while the corresponding ConA I fractions did not. The results suggest that the ConA II/ConA II CM II fraction contained most of the FSH and LH activities present in the pituitary extract.


Renal insensitivity to atrial natriuretic peptide in patients with cirrhosis and ascites. Effect of increasing systemic arterial pressure.

The IV infusion of pharmacological doses (0.05 microgram.kg-1.min-1) of atrial natriuretic peptide to 16 patients with cirrhosis and ascites induced a significant increase in sodium excretion (65 +/- 23 to 517 +/- 231 mu Eq/min), urine volume (10.7 +/- 2.3 to 15.7 +/- 3.7 mL/min), and glomerular filtration rate (89 +/- 4 to 110 +/- 4 mL/min) in only 5 patients (responders). No significant changes in these parameters (15 +/- 6 to 11 +/- 4 mu Eq/min, 5.5 +/- 1.0 to 4.2 +/- 1.1 mL/min, and 81 +/- 5 to 79 +/- 6 mL/min, respectively) were observed in the remaining patients (nonresponders). Compared with responders, nonresponders had significantly lower baseline sodium excretion (P less than 0.02), urine flow (P less than 0.05), free water clearance (2.5 +/- 0.9 vs. 6.9 +/- 2.1 mL/min; P less than 0.05), and mean arterial pressure (82 +/- 3 vs. 96 +/- 2 mm Hg; P less than 0.01) and significantly higher plasma renin activity (16.3 +/- 4.9 vs. 1.8 +/- 0.2 ng.mL-1.h-1; P less than 0.05) and aldosterone level (99 +/- 24 vs. 13 +/- 2 ng/dL; P less than 0.05). Atrial natriuretic peptide produced a similar reduction of arterial pressure in both groups. To investigate whether the blunted natriuretic response to atrial natriuretic peptide in nonresponders was caused by their lower arterial pressure, atrial natriuretic peptide was infused in 7 of these patients after increasing their arterial pressure to the levels of responders with nonrepinephrine. The increase in arterial pressure (from 81 +/- 5 to 95 +/- 5 mm Hg), which was not associated with significant changes in plasma renin activity and aldosterone concentration, did not reverse the blunted renal response to atrial natriuretic peptide in any of these patients. These results indicate that cirrhotic patients with blunted renal response to atrial natriuretic peptide are characterized by low arterial pressure, marked overactivity of the renin-aldosterone system, and severe sodium and water retention. Correction of hypotension without increasing effective blood volume does not restore renal insensitivity to atrial natriuretic peptide.


A controlled assessment of direct intraperitoneal insemination.

To test the efficacy of direct intraperitoneal (IP) insemination and its effect on cell-mediated immunity. A prospective trial with each couple having one treatment (insemination) cycle and one control (timed intercourse) cycle performed in random order with the same ovulation stimulation in both cycles. Secondary and tertiary referral fertility clinics; university teaching hospital. Twenty-six infertile couples. Excluding pregnancy, only one couple did not complete the two cycles. Ovulation induction in both cycles. Intraperitoneal insemination in the insemination cycles. These were pregnancy rate (treatment versus control) and mixed lymphocyte response (MLR) sensitivity (before and after direct IP insemination treatment). There were four control and no treatment pregnancies. This was not a significant difference (odds ratio). Mixed lymphocyte responses in fertile subjects did not change during the menstrual cycle (Wilcoxon). There was no significant increase in MLR sensitivity to partner's cells after direct IP insemination treatment. This controlled study found no benefit from direct IP insemination in terms of pregnancies over control cycles. There was no evidence that direct IP insemination had increased cell-mediated immune response sensitivity to husband's cells.


Autoantibodies to nuclear lamin C in the eosinophilia-myalgia syndrome associated with L-tryptophan ingestion.

To examine the autoantibodies (antinuclear antibodies [ANA]) present in serum from a patient with eosinophilia-myalgia syndrome (EMS). Sera obtained during the early phase of EMS and following therapy with prednisone were screened by indirect immunofluorescence on HEp-2 cells, and ANA were characterized by immunoblotting on a purified nuclear lamin fraction. ANA with a ring-like pattern of nuclear staining were identified at high titer by immunofluorescence, and immunoblotting experiments showed them to be directed against lamin C. The antibody titer declined dramatically after discontinuation of L-tryptophan and therapy with prednisone. This is the first characterization of an antigen/autoantibody system associated with EMS. The findings indicate that this EMS-associated autoantibody recognizes epitopes localized in the carboxyterminal region of lamin C. The occurrence of anti-lamin C autoantibodies in one EMS patient expands the spectrum of clinical conditions associated with these antibodies, and provides evidence for an autoimmune response in EMS.


Placebo-controlled trial of ulcerative colitis with oral 4-aminosalicylic acid.

Forty patients with active ulcerative colitis were randomly assigned to receive either 4 g of oral enterically coated 4-aminosalicylic acid (para-aminosalicylic acid) or placebo. The duration of treatment was 12 weeks. Disease activity was assessed by grading clinical symptoms of blood, mucus, urgency, sigmoidoscopic findings, and degree of histological inflammation in rectal biopsy specimens. At 12 weeks, 11 of 20 patients (55%) who received 4-aminosalicylic acid showed improvement in clinical and sigmoidoscopic variables. In contrast, only 1 of 20 patients (5%) who had received placebo showed improvement (P less than 0.005). Eighteen of the 19 patients in the placebo group who showed no improvement were treated subsequently with open-label 4-aminosalicylic acid. Of the 18, 11 showed clinical and sigmoidoscopic improvement. Patients allergic or intolerant to sulfasalazine with extensive disease were more likely to respond to 4-aminosalicylic acid.


Tricorrectional bunionectomy for surgical repair of juvenile hallux valgus.

The authors propose the use of the tricorrectional bunionectomy as an alternate correction of severe deformity in juvenile hallux valgus. In the past, hallux valgus surgery in juveniles has been avoided. A follow-up study of the tricorrectional bunionectomy as the surgical treatment for juvenile bunion deformity in seven patients is presented.


Granuloma annulare of the penis.

Granuloma annulare is an uncommon skin condition, most often found on the extremities of young females. A case of granuloma annulare occurring on the penis of a 61 year old man is reported and the current literature associating granuloma annulare and conditions likely to present to genitourinary clinics is reviewed.


Successful reintroduction of methotrexate after pneumonitis in two patients with rheumatoid arthritis.

Two patients are described with severe and progressive rheumatoid arthritis in whom methotrexate was reintroduced despite previous methotrexate related pneumonitis. In both patients a marked improvement in disease control occurred without a recurrence of the pneumonitis.


Cutaneous graft-versus-host-like reaction after paternal lymphocyte immunization for prevention of recurrent abortion.

We have presented an immunocompetent patient who, after paternal lymphocyte immunization, developed a GVH-like skin reaction; she recovered spontaneously. This complication is rarely seen. This was the only case observed in our series of over 70 patients immunized. A similar phenomenon was not reported in a larger series by Carp and colleagues (1). However, the case deserves special attention because this reaction can be life-threatening. Therefore, we suggest that paternal lymphocyte immunization should be recommended only for those patients who have undergone a thorough work-up and in whom all causes, other than immunological, for recurrent abortion have been excluded. Even then, this treatment should be given with utmost caution. In view of the above described complication, we believe that more data are still required to justify offering such a treatment modality on a routine basis.


Nutritional implications of fat substitutes.

The possibility of replacing fats in foods through the use of alternative ingredients has generated substantial interest among food industry and nutrition professionals as well as among the lay public and news media. However, even in academic circles, there is a tendency to consider "fat substitutes" as a homogeneous group, when they are not, and also to make unproven assumptions regarding their likely efficacy in reducing fat intake and aiding in maintenance of appropriate energy balance. Governmental and industrial bodies have tended to place much greater emphasis on the potential risks of these materials than on their possible benefits. A reasoned consideration of the nutritional implications of fat substitutes examines what these materials are, how they might be used, and how they might affect eating behavior and nutritional status in the general population. The existing literature suggests that although the risks of existing and proposed fat substitutes are probably limited, their nutritional benefits are largely unproven.


Symptomatic chronic paroxysmal hemicrania.

A patient with chronic paroxysmal hemicrania (CPH) associated with a gangliocytoma growing from within the sella turcica is reported. This tumor displaced the floor of the third ventricle and surrounded the internal carotid artery on the same side as the headache. Partial removal of the tumor followed by radiation resulted in amelioration of headache. The anatomical location of the tumor and its possible relationship to the pathogenesis of CPH is discussed.


Thrombin-specific inhibition by and slow cleavage of hirulog-1.

Hirulog-1 [D-Phe-Pro-Arg-Pro-[Gly]4-desulphohirudin-(53-64) (HV1)] was designed to bind by its first four and last 12 residues to the alpha-thrombin catalytic site and anion-binding exosite for fibrin(ogen) recognition respectively, with a [Gly]4 bridge and an Arg-Pro bond at the scissional position. Human alpha-, gamma- and zeta-thrombins, as well as bovine trypsin, readily hydrolyse Spectrozyme-TH (D-hexahydrotyrosyl-Ala-Arg p-nitroanilide) at pH 7.4 and approx. 23 degrees C. Both alpha- and zeta-thrombins, which have high fibrinogen-clotting activities (greater than 3000 kunits/g), were inhibited with this substrate by hirulog-1 [Ki = 2.56 +/- 0.35 nM (n = 3) and 1.84 +/- 0.15 nM (n = 3) respectively] and slowly cleaved the inhibitor [k = 0.326 +/- 0.082 min-1 (n = 12) and 0.362 +/- 0.056 min-1 (n = 18) respectively], whereas gamma-thrombin, which has essentially no clotting activity (approx. 4 kunits/g), and trypsin were not inhibited with greater than 1000-fold molar excess of hirulog-1. Similar inhibition parameters were also obtained for hirulog-1 incubated with alpha-thrombin or zeta-thrombin at approx. 23 degrees C and by measuring thrombin activity with fibrinogen in the clotting assay at 37 degrees C. Cleavage of the Arg-3-Pro-4 bond in hirulog-1 by either alpha- or zeta-thrombin was shown by identical cleavage products of either thrombin on h.p.l.c. and by sequence analysis of the alpha-thrombin products. These data demonstrate that hirulog-1 is a specific inhibitor of thrombin forms with high fibrinogen-procoagulant activities and that its Arg-3-Pro-4 bond is slowly cleaved by these thrombin forms.


Clinical diagnostic criteria for TMD. New classification permits multiple diagnoses.

One of the first to permit multiple diagnoses, this new TMD classification scheme offers guidelines for clinicians and those conducting clinical field studies. The scheme was applied to a TMD population, with control subjects.


The prognostic value of serum troponin T in unstable angina.

Cardiac troponin T is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. We used a newly developed enzyme immunoassay for troponin T to determine whether its presence in the serum of patients with unstable angina was a prognostic indicator. We screened 109 patients with unstable angina (25 with accelerated or subacute angina and 84 with acute angina at rest) for serum creatine kinase activity, creatine kinase isoenzyme MB activity, and troponin T every eight hours for two days after admission to the hospital. The outcomes of interest during the hospitalization were death and myocardial infarction. Troponin T was detected (range, 0.20 to 3.64 micrograms per liter; mean, 0.78; median, 0.50) in the serum of 33 of the 84 patients (39 percent) with acute angina at rest. Only three of these patients had elevated creatine kinase MB activity (two were positive for troponin T, and one was negative). Of the 33 patients who were positive for troponin T, 10 (30 percent) had myocardial infarction (3 after coronary-artery bypass surgery), and 5 of these died during hospitalization. In contrast, only 1 of the 51 patients with angina at rest who were negative for troponin T had an acute myocardial infarction (P less than 0.001), and this patient died (P = 0.03). Thus, 10 of the 11 patients with myocardial infarctions had detectable levels of troponin T; only 1 had elevated creatine kinase MB activity. Troponin T was not detected in any of the 25 patients with accelerated or subacute angina, and none of these patients died. Cardiac troponin T in serum appears to be a more sensitive indicator of myocardial-cell injury than serum creatine kinase MB activity, and its detection in the circulation may be a useful prognostic indicator in patients with unstable angina.


Hemisphericity and self-esteem.

The 1991 paper by Persinger and Makarec, while posing some interesting theoretical and speculative questions, misstates the magnitude of the effect size in the validation of the Hemisphericity Questionnaire and draws some unwarranted conclusions. This article briefly reviews the issues involved.


Gram scale purification and preparation of rabbit liver zinc metallothionein.

A simplified procedure for purifying gram quantities of rabbit liver metallothionein (MT) using gel filtration and anion exchange chromatography is presented. The MT purification made use of anion exchange batch elution chromatography which greatly shortened the procedure. Quantitation techniques for use with crude and purified MT are discussed. This paper also describes the preparation of large amounts of ZnMT from Cd,ZnMT.


Acute gastroenteritis in children.

Despite the great advances in modern medicine, children still die from dehydration due to acute infectious gastroenteritis. These deaths are almost always preventable by using rehydration fluids. This article focuses on assessment and treatment of the affected patient.


The association of AIDS education and sex education with sexual behavior and condom use among teenage men.

According to a 1988 nationally representative survey, most 15-19--year-old men in the United States have received formal instruction about AIDS (73%), birth control (79%) and resisting sexual activity (58%). Results of multivariate analyses show the receipt of AIDS education and sex education to be associated with modest but significant decreases in the number of partners and the frequency of intercourse in the year prior to the survey. Having received instruction in these topics was also associated with more consistent condom use. Instruction in some topics was associated with increases in knowledge and attitudes about AIDS, but these increases were not always correlated with safer behavior.


Bone cancer risk estimates.

Due to confusion between endosteal (bone surface) dose and average skeletal dose, ICRP 60 has substantially overestimated the risk of radiogenic bone cancer. This confusion apparently stems from an incorrect reading of the BEIR IV report, which does not clearly draw this distinction. It should also be noted that what appear to be summary numerical risk estimates for bone sarcoma induction in BEIR IV and BEIR V refer only to average skeletal dose as calculated for 224Ra.


Sequence discrimination by alternatively spliced isoforms of a DNA binding zinc finger domain.

Two major developmentally regulated isoforms of the Drosophila chorion transcription factor CF2 differ by an extra zinc finger within the DNA binding domain. The preferred DNA binding sites were determined and are distinguished by an internal duplication of TAT in the site recognized by the isoform with the extra finger. The results are consistent with modular interactions between zinc fingers and trinucleotides and also suggest rules for recognition of AT-rich DNA sites by zinc finger proteins. The results show how modular finger interactions with trinucleotides can be used, in conjunction with alternative splicing, to alter the binding specificity and increase the spectrum of sites recognized by a DNA binding domain. Thus, CF2 may potentially regulate distinct sets of target genes during development.


Fluctuations in perceived energy and mood among patients with chronic fatigue syndrome.

Patients currently suffering or recently recovered from chronic fatigue syndrome (CFS) were compared with each other and with a group of well-matched controls in a study of diurnal variation in levels of perceived mental and physical energy and positive and negative affect. Patients who were currently ill showed diurnal variation in patterns of energy, with maximum levels being recorded between 10.00 h and 12.00 h which were significantly higher (P < 0.05) than energy levels recorded on rising or retiring. This pattern was similar to the controls but average energy levels at each time point were lower (P < 0.05) among the ill patients. Recovered patients showed the same pattern, with mean energy levels falling between those of the ill patients and controls. Similar diurnal patterns were found for perceptions of positive, though not negative affect. Correlations between physical and mental energy and between both of these energy variables and positive affect were high (r = 0.75 to 0.85) in both controls and CFS patients. However, correlations with negative affect were low (eg r = -0.10) and non-significant. Total scores on the Hospital Anxiety and Depression Scale (HAD) were significantly higher (P < 0.05) among patients who were still ill than those who had recovered. Scores on the HAD Depression (but not Anxiety) subscale were also significantly higher among those who were still ill (P < 0.01). These findings may be of value in facilitating programmes of cognitive-behavioural modification intended to aid the recovery of patients with CFS.


Drinking water fluoridation and caries prophylaxis: with special consideration of the experience in the former East Germany.

Drinking water fluoridation for caries prophylaxis is not a means of primary prevention: i.e., avoidance of sugar and microorganisms in the oral cavity; but rather a means of secondary prevention: e.g., prevention of bacterial production of carboxylic acid from sugar, and therapy: e.g., enhancement of enamel resistance to demineralization by incorporation of fluoride in remineralization of the enamel surface. Currently available epidemiologic studies on the effects of drinking water fluoridation reveal: reduction of the incidence of caries, particularly in children no detrimental health effects; cosmetically undesirable dental fluorosis may occur, however. Nevertheless, introduction of drinking water fluoridation in Germany is not recommendable because of: the greater effectiveness of primary caries prevention, the acceptance of which is reduced, however, by drinking water fluoridation the at least equal prophylactic effect of fluoride via other routes, e.g. via toothpaste the narrow range between beneficial and detrimental dosage the avoidance of fluoride-enriched waste water the prerogative of minimal manipulation of drinking water content.


[Mercury exposure of the population. IV. Mercury exposure of male dentists, female dentists and dental aides].

Urinary mercury levels were determined in 22 dentists and 46 dental nurses and assistants working in 15 private dental offices in West-Germany. For comparison, urinary mercury levels of 29 subjects without occupational mercury exposure were studied. On average, urinary mercury in dental personnel was higher than in the reference group. Individual mercury levels, however, were all significantly below present occupational exposure limits. Urinary mercury was significantly correlated with the number of amalgam fillings in dental personnel as well as in the reference group. Following administration of Dimaval a significant increase of mercury excretion was observed in both groups. Regarding total exposure to mercury in dental personnel, the contribution of mercury exposure from the occupational environment is of the same order of magnitude as their exposure from their own amalgam fillings. Dental nurses were found to be more exposed than dentists. This finding seems to be related predominantly to the larger number of amalgam fillings in dental nurses.


Trace elements in the human blood, cerebrospinal and amniotic fluid.

Human biological samples using the atomic emission method. The concentration of 27 micro- and macro elements was specified in a total number of 1221. Some of the patients tested were under hospital treatment because of chronic disease (727 persons), others were blood donors (71 persons) or pregnant women and newborn infants (107-107 persons, respectively). In the serum samples of the tested persons the concentration of barium, mercury, nickel and gallium showed characteristic differences. Concentrations of many micro elements in the serum and cerebrospinal fluid changed with age and sex. The tendency becomes characteristic after the age of 45 and 60, respectively. The concentration of elements in the blood serum of mothers and their newborn infants seems to be nearly identical with a considerable deviation observed only in case of aluminum, barium and iron (significant difference). The detected elements can pass through the placenta. This particularly applies to lead because the average lead concentration in the serum of newborn infants is 159 micrograms/litre even at birth.


[Biological safety investigations of the production of human insulin by genetically engineered E. coli K-12 cells. 1. Survival capacity of the production strain in the digestive tract of Göttinger miniature swine].

The residence time of genetically engineered Escherichia coli K-12 cells in the digestive tract was tested by feeding Göttinger minipigs 10(10)-10(11) cells of strain W3110iqM15 (pSW3). This strain is a production strain for human insulin and carries the plasmid pSW3 which contains the genes for human insulin. The test strain could be selected as white colonies grown on McConkey ampicillin plates and could be identified by complementation analysis due to its lacZ M15 deletion. The strain could be isolated from the faeces of the animals up to 72 h after feeding, thereafter no cells of the phenotype of the test strain grew on McConkey ampicillin plates. So the production strain for human insulin W3110iqM15 (pSW3) was not able to colonize the digestive tract of the Göttinger minipig. Feeding the genetically engineered E. coli K-12 cells had no influence on the welfare of the animals.


[PATIS--a questionnaire-based, PC-assisted patient information system in the field of environmental medicine].

PATIS was developed as a questionnaire-based, PC-assisted patient-information- and documentation-systems within the framework of the "Umweltmedizinische Beratungsstelle" (advisory board for clinical environmental medicine) at the Medical Institute of Environmental Hygiene at the Heinrich-Heine-University Düsseldorf. PATIS is a substantial element of a planed knowledged-based-system in environmental medicine. This system will further-more consist of databases for chemical substances information, exposition, and literature. PATIS records information about patients concerning personal data, former diseases, symptomatology and complaints, lifestyle, residential and working area, and spare time activities. Furthermore the state of physical examination, performances of diagnostics, and laboratory investigations are documented. A different questionnaire exists for children younger than 12 years. PATIS is able to supply an automatic report based on information of the questionnaire. This system is realized in the relational-database-system dBase IV and is utilized practice since the beginning of 1991.


[The danger of infection in inhalation rooms].

There are alarming reports about high counts of Legionella and Pseudomonas in the aerosol of inhalation-rooms. We therefore investigated 14 institutions (6 kurhauses, 5 hospitals and 3 sanatoria for children) in Schleswig-Holstein, each of them at least five-fold. For that purpose the inhalant (seawater as a rule) was investigated for the total bacterial number and the number of Legionella. Cfu/m3 air were determined at the aerosol outlet and a qualitative search for Legionella was done in the piping. In addition bacterial numbers in the air at the breathing-levels of patients were measured in order to be able to assess health hazards by germs of other patients. Detected bacterial numbers (10(1) - > 10(4)) were basically subject to the handling of the equipment and the type of apparatus used. Predominantly Staphylococci and Bacilli were found and above all when the first row of investigations was carried out large numbers of Pseudomonas, Aeromonas and others occurred. Legionella could not be detected. As a whole the investigations showed that properly maintained room-inhalators pose no higher risk of infection. These facilities, however, might be contaminated at any time and there is a certain--even though comparatively low--risk of infection due to germs exhaled by other patients. Patients, which are predisposed to infections of the respiratory tract--f.i. patients suffering from mucoviscidosis or patients with lowered resistance--should therefore generally use single inhalators.


[Long-term study of the persistence of E. coli in waters of different composition].

The survival of E. coli ATCC 11229 at different initial concentrations was determined in water of standardized hardness, in tap water from Kiel and in groundwater from the Segeberger forest with pH-values of 4.5, 6.9 and 8.5. In groundwater at pH 4.5 the bacteria died relatively soon, whereas otherwise in relation to the test conditions long persistence times have been determined. The persistence of E. coli in tap water from Kiel and in water of standardized hardness differed from that in groundwater with comparable pH-values of pH 6.9 and pH 8.5. In groundwater the colony forming units generally decreased slightly, whereas in tap water and in water of standardized hardness high initial bacterial concentrations resulted in growth, low ones on the other hand in a decrease of the colony forming units. In the area of middle initial bacterial concentrations a significant growth of E. coli (frequently not before 50 days) as well as a die-off could be observed in parallel samples. The influence of the water volume of the sample and the conditioning of the bacteria (unwashed - washed) were of secondary importance.


Ring volume/ring liner ratio and effective setting expansion.

Effective radial setting expansion of wax patterns in a gypsum-bonded investment is influenced by many factors, especially by the diameter of the cylindrical casting ring. The hypothesis tested was that the ratio of the volume of the casting rings to the volume of the ring liner is a primary determinant of radial setting expansion. Mesio-occlusodistal inlay wax patterns were invested individually in plastic casting rings of different lengths and diameters and imaged using xeroradiography. Effective setting expansion was determined in 34-mm-long, 28-mm-diameter rings and used as a predictor of expansion in rings of different sizes. Experimental setting expansion results did not differ significantly from the predicted values.


Compressive strength of two modern all-ceramic crowns.

This study investigated the compressive strength of all-ceramic crowns manufactured using two recently introduced systems. The mean forces of fracture were 964 N for In-Ceram crowns, 814 N for paint-on IPS Empress crowns, and 750 N for layered IPS Empress crowns, compared with 1,494 N for metal ceramic crowns veneered on a nickel-chromium coping. The results indicate that clinical testing of these all-ceramic crowns is reasonable. Controlled, clinical, long-term evaluation is necessary to assess the safe application of these new crown systems.