Protein restriction and progression of chronic renal failure.

The effect of protein restriction upon the rate of renal functional decline was studied in 7 patients with moderate chronic renal failure (CRF). The rate of progression of CRF was evaluated by the reciprocal of plasma creatinine concentration (1/Cr) in time method, every 1-3 months, during 12 months while on ad-libitum diet and 23-40 months thereafter while on protein restriction. While on ad-libitum diet, 4/7 patients showed a progressive disease and the other 3 showed a relatively stable evolution. Six months after protein restriction, patients with a previous progressive disease showed an amelioration in the decline in renal function, and those with stable CRF showed a worsening of the disease in two cases and an improvement in the other one. During the first six months on low protein diet, a transitory increase in plasma creatinine concentration was observed, being maximum at 2.7 months. Plasma urea concentration fell, after protein restriction, to values close to that predicted at the time of the prescription of the diet. Mean systolic and diastolic arterial blood pressure remained stable throughout the study and it was not necessary to change the pharmacological treatment. Our data show that protein restriction decreases the rate of progression of CRF in patients with previous progressive disease. This benefit may result from the suppression of compensatory hyperfiltration induced by low protein diet, as suggested by the increase in plasma creatinine concentration.


[Diagnostic and prognostic elements of echography in parapneumonic pleural effusion].

A retrospective study was made with the purpose of testing Ultrasound usefulness in differential diagnosis between empyematous and non empyematous evolution of parapneumonic effusions. A total of 64 patients with pneumonia and pleural effusion assisted between February 1st, 1982 and June 30th, 1989 had an Ultrasound transparietal study at the beginning and after 3 and/or 7 days of admission, with a real time equipment and a 3.5 Mhz linear transducer; they ranged between 12 and 90 years old, 27 were females and 37 males. Of these, 51 were cured by medical treatment, and 13 needed surgical drainage because of empyema evolution. The very high significant statistic signs of good prognosis in Ultrasound study were: free effusion (Table 2, p < 0.0002), maximal width less than 30 mm in sitting position (Table 1, p < 0.0001), unblurred peripleural images (Table 3, p < 0.002), and maximal homolateral diaphragmatic movement percentage more than 39% of the total (Table 4, p < 0.004); in the evolution, decrease of the maximal width effusion and slow improvement of diaphragmatic movement. Patients not included in the previous setting (31.2% of the total) were in the risk group (Fig. 1) and had loculated effusion, and/or maximal width of 30 mm or more, and/or blurred peripleural images, and/or homolateral maximal diaphragmatic movement percentage lower than 25% of the total. Less than half of this risk group was cured only with medical treatment; and they had an ultrasound evolution similar to the others cured in the same manner.(ABSTRACT TRUNCATED AT 250 WORDS)


[Chronic hexosaminidase A deficiency associated with pure sensory peripheral neuropathy].

One patient with hexosaminidase A (Hx A) deficiency, which produces GM2 gangliosidosis, developed a complex progressive neurological syndrome, starting when he was 10 years old, which encompassed intellectual impairment, cerebellar involvement, features of upper and lower motoneurones compromise and sensory neuropathy without signs of motor fibre damage within the peripheral nerves. Sural nerve biopsy demonstrated loss of myelinated fibres, mainly of those of large and small diameters, clusters of small diameter fibres, fibres with abnormal thin myelin sheaths related to their axonal diameters, axonal degeneration, segmental and paranodal demyelination and remyelination. Electronmicroscopic examination showed small electrondense, non specific, bodies and concentric lamellar inclusions within the cytoplasm of the Schwann cells. These findings demonstrate that pure sensory peripheral neuropathy should be considered as part of the spectrum which may result from Hx A deficiency.


[Elevation of ST segment and Bezold Jarisch reflex as evidence of early post-thrombolysis reperfusion].

The prognosis of patients with acute myocardial infarction (AMI) depends on the patency of the infarct-related coronary artery. This is the reason why the early recognition of the result of thrombolysis is very important in order to implement more aggressive studies and more complex treatments in case of failure. A clinical syndrome of "early coronary reperfusion" with an excellent correlation with angiographic data has been identified, characterized by: 1) pain decrease in more than 50%, 2) descent of ST segment elevation of more than 50%, 3) early elevation of creatinine phosphokinase (CPK) enzyme; other signs of reperfusión described are the Bezold Jarisch reflex (bradycardia and arterial hypotension) in patients with inferior AMI, an additional elevation of ST segment during thrombolytic infusion. These two signs of successful thrombolysis were seen early and together in our patient. He was a 41 year old male who had an anterior AMI 4 months before admission to our Coronary Care Unit with diagnosis of unstable angina (rest angina). After 10 hours he began with intensive precordial pain of 30 minutes with 2 mm of ST segment elevation in inferior leads. Streptokinase (STK) (1,500,000 units) by infusion was administered during 45 minutes; at 30 minutes of infusion the patient had an increase of ST segment elevation in the same leads which reached 3 mm and decreased to basal line after 2 hours. He also had bradycardia and hypotension which improved with atropine 1 mg IV. An episode of acute heart failure (confirmed by clinical, radiological and hemodynamic data) resolved just before the end of STK infusion.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparative evolution of mipafox-induced delayed neuropathy in rats and hens.

Adult male Long-Evans rats and White Leghorn hens were given 30 mg/kg mipafox ip. Administration of this organophosphorus ester resulted in > or = 89% inhibition of brain and spinal cord neurotoxic esterase activity in both species 4 hr after dosing. Our sequential, comparative study of the bilateral mipafox-induced neuropathy in the medulla and cervical spinal cord in hens and rats demonstrated that the rats had well-developed, vacuolar axonopathic lesions in the fasciculus gracilis by post-dosing day 7. Severely affected rats with such lesions were noted through day 21, but not subsequently (days 28 and 35). The hen had a slower developing, but more severe, consistent and longer lasting neuropathy than the rat. In these birds, lesions in the medulla and rostral cervical spinal cord levels were more extensive, involving large regions of both the spinocerebellar tracts and fasciculus gracilis. Neuropathic changes, including myelinated fiber axonopathy and Wallerian-like degeneration, were prominent from days 14 - 35 in hens, and were associated with prominent gliosis in the later stages.


Brain aluminum in Alzheimer's disease using an improved GFAAS method.

Aluminum (Al) has been determined in autopsy brain samples (20 mg, dry weight) from 10 histologically verified Alzheimer's disease (AD) patients and 10 neurologically normal controls using an improved graphite furnace atomic absorption method. The method makes use of a potassium dichromate matrix modifier to circumvent interferences to the Al determination by the high levels of phosphorus and alkali metals in brain tissue. Brain regions studied included middle frontal gyrus, hippocampus, inferior parietal lobule, and the superior and middle temporal gyri. Small, but significant (p < 0.05) elevations of Al were observed in AD hippocampus, inferior parietal lobule and superior and middle temporal gyri, compared to corresponding control tissues. In contrast to other reports in the literature, no extremely high Al levels (> 20 micrograms/g, dry weight) were observed in our samples. Our highest value for Al in AD brain was 8.0 micrograms/g. These results suggest that there is a small focal increase of Al in specific regions of AD brain compared to age-matched controls. The fact that the increase is small, coupled with the analytical difficulties of accurate bulk sample Al determinations by any technique in the brain matrix, may account for the discordant literature reports for Al in AD brain.


Comparative dose-response studies of organophosphorus ester-induced delayed neuropathy in rats and hens administered mipafox.

A single injection of mipafox was administered to both Long-Evans hooded rats and White Leghorn hens in dosages which inhibited the activity of brain neurotoxic esterase 30-50%, 60-80%, or greater than 80% four hr after intoxication. All animals were monitored for clinical evidence of organophosphorus induced delayed neuropathy for 21 days, euthanatized, and regions of the nervous system were histologically evaluated. Only hens manifested clinical signs of neuropathy; however, light and electron microscopic lesions were present in the nervous systems of both species. In rats, these lesions were well developed in only the highest dosage group and confined to the rostral level of the fasciculus gracilis in the medulla oblongata. Swollen axons containing a single vacuole filled with flocculent material were the most prominent lesion in rats. Hens manifested more extensive and varied fiber breakdown in multiple spinal cord tracts, with the intensity of degeneration increasing with increasing dosages of mipafox. Both marked Wallerian-like degeneration and swollen axons filled with aggregates of cellular debris were observed in the nervous systems of hens. This study indicates that both rats and hens are susceptible to OPIDN. However, there are qualitative and quantitative differences in both clinical manifestations and histologic appearances between the two species.


Lead exposure during different developmental periods produces different effects on FI performance in monkeys tested as juveniles and adults.

Monkeys (Macaca fascicularis) were dosed with 0 or 1500 micrograms/kg/day of lead as lead acetate according to one of four regimens: Group 1, vehicle continuously from birth; Group 2, lead continuously from birth; Group 3, lead from birth to 400 days of age and vehicle thereafter; Group 4, vehicle from birth to 300 days of age and lead thereafter. Blood lead values of the three treated groups were approximately 20-35 micrograms/dl, depending on age. Performance on a multiple fixed interval-fixed ratio (mult FI-FR) schedule of reinforcement was assessed when monkeys were three years of age, and again at 7-8 years of age following exposure to other behavioral tasks. Results of the first assessment were largely negative, with lead-treated monkeys failing to exhibit the rate increases on the FI observed in previous groups of monkeys tested at the same age. The second assessment revealed increased run rates and decreased average IRTs on the FI in all three treated groups. Effects on the FR component were minimal and transient during both assessment periods, which is consistent with previous results. Monkeys in previous studies had a history of tasks with trials procedures, in which every correct response was reinforced, before being tested on the mult FI-FR. The monkeys in the present study had no such history before the first assessment, but extensive exposure to trials procedures between the first and second assessment. It may be that the negative results of the first assessment and positive results of the second are the result of an interaction of lead with such a behavioral history. This suggestion is especially compelling in view of the results from Group 3, dosed only during infancy. These monkeys were unaffected during the first assessment, performed two years after cessation of dosing, but performed differently from controls on the second assessment, performed 5-6 years after cessation of dosing. This finding, combined with data from previous experiments, suggests that the greater total dose of lead accumulated by Groups 2 and 4 between the first and second assessment is not an explanation for the difference in results. These results also indicate that exposure to lead during infancy is not necessary for FI performance to be affected, and that exposure only during infancy is sufficient to produce effects.


Bone and calcium homeostasis.

The principal repository of calcium is bone. Calcium enters bone largely via the trabeculae, with the rate of calcium clearance by bone approximating 50 percent. Calcium enters bone as an ion in solution, but undergoes a phase change to a solid as soon as in contact with the bone surfaces. Calcium removal from and redistribution in bone is mediated by the bone cells, principally osteoblasts and osteoclasts. Calcium enters the body via intestinal absorption, a transport process that is the vectorial result of a saturable and an non-saturable step. Calcium leaves the body in the urine and stool, with a circulating calcium ion having one chance in about four of being lost via excretion. Ions like lead can compete with calcium at the sites of calcium deposition and transport. Their rate in the body should therefore parallel that of calcium, but may be modified by differing binding affinities or interactions with specific sites and molecules.


Osteoblasts and chondrocytes are important target cells for the toxic effects of lead.

The skeleton is a major repository for divalent cations, including toxic heavy metals such as lead. Unfortunately the effects of such agents on bone (and cartilage) have been minimally investigated in the past. With the current level of understanding of the mechanisms of bone formation and cartilage development it is now appropriate to begin to research the effects of lead on cellular processes. The following discussion describes some of the points of regulation in bone and cartilage formation where interference in metabolic processes could compromise the development of normal tissues as well as affect the homeostatic mechanisms of the skeleton.


Modeling bone mineral metabolism, with special reference to calcium and lead.

Realistic modeling of lead kinetics requires both qualitative and quantitative understanding of bone metabolism. In this paper, bone metabolism is discussed based on the behavior of Ca, Sr, and Ra tracers. Apposition, the increase of mineral volume, is the chief feature of bone metabolism in the neonatal and young animal. Resorption, which together with apposition functions to model the growing skeleton, is also important during growth. In adulthood, with stabilization of the total bone mass, resorption balances apposition at a relatively low level. This continuing low-level resorption/apposition remodeling process maintains healthy bone and restructures the bone in response to changing functional demands. In addition to these processes, surface exchange and diffuse exchange occur in bone. Rapid exchange between blood and bone calcium (or tracer) takes place at all bone surfaces in intimate contact with blood. Diffuse exchange is a slow process by which bone-seeking elements can penetrate the entire bone volume. Particularly in longer-lived animals like humans, slow exchange of tracer with bone Ca is the dominant mechanism of tracer uptake during adulthood. These three mechanisms of uptake and loss (apposition/resorption, rapid exchange, and diffuse exchange) appear to be the essential mechanisms determining metabolism of bone-seeking elements. The magnitudes of accretion plus rapid exchange, of resorption, and of diffuse exchange have been estimated with the aid of radiotracers and fluorescent markers.


Intestinal interactions of lead and calcium.

The biological interactions between lead and calcium are complex and not well-understood, but can be demonstrated in virtually every tissue. High affinity lead-binding to intracellular calcium receptor and transport proteins as well as the involvement of lead in calcium-activated and calcium-regulating processes may provide a molecular basis for the broad spectrum cellular and systemic effects. The intestinal absorptive cells are responsible for transporting the entire body complement of calcium and most of the body lead burden. They represent, therefore, the first critical step in maintaining systemic and cellular calcium homeostasis, as well as the first line of defense against lead poisoning. Any interactions which occur at this level, either to enhance the body burden of lead or to diminish the transport of calcium, may have serious health-related repercussions. This article reviews research concerning those interactions involving calcium, lead and the vitamin D endocrine system which ultimately influence intestinal function, calcium homeostasis and body lead retention.


Selected aspects of the spatial distribution of lead in bone.

The macrodistribution of lead within the skeletal system is not uniform, and is clearly dependent on bone type (compact or trabecular), age and (to a lesser extent) gender. During active growth, lead deposition favors trabecular bones sites but in adulthood lead accumulates more actively in compact bone. The extent and patterns of the higher variability in trabecular bone sites require better definition through further study. Lead tends to be deposited in bone at sites of most active calcification at the time it is absorbed. During the first 15 years of life the bone growth centers dominate the process of calcification. In adulthood osteon remodelling and trabecular plate mineral exchanges are the principal calcifying sites. Both patterns probably deteriorate in old age. Microdeposition patterns of lead could be expected to conform to these changes. However, it is difficult to integrate the reported information into a clearly defined chronological sequence, because many of the studies did not control for age and other variables with sufficient precision. Furthermore, kinetic studies suggest lead is deposited in multiple sites not only among soft tissues but also within bone in molecular forms possessing varying affinities. Current efforts to design instrumentation for in vivo diagnostic lead measurements as well as therapeutic methods to mobilize and remove lead in bone require more precise knowledge than is now available concerning lead macrodistribution, microdistribution and anatomic sites of kinetic compartments. Appropriately designed studies employing contemporary, sensitive techniques involving isotopes, microradiographs, autoradiographs, histology, tomography, and high energy x-ray fluorescence (synchrotron radiation-induced x-ray emission-SRIXE) are now capable of generating the needed data.


Sampling of cortical and trabecular bone for lead analysis: method development in a study of lead mobilization during pregnancy.

The paper describes a methodological approach to the investigation of maternal-fetal transfer of lead in a non-human primate species, with particular focus on skeletal tissue, which is known to be a site of lead deposition. Eight female cynomolgus monkeys were dosed with lead acetate during gestation, and in four of the animals, the isotopic composition of the lead was modified by enriching the amount of the stable isotope 204Pb included in the dose. Biopsy and dissection procedures for the preparation of bone samples for lead analysis and stable lead isotope analysis are described. Emphasis is placed on the containment of potential contamination of the samples by lead during preparation. Containment procedures included: use of a Class 100 clean room, special cleaning regimes and use of Teflon containers and stainless steel instruments. Preliminary data of lead concentrations in adult bone (trabecular and cortical) and fetal bone subsequent to the dosing regimen of lead during pregnancy, suggest notable differences between the two bone "compartments" examined. The bone samples of fetuses from the dams which had received enriched 204Pb showed drastically reduced 206Pb/204Pb isotope ratios.


Microdistribution of lead in bone: a new approach.

A knowledge of the microdistribution of lead in bone is important in order to understand the mechanisms for accumulation and release of lead. The availability of the synchrotron x-ray microscope for sensitive measurements of bone content and distribution of lead provides a valuable tool which, when combined with kinetic, balance, and tissue measurements, can lead to better evaluation of lead toxicity. It may also provide the basis for the development of a suitable model of how lead behaves in the human body. An outline of an experimental protocol for exploitation of the x-ray microscope is given, along with synchrotron x-ray microscope measurements of the distribution of gallium in rat bone that demonstrate the feasibility of the experimental approach.


Removing lead from bone: clinical implications of bone lead stores.

The chelating agent, CaNa2EDTA, has proven useful for both the diagnosis and treatment of lead poisoning. The EDTA lead-mobilization test has demonstrated the presence of excessive body lead stores when blood concentrations were "normal." The EDTA lead-mobilization test is, however, impractical because it requires injections and timed urine collections. Bone lead measured in biopsy specimens by atomic absorption spectroscopy shows a good correlation with chelatable lead. Over 95% of the body stores of lead are retained in bone with a biological half-life approximating two decades. The half-life of lead in blood, on the other hand, approximates one month. Bone, therefore, provides a good estimate of cumulative lead absorption. In vivo tibial K x-ray fluorescence (XRF) is a safe, specific and reliable technique for the non-invasive measurement of elevated bone lead concentrations. K XRF measures lead to a depth of about 2 cm in cortical bone and is largely independent of geometric factors because lead is measured relative to bone calcium. In vivo tibial K XRF can therefore replace the EDTA lead-mobilization test and bone biopsies for assessing body lead stores and for following the efficacy and endpoint of deleading during chelation therapy.


[Inter-related arterial and venous pathologies].

The authors concomitant arterial and venous disorders. On the same patient. They point out the obvious preeminence of arterial disease on venous ones, and discuss about the panel of therapy association usable. They underline the necessity of saving the venous capital.


[Evaluation of the results of the curative treatment of varices using 3 scoring systems: clinical, Doppler and echographic].

There have been many studies reporting results of curative treatment of varicose veins. Four methodological errors are nevertheless often committed: groups of varicose vein patients not comparable with regard to the degree of venous dilatation; insufficient objective parameters; population inadequately followed up; retrospective studies. It was felt necessary to develop systems for the quantification of varicose disease. These systems provide three grades: a clinical grade, a Doppler grade and an ultrasonographic grade. Clinical grade essentially involves the maximum diameter of varicose veins found by palpation and expressed in millimetres. The Doppler grade takes into account the maximum duration of the reflux wave in compression-decompression manoeuvres. The ultrasonographic grade also involves the maximum diameter of the varicose system. These grades enable the numerical assessment of the results of curative treatment of varicose veins, as well as forming the basis for statistically satisfactory epidemiological surveys.


[Socioeconomic impact of venous diseases in Italy].

The data's from National Statistic Institute referring to all Italians hospitalized during 1988 are: 37,312 patient due venous diseases, 2.03 p. cent of all hospitalized patients. Varicose veins diseases are more represented in female (10,948 f. and 4,476 m.). A regional study shows an increase in the north of Italy. The medium amount of days in hospital per patient is reduced in the last years at 11 day (from 18 d). The days in hospital in phlebophatic patients were 409,568 (20,522,122 d. for all diseases) during 1988. The expenses for hospital charges due to venous diseases were estimated in 163,827,000,000 of Italian liras, 136,522,500 US. dollar. Other report consider the factory working as the most important in the scale of job inducing phlebophaties. The first seems to be textile industries, at the second place the food factory, the last are builders. In 1974 were lost 2,300,000 working days. We suppose that increasing of private angiological assistance and having a poor public assistance in Italy the patients undergone to hospitals are reducing (81,599 with venous diseases in 1974 and 37,312 in 1988).


[The socioeconomic impact of venous pathology in Great Britain].

The chief venous diseases which may have notable or costly economic consequences are, on the one hand, varicose veins and phlebitis (superficial and deep) with their sequelae of chronic venous insufficiency and of ulcers, and, on the other hand, pulmonary embolism and its prevention. The incidence of the former is higher and treatment is very costly. The cost of leg ulcers only in Britain is estimated at 600 million pounds per year. Pulmonary emboli have notable economic consequence because of the cost of preventive and essential measures against such events, which are often fatal.


[The importance of chronic venous insufficiency. Various preliminary data on its medico-social consequences].

The study is based on the data's of general practitioners of some Health Communities in Portugal in 1991. On 4,247 patients 1.5 p. cent consulted for venous disease, half of them with severe chronic venous insufficiency. The patients with ulcers needed an average of 32 dressings. Mean disability lasted 38.7 days and 12.5 of the patients took early retirement. The social cost of the disease is set out in this study. The author concludes that prophylactic measures should be taken at the working place.


[Various aspects of phlebology in Sweden].

The incidence of symptomatic varicose veins seems to be about the same in most industrialized countries. After decades of radical surgical treatment of most cases with this condition a much more restrictive attitude seems to be present. Patients with limited varicose veins are often told that since there is no medical danger suffering from simple varicose veins, surgery is not necessary. A simple compression stocking is frequently advised. For those patients suffering from symptoms or a finding that their varicose veins are cosmetically disturbing, surgery is performed, however, restricted to be as minor as possible. The long saphenous vein is saved in those parts being competent. The surgical procedures are performed on an outpatient basis in almost all cases which means that the cost has been very much decreased. The incidence of venous leg ulcers has also decreased in Sweden. We seem to have an incidence of 0.3 p. cent ulcers of which 54 p. cent are of venous etiology. The cost for treatment of these patients is here as everywhere else very high as is also the cost for sick-leave. A conservative attitude using compressing stockings and screening to find out in which cases reconstructive venous surgery might be a possibility seems advisable especially in recurrent ulcer cases.


Measuring units for elastic stockings: priority to mmHg rather than classes.

Seven incontrovertible arguments show that the only valid measurement unit for elastic stockings is the millimetre of mercury and not a grading system. The mmHg is an international measurement unit; a new European grading system will make prescribing much more difficult; the degree of arterial insufficiency is calculated by taking systolic pressures by Doppler and is expressed in mmHg; in case of superimposition of elastic stocking, pressure add together but not grades; the unit used for pressure instruments is the mmHg; a clinical situation may require a compression force straddled between two grades; finally, new materials will certainly provide increasingly precise forces.


[The blue rubber bleb nevus or the cellular blue nevus or Bean syndrome. A rare case of iron-deficiency anemia].

Described by Bean in 1958 the Blue rubber bleb nevus syndrome is a viscero-cutaneous hemangiomatosis, a rare condition associating typical cutaneous and visceral hemangiomas of the cavernous type. We report the case of a four year old boy who presented a microcytic and hyperchromic anemia. The previous medical history of this boy was characterized by a large cavernous angioma on the right hand operated on the at the age of three months. The stools were guaiac-positive; examination of the gastrointestinal tract to clarify the etiology of gastrointestinal bleeding was negative. An oral iron therapy was prescribed for several years by the pediatrician. At age nine and half years Labeled erythrocytes demonstrated that gastrointestinal bleeding still continues. The indication for surgical operation was established: Small bowel enteroclysis revealed an oval filling defect in the lumen of ileum. Intraoperative finding: Protuberous hemangioma in the wall of small bowel; resection of the involved intestine and primary anastomosis were performed. On histological examination a cavernous hemangioma has been observed. Clinic and Pathology of this rare condition are discussed.


[Cutis marmorata telangiectatica congenita. Apropos of 4 new cases].

Cutis Marmorata Phlebectasica is a rare congenital disorder characterized by persistent erythrocyanotic mottled areas associated with superficial phlebectases with cutaneous atrophy and ulcerations. The anomaly is present at birth. Spontaneous improvement is the rule. Four cases are described with vascular investigations, coloured echo-Doppler and phlebography. The deep venous tracts are shown to be dilated. Reflux is shown to the superficial veins.


[Low flow venous malformations in children].

Low flow venous malformations in children are a diagnostic and therapeutic challenge. They are present at birth but may not be evident; they have a commensurate growth. They are pure or combined (capillary or lymphatic-venous). At examination, one observed soft, compressible bluish swellings; there is no thrill or bruit. They are slow flow anomalies with venous stasis which may induce thrombosis or localized consumptive coagulopathy. Skeletal distortion or bony hypertrophy or hypoplasia may also be observed; histological examination of surgical specimen reveals infiltration of adjacent structures (skin, bone, muscle); ultrasonography and duplex-Doppler may be helpful in differentiating the venous malformation from lymphatic or arteriovenous anomalies. Diagnosis from hemangioma will be obtained by magnetic resonance imaging; this last investigation will also provide informations on the infiltration of the adjacent tissues by the pathologic process. Standard X ray may show phleboliths of skeletal distortion. Most of venous malformations are asymptomatic and treatment consists in reassuring the child and in giving advice to the parents to prevent trauma to the lesion. Conservative treatment must be advocated (compression garments, prevention of thrombosis with salicylates) since total excision of venous malformation is illusory and postoperative morbidity may be important. Surgical excision of limited cumbersome malformations may be indicated; sclerotherapy of the lesion with Ethibloc makes surgery easier.


[Sclerotherapy in children].

The treatment of superficial venous pathology of child is still not very developed. Yet, the frequency is certainly above the estimation of 2% made in 1969. The importance of its expansion should leads us to consider a precocious treatment. Every delay might be the source of difficulties in the future therapeutics. The preliminary non prospective study realized here, includes 43 young patients, whose mothers had varicose. The functional investigations were made after a clinical examination evocative of anomaly and they permit to evidence 6 significant reflux. The therapeutic attitude depended on the type of disease observed going from abstention till surgery. A soft sclerotherapy, generally well accepted, was a successful method without complications. The results difficult to evaluate except in case of reflux, were generally good. The main difficulty is the acceptance of this method by the medical staff, after the parents' agreement. The sclerotherapy is perfectly possible in childhood, often to be wished in case of disease, sometimes necessary, but must remain careful.


[An epidemiologic study of the pathogenesis of varices. The Bochum study I-III].

A longitudinal study was carried out at 11 secondary schools (Gymnasium) of the city of Bochum to investigate the early and preclinical stages of developing varicose veins. The same pupils were examined when being in the 5th, 9th, and 13th classes (Bochum Study I, II and III). A significant correlation between familial predisposition and the occurrence of varicose veins could not be found until the Bochum Study III. The girls dominated with respect to reticular varices and telangiectasias, the boys with respect to trunk varices, branch varices and incompetent perforators. Photoplethysmography showed shorter refilling times for children and adolescents than for adults, but was not suitable to distinguish between pathological and normal findings. Large varices appeared later than small varices and were preceded by refluxes of the long and short saphenous veins. We thus have for the first time a preclinical sign, which clearly identifies individuals at risk.


[Gender differences in schizophrenia].

The authors conclude that most male schizophrenic patients display poorer premorbid functioning during the early stages of the illness. They more often display structural micro-abnormalities of the brain, organic deficits, are more chronic and have poor prognosis. Female patients are more often burdened with genetic factors, more often express productive and affective symptomatology, are more sensitive to neuroleptics and the course of their illness is more satisfactory.


[Stress, depression and schizophrenia in view of psychoimmunology].

The authors discuss the influence of stress on the immunological system. They describe changes in this system in depressive and in schizophrenic patients and analyze the eventual effect of these changes in the pathogenesis of endogenous psychopathology. The authors conclude that despite the fact that research into the immunology of these aspects are in the beginning stages, the data so far collected indicate a promising result.


[Syntonic phenomena, autism and proportion].

The authors on the basis of extensive literature discuss the phenomenon of syntonia, autism and proportion in schizophrenia. Referring to their own research on the formation of different types of proportion, the authors define the understanding of syntonia and autism.


[Dexamethasone suppression test in endogenous depression and schizophrenia in male and female patients].

Dexamethasone Suppression Test was performed during an acute phase in 81 patients with endogenous depression and 105 schizophrenic patients. The lack of suppression of cortisol was found in 1/3 if those ill with depression and 1/3 of those ill with schizophrenia. A relationship between those results and age was shown in female schizophrenic patients. In both groups a yearly rhythm was observed, however female patients differed from male patients.


[Mineralogic research of bone union formation after transplantation of autogenic bone marrow and stromal cells into the bone defect from in vitro culture. Experimental studies. III].

In experimental studies on 3 groups of rabbits (1. with autogenic bone marrow transplantation, 2. with stromal cells from in vitro culture transplantation, 3. control group) the mineralogic changes within healing fracture have been observed. These changes were investigated with scanning microscope and chemically using Cameca electronic microprobe and X-ray diffractometer. In each group there were differences in the time of arising of trabecular structures and their mineralization. Bone trabeculae were visible first in a group of rabbits with performed transplantation of stromal cells. They were present in a great number and their structure was homogeneous. They contained prominent quantity of apatites similar to the one found in normal bone. In the final phase of observation, trabeculae of external part of union demonstrated a parallel orientation and a tendency to transformation into a compact bone. After some time trabeculae arose in rabbits after autogenic bone marrow transplantation. They were less numerous and their structure was disordered. They were characterized by a significant chemical heterogeneity. The content of Ca and P was similar to their content in a normal bone. At the very and trabeculae arose in the control group. Their structure however was heterogeneous. In the final phase of observation the content of Ca and P did not reach the level found in a normal bone. Within the whole bone union a spongy bone arose.


[Characteristics of early and late onset of schizophrenia].

Two groups of patients derived from paranoid schizophrenia population of Mokotów were compared. The early onset group (before 25th year of age 57 persons) and late onset group (after 40 year of age 48 persons). Characteristics of the course of illness in both groups were compared with respect to productive symptomatology and adaptation. The course of illness was more favorable in the case of late onset psychoses (shorter relapses, longer improvements, fewer hospitalizations, better adaptation). In late schizophrenias the productive symptoms were more often directed towards environment and identity and consistency less frequent. These differences were interpreted as differences in mechanism of personality integration with paranoid syndrome in early and late onset schizophrenia.


[Effect of autogenic bone marrow transplantation into the fracture on acceleration of long bone healing. IV].

20 cases of long bones fractures healing after autogenic bone marrow transplantation have been observed. The mean age of patients was 39.7 years. Bone marrow was taken from iliac bone and after addition of heparin transplanted percutaneously into the fracture. The bone union was observed in all the cases after the mean period of 2.5 months. The observation performed on the patients treated with bone marrow cells injection and some patients from a control group treated with traditional methods revealed that marrow cells promote acceleration the process of healing.


[The levels of folic acid and vitamin B12 in the plasma of patient hospitalized with mental illness (literature review and pilot study].

47 hospitalized patients on the Second Clinic were assessed for levels of vitamin B12 and folic acid. Insufficient amounts of vitamin B12 were found in 21 patients (44.7%) and insufficient levels of folic acid were found in 23 patients (48.9%).


[Treatment effectiveness predictors in patients with alcohol dependency].

Research was conducted on 220, 40 year old patients with a history of treatment for alcohol dependency. The prognosis of treatment effectiveness was based on a model of multiple regression. Five prognostic indices were discovered which explained 65% of total variation of the criterion variable.


[Congenital malformations in autopsy from the years 1986-1990 of children up to 1 year of age in the region of North-East Poland].

The authors retrospectively analysed 901 autopsy protocols of children up to 1 year in years 1986-1990. Congenital malformations were presented in 364 cases (40.4%). The most frequent anomalies were: multiple anomalies-32.7%, the cardiovascular malformations -32.1% and malformations of nervous system-22.2%. 235 (64.8%) cases of congenital malformations were presented in neonates. There was no significant difference in incidence of congenital malformations between girls and boys. The frequency of congenital anomalies in autopsy material increased from 27.5% (1976-1985) to 40.4% (1986-1990).


[Concentration of C3 in sera of small for gestational age newborns in relation to sex and degree of hypotrophy].

36 small-for-date newborns both sexes with body weight below 10 percentiles were included to our studies. To control group we have enrolled 33 newborns in the same fetal age. We conducted the present study to address whether fetal hypotrophy induce or not decrease of the concentration of C3 in sera of these newborns. Despite of our expectations we have found there is increase C3 in sera in relation to the degree of hypotrophy. We have noted the concentration of C3 is not related to the sex both small-for-date newborns and newborns.


[The influence of disulfiram on the metabolism of ethanol].

The author discusses the metabolism of disulfiram and the enzymes which metabolize ethanol. The restraining of the activity of ALDH in the liver by disulfiram causes an accumulation of acetaldehyde which in their turn cause a series of psychophysical symptoms which are unpleasant and in some instances dangerous for the patient. Thus, it is important to monitor changes in the activity of ALDH after administration of disulfiram.


[Analysis of the reversibility of CT brain changes in alcohol dependent patient].

Control CT assessments of the brain of 15 alcohol dependent patients who showed an improvement in their clinical state were performed after a mean of 16 months. A partial decrease of the widening of cerebral sulci and the third ventrical was noticed. Also, the neuroradiological pictures of the vermis and cerebellum were seen to improve in most patients.


[Influence of lovastatin on serum lipids in patients with primary hyperlipidemia phenotype IIa and IIb. I. Efficacy of lovastatin in the treatment of hyperlipoproteinemia].

30 male patients, aged 18-70 years, with primary hyperlipoproteinemia (HLP) IIa (20 persons) and IIb (10 persons), with total serum cholesterol concentration above 6.5 mmol/l and triglyceride concentration below 3.9 mmol/l were treated with lovastatin for 12 weeks, after 4 weeks of wash-out and 4 weeks of placebo period. The lovastatin dosage varied from 20-80 mg daily. There were significant differences between groups in serum triglyceride, HDL-cholesterol and apolipoprotein AI concentration. After 12 weeks of treatment in patients with type IIa as well as with type IIb HPL significant decrease of total cholesterol (by 26.8% and by 33.6%, p < 0.001); LDL-cholesterol (by 39.1% and by 43.2%, p < 0.001); apolipoprotein B (by 22.9% and by 29.6%, p < 0.001) was found. Significant relationship between apolipoprotein B concentration and dosage of lovastatin was found. There were no differences in concentrations of HDL cholesterol and apolipoproteins AI and AII after treatment. The results of this study indicate that lovastatin efficiently decreases total and LDL-cholesterol concentration and apoprotein B level in patients with hypercholesterolemia as well as with hypercholesterolemia with mild hypertriglyceridemia.


[Concentration of selenium in serum of patients with ulcerative colitis].

Selenium deficiency may be implicated in the pathogenesis of some human diseases, including colon cancer. The incidence of carcinoma of the colon is increased in patients with ulcerative colitis. We measured the serum concentration of selenium in 22 patients with ulcerative colitis and 22 sex-, age-, height and weight-matched controls. Although no significant difference was found in mean serum selenium between patients and controls (patients: 0.92 mumol/l, controls: 0.79 mumol/l), the serum selenium level decreased with increasing extension of the disease. The differences between serum selenium concentrations in patients with proctitis-sigmoiditis, left-sided colitis and pan-colitis were statistically significant. No correlation was found between serum selenium concentrations and the sex, age, height, or weight of the patients. The inverse correlation between serum selenium concentration and the extension of the disease may be caused by a decreased absorption of selenium from the diseased colon in ulcerative colitis.


[Effect of autogenic bone marrow transplantation in fractures on the course of delayed bone union healing. Part V].

39 delayed bone unions of long bones shafts in 34 patients treated with autogenic bone marrow transplantation into the fracture has been observed. The mean age of patients was 37.8 years. Bone marrow was taken from iliac bone and after addition of heparin injected percutaneously into the fracture. After transplantation, the previous treatment was continued. The bone union was observed in all cases after the mean period of 3.1 months. On the grounds of the performed observations it was found that bone marrow transplanted into fracture site accelerates the healing process of delayed union.


[Effect of autogenic bone marrow transplantation with "Zespol" technique of osteosynthesis on non-union healing. VI].

The results of treatment of 25 patients with long bones shafts non-union were showed. Patients were treated with autogenic bone marrow transplantation into non-union together with "Zespol" technique of osteosynthesis, without opening of non-union. The mean age of patients was 35.4 years. Bone union was observed in all the cases after the mean period 3.3 months since the time of bone marrow transplantation. On the ground of clinical and radiologic observation it was found that combination of autogenic bone marrow transplantation with "Zespol" technique is a simple and effective method of long bones non-union treatment.


[Analysis of remission of pulmonary hypertension after mitral valve replacement].

In a group of 32 patients with mitral valve disease and extreme pulmonary hypertension, the efficacy of mitral valve replacement (MVR) was analysed. In all patients hemodynamic and clinical data were obtained and compared before and after operation. After surgery a statistically significant differences (p < 0.01) of the pressure was observed in right atrium and ventricle, pulmonary artery and capillaries, the pulmonary resistance was decreased, the cardiac index was increased. The improvement of hemodynamic parameters correlated well with clinical data. But it has not influenced for return to the job.


[Activity of selected enzymes of peripheral blood erythrocytes and serum haptoglobin levels in workers occupationally exposed to styrene and formaldehyde].

In 48 and 30 workers exposed to styrene and formaldehyde respectively activities of erythrocyte acetylcholinesterase lactate dehydrogenase and glucose-6-phosphate dehydrogenase, were determined. Hematocrit, haemoglobin concentration, red blood cell count and serum haptoglobin levels were also determined. Significant decrease in erythrocyte acetylcholinesterase activity in workers exposed to styrene for 61-180 months was stated. Moreover, increased erythrocyte lactate dehydrogenase activity and decreased serum haptoglobin level was found in workers exposed to formaldehyde for 3-24 months. There were no differences in basic hematological parameters and erythrocyte glucose-6-phosphate dehydrogenase activity in both groups studied as compared to the control group.


[A study on the location of immuno-suppressive factor(s) in restraint rats and mice].

A serum lymphocyte-proliferation suppressive factor(s) induced by restraint stress over 10 h was found in previous studies in both rats and mice. The present study was undertaken to investigate the sites of its production. The results show that large doses of irradiation and cyclophosphamide (CY) decreased the total number of splenic nucleated cells, but the production of the suppressive factor was inhibited only by irradiation. This indicates that the drop in total number of lymphocytes does not play any key role in the production of the serum suppressive factor. Cell classification showed that the ratio of T to B cell was decreased by radiation but increased by CY, suggesting that this ratio may be relevant to the production of the factor. Inhibition of the production was also observed in nude mouse (an animal showing a lack of T cell activity), again supporting that T cells are involved in the production of the inhibitory factor.


[Effect of electrical stimulation of the area postrema on plasma renin activity and renal sympathetic nerve activity in rabbits].

68 urethan-anesthetized rabbits were prepared for registration of changes of respiration, arterial blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RSNA) due to stimulation of area postrema (AP) by rectangular pulse trains each lasting for 4 s for every 30 s. During 40 min of such a stimulation paradigm the venous blood samples were collected for radioimmunoassay of plasma renin activity (PRA) (both pre- and post-stimulation), RSNA registered and processed by a computer. Animals were divided into three groups: (1) with AP stimulation only (n = 47); (2) AP stimulation after bilateral renal denervation (n = 13); (3) AP stimulation after propranolol injection (n = 8). In Group I, a 91% increase in PRA, an augmentation of RSNA, a rise of BP and a decrease of HR were observed, while respiration did not show obvious change. In Group II, hemodynamic and RSNA response was similar to that in Group I, but PRA was not changed significantly. In Group III, the effects on BP, HR, respiration and RSNA showed no remarkable changes compared with Group I, but significant inhibition of the response of PRA [from 0.65 +/- 0.07 ng/(ml.h-1) to 0.72 +/- 0.10 ng/(ml.h-1), P > 0.05] was observed. The results mentioned above suggested that electrical stimulation of AP may induce an increase in renin release and renal sympathetic nerve activity and hemodynamic changes in rabbits.


[Effect of electrical stimulation of paraventricular nucleus on stress gastric mucosal lesion in rats].

The effect of electrical stimulation of hypothalamic paraventricular nucleus (PVN) on gastric mucosal lesion induced by RWIS (restraint + water-immersion stress) in rats was investigated. The main results were as follows: (1) Electrical stimulation of the PVN could obviously increase the stress gastric mucosal lesion. (2) Microinjection of L-glutamate into PVN could produce similar effect to that of PVN stimulation. (3) PVN lesion could significantly decrease the stress gastric mucosal lesion. (4) The above mentioned effects were attenuated by vagotomy or atropine injected subcutaneously. (5) A further study indicated that the gastric mucosal blood flow was reduced upon PVN stimulation, but no obvious changes of gastric juice volume, total acid output, pepsin activity and gastric barrier mucus were observed. The results mentioned above indicate that the PVN is one of the specific CNS areas capable of increasing the stress-induced gastric mucosal lesion mediated through the cholinergic fibers of the vagal nerve and related to decreased gastric mucosal blood flow, while gastric acid output, pepsin activity and gastric barrier mucus do not seem to play any important role.


[Contraction stimulates incorporation of 3H-leucine and cell growth in cultured neonatal rat ventricular myocytes].

To determine whether contraction could influence cell growth, the rate of protein synthesis (3H-leucine incorporation) and cell diameter and volume were measured in cultured neonatal rat cardiac myocytes beating spontaneously or arrested by high potassium. In medium supplemented with 10% calf serum, the 3H-leucine incorporation for 24 h in contracting myocytes (CMC) was significantly higher by 14.2% than that in quiescent myocytes (QMC), i.e. 1,229 +/- 29 cpm/10(5) cells vs. 1,076 +/- 60 cpm/10(5) cells (P < 0.01, n = 5 for each group). The cell diameter and cell volume in QMC group were respectively 15.14 +/- 0.42 microns and 1,842 +/- 123 microns3, while in the CMC group the corresponding figures reached to 16.82 +/- 0.64 microns3 and 2,495 +/- 210 microns3, increased by 11.1% and 35.5% respectively (P < 0.01, n = 6 for each group). With prolongation of culture time, the differences in these parameters between CMC and QMC became even more significant. In all these experiments, there was no significant difference in cell number between the two groups (P > 0.05). It is concluded that contraction per se can accelerate protein synthesis and cell growth in neonatal rat ventricular myocardium.


[Optimal pulmonary ventilation determined by the relation between end-tidal CO2 and arterial blood pressure in artificially respirated cat].

End-tidal CO2 (ET-CO2) provides a continuous and sensitive monitoring of proper pulmonary ventilation in artificially ventilated animals during single unit recordings of the central nervous system. To determine a reliable standard of ET-CO2 in anesthetized and paralyzed animal, the relationship between ET-CO2 and arterial blood pressure (ABP) was observed in cat under different ventilation level. The results showed that ABP changed tremendously with variation in ventilation, but remained constant at a normal level as long as ET-CO2 was maintained within the range between 4.0-5.0%, i.e. optimally at 4.5 +/- 0.5%.


[Variation of WGA and PNA binding glycoproteins in early pregnant rabbit uterine fluid].

The qualitative and quantitative changes of two kinds of lectin (WGA, PNA) binding glycoproteins in early pregnant rabbit uterine fluid (D4-D12) were measured by Western blot and Video densitometer scanning methods. During peri-implantation stage (D6, D7 and D9), there are two WGA binding glycoproteins with MW about 42 kd, 28 kd and a PNA binding glycoprotein with MW 75 kd. It is suggested that the three proteins are stage-specific glycoproteins in rabbit uterine fluid in the course of implantation.


[Effect of CCK receptor antagonists on plasma CCK bioassay].

Fasting and postprandial plasma CCK levels of 102 normal subjects were measured by bioassay with dispersed rat pancreatic acini. The reference values ranged from 0 to 4.2 pmol/L (CCK-8 equivalents) for fasting and from 1.1 to 13.5 pmol/L for postprandial state. There was no significant difference between male and female, or in different age groups. The effects of CCK receptor antagonists of 3 different categories on CCK bioactivity in plasma measured by the bioassay were investigated. L 364,718 (5 nmol/L), proglumide (1.0 mmol/L), or Bt2-cGMP (0.1 mmol/L) was either extracted by SEP-PAK C18 cartridges together with human plasma containing 8 pmol/L of CCK-8, or added into the plasma extracts before the assay. The CCK bioactivity was inhibited by all of the 3 CCK antagonists. The action of L364,718 could be eliminated by the procedure of plasma extraction, but not of proglumide or Bt2-cGMP. It was suggested that CCK bioassay can be used even if L364,718 was administered. However, CCK cannot be measured accurately if there are proglumide or Bt2-cGMP in the plasma.


Management options for pancreatic pseudocysts.

Between July 1987 and February 1990, 42 patients with pancreatic pseudocysts were treated. In 83% the pseudocyst was related to alcohol. Patients were managed by observation (7), surgical external drainage (7), and internal drainage (12). Fifteen patients were treated by ultrasound guided percutaneous catheter drainage (UGPCD) with apparent success in 67%. In 5 of these UGPCD was abandoned because of either prolonged drainage or infection of the pseudocyst. In patients with recurrent pseudocysts or in those with failed UGPCD, the cystic collections were successfully drained internally in 16 out of 17 patients (94%). Internal drainage appears to be acceptable treatment for mature pseudocysts, recurrent pseudocysts or for failed UGPCD, provided there is no downstream pancreatic duct obstruction or duct dilatation. If either exist, resection or direct ductal drainage will be required.


Influence of intraperitoneal drainage after cholecystectomy; a prospective ultrasonographic study.

One hundred and fifty patients were prospectively randomised into 3 groups (50 in each group); to receive a passive drain, closed suction drain or no drain after elective cholecystectomy. The drain was removed within 24 hours in 84% of patients and was continued longer only if the amount of drainage was excessive or bilious. On the 3rd post-operative day, an ultrasound examination was performed in all patients for detection of subhepatic/subphrenic collection. Collections were more frequently encountered in the patients without any drain (42%) followed by passive drain (26%) and suction drain group (20%). Chest complications were frequently noted (passive drain; 6% suction drain, 12%, and no drain, 8%), however, occurrence of this complication in various groups was similar (p > 0.1). Two patients (4%) without drain required ultrasound guided aspiration of subhepatic collection. Mean post-operative hospital stay was nearly equal for all the groups (passive drain: 4.22 +/- 1 days, suction drain: 4.26 +/- 1.4 days and no drain: 4.62 +/- 2.3 days). Drainage reduced the incidence of post-cholecystectomy collections and need for invasive intervention for collection related complications. However, the type of drainage (active or passive) did not influence the incidence of collection, frequency of complications and duration of post-operative hospital stay.


[Cytofluorimetric research on the content of glycogen and its fractions in the hepatocytes of patients with liver cirrhosis of different etiologies].

By cytofluorometric method, a study was made of the total glycogen and its two fractions in liver parenchymal cells both in the donors (20 men) and in patients with cirrhosis of different etiology (39 men). The examination was performed on preparations--smears of isolated hepatocytes, obtained from the live functional liver biopsies. The quantitative analysis has shown an increase in the total glycogen content in hepatocytes of patients with cirrhosis by 3 times compared to the norm, and this increase is independent on the etiology of liver cirrhosis. To study the mechanism of the discovered glycogenosis, the activity of key enzymes of glycogenolyses was determined. It was shown that glucose-6-phosphatase and glycogen-phosphorylase activity in the liver with cirrhosis was lower than in the norm. The most considerable changes were shown in hepatocytes of patients with liver cirrhosis in fractional glycogen composition and, even more significant, in the content of a hard soluble fraction. The hard soluble fraction portion was higher in hepatocytes of the patients with liver cirrhosis of alcohol etiology. The quantitative analysis of glycogen fraction contents in liver cells may be the best marker in the differential diagnosis of symptomless elapsing liver cirrhosis.


Encephalomyelopathy following portocaval shunt in noncirrhotic portal fibrosis: a case report.

A 30 year old male patient presented with the clinical picture of progressive encephalomyelopathy eleven years after a portacaval shunt for non-cirrhotic portal fibrosis (NCPF). The spinal cord involvement in this patient was restricted to the corticospinal and the spinocerebellar pathways. The clinical picture and neuropathology of encephalopathy and of myelopathy have been described in patients with cirrhosis. Cases of encephalopathy and myelopathy have also been reported following shunt surgery in NCPF. We report the first case of encephalomyelopathy developing eleven years after portacaval shunt in a patient with noncirrhotic portal fibrosis.


[A simple method of preparing permanent squash preparations using cellophane].

A technique to prepare permanent squashed preparations of cell nuclei and chromosomes is proposed. Fix a piece of material on the slide with acetic alcohol (1:3), macerate with a 45% acetic acid, cover with hydrophilic cellophane previously soaked in a 45% acetic acid and then with a cover slip and filter paper to squash finally as it is routinely performed. After that soak off the cover slip with alcohol, post-fix the squashed preparation together with cellophane in alcohol for 5-10 min, unstick the cellophane, pass the preparation through alcohol once again and dry it. The subsequent treatment of the squashed preparation depends on the purpose of investigation. The slide may be tinctured overlaid with photoemulsion for autoradiography, or processed by different ways.


Splenic hamartoma with portal hypertension: a case report.

A case of splenic hamartoma arising from the upper pole of the spleen and presenting with upper abdominal pain, ascites and pedal edema is presented. Splenectomy was performed. The histopathology, revealed splenic hamartoma of pulposal type.


[Changes in the relative arrangement of the chromosomes and nucleolus in developing mammalian oocytes during meiotic prophase I in relation to functional changes in the oocytes].

Data on chromosome transformation in meiotic prophase I during mammalian oogenesis are summarized. The main peculiarity of the female meiosis in mammals is an unusually long diplotene stage which may be subdivided into four periods: 1) the early diplotene (up to the beginning of follicle formation); 2) the dictyotene or "diffuse diplotene", implying primordial follicle oocytes; 3) the most pronounced lampbrush chromosome stage coinciding with the large growth period; 4) the stage of chromosome inactivation and karyosphere formation corresponding to the terminal stage of oocyte development before ovulation. These stages are associated with changes in the transcriptional chromosome activity. A correlation is revealed between the spatial chromosome arrangement in the oocyte nucleus and the transcriptional activity. Some regularities are followed in the transformation of the main nucleolar component arrangement during meiotic prophase I in mammalian oocytes. At the late pachytene and at the early diplotene, a segregation of the main nucleolar components has been observed. These components are disposed in the direction: chromatin--fibrillar center--dense fibrillar component--granulo-fibrillar component. At the dictyotene, signs of nucleolar segregation are still observed. At the lampbrush chromosome stage, when the nucleus is most highly transcriptionally active, an integration of nucleolar components occurs. At the late diplotene--prediakinesis stage, i.e. in the course of transcriptional activity lowering and karyosphere formation, the secondary segregation of the main nucleolar components occurs. These move to the nucleolar periphery to be disposed around a large fibrillar mass which is gradually displacing the rest of the nucleolar components. The fibrillar mass formation in the preovulatory oocyte nucleoli is one of the peculiarities of the diplotene and prediakinetic mammalian oocytes.


[The morphogenetic potentials of endometrial and ovarian tumor cells when cultured on soft agar].

Morphofunctional peculiarities of tumor cells from 15 endometrial adenocarcinomas and 2 ovarian tumors have been investigated at the ultrastructural level. These cells could develop two types of colonies in soft agar: those with histotypical differentiation (numerous microvilli, well developed tight junctions, desmosomes, secretory granules), and those without it (absence of epithelial features, ability of tumor cells to produce filamentous extracellular matrix and striated collagen fibrils which are characteristic of fibroblastic cells). The addition of progesterone and tamoxifen to cell cultures resulted in rising the level of cell differentiation in the colonies. The fact that endometrial and ovarian cancer cells can express the properties specific of connective tissue cells may suggest a multipotention of the Mullerian epithelium derivatives to shed light on the histogenesis of the mixed Mullerian tumors of uterus.


[Polyploidy and polyteny in the trophoblast cells of the mink].

According to cytophotometry, trophoblast cells in the mink placenta are both diploid and polyploid, the ploidy level ranging from 2c to 64c. A great number of mink trophoblast cells were seen to divide mitotically. In addition to the ordinary mitotic figures, polyploid mitoses as well as abnormal mitotic figures were observed. Non-classic polytene chromosomes, peculiar to the mammalian trophoblast, appeared in the mink trophoblast cells to have the highest ploidy. A relatively low ploidy degree is due, probably, to a lesser invasive activity of the mink trophoblast cells as compared to the rodent giant trophoblast cells.


[The interaction of epidermal keratinocytes and fibroblasts during the formation of a live skin equivalent].

The effect of human fetal fibroblasts and adult keratinocytes on collagen contraction was studied. Keratinocytes embedded in collagen lattices did not spread and produced only a slight contraction. When keratinocytes were seeded on the surface of tht gel, the contraction began within 24 h and correlated with the formation of epithelial colonies. Transplantation of multilayered epithelial sheets on the gel significantly accelerated the onset of contraction. Keratinocytes seeded on and fibroblasts grown in collagen lattices cooperatively contracted the gel, and keratinocytes were able to stimulate gel contraction even when they had no contact with the collagen roughly populated with fibroblasts. Swiss 3T3 cells remained spherical in collagen lattices and did not contract the gel but when cultivated with keratinocytes they stimulated gel contraction. In their turn, keratinocytes influenced the behaviour of Swiss 3T3 cells which elongated and produced processes. We suggest that both keratinocytes and mesenchymal cells can affect gel contraction 1) by a direct contact with collagen lattices, and 2) through potentiation of the ability of another cell type to contract the gel.


[Survival and the repair of single-stranded DNA breaks in gamma-irradiated Escherichia coli cells adapted to methylmethane sulfonate].

The survival and repair of single-strand breaks of DNA in gamma-ray-irradiated E. coli adapted to MMS (20 mkg/ml during 3 hours) have been investigated. It is shown that the survival of adapted bacteria of radioresistant strains B/r, H/r30, AB1157 and W3110 pol+ increases with DMF (dose modification factor) ranging within 1.4-1.8 and in radiosensitive strains Bs-1, AB1157 recA13 and AB1157 lexA3 with DMF ranging within 1.3-1.4, and does not change in strains with mutation in polA gene P3478 polA1 and 016 res-3. There is no increase in radioresistance during the adaptation to MMS under the action of the protein synthesis inhibitor chloramphenicol. The increase in radioresistance during the adaptation to MMS correlates with the acceleration of repair of gamma-ray-induced single-strand breaks in the radioresistant strains B/r and W3110 pol+ and with the appearance of the ability to repair some part of DNA single-strand breaks in the mutant Bs-1, which beyond the adaptation to MMS does not repair these damages. The incomplete reparability of DNA single-strand breaks in P3478 polA1 strain cells, both adapted and non-adapted to MMS, is equal.


[Cytofluorimetric research on the changes in the DNA content in the nuclei of Amoeba proteus during prolonged starvation and after refeeding].

Dividing amoebae were manually selected from the culture of Amoeba proteus, and so groups of synchronously dividing (synchronized) amoebae were obtained. These synchronized amoebae were maintained without food. In spite of starvation, individual amoebae in some particular groups were seen to divide, whereas in other groups of amoebae there was no division at all. The starving amoebae died not earlier than 2 weeks after the last division. A relative DNA content in isolated nuclei has been determined cytofluorometrically for each of 6 groups of synchronized starving amoebae, unable to divide. The nuclei were isolated in different intervals after division (after the feeding was ceased): 1.0-1.5 h, 1 day and up to 13 days with 1-2 day intervals. In the all groups of amoebae DNA synthesis occurred on the first 1-2 days after division. The nuclear DNA content in amoebae of 3 groups increased more than two-fold as compared with the 1 h level, in other 3 groups the nuclear DNA content did not exceed the doubled 1 h level, but probably exceeded the doubled postmitotic level. Later on, the nuclear DNA content in starving amoebae of each group was seen to decrease by 16-20%. Amoebae of 3 of the 6 groups were given the food organisms (Tetrahymena pyriformis) 8 days after division (after cessation of feeding). 2-3 days after refeeding some of these amoebae divided, and the nuclear DNA content of the refed amoebae proved to be higher than that in amoebae that continued to starve. It is suggested that the decrease of DNA content in the nuclei of starving amoebae and the increase of DNA quantity in the nuclei of refed amoebae may result from degradation and induction of synthesis of specific extra DNA synthesized in amoeba nuclei during each cell cycle.


[Recurrent urethral strictures in men. Modern diagnosis and therapy using ultrasound and laser].

The new method of urethral sonography allows visualization of urethral strictures preoperatively in more detail than conventional X-ray urethrogram. Poor results of urethrotomies can thus be avoided in patients who have peristrictural scars. These patients can be treated by the newly developed technique of laser incisions of urethral strictures. The success rate is so promising that wall-stent implantations and even open procedures may well become very rare. Diagnostic and therapeutic techniques are discussed and described in detail with reference to illustrations.


[Internal urethrotomy].

Internal urethrotomy is the first treatment for all kinds of urethral strictures except meatal stenosis and complete urethral obstruction. After urethrotomy a urethral catheter is left indwelling for up to 3 days if the urine is already sterile. In the case of infection it remains in place for 2 weeks. Long-term results depend mainly on the extent of periurethral fibrosis. The over-all success rate is about 50%. Only in a few cases can a second or third urethrotomy be definitively curative. Further urethrotomies are clearly only a palliative treatment of the stricture, comparable in effect to repeated urethral dilatation.


[One-stage urethra repair with end-to-end anastomosis].

The direct anastomosis in one session is the method of choice for the treatment of urethral strictures (< 2.5 cm length) when at least three internal urethrotomies have failed. If certain important details are kept in mind about the operative technique (wide anastomosis without tension), suitable suture materials used, and the urinary diversion is done without placing a burden on the anastomosis, the long-term results are good. The direct anastomosis and operative approach can be varied according to the special situation in individual cases. The analysis of 47 patients operated on with direct anastomosis for strictures in the posterior urethra (28 post-traumatic, 9 iatrogenic, 10 postinflammatory) revealed that 83% of the patients had good or satisfactory results, while in 8 patients (17%) the results were poor. The poorist long-term results occurred in post-traumatic strictures in the bulbomembranous part of the urethra connected with complicated pelvic fractures.


[Pedicled penis skin flap for unilateral correction of extensive urethral strictures including meatus reconstruction].

Many techniques have been described for the repair of recurrent urethral strictures. We report our experience with the use of vascularized island skin flap repairs of urethral strictures as a one-stage procedure in 24 patients and describe the rationale for selection of the procedure, surgical technique used, results and complications. Using the pedicled penile island flap and the inner preputial skin one-stage correction is possible in urethral strictures up to the tip of the penis. The combined use of scrotal skin increases the risk of complications and thus should be avoided. Meatal reconstruction as described by De Sy gives excellent functional and cosmetic results.


[Anatomy of the posterior urethra].

The short section of the urethra that passes through the urogenital diaphragm is termed the membranous urethra. It is accompanied by several vessels and nerve fibers. In surgery on the membranous urethra the perineal body is of crucial importance, and precise knowledge of the course of the urethra through the pelvic floor is essential. Furthermore, the relationship between the membranous urethra and its accompanying structures is of great importance. These include the branches of the internal pudendal artery, the prostatic venous plexus and the cavernous nerves coursing ventrally from the pelvic plexus. The nerves supplying the membranous urethra were studied in fetuses with the help of a magnifying lens. The results of the dissections are documented by histological sections, photographs and paintings.


[Urethral rupture--primary repair and reconstruction].

Whether the posterior urethra can successfully be reconstructed depends mainly on the primary care, especially in the case of strictures secondary to trauma. Prior to surgery, primary care of the lesion is mandatory, including open suprapubic fistula, drainage of the cavum retii and of the perineal space, repositioning of the urethra and immediate stabilization of the pelvic ring by means of elastic procedures. In a second step, between 1978 and 1990 we performed bulbo-prostatic surgery in 27 patients with traumatic rupture of the posterior urethra. Based on extensive anatomic be studies on the relationship of the membranous urethra to the pelvic floor and to the arteries, veins and nerves, an operative approach via the perineal body was developed. Of 18 patients followed up, only 4 had flow rates of less than 15 ml/s. Retrograde urethrograms and micturition cystograms showed good results.


[Stabilization of pelvic fractures].

In contrast to less complicated injuries to the pelvic ring, unstable bony fractures and injuries caused to ligaments by high-energy trauma require immediate stabilization by internal fixation. Since patients with severe pelvic injuries commonly present with multiple trauma, close cooperation between different medical disciplines is necessary to provide for optimum patient management. In cases with concomitant urological injuries, a joint primary intervention is recommended. Whether anterior, posterior or combined approaches are indicated for internal fixation depends on the injury pattern. The classification of pelvic ring fractures into group A, B and C injuries is discussed in detail.


[Mesh graft urethroplasty].

Since 1977 124 patients with complicated urethral strictures have been treated by using free-foreskin grafts or split-thickness skin grafts to construct a neourethra in a two-stage procedure. Excellent functional and anatomical results have been achieved in 115 patients. The technique is even useful in exceedingly long or problematic strictures, such as in patients with spinal cord injuries.


[Wall-stent for treatment of bulbar urethral stricture and DSD in spastic bladder].

Since may 1989 a urethral Wallstent has been used for the treatment of short urethral strictures and for DSD in paraplegic patients with reflex bladder activity. Forty-nine patients have now been followed-up, which exceeds the 6-month margin. Out of these, 25 suffered from a short stricture of the bulbous urethra and 24 had spastic bladders with severe DSD. Eighteen of the 25 patients with strictures had previous unsuccessful direct vision urethrotomies; 17 in the DSD group had undergone failed sphincterotomies. In all but 2 cases the infravesical obstruction could be treated effectively solely by stent implantation. The results obtained equal those of a well-performed end-to-end anastomosis of the bulbous urethra or a 12, o'clock sphincterotomy.


[Clinical experience with BCG immune prevention in superficial bladder cancer].

Previous randomized studies have shown that in cases of superficial urothelial carcinoma or carcinoma in situ of the urinary bladder, complete and long-lasting remission can be obtained by immunotherapy with bacillus Calmette-Guérin (BCG). Such studies have shown that BCG reduces the recurrence rate significantly compared with transurethral resection alone. Our 6-year experience with BCG Pasteur strain (and Connaught strain, respectively) in tumour stages pTis, pTa and pT1 (G I-II) shows lasting remission in 88.5% (73%) of 78 (26) patients after transurethral resection of the tumour. A complete remission was found in 92% of patients with carcinoma in situ (12 patients). The local and the rare systemic side effects were all of limited duration, tolerable, easily treated and fully reversible.


[Varicocele in childhood. Treatment indications and value of sclerotherapy].

Varicocele is the most common surgically correctable cause of male subfertility. The incidence of varicocele is about the same in adolescents as in men (16.3%). Percutaneous transfemoral sclerotherapy has been performed in 42 of the authors' own cases; it is an alternative to surgical ligation of the varicocele and should be recommended whenever a varicocele is found, to prevent gonadotoxic damage.


[Incidental detection of renal cell cancer].

In the present study, a comparative analysis of clinical-prognostic factors in symptomatic and incidentally found renal cell carcinomas is evaluated. A total of 141 patients with renal cell carcinoma were analyzed according to the TNMG system and involvement of the adrenals. More than 50% of surgically treated renal cell carcinomas are found incidentally. Prognostically, this group has advantageous factors.


[Combined ultrasound-urodynamic study in paraplegic patients].

Over a period of 2 years (1989-1991), combined urodynamic and ultrasonic investigations of the lower urinary tract were performed in 80 patients with spinal cord injuries. The main advantage of this procedure proved to be the lack of irradiation to both patient and investigator. Besides the real-time image of the bladder, bladder neck, prostate, pelvic floor and urethra, functional conclusions were possible, especially when urodynamic pressure curves were also considered.


[Hamartoma polyps of the urethra].

Fibroepithelial polyps are rare benign tumours that can cause obstruction of the urethra. Most such polyps occur during childhood. We present two patients, one is a child, the second an adult male. The problematic diagnosis is emphasized.


[The glycogen and lactate content of the white and red muscles in fishes with differing natural mobilities during experimental swimming].

Glycogen content of muscles has been investigated in moderately motile fishes during burst and cruising swimming, as well as in fast swimming fishes during burst swimming. It was shown that the intensity of glycogenolysis in muscles depends on the swimming regime and natural adaptation of fishes to physical loading. During burst swimming, significant decrease in glycogen content was found in both white (up to 70%) and red muscles (up to 50%) of fishes with moderate natural motility, in contrast to fast swimming fishes in which glycogen content decreases only in white muscles (by 30%). Cruising swimming in moderately motile fishes results in practically equal decrease of the glycogen content in both types of muscles (by 80-85%). The mentioned specificity of metabolism in fishes with moderate motility, as well as peculiarities of morphological organization of their skeletal muscles (the mass of red muscles amounts up to 5%), suggest that the main locomotor organ in these species is presented by white muscles.


From puberty to mid-life: a follow-up study of twins and controls.

During the years 1964 to 1971 a group of twins and a control group of singletons in the same classes, were followed from grade 3 at 10 years of age to grade 9 at 16 years of age in the Swedish compulsory school. The study was called the SLU-project (Skolöverstyrelsens och Lärarhögskolans Utvecklingsprojekt) and the main purpose was to study physical and mental growth during puberty as well as heredity and environment influences on these growth processes. Originally 323 twin pairs, MZ and DZ, and 1193 controls were included in the sample. Among the DZ twin pairs there were both same-sex and opposite-sex pairs. They were a nationally representative sample. Several kinds of information were collected, such as, a) Physical measurements (height and weight measurements, menarche, ratings of secondary sex characteristics); b) Ability and achievement measures (intelligence tests, standardized achievement tests); c) Self ratings; d) Ratings by teachers and classmates; e) Socioeconomic background data (fathers occupation and income). For the boys, supplementary data on physical growth and mental ability was collected on enrollment to military service at the age of 18. In this pilot-study, we have made a follow-up of the original SLU-sample after 20 years. They are now in their mid-thirties. The main purpose has been to investigate if they are willing to participate in a new study on health and well-being at mid-life.


A twin study of odor identification and olfactory sensitivity.

Interindividual variation in odor identification and olfactory sensitivity has been explained primarily with reference to age, sex and/or experiential factors. A twin study of olfaction can, therefore, substantially contribute to current research in this area. Thirty-nine monozygotic and twenty dizygotic twin pairs have completed the University of Pennsylvania Smell Identification Test (UPSIT), an olfactory preference questionnaire, and two odor detection threshold tests (phenyl ethyl alcohol and butanol). A genetic influence on odor identification, as assessed by the UPSIT, has been demonstrated. Future plans and directions for this research program are discussed.


[A comparative study of the substrate and inhibitor specificity of the glutathione transferase from the spring grain aphid (Schizaphis gramina Rond.) and from rat liver].

Kinetic parameters of 9 substrates interaction with glutathione transferase (GST) from spring grain aphid and rat were studied. The most significant difference in Vmax values was noticed for 4-nitropyridine-N-oxide (6 times higher for aphid) and ethacrynic acid (7 times higher for rat). Km values were practically in all cases higher for aphid GST as compared to rat GST. New class of effectors of GST suggested by us, that is azimines (2 series), was used for the inhibitor analysis. GST interaction with these inhibitors was appreciated by three types of activity: nucleophilic replacement, thiolysis and N-deoxygenation. It has been shown that the degree of GST inhibition depended considerably both on the GST source and the substrate used. New high-effective inhibitors of GST were found among azimines and their higher specificity to rat GST as compared to aphid GST was demonstrated especially in thiolysis reaction.


[The fever reaction of the polecat Mustela putorius x Mustela putorius furo to a bacterial pyrogen: the hypo- and hyperthermic phases].

It has been demonstrated that the ferret (Mustela putorius x Mustela putorius furo) responds to intramuscular injection of Salmonella typhi lipopolysaccharide (30 ng/kg-100 micrograms/kg) by biphasic change in the body temperature (Tb): the initial decrease in the latter is followed by hyperthermia. Maximum rise in Tb (1.6 +/- 0.1 degrees C) was observed after the injection of lipopolysaccharide in the highest dose. Rabbit leucocytic pyrogen/interleukin-1 (1 ml from 3.5 x 10(7) peritoneal phagocytes, 3 ml/kg) induces a pronounced (1.1 +/- 0.3 degrees C) decrease in Tb. Mechanisms of hypothermic effects of pyrogens are discussed. The described pattern (hypothermia-hyperthermia) of Tb response to lipopolysaccharide in the ferret presumably reflects the central thermoregulatory process which is the same for different changes in Tb during fever.


Temperament prediction for neonate twins: relation to size for gestational age in same-sex pairs.

Infants from 22 pairs of appropriate-for-gestational-age/small-for-gestational-age (AGA/SGA) same-sex twins were assessed for temperament stability between the neonatal period and 30 months of age. The evaluation of neonatal temperament included observers' ratings of irritability, resistance to soothing, activity level while awake, activity level during sleep, reactivity, and reinforcement value. At 6, 9, 12, 18, 24, and 30 months mothers rated their infants' temperament on standardized questionnaires which yielded nine temperament categories: activity level, rhythmicity, approach or withdrawal, adaptability, intensity of reaction, quality of mood, attention span, distractibility, and threshold of responsiveness. The Bayley Scales of Infant Development were administered at 6, 9, 12, 18, 24, and 30 months to assess mental development. The results of longitudinal correlational analyses indicated that, for the AGA infants, there was a pattern of significant predictive relations between the neonatal ratings of temperament and maternal ratings of temperament at 6, 9, 12, 18, 24, and 30 months. The SGA infants did not demonstrate similar behavioral stability from the lying-in period up to 30 months of age. Furthermore, for AGA infants there was a consistent trend for both reactivity and neonatal activity during sleep to predict mental development scores between 6 and 30 months. A similar pattern was not observed for the SGA cotwins. The results indicated that temperament stability is an additional area of risk for SGA twins, and that the developmental function of the underlying processes in the neonatal measures is different for AGA and SGA infants.


Twin umbilical cord blood gas values.

In vaginally delivered births (including a few cases where the mothers were under epidural anesthesia), differences between first and second born twins were compared according to presentation at delivery. Of twins with vertex/vertex presentation in 15 primipara cases and in 14 multipara cases, pO2 levels for the second born were significantly lower (both being p < 0.05) than for the first born. Of twins vertex/non-vertex presentation, the second born in 9 primipara cases showed significantly lower pH, pO2 and HCO3 levels (p < 0.05). Also for multipara twins, the second born had significantly lower pH (p < 0.05) and significantly higher pCO2 (p < 0.05) values. Umbilical cord blood gas value findings indicate unfavourable conditions for second born twins.


Effects of early mother-twin relationships from birth to age 3, on twin bonding.

Findings from an earlier phase of this research project clearly pointed to the mother's psychological adaptation inherent to the specificities of triadic interaction. Mothers' attitudes were classified in a typology ranging from "early twinness" where the two babies are treated as though they were a single unit, to attempt to create two dyadic relationships. The current program deals with the effects of the type of parent-child relationship at one year on the emergence of twin bonding. Sixty-eight families of twins (26MZ, 24DZ same sex, 18DZ different sex) are followed up from birth to the age of 3 using a method based on clinical interviews, videotaped observations, and questionnaires. The data cover mothers' rearing attitudes towards organization of babycare and outward signs of twinness, maternal representations of the relationship between the twins and observation of the children's interaction in a standardized game situation. The findings are discussed in terms of zygosity, and parental SCS.


[A comparative study of the DNA structural damages and synthesis in embryos of the silkworm Bombyx mori irradiated with gamma rays at different developmental stages].

Studies have been made on formation and reparation of apurine-apyrimidine (AP) regions, monothread DNA ruptures, as well as on inhibition and recovery of DNA synthesis in gamma-irradiated 3- and 7-day embryos of the silkworm which sharply differ in their radiosensitivity. It was shown that in 3-day embryos, the number of AP regions and DNA ruptures immediately after irradiation is significantly higher than in 7-day embryos. DNA synthesis is more radiosensitive in 3-day embryos as compared to that in 7-day ones. Kinetics of postradiation recovery of regions and DNA ruptures in 3- and 7-day embryos is heterogeneous and significantly different. However, radiation inhibition and postradiation recovery of DNA synthesis in irradiated 3- and 7-day embryos are associated mainly with postradiation survival of these embryos.


Perinatal management of twin pregnancy.

Of 104 cases, 38 (ie, 36.53%) experienced premature delivery (controls: 4.32%). In instances of threatened premature delivery, 28 cases (26.92%) underwent ligation of the cervix. EPH gestosis occurred in 62 cases--a high incidence rate of 59.61% (controls: 12.9%). Forty-nine cases (47.11%) were complicated by anemia (controls: 8.36%). There were 57 cases of SFD infants, again a high 27.40% incidence rate (controls: 5.94%). Apgar scores of 7 or less at 1 minute after birth indicated that of the 208 neonates, the second-born twin only in 20 cases (9.61%); both infants in 14 cases (6.73%); and, the first-born only in 3 cases (1.44%), developed asphyxia neonatorum. Given the high incidence of premature and immature infants in cases of twins, caution should be employed against threatened premature delivery from around the 28th week of gestation onwards. Ligation of the cervix with ritodrine administration should be performed following admission to hospital, and EPH gestosis, anemia and IUGR should be carefully monitored.


Within-pair similarity in MZ and DZ twins from birth to eighteen years of age.

This study is based on 145 pairs of twins included in a longitudinal study of a cohort of singletons born in 1953 and living in the Stockholm metropolitan area in 1963. Of these 145 pairs, 28 were classified as MZ, 103 as DZ and 14 pairs could not be classified. School achievement and ability test results have been collected for this group as well as data for the boys from physical and mental examinations on enrollment to military service. The purpose of this study was to compare within-pair similarity for MZ and DZ twins from birth onwards. There seems to be a divergent trend over time for MZ twin pairs to become more similar and DZ twin pairs to become less similar in height growth, school achievement and verbal ability. This is in accordance with previous research in this field. In relating similarity within pairs to birthweight, we found a drop in within-pair similarity for low birthweight MZ and DZ twin pairs (both twins < or = 2.500 g), but not for normal weight twin pairs. A discussion is initiated concerning methodological implications of these results.


Twinning rates in Japan, 1951-1990.

Twinning rates in all of Japan for 1951-1968 and 1974-1990 were analyzed using data from vital statistics of Japan. The twinning rate per 1,000 births was 6.43 in 1951 and remained nearly constant until 1968, then decreased to 5.79 in 1974 and gradually increased to 7.00 in 1990. The MZ twinning rate increased slightly up to 1966, but decreased thereafter, whereas the DZ rate declined over the entire period. As for maternal age, the DZ rate increased up to the age group 35-39 and decreased thereafter. The same tendency is seen in the MZ rate, but the maternal age effect is less marked than in DZ twins. The same tendency is also seen in the overall rate for 1975-1985. As for geographical variations, the MZ and DZ rates were computed in each prefecture for 1955-1959 and in 1974. The DZ rate increased from a low level in the southwest Japan to a high level in the northeast for both periods, whereas the MZ rate was rather constant in 1974 throughout Japan. As for seasonal variation, the highest rates per 1,000 births for MZ(4.56) and DZ(2.20) twins were seen in April, with the lowest rate in September (3.69) for MZ twins and in July (1.71) for DZ twins.


Intrapair differences of physical aging and longevity in identical twins.

The genetic and environmental contributions to physical aging (hair graying, balding, presbyopia) and longevity (age at death) were examined by within-pair comparison in monozygotic (MZ) and dizygotic (DZ) twins in later adulthood. Physical aging was investigated on 135 pairs of adult twins aged over 50. Hair graying and hair loss (baldness) showed significantly higher rates of concordance in the MZ twins than in the DZ twins. The intrapair difference of the degree of hair graying was negligible in 79%, slight in 15% and striking in 5% among the MZ pairs; while negligible in 40%, slight in 50% and striking in 10% among the DZ pairs. The intrapair difference of the degree of hair loss was negligible in 92%, slight in 8% (and striking in none) among the MZ pairs; while negligible in 69%, slight in 25% and striking in 6% among the DZ pairs. The age at onset of presbyopia showed a slightly higher rate of concordance in the MZ than in the DZ pairs. Longevity (age at death) was surveyed on 184 pairs of twins who died at over 40 years of age. The intrapair difference of longevity was 6.65 +/- 5.6 years (maximum 18.0; minimum 0.04) in the MZ pairs, and 8.66 +/- 7.2 years (maximum 18.6; minimum 2.9) in the DZ pairs. The MZ pairs showed a slightly smaller within-pair difference of longevity than the DZ pairs.


Risk factors for cognitive aging in adult twins.

Monozygotic (MZ) and dizygotic (DZ) twins in later adulthood were studied in order to examine genetic and environmental contributions to the decline of cognitive performance. In this study, 118 twin pairs took a comprehensive medical examination at a university hospital. Cognitive function was measured by the Wechsler Adult Intelligence Scale (WAIS). The intraclass correlation coefficients on Digit Span (D) and Digit Symbol (DS) subtests of the WAIS did not show any significant difference between MZ and DZ twins although Block Design (BD) showed a significant difference. The values of the intraclass correlation coefficients were mostly around 0.5 and showed significant within-pair similarity of test scores. The mean score of D, DS and BD declined with advancing age. The intraclass correlation coefficients for D, DS and BD were around 0.2 in the MZ twins reared apart, and around 0.6 in the MZ twins reared together. These results indicated a significant environmental influence on cognitive aging in later adulthood.


Perinatal mortality and prevalence of major congenital malformations of twins in Taipei city.

In order to examine perinatal mortality and prevalence of major congenital malformations in twins, deliveries in four teaching hospitals in Taipei City were studied. Among a total of 73,264 deliveries from October 1985 to June 1989, there were 844 pairs of twins. The zygosity of the twin pairs was determined by sex, placentation and 12 red blood cell antigens. There were 482 MZ and 252 DZ twin pairs identified, but the zygosity of a further 110 twin pairs was indeterminable due to lack of information on plancentation and/or blood types. A total of 4,573 singletons delivered in one study hospital from July 1986 to June 1987 were also studied as controls. The perinatal mortality rate was 7.5% for MZ twins, 1.4% for DZ twins, and 0.7% for singletons. The concordance rate of perinatal death was significantly higher in MZ (60%) than in DZ (0%) twins. The prevalence of major congenital malformations was 2.7% for MZ twins, 1.0% for DZ twins, and 0.6% for singletons. The concordance rate of major congenital malformations was 18% for MZ twins, but no DZ pair was concordant in any major congenital malformation. The concordance rate of facial clefts was 29% for MZ twins. There were 2 sets of conjoined twins giving a prevalence rate of 2.7 per 100,000 deliveries. These findings showing the prevalence of perinatal mortality and major congenital malformation to be highest in MZ twins, intermediate in DZ twins and lowest in singletons, suggest the importance of intrauterine environments in the determination of perinatal mortality and congenital malformations.


Secular trend and associated factors of twinning in Taiwan.

Delivery records of public hospitals and local health centers were analyzed to investigate the secular trend of multiple births from 1955 to 1990 in Taiwan. Twinning rates decreased gradually from the late 1950s to 1973, slightly increased and remained stable from 1974 to 1980, and then increased strikingly from 1981 to 1990. During the study period, MZ rates were consistently higher than DZ rates except in 1986 when a higher DZ rate was observed. The highest MZ rate of 7.7 per 1,000 deliveries was observed in 1985, while the highest DZ rate of 4.6 per 1,000 deliveries was observed in 1986. The triplet incidence rate also declined from the early 1960s to 1973 and then increased markedly from 1974 to 1990. A case-control study including 482 MZ and 252 DZ twin pairs and 1,496 singletons was carried out in four teaching hospitals in Taipei City between October 1985 and June 1989 to examine factors related to twinning. The zygosity of twin pairs was determined by sex, placentation and red blood cell antigens. Multiple logistic regression analysis showed that the higher the maternal age, the lower the MZ and DZ rates, while the higher the parity, the higher the rates. There was no association of paternal age or of maternal educational level with twinning rates.


Improvement of ocular blood flow with dopamine antagonists on ocular-hypertensive rabbit eyes.

The eyedrops of the ocular-hypotensive dopamine antagonists, trifluperidol, moperone, lenperone, and spiperone, were instilled into an ocular-hypertensive rabbit eye. The blood flows in the choroid, retina, iris root-ciliary body, and iris were measured with colored microspheres at various time periods. It was found that all these dopamine antagonists, at a concentration of 0.5%, increased the blood flow in all eye tissues. Dopamine, at a concentration of 3%, produced a biphasic action by decreasing the blood flow initially at 30 min, then increasing it at 120 min and thereafter. But 1.5% dopamine produced a monophasic action which increased the blood flow after 180 min. Since dopamine antagonists are not cholinergics or adrenolytics, they are not supposed to produce the side effects induced by pilocarpine or timolol. It is hoped that they can become satisfactory drugs for glaucoma and ocular hypertension.