[A case of thalamo-subthalamic hemorrhage presenting monoballism in the contralateral lower extremity].

We report a 62-year-old man with ballism confined to the right leg, so-called monoballism. He was admitted to our hospital complaining of gait disturbance due to violent involuntary movements in the right lower extremity which had developed seven days before. He had a ten-years' history of hypertension and at age 57 had been diagnosed as having asymptomatic multiple cerebral infarcts. Until admission, he was taking antiplatelet drugs for the purpose of preventing thrombotic stroke. On neurological examination, he showed mild impairment of higher brain function, Horner's sign in the left eye, and typical ballism in the right lower extremity. Involuntary movements were never observed in the face and the other extremities. Surface electromyography also showed reciprocal burst discharges at about 1 Hz related to the ballistic movements in the right lower extremity. CT scan revealed a high density lesion surrounded by a low density in the left subthalamic area. MRI examination demonstrated a dumbbell shaped hemorrhage extending from the left subthalamic nucleus to the dorsomedial nucleus of the ipsilateral thalamus. Adding to the hemorrhage, many ischemic lesions were observed in the bilateral basal ganglia and thalamus including the left pallidum. The causal end of the hemorrhage apparently located in the anterior dorsomedial portion of the subthalamic nucleus. There were few reports concerning monoballism, especially monoballism limited to the lower extremity. Recent researches indicate that a subthalamic lesion reduces the excitatory control from the subthalamus to the internal segment of the globus pallidus, which leads to a disinhibition of the thalamus and gives rise to ballism.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of foreign-body granuloma treated with steroid hormone].

A 68-year-old woman was admitted to Nagasaki University Hospital complaining of gait disturbance. She had suffered from hemifacial spasm since the age of 56 and had undergone neurovascular decompression for the spasm in another hospital five years before admission. At surgery, the vertebral and posterior inferior cerebellar arteries had been separated from the facial nerve with cotton string and attached to the clivus with alpha-cyanoacrylate monomer. Although the hemifacial spasm had improved postoperatively, the patient had suffered from gait disturbance and headache for two months after surgery, and hearing disturbance and hemifacial palsy on the same side as the hemifacial spasm for seven months after surgery. At the time of the present admission, contrast-enhanced CT scan revealed a mass at the left cerebello-pontine angle. In the T1-weighted inversion recovery sequence of MRI, the mass showed a slightly lower intensity than that of surrounding tissues. In the T2-weighted spin echo sequence of MRI, it showed a heterogenously low intensity with some high intensity spots. We diagnosed this mass as a foreign-body granuloma and treated it with dexamethasone injected intramuscularly. Edema decreased around the granuloma, and her gait disturbance improved markedly. But the hearing disturbance and hemifacial palsy did not improve at all, indicating that these two symptoms might not be caused only by brain edema but also by direct damage due to granuloma or inflammation. We thought that the steroid hormone elicited good results in the treatment of inoperable foreign-body granuloma.


[A case of early onset cerebellar ataxia with hearing loss, mental disturbance and primary hypogonadism].

A 14-year-old girl, whose birth and developmental history were normal till the age of 7, was admitted to our hospital because of slowly progressive difficulties in walking, speaking and hearing. She also complained of absence of menstruation. She showed poor school records since the age of 7. On neurological examination, she showed limb and truncal ataxia. There was no nystagmus but slurred speech was found. Muscular power was good and her sensory system was normal. Tendon reflexes were equally present, and plantar reflexes were flexor. Bilateral moderate nerve deafness was also present. Mental deficiency was diagnosed on an intelligence test. Brain CT and MRI showed cerebellar atrophy. Gynecological examination revealed scanty pubic hair and small uterus. Karyotype was 46XX. Endocrinological studies demonstrated high level of FSH, low level of E2, and the normal response to pituitary stimulation with LHRH, indicating the existence of primary hypogonadism. Although the etiology of this multisystem disorder is unknown, it is possible that both nervous and endocrine disorders were genetically determined.


[An adult case of transverse myelitis with erythema infectiosum].

We reported an adult case of transverse myelitis with erythema infectiosum. A 33-year-old female was admitted to Kyoto University Hospital because of a weakness in the lower extremities and "cloth-wearing" sensation of the trunk and legs. One month before admission, she became febrile and developed a symmetrical erythema on the extremities. At the same time she noticed a slight weakness of the legs and numbness in her fingers and toes, which disappeared next few days. A week later, she again developed a fever, severe weakness of the legs and "cloth-wearing" sensation on the trunk, and erythema appeared on the cheek. Physical examination on admission revealed a weakness and hyperreflexia in the extremities, in particular, knee and ankle jerk, and hypesthesia of the trunk and legs below the level of Th6. Cerebrospinal fluid (CSF) examination revealed 181/mm3 cells (mononuclear cell dominant) and 30 mg/dl protein. Magnetic resonance imaging, CT and electrophysiological studies indicated no abnormalities. IgM antibody against human parvovirus (B19) was detected in the serum and CSF. She was diagnosed as transverse myelitis with parvovirus infection and was medicated with prednisolone 40-60 mg/day, and improved gradually with the residua of a mild weakness of the legs and hypesthesia on the trunk between the level of Th6 and Th10.


[A mother and her son with autosomal dominant bulbar spinal muscular atrophy].

We reported a 49-year-old mother and her 28-year-old son with autosomal dominantly inherited bulbar spinal muscular atrophy (AD-BSMA). They showed progressive bulbar paresis, muscle wasting and weakness dominant in the proximal groups of limb muscles, and finger tremor. Onset of illness was in adult life. In laboratory examinations, elevated creatine kinase in serum and neurogenic changes either in EMG or muscle biopsy were noted. The son had neither gynecomastia nor abnormal sexual hormone levels which were observed in the sex-linked recessive bulbar spinal muscular atrophy (SR-BSMA). Elongation due to the CAG repeats at the androgen receptor gene of the X chromosome in SR-BSMA was not detected. In conclusion, it is clear that AD-BSMA is different from SR-BSMA on the basis of clinical and genetical aspects.


[Multiple mononeuropathy during recombinant interferon-alpha 2a therapy for chronic hepatitis C].

Reported is a case of multiple mononeuropathy which appeared during the administration of recombinant interferon-alpha 2a (rIFN-alpha 2a) for treatment of chronic hepatitis C. A 38-year-old man received an intramuscular injection of rIFN-alpha 2a, 6 x 10(6) IU, every one or two days for a nine week period. Seven weeks after the initiation of rIFN-alpha 2a therapy he developed numbness of the tongue and extremities and weakness of the upper extremities. Neurological examination revealed an asymmetrical disturbance of touch and pain sensation in the tongue, trunk, left shoulder and extremities accompanied by painful dysesthesia. Moderate weakness and muscular atrophy were noted in the right hand and left shoulder. Electrophysiological studies showed the amplitude of the compound muscle action potentials and sensory nerve action potentials were significantly decreased, when the right median and ulnar nerves were stimulated. Additionally, the conduction velocities were normal and needle electromyography showed fibrillation potentials suggesting an axonal form of multiple mononeuropathy. Biopsies of the muscle and nerve failed to show pathological changes, however. The clinical and electrophysiological abnormalities reduced gradually with methyl-prednisolone pulse therapy and administration of prednisolone and mizoribine. Therefore, in this case, administration of rIFN-alpha 2a may have induced multiple mononeuropathy of the axonal form.


[Isolated angiitis of the central nervous system with high immune complex titer, first presenting as intracranial hemorrhage during cesarean section].

A case of isolated angiitis of the central nervous system (IACNS) which first presented as intracranial hemorrhage during cesarean section was reported. The patient was a 27-year-old female who showed severe headache during cesarean section. CT scan disclosed hematoma in the right parieto-occipital area. Carotid and vertebral angiograms demonstrated striking areas of stenosis and irregularity of all intracranial arteries. There was no abnormality in the branches of the external carotid arteries. Systemic angiograms showed no evidence of systemic vasculitis. Biopsy of the temporal artery showed no abnormal findings. Titer of immune complex was elevated. Angiitis showed no improvement with corticosteroid alone, but improved markedly with corticosteroid plus cyclophosphamide. Elevated titer of immune complex became normal. Treatment with a combination of corticosteroid and cyclophosphamide is recommended in IACN.


[Multivariate analysis of the clinical signs in late cortical cerebellar atrophy (LCCA) in Japan--compared with olivo-ponto-cerebellar atrophy (OPCA) and hereditary cortical cerebellar atrophy (HCCA)].

We investigated the clinical features of 179 patients with late cortical cerebellar atrophy (LCCA) comparing with 382 patients with olivo-ponto-cerebellar atrophy (OPCA) and 91 patients with hereditary cortical cerebellar atrophy (HCCA) using multivariate analysis. They had no significant difference in durations from onset. Disorders of finger-nose test were of more severity and disorders of heel-knee test were less involved in LCCA than in HCCA. Eye movements tended to be normal in LCCA. LCCA showed more depressive and euphoric character than OPCA and HCCA. Analysis of LCCA and OPCA demonstrated that LCCA revealed hypotonia in muscles, normal or weak reactions of muscle stretch reflexes. There existed 21.4 percent of cases which could not be discriminated by multivariate analysis using clinical signs in LCCA and OPCA. Multivariate analysis of LCCA and HCCA, which are very similar in clinical signs, showed 66.3 percent of discriminatory rate. Thus, we could diagnose them to a certain extent only by clinical signs.


[Mechanism to induce scoliosis in Duchenne muscular dystrophy--a study of paraspinal muscle by X-ray computed tomography].

We studied mechanism to induce scoliosis in Duchenne muscular dystrophy (DMD) by use of X-ray computed tomography (CT) of paraspinal muscles. CT examination of paraspinal muscles was performed on 15 DMD patients at the following six levels; 1. Th3 vertebrae (upper thoracic spine level) 2. Th6 vertebrate (middle thoracic spine level) 3. Th10 vertebrae (lower thoracic spine level) 4. L1 vertebrae (upper lumbar spine level) 5. L3 vertebrae (middle lumbar spine level) 6. L5 vertebrae (lower lumbar spine level). We evaluated the degeneration of paraspinal muscle by a decrease in radio-density of the muscle which indicates infiltration of fatty tissue. The degeneration of the lateral portion of paraspinal muscle was more marked than that of the medial portion. The muscle was most severely affected at the middle lumbar spine level, showing a tendency to increase degeneration at the lower level of the spine. In cases showing laterality of the degeneration of paraspinal muscle, the less affected muscle on CT was located at the convex site of scoliosis. We speculate that the scoliosis occurs when DMD patients have asymmetrical paraspinal muscle degeneration, leading them to take compensatory posture.


[A new method of gait analysis in Duchenne muscular dystrophy].

We assessed gait in Duchenne muscular dystrophy (DMD) mainly by determining alteration of foot pressure using a new gait analyzing procedure. DMD patients showed a characteristic foot pressure pattern according to their degree of dysfunction. In stage I disease, the observed pattern was the same as that of normal controls. In stage II, the period during which the center of foot pressure was seen in the front part of the foot was prolonged. This change became more marked in stage III. In stage IV, the center of foot pressure began at the head of the ossis metatarsalis primi and moved back and toward the lateral side. Thereafter, the center of foot pressure again moved forward along the outside of the foot. These changes were considered to be the result of talipes equinus and waddling gait, which are commonly demonstrated in patients with DMD.


[Central nervous system lesion in myotonic dystrophy--demonstrated by X-ray computed tomography and magnetic resonance imaging].

We made an attempt to detect organic brain lesions in eight patients with myotonic dystrophy (MyD) using X-ray computed tomography (CT) and magnetic resonance imaging (MRI). The patients comprised seven men and one woman with ages ranging from 41 to 58 years (average 47 +/- 5.3 years). Seven patients had intellectual impairment assessed using an intelligence quotient test (WAIS-R < 70). CT scans were obtained in the axial plane with a slice thickness of 10 mm, and MRI scans were performed on a 1.5 tesla system in the axial and coronal sections with a slice thickness of 8 mm. CT scans displayed both marked sulcal and prominent ventricular enlargement in 6 of the 8 patients, indicating the presence of brain atrophy, and 3 cases had a few paraventricular low density area in the cerebral hemispheres. In contrast to CT, MRI study revealed more widespread brain parenchymatous lesions in all the 8 cases, showing the multiple foci of high signal intensity with varying size in the white matter on T2-weighted images and proton density-weighted images. No visible changes were detected on CT or MRI in the brain stem and cerebellum. The present study demonstrated that there exist organic cerebral lesions, predominantly located in the white matter in patients with MyD, regardless of focal neurological symptoms. The parenchymatous lesions in the brain can be detected with MRI, and lesser extent with CT, and are considered to be intimately correlated with intellectual deterioration commonly seen in patients with MyD.


[Influence of protein-restricted diet on motor response fluctuations in Parkinson's disease].

The clinical management of Parkinson's disease has been revolutionized by the introduction of levodopa therapy. It has significantly reduced disability and has extended life expectancies of patients with Parkinson's disease. However, motor response fluctuations frequently appear in patients after long-term treatment with levodopa. In this study, we investigated the effect of protein-restricted diet on fluctuations in eight patients with Parkinson's disease who had been receiving long-term levodopa treatment (mean 12.5 years). Two weeks of protein-restricted daytime diet (7.5 g total at breakfast and lunch) was followed by 12.5 g total at breakfast and lunch. At night, high-protein diet (40-50 g at dinner) was offered to the patients in order to maintain total daily protein intake at Japanese standard level. The medication schedule of levodopa and other antiparkinsonian drugs was not changed within 2 weeks after the study was began. Fluctuations were reduced in 7 of the 8 patients. But in only one patient (case 6), dyskinesia and general condition got worse and stopped this therapy. Body weight, serum protein and albumin levels did not change significantly for at least three month after the study was begun in every 6 patients who were examined. Homovanillic acid level of cerebrospinal fluid reduced in every 4 patients who were examined. We concluded that protein-restricted diet during the daytime offers a fascinating technique for the control of motor response fluctuations in patients with Parkinson's disease undergoing long-term levodopa treatment. But this therapy must be indicated carefully. Mechanism of this therapy may has something to do with improvement of dopamine metabolism in the brain.


[The pattern of neurological deterioration and the mechanism of neurological deficit in syringomyelia].

Sixty-five cases of syringomyelia were evaluated. The cases were classified into two groups: group 1 (56 cases) was patients who presented with hind-brain related syringomyelia and group 2 (9 cases) was patients who presented with primary spinal syringomyelia. Group 1 was further divided into two subgroups, group 1a and group 1b: group 1a (46 cases) consisted of patients with hind-brain related syringomyelia without basal arachnoiditis and group 1b (10 cases) consisted of patients with hind-brain related syringomyelia with basal arachnoiditis. The most common initial symptom of group 1a patients was abnormal motor function of an upper limb (14 cases), followed by pain in an upper limb (12 cases), and dissociated sensory loss (10 cases). In group 1b, motor symptoms of an upper limb were also the most common initial symptom, again followed by pain in an upper limb. Paraplegia was the most common initial symptom in group 2. About 80% of patients in groups 1a and 1b had both sensory and motor deficits at the time of examination and the majority of group 1b patients also had brain stem signs and/or pain. Brain stem signs were not commonly seen in group 1a patients, however. The neurologic deficits of group 1b patients were generally more severe than those of group 1a patients. Most group 2 patients also had sensory and motor deficits of both lower limbs. The progression of neurological deficits in groups 1a and 1b was classified into four stages.(ABSTRACT TRUNCATED AT 250 WORDS)


[Therapeutic effect of lymphocytapheresis on patients with HTLV-I-associated myelopathy (HAM)].

Lymphocytapheresis (LCP) was performed in 7 patients (1 male and 6 females) with HAM to delete lymphocytes from their peripheral blood, resulting in an improvement of motor disability in 6 of 7 patients with HAM. The therapeutic effect appeared within one day after first LCP, and reached maximum in 2 or 3 sessions of LCP. The side effects were only dysesthesia in 5 patients during LCP and mild leukopenia in a patient after LCP. Both of them were mild and transient. The effect of LCP continued for two to five months in 6 patients, the remaining one deteriorated in a month. In the study of T cell subsets of peripheral blood lymphocytes by flowcytometry, the CD4/8 ratio and the cell counts of CD4+ DR+, CD8+ DR+ and IL-2R positive cells were gradually decreased by LCP. These results suggest that LCP is one of the effective therapies for HAM and peripheral blood lymphocytes implicate in the pathogenesis of HAM.


[Chorea associated with antiphospholipid antibodies].

We report a 21-year-old woman in whom chorea was associated with antiphospholipid antibodies. In August 1986, she developed involuntary movement which started in the right hand but subsided spontaneously. In September 1988, she again developed right-sided involuntary movements which started in the right hand but rapidly progressed to involve the whole of the right side. In September 1990, she was admitted to our hospital for investigation of choreiform movements, because her involuntary movements had progressed to involve all four extremities. She had no family or past history of chorea, psychiatric, rheumatological or vascular disease. On admission, she had difficulty in speaking and swallowing due to choreiform movements of her mouth and tongue. Her gait was unsteady. On walking she had wild gyrations of the arms. Choreiform movements of all four extremities, neck, face, mouth and tongue were present at rest, more marked on the right side. There was no other neurological deficits. She had none of the classical features of SLE. She had none of the complications commonly associated with antiphospholipid antibody syndrome (APS) (i.e., recurrent spontaneous abortion, thrombosis and thrombocytopenia). Laboratory tests revealed that antinuclear antibody was present. Cardiolipin antibody (VDRL) was positive but specific tests for syphilis were negative. Anticardiolipin antibodies were present. All coagulation studies have failed to reveal lupus anticoagulant. Brain CT, MRI, 123IMP-SPECT and cerebral angiography were normal. Associated with her chorea, she had the serological but not the clinical features of APS. We suggest that antiphospholipid antibodies should be looked for in all unexplained cases of chorea, even when the associated clinical signs of APS are absent.


[A case of early syphilis presenting general paresis-like symptoms and bilateral tonic pupils].

A 40-year-old man was admitted after 8 months of speech disturbance and locomotive ataxia. He had no seizures, lightning pains, paresthesia, visual loss, bladder disturbance or rectal incontinence. He had never been neurologically or psychiatrically ill and had no history of syphilis. When the patient was admitted, his general physical examination including blood pressure and dermatologic examination was normal. His consciousness was alert. He was found to have a deterioration of mental status such as inability to concentrate, failing memory, amnesia and circumstantiality. His pupils were anisocoric and Achilles jerks were absent. No rigidity of the neck muscles, paralysis and sensory disturbance were recognized. Romberg's sign was absent. The right pupil was 7.0 mm and the left was 6.0 mm in room illumination. The pupils were nonreactive to bright light and both did not constricted to near stimuli. 0.125% pilocarpine eyedrops produced bilateral pupillary constriction. The results indicated bilateral tonic pupils. Laboratory data revealed white cell count of 12,600/mm3 and normal erythrocyte sedimentation rate of 8 mm/hr. Cerebrospinal fluid (CSF) examination revealed the following: opening pressure, 140 mm of water; cell counts, 76/mm2 (mononuclear cells); total protein, 116 mg/dl; glucose, 57 mg/dl. A serum venereal disease research laboratories (VDRL) test was positive in a 1:32 titer confirmed by positive treponema pallidum hemagglutination (TPHA) test in a 1:40,960 titer and positive fluorescent treponemal antibody-absorption (FTA-ABS) test. Serum TPHA-IgM was positive in a 1:320 titer but TPHA-IgG was negative. CSF examination revealed positive TPHA test (titer of 1:2,560) and positive FTA-ABS test.(ABSTRACT TRUNCATED AT 250 WORDS)


[Comprehensive analysis of histological types in 14006 cases of ovarian tumors].

Fourteen thousand and six cases of ovarian tumors were reported by 15 hospitals in Zhejiang and other 5 provinces. Of all the tumors, there were 3,363 cases (24.0%) of malignancy. According to the criteria based on WHO's classification, malignant tumors of the ovary comprised of 1,999 cases (59.4%) of epithelial cancer, 646 cases (19.2%) of germ cell tumors, 273 cases (8.1%) of metastatic tumors, 236 cases (7.0%) of sex cord stromal tumors and 209 cases (6.2%) of other tumors. Mucinous cystadenocarcinoma was found to be the most frequent in borderline epithelial tumors, while serious cystadenocarcinoma to be the most one in malignant epithelial tumors. Dysgerminoma, endodermal sinus tumors and immature teratomas appeared to be similarly frequent in malignant germ cell tumors. The tumors metastasizing from gastroenteric carcinoma was the commonest in metastatic tumors. Compared with reports abroad, the different types of malignant ovarian tumors in China have the different distributive patterns. It is very important to pay attention to prevent and early diagnosis of malignant ovarian cancer.


[Lymph node metastasis in stage I ovarian cancer].

One hundred and sixteen cases of stage I Ovarian cancer from nine hospitals in all the China during Sept. 1982-April 1991 were investigated for their lymph node metastasis. There were 70 epithelial tumors, 36 malignant germ cell tumors, 8 from gonadal stroma and 2 undifferentiated. In 89 patients the ovarian tumor was confined to one ovary (stage Ia); in 6 cases both ovaries were involved (stage Ib); 21 cases was documented stage Ic. Systemic lymphadenectomy covering all pelvic groups of node together with aortic lymph node accomplished in 82 cases. In the remaining 34 cases only pelvic lymph node dissection was performed. There was 10.3 percent incidence of lymphatic metastasis in this series. The most common lesion was serous cystadenocarcinoma. All patients were follow-up for at least half year. The mortality rate in patients without lymph node metastasis was 2.8%, but 8.3% for those with lymph node metastasis. The clinical significance of retroperitoneal lymphadenectomy in early ovarian cancer was discussed.


[Surgical treatment of cervical cancer].

The clinical data and long-term following up results of 1,320 cases of cervical cancer from Jan. 1 st, 1953 to Dec. 31 th 1988 were presented. The routine operative extent for invasive cervical cancer in this hospital has been radical hysterectomy and pelvic lymphadenectomy. The cardinal ligament, para-vaginal tissue and vaginal wall removed varied according to the different clinical stage and extent of the lesion. The operative complications were: trauma 0.8%, the postoperative complication of ureteral fistula 0.2%, and there were no operative death. Long-term following up rate were 99.8%. In this series. The cumulative survival rate calculated by computerized life table method were following: 5 year survival rate sq. cell ca. stage Ia 100%, stage > or = I b 97.6%; adenoma. 90.8%. 185 cases died, among which 60 cases died of recurrent cervical cancer, 85 cases died of other benign diseases, 40 cases died of primary cancers of other organs other than cervix of uteri. It denotes that once a patient suffers from one kind of cancer, she will have possibility of suffering from another kind of cancer.


[Influence of passive smoking on the fetus during pregnancy].

The study on the hazard of passive smoking to the fetus during pregnancy was carried out in 188 cases. The rate of SGA, premature labor and neonatal asphyxia in this group were higher than that of 65 cases without passive smoking. The data was analysed by logistic multifactor regression analysis. The result showed that, for those patients with hypertension and husband smoking, the risk of SGA, and neonatal asphyxia were 1.6, 2.8 and 3.2 times higher than those without hypertension and husband smoking. In the group of passive smoking, their blood CoHb and umbilical venous CoHb levels were obviously higher than those of the normal control. The possible cause of hazard of passive smoking to the fetus was also analysed and discussed.


[Stereological study of the placentae in intrauterine growth retardation with different ponderal index].

10 placentae each from the cases of IUGR with normal ponderal index (NPI) and low ponderal index (LPI) and 10 from normal pregnancy as control were analysed quantitatively with stereological principles. This study showed the placental weight, volume, surface area of villi and villous fetal capillary in IUGR were significantly reduced than that in control group. The percentage ratio of the fetal capillary volume was increased significantly in IUGR group but the ratio of vasculo-syncytial membrane/villous fetal capillary decreased. It suggested that compensation to anoxemia in placenta of IUGR was incomplete. The data also found that all the parameters in NPI group were decreased significantly than that in LPI group, which implied NPI group had a more severe growth deficiency of the placental functional structure. When placental growth deficiency occurs in the first or second trimester, both the fetal length and weight will be severely affected.


[Eclampsia complicated with cerebrovascular disease].

Ten eclamptic patients complicated by acute cerebrovascular disease were admitted during the past eight years from Feb. 1982 to Feb. 1990. There were six cases of superior sagittal sinus thrombosis, two cases of cerebral hemorrhage, one cases of subarachnoid hemorrhage and the other one of cerebral infarction. Among them, eight patients were cured. Our analysis demonstrates that it is advisable to terminate pregnancy by cesarean section as soon as possible. A comprehensive management proposed by good cooperation between neurologist, neurosurgeon and obstetrician is the key to get a good way to cure these patients.


[Doppler velocimetry measurement in pregnancy complicated with diabetes mellitus].

To evaluate the effects of diabetes mellitus (DM) on fetoplacental circulation, Doppler velocimetry was carried out in diabetic pregnant women (n = 21) and normal pregnant controls (n = 20) every 2 weeks from the 20th week of gestation till term. Blood flow wave form of umbilical artery (Um) and uterine artery (Ut) were measured and the systolic/diastolic ratio (S/D) of Um and Ut calculated. The results showed that the Um and Ut S/D ratio of diabetic mothers with AGA babies (n = 15) and normal controls were not different. The S/D ratio of diabetic women with LGA newborns (n = 6) elevated after the 30th week of gestation, and the time of elevation was in accordance with the accelerating growth stage of LGA fetus. It is suggested that the elevation of S/D ratio may be related to the increasing requirement of blood supply for LGA babies in DM mother.


Expulsive choroidal haemorrhage.

Expulsive choroidal haemorrhage is a dramatic and serious complication of cataract surgery that occurred in five patients out of ten thousand consecutive cataract surgeries performed by the author during the year 1989 and 1990. Report about this dreaded complication after cataract surgery are scanty and as far as I can remember I have not seen any report in Indian ophthalmic literature recently. Since cataract surgery forms the major part of intra ocular surgeries performed in our country, I thought it would be appropriate to report about this rare complication which may occur to all of us. Out of five cases 3 were males and 2 were females in the age group ranging between 45-72 years. Two eyes regained vision up to 6/12 after intra operative expulsive haemorrhage. All the eyes were salvaged by doing anterior sclerotomy. Diabetes, hypertension, glaucoma and myopia are the commonest predisposing factors.


Subconjunctival total excision in the treatment of chronic chalazia.

A technique of subconjunctival total excision was used to treat 34 chronic chalazia. Another 34 were treated by incision and curettage and a further 32 by intralesional injection of long acting steroid. Subconjunctival total excision showed a higher success rate (94.12%) compared to the incision and curettage group (76.47%) and the injection group (75%). As the difference was statistically significant and due to other advantages we recommend subconjunctival total excision as a primary approach in the treatment of chronic chalazia.


Compendium of dietary sources of vitamin A in the Thar desert.

The undisputed long term solution to prevent nutritional blindness lies in changing the dietary habits of a given population through nutritional education, nutritional supplementation, and nutritional rehabilitation. Before such strategies can be successfully implemented, it becomes necessary to study the existing dietary pattern of the population and to identify locally grown foods rich in vitamin A. Seventy eight rural women were interviewed to determine the common dietary items in western Rajasthan. These items were then matched with their B-carotene contents, only to discover that, 100 grams of any of them would not provide the RDA for a 1-3 year old child, with the exception of Suva (Peucedanum graveolens) and Bathua (Chenopodium album) leaves. The B-Carotene contents of several food items is unknown at present and there is an urgent need to evaluate them.


Preoperative topical flurbiprofen-Na+ in extracapsular lens extraction role in maintaining intraoperative pupillary dilatation.

Induction of intraoperative pupillary constriction, is predominantly a prostaglandin mediated process. The most potent antiprostaglandin NSAID, Flurbiprofen was used topically to study its efficacy against the above. In a prospective double blind clinical study, 50 brown eyes undergoing planned E.C.C.E., the pupils were dilated with 10% phenylephrine and 2% homatropine 1%/tropicamide. 25 eyes received 0.03% Flurbiprofen-Na+ eye drops 1/2 hourly starting two hours before surgery. The maintained intraoperative mydriasis in the two groups before anterior chamber entry (stage I) vs at the end of complete cortex wash (stage III) was: in control group (stage I) 8.46 +/- 0.48 mm vs (stage III) 3.56 +/- 0.43 mm (highly SS); in flurbiprofen group (stage I) 8.60 +/- 0.48 mm vs (stage III) 8.01 +/- 0.63 mm (NSS). The pupillary area available for surgical manipulation in the control group was significantly decreased from 56.18 mm2 in state I to 9.94 mm2 in stage III, while in flurbiprofen group it changed insignificantly from 58.05 mm2 in stage I to 50.24 mm2 in stage III. Postoperatively after cataract was observed in 44% eyes of control group as compared to only 8% of eyes of flurbiprofen group. Thus a maintained intraoperative mydriasis in flurbiprofen group led to better E.C.L.E. which is a mandatory prerequisite to preferred and better present day posterior chamber IOL implantation.


Ipsilateral Coat's reaction in the eye of a child with en coup de sabre morphoea--a case report.

A female child with post-traumatic en coup de sabre type of morphoea (fronto-parietal circumscribed scleroderma) involving the left side of the forehead and face, who developed a Coat's disease-like fundus picture over the following two years, is being reported.


Butylated hydroxyanisole produces both mutagenic and desmutagenic derivatives under gastric conditions.

Dietary butylated hydroxyanisole (BHA) has been known to have inconsistent functions on carcinogenesis, both prevention and initiation. We assumed that both functions of BHA were introduced by the derivatives formed after the reaction with gastric components such as nitrite in the stomach. We then identified the derivatives produced by incubating BHA with sodium nitrite at pH 2.0 or pH 5.0. Eight derivatives were detected; 2-tert.-butyl-p-quinone (BQ), 3,3'-di-tert.-butyl-biphenyldiquinone-(2,5,2',5') (BBDQ), 2,6-di-tert.-butyl-8-hydroxy-dibenzofuran-1,4-quinone (BHDQ), 6-nitro-BHA, 2,2'-dihydroxy-3,3'-di-tert.-butyl-5,5'-dimethoxy-biphenyl (di-BHA), an oxidized product of di-BHA, and two unstable reaction intermediates. BQ was a major final product at pH 2.0, but not at pH 5.0. 6-Nitro-BHA and the oxidized products of di-BHA were also the final products. BBDQ was formed from di-BHA and easily converted to BHDQ. Their mutagenicity and desmutagenicity were assayed using Salmonella typhimurium strains. BQ and BBDQ were the mutagens of base-substitution type, BHDQ was the potent desmutagen against a mutagenicity of Trp-P-2, and the others had neither of the two activities. Thus, BHA was found to produce both the mutagen and desmutagen under the gastric conditions. BQ has been previously reported to be easily detoxified by glutathione, and BHA itself is well known to prevent carcinogenesis. In the assessment of dietary BHA on carcinogenesis, since one of the mutagens from BHA is easily detoxified in our bodies and another is converted to a desmutagen, BHA appears to be one of the favourable chemicals for us.


Altered interleukin-1 production in mice exposed to rotation stress.

This study examined the effects of rotation stress (78 circles per 1 min for 1 h: 10 min rotation + 5 min interval) on peritoneal macrophage release of lymphocyte-activating factors (LAF) and interleukin-1 alpha (IL-1 alpha) concentration in mice (CBA x C57BL6)F1. Rotation stress induced the macrophages' release of LAF with peak reactions in 0-1 h after termination of stress, followed by elevation of plasma IL-1 alpha. Induction of LAF release was accompanied by a higher concentration of corticosterone (Cs) in the blood, most prominent at 0 and 0.5 h after termination of the stressful procedure, and recovering to normal values 1 h later. It is suggested that the stimulating effect of stress on LAF and IL-1 production possibly involves glucocorticoid hormones, as well as other stress-induced neurohumoral shifts accompanying the reaction of glucocorticoids. It is also possible that the activated production of LAF and IL-1 by macrophages has a stress-limiting role in cases of mild stress.


Acanthamoeba keratitis--a report of two cases.

Two cases of unilateral corneal ulcers caused by Acanthamoeba are reported. Neither of the patients had contact lenses at any time. The diagnosis was confirmed by Giemsa stain and cultures of the corneal scrapings.


Role of endothelin-1 in carrageenin-induced inflammation.

Many vasal factors are produced during an experimental model of inflammation such as rat-paw oedema induced by carrageenin. We investigated whether among the other well-known mediators of inflammation, i.e. serotonin, PAF, eicosanoids and kinins, the peptide endothelin-1 is produced by this kind of inflammatory process caused by carrageenin. Our results indicated that plasma endothelin, and the tissue concentration of endothelin in the oedematous paw, is increased as compared to the control. Consequently, endothelin should also be considered as an important factor in inflammatory processes.


In-vitro evaluation of drugs proposed as chondroprotective agents.

Three proposed chondroprotective agents (CP), namely glucosamine sulfate (GAS), chondroitin sulfate (CS) and glycosaminoglycan-peptide complex (GP-C), were tested on differentiated human articular chondrocytes cultured in clusters. Chondrocyte productions of proteoglycans (PG), type II collagen (coll. II) and prostaglandin E2 (PGE2) were established by specific radioimmunoassays applied to the culture medium (CM) and in chondrocyte clusters (CC). Collagenolytic activity was assayed in CM. DNA synthesis, studied by measuring 3H-thymidine incorporation, was unaffected by CS and GAS. GP-C, at low concentration, stimulated DNA synthesis. GP-C, at higher doses, induced a high increase in PG and coll. II productions. GAS and CS induced a stimulatory effect limited to PG production. None of the CP tested here affected the basal PGE2 production by human chondrocytes.


Clinical research in osteoarthritis: design and results of short-term and long-term trials with disease-modifying drugs.

Putative disease-modifying drugs are usually clinically used in osteoarthritis with two main aims: not only stopping or reducing the cartilage degenerative process after a long-term treatment, but also controlling the symptoms of the disease within a few days or weeks, thus avoiding or diminishing the use of symptomatic medications. Due to the difficulties of implementing the first aim, the latter aim was more often investigated, even if most often with inadequate study design and insufficient numbers of patients. We have recently carried out three double-blind, controlled, parallel groups, randomized, 4-6 week trials of glucosamine sulphate versus placebo or the NSAID ibuprofen on a total of 606 gonarthrosic out-patients. Movement limitation and pain were scored according to the Lequesne index, and the efficacy goals were strictly pre-determined. Access to other medications was not allowed. Glucosamine was significantly more effective than placebo, while no difference was detected in comparison with the NSAID (p < 0.025 and p = 0.77, respectively: Fisher's two-tailed exact test). On the other hand, glucosamine was as well tolerated as placebo, while the percentage of patients suffering adverse drug reactions was higher in the ibuprofen group (37% vs 7%: p < 0.001). Long-term trials are in progress and several aspects are to be considered in their design: they must be double-blind, placebo-controlled, randomized, continued for a period of years and (most importantly) with the careful use of imaging and biochemical techniques capable of generating objective evaluation criteria.


Antireactive properties of "chondroprotective" drugs.

The medicinal therapy of osteoarthritis is based on the use of analgesics, NSAIDs and corticosteroids to relieve pain and inflammation. In addition, "chondroprotective" agents (CPA) are used to stop the evolution of the disease. In this review the biochemical and pharmacological activities of some of the most widely used CPAs are described. All of these show more or less marked antiinflammatory activities, which for some of them are the result of an inhibition of cyclo-oxygenase and of prostaglandin biosynthesis, in which case they should be more properly classified as mild NSAIDs. Only two of the CPAs reviewed, diacerein and D-glucosamine sulfate, elicit antiinflammatory and antireactive effects without significant inhibition of the prostaglandin biosynthesis. These agents have also remarkable chondroprotective effects, and only these two agents should be classified as true CPAs. In particular glucosamine sulfate, which naturally occurs in the human body and is almost devoid of toxicity, is suitable for long-term therapeutic use. This, with its chondrometabolic, antireactive and antiarthritic properties, represents the pharmacological rationale for the use of glucosamine sulfate as a disease-modifying agent in osteoarthritis.


Effectiveness and tolerability of nimesulide in the treatment of osteoarthritic elderly patients.

One important point in the treatment of osteoarthritis is to control the pain that accompanies the persistent inflammatory conditions. Because of the chronic nature of the disease, drugs with a good ratio of effectiveness to tolerability must be used. In the following double-blind study the effects of nimesulide, a non-steroidal antiinflammatory drug, were compared with those of placebo in 40 elderly osteoarthritic patients, during and after a treatment cycle of 90 days with two 100-mg tablets a day. The reduction of spontaneous and motion-induced pain and of morning stiffness seen at the various check-ups attested the good effectiveness of nimesulide. Functional status as a whole was improved, and it was found that the concomitant weekly intake of an analgesic (paracetamol) treatment could be decreased during the 3 months of the study. The tolerability of nimesulide was good.


Psychiatric epidemiology in Israel.

Psychiatric epidemiology in Israel began with the inauguration of the Psychiatric Case Register in 1952. Periodic statistical reports by the Ministry of Health Mental Health Services, as well as several Case-Register-based epidemiological studies, have since been published, all of which have related to in-patient data. Community psychiatric surveys have primarily included populations in treatment. The most comprehensive study was carried out on a nationwide basis in 1986 in collaboration with the Nathan Kline Institute. However, only a few community surveys of the general population have been carried out thus far in Israel. The population studied was not nationally representative, and the more advanced screening and diagnostic instruments were not utilized. The necessity for a large-scale, multi-centered community survey in Israel, similar to the Epidemiological Catchment Area project in the U.S.A., is suggested. Furthermore, the particular needs of recent and future waves of immigrants must be taken into consideration.


Psychiatry and primary medicine.

Psychiatry and primary medicine are related to one another for theoretical and practical reasons. The development of this relationship in Israel in recent years is described. Many patients with mental problems are seen by the primary physician only. The most serious cases are usually detected and referred. The main problem is that people with modest mental disturbances are often neither detected nor referred and treated. The development of various forms of communication between psychiatry and primary medicine, such as consultation-liaison programs, Balint groups and other methods of training, are described and discussed.


Approach to organic psychiatry or the dialogue between brain and mind.

This article describes the evolution of concepts of the relationship between brain and mind. Instead of the earlier dualistic approach to mental and brain disorders, we are nowadays confronted with a new approach where the boundaries between these two "worlds" become more and more blurred.


New actions of parathyroid hormone through its degradation.

Parathyroid hormone degradation is intimately connected with its action. By the action of the unique renal neutral cytosolic PTH ase, PTH is split into 1-34 and 35-84 fragments, and further into 35-70 and 71-84 fragments. Amino-terminal 1-34 peptide was found to participate in the autoregulation of PTH secretion, suppressing the intact PTH secretion both in vivo in humans and in vitro in the dispersed bovine parathyroid cells. C-terminal fragment 35-84 and N-terminal fragment 1-34 both suppress the alkaline phosphatase production by ROS 17/2.8 cells to a lesser extent than the intact PTH 1-84, and the sum of the effects of the two fragments approximately equaled that of the intact hormone. Fragments 35-70 and 71-84 were devoid of such activity. Intracellular free calcium of human vascular endothelial cells was raised by intact 1-84, lowered on the contrary by C-terminal 35-84 fragment, but fragments 1-34, 35-70 and 71-84 had no effect. Fragments generated by the actions, supporting the physiological significance of PTH degradation by its target cells.


Magnesium deficiency enhances secretion of parathyroid hormone in normal and 5/6-nephrectomized uremic rats.

Hypercalcemia, rather than hypocalcemia, has been observed in conjunction with severe magnesium (Mg) depletion in rat, in contrast to the development of hypocalcemia in Mg deficiency in various animal models. In the present study, a possible involvement of parathyroid hormone (PTH) in the development of hypercalcemia in rat was studied by using a newly-developed sensitive and specific radioimmunoassay system for the determination of rat PTH. In normal rat model, hypercalcemia occurred in association with a decrease of serum phosphate levels in Mg deficiency. However, serum PTH levels were not suppressed despite the occurrence of hypercalcemia, suggesting PTH as an important factor for the development of hypercalcemia. Of interest, in 5/6-nephrectomized uremic model, hypocalcemia, rather than hypercalcemia, was observed in Mg-deficient rats. Serum PTH levels seemed to be higher, but not statistically significant probably due to a small number of rats. However, infusion study clearly demonstrated that PTH secretion was significantly increased in Mg-deficient uremic rats compared with Mg-replete counterparts. The reason for an increase of serum PTH responses might be explained by Mg depletion itself in addition to a fall in serum Ca levels, because infusion study revealed that the magnitude of the stimulation of PTH secretion was increased in Mg deficiency despite the similar degrees of changes in serum Ca levels and that the set point for the suppression of PTH secretion by Ca might be altered in Mg deficiency. Taken these data together, it was strongly suggested that Mg depletion might enhance PTH secretion in rat.


Parathyroid function in hypertension.

PHF, secreted by the PTG, induces hypertension by increasing vascular smooth muscle calcium uptake and thereby increasing intracellular calcium levels. PHF secretion is inhibited by dietary calcium and the effects of PHF are blocked by calcium channel antagonists. This explains the paradox whereby both calcium and calcium channel blockers may be effective antihypertensive agents. PHF may be secreted by a specific cell type in the parathyroid gland, numbers of which seem to correlate with PHF levels. Thus, the parathyroid gland does seem to play a role in some forms of hypertension, but this role is probably not due to its production of PTH, but may be related to the secretion of the new factor--PHF.


Involvement of parathyroid hormone (PTH) in genetic models of hypertension.

Although the precise mechanism(s) of PTH in GHR were not yet fully understood, the research to date is compatible with the presence of a secondary hyperparathyroidism in the GHR models. A low serum ionized calcium level due to renal calcium leak and/or low intestinal absorption of calcium should be the stimulus for PTH hypersecretion. This hypothesis is supported by the fact that both long-term oral calcium supplementation or removal of parathyroid glands prevents and attenuates the development of genetic hypertension. It is concluded that PTH, probably in concomitant with other factors such as vitamin D or parathyroid hypertensive factor, has a permissive effect in the development and the maintenance of hypertension in GHR.


Issues related to dust aerosols in the magnesite industry. II. Environmental exposure.

Magnesite waste containing largely magnesium oxide (MgO) and a mixture of other metals forms aerosols with a considerable portion of respirable particles when released into the atmosphere. Several animal species (domestic rabbits, Wistar rats, cattle) were used to biologically monitor the accumulation and effects of inhaled magnesite aerosol in two actual locations of the magnesite industry. The study revealed the biological accumulation of magnesium, iron and other metals in the bodies of exposed animals (and F1 animals) as well as specific lesions on tracheal relief, morphological changes in organ microstructure (especially in the lungs, spleen, liver and myocardium), alternations in the reproductive capacity of females, distorted Mg:Ca:P ratio as well as changes in the immune profile. The findings of biological monitoring of animals are consistent with the conclusions of epidemiological studies.


Risk of contamination of human and agricultural environment with parasites through reuse of treated municipal wastewater in Riyadh, Saudi Arabia.

Two selected sites in the Riyadh metropolitan area were surveyed for the presence of human pathogenic parasites in treated municipal wastewater (TMWW). A total of 100 samples were collected from both sites at two different seasons, the winter and summer reason. The most common parasites seen were the larvae and adult of Strongyloides sp. There were few Ascaris lumbricoides ova, some of which were embryonated and possibly infective, while the highest frequency of Ascaris ova (100 +/litre) was found at site 2 h, the highest frequency of Strongyloides sp. larvae (36-72/litre) and Strongyloides sp. adult (100 +/litre) were found at sites 2 W and 1 W respectively. The variation between sites and seasonal fluctuations showed a significant difference in parasite per litre. High atmospheric temperatures in the Riyadh area seem to be lethal to most intestinal pathogens similarly the absence of protozoal cysts in the TMWW could be attributed to certain treatment processes and other environmental factors. Data obtained from this study will be valuable in planning for the control of parasitic diseases in particular and public health pathogens in general.


Fungi associated with stored unprocessed cowpea and groundnut varieties available in Borno State, Nigeria.

Five stored unprocessed cowpea (Vigna spp) and four groundnut (Arachis hypogeae) varieties available in Borno State were examined for the mould flora. The degree of infestation of the grains ranged from 31% to 100% and 68% to 86% for surface sterilized cowpea and groundnut respectively. The mould flora commonly encountered were species of the genera Aspergillus. Penicillium species, Scopulariopsis species and Trichoderma species were also found. The flora of the cowpea was dominated by Aspergillus niger while Aspergillus flavus was the dominant mould on groundnut.


Efficacy of praziquantel treatment of schistosomiasis in a non-endemic country: a follow-up of parasitological, clinical and immunological parameters.

Schistosomiasis patients were immigrants to Czechoslovakia from Angola and Yemen. Most of them had light or moderate infections and felt subjectively healthy. They received treatment with praziquantel (two doses with a total of 40 mg/kg) and were followed up for several years. In nine of 13 patients, Schistosoma haematobium or S. mansoni eggs with undamaged miracidia were detected in biopsies from the bladder or the rectum one year or later after treatment. Granulomatous reactions in the rectum and bladder lesions of stage 1 including thickened bladder walls persisted in most of the patients. Antibody levels against adult S. mansoni worm antigen remained elevated for at least two years after therapy in some patients and declined in others. Among the nine patients, for whom pre- and post-treatment sera were available, the changes in relative levels of antibodies did not strictly correlate with the continued presence of schistosome eggs in, or their absence from, biopsies. We discuss the results obtained with sensitive diagnostic techniques in the absence of subjectively perceived disease.


Diagnostic laboratory parasitology--a stepping stone to medical research in tropical Africa.

African countries can concentrate mainly on operational and problem-solving type of medical research using as a basis routine diagnostic laboratory parasitology which can be elevated to research level by incorporating all relevant techniques backed by statistically-based programming. Because of high incidence of parasitic infections and the peculiar host-parasite relationship, co-operation between all departments of any major hospital will be required to deal with the diseases due to them. Longitudinal studies on some parasites will enable generalisation and specific views to be formed on some infections. Multiplicity and wide variety of available techniques offer several research possibilities of clinico-pathological and epidemiological significance. Routine laboratory-based research offers the right environment for training various types of laboratory workers from technicians to medical parasitologists, through on-the-job training on techniques, investigative studies and research, backed by formal lectures and practicals at various levels. Trainee medical parasitologists can obtain higher degrees locally or abroad. The research can be organised around micro and mini research units. This approach is cost-beneficial because it minimises administrative difficulties and so avoids wastage. The results can be used to monitor impact of national development on parasitic infection prevalence and to formulate a policy on parasitic disease management.


Persistence of low levels of Plasmodium falciparum resistance to chloroquine in the autochthonous population of the Central African Republic.

In Central African Republic, the first cases of resistant P. falciparum to chloroquine occurred in 1983 in non immune expatriate residents on regular chemoprophylaxis. From 1984 to 1991, 950 in vivo tests with a seven days observation period were performed in semi-immune autochtonous children living in seven towns of the country. Chloroquine treatments were given at 25 mg/kg over 3 days period to children with P. falciparum parasitaemia > 500 (634 simplified methods) or > 1000/mm3 (316 WHO standard field tests), usually asymptomatic. Until 1988, the surveys show an absence or a low frequency of chloroquine resistance (usually below 10%) according to the town; since 1989, the resistance has been present in all towns but everywhere with a frequency under 20%. None cases of R III level resistance was observed and all children became or remained asymptomatic at day 7. Until further surveys demonstrate a decreased efficacity of chloroquine, it is advised that chloroquine be used at 25 mg/kg over 3 days period as the treatment of choice in uncomplicated acute malaria in the Central African Republic.


Non-ocular clinical onchocerciasis in relation to skin microfilaria in the Taraba River Valley, Nigeria.

Examination of 2,876 persons in fourteen communities was carried out for clinical onchocerciasis on the Taraba river valley, Nigeria, where parasitological findings indicate unusually high endemicity. Forty-five percent of the population had at least one type of skin lesion or the other, the commonest of which was pruritus. Thirty-two percent had nodules. Some of the nodules were located in unusual sites such as the mammae, anus. Nodule carriage and nodule-load as well as lymphatic enlargement were higher than those recorded elsewhere in Nigeria and tended to increase with increase in age. When subjected to regression analysis, the relationship between skin lesion, nodule carrier rate, nodule load, scrotal enlargement and microfilaria rate (mf) on one hand and microfilaria density (mfd) on the other showed a near-perfect correlation. The findings of this study suggest that certain clinical manifestations of onchocerciasis may be a reliable and more rapid alternative to the parasitological approach in the assessment of the prevalence and severity of the disease in communities with similar socioecological characteristics.


Weight loss, total and differential leucocytic counts in mice treated with alcohol during Ancylostoma caninum infection.

Females of Swiss albino mice were treated with various doses of alcohol and Ancylostoma caninum larvae. Mice which received 40% alcohol for 20 days showed a significant decrease in body weight and in the number of leucocytes. Eosinophilia was also observed in mice which were treated with 40% alcohol for 20 days.


Cryptosporidiosis in young children suffering from diarrhoea in Riyadh, Saudi Arabia.

A one-year study of patients (0-120 months of age) with diarrhoea at King Abdel-Aziz University Hospital (KAUH) in Riyadh, Saudi Arabia, detected two cases of cryptosporidiosis. Stool specimens from 174 children with diarrhoea and negative for other parasitic infection were examined using a safranin-methylene blue stain (S-MB). Two children (L.1%) were showing Cryptosporidium oocysts. None of 50 control children who did not have diarrhoea and was free of Giardia lamblia was Cryptosporidium positive.


Hydrolytic enzymes in leprosy sera.

Serum samples collected from 45 untreated leprosy patients and 10 healthy subjects were studied for the activities of alkaline phosphatase, N-acetyl beta-glucosaminidase and beta-glucuronidase. A highly significant increase in the specific activity of these enzymes was observed in all types of leprosy patients as compared to controls. Increase in the level of circulatory hydrolytic enzymes could be a tissue damaging factor and may be responsible for many of the lesions seen in leprosy.


Release of acid hydrolases in spectrum of human leprosy.

Release of acid hydrolases by blood monocytes (BM) of leprosy patients both before and after 6 months of chemotherapy was measured fluorimetrically. Monocyte cultures were set up for spontaneous as well as zymosan dependent enzyme release measured after 2 hrs and 24 hrs of culture. In the untreated multibacillary group (BL/LL) a significantly higher (P < 0.001) release of both B-glucuronidase (BG) and N-acetyl glucosaminidase (NAG) was observed compared to the paucibacillary group (BT/TT) and healthy controls. On comparing the BT/TT group with controls a significant decrease (P < 0.001) in zymosan dependent NAG release was observed in the former group at 2 hrs culture. After 6 months of antileprosy therapy, a significant decrease (P < 0.05) in BG release was observed from BM of multibacillary patients, whereas NAG activity increased significantly (P < 0.05) in the paucibacillary group compared to the controls. The results of the present study suggest that non-oxidative metabolic status of BM vary within the leprosy spectrum.


Penicillinase-producing Neisseria gonorrhoeae conjunctivitis on some Nigerian children.

During 21 month study of bacterial conjunctivitis among 121 children in two health care centres in Calabar, Nigeria, a total of 90 (74.4%) cases were culturally confirmed. Neonates had the highest age-specific attack rates with 48 (53.3%) cases. Neisseria gonorrhoeae, the predominant pathogen, was recovered from 32 (35.6%) infections; 21 (65.6%) of them from neonates. Cultures of genital swabs of consenting parents of infected neonates as well as those of three female children aged 2-12 years with concurrent vulvo-vaginitis yielded N. gonorrhoeae. Younger women, mostly primi-gravidae were more frequently found to have benefited from peri-natal health care services than older multi-gravidae. Nevertheless, such access to health care services did not appear to influence the frequency of gonococcal conjunctivitis in neonates from the two maternal groups (P < 0.01). Sexual abuse and contaminated fomites were the possible modes of gonococcal infection transmission to older children. Overall, 22 (68.8%) strains of gonococci were resistant to penicillin; 19 (59.4%) were penicillinase-producing Neisseria gonorrhoeae (PPNG), while 5 (15.6%) had chromosomally-mediated resistance. All isolates were sensitive to erythromycin. This study recommends a review of gonorrhoea surveillance in pregnancy to include routine examination of cervical swabs just before delivery.


Pilot studies on the occurrence of some infectious diseases in two different areas in south Yemen (Aden) (part II. Microbiology).

This paper is the second part of the article dealing with intestinal bacteria. The findings are relatively poor in comparing with the frequency of intestinal protozoa. Among 83 stool specimens taken for bacteriological examination 14 isolations of different bacteria were proved. One S. muenchen was isolated from a 3 year old boy with fever, diarrhoea. Five cases of Alkalescens dispar 05 manit negative and 05 manit positive were identified. Two of these cases were without clinical symptoms. All were males aged 10-17 years. One isolation of E. coli EPEC 086 K6 H11 was in a 10 year-old boy with diarrhoea, four watery stools daily and cramps. Six cases of other E. coli were of different types, all with clinical symptoms. Of them three were males and three females at the age from 3-46 years. One case had a mixed infection of Citrobacter, E. coli and Klebsiella with diarrhoea, about 5 watery stools daily and abdominal pain. The frequency of intestinal bacteria in males was nearly three times higher than in females. The occurrence in age groups 10-20 was almost equal 20.0-22.2%, in 0-4 it was 42.9% and surprisingly low in 5-9 years old--3.4% only.


Treatment of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma is a common cancer among Thai males. When first seen, the disease is almost always locoregional. Evaluation of the tumor volume at the nasopharynx by computerized axial tomogram must be done prior to therapy. Treatment is done by radiation therapy to the nasopharynx and cervical lymph nodes, and is effective. Chemotherapy has high activity in this disease. However, more studies are needed to define its role. Side effects of treatment are radiation related, and confined to the area of previous radiation. They can be minimized if the patients strictly adhere to the physician's advice. Causes of treatment failure and death can be due to both locoregional failure and distant metastasis, notably to bone, liver and lungs.


Maternal risk factors for low birth weight newborn in Thailand.

The present study assesses the risk approach for maternal risk factors for LBW newborn in Thailand. This study can be considered as a managerial tool for developing local strategies and is particularly useful in the field of maternal and child health care. A summary of maternal risk factors for LBW newborn as listed in Table 7 and can be used as a health educational tool for pregnant women and as basic data for marital counseling. It can also be used to keep the public informed about the maternal risk factors for LBW newborn which will help Thai women of reproductive age avoid the chance of having such babies.


Risk factors for neural deficit in spinal tuberculosis.

From 1975 through 1989, retrospective study of 155 patients with spinal tuberculosis was carried out at Ramathibodi Hospital to study predisposing factors to neural deficit and results of treatment. Two groups of patients who had no neural deficit and had neural deficit were compared. Clinical characteristics of the patients between the two study groups were similar with regard to sex, duration of symptoms, number of vertebrae involved, angle of gibbus deformity and erythrocyte sedimentation rate. There were statistical differences in age, cephalad level of infection, loss of vertebral body and clinical evidence of cold abscess. For patients with neural deficit, the results generally are good with anterior decompression and stabilization.


Incidence of cholelithiasis in the northern part of Thailand.

It may be concluded from comparisons of recent u/s examinations in Northern Thailand to studies in Japan and to the gallstone study conducted over two decades ago that gallstone disease in Thailand is starting to exhibit the same situation as in the West. In comparing overall rates over time the gallstone incidence in Thailand appears to have climbed from 2.61 to 3.10 per cent (Fig. F). The rate increase is even more significant when broken down by sex (male: 1.89%--> 2.50%, female: 3.23%--> 3.70%). In addition, the present rates of female and male gallstone incidence in Northern Thailand closely match the rates found in studies of the Japanese population. Because gallstone disease has become a major public health problem in the West, a number of studies have emphasized the epidemiological characteristics of the disease in order to implement controls. As Thailand's gallstone problem seems to be heading towards the same level of importance further studies involving epidemiological factor linkage may be necessary and the technological advances in Ultrasonography make such studies quite feasible.


A study of unit cost of routine investigations in Srinagarind Hospital.

We have used the step up allocation accounting method to determine the actual costs of complete blood count, urinalysis, chest radiograph and electrocardiogram. We found that the actual costs were quite different from the price set up by the hospital. The actual cost were much higher than the price for the complete blood count and urinalysis and much lower for the chest radiographs and especially for electrocardiogram. We propose that in performing economic analysis involving all these investigations, the actual cost should be used instead of the price.


Decreased suppressor T-lymphocytes in women who received progestogen injections.

Decreased levels of suppressor T-cells (CD8+) were found in 17 normal women who received progestogen (Depoprovera) injection, 150 mg intramuscularly every three months for contraceptive purposes, for more than 30 months. The helper: suppressor T-cells (CD4+ : CD8+ ratio) was significantly elevated in this group compared to 30 normal female controls. No significant change of T-lymphocyte was found in 53 normal women who received the injection for less than 30 months or who received combined oral contraceptive pills. In conclusion, long term progestogen injection induced a lowering of suppressor T-cell levels, which is the same immunological change found in several autoimmune diseases.


Biparietal diameter/femur length ratio and actual femur length/expected femur length ratio: a sonographic screening method for Down's syndrome.

Several ultrasonographic signs have been described in second-trimester Down's syndrome fetuses. Previously published reports have shown that fetuses affected with Down's syndrome have normal biparietal diameter (BPD), high BPD-to-femur length (FL) ratio, and low actual FL-to-expected FL ratio. A retrospective comparison of the BPD-to-FL ratio and actual FL-to-expected FL ratio was made between 3 fetuses with Down's syndrome diagnosed prenatally by second-trimester amniocentesis and 189 normal fetuses with gestational age varying from 13-25 weeks who were seen in the Ultrasound Unit of Department of Obstetrics & Gynaecology, Chulalongkorn Hospital between January 1, 1989 and May 31, 1990. The sensitivity of BPD-to-FL ratio and actual FL-to-expected FL ratio as a screening technique for Down's syndrome in this study was 66.7 and 100 per cent, with a specificity of 93.4 and 89.2 per cent respectively. These sonographic parameters appear to be a useful screening method for Down's syndrome.


Late ulnar nerve injury following Kirschner wires fixation of the supracondylar fracture of the humerus.

Most supracondylar fractures of the humerus can be treated by closed methods. Open reduction and internal fixation by wires or pins are indicated in a difficult fracture (Kekomaki et al 1984) or in vascular injury following the fracture. This fixation should be temporary and removed immediately upon obtaining the desired purpose. To increase surgeons awareness of inadvertently leaving the implant for too long, we are reporting an unusual complication of migration of the Kirschner wire resulting in late ulnar nerve injury.


Characteristics of laser Doppler flowmeters with differing optical arrangements.

Recently, various laser Doppler flowmeter (LDF) systems have been used for evaluation of tissue microcirculation. However, indifference has often been shown by doctors and researchers regarding their sampling volume, stability and accuracy, which differ with various optical arrangements. In this study we evaluated the characteristics of three LDF systems with different optical arrangements. The sampling depths in both blood and tissue were found to differ with the different optical arrangements, although the laser power emitted from the probes is nearly equivalent. Each depth significantly changed at haematocrits between 5.0 and 36.5%. The stability and the accuracy of the measurements also differed. In the practical case of tissue microcirculation it is important to measure blood flow with an understanding of the material differences in the characteristics of the LDF systems.


A picture communicator for symbol users and/or speech-impaired people.

There are several approaches to producing communication aids for people with disabilities. The system described here takes the approach of utilizing as much mainstream hardware as possible, and adapting it with some modular software tools which have been designed to facilitate the building of customized symbol communication systems. The target audience are clients who are symbol users and/or have a speech impairment. The system provides several levels of screens, each of which can contain grids of scalable icons. A number of input methods are provided including keyboard, switch, mouse and touch-screen. Digitized and/or text to speech synthesis can be used for reinforcement of selections and for communication. The structure of the system is discussed and initial feedback from the first field trials is presented.


Microwave thawing of biological materials using a cylindrical rotational mixing system: a calibration model.

A cylindrical device is described for placement within a domestic microwave oven, in order to achieve rapid thawing of biological materials, including plasma, located within the cylinder. The device is economical to fabricate within standard workshop facilities. It secures uniform microwave exposure and continuous mixing of material by rotation of the cylinder in two planes, entraining the motion of the oven drive spindle by a very simple system of frictional gears. Data are presented on the accuracy of this system, and on some important points relating to its use both as a calibration model and a research tool. Such research may eventually enable this system to provide a cheap and reliable option for thawing therapeutic materials for clinical use.


[Study on the influence of silicone oils of various viscosities on anterior eye structures].

Intraocular silicone oil tamponade plays important role in the treatment of complicated retinal detachments. Aim of present study was an investigation of the effects of different silicone oil fluids on the anterior chamber structures. Standard silicone oils with 100, 990, 3690 mPa.s viscosity and highly purified silicone oil with viscosity 5000 mPa.s were used. Corneal silicone oil impregnation was observed in corneas which were in contact with silicone oil with 100 mPa.s. viscosity. Silicone oil impregnation of uveal structures was observed in all cases after the 4 months follow-up. "Posterior collagenous layer" was observed subendothelial in eyes injected with various silicone oil fluids including highly purified one. Results of our investigation show that use of highly purified silicone oil does not allow to reduce the side effects on ocular structures caused by emulsification or a barrier to the nutrition and exchange of products of metabolism provided by silicone oil bubble.


[The state of corneal endothelium after cataract extraction as examined by contact endothelial microscopy].

The central area of the corneal endothelium was examined in 130 patients after an intracapsular extraction of a senile cataract without implantation of an intraocular artificial lens, with implantation of an anterior chamber artificial lens and after an extracapsular extraction of senile cataract with implantation of a posterior chamber artificial lens. The authors used the endothelial contact microscope Copper Vision with an endothelial cell counter from MLC Technologies. The mean proportional loss of the corneal endothelial cells for the 1st group after 1 month amounted 11.6%, after 6 months from operation 13.0%; for the 2nd group after the 1st month 15.0%; for the 3d group after 1 month 13.5% and after 6 months 17.0%.


[Spontaneous Pulfrich's effect in patients with dysfunction of the optic nerve].

Twenty patients with various dysfunctions of the optic nerve were subjected to examinations by means of a test based on the Pulfrich's phenomenon. The Pulfrich's effect was observed in 18 among them. The survey of the phenomenon was continued in 5 patients in the course of the treatment. It was detected that the dimension of the spontaneous Pulfrich's illusion diminishes gradually tending towards norm. The results obtained assure us of the usefulness of the application of the Pulfrich's effect as a diagnostic test in ophthalmology and neurology.


[Morphology of changes in records of visual evoked potentials in patients with multiple sclerosis].

Statistical analysis of the parameters of the waves of visual evoked potentials were performed in 2 groups: in 32 patients with a sure diagnosis and in 21 with a probable diagnosis of multiple sclerosis. In the 1st group prevailed the reduced record with a delayed latency of peaks of the A, B, C waves and with the interhemispherical and interocular asymmetry of the diagram. In the 2nd group dominated an delayed latency of the B and C waves and interhemispherical asymmetry of those waves. Abnormal characteristic of the record was obtained also after stimulation of the eyes of the examined patients with a full visual acuity.


[Ocular symptoms in internal carotid artery occlusion].

The internal carotid artery occlusion causing an insufficiency of the cerebral circulation manifests itself--besides the neurological symptoms--by disorders of the visual organ. One can distinguish among them early, functional symptoms in the form of transient unilateral hemianopia on the side opposite to the occluded carotid artery and the attacks of transient amblyopia. Signs of fixed ischaemia of the eye ball appear afterwards in the form of oculomotor and pupillary disturbances, neovascularization of the iris, disturbances of the IOP, central retinal artery occlusion, ischaemic optic atrophy. The authors emphasize the value of Doppler's diagnostic ultrasonography, a fast and non-invasive method of direct evaluation of the blood flow in the internal carotid artery system.


[Prognostic value of treatment trials used during the preoperative period in patients with primary retinal detachment].

Analysed are the results of surgical treatment and the methods applied in patients with primary retinal detachment who have been placed in recumbent position in the preoperative period. It was demonstrated that in all the cases in which after staying in bed one could observe a full or partial retinal re-apposition--a relatively simple and sparing operation was sufficient for a lasting cure. The presented results show that a successful outcome of the reclining position trial constitutes one of the favourable prognostic factors for the success of the surgical intervention.


[Use of photocoagulation during surgery for retinal detachment].

On the basis of a 10-years clinical material comprising 95 eyes operated for retinal detachment in the Department of Ophthalmology in Krakow the authors evaluated the usefulness of xenon and laser coagulation as a method complementing the blockade of the retinal holes. It had been used in 18 p.c. of all operated eyes attaining in this group of cases the re-apposition of the retina in 61 p.c. The efficacy of the coagulation depended on the adherence of the retina and showed itself as formation during the surgery of visible foci and the development of a distinct, pigmented scar. There were no complications connected with photocoagulation as well the xenon as the laser one; all this encourages to employ both these methods.


[Probability of successful operation in very severe retinal detachment using scleral buckling procedure].

The aim of this study was to study the efficacy of operation of scleral invagination in the treatment of very severe retinal detachment with proliferative vitreoretinopathy (PVR). The investigations comprised 36 eyes operated in the Department of Ophthalmology in Krakow in the period 1986-1990. The authors performed in 24 patients a encircling operation with a silicone band, in 12-meridional or parallel extrascleral silicone sponge implants. Reattachment of the retina was achieved in 58 p.c. of eyes and an improvement of the visual acuity in 47 p.c. The performed analysis showed a substantial dependence of the attained effect of surgery on the grade of advancement of the PVR; it enabled to ascertain that the limit of possibilities of the scleral buckling procedure determines PVR stadium C3.


[Evaluation of the usefulness of vitrectomy in the treatment of proliferative diabetic retinopathy].

The authors analyse the results of 146 operations of vitrectomy through the pars plana executed in cases of complications of diabetic retinopathy. In 50 eyes with prognostically very severe conditions (tractional retinal detachment, presence of central retinal holes, recurrent intraocular haemorrhages) vitrectomy was connected with an intra-bulbar injection of silicone oil. In the period of 6 months to 3 years after surgery the improvement of the visual acuity was attained in 96 eyes (66 p.c.). Intravitreal injection of the silicone oil increased the chance of reattachment of the retina and reduced the incidence of a postsurgical recurrent intraocular haemorrhage.


[Evaluation of the use of excimer laser in the treatment of keratitis and pterygium].

Excimer laser was used for the treatment of 67 eyes with keratitis and 15 eyes with corneal ulceration. Also by means of excimer laser 18 eyes were treated for pterygium; cure was observed in 17 cases. The observation period was 6 months.


[Use of a new model of keratoprosthesis made from carbon in treatment of dense leukoma after ocular burns].

Discussed are the results of kerato-prosthetics in 12 cases of severe post-burn leukoma by means of a new model of keratoprosthesis with a carbon bearing. The material for construction of the carrier part of the prosthesis is based on carbon fibres and Polish technology worked up by the Institute of Material Engineering of the Mining-Metallurgic Academy in Krakow.


[Lamellar keratoplasty in treatment of recurrent pterygium].

Presented are 4 cases of recurrent pterygium treated by lamellar keratoplasty. The surgical technique and the results of the treatment are described.


[Penetrating keratoplasty in post-burn corneal leukoma in personal material].

The authors present the surgical technique and the results of treatment of 12 patients with corneal leukoma caused by scalding. In all the cases they performed a perforating keratoplasty. Two years after operation among 7 grafts 5 were transparent. Perforating grafts in leukoma caused by a chemical burn have poor prognosis in contrary to thermic burns.


The use of ethnography and structured observations in the study of risk factors for the transmission of diarrhea in highland Papua New Guinea.

Methods that combine anthropological and epidemiological data are needed for the study of behavioral risk factors in communicable diseases, but as yet remain undeveloped. Ethnography is often undervalued as both the preliminary and integrative step in the design and execution of such studies. The analysis of critical methodological issues emerging from a case-control study of the behavioral and environmental risk factors for the transmission of childhood diarrhea in both urban and rural highland Papua New Guinea suggests that focused ethnographic assessments, complemented by structured observations performed by nonprofessionals, may provide a viable research design. In highland Papua New Guinea, significant risk factors include non-usage of latrines and sleeping with pigs; the latter is a factor that could have important implications regarding women's roles in a changing economy.


[Bilateral Purtscher's syndrome].

Purtscher's syndrome (traumatic retinal angiopathy, posttraumatic retinopathy) belongs to rare posttraumatic retinopathies. The authors present a case of a bilateral occurrence of this syndrome after a head injury connected with pancreatitis. A 6-months long observation of the patient showed an improvement of the visual acuity from counting fingers to 0.1 and receding of the inflammatory-oedematous changes at the eye fundus; there remained a pallor of the temporal side of the optic discs.


[Unilateral exophthalmos during the course of epidural hematoma].

Based on 10 cases in the literature and one of our own a review is made on the occurrence of an association of an intracranial epidural haematoma with unilateral exophthalmos. The possible pathogenesis of this infrequent phenomenon is discussed.


[Necrotizing scleritis--successful treatment with solcoseryl].

A case of the patient with necrotising scleritis in osseous rheumatism is presented. The patient was treated with Solcoseryl injected intravenously. During the 20-days treatment, the drug has been tolerated well. It speeded the healing of the sclera which prevented secondary complications and made it possible to maintain the eye's visual ability.


The biocultural approach in nutritional anthropology: case studies of malnutrition in Mali.

Socioeconomic status is often cited as the most important factor influencing nutritional status and growth in children. Research in Mali, however, has shown that relative poverty is not an accurate predictor of nutritional status and growth, and that other factors may be more important. In Mali, these factors include maternal age, marital problems, untreated illness, allocation of household resources, maternal attitudes, maternal competence, support networks, and the social structure of a polygynous, patrilineal society. In this paper, case studies of children in three families illustrate how sociocultural malnutrition in young children can be viewed as an unintended consequence of the complex interactions among these factors.


[What is the visual field?].

Eye movements were recorded in the course of visual field determination. The behaviour of the eye is various in different persons, defying any rule, except, contrary to the definition of the visual field, it does not remain immobile but executes one or more saccades. Discussing the results the authors present a new concept of the visual field.


Symbolic mediation and commoditization: a critical examination of alcohol use among the Haya of Bukoba, Tanzania.

Low-alcohol-content fermented beverages are thoroughly enmeshed in the social, economic, commensal, and cosmological spheres of life among most peoples of sub-Saharan Africa. This paper describes and analyzes the role of alcoholic beverages as symbolic mediators and commodities among the Haya of northwest Tanzania. Data gathered during field research in 1985-86 are employed to describe the ways in which the Haya portray excessive drinking and the indigenous strategies they use to address frequent drunkenness when it is perceived as a health problem. A central feature of the paper contrasts the role of a cultural schema of four levels of intoxication in processes of symbolic mediation and commoditization, thereby contributing to critical medical anthropological analysis.


The biological impact of social responses to the AIDS epidemic.

This paper examines the extent to which social responses to the AIDS epidemic contribute to the continued transmission of the virus, thereby exacerbating the biological impact of the epidemic. Following the model of McGrath (1991), social responses to AIDS are examined in terms of their impact on potential transmission of HIV. Responses are evaluated using established criteria for decreasing disease transmission: eliminating the source of infection, eliminating contact necessary for infection, decreasing susceptibility of hosts, or decreasing the infectivity of infectious persons. The most frequent responses to AIDS have been scapegoating, resulting in ostracism, stigma, and blame; resignation; use of alternative therapies; political mobilization; and research. With the exception of political mobilization in some communities, the social responses to AIDS have not decreased the biological impact of the epidemic, and, therefore, may not be "biologically appropriate".


Garbage imperialism: health implications of dumping hazardous wastes in Third World countries.

This paper calls for studies of the potential health implications of today's hazardous waste disposal practices, and suggests that such studies are urgently needed in Third World countries where industrial nations are increasingly dumping their unwanted waste materials. The United States produces enormous quantities of hazardous waste each year, and approximately 1,200 "priority hazardous waste sites" presently threaten the nation's health. Because of environmental regulations, landfill closings, and citizen opposition to local waste facilities, industrialized countries are increasingly disposing of their problematic materials by shipping them to the Third World, where they pose substantial threats to human health and the environment. From a political economy perspective, this paper suggests that global health would be better served by reducing hazardous waste production, encouraging reusing and recycling, and restricting or banning international shipment of toxic wastes.


Primary IgA nephropathy: the relevance of experimental models in the understanding of human disease.

IgA nephropathy is the most common form of primary glomerulonephritis worldwide. About one quarter of patients progress to terminal renal failure 10 years after the apparent clinical onset. Therefore, the disease represents a social problem in terms of number of patients requiring maintenance hemodialysis. Despite the intense research effort devolved to clarify the pathogenesis of IgA nephropathy, the exact relationship linking the several factors involved is still unknown. In this review we analyze the experimental works reported since 1979, when the first animal model of IgA nephropathy was published by Rifai et al. We also discuss the interplay between experimental data and clinical observations to maximize the information gathered from the different animal models. Finally, we report the new insights into the role played by cytokines, growth factors and autacoids.


Very late activation-3 integrin is the dominant beta 1-integrin on the glomerular capillary wall: an immunofluorescence study in nephrotic syndrome.

The expression of alpha 2; alpha 3; alpha 5; alpha 6-subunits of the beta 1 [very late activation (VLA)] integrin family was studied in kidney specimens using an immunofluorescent technique. 6 specimens from normal kidney were compared with 10 specimens from patients affected by various glomerulopathies [minimal change nephropathy (MCN), membranous nephropathy (MN) and systemic lupus erythematosus nephritis (SLEN)]. On normal glomeruli, alpha 3 was the dominant integrin, being mainly present on podocytes and showing a linear fluorescent pattern codistributed with laminin. In MCN and SLEN, alpha 3 presented a normal pattern. In MN, alpha 3 revealed a trabecular picture on thickened glomerular basement membranes. Moreover, in stage-III MN, a segmental loss of alpha 3-integrin was detected. In our opinion, VLA-3 may offer an interesting approach to the study of the relationships between podocytes and their substrate.


Treatment of hyperlipidemic kidney graft recipients with lovastatin: effect on LDL-cholesterol and lipoprotein (a).

An increased incidence of hyperlipidemia places kidney graft recipients at increased risk for cardiovascular disease and may contribute to a decline in graft function. A study was undertaken to evaluate the safety and efficacy of lovastatin in these patients. Twelve kidney graft recipients with stable graft function and a cholesterol (chol) level over 250 mg/dl (6.46 mmol/l) were included. The lipid-lowering treatment consisted of 20 mg lovastatin daily, and all patients received immunosuppression with ciclosporin (CS) and prednisolone. Total chol decreased by 27% (300 +/- 56 to 219 +/- 28 mg/dl; 7.76 +/- 1.45 to 5.66 +/- 0.72 mmol/l; p < 0.01), LDL-chol by 35% (220 +/- 38 to 143 +/- 17 mg/dl; 5.69 +/- 0.98 to 3.70 +/- 0.44 mmol/l; p < 0.01) and triglycerides by 33% (207 +/- 127 to 138 +/- 56 mg/dl; 2.36 +/- 1.44 to 1.57 +/- 0.64 mmol/l; p < 0.05). HDL-chol increased by 10% (57 +/- 11 to 63 +/- 13 mg/dl; 1.47 +/- 0.28 to 1.63 +/- 0.34 mmol/l; NS). The ratio of total chol/HDL-chol, a generally accepted risk predictor of atherosclerosis, fell from 5.4 +/- 1.3 to 3.3 +/- 1.2, p < 0.01. Lipoprotein (a) [lp(a)], an independent risk predictor for atherosclerosis, was also evaluated at baseline and after 6 months of lovastatin treatment and showed a decrease of 39% (32.9 +/- 27.6 to 19.9 +/- 22.9 mg/dl; 0.85 +/- 0.71 to 0.51 +/- 0.59 mmol/l; p < 0.05). No adverse side effects were seen at this dosage, and hepatic and renal parameters remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)


25-Hydroxyvitamin D3 metabolism in vitro by mononuclear cells from hemodialysis patients.

Hemodialysis patients have a capacity for extrarenal production of 1 alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3]; however, the source of the hormone is unknown in these patients. Since 1,25(OH)2D3 synthesis by cultured hematopoietic cells has been demonstrated previously, we assessed hormone production by mononuclear cells from peripheral blood obtained from normal subjects (n = 6), uremic patients not yet requiring dialysis (n = 4) and hemodialysis patients (n = 14). 1,25(OH)2D3 production was analyzed by sequential straight phase and reverse phase HPLC. In the hemodialysis group, the mean specific production of a metabolite co-eluting with 1,25(OH)2D3 (in fmol/100,000 cells/h) both by monocyte-enriched adherent cells (Mo) and lymphocyte-enriched non-adherent cells (Ly) was increased as compared to non-dialyzed subjects (119 vs. 22 for Mo, not significant, 65 vs. 14 for Ly, p < 0.05). Taken together, Mo and Ly from hemodialysis patients synthesized significantly more 1,25(OH)2D3 (p < 0.02) than non-dialyzed subjects (184 vs. 36, means). No differences were found between cells from normal subjects and patients with preterminal renal failure. Exposure of cultured normal Mo (n = 6) to cuprophane (CU), polyacrylonitrile (AN69) or polycarbonate-polyether (PC) membrane devices resulted in increased 1,25(OH)2D3 production as compared to control incubations without membrane. The rank order of increase was PC > AN69 > CU, whereby only PC (p < 0.05) was significantly different from control. Our results suggest that blood mononuclear cells contribute to extrarenal 1,25(OH)2D3 synthesis in hemodialysis patients, and that this synthetic activity may be related to the hemodialysis procedures.


Potential deleterious effect of furosemide in radiocontrast nephropathy.

The purpose of the study was to determine the efficacy of furosemide in addition to intravenous fluids in the prevention of radiocontrast nephropathy. 18 patients, referred to a radiocontrast study, considered at risk because of preexisting renal insufficiency, were enrolled in a prospective, randomized, controlled trial, performed at the secondary care center of a 1,100-bed private university hospital. In addition to fluids, the treatment group received furosemide (mean dose 110 mg) intravenously 30 min prior to the injection of contrast material. The control group received fluids (mean 3 liters). Radiological studies were mostly angiographies performed with both ionic and non-ionic contrast material, at an average dose of 245 ml. Renal function significantly deteriorated in the group pretreated with furosemide (p < 0.005 by ANOVA), with a rise in serum creatinine from 145 +/- 13 to 182 +/- 16 mumol/l at 24 h, while no change occurred in the control group (from 141 +/- 6 to 142 +/- 7 mumol/l). Renal failure was associated with weight loss in the furosemide-treated group. Furosemide may be deleterious in the prevention of radiocontrast nephropathy.


Effect of lymphokine from nephrotic peripheral blood mononuclear cells on catabolism of rat glomerular basement membrane sulfated compounds.

We have previously shown a significant increase in sulfate-35 uptake in rat glomerular basement membrane (GBM) when glomeruli were cultured with peripheral blood mononuclear cells (PBMC) from patients with idiopathic minimal lesion nephrotic syndrome (IMLNS) in relapse. In the present study, we have isolated the lymphokine mediating the augmented sulfate-35 incorporation and evaluated its effect on the catabolism of the GBM sulfated compounds. Supernatants from IMLNS PBMC cultures of 13 patients in relapse and 10 in remission were fractionated using gel filtration chromatography. There was a significant increase in rat GBM sulfate-35 uptake when glomeruli were cultured in carbonic anhydrase fraction from patients in relapse (12.9 +/- 3.2; cpm/microgram GBM protein, mean +/- SEM) as compared to glomeruli cultured in the same fraction from patients in remission (8.2 +/- 2.5: cpm/microgram GBM protein; p < 0.05). The catabolism of the GBM sulfated compounds was determined by studying the washout of the sulfate-35 macromolecules after equilibration in sulfated isotope-free medium for 12 h. There was a significant decrease in residual sulfate-35 in rat GBM when glomeruli were cultured in a 29-kD fraction from patients in relapse (7.0 +/- 2.5; cpm/micrograms GBM protein, mean +/- SEM) as compared to glomeruli cultured in the same fraction from patients in remission (31.8 +/- 1.6; p < 0.005). No significant differences in sulfate-35 incorporation were seen when other fractions from patients in relapse and in remission were compared. These studies suggest that the lymphokine secreted by PBMC from IMLNS patients in relapse increases the catabolism of the GBM sulfated compounds.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of haemostatic activity in haemodialysis and peritoneal dialysis patients with a novel technique, haemostatometry.

Bleeding due to impaired primary haemostasis is common in uraemia. However, thrombo-embolic episodes are also a clinical problem in dialysis patients. Platelet reactivity to shear stress (haemostasis, H1 and H2), exposure to collagen fibre (thrombus growth) and coagulation of flowing blood (clotting time, CT1 and CT2) were measured in non-anticoagulated blood samples taken immediately before and 18-24 h after haemodialysis (n = 26) and from patients maintained on continuous ambulatory peritoneal dialysis (CAPD, n = 30). H1 (p < 0.001), H2 (p < 0.01), percent thrombus growth rate (p < 0.03), CT1 (p < 0.01 and CT2 (p < 0.05) were restored towards normal after haemodialysis. Results obtained in the CAPD patients demonstrated that the mean values for formation of the haemostatic plug lay between the pre- and posthaemodialysis values; however, CT1 (p < 0.01) and CT2 (p < 0.05) were prolonged in CAPD compared with values after haemodialysis. These data, which indicate platelet function from non-anticoagulated blood and coagulation under flow conditions, (1) confirm that there is impaired haemostasis in uraemia; (2) demonstrate an improvement in haemostasis after haemodialysis; (3) show that peritoneal dialysis results in a haemostatic profile which falls between the pre- and posthaemodialysis pattern, and (4) show that neither dialysis modality returns haemostasis to normal.


Nephropathy associated with infection by human immunodeficiency virus: a report on 11 cases including 6 treated with zidovudine.

The human immunodeficiency virus (HIV) was recently suggested to be involved in generating kidney lesions in HIV-associated nephropathy (HIVN). The possibility that antiretroviral agents can slow down the usually explosive evolution of HIVN to end-stage renal failure (ESRF) has not been studied in many of the series of cases published. The present work is a retrospective analysis of 11 patients with histologically proven HIVN, 6 of whom were treated with zidovudine. Seven patients (group 1) either required dialysis at the outset, when HIVN was diagnosed, or progressed very fast to ESRF within 15-45 days. Two patients of this group were treated with zidovudine, but it had no effect on kidney function. In the remaining 4 patients (group 2), HIVN progressed more slowly than in group 1. All 4 patients were treated with zidovudine at an earlier stage of the disease than ESRF. Only 1 deteriorated to ESRF in 9 months. The 3 others, who did not have ESRF, were followed up for 13, 10 and 32 months, respectively. Although this is a preliminary study, its results do suggest that zidovudine can slow down the evolution of HIVN to ESRF. They highlight the need to screen HIV-positive patients regularly for proteinuria, in order to detect HIVN by renal biopsies at an early stage of renal lesion formation.