[Role of embolization in the emergency treatment of ruptured cerebral arteriovenous malformations].

Embolization of cerebral arterio-venous malformations (A.V.M.s) is nowadays recognized as belonging to the therapeutic panel applied to these lesions. After an hemorrhagic accident, embolization is most often performed several weeks later. We report three cases of intracerebral hematoma due to A.V.M. rupture (cortico-ventricular rolandic, lateral ventricle subependymal, cortical anterior temporal A.V.M.s). These were treated by endovascular methods, using fluid material (N.B.C.A.), in emergency or semi emergency (hours, days). This had been done for direct preoperative purposes or medical reasons (heparinization in thrombophlebitis). If, at Bicêtre, the treatment of A.V.M.s by embolization is daily performed, this type of emergent treatment is rare (3 cases on the 350 patients treated till now). No complication was reported for these three patients. The efficiency of such an "emergent procedure" is unknown and cannot be compared to similar experiences. The empiric data we obtained make us think that embolization, necessarily done without heparin, is possible and may constitute an important help to surgery without delaying it. It reduces the risk of rebleeding by targetting the treatment on angio-architectural weakness points (false aneurysms). It redistributes the arterial blood, lowers the venous hyper-pressure, improves the locoregional perfusion and finally leads to a better final neurological status.


[Practical value of transcutaneous pressure adjustable valves (Sophy SU 8) in the treatment of hydrocephalus and arachnoid cysts in adults (75 cases)].

The authors report a series of 75 adults treated over the four last years for hydrocephalus (69 cases) or arachnoid cysts (6 cases) by using a transcutaneous pressure adjustable valve (sophy SU 8) the mechanism of which is recalled. The shunt was ventriculo-atrial 46 times, ventriculo-peritoneal 23 times and cysto-peritoneal 6 times. The opening pressure of the valve was initially adjusted 56 times in a medium, 9 times in a high, and 10 times in a low position, according to each particular patient's features. Following the evolution of the neurological status and/or the CT findings, the opening pressure was secondarily modified in 27 patients (i.e. in 36%), and in some of them several times. It was raised 16 times: 10 times because of subdural hydroma(s) (complicated with a subdural hematoma which required a surgical removal, in one case), and 6 times because of clinical symptoms of intracranial hypotension associated with hyper-drainage signs on CT. It was diminished 20 times because of the absence of clinical improvement and persistence of dilated ventricles on CT. In these 27 patients the Sophy SU 8 valve allowed modification of its opening pressure according to the clinical and CT evolution, without need for reoperation. It is concluded that the patients who can benefit the more from this valve system are patients with normal pressure hydrocephalus or with arachnoid cysts.


[14 cases of communicating syringomyelia associated with Chiari I malformation in children].

The authors review their experience of 14 children with syringomyelia and associated Chiari I malformation observed during the last 21 years. Initial symptoms were motor weakness (57%), sensory signs (50%), scoliosis (50%) and bladder dysfunction (21.5%), while signs of admission were pyramidal signs (78.5%) with motor deficit (43%), spinal deformities (64.2%), syringomyelic syndrome (36%) and sensory deficit (21.5%). Four children were investigated with myelography, three with myelography and spinal CT Scan and the last seven cases with MRI. Ten children (71.4%) underwent a decompression of the Chiari malformation with or without drainage of the cyst and shunting of an associated hydrocephalus. Syringo-peritoneal shunts were used in 3 children and laminectomy with syringo-subarachnoid shunt in 1 case. The neurological symptoms improved in 57% of the cases, 2 patients deteriorated and 4 patients were lost to follow-up. The authors discuss the clinical symptomatology, the MRI study, the controversies concerning the treatment and concluded with their attitude concerning this pathology in children.


[Epidermoid cyst of the corpus callosum].

Epidermoid cysts are most commonly located in the cerebellopontine angle and the parasellar regions. The authors report a case of an epidermoid cyst of unusual location: it arises in the midline and involves the body of the corpus callosum with interhemispheric exophytic growth. Reviewing the literature they did not find any similar report. C.T. scan and M.R.I. are the methods of choice for establishing the diagnosis and differentiating between epidermoid cyst, dermoid cyst, lipoma and arachnoid cyst. M.R.I. is highly sensitive and is especially useful in determining tumour extension, particularly in the sagittal and coronal planes, essential for surgical treatment planning. Treatment should be complete surgical resection in order to avoid recurrence and chemical meningitis.


[Cervicobulbar intramedullary lipoma. Apropos of a case with review of the literature].

The authors report a case of cervical intramedullary lipoma extending into the bulbomedullary junction. 99 cases of cervical and/or dorsal intramedullary lipomas without spinal dysraphism, reported since 1884, are reviewed. There is poor correlation between lipoma's length and age of onset. Only lipoma extended to all the spinal cord begin in the first years of life. Clinical presentation is in 58% of cases a slowly compressive myelopathy, a syringomyelic syndrome in 9.5% of cases, a Brown Sequard syndrome in 6.5% of cases or atypical clinical features in 26% of patients. Finding of a subcutaneous lipoma at the level of the lesion helps for diagnosis. C.T. scan and magnetic resonance imaging (M.R.I.) precise lipomatous constitution of the tumor, its limits and relations with neighbouring tissues. Surgery is necessary when clinical features are advanced. Surgery indication is debatable when neurological manifestations are poor or absent. Post operative course is generally good and is not related with type of intervention.


[Intramedullary neurinoma. Apropos of a case. Review of the literature].

The authors present a case of intramedullary neurinoma. A 44 years old patient was admitted for lumbar pain and bilateral sciatica. Neurological examination was normal except for dysuria and diminution of Achilles tendon reflexes. Lumbar spine X-rays and spinal cord angiogram were normal, but myelogram and myelo-scan revealed a fusiform enlargement of the conus medullaris. MRI confirmed this aspect. Total removal of an intramedullary tumor was done, using ultrasonography, operating microscope and ultrasonic aspiration. The post-operative course was uneventful, with, as sequelae a perineal hypoesthesia. Histological examination of the excised tumor revealed a neurinoma. The epidemiology, clinical features, radiology, and surgical treatment of such rare intramedullary tumors are discussed.


[Crescent: structure, evolution, pathogenesis].

Extracapillary crescent is an elementary lesion which can be superimposed to any type of glomerulonephritis, or constitute the main lesion as in vasculitis, or appear to be idiopathic. One must oppose cellular crescent which is partially reversible, to irreversible fibrous crescent. Cellular composition of crescents has been much controversial: initially considered as having an epithelial-cell origin, then an exclusive macrophagic origin, crescents are in fact composed of epithelial cells, monocytes-macrophages and lymphocytes all together. The former are prevailing when Bowman's capsule (BC) is intact, whereas macrophages predominate when there is extensive damage of GBM and of BC. The initial event in crescent formation appear to be breaches in glomerular capillary wall, leading the deposition of fibrin within Bowman's space. The consequence is the proliferation of parietal epithelial cells and of activated macrophages followed by a production, in series, of cytokines and growth factors.


[Role of hemostasis in the formation of crescents in extracapillary glomerulonephritis].

Extracapillary glomerulonephritis are associated with fibrin deposition in the urinary space of the glomerulus. Such deposits were correlated with the severity of the disease and with a poor renal outcome. Fibrin formation involves an activation of the coagulation cascade either through the intrinsic pathway, Hageman factor being activated by the altered glomerular basement membrane, either by the extrinsic pathway, infiltrating monocytes and glomerular cells exhibiting a procoagulant activity i.e. thromboplastin or tissue factor. Treatments with heparin or warfarin were shown to decrease the severity of experimental glomerular diseases. A similar beneficial effect was obtained with a monocyte-depleting serum and more recently with a treatment by a tissue type plasminogen activator. Glomerular cells also produce a fibrinolytic activity which could be too low or uneffective on extracapillary fibrin deposits if they contain high amounts of plasminogen activator inhibitors. Thrombin has procoagulant activity, antifibrinolytic activity and has cellular chemotactic and proliferative effects. It could play a major role in the pathogenesis of crescent formation.


Rapidly progressive glomerulonephritis and Wegener's granulomatosis.

Wegener's granulomatosis is estimated at 1/100.000/year. Histological proof of the characteristic granuloma is only demonstrated in 1/3 of patients suspected of having WG. The ANCA test is essential in making the diagnosis. Wegener's granulomatosis can affect any organ system. That the beginning of the disease is restricted to one organ (limited WG) is postulated to be true in at least 1/3 of all patients. One peculiar organ manifestation of WG is the pulmonary-renal syndrome. Renal involvement in WG is common and can reach from pauci-immune mild mesangial to crescentic lesions, depending on the severity of the disease. Predictors of renal outcome are glomerular obsolescence and degree of tubulo-interstitial lesions.


[Micropolyarteritis].

Micropolyarteritis are defined as necrotizing inflammatory lesion of the wall of small vessels affecting different organs. A necrotizing crescentic glomerulonephritis without immuno-deposits is observed in the kidney, frequently involved in this microscopic form of systemic vasculitis. Micropolyarteritis are regrouped with Wegener's syndrome and isolated pauci-immune necrotizing crescentic glomerulonephritis as "ANCA-related vasculitis", whose diagnosis is assessed throw renal biopsy and prognosis dependent on immuno-suppressive treatment. Sixty-one patients treated in our nephrology department for a RPGN during these ten recent years have been retrospectively studied. Among them, twenty-five patients presented clinical and morphologic aspects compatible with the diagnosis of micropolyarteritis. We present their clinical aspects and evolution under treatment.


Evolution of blood magnesium, sodium and potassium in depressed patients followed for three months.

No consensus has been obtained about blood electrolyte status, especially about magnesium, in affective disorders. This is mainly due to the lack of information about the distribution of the patients in clinical subgroups, sex, type of treatment and about the severity of their illnesses. Most of these studies concerned treated patients. We confirmed in this study that drug-free depressed patients have higher erythrocyte and plasma magnesium than controls, as shown in previous reports. Significant differences are observed in as shown in previous reports. Significant differences are observed in patients for sex and between clinical subgroups. Low plasma potassium levels are described in both male and female depressed patients. The erythrocyte magnesium level tends to normalize in parallel with clinical improvement, depending on sex and clinical subgroup, and seems then to be related to the intensity of the depression. Plasma magnesium in male and female patients, except for female unipolars, remains higher than controls in all conditions and might be related to the diagnosis of affective disorders.


Autoaggressive behaviour and cholesterol.

A retrospective analysis of a sample of 1,088 patients suffering from affective psychoses did not reveal associations between serum cholesterol and suicidal behaviour. However, suicide was associated with lower body weight.


Examination of pre- and posttreatment MHPG during cognitive therapy.

Sixteen unipolar depressed patients were treated with cognitive therapy for 12 weeks. Pretreatment 24-hour urinary MHPG levels were unable to predict treatment response. There was a nonsignificant trend for cognitive therapy responders to show a decrease in MHPG during treatment when compared to nonresponders.


Perspectives in clinical psychopharmacology of amitriptyline and fluvoxamine. A double-blind study in depressed inpatients.

The efficacy of fluvoxamine was compared to that of amitriptyline in a double-blind 6-week fixed-dose trial of 56 inpatients with major depressive episode. The two drugs were comparable in their antidepressant efficacy. We tested the percentage of improvement in Hamilton-D scores during the first and the second weeks of treatment as predictors of efficacy for the last week. Improvement rates during the second week significantly predicted the outcome. We also investigated whether or not some symptomatological characteristics would permit prior prediction of the outcome with amitriptyline or fluvoxamine, dividing our sample into responders and nonresponders to the two drugs. The four groups showed differences in their symptomatological profiles.


Effects of delta sleep-inducing peptide on sleep of chronic insomniac patients. A double-blind study.

The influence of delta sleep-inducing peptide (DSIP) on sleep was studied in 16 chronic insomniac patients according to a double-blind matched-pairs parallel-groups design. Subjects slept for 5 consecutive nights in the laboratory. Night 1 was used for adaptation, night 2 for baseline measurements. In the afternoon before the 3rd, 4th and 5th night, half of the patients received intravenously 25 nmol/kg body weight DSIP, and half of the patients a glucose solution (placebo). Measures for sleep structure, objective (polysomnography) and subjective sleep quality and for subjective tiredness were assessed. The results for objective sleep quality indicated higher sleep efficiency and shorter sleep latency with DSIP as compared to placebo. One measure of subjectively estimated tiredness decreased within the DSIP group. Data analysis suggested, however, that the statistically significant effects were weak and in part could be due to an incidental change in the placebo group. As none of the other measures, including subjective sleep quality, showed any change, it was concluded that short-term treatment of chronic insomnia with DSIP is not likely to be of major therapeutic benefit.


Effects of breakfast and caffeine on performance and mood in the late morning and after lunch.

The aim of the present study was to examine the effects of breakfast and caffeine on performance, mood and cardiovascular functioning in the late morning and after lunch. Forty-eight subjects were tested at 07.45 and subjects then assigned to one of the four conditions formed by combining caffeine and breakfast conditions. Subjects in the caffeine condition were given a dose of 4 mg/kg, the caffeine manipulation being double blind. At 11.15 subjects were given another coffee (subjects remained in the same caffeine condition) and had lunch at 12.30. Performance was examined prior to lunch (11.30) and after lunch (14.00). Effects of breakfast on recognition memory (lower false alarm rate) and logical reasoning (reduced accuracy) were found in the late morning but not after lunch. However, a semantic processing task was performed more slowly by the breakfast group after lunch. Caffeine improved performance on a sustained attention task, the logical reasoning task and semantic memory task. Subjects given caffeine also reported greater alertness and feelings of well-being, whereas the effects of breakfast on mood changed from the late morning to early afternoon. Few interactions between breakfast and caffeine conditions were obtained.


Action of the N-methyl-D-aspartate receptor antagonist MK-801 against focal seizure activity from the feline hippocampus.

This study assessed the effects of MK-801 (0.1 and 0.5 mg/kg), a noncompetitive antagonist of N-methyl-D-aspartate receptors, on focal seizure activity elicited by electrical stimulation to the feline hippocampus. Neither afterdischarge duration nor behavioral seizure stage was significantly suppressed following intraperitoneal administration of MK-801 at two dose. Rather, MK-801 at a higher dose induced hippocampal seizure status in some of the cats tested. The present data suggest convulsant properties of MK-801 and limitations of its clinical utility as an antiepileptic agent.


Topographical analysis of sleep spindle activity.

There is evidence for two types of sleep spindle activity, one with a frequency of about 12 cycles/s (cps) and the other of about 14 cps. Visual examination indicates that both spindle types occur independently, whereby the 12-cps spindles are more pronounced in the frontal and the 14-cps spindles in the parietal region. The purpose of this paper is to provide more information about the exact topography of these patterns. First the occurrence of distinct signals in anterior and posterior brain regions was verified using pattern recognition techniques based on matched filtering. Thus the existence of two distinct sources of activity located in the frontal and parietal region of the brain, respectively, was demonstrated using EEG frequency mapping. Evaluation of sleep recordings showed high stability both in the frequency and location of the presumed spindle generators across sleep. Pharmacological effects of lormetazepam and zopiclone on both spindle types were investigated. Both substances enhanced the sleep spindle activity recorded from the frontal and parietal electrodes, but this increase was more pronounced in the parietal brain region.


Serum antibody responses to Streptococcus mutans antigens in humans systemically infected with oral streptococci.

Sera from patients with subacute bacterial endocarditis (SBE) due to Streptococcus mutans or other oral streptococci and from normal subjects were assayed by enzyme-linked immunosorbent assay for antibodies to defined S. mutans antigens. Antibodies of IgG and IgA isotypes to Ag I/II and Ag III were greatly elevated in S. mutans-SBE sera, and the IgA antibodies in 3 sera included both polymeric and monomeric forms. Elevated IgM and IgG anti-lipoteichoic acid and IgG and IgA anti-serotype c polysaccharide antibodies were also found. The sera of 4 of 6 patients infected with other oral streptococci also displayed antibodies to S. mutans Ag I/II. Sera of 3 patients infected with Streptococcus mitis or Streptococcus oralis, but none of the S. mutans-infected cases, showed elevated antibodies to human heart sarcolemma, and all SBE sera had elevated rheumatoid factor. These results suggest that the known surface protein antigens of S. mutans are immunodominant in humans, and are not likely to be heart cross-reactive.


Immunoglobulin A antibody activity to mutans streptococci in parotid, submandibular and whole saliva.

Antigen extracts of 9 strains of Streptococcus mutans, Streptococcus sobrinus, Streptococcus salivarius and Streptococcus mitis were separated in acrylamide gels by electrophoresis. Strains of the same genotype of mutans streptococci were found to have virtually identical sodium dodecyl sulfate-polyacrylamide gel electrophoresis patterns but differed clearly from other genotypes of mutans or with the reference strains S. salivarius and S. mitis. Immunoglobulin A (IgA) antibody activity to antigens of S. mutans, S. sobrinus and S. mitis in the parotid, submandibular and whole saliva of 12 people was detected by Western blotting. IgA antibodies reacted with several of the antigens, and the reaction pattern was unique for each of the individuals. To certain antigens, all the salivas blotted bands if both clear and questionable bands were counted. Significantly more blotted bands were revealed with antigens from S. mutans than S. sobrinus. The results of the 3 different salivas of the same individual had a high degree of resemblance but in a few individuals, more blotted bands were obtained with parotid saliva to S. mutans and S. sobrinus antigens.


Immunosuppressive effect induced by Actinobacillus actinomycetemcomitans: effect on immunoglobulin production and lymphokine synthesis.

The soluble sonicated extract (SE) from Actinobacillus actinomycetemcomitans inhibited primary T cell-dependent antibody responses in vivo. The production of IgG and IgM to sheep red blood cells (SRBC) was depressed when mice were treated with high concentrations of SE plus SRBC. Preinjection of SE 3 days prior to SRBC completely inhibited IgG production. SE plus SRBC-primed mice showed markedly depressed CD4/CD8 ratios relative to phosphate-buffered saline plus SRBC- or SRBC-immunized mice. SE-sensitized mice showed low blastogenic activity to concanavalin A (Con A) depending on sensitized periods induced by SE. This inhibitory mechanism was, in part, clarified by a suppression of IL-2 synthesis, IL-2 receptor expression and IL-6 secretion by the splenic T cells stimulated with Con A. These results support the hypothesis that the severe infection of A. actinomycetemcomitans suppresses the immune response by affecting CD4/CD8 ratios, followed by lymphokine production and finally antibody responses.


Evaluation of the E test for antimicrobial susceptibility testing of Actinobacillus actinomycetemcomitans.

The E test was compared with an agar dilution method for antimicrobial susceptibility testing of Actinobacillus actinomycetemcomitans on Mueller-Hinton Haemophilus test medium. Eighty recent isolates of A. actinomycetemcomitans from 40 subjects and 3 reference strains were studied. Excellent agreement was obtained between the E test and the agar dilution test for benzylpenicillin (98.8%), ampicillin (97.5%), cefaclor (100%), cefuroxime (100%), tetracycline hydrochloride (100%) and ciprofloxacin (98.7%); 76.0% agreement was obtained for metronidazole and only 5.2% for cotrimoxazole. This study indicates that the E test is a reliable method to determine minimal inhibitory concentrations of antimicrobials against A. actinomycetemcomitans, except for metronidazole and cotrimoxazole.


Hydrogen sulfide and methyl mercaptan in periodontal pockets.

A sensitive gas chromatographic method was developed to determine the amounts of volatile sulfur compounds in gingival fluid. Hydrogen sulfide was the predominant volatile sulfur compound and was detected in 61 out of 79 studied periodontal pockets. Methyl mercaptan was found in about 20% of the pockets. No other volatile sulfur compounds were detected. The highest concentration of hydrogen sulfide in gingival fluid was 1.9 mmol/liter, and of methyl mercaptan 0.16 mmol/liter.


[The biology of the thorny-headed worms, parasites of trout acclimatized in the bodies of water of the Tien Shan].

A new species of Acanthocephala, a parasite of local Naemacheilus stoliczkai, was recorded from Salmo gairdneri after 9 years of its introduction into mountain water bodies of Tien Shan. Gammarus lacustris serves as an intermediate host. Dynamics of infection of trout for 9 years is shown.


[Fish parasites as bioindicators of the pollution of bodies of water].

The paper presents the results of studies on the effect of wastes of the Cherepovets iron-and-steel works containing phenol, naphthaline and oil products on fish parasites of the Sheksna part of the Rybinsk water reservoir (the Volga river system). It has been shown that the number of highly sensitive ectoparasites of Abramis brama (Protozoa, Dactylogyrus monogeneans, Ergasilus sieboldi crustaceans and Caspiobdella fadejewi leeches) considerably decreases in the zone of pollution. It has been first suggested to use Diplozoon paradoxum and Caryophyllaeus laticeps, parasites of bream highly resistant to toxic effect, the number of which considerably increases in the zone of pollution, as indicators of anthropogenic pollution and ecological state of a water body. Among diplozoons there have been first discovered individuals having structural anomalies (reduction of the attachment organs, violation in the symmetry of arrangement and number of valves) that serves as evidence of mutagenic effect of toxic substances of polluted waters on morphogenesis of the parasite.


[Increase of excretion of urinary catecholamines and its catabolites in a case of pulmonary sarcomatous tumor].

A five-year-old child presented with a large undifferentiated sarcoma in the right lung. Urinary catecholamines were assayed as tumor markers. A short-lived but significant rise in urinary norepinephrine and dopamine followed by rises in urinary levels of corresponding breakdown products were evidenced.


[Differences in the distant transmission of the tick-borne encephalitis virus by ixodid ticks of 2 subfamilies].

Simultaneous but separate feeding of ticks on nonviremic animal (guinea pig) has shown that Amblyomminae ticks are practically unable to transmit distantly tick-borne encephalitis virus (TBEV) to the specimens of their own subfamily and to Ixodinae as well. Ixodes persulcatus and I. ricinus displayed their ability as donors and recipients of TBEV (adults and nymphs) not only for their own subfamily representatives but also as donors for recipients of Amblyomminae subfamily (nymphs and adults of Dermacentor and Rhipicephalus and nymphs of Haemaphysalis). Experimental and literature data analysis permits the authors to conclude that the very important role of TBEV circulation in nature belongs to the distant virus transmission. The absence of such type of virus exchange among Amblyomminae excludes this group of ticks from active virus circulation in TBEV foci.


[Markers for smoking].

Quantitative and objective measurement of exposure to cigarette smoke by assays of chemical markers is desirable, especially in preventive medicine, since the negative health effects of tobacco smoke are well documented. Chemical markers include nicotine and cotinine in plasma, urine, and saliva; carbon monoxide in exhaled air; carboxyhemoglobin in blood and thiocyanate in biological fluids. Ease of use, cost, specificity, and sensitivity vary across markers. Determination of the thiocyanate/creatinine ratio in urine is a reliable, noninvasive, and inexpensive test for evaluating exposure to cigarette smoke. No marker for cumulative exposure to cigarette smoke is available to date. The plasma level of fluorescent lipoperoxides may provide an estimation of the in vivo toxicity of exposure to cigarette smoke.


[Notes on fleas (Siphonaptera) in plague foci on the Tay Nguyen plateau (Vietnam)].

The fleas of wild and commensal small mammals, domestic animals (dogs, cats) and free-living flea forms in houses have been collected in plague nidi of Tay Nguyen plate, Dak-Lak province, Vietnam. Pulex irritans, Ctenocephalides felis felis, Ct. felis orientis were found in the houses on dogs, cats and on the ground floor. Commensal rats in populated areas were infested by Xenopsylla cheopis and rarely by Lentistivalius klossi. The agricultural zone was inhabited by both home and wild animals such as commensal, savannah and forest-dwelling small mammals. The flea fauna of this zone is presented by X. cheopis and L. klossi. In the tropical forest surrounding villages four of the flea species were found: X. vexabilis, a specific parasite of the forest-dwelling rat Berylmys berdmorei, L. klossi found on six species of forest small mammals, Acropsylla girshami from Berylmys bowersii and Pariodontis subjugis from Hystrix brachyura. The agricultural zone is the most possible place of commensal and forest-dwelling small mammals contact, where the latter can get plague microbe.


Echinomycin.

The story of echinomycin is of an antibiotic whose anti-cancer activity was rediscovered thanks to scientific investigation of its mode of action at the molecular level. It was the first DNA bis-intercalator identified (in 1974). Molecular models for echinomycin and its congeners are now well-founded on crystallographic data. These are beginning to throw light on significant variations in conformation which affect the ability of the antibiotics to recognise specific nucleotide sequences in DNA. Kinetic and other physical experiments have revealed much about the stability and selectivity of antibiotic-DNA complexes: stacking forces are important, as are hydrogen bonding interactions. Echinomycin preferentially recognises sites in DNA containing the CpG step, but other sites of lower occupancy exist and the antibiotic can migrate between them. Currently a good deal of attention is being paid to the suggestion that echinomycin might change Watson-Crick base pairs to a Hoogsteen form.


[Occupational risk of exposure to blood in nurses. Results of a one-year monitoring of the risk for nurses in 17 hospitals].

To evaluate the incidence of risk factors for exposure of health care providers to patients' blood, a prospective multicenter study was carried out in 1990 in 17 hospitals in continental France. 521 nurses from 20 departments of medicine and 9 intensive care nurses participated in the study. Trained investigators documented exposures to blood using a standardized questionnaire and carried out monthly 24 hours cross-sectional surveys to determine the number of high risk procedures performed on a given day. One hundred and eighty-three exposures to blood were documented, for an incidence of 0.35/nurse/year. Needle-stick injuries were the most common events (75%). Exposure to blood occurred during a sampling procedure in 48% of cases, an infusion-related procedure in 20% of cases, and an injection in 17% of cases. Comparisons of rates of procedures associated with needle-stick injuries and of procedures performed during a typical day demonstrated differences in the magnitude of the risk associated with each procedure: infusion-related procedures carried the greatest risk, followed by venous blood sampling procedures. Sixty-four percent of exposures to blood occurred after completion of the procedure. Forty-nine percent of documented exposures to blood would probably not have occurred if universal infection control recommendations (CDC, DGS) had been implemented. Twenty-seven percent of exposures to blood involved HIV-positive patients, who accounted for only 7% of patients managed in the participating centers during the study period.(ABSTRACT TRUNCATED AT 250 WORDS)


[Study of the ototoxicity of amikacin and netilmicin using provoked acoustic oto-emissions and high-frequency audiometry].

To compare the ototoxicity of amikacin and netilmicin, tone audiometry, high-frequency audiometry, early auditory evoked potentials, and evoked otoacoustic emission testing were used to evaluate 30 patients (15 under amikacin and 15 under netilmicin). Ototoxicity was not significantly different in the two groups.


[Study of ninety strains of serogroup A Neisseria meningitidis isolated from cerebrospinal fluid (25) and rhinopharynx (65) in Morocco (December 1989-April 1990)].

Ninety strains of Neisseria meningitidis were recovered from cerebrospinal fluid and nasopharyngeal specimens during the outbreak which occurred in Morocco between December 1989 and April 1990. All the strains recovered belonged to serogroup A. Serotype determination carried out using the "whole cell ELISA" method showed that all strains were serotype 4, subtype P1.9. Antigenic formula of the strains was therefore A:4:P1.9. Electrophoretic characterization of outer membrane proteins demonstrated proteins belonging to classes 1, 3, 4, 5 and 6, with a few rare exceptions which are discussed.


[Activity of ethambutol, isoniazid and rifampicin on Corynebacterium urealyticum and Corynebacterium jeikeium].

Because corynebacteria and mycobacteria have walls of similar composition, it was of interest to test the effects on resistant corynebacteria of two agents with anti-wall effects, i.e., ethambutol (EMB) and isoniazid (INH). Rifampicin was also studied to extend previous data and clarify conflicting results in the literature. INH was not active in levels achieved in vivo with standard dosages. The minimal inhibitory concentration (MIC) of EMB was under serum levels for only three of 78 strains. All minimal bactericidal concentration (MBCs) were greater than serum levels. With RIF, 59% of strains were susceptible and 19.2% exhibited intermediate susceptibility as defined by the French Committee on Antimicrobial Susceptibility Testing. CMI and CMB distributions were heterogeneous, suggesting a possible acquired heterogeneous resistance to RIF.


Effects of psychoeducational care for adult surgical patients: a meta-analysis of 191 studies.

A quantitative review of the literature (meta-analysis) was conducted with 191 studies of the effects of psychoeducational care on the recovery, postsurgical pain and psychological distress of adult surgical patients. Studies issued between 1963 and 1989 were included in the review. Statistically reliable, small to moderate sized beneficial effects were found on recovery, postoperative pain and psychological distress. In further analyses it was shown that these beneficial effects were not an artifact of the biases associated with the decision whether to publish a paper, low internal validity, measurement subjectivity, or a Hawthorne effect. The overall efficacy of psychoeducational care provided to adult surgical patients has been reconfirmed with this larger sample of studies. It is particularly noteworthy that these findings are of more than strictly historical interest. Despite changes in health care delivery, beneficial effects continue even in studies issued between 1985 and 1989. Implications for clinical practice are drawn.


A meta-analysis of controlled trials of cardiac patient education.

Because of the heavy burden of morbidity and mortality exacted by coronary heart disease and the role of behavior in secondary prevention, patient education is a crucial part of cardiac care. Yet evaluations of such programs have not been synthesized to assess the average effects nor which program characteristics have greatest impact. This study used the quantitative methods of meta-analysis to answer these questions, with 28 controlled studies measuring behavioral and clinical outcomes. Results indicate that cardiac patient education programs have demonstrated a measurable impact on blood pressure, mortality, exercise, and diet, other parameters are positively affected, although less consistently. Type of communication channel did not influence outcome; adherence to educational principles did. Thus, cardiac programs should use reinforcement, give feedback, offer opportunity for individualization, facilitate behavior change through skills and resources, and be relevant to patients' needs and abilities.


Approaches to patient and family education with affective disorders.

This paper provides an overview of prevalence, types, effects and treatment for affective disorders, with particular emphasis on educational and psychoeducational interventions. It reviews several models of psychoeducation including the approaches used in various programs at the Psychiatric hospital in which the authors work. These approaches are based on the Psychoeducational Model of Family Treatment developed by Dr. Carol Anderson and colleagues. Outcome data from several studies are also presented evidencing the positive impact of these interventions on patients and families.


Characteristics of controlled studies of patient education and counseling for preventive health behaviors.

To determine characteristics of controlled studies (quasi-experimental and randomized) of clinical patient education/counseling for behavior change to prevent disease, we conducted an extensive literature review of published and unpublished studies from 1971 to 1989. Sixty-four studies with 101 intervention groups met specific criteria for relevance and scientific acceptability. We examine these studies in terms of prevention area, subject source, intervention characteristics, and use of educational principles. Findings reveal many controlled clinical studies in smoking cessation, nutrition, and weight control but sparcity in other areas (injury prevention, exercise, stress, drug and alcohol misuse, STD prevention); an emphasis on communication by a single clinical practitioner; and varied use of educational principles. We recommend adhering to educational principles to enhance likelihood of success.


Methods of psychoeducational program evaluation in mental health settings.

Psychoeducational programs for families of the mentally ill became widespread during the 1980s as a means of providing a forum for the relevant education and mutual support of participants. While these programs are thought to be extremely useful as interventions, very little emphasis has been placed on evaluation as a means of demonstrating their effectiveness in achieving goals. There is a possibility, then, that psychoeducation will continue to flourish with little direct evidence of positive outcomes for its family participants. This article consists of a literature review of existing methods of psychoeducational program evaluation, both quantitative and qualitative, all of which may be applicable in certain circumstances. The process by which an evaluation instrument was developed for a program with families of the mentally ill is then presented in some detail.


FSH and LH receptor concentrations in large ovarian follicles of beef cows in high and low levels of body condition at nine weeks post partum.

An experiment was conducted to determine whether or not the effect of body condition at parturition, and thereafter, on the duration of the post-partum anoestrous period was mediated through differences in gonadotrophin receptor concentrations in the ovarian follicles. Two groups of cows were fed to achieve body condition scores of > or = 2.75 (H; n = 14) or < or = 2.00 (L; n = 15) at parturition (this had led to differences in the duration of post-partum anoestrus in previous experiments) and then fed to maintain liveweight and condition until ovariectomy at nine weeks post partum. There was no effect of body condition on the mean (+/- s.e.) number of large (> or = 8 mm diameter) follicles per cow (3.0 +/- 0.27) but a greater proportion of the follicles of H cows, compared with L cows, was oestrogenic (secreting > 250 pg oestradiol h-1 in culture) (0.75 v. 0.5; chi 2 = 3.40; P = 0.06). Mean concentrations (pg hormone bound per mg protein) of follicle stimulating hormone (FSH) receptors in both granulosa (H, 157.3; L, 136.6; standard error of difference (s.e.d.) = 27.2) and thecal tissue (H, 4.14; L, 4.35; s.e.d. = 1.66) were similar for H and L cows. There was no difference associated with treatment in luteinizing hormone (LH) receptor concentrations in either granulosa (H, 40.3; L, 37.2; s.e.d. = 6.67) or thecal tissue (H, 48.9; L, 48.0; s.e.d. = 6.03). The concentration of FSH receptors in granulosa tissue was lower in non-oestrogenic follicles than in oestrogenic follicles (80.0 v. 188.1; s.e.d. = 40.4; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


Studies on the reproductive performance of Ethiopian sheep by means of an enzyme immunoassay technique; a review.

Measurement of the concentration of hormones associated with reproductive function in female animals can aid in the evaluation of their reproductive status. In particular, from the point of view of production, determination of the concentration of circulatory progesterone can aid in the correct assessment of ewes. Many investigators have used radioimmunoassay for this purpose, but the enzyme-linked immunosorbent assay (ELISA) is equally reliable, quicker and cheaper. This report reviews the use of the ELISA in Ethiopian Menz sheep. Progesterone profiles in Ethiopian Menz sheep during pubertal development, the oestrous cycle, pregnancy and post-partum anoestrus were similar to those of temperate breeds. The practical applications of progesterone determination to sheep production and the requirement for the correct handling of samples are emphasized.


Protein synthesis and secretion by the epididymis of the tammar wallaby, Macropus eugenii (Macropodidae: Marsupialia).

The objectives were to assess the following in a marsupial: which proteins are synthesized by the different regions of the epididymis and secreted into the lumen of the ductus; the effect of the experimental method on the detection of protein secretion; the role of the testis in regulating the protein synthesis and secretion; and whether any of the secreted proteins may associate with spermatozoa. Samples from untreated animals were collected for examination by perfusing Krebs-bicarbonate through the ductus epididymidis in vivo (microperfusion), and after incorporation of [35S]methionine during incubation of minced duct in vitro. Electrophoresis of the samples showed that the caput and corpus epididymidis (initial segments) secreted most of the proteins that were synthesized and secreted by the epididymal mucosa, and that the cauda epididymidis secreted mainly blood proteins. Also, many more proteins were secreted in vitro than into the microperfusates in vivo, or were found by Jones (1987) in micropuncture samples of epididymal plasma. The synthesis and secretion of five proteins was androgen dependent (M(r) 75,700, 30,000, 18,700, 17,400 and 12,800). Also, the luminal fluids from the testis stimulated the secretion of two proteins (M(r) 46,300 and 36,100) and inhibited the secretion of three proteins (M(r) 43,000, 32,300 and 21,400). Examination of detergent extracts of spermatozoa indicated that they lose three proteins (M(r) 28,000, 30,000 and 47,000) and gain one (M(r) 30,400) during passage through the epididymis. The method of determining protein secretion affected the findings. Protein secretion, its control and its association with spermatozoa are broadly similar in the tammar wallaby to the processes described in eutherian mammals.


Developmentally related changes in the uptake and metabolism of glucose, glutamine and pyruvate by cattle embryos produced in vitro.

The metabolism of, and retention of radioactivity from, radiolabelled glucose, glutamine and pyruvate were measured in individual cattle embryos produced in vitro from the 2-cell to hatched blastocyst stage. Uptake was defined as the numeric sum of metabolism and retention of radiolabel. Glucose metabolism increased significantly between the 8- and 16-cell stages, but was accompanied by a much larger increase in glucose uptake. Consequently, the proportion of glucose uptake that was metabolized through the pentose-phosphate and Embden-Meyerhof pathways reached a minimum at those stages. From the compacted morula stage onward, the calculated uptake of [14C]glucose was only 25 to 33% of that calculated for [5-3H]glucose. This suggests that 66 to 75% of glucose carbon leaves the embryo, after metabolism to phosphoenolpyruvate, in some form other than CO2. Little or no glucose metabolism by the Krebs cycle could be detected at any stage. Both glutamine and pyruvate metabolism were relatively high at the 2- and 4-cell stages, declined to a minimum at the compacted morula stage and then increased with blastulation. Glutamine metabolism continued to increase with expansion and hatching of the blastocyst, but pyruvate metabolism did not. This suggest that, relative to the activity of the pathway from pyruvate to 2-oxoglutarate, the activity of the 2-oxoglutarate-to-oxaloacetate segment of the Krebs cycle is of increasing significance during expansion and hatching of the cattle blastocyst.


Interaction of ovary lectin with homologous sperm from Bufo arenarum.

A soluble beta-galactoside lectin purified from Bufo arenarum ovary agglutinated homologous neuraminidase-treated spermatozoa. Microscopic observations of sperm clusters showed that spermatozoa agglutinated in a random way, but the head-to-head type of sperm agglutination was the most common (94-98%). The lectin activity was specifically inhibited by D-galactose and its derivatives, thio-digalactoside being the most active saccharide inhibitor.


Timing of the window of uterine sensitivity to decidual stimuli in mice.

The refractory period that follows the period of sensitivity to a decidual stimulus in ovariectomized hormone treated mice was investigated. Medroxyprogesterone acetate provided constant progestin concentrations and silastic implants containing oestradiol maintained constant nidatory oestrogen concentrations. The nidatory stimulus was provided by crushing the uterus with a haemostat or by the intrauterine instillation of arachis oil. The decidual response was assessed by measuring changes in uterine weight or by examining the stroma for the presence of alkaline phosphatase. Sensitivity to the oil was first observed approximately 14 h after the insertion of the oestradiol implant but this sensitivity had waned by 32 h and was absent at 40 h. Crushing the uterus initiated a decidual response in mice treated with progestin alone but if the oestradiol implant was inserted then the uterus was responsive to crushing 24 h after insertion but not at 45 h. The traumatic decidual cell reaction (crushing), although not requiring nidatory oestradiol for its successful initiation, was nevertheless subject to the refractoriness that followed oestradiol sensitivity.


Evaluating an in vitro culture system of bovine uterine and oviduct epithelial cells for subsequent embryo co-culture.

Three experiments were conducted to evaluate the effects of culture medium and incubation temperature on bovine uterine and oviduct epithelial cell growth, so that the most efficient combination could then be used to develop a co-culture system for bovine embryos. In the first experiment, uterine and oviduct epithelial cells at either the second or third subpassage were incubated for 8 days at 37 degrees C with 5% CO2 in Tissue Culture Medium-199, CMRL-1066, Minimal Essential Medium, Ménézo's B2 or Ham's F-12 medium. In addition to plotting growth curves of cell populations, the cell cycle was monitored for 8 days by flow cytometry. Uterine and oviduct epithelial cells incubated in CMRL-1066 exhibited the highest growth rates during the 8-day culture period. However, there were no differences in cell cycle analysis among treatment groups during the incubation period. In the second experiment, CMRL-1066 medium was used to evaluate growth and proliferation of uterine and oviduct epithelial cells incubated at 37 degrees C or 39 degrees C; temperature had no significant effect on growth rates or proliferation rates for either uterine or oviduct cells during the 8-day incubation. In the third experiment, the more promising culture media for epithelial cell culture studies were chosen for in vitro maturation and subsequent in vitro fertilization (IVF) of bovine oocytes. Early cleavage-stage embryos produced by IVF procedures were subsequently cultured in vitro for 7 days in medium alone or with oviduct epithelial cells. In this study, the culture medium did not influence fertilization or cleavage rates. However, more embryos co-cultured with oviduct epithelial cells were considered viable after 7 days of incubation compared with embryos incubated in medium alone. These results indicate that various incubation conditions can influence the growth of bovine uterine and oviduct epithelial cells in vitro. However, in spite of changes in cell growth patterns, there does not appear to be a change in their embryotropic capabilities in vitro.


GIFT or IVF for patients with patent fallopian tubes?

The pregnancy rate in a group of 39 couples who underwent in vitro fertilization (IVF) with donor sperm was compared with that of couples undergoing gamete intra-Fallopian transfer (GIFT) over the same period (31 December 1986 to 30 June 1991). The diagnostic status of the female partners in each group was qualitatively similar. The women had patent Fallopian tubes, mild endometriosis or minor tubal adhesions. The male partners in the GIFT group had normal or marginally abnormal semen parameters which were considered to be comparable to the post-thaw quality of the semen used in donor insemination (DI). The mean age of the women in the DI group was 32 years (range 25-40) which was similar to that in the GIFT group [32 years (24-39)]. The women in the IVF group had undergone a mean of eight cycles of DI before proceeding to treatment with IVF. There was no difference between the pregnancy rate in the two groups (log-rank test). These observations advance the proposition that IVF should be reconsidered as an effective treatment for women with patent Fallopian tubes.


Oxytocin delays oestradiol-induced luteolysis but does not affect oestradiol-induced luteinizing hormone secretion in the ewe.

Circulating concentrations of progesterone, the prostaglandin F2 alpha (PGF2 alpha), metabolite 13,14-dihydro-15-keto PGF2 alpha (DHKF2 alpha) and luteinizing hormone (LH) have been measured in cyclic ewes receiving a continuous infusion of oxytocin, in order to investigate the effect of maintained concentrations of circulating oxytocin on the luteolytic action of oestradiol-17 beta. Oxytocin (3 nmol h-1 intravenously) was given from Day 7 until Day 17 after oestrus with oestradiol-17 beta (2.76 mumol, intramuscularly in sesame oil, 0.5 mL-1) administered on Days 9 and 10. Control ewes, given a continuous infusion of saline (154 mmol L-1, 3 mL-1 h-1) and sesame oil on Days 9 and 10, underwent luteal regression at the expected time, with mean concentrations of plasma progesterone falling to below 1.5 nmol L-1 on Day 16 (0900 hours). Mean plasma progesterone concentrations fell to less than 1.5 nmol L-1 on Day 13 (0900 hours) in ewes receiving saline and oestradiol-17 beta. Oxytocin infusion delayed luteolysis in all treated ewes; those receiving oxytocin infusion and sesame oil failed to undergo luteal regression during the period studied and in animals receiving oxytocin and oestradiol-17 beta, luteolysis was significantly delayed when compared to ewes treated with saline and oestradiol with progesterone concentrations falling to < 1.5 nmol L-1 on Days 14 (n = 1 ewe), 15 (n = 1 ewe), 16 (n = 2 ewes) and > 17 (n = 2 ewes) (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)


Intracellular movements of Rickettsia conorii and R. typhi based on actin polymerization.

Human vascular endothelial, Vero and human embryonic lung cells infected with rickettsiae for 24 h or 48 h were labelled for polymerized actin with NBD-phallacidin. Between 20 and 68% of the intracellular Rickettsia conorii had an actin tail of between 0.33 and 15 microns, with the longest tails being observed in Vero cells. In the case of R. typhi less than 1% of the organisms had actin tails and these were considerably shorter than those of R. conorii. These findings provide new information concerning the different cytopathic effects observed with the two rickettsial species.


Characterization of a linear extrachromosomal DNA element (pBL1) isolated after interspecific mating between Streptomyces bambergiensis and S. lividans.

Streptomyces bambergiensis S712 harbours a giant linear plasmid PSB1 of 640 kb. After mating with the plasmidless S. lividans strain TK64, conjugants carrying a smaller extrachromosomal DNA element, pBL1, were identified. pBL1 is a 43-kb linear DNA molecule bound to a protein which protects it from attack by both 3'- and 5'-exonucleases. The absence of this protein drastically reduces the transforming efficiency of pBL1. pBL1 shares homology with linear plasmids and chromosomal DNA from S. bambergiensis strains.


Nitrogenase activity in wheat seedlings bearing para-nodules induced by 2,4-dichlorophenoxyacetic acid (2,4-D) and inoculated with Azospirillum.

Nitrogenase activity (C2H2 reduction) was demonstrated in seedlings of wheat roots bearing para-nodules induced by 2,4-dichlorophenoxyacetic acid (2,4-D) and inoculated with Azospirillum brasilense. Increased nitrogenase activity was observed in inoculated para-nodulated seedlings as compared to inoculated roots not treated by 2,4-D under the conditions of assay used. 2,4-D had no stimulating effect on plant ethylene production in the absence of acetylene. When inoculation was performed with a Nif-mutant of A. brasilense, no ethylene production was detected. It was also shown that the energy source required for nitrogenase activity was supplied by the host plant.


A fourth metalloprotease gene in Erwinia chrysanthemi.

Erwinia chrysanthemi, a Gram-negative phytopathogenic bacterium, was previously shown to secrete 3 related extracellular metalloproteases, A, B and C via a specific signal-peptide-independent pathway. A new gene (prtG) encoding a fourth, 52-kDa metalloprotease was identified on the same recombinant cosmid (pEW1) that carries the genes for the previously described proteases (prtA, prtB and prtC), for the specific secretion factors (prtD, prtE and prtF) and for a protease inhibitor (inh) cloned from E. chrysanthemi B374. The predicted sequence of PrtG was similar to those of PrtA, PrtB and PrtC, its secretion required PrtD, PrtE and PrtF; its secretion signal was located at the C terminus but its proteolytic activity was distinct from that of the 3 other proteases. Results presented here suggest that prtG could be the first gene of an operon that includes inh, prtD, prtE and prtF.


Regulation of nisin biosynthesis by continuous cultures and by resting cells of Lactococcus lactis subsp. lactis.

Nisin production by Lactococcus lactis subsp. lactis has been investigated using lactose as carbon source. Whether or not continuous cultures were lactose-limited, maximum nisin titre was observed at an intermediate mu value with a sharp peak of activity between 0.2 and 0.3/h. The maximum specific growth rate obtained in the medium used was 0.6/h and the maximum titre of nisin at mu = 0.25/h (160 AU/ml) was about nine-fold higher as compared with activity obtained at a dilution rate of 0.05/h or 0.4/h. With a constant dilution rate of 0.25/h and varying initial lactose concentrations from 3 to 40 g/l, there is an increase in nisin biosynthesis with increasing lactose concentration correlated with higher rates of sugar consumption. A Ymax value of 0.2 g bacterial dry weight and a maintenance coefficient of 124 mg lactose/g bacterial dry weight/h were determined. Lactose consumption increased from 1 to 3.28 g of lactose/g (dry wt) of cell mass/h and the nisin titre from 12.5 to 164.2 AU/ml. At higher values, nisin production declined. This implies that biosynthesis of nisin is regulated by a system of repression and derepression. Addition of lanthionine and beta-methyllanthionine precursors to the medium decreased the nisin titre when either threonine, threonine-cysteine, or cysteine-serine-threonine was added at the optimal dilution rate of 0.25/h; however, simultaneous addition of serine and cysteine elicited a slight increase in nisin activity. Studies with resting cells confirm that the biosynthesis of nisin is tightly regulated, since the production rate can be 5.6-fold higher than in cells grown in continuous culture. In addition, cell-adhered nisin appears to play a role in the production of the enzyme: low levels of cell-adhered nisin elicited high production rates, whereas high levels were not associated with nisin biosynthesis. In addition to pH, magnesium sulphate and lactose concentrations, nitrogen sources were also able to interfere in cell-adherence nisin.


Characteristics of cellulose colonization by a mesophilic, cellulolytic Clostridium (strain C401).

Using the technique of incorporation of 3H-thymidine into DNA, we describe colonization properties of an anaerobic, mesophilic, cellulolytic Clostridium, strain C401. This method took into account both bacteria which adhered and those which did not adhere to the substrate. The observed generation time (7.5 h) was faster than that detected (26 h) with other methods. Under the conditions used, the end of growth was characterized by a sharp release of biomass. A depletion in the supply of carbon source and therefore, of the adhesion site, was responsible for this release.


[An outline of a conceptual framework for nursing].

The taxonomy of the functions of the nurse is an attempt at the systematization of an aspect of nursing knowledge. The taxonomy consist of six classes (groups) with their corresponding categories which illustrate the performance of nurses in their field.


[The implementation of a program for preparing parturients for childbirth at the University Hospital of the University of São Paulo].

The Obstetric and Neonatal Nursing Program of the School of Nursing of USP has worked with the Maternal and Infant Division of the University Hospital of USP since 1981. Among the activities carried out are the childbirth classes to prepare pregnant women, developed from 1990 as teaching-practice linkage. The evaluation of the preparation take into account the process of collaboration nursing education and nursing services.


[The design of a personal computerized database].

The development of a personal data base about informatics and nursing for use on a microcomputer is presented. The advantages, effectiveness and problems involved with the construction of personal library, as well as the employed software and the references classification problems are discussed.


[Knowledge about AIDS among rural workers].

The objective of the present study was to identify the knowledge rural workers have about AIDS in order to develop a specific educational projects. It was observed that part of the population which spontaneously participated in the study presented characteristics of misinformation and alienation about AIDS, as well as about situations that may pose risks to workers. On the basis of the responses obtained, an educational project about AIDS was elaborated to reach 1300 workers employed at a Sugar and Alcohol Mill.


[Mental health nursing for women in a crisis due to accident].

This study shows that the psychiatric nurse has been called to act therapeutically with hazard population in the ambit of the mental health. The author uses the technique of the aid relationship to the persons in a systematic and empathetic performance. In respect to the results obtained in intervention near the women in accidental crisis the nurse earns a real space to her mental health actions.


[The nursing consultation in school health: a proposal and evaluation of an operational model].

This study has the main purpose of offering some aids for a systematization of nursing attendance to the scholar and for this purpose a pattern of nursing consultation in scholars health was elaborated and evaluated by opinions of nurses (27) and students of nursing (17). The results showed its utility because the model made easy the rising of problems and needs of scholars and the performance of a nursing diagnosis and the further planning of nursing actions according to the responders. The model was considered applicable (86.4%) and some conditions were presented for its applicability.


[The patient undergoing amputation of the lower limbs and the changes in activities of daily living].

The present study is part of the DIOGO monograph. The objective is to verify the alterations identified in aged patients which had been submitted to amputation of their lower limbs, in relation to everyday life. The data was collected from 25 inpatients, of a government university hospital. The analysis of the results suggests that the alterations referred by the patients submitted to amputation less than 10 days before coincide with those referred by aged patients which had had their limbs amputated over a month before, in the items related to body hygiene and locomotion.


[The joint hospitalization of mother and child at the Hospital das Clínicas of the State University of Campinas. The assessment of a group of mothers].

This investigation is a field study involving 84 mothers who participated in the rooming-in program in the Pediatric Ward at the University Hospital of UNICAMP, Campinas São Paulo. The purpose of the study was to identify the mother's opinions concerning the hospitalization of their children under the rooming-in program, as well as to make a contribution towards the improvement of planned nursing care in the Pediatric Unit. Data collection was obtained through the use of a structured interview with each mother. The interview form included some mother's opinions concerning rooming-in. The results showed that these mothers considered the rooming-in program important for the treatment of the child, and that they related as "good" and "excellent" about care given in the unit.


[A model of the analysis of nursing knowledge].

We present an analysis based on the systemic idea where production, dissemination and utilization are constituting elements of knowledge, interdependent, allowing, in a global approach, identification of the interactions and areas of intersection. Each part, with its specific dynamism, interacts with the others, creating areas which contribute to growth. The concomitant intersection of the parts is characterized as the essence of knowledge and the dynamics of these seek the equifinality of the system: the incorporation of knowledge to practice.


[The scientific production of nurses in São Paulo State in the triennium of 1985-1988].

An exploratory study of the research carried out by nurses belonging to the Brazilian Nursing Association from 1985 to 1988 was conducted with following objectives: to analyze the characteristics of the scientific production of nurses; to identify the forms of dissemination of these studies, and to determine the expectations of nurses with respect to the Center of Nursing Studies and Research "Centro de Estudos e Pesquisas em Enfermagem" (CEPEn). Scientific papers, reports of experience, theses and monographs predominated in the production identified. The forms of dissemination most frequently mentioned were scientific events and publication in Brazilian journals. The suggestions presented to CEPEn point at the need of promoting events, courses, research meetings, research dissemination and consulting on projects.


[Do converting enzyme inhibitors differ from each other in the treatment of hypertension?].

Novel angiotensin converting enzyme inhibitors (ACE inhibitors) have recently been commercialized and the question arises whether differences in pharmacodynamic and pharmacokinetic properties should lead to specific therapeutic choices. To our knowledge there is no data which allows the physician to conclude to any different antihypertensive efficacy when ACE inhibitors are used at adequate dosage. Their pharmacokinetic characteristics may differ at every level: absorption, distribution, metabolism and excretion. Differences in chemical structure may also influence their diffusion in various tissues, therefrom the amplitude and duration of inhibition of angiotensin II at these sites. The duration of maximum blockade of ACE and the amplitude of residual blockade may theoretically influence the duration of the hypotensive effect and the number of daily dosages. Once-daily administered long acting ACE inhibitors keep their antihypertensive action through the whole 24-hour period, during chronic treatment. The theoretical advantage of such a property is an improved control of 24-hour blood pressure. However, no study, to our knowledge, concluded to any difference between long acting ACE inhibitors as far as this parameter was concerned. In addition, except captopril which has been reported to induce major untoward effects at the time high dosages were introduced, ACE inhibitors do not seem to bear different undesirable effects.


[Prospective analysis in nursing: a methodology to be disseminated].

This paper intends to motivate the nurses in the evaluation of any teaching or health institutions. The authors propose the prospective analysis in nursing as a new methodological option to be used in that evaluation. The conceptual bases, as well as the methods and instruments, of the research are presented.


[Are non blood pressure effects of converting enzyme inhibitors important in arterial hypertension?].

Lowering blood pressure by medical treatment is not enough for correct prevention of the cardiovascular complications of high blood pressure. In this respect, we would like to emphasize the potential value of the non-antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors which may be summarized as follows. In the heart, ACE inhibitors significantly reduce left ventricular hypertrophy. They have no noticeable anti-ischaemic activity and are devoid of antiarrhythmic effects. On the kidneys, ACE inhibitors seem to have a protective effect, still to be determined, in certain cases of diabetes or renal impairment. ACE inhibitors have no deleterious metabolic effects. Other antihypertensive agents share the same properties. Long-term comparative trials are necessary to find out whether some of these drugs are more effective in this field than the others.


[For which hypertensive patient should angiotensin-converting enzyme inhibitor be prescribed or forbidden?].

Angiotensin-converting enzyme (ACE) inhibitors act by lowering the level of angiotensin II. The therapeutic benefits of these drugs and their potential side-effects therefore result from suppression of the physiological effects of angiotensin II. It is rational to prescribe an ACE inhibitor when the renin-angiotensin system is activated, as in renin-dependent essential hypertension, malignant hypertension and hypertension associated with heart failure. The beneficial effects of ACE inhibitor must be weighed against the special risks of renovascular hypertension: risk of renal artery thrombosis in case of unilateral stenosis and risk of renal failure if the stenosis is bilateral or affects a solitary kidney. In some situations the renin-angiotensin system is not directly involved in hypertension but may play a local haemodynamic role, as in some cases of primary or diabetic nephropathy. In such case the ACE inhibitors are thought to exert a protective effect. ACE inhibitors were reputed to be less effective in the elderly than in younger patients, but we now know that they can be prescribed with equal success in both instances to reduce peripheral resistance and improve regional blood flow as well as arterial compliance. Finally, ACE inhibitors can be prescribed, albeit with limited effectiveness, when the renin-angiotensin system is not activated, as in low renin hypertension and idiopathic hyperaldosteronism due to adrenal hyperplasia. They are ineffective in case of Conn's adenoma and contra-indicated in pregnant women.


[Usefulness of converting enzyme inhibitors in the diagnosis of arterial hypertension].

Angiotensin-converting enzyme (ACE) inhibitors are now widely used as first-line treatment of essential hypertension. Their effectiveness is potentiated by a low-salt diet and, above all, by the simultaneous prescription of diuretics. When secondary hypertension is suspected, ACE inhibitors are a good pharmacological tool to study the renin-angiotensin system. Since activation of this system is the main mechanism responsible for renovascular hypertension, ACE inhibitors are very useful for diagnosis. Conversely, blood pressure is not influenced by ACE inhibitors in primary hyperaldosteronism because of the low plasma renin and angiotensin II levels. Pheochromocytoma activates the renin-angiotensin system, and ACE inhibitors combined with beta-blockers enable the hypertension to be controlled prior to surgical treatment of the tumour. Finally, ACE inhibitors can be used to explore the renin-angiotensin system in the experimental model of renovascular hypertension and therefore contribute to our knowledge of the complex pathophysiology of this most frequent type of secondary hypertension.


[Converting enzyme inhibitors and aims of the objectives of the treatment of cardiac failure].

Angiotensin-converting enzyme (ACE) inhibitors were introduced in the treatment of heart failure in 1982. They improve the life comfort of the patients and their capacity for exercise in both moderate and severe heart failure. In moderate heart failure, their effectiveness on exercise performance is about the same as that of digitalis compounds and classical vasodilators, and superior to that of diuretics. The superiority of ACE inhibitors lies in that they improve the prognosis of heart failure, as has been demonstrated in the severe and moderate forms of the disease and, quite recently, in asymptomatic left ventricular dysfunction following myocardial infarction. Their beneficial effects on mortality undoubtedly result from their favourable action on the neurohormonal systems which are activated early in the course of heart failure. Extending the indications of these drugs to asymptomatic patients raises questions concerning optimal dosage, date of initiation and duration of treatment and possible class effect.


[Management of the treatment with converting enzyme inhibitors in chronic heart failure].

Treatment with angiotensin-converting enzyme (ACE) inhibitors can begin at any time when a left ventricular dysfunction has been diagnosed. In the absence of rare contra-indications (renal artery stenosis, connective tissue disease, severe renal failure), all patients with asymptomatic or, a fortiori, symptomatic chronic heart failure can benefit from ACE inhibitors, whatever the origin of the heart failure. Among the ACE inhibitors now available, the benefits of captopril (3 daily doses) and of enalapril (2 daily doses) on all the targets of cardiac failure treatment are now well established. The effects of lisinopril on mortality are not yet known, but the haemodynamic and symptomatic benefits of this drug are also well established (with the advantage of once daily administration). Other ACE inhibitors with less numerous and less convincing trial reports can be used or rejected depending on the physician's faith in the effects of this pharmaceutical class. With all ACE inhibitors the initial dose must be very low, to be gradually increased over several days or even weeks until the highest dose tolerated is reached. ACE inhibitors can be associated with the classical treatment of cardiac failure. A previous diuretic treatment with sodium depletion may increase the risks of first dose effect and renal intolerance due to the introduction of the ACE inhibitors. Theoretically, the combination of ACE inhibitors and spironolactone is to be avoided for fear of hyperkalaemia and renal deterioration. Yet, provided some precautions are taken this combination may improve the benefits of ACE inhibition when the renin-angiotensin-aldosterone system inhibition is not optimal. However, this has yet to be demonstrated by prospective clinical trials.


[Converting enzyme inhibitors and coronary failure].

Nearly 15 years ago, it has been shown that myocardial infarction is accompanied by left ventricular dilatation. In the following years more details were obtained on morphological changes consecutive to myocardial infarction, now grouped together under the term left ventricular remodelling. These changes enable the patients to survive despite reduction of the contractile ventricular mass, but they expose the ventricles to constraints resulting in excessive work load. It has been shown that these changes can be reduced by early myocardial reperfusion and by administration of angiotensin-converting enzyme (ACE) inhibitors. These findings were established first in animals, then in man. Administering ACE inhibitors to patients with symptomatic heart failure consecutive to advanced ischaemic cardiopathy prolongs the patients' survival. When ACE inhibitors are given to patients with severe asymptomatic left ventricular dysfunction which started soon or long after a myocardial infarction, they reduce the frequency of ischaemic events, passage to symptomatic heart failure and, at least in one study, mortality. ACE inhibitors have also been shown to reduce the size of myocardial necrosis when administered in the acute phase of experimental myocardial infarction. Preliminary data have demonstrated that ACE inhibitors given in the acute phase of myocardial infarction reduce the left ventricular dilatation which follows infarction. However, a study of ACE inhibitors administered to a large number of patients in the acute phase of myocardial infarction had to be interrupted because of the over-mortality in the treated group. These facts are reviewed in this article, and attempts have been made at deducing from them the current indications of ACE inhibitors in patients with coronary heart disease.


[Converting enzyme inhibitors in diabetes].

ACE inhibitors are used on a large scale basis in hypertensive diabetics, while the association between diabetes and hypertension is frequent and harmful. This is due to their excellent tolerance and efficacity. No specific advantage has been reported in their use regarding tolerance, i.e., they may not alter insulin sensitivity consistently. Conversely, ACE inhibitors may offer the specific advantage of protecting kidney function against diabetic microangiopathy, since their effects on glomerular haemodynamics seem independent from their hypotensive effect.


[Pulmonary pathology of drug origin].

Over the past ten years, there has been an impressively growing number of reports about drug-induced pneumonitis (DIP) due to more than one hundred different drugs. The most troublesome question is how to establish with certainty the diagnosis. Usually, five criteria are necessary. 1) The administration of a drug on a more or less long term basis. 2) Newly occurrence of an interstitial pneumonitis (defined on symptomatology, radiological features, pulmonary function test results). 3) Elimination of all other causes of pneumonitis (haemodynamic, infectious, systemic, environmental diseases). 4) Broncho-alveolar lavage (BAL) cell data showing in most cases a lymphocyte alveolitis with an inverted CD4/CD8 ratio. In a certain number of ambiguous circumstances, coupling a provocation test with a sequentially performed BAL could firmly establish the diagnosis. 5) Rapid resolution within a few days or months of the pneumonitis as early as the incriminated drug administration is stopped. Nevertheless sometimes one or more of these criteria are not met, mainly when the pneumonitis is a fibrosis directly induced by a fibrosing toxic mechanism.


[Multicenter prospective study of cardiac accidents during treatments with 5-FU].

In a prospective, multicenter study, we evaluated the incidence of adverse cardiac effects in 1097 patients receiving 5-FU as a short i.v. perfusion or as a continuous perfusion over 3 to 5 days. There were 29 cardiac events (incidence 1.6%; 4.5% in patients with a history of cardiovascular disease, 1.1% in the remainder). Adverse effects were more frequent in the patients with advanced WHO (WHO = OMS) stage (2 or 3) primary tumors of the upper respiratory or digestive tract, or of the gastrointestinal tract, when 5-FU was given as a continuous perfusion. They also appeared to be more frequent in patients with a history of cardiovascular disease, and mainly occurred during the second or third day of the first course of treatment. Retreatment of eight patients with 5-FU led to the recurrence of symptoms in five. The outcome of these adverse cardiac effects was generally favorable, but 11.5% of the patients died.


[Antidepressants and cardiac side effects. Evaluation trial].

When a new antidepressant is put on the market, everyone is afraid of its possible cardiac effect. The control of unicellular potentials can give an hint about that effect, without being able to assess its severity; the 27 antidepressants commercialized in France have been reviewed. 180 cases of conduction delays from 10,060 overdosage in the Paris poison center were found, 7 times more often than with other drugs. In addition the 30 centers for monitoring of side effects of drugs have collected 38 cardiac side effects, as well arrhythmias or conduction disturbances.


[Economic impact of adverse drug effects. Some reflections].

The cost of adverse drug effects first began to be analyzed in the 1960s, with an evaluation of related admissions to hospital in the USA. The average cost per patient of adverse events requiring hospitalization in France was estimated at 6,250 F in neurology units in 1979/1980, and 14,920 F in geriatric units in 1984. Fifty per cent of these events were avoidable. A second approach is to measure the cost of certain iatrogenic manifestations, e.g. fever due to fipexide, stenosis and perforation of the small intestine due to potassium chloride, gastrointestinal bleeding due to NSAIDs, kidney damage due to aminosides, etc. Calculations of the economic impact of adverse drug effects must also take into account indirect costs such as loss of productivity. The lack of such studies should not make health care specialists forget the magnitude of the problem.


[Adverse effects of oxybutynin chloride (Ditropan). Evaluation of the official survey of Regional Pharmacovigilance Centers].

We analyzed the 200 reported cases of adverse reactions to Ditropan (209 side-effects) collated by the Centres Régionaux de Pharmacovigilance and Laboratoire Debat since the drug was first marketed. The frequency of such side-effects was of the order of 1 per 20,917 treatment months. Children were affected four times more frequently than adults. The manifestations resembled atropine overdose in 103 cases (52 children, 51 adults), and were mainly neurological (59%) and ocular (22%). Two cases of erythema multiform and 33 of miscellaneous allergic skin reactions occurred. The fact that atropine overdose was more frequent in children can be explained by the proportionately higher dosage. Dose adjustment based on pediatric pharmacokinetic studies appears to be essential. In children, the drug is prescribed most frequently (56%) for conditions outside the licensed indications, particularly nocturnal enuresis, a condition for which the efficacy of Ditropan has not been established. We consider that this calls for a specific contraindication in isolated nocturnal enuresis and in children aged less than five years.


[Pulmonary toxicity of nilutamide (Anandron). Cooperative evaluation of French Regional Pharmacovigilance Centers].

We have studied 12 reports of pneumonitis associated with nilutamide (Anandron) and notified to the French regional ADR monitoring centers between November 1987 and June 1990. The mean age of the patients was 71.5 +/- 9.5 years, and 35% (5/12) had a history of lung disease. All 12 patients developed dyspnea, cough and fever, 4.7 +/- 6 months after starting nilutamide. Ten patients (83%) required admission to hospital. The symptoms revolved in 11 cases when the drug was withdrawn. In the other case, they disappeared when another drug was stopped and the dose of nilutamide was reduced. Six patients were treated with glucocorticoids. The severity of nilutamide-associated pneumonitis appears to be related to the time between the onset of dyspnea and consultation.


[Drug-induced aseptic meningitis].

Aseptic meningitis is a very rare drug reaction involving non-steroidal antiinflammatory agents (ibuprofen and sulindac), antibiotics (cotrimoxazole, trimethoprim, ciprofloxacin) and miscellaneous drugs such as carbamazepine, human immune globulin and muromonab CD3. Meningeal symptoms occur a few hours after drug intake and resolve without sequelae within one or two days after drug withdrawal, mainly in young females with systemic lupus erythematosus or mixed connective tissue disease. Biological findings and radiological investigations are not suggestive of an infectious etiology or rheumatological/neurological disturbances. Diagnosis is simple when recurrent episodes coincide with drug ingestion.


[Drug-induced benign intracranial hypertension. Apropos of a case with amphotericin B. Review of the literature].

Benign intracranial hypertension (BICH) is a rare adverse event. We report the case of a 31-year-old female drug addict who had been seropositive for HIV since 1987. She had stage IV C1 AIDS, and was receiving intravenous amphotericin B for generalized cryptococcosis with no neuromeningeal involvement. She developed BICH that regressed when the antifungal drug was withdrawn and treatment for cerebral edema was started. BICH is a clinical entity involving intracranial hypertension with no focal neurological signs or detectable intracranial lesion. The manifestations include headache, transitory or permanent visual disturbances (diplopia, loss of visual acuity) and the perception of intracranial noise. The cerebrospinal fluid is under increased pressure but the composition is normal. The eye fundus examination shows papillary edema, and the neuroradiological workup is normal. BICH can only be diagnosed once an expansive intracranial process, neuromeningeal infection, and non-communicative hydrocephalus have been ruled out. In the majority of cases, no etiology is found. Such cases of idiopathic BICH usually occur in overweight young women, although drugs can be implicated. Amphotericin B has not previously been held responsible for BICH. On the basis of this observation, we present a review of the literature.


[Thrombopenia due to pefloxacin (Peflacine): dose-dependent toxicity?].

Pefloxacin (Peflacine) can give rise to thrombocytopenia, although the responsibility of the drug can be difficult to demonstrate in infectious patients and those receiving other drugs simultaneously. We have collated 18 cases in which the responsibility of pefloxacin was suspected. In 13 cases, the patients were also taking other drugs which may have been contributory (heparin, Bactrim, Augmentin, ranitidine,...). The remaining five cases were of particular interest as pefloxacin was the only drug administered. The mean age of the patients was 75 years, and the mean bodyweight 56 kg (range, 47-65 kg). The pefloxacin dosage was 800 to 1,600 mg/day i.v. or p.o., i.e. 13-18 mg/kg/day. Thrombocytopenia occurred from five to 19 days after beginning treatment and resolved between 7 and 12 days after drug withdrawal. A number of factors argue in favor of dose dependency: 1 patient had high plasma concentrations (peak and residual); thrombocytopenia occurred in one patient when the previous, well-tolerated dosage of 800 mg/day (for 15 days) was increased to 1,600 mg/day; thrombocytopenia resolved in one patient when the dosage was reduced to 400 mg/day (1 tablet) and continued for a further 10 days. This toxic reaction may be avoided by reducing the drug dosage to 400 mg/day in elderly patients with a low bodyweight. Differential blood counts appear to be warranted for patients at risk.


[Neurologic side effects of fluoroquinolones. Apropos of 9 cases concerning pefloxacin].

Neurological side-effects were a limiting factor with older quinolones. Although they appear to be less frequent with the newer fluoroquinolones, we observed nine such cases at Amiens University Hospital over a four-year period. The patients were six women and three men, with a mean age of 61 years. They received a mean dose of 800 mg/day of pefloxacin. Four had septic shock, one left ventricular failure, and seven had signs of cholestasis (signs of liver failure were absent). Neurological manifestations occurred between 24 hours and seven days after starting treatment and disappeared within 24 to 48 hours of stopping the drug or reducing the dosage. They included myoclonia (3 cases), convulsions (2 cases, one with concomitant theophylline), delirium and agitation (2 cases, one in a patient on steroids) and confusion (3 cases). Plasma drug levels were determined in six patients and were above normal peak levels (10 micrograms/ml) in five. Pefloxacin was measured in the cerebrospinal fluid in two cases (8.7 and 15.0 micrograms/ml). Neurological manifestations during pefloxacin treatment are probably related to overdose (plasma levels were above normal in 5/6 cases), possibly being favoured by cholestasis (7/9 cases) and/or hemodynamic factors (5/9). Symptoms can resolve when the pefloxacin dosage is reduced.


[Evaluation of the activities and value of allergo-anesthetic consultation at the University Hospital Center of Nice 1985-1991].

Life-threatening accident during anesthesia scarcely happen but the consequences may be dramatic. We report our experience of an allergo-anesthesia consultation created since 1985 in Nice hospital. 452 patients have been investigated: 1) 109 for life-threatening anaphylactic and anaphylactoid drug reactions. They have been investigated by: skin tests intradermal reactions (IDR) and prick tests with substances used during anesthesia (drugs and latex) and for all the muscle relaxants; the radioabsorbent test (RAST) for the muscles relaxants, propofol and latex; the human basophilic degranulation test (HBDT) for all the other drugs. We used the imputability decision table to classify the reactions. When anaphylaxis diagnosis was established (14) an "allergy card" was given to patients which identified the drugs to which they had a positive reaction. 62 patients have presented an anaphylaxis: 57 due to muscle relaxants (37 due to suxamethonium), 4 to latex and 1 to a gelatin. Patients were subsequently contacted and 50 of the 58 have responded. 18 of these patients have received 22 new anesthesias. Without exception, the advises to avoid a drug have been followed, 17 patients have a positive reaction to a muscle relaxant. In four of these, another muscle relaxant (skin test negative) was used without any trouble. For the other 13 who had shown a cross reactivity, all the muscle relaxants had been rejected and another anesthetic technique have been used: local anesthesia (3 cases), epidural (2 cases) associated or not with narcotics (propofol, midazolam), general anesthesia (propofol, midazolam, droperidol, phenoperidine). These drugs were all skin test negative.(ABSTRACT TRUNCATED AT 250 WORDS)


[Role of pharmacovigilance center in information for the public on drugs. Experience in Marseille on 9 month].

We analyzed the role of the Marseille pharmacovigilance center (working in collaboration with the local poison treatment center) in informing the general public on medicinal drugs. Over a 9-month period, the center received 115 requests from members of the public for information. 82.6% of callers were not members of the health professions and wanted information for themselves (61.7%, 67.6% women) or their children (26.08%). The questions mainly involved drug interactions (28.7%), side-effects (26%) and precautions for use in particular circumstances (20%). 178 proprietary drugs (47 of which had been bought over the counter) were mentioned. The main therapeutic classes were neuropsychiatric drugs (n = 41), cardiovascular drugs (n = 17) and analgesics (n = 16). A number of communication difficulties and problems of a deontological nature were encountered. Full information was provided in every case, together with advice on prevention to about half the callers.


[Comparative study of data banks on drug interactions].

Authors have listed 9 criteria for testing scientific quality of computerized drug-interactions data banks. Pair of drugs with or without interactions, have been selected for each of these criteria and have been used for interrogation of eight data banks. None of these are completely satisfactory but errors or omissions are more or less important.


[Renal artery aneurysms in children].

Renal artery aneurysms were diagnosed in 11 patients (9 boys) aged 1 to 14. The examinations were carried out for vasorenal hypertension in 4 cases, for bladder-ureter reflux, hematuria, nephroptosis in 4, ureterohydronephrosis in 2 cases, and for interstitial nephritis. Aneurysms of the major trunk of the renal artery, mostly oval-shaped, 11 x 14 to 25 x 28 mm in size, were detected in 4 patients, intrarenal aneurysms 2 x 3 to 5 x 6 mm in size in 7 cases. The share of aneurysms among uronephrologic conditions in children was found to be 1.54%, among vasorenal hypertension cases, 4.3%. Vasorenal hypertension is the main optional sign of aneurysms of the main trunk of the renal artery, whereas for intrarenal aneurysms such sign is hematuria.


[The shape of the thorax based on data of fluorographic studies].

Five thoracic types were distinguished on the basis of 3 transverse sizes between the 4th, 7th, and 10th ribs, detected on the thoracic fluorograms of 1116 men and 1460 women: cylindrical, narrow conical, conical, wide conical, and egg-shaped. A subtype of a cylindrical thorax--cylindrical with a waist--was distinguished in women. In men conical chests occurred in 48.9% of cases, wide conical in 24%, whereas in women narrow conical chests occurred in 41.8% and cylindrical in 27.5% of cases. The examinees were grouped in accordance with the thoracic shape and their physical parameters and the parameters of the chests were compared. The chest proportions represent the most comprehensive characterization of the skeletal index: the ratio between the transverse size between the 7th ribs and the vertical size in per cent. The skeletal index directly correlates with body mass, thoracic circumference, transverse and longitudinal sizes of the heart and is in inverse correlation with body length, angle of inclination of the 8th rib and angle of inclination of the heart axis to the horizontal line.


[Algorithms of x-ray and ultrasonic diagnoses in urology].

Roentgenourologic methods and ultrasonic scanning (USS) should be combined in the radiologic diagnosis of urologic diseases. USS should be the first stage of examinations of urologic patients, and its results should be taken into account when planning and carrying out excretory urography. USS can be repeated before more sophisticated roentgenourologic examinations in order to single out the "zones of interest"; special programmes are possible for the purpose-pharmacoechography, dopplerography, etc. Development of tentative algorithms of x-ray and ultrasonic diagnosis of the major urologic diseases will help optimize the diagnostic process.


[The use of Doppler ultrasound of the renal arteries for the diagnosis of vasorenal hypertension at the outpatient stage].

Ultrasonic dopplerography of the renal arteries was used to improve the differential diagnosis of arterial hypertension before hospitalization. Dopplerograms of the renal arteries of normal subjects were characterized by almost symmetrical parameters of the blood stream. In patients with vasorenal hypertension a marked asymmetry of the blood stream was seen with its reduction and qualitative changes in the dopplerogram on the side of the stenosed renal artery, that was confirmed by angiographic findings. Chronic pyelonephritis was dopplerographically characterized by hemodynamically insignificant asymmetry of the blood stream in the renal arteries with its reduction on the side of the involved kidney. In essential hypertension the type of asymmetry of blood stream parameters in the renal artery seemed similar to that in normal subjects.


[Structural changes in the brain according to computed tomographic data in patients undergoing combination therapy for hemispheric gliomas].

Basing on CT data, the authors analyze the qualitative changes in the brain of patients with a history of multiple-modality treatment for immature neuroectodermal tumors. Plani- and volumetric parameters of the total brain, the involved and the contralateral hemispheres are compared with the same parameters in the reference group. The pattern and degree of structural changes were found related to the site of the tumor and surgery. The brain matter in both hemispheres was lost mostly in the interstitial and end portions predominantly on the side of the tumor and surgery. Changes of the brain were individual in the patients.


[X-ray endovascular surgery of the right ovarian vein syndrome].

The author analyzes the causes of the disorders in the urodynamics and retention changes in the upper urinary routes of 43 infertile women who suffered from disordered venous reno-ovarian circulation. In chronic phlebostasis of the pelvic organs a compensatory varicose dilatation of the right ovarian vein, mediating the hemodynamic decompression of the venous bed of internal genitals, is responsible for the development of the venous compression syndrome of the right ureter. To correct the vasourethral conflict roentgenoendovascular embolization of the left ovarian vein was carried out. In the remote postembolization period 40 women presented without pain or urodynamic disorders and with normal urinalyses, in 3 women the right ureter dilatation persisted but had not progressed.


[X-ray semeiotics of cranial involvement in endocrine diseases].

The incidence and type of x-ray semeiotics of the skull involvement were studied in 703 patients with endocrine diseases (26 with acromegaly, 36 with hypercorticism, 104 with thyrotoxicosis, 23 with hypothyrosis, 98 with primary hyperparathyrosis, 302 with diabetes mellitus, 114 with hypogonadism). Craniogram analysis involved study of the thickness and structure of the vault bones, shape and size of the skull, status of the sutures, internal plate relief, changes of the base of the skull, of the sella turcica first of all, and facial bones. The characteristic x-ray symptom complexes of the involvement of the skull in some endocrine diseases were distinguished.


[Potentialities of transcutaneous and transhepatic cholangiography as a method of studying diseases of the bile excretory system].

Comprehensive examinations of 62 patients with jaundice of obscure origins involved transcutaneous transhepatic cholangiography carried out in all the patients, hepatolymphography in 60 cases, relaxation duodenography in 31, angiography in 41, ultrasonic examination of the liver in 31, endoscopic retrograde pancreatocholangiography in 28 and liver scanning in 19 patients. These studies have extended the knowledge on the biliferous system status in obturation and parenchymatous jaundices and helped define the role of transcutaneous transhepatic cholangiography among the invasive methods of radiologic examinations and pararadiologic methods.


[The role of computed tomography in the diagnosis of brain involvement in patients with posttraumatic epilepsy].

Fifteen patients with posttraumatic epilepsy (10 men and 5 women aged 15 to 47) were examined in 1990-1991. All the patients had a history of craniocerebral injury (closed in 7 and open in 8 cases), 6 of them were operated on for intracranial hematomas. Besides CAT, electroencephalography, craniography, and examination of the fundus oculi were carried out. CAT was performed with a Ct MAX (General Electric) unit. Standard positioning of the patients with sectional projections parallel to the orbital meatal line was used. Changes in the brain matter were detected in 13 of these 15 patients: foreign bodies (2 cases), meningeal cerebral cicatrices (5), dilatation of the ventricular system (4), petrificates in the brain matter (1), atrophic changes of the cerebral cortex (1). The tomograms of two patients were normal. Ten patients were operated on: 2 were subjected to anterior callosotomy, in 2 foreign bodies were removed, and in 6 patients staged plasty with removal of the meningeal cerebral cicatrix was carried out. The detected CAT changes helped diagnose the topical location of the epileptogenic focus and choose the optimal method of surgery for posttraumatic epilepsy.


[A comparative evaluation of the clinical x-ray picture of uremic osteodystrophy before and after parathyroidectomy].

The authors present the results of clinical, x-ray, and biochemical studies carried out in 51 patients with uremic osteodystrophy, treated with hemodialysis, before and after parathyroidectomy. The patients were divided into 4 groups with various patterns of x-ray symptoms. Patients with x-ray signs of fibrous osteodystrophy made up group 1, the second group consisted of patients with a combination of fibrous osteodystrophy and osteomalacia with secondary hyperparathyrosis predominance; the third group, like the second one, included patients with the mixed form of uremic osteodystrophy, but with the predominance of the osteomalacic syndrome; Group 4 patients had no x-ray signs of bone changes, and the diagnosis of uremic osteodystrophy was confirmed by clinical laboratory evidence. Analysis of the clinical and x-ray data before and after parathyroidectomy has brought the authors to a conclusion that such an intervention was effective only in cases with manifest clinical and x-ray symptoms of fibrous osteodystrophy. In Group 2 patients with the mixed form of uremic osteodystrophy and less manifest osteomalacia as against fibrous osteodystrophy, subtotal or partial parathyroidectomy is advisable only in cases when conservative therapy is of no avail and fibrous dystrophy is progressing. Surgical treatment is contraindicated to patients in whom x-ray signs of osteomalacia predominate over fibrous osteodystrophy in the total picture of uremic osteodystrophy; it may result in a rapid progress of osteomalacia.


[Echotomography and excretory urography in the diagnosis of renal parenchymal "bridges"].

Sonographically detectable parenchymal 'bridges' in the median segment of the kidney may look atypical. The most incident parenchymal 'bridges' are asymmetric irregular ovoid incomplete connections, not reaching the parenchyma at the site of renal hilus; such 'bridges' may be compared to a 'humpbacked' overturned kidney. Besides that, double and Y-shaped connections were detected, occurring in different variants of fused kidneys. Clinical significance of atypical 'bridges' of the parenchyma consists in simulation by them of echomixed processes, of renal tumors first of all. Excretory urography should be the second stage of the diagnosis after initial ultrasonic examination of the kidneys; after it repeated pointed ultrasonography should be carried out, that will help rule out the diagnosis of a renal tumor.


[A study of regional ventilation of the lungs in patients with chronic bronchitis using scanning densitometry tomograms].

A new method for examination of regional ventilation of the lungs has been developed, that permits assessment of the ventilation in patients with chronic bronchitis and detect a latent respiratory insufficiency. The results of examinations with this method conform to the results of examinations of external respiration function.