Monoclonal antibody-drug conjugate therapy for the patients with colorectal cancer.

Monoclonal antibody drug conjugate A7 was prepared from a mouse splenocyte immunized against human colon cancer. A7 reacted with 80 percent of colorectal cancer and pancreatic cancer. A7 was bound covalently to neocarzinostatin (NCS) to form A7-NCS. A7-NCS had strong cytotoxic activity in vivo and in vitro study. A total of 77 patients with colorectal cancer, including the patients with liver, lung and peritoneal metastasis, were treated with A7-NCS. There were some tumor reduction of liver metastasis on CT scan and pain relief. Follow up study of colorectal cancer patients treated with monoclonal antibody drug conjugate A7-NCS was carried out, with comparing to those treated conventional chemotherapy. Survival rate of the patients with postoperative liver metastasis treated with A7-NCS was slightly higher than that of the patients treated with conventional intraarterial infusion chemotherapy. There was no difference between the group treated with A7-NCS and that treated with conventional chemotherapy in the overall postoperative survival. Patients given a higher dose of the conjugate had a higher survival rate. There were no serious adverse effects in the patients given A7-NCS. Human anti-mouse antibody (HAMA) was detected in all A7-NCS treated patients.


Characterization and the clinical application of cultured human pulmonary carcinoma cells.

We had developed a new method for the selective cultivation of cancer cells in short-term. As a result of these improvement in the culture technique, long-term subcultures of cancer cells are possible in about 80% of cases of small cell carcinoma of the lung and nearly 40% of cases of non-small cell carcinoma of the lung. 23 small cell lung carcinoma (SCLC) cell lines, 48 non-SCLC cell lines and 4 metastatic lung tumor cell lines were established in our institute using the culture method. Fractional culture of cells exhibiting the same growth pattern in primary culture produce several subtype cell lines, which can be used in experimental studies of the heterogeneity of lung cancer and in treatment of patients with lung cancer. Using subcultured cancer cells of the second or third generation, we have developed and have clinically utilized a simple sensitivity test with a Terasaki's microplate for anticancer drugs. In 15 surgical patients with SCLC treated between April 1982 and March 1985, the sensitivity test was used to select optimal anticancer drugs for postoperative chemotherapy. The routine use of the sensitivity test in selecting postoperative chemotherapy definitely improved the 3-year survival rate from 38% to 52%.


Control of growth and differentiation of Philadelphia chromosome-positive leukemia cells by tyrosine kinase inhibitors.

Herbimycin A, a selective inhibitor of tyrosine kinase activity, induced differentiation of leukemia cells isolated from Philadelphia chromosome-positive chronic myelogenous leukemia patients. However, it did not induce differentiation of leukemia cells from acute myelogenous leukemia patients, although these cells could be induced to differentiate by treatment with appropriate compounds. A selective inhibitor of tyrosine kinase might be useful in chemotherapy of Philadelphia chromosome-positive leukemia.


Protein kinase C activity in human leukemia cell lines with reference to sensitivity to antineoplastic agents.

Protein kinase C (PKC) regulates many cellular processes. In view of its possible relevance to the drug resistance, the levels of PKC activity were assessed in human leukemia cell lines with reference to the sensitivity to antineoplastic agents. K562/ADM exhibited approximately 2-fold higher levels of PKC activity as compared with the parental K562. After a 1-hr preincubation with Adriamycin (ADM) (0.5, 1, 10 microM), PKC activity in K562 tended to increase dose-dependently, while no substantial alteration was found in K562/ADM. Cisplatin (CDDP) or etoposide was of no effect. The activity in THP-1/E was slightly lower than THP-1, and the basal level stayed unchanged with any one of the above drugs. These results suggest that in K562 increase in PKC activity with ADM may play a role in the process of acquisition of resistance.


Tumor localization and biodistribution with radiolabeled monoclonal antibody against pancreatic cancer in tumor-bearing nude mice.

Nd2 is a murine monoclonal antibody produced against a mucin fraction purified from xenografts of a human pancreatic cancer cell line SW1990. Immunoperoxidase staining showed that the antigen recognized by Nd2 was present in 82.9% of pancreatic cancer tissues but not in tissues of normal pancreas and chronic pancreatitis. However Nd2 antigen was found not to be elevated in the sera of patients with pancreatic cancer. Four days after injection of 111In-Nd2 into athymic nude mice bearing SW1990 xenograft there was a higher accumulation in the tumor compared to 111In-normal mouse IgG1. When these mice were scanned with a gamma camera, labeled Nd2 was shown to accumulate in the tumor rapidly on the 1st day after injection and by the 4th day tumor accumulation was more distinctly visualized than non-specific accumulation in liver. These results indicate that Nd2 has high specificity and reactivity for pancreatic cancer and may have possible applicants in radioimmunodetection or targeting of therapeutic drugs in pancreatic cancer.


The difference in immunological properties between lymph node metastatic and non-metastatic cell lines of MCA-induced fibrosarcoma of C4W mice.

To pursue the process of lymph node metastasis, i.e, the preferential tumor growth in lymph node, we have established the non-metastatic M2B cell line which was derived from 3-methylcholanthrene-induced fibrosarcoma of C4W mouse and a metastatic cell line, M2BLN-M+ which was obtained from metastatic lymph nodes of irradiated C4W mouse which was subcutaneously implanted with cultured tumor cells, because implanted tumor cells were derived from the spontaneous metastatic lymph node of the parental M2B tumor, but regressed in naive C4W mouse. We examined the characteristics of both tumor cell lines in terms of the immunological cellular interactions. M2BLN-M+ showed unexpectedly to be more susceptible to cytotoxicity of immune effectors (NK cell, macrophage and cytotoxic T lymphocyte) than M2B did. When cultured both tumor cells with these effector cells, the growth inhibition of M2BLN-M+ was greater than that of M2B. The regional lymph node of tumor-bearer, however, showed no effective cytotoxic activity as reported by others. On the contrary, when cultured both tumor cells with non-immune lymph node cells, to be surprised, the proliferation of M2B was markedly suppressed, while that of M2BLN-M+ was slightly inhibited. The lymph node cells of M2B-bearing mice showed stronger cytostatic activity to M2B. The results suggest that the cytostatic activity of lymph node cells will be a pivotal factor, concerning the establishment of lymph node metastasis.


Augmented accumulation of transferred lymphokine-activated killer (LAK) cells at murine tumor sites through production of LAK-attractant facilitated by chemotherapy.

We observed that effects of adoptive immunotherapy with lymphokine-activated killer (LAK) cells on BMT-11, a fibrosarcoma in C57BL/6 mice were improved by combination with cyclophosphamide (CY)-chemotherapy corresponding to enhanced accumulation at tumor sites of LAK cells. On the other hand, cytotoxic T lymphocytes (CTLs) which were able to accumulate at tumor sites more densely than LAK cells produced significant therapeutic effects by themselves. We have also found observed that LAK-attractant activity was detected in conditioned medium (CM) of CY-treated tumor tissue but not in the CM of untreated tumor tissue. These findings reveal that CY-chemotherapy facilitates LAK-attractant-production and enhances the accumulation in tumor tissue of LAK cells and that therapeutic effects of adoptive transfer of LAK cells are augmented by cancer chemotherapy through the enhanced accumulation of LAK cells.


The role of complement receptors in tumor cell destruction.

Murine peritoneal macrophages exuding early after stimulation with the activators of the alternative complement pathway are able to destroy some of the tumor cells. This destruction is inhibited by anti-Mac-1 and anti-C3. The tumor cell killing needs longer incubation time (> 15 hr), and anti-Mac-1 affects the reaction even if it were put into the reaction mixture at later time of incubation. The results suggest that complement produced by macrophage is deposited onto target cells, and the complement binding targets interact with macrophages through the complement receptor type 3 (CR3), which leads to the cell destruction. It is known that fully activated macrophages kill the tumor cells with the aid of antibody (ADCC) or lectin, but we show here another route of tumor cell destruction, that is, some sort of incompletely activated macrophages can kill some type of tumor cells in cooperation with endogenous complement and complement receptors (CR3) without participation of antibody.


Antitumor activity of new antitumor substance, polyoxomolybdate, against several human cancers in athymic nude mice.

Antitumor polyoxomolybdates have been recognized in the course of study on the medical utilization of polyoxometalates, inorganic polymers of metal oxide. [NH3Pri]6[Mo7O24].3H2O (PM-8) was found as a representative of antitumor polyoxomolybdates. The growth suppressions of PM-8 against Co-4 human colon cancer xenografted under the subrenal capsule in cd-1 mice were equal or superior to that of 5-FU, MMC, ACNU, ADM and CDDP. Potent antitumor activity of PM-8 is also established against MX-1 human breast and OAT human lung cancer xenografted in athymic nude mice. Polyoxomolybdate is a new type of antitumor substance.


Which postoperative combined therapy results in the best prognosis: radiochemocytokine therapy or aggressive chemotherapy?

The recurrence of esophageal cancer involving regional nodes, even in patients who have undergone curative surgery, often takes place within three years after surgery. Thus, a new multidisciplinary treatment including cytokines or aggressive chemotherapy with active nutritional support to improve the prognosis in cancer of the thoracic esophagus has been adopted.


Tumor radiotherapy monitoring with radioscintigraphy tracers: a comparative study with multiple-tracer technique.

A comparative multiple-tracer study was performed to assess the tracer feasibility of monitoring tumor radiotherapy. Metabolic tracers for glucose, amino acid, nucleic acid metabolism: F-18-FDG, C-14-Met, H-3-Thd, and F-18-FdUrd and conventional Ga-67 were compared in the same AH109A radiotherapy model using a new quadruple-tracer technique. F-18-FDG showed a large uptake change and a steady response to radiotherapy which is similar to Ga-67. F-18-FdUrd showed a rapid decrease, but the range of change in uptake was narrow. H-3-Thd and C-14-Met showed a rapid response to irradiation and a high sensitivity for monitoring radiotherapy, suggesting that if labeled with C-11, they may be feasible for PET study.


Impacts of the evolutionary concepts of cancer on the study of human diseases.

Evolutionary concepts of cancer (Okuyama and Mishina 1984; 1990) have already been found useful in understanding carcinogenesis and anti-cancer defense lines in the body and various cancer attributes. The concept of endosymbiotic disorders gave an impact upon the science of internal medicine leading to discovery of amitosis in Reed-Sternberg cells, a primitive eukaryotism (Okuyama 1991a). A novel concept of vasogenic necrosis was also developed for such diseases of Perthes' disease, cerebral vascular diseases and myocardial infarction: costs of bipedalitic evolution in man.


Analysis of human cytochrome P450 catalytic activities and expression.

Cytochromes P450 are a large group of membrane-associated heme protein monooxygenases, most of which are responsible for metabolizing foreign compounds. Chemical carcinogens, which are ingested or absorbed into the body as inert forms, are metabolically activated by P450s to electrophilic metabolites capable of binding to and mutating DNA. Different P450 forms are responsible for activation of the various classes of chemical carcinogens including the arylamines, polycyclic aromatic hydrocarbons, nitrosamines and aflatoxins. Thus, the cellular constituency and levels of P450s could determine the fate of a particular carcinogen and the risk of humans to exposure. To study the catalytic activities of human P450s, human P450 cDNAs were cloned and expressed into active enzymes using cultured cells. By both transient and stable cDNA expression systems, several human P450s were found to be capable of metabolically-activating the human hepatocarcinogen aflatoxin B1. These cDNA expression systems can also be used to determine whether an unknown chemical will be activated by a human P450 and thus be toxic or mutagenic in humans. To assess the extent of interindividual variation in P450 expression, probes developed from P450 cDNAs are being used to quantify levels of P450 mRNAs in various human tissues. Studies using RNase protection revealed that the closely related CYP2B6 and CYP2B7 mRNAs could be independently quantified in liver and lung, respectively. This procedure can be used to examine expression of different P450 genes in banks of human tissue specimens.


Molecular genetics of the human cytochrome P450-dependent monooxygenases.

In this work, the role of genetic as well as environmental factors in determining cytochrome P450 isozyme levels in man have been studied. Simple DNA based assays for the identification of individuals nulled at the CYP2D6 locus are described and have been applied to investigate whether this gene defect is associated with altered cancer susceptibility. In contrast to literature reports, in no cancer type were poor metabolizers underrepresented, indeed in several cancers the mutant allele frequency was increased. A model using human tumours grown as xenografts is described that should help elucidate the factors which regulate P450 levels in man.


Human fetal liver cytochrome P-450: capacity to form genotoxic metabolites.

Unlike most experimental animals, human fetal liver possesses forms of cytochrome P-450. Thus, the purpose of this study was to clarify the toxicological significance of these forms of cytochrome P-450 to understand possible roles of these cytochromes in producing genotoxic metabolites from promutagens. In fact, human fetal livers showed considerable capacity to activate aflatoxin B1 and IQ (2-amino-3-methylimidazo [4,5-f] quinoline). Three of four forms of cytochrome P-450, P-450HFLa-d, which we could purify from human fetal livers were capable of activating promutagens to mutagens. One of these three forms, namely P-450HFLa, catalyzed the metabolic activation of aflatoxin B1 and IQ. An expression plasmid containing HFL33 cDNA encoding P-450HFLa was constructed and the protein expressed in insect (Sf9) cells and in human cancer cells, MCF-7. Aflatoxin B1 was efficiently activated to a mutagen upon addition of the lysate of Sf9 cells to the incubation mixture for the assay. Transformants of MCF-7 cells expressing P-450IIIA7 (HFLa) showed higher sensitivity to aflatoxin B1 than the parental MCF-7 cells as detected by cytotoxicity.


Specific expression of glutathione S-transferase Pi forms in (pre)neoplastic tissues: their properties and functions.

The detection of preneoplastic cells is very important for the analysis of carcinogenic processes and for developing strategies for prevention and treatment of cancer. We have been investigating enzyme alterations occurring during rat chemical hepatocarcinogenesis, especially to find more specific enzyme markers for preneoplastic hepatic lesions. We identified the placental form of glutathione S-transferase (GST-P; GST 7-7) as a new marker enzyme for preneoplastic hepatocytes. We also found human placental form, GST-pi, to be a possible tumor marker for various human tissues except liver. In this article, their properties and possible functions are reviewed on basis of our recent investigations. A peroxisomal enzyme, enoyl CoA hydratase, in also described as a possible negative marker for rat preneoplastic hepatic foci/nodules and hepatomas induced by peroxisome proliferators.


Congenital hypothyroidism in Turkey: a retrospective evaluation of 1000 cases.

In this retrospective investigation, 1000 cases of congenital hypothyroidism followed-up in the Pediatric Endocrinology Unit at Hacettepe University Children's Hospital between 1964-1989 were evaluated with respect to age at diagnosis, main complaints, symptoms and physical findings. The mean age at diagnosis was 49.22 months, with 55.4 percent of patients diagnosed after two years of age and only 3.1 percent during the neonatal period. The main complaints of the patients were growth failure (26.7%), inability to speak (21.4%), and inability to walk (18.1%). The physical signs and symptoms most commonly detected by the physician were hypotonia (72%), constipation (66.8%), cretinoid face (64.6%), and macroglossia (64.6%). These results emphasize the necessity for routine neonatal screening programs to be established in Turkey, with the aim of detecting congenital hypothyroidism.


Effects of intravenous immunoglobulin on clinical and immunological findings of patients with humoral immunodeficiency diseases.

We evaluated nine patients with humoral immunodeficiency (6 immunodeficiency with hyper-IgM, 2 X-linked agammaglobulinemia, 1 common variable immunodeficiency) who were being treated with intravenous immunoglobulins (IVIG). After the use of the IVIG regimen in a dose of 250-300 mg/kg/4 weeks for one year, the severity and frequency of infections, even in patients with chronic lung disease, decreased significantly. An improvement in pulmonary function tests was observed in four patients who had airway obstruction prior to IVIG therapy. Side effects such as chills and fever were observed in 21 of 91 infusions, particularly in the early months of therapy. Preinfusion administration of aspirin and diphenhydramine prevented these side effects. The inversion of the CD4+/CD8+ ratio was detected in most patients during both intramuscular gammaglobulins (IMIG) and IVIG therapy.


Membranoproliferative glomerulonephritis in sibs.

Idiopathic membranoproliferative glomerulonephritis (MPGN) is a chronic renal disease with variable clinical expression and several distinct morphological subtypes. Two sibs, aged 10 and 13, presented with clinical and laboratory findings of MPGN at the time of admission. After an interval of one year, the diagnosis of MPGN was established by renal biopsies. The complement pathway was unremarkable. HLA typing in the unrelated parents and the two male sibs revealed common HLA A2,A11,Bw60, DR2,DQw1 antigens in the brothers. Of these antigens, A2 has been reported previously in cases of MPGN. The other antigens regarding this disease need to be evaluated from the standpoint of genetic importance.


Use of single voided urine samples to estimate quantitative proteinuria in children.

Quantitation of protein excretion in urine is used for diagnostic and prognostic purposes and also to assess the effects of therapy in children. The method in common use is to measure urinary protein in a 24-hour urine sample, which may be time consuming and is often inaccurate. The aim of this study was to determine if the urine protein/creatinine ratio in a single-void urine sample had a high correlation with the quantity of protein in a 24-hour urine specimen. We found that there was an excellent correlation between the protein content of a 24-hour urine excretion and the protein/creatinine ratios in single morning urine samples of 50 patients. We also discovered that a protein/creatinine ratio greater than 4.9 could signify "nephrotic-range" proteinuria, while a ratio less than 2.5 indicated nephritic syndrome or other renal diseases. We concluded that the determination of urinary protein/creatinine concentration ratios in a single morning urine sample under most clinical circumstances, especially in nephrotic syndrome, could replace the measurement of protein excretion in 24-hour urine specimens.


Analyses of serum vitamin D-binding protein, ceruloplasmin and copper levels in preterm infants.

The cord blood specimens of 12 preterm and 20 term babies were investigated. We determined serum calcium (Ca), phosphorus (P), magnesium (Mg), vitamin-D binding protein (DBP), ceruloplasmin (Cp) and copper (Cu) levels in two groups. We found that Ca, P, and MG levels of cord sera did not differ between the groups (p > 0.05), but DBP, Cp and Cu values showed a significant decrease in the preterm group (p < 0.05). The Cu and Cp values of the preterm infants correlated with those of the term infants.


Two-dimensional and Doppler echocardiography in the diagnosis of absent pulmonary valve syndrome (surgery without catheterization).

The majority of severely affected infants with absent pulmonary valve syndrome develop varying degrees of respiratory distress. Cardiac catheterization and angiocardiography are still performed in the diagnosis of these infants prior to surgery. However, considering the high risks of these invasive investigations for severely symptomatic infants, diagnosis using only noninvasive methods becomes important. In this regard, we present three cases of absent pulmonary valve syndrome, diagnosed pre-operatively by both two-dimensional and Doppler echocardiography. The diagnosis was confirmed by cardiac catheterization and angiocardiography in two cases and by surgery in a symptomatic infant. Therefore, we are of the opinion that the two-dimensional and Doppler echocardiographic methods are most reliable in diagnosing absent pulmonary valve syndrome, and that severely symptomatic infants can be referred for surgery without catheterization.


Craniosynostosis: a review of 143 surgically-treated cases.

In this study, 143 cases of craniosynostosis are presented. There were 109 males and 34 females. The major complaints were skull deformity (92 patients), proptosis (38 patients) and microcephalus (32 patients). Neurological examination revealed the presence of optic atrophy in 24 patients and papilledema in 20 patients. Seventy-four patients (53%) had three or more suture closures, with the sagittal suture being the most commonly involved (20% of patients). All patients underwent surgery. Suture removal was performed in 131 patients (91.7%), suture removal plus orbital decompression in 34 (23.8%), and linear craniectomy plus wrapping in 12 (8.3%). The reoperation rate was 6.2 percent. During the follow-up period, preoperative papilledema and proptosis improved in 88.2 and 78.9 percent of patients, respectively. Skull deformity disappeared in 46.9 percent of patients, but remained unchanged in 16.6 percent.


Intussusception due to ectopic pancreatic tissue in a nine-month-old child.

Ileo-colic intussusception was diagnosed in a nine-month-old male infant who presented with abdominal distention, irritability, and bilious vomiting. After reduction of the invaginated segment, a mass measuring one cm was palpated at the antimesenteric border of the terminal ileum. Pathological examination of the mass revealed ectopic pancreatic tissue, which most likely caused the intussusception.


Primary lymphedema precox of the penis and its surgical treatment: a case report.

Primary penile lymphedema occurs infrequently and is seen in conjunction with a similar process in the scrotum. The accepted form of treatment is surgery since conservative medical treatment is of little value. Different surgical techniques have been described, but no single procedure has emerged as the ideal treatment. Radical excision of all lymphedematous tissues and reconstruction using local penile flaps yield excellent functional and cosmetic results. We treated a 13-year-old boy with primary penile lymphedema precox using radical excision and reconstruction with local penile flaps. At follow-up two years later, functional and cosmetic results were satisfactory.


A case of juvenile chronic myeloid leukemia with XX/XXX mosaicism.

Cytogenetic abnormalities are rarely found in patients with juvenile chronic myelogenous leukemia (JCML). In patients with chromosomal abnormalities, chromosomes 7 and 8 are usually involved. A case of JCML with 47 XXX and a 46 XX karyotype is described and the literature is reviewed. To our knowledge, this is the first case ever to have been reported.


Accidental falls and injuries among seniors.

This study analyzes data on accidental falls for those aged 65 and older. The data are based on mortality statistics from 1980 to 1989 and morbidity statistics from 1985 to 1989. These statistics are provided to the Canadian Centre for Health Information by the provincial governments. Mortality rates and hospital separation rates for accidental falls are highest for those aged 65 and older. Accidents are one of the leading causes of death and hospitalization among seniors. In 1989, for those aged 65 and older, accidental falls accounted for 56% of accidental deaths and 65% of accident-related hospital separations. Mortality and hospital separation rates for accidental falls increased with age. For those aged 65 and older, the mortality rates for accidental falls were higher for men than women. However, the accident-related hospital separation rate was higher for women than men. The reason for this difference is not fully understood, but it has been suggested that while more women fall than men, more men seriously injure themselves. For men requiring hospitalization due to accidental falls, the most common injuries, in descending order, were fractures of the hip, ribs, vertebral column, humerus, and pelvis. For women, the most common injuries were fractures of the hip, humerus, radius and ulna, pelvis, and ankle. Of fall-related injuries resulting in hospitalization, hip fractures were the leading cause of death and proportionately more men than women died of hip fractures.


Measures of outside care given and received by seniors.

Selected data from Cycle 5 of the 1990 General Social Survey are presented in this study. Among other topics, this article focuses on the provision of caregiving services to the population aged 65 and over by persons outside the recipients' household. Although assistance is often received from family members, it is also provided by friends, neighbours, and other members of the community. Persons whose health was good or excellent were more likely to be caregivers than those who rated their health status as poor. However, several persons in the latter category did offer their support despite their poor health. Satisfaction with the aspects of life examined in this study did not vary markedly between caregivers and non-caregivers.


Effects of anticonvulsant drugs on thyroid hormones in epileptic children.

Serum total and free thyroid hormones, reverse T3 (rT3), thyroxin binding globulin (TBG) and thyroid stimulating hormone (TSH) concentrations were measured in 35 epileptic patients receiving anticonvulsants (phenobarbitone, phenytoin). There was a significant reduction found in total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), free triiodothyronine (FT3) and rT3 in the group treated with, phenytoin. The thyroid hormone levels were within normal limits in the group receiving phenobarbitone.


Does this patient need a narcotic injection? A descriptive analysis of decision making.

Thirty six nurses divided into three groups were asked in a series of three questionnaires to evaluate patients' needs for post-operative narcotic pain relief. Using a decision-analytic procedure, which combined a version of the Delphi technique and the multi-attribute utility approach, the six most salient criteria in order of priority were identified. These criteria were then tested in the clinical situation using a series of scenarios. A difference between how nurses purportedly evaluated patients' needs for narcotic pain relief and what they actually did in hypothetical clinical situations was found. The theoretical implications of these results are discussed.


Reductions in age-specific mortality among children and seniors in Canada and the United States, 1971-1989.

We compared mortality rates for children and seniors in Canada and the United States in 1971 and 1989. Children in Canada experienced a greater decrease in mortality during this period than did all children in the United States. In particular, while mortality rates for both boys and girls in Canada were higher than those for White children in the United States in 1971, in 1989 the rates for Canadian children were lower. Seniors in Canada experienced a similar or lesser reduction in age-specific mortality than did seniors in the United States. Even though senior women in the United States experienced a reduction in mortality comparable to that of senior women in Canada, Canadian senior women in general had lower level of mortality than their counterparts in the United States. Senior men in the United States experienced a relatively greater reduction than did their counterparts in Canada. The greater decline in mortality for senior men in the United States enabled them to catch up with the lower level of mortality for their Canadian counterparts in 1989. These general conclusions apply whether we compare the Canadian experience to that of the entire population or the White population in the United States. These trends in mortality reductions may reflect the fact that free universal Medicare is available for all ages in Canada, while most publicly-funded Medicare entitlements begin at age 65 in the United States.


Transforming mediocrity to excellence: a challenge for nurse leaders.

A grounded theory study of nursing leadership in Western Australia was undertaken to shed light on complex contextual and individual variables associated with nursing leadership. By applying the constant comparative method of data analysis, the core problem facing nurse leaders was identified as overcoming and compensating for disadvantage related to a repressing context which impeded the movement of nursing from retardation and mediocrity, through turbulence and toward excellence. Following a long period of stagnation (reflecting mediocrity in the nursing system) and a shorter evolutionary phase, revolutionary changes were being implemented, creating an extremely turbulent environment. Findings revealed that nurse leaders used a core process labelled optimising to deal with the core problem and to achieve influence and advancement. This process had progressive phases identified as surviving, investing, and transforming. Failure to optimise led to floundering. Transforming reflected exceptional performance or excellence and involved using the optimising strategies of reversing negative situations and creating additional resources to achieve influence and significant advancement or change in the nursing system. This study has implications for leadership practice, for the development of future leaders and for future research and theory development.


An investigation of the increase in preschool-age asthma in Manitoba, Canada.

Asthma has long been a major cause of illness and disability among young Canadians. From 1970-71 to 1987-88, hospital admissions for asthma increased significantly among Canadian children under the age of fourteen. Many hypotheses may explain this increase in asthma prevalence. There could be a true increase in the number of people developing symptoms of the disease or increased asthma rates could be an artifact due to changes in detection, diagnosis, treatment, or coding. This study reviews hypotheses put forward to explain the increase in asthma prevalence, and tests some of them in Manitoba for children aged 0-4. Physician claims data and hospital separation data were merged to create unique person oriented medical records. These records were used to estimate the number of children seeking medical services for asthma during a five-year period (1984-85 to 1988-89) and the change in rates over this time period. From 1984-85 to 1988-89, both prevalence and incidence rates for children less than five years of age increased. Prevalence rates showed strong seasonal peaks in the spring and the fall. There is no indication that asthma increased in severity. The hospitalization rate (the number visiting a hospital for asthma divided by the total number seeking medical care for asthma), the average number of hospital admissions per year, and the average number of days spent in a hospital per year did not increase. Levels of ozone (O3) and nitrogen dioxide (NO2) in downtown Winnipeg increased over the study period and asthma prevalence increased twice as fast in Winnipeg as in the rest of the province. For Manitoba, the increase in preschool-aged asthma does not appear to be due to increased use of medical services, a change in ICD coding, an increase in the severity of the cases, or a decrease in income levels. The increases appear to be at least partly due to changes in diagnostic practices. The relationship between asthma and air pollution needs more detailed study as pollution is likely to be an important factor, particularly during the spring. Other areas for further investigation are changes in allergy and virus precursors, maternal smoking, and increased levels of pollens, molds and dust mites.


Passing school biology: a predictor of success in nursing science courses?

A correlation was found between students' SA Year 12 public examination school biology scores and subsequent success in an undergraduate nursing science course. The group of students most successful in science courses had a higher mean school biology score than the group who were least successful. Some mature age students with no background in science were able to perform as well as those who had passed publicly-examined biology at school. Hence biology should not be a prerequisite for mature age entrants.


Demographic trends of marriages in Canada: 1921-1990.

This paper mainly describes levels and trends of marriages and rates and its relationship with demographic and social conditions in Canada from 1921 to 1990. In Canada, the propensity to marry was much higher in the 1960s and early 1970s than in the 1980s. A similar tendency was observed for a few years prior to, and at the beginning of, World War II and a couple of years after. The number of marriages peaked at an all time high of 200,470 in 1972 with a rate of 44.3 per 1,000 unmarried population aged 15-59. By 1986 the number of marriages had declined by 12.4% and the rate by 33.2%, but both the number of marriages and the rate increased marginally in the following three years. Since 1921 the average age at marriage has increased by 3.6 years for brides and 1.7 years for grooms. The proportion of marriages by previously divorced persons increased sharply after 1968. The changes in marriage rates in Canada parallel those exhibited in the United States and other developed countries in the western hemisphere.


Management of patients with ovarian cancer using monoclonal antibodies.

We describe in detail the current trend using monoclonal antibodies to diagnose ovarian cancer either in vitro or in vivo. The approach with such powerful reagents allows to differentiate in vitro tumor histotypes and to detect in peritoneal washings the presence of a few neoplastic cells which characterize the minimal disease. The detection of elevated sera levels of ovarian cancer-associated antigens, such as CA-125 and TAG-72, allows the monitoring, follow-up of these patients and the response to therapy with great accuracy. We focused our attention on the role in vivo of labelled monoclonal antibodies, mainly for diagnostic purposes. Radioimmunoscintigraphy has been found to be more reliable than CT and US to detect foci of disease mainly in patients already treated by surgery, overcoming all the problems usually encountered with these two procedures.


Current status of interleukin-2 therapy in cancer.

In vitro studies and animal experiments showed the existence of a physiological immune response against tumors. Interleukin-2 was the first immunological agent which demonstrated an anti-tumor effect by activating immune effectors. In vitro IL2 may generate Lymphokine Activated Killer (LAK) cells from peripheral blood lymphocytes or Tumor Infiltrating Lymphocytes (TIL) expanded from tumor. In melanoma and renal cell carcinoma, IL2 alone or associated with LAK cells or TIL, mediated clinical responses. However, their clinical efficacy was associated with some toxicity related to a capillary leak syndrome. This implies an improvement in the selection of patients and in the understanding of IL2 action. Future directions in immunotherapy included combination IL2 with other cytokines or monoclonal antibodies or chemotherapy. Lymphokine gene therapy is designed to introduce IL2 or other cytokine genes into tumor infiltrating lymphocytes or directly into tumors to reduce systemic toxicity and to achieve high local cytokine concentration. Animal models and the first human trials make this approach promising.


Variation of choline-substituted lipid metabolism in doxorubicin-resistant leukemia cells.

In adriamycin-resistant murine (FLC) and human (K562) leukemia cells, phosphatidylcholine increases and phosphatidylethanolamine decreases compared to adriamycin-sensitive lines. This change is due to an increase in phosphatidylethanolamine methylation. The choline pathway of phosphatidylcholine biosynthesis is also disturbed in resistant cells with a blocking step of CDP-phosphocholine transferase and a decrease in sphingomyelinase activity. These changes in phospholipid metabolism are suggested to be responsible for the changes in membrane fluidity reported previously (Tapiero et al, 1986) for resistant cells.


Anti-infectious effect of C granulosum-derived P40 immunomodulator given by aerosolization and intranasal instillation.

It is known that C granulosum-derived P40 immunomodulator displays strong anti-microbial effects in mice by the intravenous route. Since microbial contamination of humans occurs in many instances via the airways, the effect of P40 on infections was investigated when it was given intranasally or by aerosolization. In order to augment its bioavailability, P40 was derivatized by coupling with polylysine chains (P40-PL). The results showed that P40-PL exercised a significant protective effect, both by the intranasal route and by aerosolization on both influenza and K pneumoniae infections produced by aerosolization or intranasal instillation. Stimulation of the phagocytic capacity of alveolar macrophages by these types of treatment is likely to account for the increased resistance of mice toward microbial infections.


Nitric oxide mediates the depression of lymphoproliferative responses following burn injury in rats.

Among the multiple biological activities of nitric oxide (NO) an immunoregulatory role consisting of the mediation of macrophage suppressive activity, has recently been evidenced. In the present work, we investigated whether NO was implicated in immunosuppression following burn injury. Thermal injury affecting 20-25% of the total body surface area in Wistar rats, provoked a biphasic depression of spleen cell proliferative responses to phytohemagglutinin (PHA) and concanavalin A (Con A). We show that these responses are fully restored on day 4 after burn and only by 55% on day 10 when spleen cells were stimulated in the presence of NG-monomethyl-L-arginine (NMMA), a potent inhibitor of the macrophage inducible NO synthase. Nitrite content in culture supernatant, as an indicator of NO release (in the absence of NMMA), was significantly augmented in Con A-stimulated spleen cells from burned rats as compared to normal spleen cells. These results show for the first time that NO is implicated, at least in part, in an immunosuppression state which is not linked to an infectious disease.


The dynamics of a hydrogel strip.

A hydrogel strip relaxes when it is stretched. The decay in tensile stress can be ascribed primarily to strain-induced swelling of the polymer network--a result that follows from a continuum model of the gel-solvent system. An equation of motion and a linear constitutive law of the polymer network, Darcy's law, and the conservation of mass of the network and interstitial fluid are solved with boundary and initial conditions appropriate for a stress-relaxation experiment. This model predicts that the time constant of decay depends inversely upon the square of the thickness of the sample. This result is confirmed by experiments. In addition, the network shear modulus, mu, bulk modulus, k, and hydraulic permeability, 1/f, which are estimated by non-linear regression, all agree with measurements obtained using other methods.


Mathematical model of the filtration in the vascular network of the ophidian glomerulus.

The present work is a mathematical model of the fluid filtration in the glomerular network occurring in snakes. The model is based on the differential form of Starling's hypothesis and takes into account the angioarchitecture of the network and the behaviour on the microrheology of blood with nucleated red cells. The model predicts the hemodynamics and the transvascular fluxes in each vascular segment within the network. The model is applied to a vascular network of the glomerulus of the garter snake. A value of 0.593 microns/(s.mmHg) was determined for the hydraulic conductivity of the glomerular capillaries using the geometrical data of the network together with experimental data for the pressures and the blood flow rate reported in the literature. The analysis shows that the local filtration rates cover a wide range. In some of the vascular segments, the filtration leads to such a high increase in colloid-osmotic pressure that the level of the transvascular hydrostatic pressure difference is reached. Mathematical simulations of the variation of the glomerular blood flow rate due to vasoactivity of preglomerular arterioles show the effect on the filtration rate and the hemorheologic parameters.


influence of concentration and mannuronate/guluronate [correction of gluronate] ratio on steady flow properties of alginate aqueous systems.

Steady flow properties were measured at various concentrations for aqueous systems of alignates with different mannuronate/gluronate (M/G) ratios using a cone-plate type rheometer. The flow curve (a plot of shear stress vs. shear rate) shows a plateau region, which is ascribed to a heterogeneous structure, at low shear rate. This plateau region is more noticeable in the G-rich systems than in the M-rich systems. On the other hand, the flow curves for the systems with the same molecular weight but different M/G ratios are congruent in the high shear rate region. The zero shear viscosity can be reduced by the segment contact parameter, cMw, for the alginates with the same M/G ratio but different molecular weights. The zero shear viscosity is proportional to cMw in a low concentration region and is proportional to (cMw)3.4 at relatively high concentrations. The critical value of cMw for which the zero shear viscosity changes from proportionality with cMw to proportionality with (cMw)3.4 is ca. 900.


Experimental analysis of the influence of stenotic geometry on steady flow.

We studied the flow behavior under steady flow conditions in four models of cylindrical stenoses at Reynolds numbers from 150 to 920. The flow upstream of the constrictions was always fully developed. The constriction ratios of the rigid tubes (D) to the stenoses (d) were d/D = 0.273; 0.505; 0.548; 0.786. The pressure drop at various locations in the stenotic models was measured with water manometers. The flow was visualized with a photoelasticity apparatus using an aqueous birefringent solution. We also studied the flow behavior at pulsatile flow in a dog aorta with a constriction of 71%. The flow through stenotic geometries depends on the Reynolds number of the flow generated in the tube and the constriction ratio d/D. At low d/D ratios, (with the increased constriction), the flow separation zones (recirculation zones, so-called reattachment length) and flow disturbances increased with larger Reynolds numbers. At lower values, eddies were generated. At high Re, eddies were observed in the pre-stenotic regions. The pressure drop is a function of the length and internal diameter of the stenosis, respective ratio of stenosis to the main vessel and the Reynolds numbers. At low Re-numbers and low d/D, distinct recirculation zones were found close to the stenosis. The flow is laminar in the distal areas. Further experiments under steady and unsteady flow conditions in a dog aorta model with a constriction of 71% showed similar effects. High velocity fluctuations downstream of the stenosis were found in the dog aorta. A videotape demonstrates these results.


Correlation between rheologic properties and in vitro ciliary transport of rat nasal mucus.

The relationship between mucus rheologic variables and in vitro ciliary transport was investigated in mucus samples collected from the upper airways of 30 Wistar rats. In vitro mucus transportability was determined by means of the frog palate preparation. Rheologic evaluation was done by measuring the rigidity modulus (log G*, representing the vectorial sum of viscosity and elasticity) and the loss tangent (tan delta, i.e. the ratio between viscosity and elasticity) at 1 and 100 radian/s using a magnetic microrheometer. The correlation between the rheologic variables and in vitro mucus transportability was made by stepwise multiple linear regression analysis, with frog palate transport rate considered as the dependent variable. A significant relationship was obtained between the rheologic parameters (log G* and tan delta) measured at 1 radian/s and the frog palate transport ratio. The relative speed of mucus samples was related to rheology according to the following relationship: rat/frog speed ratio = 1.666-0.434 log G*-0.331 tan delta, for G* and delta determined at 1 radian/s (multiple r = 0.666, p < 0.001). Transport rates predicted from the above formula gave a satisfactory fit to those observed in a second set of 30 rats. The present results indicate that the overall mucus impedance, as well as the ratio between viscosity and elasticity, are important in determining the efficiency of clearance. In addition, it was shown that measurements performed by applying relatively low frequency deformations are preferable for predicting ciliary transport.


Changes in the rheological properties of blood vessel tissue remodeling in the course of development of diabetes.

Rheological properties of blood vessels are expected to change in disease process if the structure of the vessel wall changes. This is illustrated in diabetes, which can be induced in rat by a single injection of Streptozocin. One of the rheological properties of the blood vessel is the stress-strain relationship. The nonlinear stress-strain relationship of arteries is best expressed as derivations of a strain-energy function. In this paper, the stress-strain relations are measured and the coefficients in the strain energy function of arteries are determined for diabetic and control rats. The meaning of these coefficients are explained. The influence of diabetes on the elastic property of the arteries is expressed by the changes of these coefficients. A point of departure of the present paper from all other blood vessel papers published so far is that all strains used here are referred to the zero-stress state of the arteries, whereas all other papers refer strains to the no-load state. The existence of a large difference between the zero-stress state and no-load state of arteries is one of our recent findings. We have explained that the use of zero-stress state as a basis of strain measurements reveals that the in vivo circumferential stress distribution is quite uniform in the vessel wall at the homeostatic condition. It also makes the strain energy function much more accurate than those in which the residual stress is ignored. Using these new results, the stress and strain distribution in normal and diabetic arteries are presented.


Dynamics of cell movement during the wound repair of human surface respiratory epithelium.

Epithelial wound repair represents an important process by which the epithelial barrier integrity recovers after wounding. To evaluate and quantify the dynamics of surface airway cell movement during the wound repair process, we developed an in vitro wounding model of human respiratory cells in culture and we analyzed the wound repair by using videomicroscopic and image analysis techniques. We observed that wound closure occurred within 6 hours, due to the spreading and migration of the cells surrounding the wounded surface. The migration rate of the cells at the leading edge of the wound surface increased progressively up to 26 microns/h during the repair process which was characterized by a uniform centripetal direction of cell movement. The distance travelled by these cells was 2.5 fold longer than the distance travelled by ciliated cells which were located far from the wound area. These results suggest that cell migration after wounding is an important process by which the respiratory epithelial barrier integrity is maintained.


Red cell membrane elasticity as determined by flow channel technique.

The elasticity of red cell membrane was determined in a rectangular flow channel under controlled shear flow. The relation between shear stress and cell extension ratio (lambda) has been analyzed with the use of Evans' two-dimensional model. The deformed cell shapes observed experimentally agreed well with the model with lambda up to 1.4. The best correlation was found at lambda = 1.2. The analysis suggests a nonlinear extensional membrane modulus in the low stress range encountered in the flow channel. In terms of an appropriate strain parameter, the elastic modulus is shown to rise toward the level encountered in micropipette aspiration experiments. The implications of the present findings in modeling of cell mechanics and in cell hemolysis are discussed.


An interpretation of partial plug flow of concentrated suspensions.

The partial plug flow of a concentrated suspension of rigid particles in a circular tube has been previously studied experimentally. It has been shown that a central core may exist in which the mean velocities of the particles and the suspending fluid are equal and constant within a cylindrical core of the flow. This behavior has been attributed to hydrodynamic interaction of the particles within the core. In the present analysis this interaction is interpreted in terms of passing vs. non-passing motions of adjacent particles. A hypothesis of a critical parameter alpha c involving the shear stress and the pressure gradient is explored and a new form of the relation of core diameter to particle size and concentration is developed based on alpha c.


Fabrication of glass micropipettes: a semi-automatic approach for trimming the pipette tip.

Micropipettes as research instruments are well established in cell biology, including blood rheology. However, the experimental results are, to some extent, dependent on the quality of the pipette itself; it is usually critical to have the desired pipette internal diameter and a perpendicular tip. Pipette fabrication is a two-step procedure involving: a) the pulling of the pipette from a glass capillary; b) the trimming of the pipette tip. A common method to trim and fracture the pipette tip is the use of a melted glass bead on a heated tungsten wire. Previous devices using this method were often associated with problems because the heated wire varied in length with temperature. As a result, the bead together with the attached pipette tip moved markedly and thus hampered the possibility to obtain a perpendicularly cut pipette tip. An improved design, based on the same principle with a melted glass bead, is thus suggested; it eliminates the problem with a moving glass bead and, in addition, allows semi-automatic pipette trimming by utilizing the heat-induced elongation/retraction of the heated wire to fracture the tip without requiring manual assistance. Furthermore, a simple pipette storing technique is suggested, based on standard laboratory utensils, in order to more easily handle fragile pipettes without risk of breakage.


Dysarthria associated with focal unilateral upper motor neuron lesion.

Speech motor changes in six patients with focal unilateral upper motor neuron (UUMN) lesions were characterised using a variety of techniques including listener judgements, speech acoustic analyses, electromyographic and strength measures. Listener judgements of speech understand-ability, intelligibility and dysarthric features indicated mild dysarthria. Diadochokinesis, electromyographic and strength measures corroborated these observations. The findings of this study delineate the characteristics of the dysarthria associated with unilateral upper motor neuron lesions and have important implications for identifying potential upper motor neuron components of other neurogenic disorders of speech and language.


Confrontation naming in the elderly: the Build-up Picture Test as an aid to differentiating normals from subjects with dementia.

This paper reports the results of a study in which the Build-up Picture Test (BUPT) was given to three groups of elderly subjects with 15 subjects in each group: independent, dependent and those with probable senile dementia of the Alzheimer type (SDAT). The BUPT is a task designed to combine confrontation and generative naming, incorporating priming, cueing and latency aspects to facilitate responses. It involves presentation of degraded line drawings of objects, built up in stages to black and white photographs of the objects. Results showed the scores by the probable SDAT subjects to be highly significant at the 1.00 level (P = 0.0000). Analysis of scores showed better than expected responses from the probable SDAT subjects to representations of familiar objects with simple outline shapes. The implications for differential diagnosis are discussed.


A model of the factors affecting interstitial volume in oedema. Part I: Hierarchies, some new factors and their equations.

A mathematical model has been constructed to investigate the alterations, in amount and in importance, of the Factors controlling interstitial fluid volume in a number of steady-state oedemas. There are many so-called "Safety Factors" (at least 15), including a whole group concerned with regulating the amount of protein in the tissues (and thus tissue colloidal osmotic pressure). They are often in long hierarchies (of even up to 11 Factors), each influencing the next. Sometimes a Factor is recursive, i.e., it influences itself (either positively or negatively) via a Hierarchy of other Factors. The effects of some Factors differ in different Hierarchies, i.e., an increase in the Factor will increase VI via some of the Hierarchies and decrease it via some other Hierarchies. Which effect is most important varies with the Hierarchies and conditions existing at the time. The Factors are best compared if expressed in the same units: ml/min/100g of tissue. This is possible via appropriate multiplication factors derived from the relevant equations.


Factors influencing accuracy of estimation of comprehension problems in patients following cerebrovascular accident, by doctors, nurses and relatives.

Previous work has shown that doctors, nurses and relatives are inaccurate at estimating the comprehension problem of stroke patients. Possible factors that influence the accuracy of these judgements were studied, including confidence of the respondents, the severity of the comprehension problems of the patients and factors specific to relatives (educational background and the length of the relative's relationship with the patient). Doctors, nurses and relatives involved with 30 recently aphasic stroke patients were asked to estimate how patients would perform on the comprehension sections of two tests (Western Aphasia Battery and Functional Communication Profile). Results show that although all respondents over-estimated patients' comprehension abilities, they were more accurate for patients who had mild problems. Doctors and nurses who were more confident about their predictions tended to be more accurate on some parts of the tests than those with less confidence, whereas relatives were equally inaccurate when giving high and low confidence judgements. Length of relationship and educational level did not predict relative's accuracy.


Parental recall of children's early development.

This study investigates the accuracy of mothers' memories of their child's developmental milestone when the child has reached the age of 4-5 years. Certain aspects of development were well remembered; others, including some speech milestones, were not recalled accurately.


Rheology of the vitreous body. Part I: Viscoelasticity of human vitreous.

The rheological properties of the vitreous body of the eye are believed to be a function of composition and to differ among species, as well as to vary regionally within the vitreous. These properties are essential to the mechanical functioning of the eye. Although there are gross, qualitative data on vitreous rheology available in the literature, quantitative rheological measurements on human vitreous and on eyes of other species are sparse and incomplete. The aim of the research reported in this series of papers is to study the rheological behavior of human, bovine, and porcine vitreous, to measure the macromolecular and electrolyte content of these samples, and to correlate and compare these values for the different species as a function of location in the vitreous. In this paper, the rheological model used to correlate viscoelasticity of the vitreous is presented, and a detailed description of the rheological instrumentation and methods of analysis used is given. Data on the rheological properties of human vitreous, as a function of location within the eye, are presented. The results show that in the human eye there are significant differences in a number of the viscoelastic parameters as a function of location within the vitreous body.


The assessment of symbolic play in young children: a prototype test.

In this paper it is argued that assessing symbolic play (defined as one object substituting for another, a property being attributed to an object which it does not have or an absent object being referred to as if present) is particularly useful for young children in whom language and/or play is not developing normally. A new test of symbolic play is described which assesses the child's ability to substitute her- or himself, a teddy or a non-representational object such as a piece of material for another object, to attribute a property to her- or himself or a teddy, and to refer to an absent object used by her- or himself or a teddy. The play may be modelled or instructed or the child may produce examples of her or his own. Some preliminary results from a group of 43 children are reported. It is concluded that this new test of symbolic play will provide clinicians working with children whose language and/or play is impaired with information of value in reaching a diagnosis and in understanding immediate treatment needs.


Language screening in preschool Chinese children.

The incidence of language delay in Chinese preschool children was studied by a stratified proportional sampling of all 3 year olds in Hong Kong. The Developmental Language Screening Scale (DLSS) devised for use with Cantonese speaking children was used to identify children with language delay. Of 855 children sampled in the stage I screening procedure, 4%, 2.8% and 3.3% were identified as having delay in verbal comprehension, expression or both respectively. The stage II clinical diagnostic study included a randomly selected group of children screened in stage I with or without any associated behavioural problem. Among these, 3.4% were identified as having a language delay using the Reynell Language Developmental Scale (RDLS) with a criterion of language age of less than or equal to two-thirds of the chronological age; 3% had specific language delay using the criteria of language age less than or equal to two-thirds the chronological age and developmental age more than or equal to two-thirds the chronological age. More boys were found to have language delay, although this was not statistically significant.


Some flow visualization and laser-Doppler-velocity measurements in a true-to-scale elastic model of a human aortic arch--a new model technique.

Flow studies were done in an elastic true-to-scale silicone rubber model of an aortic arch to study further hemodynamic influences on atherosclerosis. The model was prepared from a cast of a young woman. A revised model technique was used. The model had a compliance similar to that of the human aortic arch. Velocity measurements were done in the model with a two component laser-Doppler-anemometer in steady and pulsatile flow using a calcium chloride solution with a viscosity of eta = 3.18 mPas and density of rho = 1.28 kg/m3 at 20 degrees C. The time average Reynolds numbers over a whole cycle in the ascending aorta was Re = 1350. The Womersley parameter for pulsatile flow was a = 20. The pulse wave velocity in the ascending aorta was about c = 5.4 m/sec. The secondary flow behavior was discussed for steady and pulsatile flow. Reverse flows were found, especially along the inner radius of the aortic arch in the descending aorta in steady and pulsatile flow and also in small areas of the ascending aorta and at the branches of the aortic arch. The formation of atherosclerotic plaques at preferred local flow regions is discussed.


Platelet thrombi produced on cultured endothelial cells by the dye/light method.

Platelet adhesion and aggregation were induced on cultured endothelial cells using the fluorescent dye/light method. A cone-and-plate apparatus was newly developed to observe interactions between platelets and cultured endothelial cells under a shear flow condition. The platelet deposition grew on the light-irradiated area of the cells. Degree of endothelial cell injury induced by the dye/light reaction seemed to depend on the dye concentration. Application of either aspirin or indomethacin significantly inhibited the growth of platelet aggregation, but was not effective for the platelet adhesion to endothelial cells. The platelet thrombi were formed on endothelial cells without their denudation. It was found by transmission electron microscopy that platelets directly adhered to endothelial cells which were not seriously damaged. This thrombus model is expected to be applicable to some physiological and pharmacological studies investigating platelet-endothelial cell interaction and mechanism of platelet thrombus formation in blood vessels.


Spontaneous activation of circulating granulocytes in patients with acute myocardial and cerebral diseases.

Recent animal studies have suggested that there exists an activated subpopulation of circulating granulocytes which plays an important part in microvascular sequestration and tissue injury during shock and ischemia. In this respect, spontaneous granulocyte activation in form of pseudopod formation, a manifestation of actin polymerization, is a high risk for microvascular entrapment. The present investigation was carried out to determine if there is a significant difference in pseudopod formation in vitro between granulocytes obtained from healthy volunteers without symptoms and patients with acute cardiovascular illnesses. Blood samples from 25 healthy volunteers, 12 patients with acute myocardial infarction (AMI) and 12 patients with acute cerebral infarction (ACI) to determine spontaneous pseudopod formation in granulocytes with a high resolution light microscope over a period of several hours. The results revealed that the mean percentage of cells with pseudopod formation in the control group was below 10% in the first 3 hours, and increased to about 50% at 12 hours. In AMI patients, the level of activation within the first hour was not significantly different from the controls, but it rose rapidly to 90% in 4 to 5 hours. Patients with cerebral infarction, however, showed no significant difference from the control group. When the granulocytes of healthy subjects were incubated in plasma of AMI, the cells were activated similar to AMI granulocytes in their own plasma. When AMI plasma was serially diluted with Ringer's solution, the activation curve fell successively. These results indicate that AMI patients' blood contains plasma factor(s) which can activate granulocytes at a more rapid rate than controls.


Membrane labelling by fluorescent probes: incorporation of TMA-DPH in erythrocyte membranes.

A study of the labelling of isolated resealed erythrocyte membranes by TMA-DPH has been carried out. A quantitative study shows that saturation appears to take place when increasing the relative quantity of probe bulk concentration to membrane concentration; this is readily interpreted by a simple incorporation model with a limited number of sites in the membrane. A qualitative study shows that an increase in the labelling leads to an evolution of the probe fluorescence properties; the existence of different types of sites is involved in the interpretation but the system is too complex to allow it to be represented by a simple model. As a consequence of this study, care has to be taken in labelling biological material so as to avoid excessive probe incorporation.


[Sources of stress perceived by caregivers: a phenomenological study].

The purpose of this phenomenological study was to identify the sources of stress experienced by caregivers. Twenty-five spouses were interviewed. All were taking care of their husbands who were living at home with a chronic illness. Two instruments were used: a sociodemographic questionnaire and a semi-structured interview developed by Desjean, Doucet, and Gagnon (1983) specifically for phenomenological studies. Interviews were audiotaped, transcribed, and analyzed by Giorgi's test. The results indicated that being a caregiver is stressful. The unsatisfied needs for education and social support, the uncertainty about the outcome of the illness, and the loss of freedom and social activities are the major sources of stress expressed by caregivers. These findings should encourage nurses to evaluate the caregivers' situation and initiate interventions that assist them in decreasing sources of stress.


[Comparative study of Legionella pneumonia and other nosocomial-acquired pneumonia].

We studied 20 cases of legionella pneumonia and 23 cases of non-legionella pneumonia. Hyponatremia, elevated GOT and GPT were higher (P < 0.05) in legionella pneumonia group. In spite of the number of cases with diarrhoea, dyspnea, nervous symptoms, myalgia and complication were higher, especially with diarrhoea in legionella pneumonia group when compared to non-legionella pneumonia group, but the number of cases in both types of pneumonia did not show a statistically significant difference.


[A clinical study of 50 cases of Legionnaires disease].

The clinical features and X-ray manifestations of 50 cases of legionnaires disease were analysed. 8 cases might be due to nosocomial infection through breathing in flying particles of the saliva or phlegm. According to the main clinical features, this disease could be divided into common pneumonia type; acute gastroenteritis type; encephalopathy type; shock type; acute renal insufficiency type. The differential diagnosis of legionnaires disease with mycoplasmal pneumonia, pneumococcal pneumonia and infiltrative pulmonary tuberculosis was also discussed. The first choice for treatment is erythromycin or erythromycin with rifampicin.


[The characteristics and changes in high altitude ventilatory response during acclimatization at 5000 meters altitude].

To assess the characteristics and changes of high altitude ventilation response during acclimatization at 5000m altitude. The poikilocapnic hypoxic ventilatory responses (PHVR) were tested on nineteen healthy men who sojourned 5000m altitude for 12 weeks. The results were that there was a linear correlation between predicated ventilations which were calculated for 5000m altitude depended on PHVR values before ascent and actual ventilations tested when arrived at altitude. The PHVR was increased at second week after ascent, but at twelth week it was dropped near the level before ascent. The authors thought that peripheral chemoreceptor function might be enhanced within a period after ascent. With the acclimatization becomes perfected, the role of compensatory hyperventilation drops gradually to secondary position. So the activity of the chemoreceptor was restored gradually. The PHVR values in Xining group were lower than that in sea level group before ascent, but opposite change appeared at second week at 5000m altitude. There were no significant difference in PHVR between with and without acute mountain sickness groups.


[Mutual influence of aminophyllin and cefotaxime in the treatment of pulmonary heart disease].

The serum Aminophyllin (TP) and Cefotaxime (CTX) concentration of the patients of pulmonary heart disease during alute attack were measured by HLPC at 2 h and 6 h after infusion. (1) TP and CTX alone were used (2) TP and CTX were used simultaneously. The result showed that the concentrations of TP were much higher, but CTX were much lower when use CTX and TP simultaneously, at 2 h and 6 h (P < 0.01, P < 0.05). The concentration of TP of pulmonary heart disease with heart failure was higher than without heart failure at 6 h when alone were used or simultaneous were used (P < 0.01), CTX wasn't correlated with heart failure. The concentrations of TP and CTX did not correlate with PaO2 and PaCO2. It showed that TP and CTX would not be used simultaneously.


[The breathing pattern and inspiratory drive in chronic obstructive pulmonary disease].

Quantitative analysis of breathing pattern in 20 cases of COPD patients and 15 normal persons showed a significant correlation between values of VT/TI and P0.1; VT/TI value may be used clinically as an index of inspiratory drive. The elevation of VT/TI values of COPD patients at the end of high CO2-rebreathing denoted the sensitivity of their respiratory center is still preserved. However, the impairment of respiratory muscle endurance in hypercapnic COPD patients under rebreathing stress showed a prolongation of TI/TT.


[Comparison between radiograph and hemodynamics in obliterative pulmonary vascular disease].

A radiologic-hemodynamic comparitive study was made in 51 cases of obliterative pulmonary vascular disease. The results showed that the pulmonary arterial pressures were all elevated when their radiologic parameters (RDB, RDB/B, PL/T, C/T, DPA/DHT) had abnormal changes, and they had higher sensitivity (76.5-92.2%), specificity (100%) and accuracy (81.8-93.9%) except for DPA/DHT, and there were certain correlations between radiologic parameters and pulmonary arterial pressures (r = 0.36-0.63, P < 0.05-0.01) except for PL/T. In conclusion the radiologic parameters can be used as qualitative diagnostic parameters for pulmonary hypertension in obliterative pulmonary vascular disease, and some parameters might be helpful for evaluating the level of pulmonary hypertension.


[Observation on red cell deformability in patients with cor pulmonale].

The measurement of red cell deformability index (RCDI) was made in 29 patients with cor pulmonale and 31 persons of normal controls, at the same time blood gas values and plasma osmolarity were also measured. The results were as follows: (1) The RCDI of patients with acute respiratory and cardiac failure especially with respiratory encephalopathy was significantly lower than that of patient in stable conditions and normal controls. There was no significant difference in RCDI between patients in stable conditions and controls. (2) The PaO2 and pH (in a range of 7.31-7.39) were positively correlated with RCDI. There was no significant difference in RCDI between patients with normal plasma osmolarity and those with abnormal one. We suggested that this might contribute to the increase in pulmonary arterial pressure; and that the hypoxemia and acidosis might play an important role in decrease of RCDI.


[Clinical evaluation of the metabolism and imaging of the lung in the patients with chronic obstructive pulmonary diseases using 131I-HIPDM].

The accumulation of venously injected 131I-HIPDM in the rat lung was observed. In this article we report the results of application of 131I-HIPDM in the patients with COPD. The results showed that the metabolism and development of 131I-HIPDM in the lung reflected on condition of the pulmonary endothelial cells or receptors. The clearance curve of HIPDM displayed that COPD, especially COPD of smokers was slow. The analysis of the lung clearance of 131I-HIPDM forms a new index of lung dysfunction.


[Facial or nasal mask pressure support ventilation in managing acute exacerbation of chronic respiratory failure in chronic obstructive pulmonary diseases].

11 COPD patients (age: 65 +/- 9 Yrs) with acute exacerbation of chronic respiratory failure (PaCO2 11.3 +/- 1.1kPa) were treated with mask pressure support ventilation, another 10 similar patients (age: 68 +/- 12 Yrs) served as control. BiPAP ventilator was used with the following modifications: (1) Non-rebreathing valve set-in proximal to mask; (2) 5 LPM oxygen flow delivered into mask to reduce the dead space effect. Mask ventilation was given 2-3 hours every time and 1-2 time daily for 7 days. Synchrony and airway patency were specially monitored. The results suggested that mask ventilation could reduce PaCO2, improve PaO2, relieve dyspnea and decrease the possibility of intubation.


[The study of alveolar macrophage nitroblue tetrazolium reduction in patients with lung cancer].

Authors studied experimentally PAM NBT reduction function in patients with lung cancer. Results indicate that PMN and lymphocyte counts in the lung cancer group are significantly lower than that in the control group, and NBT reduction of PAM is significantly decreased. We conclude that host defense and immune function in patients with lung cancer are decreased.


[Papillary adenoma of the lung-two cases report].

Two rare cases of papillary adenoma of the lung were reported. Histologically, the tumor cells had noninfiltrating papillary growth, cuboidal to columnar with eosinophilc granular cytoplasm and without nuclear atypia. Ultrastructurally, the tumor cells had cytoplasmic osmiophilic lamellar bodies. This benign papillary adenoma of the lung has morphologic characteristics consistent with aveolar type II pneumocyte differentiation.


The effect of body fat distribution on cardiovascular risk factors in the population of the Czech Republic.

A study of cardiovascular risk factors including anthropometry was performed as part of the MONICA project in 1988 in the population of six districts of the Czech Republic. In addition to probands' weight and height, the circumferences of waist and hips were measured to calculate the index of body fat distribution given as WHR (wast/hip ratio). In the age group of 25-64 years, WHR was significantly higher in men (0.936) than in women (0.836 - p < 0.001); in either sex, its value rose with increasing age. WHR values were statistically significantly higher in this group than those found in a Finnish population where males aged 25-64 years had a mean WHR value of 0.90 (p < 0.001), and women of the same age group had a mean WHR of 0.78 (p < 0.001). An analysis of the relationship between abdominal obesity and some cardiovascular risk factors revealed significant correlations between WHR and total cholesterol (men: r = 0.112, p < 0.001; women: r = 0.122, p < 0.001), HDL cholesterol (men: r = -0.184, p < 0.001; women = -0.23, p < 0.001); atherogenic index, i.e., total cholesterol/HDL cholesterol (men: r = 0.183, p < 0.001; women: r = 0.345, p < 0.001), systolic blood pressure (men: r = 0.295, p < 0.001; women: r = 0.263, p < 0.001), diastolic blood pressure (men: r = 0.32, p < 0.001; women: r = 0.237, p < 0.001). The closest correlation was demonstrated between WHR and BMI (men: r = 0.525, p < 0.001; women r = 0.345, p < 0.001). The authors believe WHR is an important parameter for cardiovascular risk assessment and should be determined on a routine basis. The frequent prevalence of abdominal obesity, as suggested by the high values of WHR, contributes to the high cardiovascular risk of the population of the Czech Republic.


Ischaemic heart disease in men of productive age: comparison of epidemiological and morphological data.

Data obtained from a cross-sectional population study of men aged 20-54 years and results of a morphological epidemiological examination of the aorta and coronary arteries of 507 men aged 20-59 years, deceased from various causes in the city of Tallinn, were analysed to find whether there is a relationship between the prevalence of ischaemic heart disease (IHD), its risk factors and morphological features of atherosclerosis. An association has been found between the development of clinical IHD manifestations with age, extent of morphological signs of atherosclerosis in the abdominal aorta and coronary arteries, and occurrence of hypercholesterolaemia. Estonian men showed more marked changes in lipid indicators and greater extent of morphological signs of atherosclerosis than men of other nationalities; this corresponds to the more atherogenic character of the former's diet. However, Estonian men did not differ from other nationalities in the occurrence of IHD and expected death risk--a finding the authors explain by the lower percentage of smokers among Estonians.


The magnitude of left ventricular myocardial hypertrophy related to the degree of its dysfunction in patients with dilated cardiomyopathy (DCM).

The aim of the study was to analyze the relationship between the magnitude of left ventricular (LV) hypertrophy and selected haemodynamic parameters reflecting LV systolic and diastolic function. The "hypertrophy-function" relationship was evaluated in 22 patients with dilated cardiomyopathy (DCM) and in patients with left ventricular dilatation resulting from volume overload due to valve disease (DVOL). The parametres of systolic and diastolic left ventricular function were obtained from right- and left-heart catheterization and quantitative angiocardiography, DCM patients were divided into subgroups depending on the magnitude of hypertrophy and degree of dilatation: Ia- moderate hypertrophy (100 g/m2 < LVMI < 175 g/m2). Ib- massive hypertrophy (LVMI > 175 g/m2); IIa- mass/volume ratio (M/V) < 1.1, and IIb - M/V > 1.1. It was found that the magnitude of myocardial hypertrophy and the M/V ratio do not affect the degree of systolic and diastolic dysfunction in patients with DCM. Myocardial hypertrophy accompanying dilatation due to DCM and DVOL showed very similar progression of impairment of isovolumetric systole and relaxation. Significant differences in EF, LVMDP and LVEDP may result from a different degree of total LV volume stiffness as a consequence of various mechanisms of hypertrophy in DCM and DVOL.


A genetic study in hypertrophic cardiomyopathies (Czech population).

In order to verify the type of heredity and to identify other genealogical characteristics in the Czech population, the authors examined 105 families with incidence of hypertrophic cardiomyopathy (HCM). The probands' siblings presented a 24-percent empiric risk of the disease; in male probands the risk for brothers was four times that for sisters, in female probands it was three times higher for sisters than brothers. Sex ratio of affected siblings was 20:4 in male and 3:14 in female probands. Disease risk for children was substantially higher in younger probands (under 30 yrs. of age: 40%, above 51 yrs.: 6.7%). Reproduction fitness was decreased in the whole group more so in women. Gene penetration was estimated using the "safe carriers" method, as 50 p.c. Anticipation and more severe course were recorded in all families with HCM incidence in more than two generations. The HCM heredity does not resemble that of the autosomal dominant type. The heterogeneity, phenocopy and sexual modulation could not be excluded. Genetic counselling and, possibly, DNA diagnostics would be necessary to elucidate the hereditary nature of hypertrophic cardiomyopathy.


Endogenous digitalis-like factor in patients with acute myocardial infarction.

The authors examined endogenous digitalis-like factor (DLF) concentrations in the serum and urine in 65 patients with acute myocardial infarction. Radioimmunoassay was used for the examination and patients' data were analyzed in detail in relation to sex, risk factors and acute myocardial infarction complications. The concentrations of digitalis-like factor found in the serum of men (0.317 +/- 0.026 micrograms/l) and women (0.256 +/- 0.057 micrograms/l) with acute myocardial infarction were much higher compared with values of healthy men (0.009 +/- 0.004 micrograms/l) and women (0.015 +/- 0.012 micrograms/l). This finding is in agreement with data published by others and suggests a role of DLF in the pathogenesis of myocardial infarction.


Activity of ATPase and 5'nucleotidase in endothelium of human atherosclerotic aortas.

Twenty necroptic atherosclerotic aortas were studied using a modified en face Hautchen preparation method. Endothelium of 1 x 1 cm pieces of aortas was frozen onto slides with the help of dry ice. Endothelial cells on atherosclerotic lesions were irregularly oriented, had ununiform shape and giant multinucleated endothelial cells were present. The endothelial pavement on atheromatous lesions was usually defective. There was increased activity of ATPase and 5'Nase in endothelial cells on atherosclerotic lesions and on their borders. It is suggested that the high activity of ectonucleotidases of the endothelium on atherosclerotic lesions results in rapid dephosphorylation of ATP and ADP released by platelets aggregating to adenosine. Adenosine accumulated in the unstirred layer of plasma in the macrovasculature can effectively inhibit platelet aggregation and subsequent thrombosis on pathologically changed vascular pavement in atherosclerosis.


Plasma lipids, lipoproteins and atherogenic index in men and women administered vitamin C.

The aim of the study was to establish whether it is possible, in a group of deliberately selected subjects with hyperlipidaemia, to modulate cholesterol levels by ascorbic acid administered at a dose of 500 mg/day. The authors assessed the levels of vitamin C, total and HDL cholesterol, triacylglycerols in the blood serum of 140 probands assigned to an 83-member experimental group, and to a 57-member control group. The experimental group was provided Celaskon effervescens Spofa at a dose of 500 mg/day/person. The experiment lasted for 18 months. Blood collections were made in the whole cohort at six-month intervals. Administration of L-ascorbic acid led to a highly significant decrease in the levels of total and LDL cholesterol. After 12 months of study, a highly significant decrease in atherogenic index and an increase in HDL cholesterol levels were found persisting until the end of the experiment.


Venous wall ultrastructure in generalized venomegaly.

The ultrastructure of the v. colica sinistra in a case of generalized vasomegaly in man was examined. Elastic material was found in three forms: as a lightly osmiophil amorphous material bordering on myocytes, as a highly osmiophil elastic membrane, and as highly osmiophil slim elastic fibres of different orientation in the tunica media and adventitia. The slightly osmiophil elastic material is assumed to be newly formed by pinocytotic activity of the myocytes. The highly osmiophil elastic material indicates its impairment. No typical atherosclerotic changes were found in the examined vein. Based on a comparison with previous findings in the case of vasomegaly of the a. mesenterica inferior, the authors conclude that the venomegaly phenomenon is connected with degenerative changes in the elastic material of the vessel wall.


[Current role of reconstructive surgery in the treatment of acute mediastinitis after cardiac surgery].

Infected median sternotomy often requires wide debridement. A large thoracic defect usually results with subsequent exposition of heart, great vessels, aortocoronary bypass grafting, vascular prosthesis. Coverage with muscles transplantation was the standard procedure carried out in this series of 150 cases observed between 1983 and 1991. Details of technique are presented as well as a review of our reconstructive options. Rewarding results were observed even in the most challenging circumstances, suggesting that pursuing this aggressive approach was warranted.


[Upper parietal pleurectomy with resection of bullae by thoracoscopy in spontaneous pneumothorax. New perspectives from preliminary results in 20 cases].

In view of the increasing development of laparoscopic surgery and hoping to minimize thoracotomy's risks, we had the idea to perform pleurectomy as a treatment of Spontaneous Pneumothorax (S.P.) through video thoracoscopy. The operation was performed under general endobronchial anesthesia, the patient placed in the posterolateral thoracotomy position. Three trocars inserted through the 5th, 7th and 9th intercostal space, allowed the introduction of non specific thoracoscopic instruments similar to those used in laparoscopic surgery. The apical pleurectomy was delimited by the 6th rib, the internal thoracic vessels, the costovertebral sulcus and the first rib. Blebs and small bullae are now transected with application of the "EndoGIA 30". Pleural cavity was drained by F28 ans F32 tubes through the lower orifices. This procedure was performed in 18 patients presenting 20.S.P.. Operative indications were: persistent air link (7 cases), recurrence (9 cases), bullae with bridle and or anterior thoracotomy for S.P. (4 cases). One bleeding of 200 ml from a wounded intercostal vessel ligated with a clip was the sole operative hitch. Operative duration decreased from two to one hour. Average drainage duration was 3.5 dys and hospital stay 4.5 days. There was no death nor immediate complications. Post-operative pain was judged in all cases less intensive than that experienced after pleurectomy with thoracotomy. This original procedure is the first described as entirely performed through thoracoscopy with non specific instruments and hence economic impact.(ABSTRACT TRUNCATED AT 250 WORDS)


[False anastomotic iliac aneurysms. How to detect them?].

We report about 5 iliac anastomotic false aneurysms that occurred in 4 patients 8 to 21 years (average 15.5 years) after aortoiliac prosthetic reconstruction. The diagnosis was not established at once because of atypical clinical signs, in spite of the constant presence of an abdominal pulsating mass. All patients were operated by portal excision and graft replacement. One patient, who had presented with a hypovolemic collapse due to an acute rupture, died. The incidence of iliac false aneurysms after aortoiliac reconstructions is underestimated because the clinical surveillance is not reliable. The analysis of the explorations that were proposed led to prefer computed tomography to ultrasonography and angiography. The period of occurrence of iliac false aneurysms ranges between 6 to 10 years in average after the first operation. We therefore propose to perform a systematic follow-up CT examination on the 5th postoperative year, then every 5 years, and to operate the iliac false aneurysms as soon as their diagnosis is made.


[Hepatobiliary complications of total parenteral nutrition].

Total parenteral nutrition has showed his efficacy in severe digestive diseases. However, infections, metabolic and hepato biliary complications can appear. Aim of this study is to report hepato biliary complications in 200 adult patients, mean age 53 years, treated between 1979 and 1988. Three types of hepato biliary complications occurred in 138 patients initially free of hepato biliary disorders: 1) biochemical hepatic disorders (cholestasis and/or cytolysis) occurred in 58 patients (42%) with mean time of 27 days. In 40% these disorders disappeared after modifications or stop of parenteral nutrition. 2) Jaundice occurred in 9 patients (7%) with mean time of 73 days. Regression of Jaundice is possible only if enteral nutrition is reestablished. Sludge or cholelithiasis occurred in 34 patients (25%) with mean time of 43 days. In five of these patients cholecystectomy must be performed. Literature confirms high frequency of hepato biliary complications in total parenteral nutrition. Occurrence of these complications seems to be related to duration of total parenteral nutrition and to type of nutrition. Most complications decrease when we can stop total parenteral nutrition. Use of lipids in separated perfusion decreases significantly (p < 0.05) biochemical hepatic disorders occurrence. In conclusion, 1) biochemical hepatic disorders are very common, requiring biochemical hepatic tests weekly. 2) Jaundice is rare but serious, requiring stop of parenteral nutrition, and sometimes surgery to reestablish an enteral nutrition. 3) high frequency of cholelithiasis justifies ultrasonographic follow-up, and perhaps preventive cholecystectomy in operation leading total parenteral nutrition.


[Retro-costo-xyphoid hernia in adults. Apropos of 3 cases].

Three cases of retrosternal diaphragmatic hernia (Morgagni hernia) are reported. Diagnosis have been made by conventional radiology (Chest X-ray, Upper G-I series) in 2 cases: the third one was found incidentally during a laparotomy. Peritoneography, CT scan, NMR are recommended in the difficult cases. ONe case presented as acute gastric outlet obstruction secondary to an intra-thoracic volvulus of the herniated stomach. Surgical treatment is indicated in all cases of retrosternal diaphragmatic hernia because of the high-risk of complications (gastric volvulus, colonic obstruction). Surgery through an abdominal approach is preferred and post-operative course is benign.


[Failure to assist persons in danger in surgery].

From 1949 to 1990, the authors gathered 120 files relating to 181 decisions, most of which are unpublished, and analyzed the teachings provided by case law about physicians faced with failure to assist persons in danger. This long series, extending over 30 years of application of article 63, paragraph 2, of the Penal Code--repressing failure to assist-, describes the most various conditions in which general practitioners or specialists were prosecuted, and most often charged and judged, by various criminal courts. In a number of cases, the appeals that were lodged enabled the Criminal Chamber of the Supreme Court to dram up Law rules taking primarily into account the strict application of the Penal Code article in cause, since its first decision in 1949. This article may involve surgeons as specialists, but also as "medical citizens" who are always regarded as having a particular mission of assistance, because of their vocation to rescue victims of accidents or patients in a pathological condition requiring assistance. The effectiveness of assistance is not considered in this legal requirement, which all representatives of the medical profession regard as a permanent sword of Damocles that must never be ignored whatever the circumstances and the practitioner's specialty.


[Treatment of inguinal hernia by insertion of a subperitoneal patch under pre-peritoneoscopy].

From 1989 to 1991, 50 male patients presenting with reducible oblique lateral inguinal hernias were treated with a technique consisting in the insertion of a prosthetic Prolene patch (60 x 110 mm) interposed between the muscular wall and the peritoneal pouch. The prosthetic material was introduced and positioned anterior to the peritoneum using a laparoscope, after creating a pre- then a retropneumascos. This technique is a new application of non-invasive endoscopic surgery.


[Early postoperative complications of resection anastomosis in colonic and colorectal surgery. An analysis of 624 cases].

Six hundred twenty seven patients have been studied retrospectively to evaluate early complications after sewn or staples colonic anastomosis. Seventy four per cent of the patients underwent surgery because of malignant lesions and seventy seven per cent had an elective operation. Fourty seven per cent of the patients had a sewn anastomosis, 53% a stapled anastomosis. In elective surgery, most of the right hemicolectomies and partial proctocolectomies have been performed using stapler devices (p < 0.05). In emergency surgery, most of the anastomosis after partial and total colectomy have been hand sewn (p < 0.05). Operative mortality was 5.6%. It was significantly higher in older patients (> 80 years old) (p < 0.01) and after emergency operations (p < 0.0001). The rate of anastomotic leak was 3.7% and it was significantly higher after right hemicolectomy and partial proctocolectomies when anastomosis has been hand sewn compared to stapled anastomosis (p < 0.05). With regard to postoperative mortality, intra-abdominal abscess, intestinal obstruction, evisceration, pulmonary embolism and anastomotic stenosis 1.4% (global: after a 6 months follow-up) no significant differences have been observed between sewn and stapled anastomosis.


[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.


[An experimental study of the antitumor activity of tumor-infiltrating lymphocytes (TIL) in human tongue carcinoma in vitro].

In the present paper tumor-infiltrating lymphocytes (TIL) from lymph nodes of human tongue carcinoma patients were obtained by discontinuous density gradients centrifugation and used in experimental treatment. The results showed that 1.3 x 10(8) TIL/g lymph node tissue were gotten by the above method. TIL activated by rIL-2 exhibited higher cytotoxicity to Tca8113 cell line than the same patient's LAK cells (81.48% and 24.69% respectively). There was significantly difference in the cytotoxicity between two groups (P < 0.01), indicating that TIL were the best source of adoptive immunotherapy.


[Sagittal fracture of the mandibular condyle (SFMC): its clinical image diagnosis].

Each of 12 SFMC patients (13 TMJs) underwent 8 X-ray examinations. It was found that SFMCs were easily missed from the conventional X-ray views, while CPMOT (Condyle pterygoid-maxillo oblique tomography) and CT were effective to demonstrate them. The reasons for SFMCs' being missed from the conventional views are discussed. It is concluded that the best procedure to show a possible SFMC is: the reversed Town's view-->TMJ coronal tomography or CPMOT-->CT (using coronal or CPMOT sections as the first choice). The authors declare that SFMC could not be explained by the acknowledged theory that the neck of condyle is a safety mechanism to protect the brain.


[Effect of connective tissues underlying precancerous lesions combined with epithelia separated from normal mucosa].

The connective tissues underlying the precancerous changes of the epithelia were separated and combined with the epithelia which were separated from the normal mucosa. The combinations were transplanted in nude mice. Specimens were taken at 6 and 10 weeks after transplantation and routinely processed for microscopic examination. The results show that the connective tissue underlying epithelial dysplasia may induce the normal epithelium undergoing epithelial dysplasia changes. The experiment demonstrates the etiological importance of the connective tissue in the development of cancer, and may be applied clinically in the treatment of precancerous lesions.


[Stress distribution in the periodontal tissue around roots of an inclined abutment by 3-D photoelasticity].

The stress distribution in the periodontal tissue around roots of a mesially inclined mandibular second molar as the the abutment of a fixed bridge was analysed by the three dimensional photoelasticity. It was shown by 3-D photoelasticity that the stress distribution in the alveolar bone around the roots of the abutment was modified by the placement of the fixed bridge. The maximum stress points in alveolar bone around the roots of abutment were also located.


[Clinical application of antidromic angiography through external jugular vein].

Antidromic angiography through external jugular vein could show the real appearance, limits and reflux veins of cavernous hemangioma. Pathologic changes in venous system were shown with this method. It is a simple and the best method in diagnosing deep and larger cavernous hemangioma which is hard to treat agent. It plays also a role in differential diagnosis of some cystic mass with intracapsular blood. It is also better than tumor cavity angiography.