Circadian rhythm of blood pressure in patients with obstructive sleep apnea.

The aims of this study were to examine the circadian variation in blood pressure (BP) in obstructive sleep apnea (OSA) and to compare this between normotensive and hypertensive subjects. We measured 24-hour ambulatory BP (ABP) in 72 men (mean age 51 +/- 8 years), with OSA diagnosed on overnight sleep study. Measurements of BP were made at 15 min intervals for 24 h using either an Oxford Medilog ABP or Spacelabs 90207 recorder. All recordings were performed after > or = 3 week washout of anti-hypertensive drugs. The day-time monitoring period was defined as 07:00 hrs to 22:00 and night-time 22:00 to 07:00. The ratio of night:day systolic and diastolic BP was calculated. The patients were obese (mean body mass index 33 +/- 5 kg/m2) with a central pattern of obesity (waist:hip ratio 0.99 +/- 0.14, normal < 0.94). The mean 24-h ABP (systolic/diastolic) was 138 +/- 18/88 +/- 12 mmHg. The mean daytime ABP was 143 +/- 18/93 +/- 12 and night-time ABP 128 +/- 20/80 +/- 12 Hg. The night:day BP ratio was 0.90 +/- 0.07 (systolic) and 0.87 +/- 0.09 (diastolic) indicating that average BP was lower during the night. This pattern was similar in normotensive and hypertensive subjects. In contrast there was a significant relationship between increasing BMI and night:day blood pressure ratio (r = 0.56, p < 0.001) independent of the effects of OSA. In contrast to previous studies, men with OSA have a normal diurnal pattern of blood pressure levels. These findings suggest that any influence of OSA on BP is manifested throughout the 24-h period.


The Bergen Blood Pressure Study: definition of hypertensive and normotensive families based on 27 years' follow-up.

The familial aggregation of hypertension is well documented. However, many studies on the familial predisposition have suffered from insufficient knowledge of parental blood pressure (BP). In the present study, the family history is defined according to parental data from two BP surveys conducted almost 30 years apart. Data from a population screening in Bergen in 1963-64 were linked with information on marital status to define couples with or without a history of hypertension. Within the screened population a total of 344 married couples, 688 individuals, matched defined age and BP criteria. Four hundred and thirty individuals, representing 270 of the 344 families initial included (79%), attended a follow-up examination in 1990. Six hundred and ninety-one offspring were registered. In all families represented at follow-up, parental BP data from the 1963-64 screening were available. In 160 families (noffspring = 393), both parents also attended the follow-up examination in 1990. In 23 families (noffspring = 54) both parents were hypertensive in 1963-64 as well as in 1990. In 22 families (noffspring = 55) both parents were normotensive at both examinations. Thus, a family data base which is assumed to be useful for studies on offspring with or without a family history of hypertension, has been established. The offspring studies include BP, 24-h ambulatory BP, electrocardiography, echocardiography, endocrine parameters, electrolytes and anthropometric variables.


Blood pressure in middle-aged women: a comparison between office-, self-, and ambulatory recordings.

A blood pressure screening was carried out in women aged 40-64 years in a geographically defined area in southern Sweden; the attendance was 72%. Middle-aged women classified as normotensives by standard criteria were found to differ from hypertensives also when blood pressure was recorded with non-invasive ambulatory technique; this was so when calculated for day, night, and 24 hours. The frequency of ambulatory blood pressure values > or = 140/90 mmHg was also significantly lower in normotensives than in hypertensives. The established way of diagnosing hypertension and normotension thus correlated well with the results of ambulatory monitoring in women. Furthermore, women had their highest blood pressure in the late afternoon and not in the mornings, as previously shown in men. This was so in all three groups of women (normotensives, borderline hypertensives, and hypertensives). This difference leaves room for speculation about different types of stress load during the day in men and women.


The influence of chronic captopril treatment and its withdrawal on endothelium-dependent relaxation.

The current experiments were designed to explore the relationship between the renin angiotensin system (RAS) and prostanoid formation in aortic ring preparations from spontaneously hypertensive rats (SHR). A further aim was to examine the mechanisms responsible for the reversal of the impaired acetylcholine (ACh) mediated relaxation induced by chronic administration of the angiotensin converting enzyme inhibitor captopril and the relationship of the ACh response to blood pressure. Rats were administered captopril (100 mg/kg/day) and their blood pressures monitored from 5 to 17 weeks of age. ACh-mediated relaxation was determined in aortic ring preparations from untreated and treated rats, and drug withdrawn rats. The influence of indomethacin, saralasin, SQ29548 and captopril on ACh-mediated responses was determined. It was found that chronic captopril treatment produced a marked suppression of the development of hypertension in the SHR. After the withdrawal of the drug the blood pressure remained significantly lower than in untreated animals for 4 weeks. ACh relaxation was impaired in SHR ring segments; this was reversed with captopril treatment and returned to the impaired state upon withdrawal of the drug. In vitro inhibition of the RAS did not significantly influence ACh relaxation. In contrast, impairment of the prostanoid system in vitro reversed the impaired relaxation. The results suggest that the influence of captopril on enhancing ACh relaxation in the SHR does not involve an acute interaction of local angiotensin II synthesis with prostanoid mechanisms. Importantly, the results highlight a dissociation between the impaired ACh relaxation and elevated blood pressure in the SHR.


Impaired vasodilator and chronotropic responses to 5-hydroxytryptamine in two models of hypertension-associated cardiac hypertrophy.

In connection with hypertension, research concerning 5-hydroxytryptamine (5-HT) receptors and subtypes in the cardiovascular system has so far been predominantly focused on various vascular tissues. In this study, the effects of 5-HT were investigated in isolated hearts with experimental cardiac hypertrophy. Cardiac hypertrophy was induced by stenosing the abdominal aorta (ASR) of 5-week-old Wistar rats. The functional response to serotonin was measured in unpaced, ASR hearts (18-20 weeks) and compared with those of "sham" operated SHR and WKY rats. The ASR, less hypertensive than SHR, showed more pronounced cardiac hypertrophy. The positive chronotropic and coronary vasodilator response to 5-HT was reduced in hypertrophied hearts from SHR and ASR when compared to "sham" operated and normotensive controls. The positive chronotropic effect of 5-HT could be antagonised with ketanserin, without affecting the coronary vasodilation. 5-HT did not induce any change in contractile force. Cardiac hypertrophy is associated with impaired coronary vasodilator and chronotropic responsiveness to serotonin. The chronotropic response to 5-HT is mediated by the 5-HT2-receptor subtype.


[Echocardiographic evaluation of the size and systolic and diastolic function of heart muscle i patients with acromegaly].

In 20 patients with acromegaly, morphology of the heart and its systolic and diastolic function were studied by echocardiography, and growth hormone concentration was examined in the serum. Increased muscle mass of the left ventricle was found and that increase depended on disease duration and the growth hormone serum concentration. An increase was also shown of the left ventricular end-diastolic dimension, and the dimensions of left ventricle posterior wall and intraventricular septum, as well as an increase of end-systolic left ventricular dimension and of the size of the left atrium. Out of systolic function parameters, an increase was shown of stroke volume, cardiac output and cardiac index. In 40% of the studied patients an impairment was shown of left ventricular diastolic function but in a half of them no diseases other than acromegaly were found which could have been its cause.


[Evaluation of the activity of angiotensin I converting enzyme (ACE) and of humoral immunity in patients with active pulmonary sarcoidosis].

In a group of 20 patients with active pulmonary sarcoidosis and in 20 healthy subjects, serum levels were determined of angiotensin I converting enzyme, immunoglobulins, and of the third and fourth complement components. An increased level of IgG and IgM was found in patients with sarcoidosis, as compared with the control group. High ACE levels were observed in the second and third phase of the disease. A tendency was also observed for simultaneous increase of IgG and ACE levels in patients with sarcoidosis.


[Degree of ventilation disturbances in persons with occupational exposure to manganese].

In workers chronically exposed to manganese who showed spirometric abnormalities, an evaluation was done of the degree of ventilation disturbances in relation to age, duration of work, cigarette smoking, and the presence of chronic bronchitis. It was shown that of greatest influence on the loss of ventilation efficacy was cigarette smoking, and, in a lower degree, age. Chronic bronchitis however, caused no greater impairment of ventilation efficacy. Duration of work remained almost without influence on the degree of ventilation impairment.


[Analysis of congenital malformations in newborns].

We analyzed data from 194 newborns with congenital malformations of central nervous, cardiovascular, gastro-intestinal, skeletal, genito-urinary systems and Down's syndrome. We detected that the highest frequency of congenital malformations occurred from may 1986 to december 1986. Congenital malformations were detected more frequently in female newborns and newborns delivered by multipara. The percentage of CNS malformations was constant but at the same time the number of other malformations were significantly changed. We made an attempt of statistical analysis of frequency and type of malformations taking into consideration possible influence of radiation during analyzed period.


[The role of clinical examination in early diagnosis of testicular malignancies].

Sixty-seven patients were subjected to a retrospective analysis, who had been referred to the Department of Urology with suspected testicular malignancy. In every patient history was taken carefully with special attention paid to lacking testicular descensus in the past, testicular enlargement, pain, symptoms related to metastases, duration of symptoms until the beginning of appropriate treatment, the type of treatment, they had obtained before admission to the department. It was found that the most common symptom was painless testicular enlargement (82% of patients). However, there was a very long time between noting of the change by the patient and the beginning of appropriate treatment (on the average about 7.8 months).


[Crohn's disease with a severe course in a 12-year old girl].

A case is described of severe course of Crohn's disease in a 12-year-old girl. Discussing the period of three years of clinical observation, diagnostic and therapeutic difficulties are presented.


[Cystic lymphangioma of the supraclavicular and right axillary fossae].

Five years ago, in a 34-year-old female patient a tumour developed in the right supraclavicular fossa which gradually increased in size. A few months ago she had noticed also a tumour in the axillary fossa on the same side. On physical examination, USG, and contrast X-ray it was found that it was a cyst of hour-glass shape (narrowing of retro-clavicular). The cyst was removed totally. Histological examination: cystic lymphangioma (hygroma). The aetiology, diagnosis, and treatment of this type of tumours are discussed.


[Usefulness of Dallop fascia prosthesis for the closure of recurrent inguinal hernia from intraperitoneal access].

Two patients are presented with recurrent inguinal hernias. In view of excessive tissue damage hernial sac adhesions and extensive scar, both hernias were closed from intraperitoneal access, suturing onto the borders of deep inguinal ring doubled leaflets of Dallop fascia. The authors consider this method of hernia closures as recommendable and safe.


[Post-traumatic hepatic abscess in a 5-year old girl].

A case is presented of hepatic abscess probably of post-traumatic in a 5-year-old girl. The child was admitted to the hospital with high fever, decreased well being, abdominal pain, and vomiting. A preliminary diagnosis was made of septicaemia of unknown origin. During many days of observation the serous general condition with evidence of generalized infection persisted in spite of intensive antibiotic treatment. The correct diagnosis was made only after several USG examinations and completion of history data. A surgical operation with external drainage of the hepatic abscess resulted in complete cure.


[Giant cystic kidney as the cause of mechanical ileus].

A rare case is presented of mechanical ileus caused by a giant cystic kidney. With absent symptoms from the urinary tract, the patient was operated on in emergency situation, and the diagnosis of polycystic renal degeneration in a 64-year-old female patient was made during the operation. The fact is worth stressing of sure imposition in the X-ray image of the signs of ileus and of presence of fluid within numerous renal cysts, and in case of lacking other signs this may lead to diagnostic errors.


[Crural amputation in the course of systemic lupus erythematosis].

A case is presented of a 22-year-old woman in whom, in the course of unrecognised systemic lupus erythematosus, spontaneous abortion, thrombosis of the femoral artery, and inflammatory changes of the crural vessels developed. The administered treatment with steroids failed to prevent crural amputation.


[A case of Phalen-Dickson syndrome].

A case of dysplastic spondylolisthesis with a complete slipping of the L5 vertebrae accompanied by neurological disorders and characteristic contracture of hamstrings (Tight Hamstrings Syndrome) has been described. This disease entity, described in literature, has a name of Phalen-Dickson Syndrome. Neurological disorders were caused by compression of radices at the level of the slipping. Surgical treatment were: laminectomy of the arcus of L5, decompression of the compressed radices with postero-lateral fusion of the L5-S1 segment without reduction of the slipping. The final, functional and radiological results were good.


[Remarks on iodination of dietary salt in the province of Wrocław].

A review is presented of KJ content in edible salt in the years 1975-1991. Salt samples were taken for study from shops and mass catering institutions in the Province of Wrocław--a region of endemic struma. The content of KJ in salt was very low--on the average less than 10 mg/kg and very varied--from zero to over 100 mg/kg.


Upper extremity revascularization. Axillary-brachial bypass for temporal arteritis.

The perioperative nurse must understand the temporal arteritis disease process and surgical procedure so that he or she may function as an integral member of the surgical team. Preoperative, intraoperative, and postoperative nursing interventions are important and necessary to provide holistic patient care.


Thought and talk. The intrapersonal component of human communication.

The intrapersonal component of human communication, self-talk, influences what we say and how we respond to another in interpersonal dialogues. A model of communication that incorporates the notion of self-talk, both that of the speaker and that of the listener, is useful in assisting nurses in making more realistic appraisals of communication interactions and addressing problems in communication failures.


Ambulatory blood pressure monitoring. A tool for more comprehensive assessment.

To investigate the usefulness of more comprehensive blood pressure measurements, made during daily life, in the diagnosis and treatment of hypertension. A blood pressure screening was carried out in middle-aged men and women in Kävlinge, a municipality in southern Sweden. Subjects were classified according to Swedish standard criteria. Ambulatory blood pressure (amb-BP) was recorded in a random sample of normotensives and borderline hypertensives as well as in all the untreated hypertensives identified at screening and willing to participate. A subgroup of borderline hypertensives also carried out self-measurements of blood pressure (self-BP) both at work and at home. The blood pressure lowering efficacy of atenolol 50 mg o.d. and enalapril 20 mg o.d. was compared in hypertensives at rest, during 24 hours, and during dynamic and isometric exercise. The efficacy of enalapril and lisinopril (two ACE inhibitors with different durations of action) were also compared, with special focus on the early morning hours. Men and women classified as normotensives clearly differed from those with hypertension, also when blood pressure was recorded with ambulatory technique. The number of correctly classified subjects did not differ between self-BP and office-BP; combining the two added little. Atenolol reduced blood pressure better during dynamic exercise than did enalapril, while there was no significant difference in effect between enalapril and lisinopril, not even 18-24 hours post-dose. More comprehensive blood pressure measurements should be considered in the evaluation of hypertension treatment. Office BP, however, seems a reasonably good tool for diagnosing hypertension.


Structural cardiovascular changes in essential hypertension. Studies on the effect of antihypertensive therapy.

These studies were undertaken to evaluate different manifestations of structural cardiovascular changes and the effects of antihypertensive therapy in essential hypertension. A meta-analysis of 109 studies that had examined the effect of different pharmacological blood pressure lowering regimens on left ventricular structure, examined by echocardiography, was undertaken to increase the statistical power, to resolve uncertainty and to improve the accuracy of estimation of the magnitude of effect. Strict preset criteria were applied. The effect of different drugs in monotherapy and in particular first line antihypertensive therapies were compared, using an analysis of covariance (ANCOVA). ACE-inhibitors, beta-blockers and calcium antagonists all reduced left ventricular mass (LVM) through a reduction in wall hypertrophy, the effect being most pronounced with ACE-inhibitors. Conversely, diuretics reduced LVM mainly through a reduction of left ventricular volume. Previously untreated males (n = 28, 86 kg, 46 years, 27 kg/m2) with non-malignant essential hypertension (supine diastolic blood pressure (DBP) > 95 mmHg 3-4 times (in triplicate) on placebo) were randomized to long-term double-blind treatment with enalapril (E) or hydrochlorothiazide (H). There were no significant differences between the groups at baseline. Vascular alterations in the retina (eyeground photo, refined grading), cardiac morphology (M-mode echocardiography, ASE), structural vascular changes of the hand (plethysmography, minimal resistance (Rmin)), total peripheral resistance ((TPR), calculated from dye-dilution) and blood pressure (intraarterial) were significantly interrelated at baseline except LVM and Rmin. After 6 months of therapy, E reduced the signs of vascular changes in the retina as well as Rmin in the hand circulation, while H did not change or increased these structural vascular changes. The blood pressure lowering effect of E (mainly through lowering of TPR) tended to be more pronounced, measured both intraarterially and indirectly, than that seen with H (mainly through lowering of cardiac output), however, there were no significant differences. LVM decreased progressively with E while the effect of H was non-significant. E reduced wall thickness but not left ventricular diameter and also improved left ventricular distensibility significantly. The effect on cardiac morphology was significantly different between therapies when taking change in blood pressure into account. After the longest follow-up on monotherapy (18 months) E had reduced LVM by 2.7 g/mmHg and H (14 months) by 1.3 g/mmHg (significant for E only). In univariate analysis the changes in cardiovascular structure were significantly related to the changes in the Renin-Angiotensin-Aldosterone System (RAAS).(ABSTRACT TRUNCATED AT 400 WORDS)


Menopause and hyperlipidemia: pravastatin lowers lipid levels without decreasing endogenous estrogens.

In study 1, serum lipid and estrogen levels were determined in 30 women (aged 40 to > 60 years). Total cholesterol (TC) levels increased significantly with age, but no significant association was found between TC levels and menopausal status. Hypercholesterolemia (TC > 220 mg/dl) was identified in 10 women and hypertriglyceridemia (> 150 mg/dl) in 5 women. Among women not receiving estrogen replacement therapy, a significant negative correlation was found between TC levels and estradiol-17 beta levels. In study 2, serum lipid and estrogen levels were determined in 74 women; 12 of the 74 were receiving conjugated estrogen for the treatment of the menopausal syndrome and 21 hyperlipidemic women were receiving pravastatin (2.5 to 30 mg daily). Among postmenopausal women, high-density lipoprotein cholesterol levels were significantly higher and low-density lipoprotein (LDL) cholesterol levels significantly lower in the estrogen-treated than untreated women. Serum TC and LDL cholesterol levels were significantly reduced during pravastatin treatment. Levels of endogenous estrogens (estradiol-17 beta, estrone, and estrone sulfate) were not significantly affected by pravastatin treatment. The results indicate that pravastatin can be used to reduce hyperlipidemia in menopausal women without affecting endogenous estrogen levels.


[Minimal inhibitory and bactericidal concentrations of some antiseptics and disinfectants against strains of hospital origin].

The MIC in solid media and the B.M.C. by the dilution-neutralization test using sterile water, was determined using 10 antiseptics and disinfectants with 70 strains of 10 species of Gram negative bacteria more frequently causing nosocomial infections in Ciudad Sanitaria Reina Sofía, Córdoba, in Spain. Relationship between the two tests was searched with no positive results. The more effective antiseptics were silver nitrate and chlorhexidine, the less active was phenol. Activity of some antiseptics was similar at 30 or 60 minutes of contact with the microorganisms.


Neonatal septicaemia due to K. pneumoniae. Septicaemia due to Klebsiella pneumoniae in newborn infants. Nosocomial outbreak in an intensive care unit.

The authors report a nosocomial infection outbreak by Klebsiella pneumoniae, observed in neonates at a gyneco-obstetrical hospital from Mexico City. Forty six newborns presented one or more infections due to K. pneumoniae during their stay in neonatal care units, between October 3 and November 12, 1988. Sepsis was documented in 41 cases by clinical picture and routine laboratory exams, including one positive, blood culture at least. The most frequent invasive procedures practiced in these patients were catheterization and ventilatory support. K. pneumoniae was isolated as well from several environmental sources that could have led to infection of patients. Treatment of cases was initiated with ampicillin-amikacin, however, therapeutic failure with a lethality rate of 50% (14/28) and results of antimicrobial susceptibility conducted to treatment with cefotaxime. Fifteen out of 19 patients receiving the cephalosporin survived. To prevent outbreaks like the one presented here, we concluded that appropriate measures dealing with hygiene and education of personnel plus monitoring of bacterial susceptibility to antimicrobials, should prove successful in our environment.


[Preparation and use of fish fillet infusion as a basic medium for culturing bacteria].

The authors present the first results on the utilization of fish infusion (IFP) as a basic medium for the cultivation of bacteria. The infusion was obtained from a common marine fish, corvina (Micropogonias furnieri) according to the technique used in the preparation of beef infusion broth. Streptococcus pyogenes, S. pneumoniae, Neisseria meningitidis, Campylobacter jejuni, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, Pseudomonas aeruginosa, Staphylococcus aureus and Bacillus subtilis were cultured in liquid and solid media prepared with IFP as well as in recommended standard media. Solid media used for cultivation of S. pyogenes, S. pneumoniae, N. meningitidis and C. jejuni were supplemented with 5% of defibrinated sheep blood and for the latter, substances recommended to increase aerotolerance were included in solid and liquid media. All of these strains grew on the media prepared with IFP except S. pneumoniae when cultured in IFP diluted 1:2 with a sodium chloride solution. Only S. pyogenes produced colonies smaller than those of the standard medium. No more differences were detect in the observation of colony morphology. The growth of E. coli, K. pneumoniae, S. marcescens, P. aeruginosa, S. aureus and B. subtilis was measured in liquid media after 8 hours. In solid media, the growth index was expressed by dividing the number of colonies produced in IFP-agar and Nutriente Agar by the number of colonies on Trypticase soy agar plates. Some differences were observed in colonial size and morphology when compared with those generated in standard media. The average value obtained from the analyses of total proteins by biuret reaction in twelve batches of IFP was 5.03 mg/ml. The experiments showed that culture media prepared with IFP supported the growth of bacterial strains used in this work. It suggests that fish infusion has promising conditions of being an alternative substrate for cultural purposes.


[Envelope and membrane glycoproteins of Herpes simplex virus].

A bibliographic update on the herpes simplex virus (HSV) envelope is made with special emphasis on the membrane glycoproteins and their role in adsorption, spreading and escape of the immune response. The HSV has at least seven glycoproteins on its envelope; three out of them are essential for in vitro replication, they are designated as gB, gD and gH; four are dispensable: gC, gE, gI and gG. Their main functions are: gC, gB and gD attach the virion to the cell surface, binding to molecules of heparan sulfate on the plasma membrane. Later, the three essential glycoproteins induce fusion of the viral envelope with the plasma membrane, through the gD receptor. To evade the immune response, the HSV has two major mechanisms: gE and gI are Fc receptors of immunoglobulin G; while gC acts as a receptor for the C3b fragment of the third component of complement. Finally, gG and gC have epitopes responsible for the antigenic differences between HSV type 1 and HSV-2. These glycoproteins have several possible applications for the development of a synthetic vaccine, and for treatment of herpetic recurrent disease.


[The oral route: an access port for Trypanosoma cruzi].

Rats and mice were inoculated by oral route with T. cruzi from: 1. Infected mice blood, 2. Experimentally infected triatomines feces, 3. Experimentally infected alive triatomines, and 4. Free cell cultures. Mice showed to be more susceptible to the infection than rats. Mice exhibited to be infected: 30% with blood forms, 85% with triatomines feces, 75% with alive triatomines and 35% with culture forms. Rats exhibited to be infected: 10%, with blood forms, 45% with triatomines feces, 60% with alive triatomines and 25% with culture forms. In both species we observed that metacyclic trypomastigotes originated higher infection percentage than blood and culture forms. With these results we confirm that oral route is a probable way of transmission of T. cruzi and under standardized conditions, it represents a better experimental inoculation route than intraperitoneal route.


[Recognition by immunoelectroblotting of antigens from Taenia solium and its larva].

Golden hamster (Mesocricetus auratus) were infected with cysticerci of Taenia solium. Groups of three were bled and killed weekly up to 15 weeks recording the number of implanted adults in the small intestine. A longitudinal study on the antibody response against adult and larvae Ags was carried out, as well as against Ags of H. nana. By ELISA, antibodies against larvae and adult Ags of T. solium were detected since the first week, showing a peak at 3 and 5 weeks respectively. At 14 weeks antibodies levels were very low, which is the time when the parasite is eliminated. The response against Ags of H. nana was very low and disappeared at 4 weeks. By western blot we found that the infected hamsters can distinguish specific stage Ags both in the adult and larvae of T. solium. After 12 weeks only the adult was recognized, the Ags of H. nana were recognize in western blot only during the first week.


[Interaction of a mixture of epimastigotes and tripomastigotes from a culture of a Mexican isolate of Trypanosoma cruzi with mouse macrophages].

Chagas disease, a cause of important morbo-lethality in Latinamerica, is produced by a protozoan which has a circulating and tissular phase the Trypanosoma cruzi. Adhesion between T. cruzi and phagocytes is the first step in cellular parasitism, which has a central role in pathogenesis. Although there are studies on parasite phagocyte interaction with some strains of T. cruzi, and it is known that biological variation does exist. We now report the first studies with a mexican isolate using a mix of different phases of T. cruzi obtained from acellular culture resembling the natural conditions. Murine macrophages adheres to epimastigotes, transitional trypomastigotes and metacyclic trypomastigotes since the first minutes of observation, progression on cell-cell interaction was demonstrated, there were no differences among parasite faces however, in some cases there was a failed adhesion, this suggest a possible parasite evasion mechanism. These studies limited only to morphologic aspects the adhesion phenomena, should be pursued.


[Presence of antibodies against Toxoplasma gondii in adolescents from the African continent].

It was determined the presence of antibodies anti-T. gondii in young, 13-16 year old, belonging to Republic Arab Saharaui; Popular Republic of Angola; Ethiopia and Republic of Ghana. From a total of 707 sera analyzed, the 71.43% of them showed the presence of specific antibodies. The prevalence of antibodies did not differ significantly (P > 0.05) between males and females in Angola and Republic Arab Saharaui. It was found a significant difference (P < 0.0001) among countries.


Genetic characterization of the mechanism by which certain strains of Escherichia coli survive in high kanamycin concentrations.

By genetic studies, it was tried to find the mechanism by which a bacterial fraction from different isolated clinical cultures resistant to 25 micrograms/ml of kanamycin can grow in media containing 500 micrograms/ml of kanamycin (at a frequency of about 10(-5)). This study was done in six clinical isolates of Escherichia coli resistant to more than three antibiotics. The results from the bacterial fraction (subpopulation) resistant to high concentrations of kanamycin in the level of resistance to aminoglycoside and non-aminoglycoside antibiotics, in the conjugation experiments, and in the percentage of resistant bacteria to 500 micrograms/ml of kanamycin when the subpopulations were subsequently cultivated in the absence of antibiotics suggest that genetic amplification occurred when one of the strains was growing in the presence of 500 micrograms/ml of kanamycin. Moreover, this strain increased its frequency of survival in high kanamycin concentrations when it was transduced by bacteriophage P1, propagated in cultures resistant to 500 micrograms/ml of kanamycin.


[Decrease of spontaneous mutations in Haemophilus influenzae caused by transformation with its own DNA irradiated with near-ultraviolet light].

Transforming DNA containing the streptomycin resistance marker, was irradiated for 8 h with broad near ultraviolet light (325-400 nm) at pH 4.8, and the inactivation kinetics determined. After selection of streptomycin resistant transformants, they were grown until a turbidity of 150-200 Klett units. In these cultures we looked for new markers coming from the irradiated transforming DNA. We looked and found the novobiocin resistance marker and one that conveys to protoporphyrin IX utilization, measured as an increase in the mutation frequency of these markers in the streptomycin resistant population. In other experiments, we found a decline in spontaneous mutation frequency for the same markers in the cells transformed with irradiated DNA. This last finding rises the possibility of alterations on the mutator genes as a result of near ultraviolet irradiation.


Partial characterization of a novel chemotactic factor produced by macrophages.

The production of substances by lymphocytes or macrophages under activation involved in regulating immune responses, has led us to study a new macrophage factor with chemotactic activity for lymphocytes. This factor is produced early in the immune response activation (6 hours, in vitro) by peritoneal exudate adherent cells under stimulation with sheep red blood cells (SRBC) and it induces lymphocyte chemotaxis. We have confirmed this factor is a polypeptide susceptible to proteolytic digestion. Besides, its receptor on T cells requires the presence of glycosylated sites, specially sialic acid. It was determined that such a chemotactic factor was not interleukin-1, a well-characterized mitogenic and chemotactic substance for T lymphocytes.


[Sensitivity and specificity of mouse peritoneal macrophages in the diagnosis of Chlamydia trachomatis infections].

We analyzed the sensitivity and specificity of mouse peritoneal macrophages (MPM) for the diagnosis of infection by Chlamydia trachomatis. Fifty seven samples were studied, 25 of them were from cervix and 32 were from bronchial aspiration, resulting 29 positive by immunofluorescence in McCoy cells and only 16 in MPM. The sensitivity and specificity for MPM were 55% and 96% respectively. We concluded that McCoy cells are the election cells for the diagnosis of Chlamydia infection. However, the MPM can be useful in the recuperation of this microorganism, if no other method is available.


Humoral response to blastospores and mycelium in mice injected with different doses of Candida albicans.

An indirect immunofluorescence assay was carry out to determine the IgM and IgG antibody responses to yeast and mycelial forms of Candida albicans in mice injected with a 5 x 5(5) and 5 x 10(7) live cells suspensions. Prior adsorption of the serum samples with heat-killed blastospores enabled us to follow the specific antimycelial response which were detected considerably later than expected. Slow level of antibodies were obtained within an infection of 5 x 10(5) cell for both antibody classes and for yeast and mycelial forms. When a 5 x 10(7) cell dose was used for inoculation, maximum titers of antibodies to blastospores and mycelium in non-adsorbed sera appeared almost simultaneously (days 15 and 13, respectively). When serum samples from mice infected with the same dose were previously adsorbed with blastospores, the antimycelium antibodies for both types of Igs, were detected delayed during the infection course. In this case the higher titer for IgG appeared on day 33 and on day 23 for IgM. We suggest that the high titer obtained with the blastospore forms for the 5 x 10(7) cell dose may be due to a major immunogenicity of this forms, for to induce an immune response in the host, or that the delay in the antimycelium antibodies detection could be due to that a blastospore form is the predominant in the infection early stages. Implications of this fact for pathogenesis are discussed.


Phagocytic activity of circulating polymorphonuclear leukocytes from patients with carcinoma of the uterine cervix.

Peripheral blood leukocytes and the sera from 10 healthy women and 12 patients with invasive carcinoma of the cervix (stages I to IV), showed no differences in their capacity to inhibit the replication of an invasive strain of Escherichia coli. The serum from only one patient was unable to arrest the bacterial growth. The quantitation of myeloperoxidase in the polymorphonuclear leukocytes from 21 patients (stages I to III) and 11 healthy women showed, however, a lower activity in the group of patients (P = 0.001). Most patients also showed lymphocytopenia, neutrophilia, and eosinophilia but normal counts of total leukocytes.


[Bacteriologic profile of the Andalien estuary (Chile). Count, biomass, and productivity].

Bacterial population, biomass and productivity from the Andalien estuary (Concepción, Chile) were investigated by measuring the viable counts and the total cell population by epifluorescence. There were differences in the viable counts obtained during fall and spring, but not in total counts. The bacterial productivity in the estuary and the nearest sea was increased during the spring, probably due to a larger proportion of metabolic active cells. The results also suggest an increased bacterial activity in the estuary and the nearest sea for the spring time.


[Preparation and evaluation of coagglutination reagents for the identification of Vibrio cholerae 01. Its trial during a cholera outbreak in Minatitlán, Veracruz].

This study was realized in Minatitlán, Veracruz during a cholera outbreak. 169 rectal swabs were taken from hilles and their contacts. They were transfer alkaline peptone water for enrichment to V. cholerae and incubated for 8 hrs to 37 degrees C, 70 were positive for V. cholerae in both techniques. The coagglutination was done with a reagent prepared at the Instituto de Diagnóstico y Referencia Epidemiológicos of México and the culture were also performed in the same Institute. We obtained 100% of sensitivity and specificity of co-agglutination in relation with culture. This results gave the possibility to use this kind or reagents for a rapid presumptive diagnosis of cholera.


Identification of enteropathogens in infantile diarrhea in a study performed in the city of Posadas, Misiones, República Argentina.

The following work informs of the results of isolation, frequency and distribution of enteropathogens in children under five years old, without previous antibiotic treatment, less than seven days with diarrhoea, ambulatory or in Hospital "Dr. Ramón Madariaga" de Posadas, Misiones, República Argentina, from June 1986 to May 1989. From a total of 972 children with diarrhoea, 78% required to be hospitalized. The greatest number of cases were found during spring and summer in children from 1 to 11 months of age. Distribution of the main enteropathogens was: enteropathogenic Escherichia coli (EPEC) (29.4%), parasites (22%), Shigella (16.3%), enterotoxigenic Escherichia coli (ETEC) (14%) and rotavirus (12.9%). Highest incidence of rotavirus was registered in the coldest months and Shigella, ETEC, Salmonella and parasites in the warm months. The group of most affected children were from 1 to 11 months of age, with higher incidence of EPEC, Salmonella and rotavirus, and parasites were found in older children. ETEC and Shigella had no relationship with the age of children. The most frequent association was EPEC with rotavirus. This is the first finding of Salmonella zaiman in humans and of Salmonella hadar in Argentina. Cryptosporidium, etiological agent of serious diarrhoea in the immunocompetent, was isolated in 3.9% of our cases.


[Characterization of a substance which protects Klebsiella pneumoniae from the bactericidal effect of normal human serum].

Chemical composition of a substance produced by Klebsiella pneumoniae which is accumulated in chemically defined medium was determined. This substance (the protective factor) protects the bacterium from being killed by normal human serum. Protective factor was treated with DNase, lysozyme and an alkaline protease. The two former enzymes did not affect the protective factor. On the other hand, when alkaline protease was used, the protective activity was totally lost. Results showed that the protective factor is a protein.


Tropical oils: nutritional and scientific issues.

Individually and in combination with other oils, the tropical oils impart into manufactured foods functional properties that appeal to consumers. The use of and/or labeling in the ingredient lists give the impression that these oils are used extensively in commercially processed foods. The estimated daily intake of tropical oils by adult males is slightly more than one fourth of a tablespoon (3.8 g), 75% of which consists of saturated fatty acids. Dietary fats containing saturated fatty acids at the beta-position tend to raise plasma total and LDL-cholesterol, which, of course, contribute to atherosclerosis and coronary heart disease. Health professionals express concern that consumers who choose foods containing tropical oils unknowingly increase their intake of saturated fatty acids. The saturated fatty acid-rich tropical oils, coconut oil, hydrogenated coconut oil, and palm kernel oil, raise cholesterol levels; studies demonstrating this effect are often confounded by a developing essential fatty acid deficiency. Palm oil, an essential fatty acid-sufficient tropical oil, raises plasma cholesterol only when an excess of cholesterol is presented in the diet. The failure of palm oil to elevate blood cholesterol as predicted by the regression equations developed by Keys et al. and Hegsted et al. might be due to the dominant alpha-position location of its constituent saturated fatty acids. If so, the substitution of interesterified artificial fats for palm oil in food formulations, a recommendation of some health professionals, has the potential of raising cholesterol levels. A second rationale addresses prospective roles minor constituents of palm oil might play in health maintenance. This rationale is founded on the following observations. Dietary palm oil does not raise plasma cholesterol. Single fat studies suggests that oils richer in polyunsaturated fatty acid content tend to decrease thrombus formation. Anomalously, palm oil differs from other of the more saturated fats in tending to decrease thrombus formation. Finally, in studies comparing palm oil with other fats and oils, experimental carcinogenesis is enhanced both by vegetable oils richer in linoleic acid content and by more highly saturated animal fats. The carotenoid constituents of red palm oil are potent dietary anticarcinogens. A second group of antioxidants, the tocotrienols, are present in both palm olein and red palm oil. These vitamin E-active constituents are potent suppressors of cholesterol biosynthesis; emerging data point to their anticarcinogenic and antithrombotic activities. This review does not support claims that foods containing palm oil have no place in a prudent diet.


[Diagnosis from urine culture in 4 hours using the DIRAMIC-03 system].

The results obtained with DIRAMIC-03 System for its application of detection of urinary infection by utilization of simulated samples and real samples from hospital service, are shown. It was possible to establish a methodology based on conductimetry which perform a diagnostic in four hours with a global effectivity of 86% in relation with the traditional methods.


[Diagnosis of blackleg by direct immunofluorescence in bovine bone marrow].

On smears of marrow-bone death bovines, presumptively diagnostic of black-leg, we have carried out the direct immunofluorescence test (IF). We used two labelled immunosera with fluorescein isothiocyanate. The immunosera wer prepared with the reference strain 5078 of Clostridium chauvoei as following: a) a cellular extract obtained with veronal buffer 0.045 M pH = 8.6, and b) a flagellar suspension obtained by agitation with glass beads, centrifuged at 3,500 x g, and centrifuged again at 16,000 x g during 20 min at 4 degrees C. Both antigenic preparations were injected into rabbits, five doses (0.2, 0.4, 0.8, 1.6 and 3.2 ml) each by i.v. route. Control positive strain of C. chauvoei were used, and control negative strains of C. septicum and C. perfringens were used too. Of all 56 examined samples, 26 (47.5%) gave positive IF test. These results had a 100% of correlation by culture and biochemical identification.


Clinical impact of introducing thrombolytic and aspirin therapy into the management policy of a coronary care unit.

To evaluate the impact of introducing thrombolytic and aspirin therapy into the management policy of a coronary care unit, with particular reference to its effects on the hospital course of nonselected patients with acute myocardial infarction. End points chosen were the utilization of thrombolytic and aspirin therapy, hospital mortality, discharge diuretic requirements, and the incidence of ventricular fibrillation and cardiogenic shock. A total of 336 patients with acute myocardial infarction were studied, comprising consecutive admissions to the coronary care unit over two separate 12-month periods: January to December 1986 (n = 158) and September 1989 to August 1990 (n = 178), before and after thrombolytic and aspirin therapy had been introduced into the management policy of the unit. Thrombolytic and aspirin therapy was given to 87% and 93%, respectively, of all patients in the 1989/1990 cohort. This high treatment rate led to substantial improvements in morbidity and mortality. Thus, comparison of the 1986 and 1989/1990 cohorts showed reductions in hospital mortality (24% to 11%, p less than 0.005), ventricular fibrillation (22% to 13%, p = 0.05), and cardiogenic shock (20% to 6%, p less than 0.001), particularly in patients aged over 60. Reductions in the incidence of lesser degrees of heart failure are reflected in the proportions of patients discharged with diuretic requirements, which declined from 43% in 1986 to 22% in 1989/1990 (p less than 0.001). The duration of hospital stay for patients who survived showed no change between 1986 and 1989/1990, but time spent in the coronary care unit decreased from 3.1 +/- 1.8 to 2.1 +/- 1.4 days (p less than 0.001). The great majority of nonselected patients with acute myocardial infarction are candidates for thrombolytic and aspirin therapy, which can be given safely, leading to profound reductions in mortality and the incidence of major complications, particularly in the older age group.


[Presence of neuraminidase in Rhodnius prolixus infected with Trypanosoma rangeli].

Using three different methods, the activity of neuraminidase was studied in the promesenteron, postmesenteron, rectal ampulla, haemolymph and salivary glands in 600 Rhodnius prolixus experimentally infected with Trypanosoma rangeli stock San Agustín. The haemagglutination method with peanut lectin, and the fluorescence test with peanut lectin conjugated with fluorescein isothiocyanate, and the fluorescence emitted by 4-methylumbelliferone showed in all cases the presence of neuraminidase in the supernatant culture of T. rangeli in Tobie's medium between 8 to 15 days growth. None of the three methods was able to detect the presence of neuraminidase in R. prolixus infected with T. Rangeli, thus suggesting that this enzyme is not produced in vivo, and consecutively is not implicated in the pathogenicity that this trypanosome has to its vector.


Antibacterial activity of some triclosan-containing toothpastes and their ingredients.

The antibacterial activity of 4 triclosan-containing toothpastes was compared to a conventional fluoride dentifrice and triclosan and sodium lauryl sulphate (SLS), both singly and in combination. A panel of 17 bacteria was tested by an agar dilution method. At concentrations typical of those found in toothpastes, triclosan and SLS displayed approximately equal antibacterial activity. A paste containing triclosan and zinc citrate appeared more active than the other triclosan pastes which, in general, showed marginal superiority over the conventional paste. SLS, although included in dentifrice formulations for its detergent properties, may significantly contribute to the antibacterial profile of a product. The need for appropriate controls when evaluating experimental toothpastes is emphasized.


Recognition of Trichinella spiralis muscle larvae antigens by sera from human infected with this parasite and its potential use in diagnosis.

Human antibody response to total soluble extract of Trichinella spiralis muscle larvae (TSE) was analyzed by Western blot. The most frequently recognized antigens had molecular weights of 96, 67, 63, 60, 55 and 47 kDa. An antigenic fraction containing two peptides with M.W. of 43, 47 kDa from the parasite (p43, 47 Ts L1) was isolated by elution from polyacrylamide gel slabs. It was used as antigen in an ELISA test and compared to that of TSE. Serum samples from 51 symptomatic trichinellosis patients--43 with high antibody levels to TSE, 5 of them with positive biopsy and 8 with low levels of these antibodies--as well as 38 from asymptomatic individuals from the area where the trichinellosis outbreaks had occurred and 43 from apparently healthy individuals from a non-endemic area, 37 from patients with intestinal parasitic infections caused by helminth and protozoan parasites--11 from recurrent and 26 from non-recurrent disease--were analyzed by ELISA using both antigens. The ELISA using p43, 47 Ts L1 detected all trichinellosis patients with high antibody levels as well as 6 out of 8 of those with low antibody levels. All control groups were negative. Therefore, this purified fraction allowed the ELISA to be more specific and sensitive for human trichinellosis diagnosis.


Symptomatic lower urinary tract infection induced by cooling of the feet. A controlled experimental trial.

We conducted an open, non-randomized experimental study as a first step to find out whether cooling of the feet may cause symptomatic lower urinary tract infection (UTI) in cystitis-prone women. Twenty-nine healthy women, aged 19-68 (mean 42.5) years, who had had three or more symptomatic episodes of UTI during the previous 12 months were included. They registered symptoms and carried out a strip urinalysis at each urination during a control period of 72 hours. Their lower legs and feet were then immersed in increasingly cold water for 30 minutes. Another 72-hour period of registration followed. Six subjects developed acute distal urinary symptoms at a mean of 55 (95% confidence interval 50 to 61) hours after the cooling, compared with none in the control period. Five of the six had bacteriologically verified lower UTI (P = 0.03 v. the control period). Cooling of the feet seems to provoke symptomatic lower UTI in cystitis-prone women.


Canine distemper virus transcripts sequenced from pagetic bone.

Paget's disease is a chronic disease of the skeleton which is believed to be caused by a persistent virus of the paramyxovirus family. There is still conflict as to the precise identity of the virus(es) involved in causing this disease. Our previous results using in situ hybridisation have implicated distemper as a possible cause of this disease. In order to confirm these results, we have reverse transcribed RNA from pagetic bone and have specifically amplified for distemper and measles sequences using the polymerase chain reaction (PCR) technique. We have found that 8/13 of the patients examined had distemper and 1/10 cases had measles nucleic acids sequestered within their bone cells. One individual was found to have both viruses sequestered in his bone cells. Dideoxy sequencing of the distemper virus PCR products revealed 2% base pair changes in the nucleic acid sequences relative to the Onderstpoort strain of canine distemper. We can conclude that in Paget's disease, canine distemper and possible other paramyxoviruses reside in bone cells and that the persistent nature of the virus may be due to mutations in the viral genome.


Vegetable oil fortified feeds in the nutrition of very low birthweight babies.

Two kinds of oils (i) Polyunsaturated fatty acids (PUFA) rich Safflower oil, and (ii) Medium chain triglyceride (MCT) rich Coconut oil were added to the feeds of 46 very low birthweight (VLBW) babies to see if such a supplementation is capable of enhancing their weight gain. Twenty two well matched babies who received no fortification served as controls. The oil fortification raised the energy density of the feeds from approximately 67 kcal/dl to 79 kcal/dl. Feed volumes were restricted to a maximum of 200 ml/kg/day. The mean weight gain was highest and significantly higher than the controls in the Coconut oil group (19.47 +/- 8.67 g/day or 13.91 g/day). Increase in the triceps skinfold thickness and serum triglycerides were also correspondingly higher in this group. The lead in the weight gain in this group continued in the follow up period (corrected age 3 months). As against this, higher weight gain in Safflower oil group (13.26 +/- 6.58 g/day) as compared to the controls (11.59 +/- 5.33 g/day), failed to reach statistically significant proportions, probably because of increased statistically significant proportions, probably because of increased steatorrhea (stool fat 4+ in 50% of the samples tested). The differences in the two oil groups are presumably because of better absorption of MCT rich coconut oil. However, individual variations in weight gain amongst the babies were wide so that some control babies had higher growth rates than oil fortified ones. The technique of oil fortification is fraught with dangers of intolerance, contamination and aspiration. Long term effects of such supplementation are largely unknown.(ABSTRACT TRUNCATED AT 250 WORDS)


Hemodynamics of the male fat distribution pattern.

A male fat distribution pattern with abdominal obesity increases the risk for hypertension and cardiovascular disease, and is closely linked to a number of metabolic aberrations including insulin resistance. Recent observations suggest that changes in the peripheral vasculature may be of pathophysiological importance for the development of hypertension and its associated metabolic disturbances. We therefore investigated the hemodynamic correlates of abdominal obesity. A central fat distribution was found to be associated with a specific hemodynamic profile, characterized by elevated total peripheral resistance and lower cardiac output. In response to sympathoadrenal activation during mental stress, the normal cardiac output-dependent pressor response was reversed into a systemic vasoconstrictor response. There was a direct relationship between degree of abdominal obesity (expressed as waist-hip ratio) and fasting serum insulin. Furthermore, the stress-induced increase in total peripheral resistance correlated positively with fasting serum insulin concentration, whereas there was an inverse relation between serum insulin and cardiac output and heart rate. In a second study, the circulatory responses to stress during physiological hyperinsulinemia were investigated. During hyperglycemic hyperinsulinemia the central hemodynamic response to stress was changed into a systemic vasoconstrictor response. In the forearm the physiological vasodilation during stress was markedly attenuated, suggesting that insulin may have peripheral vascular effects. In conclusion, central obesity is associated with a specific hemodynamic pattern characterized by higher total peripheral resistance and lower cardiac output, and a vasoconstrictor response to psychosocial stress. This hemodynamic response pattern may be related to insulin metabolism.


Cholesterol reduction in single and multifactor randomized trials: relationship to CHD incidence and total mortality as found by meta analysis of twenty-two trials.

This paper reports on a meta analysis in twenty-two randomized both single and multifactor trials regarding the effect of designed cholesterol reduction on total mortality and CHD incidence. Per cent reduction in CHD incidence was 2.5 for every per cent associated net reduction in total cholesterol, but was only 0.74% for total mortality. Since total net reduction in cholesterol was about 5% in all trials combined, the number of participants was far too small to demonstrate a significant expected reduction of 4% in total mortality. However, the 4% reduction lies just outside the observed 95% confidence limits of the overall estimate of effect on total mortality (OR = 1.02; CL 0.97, 1.07). It is concluded that cholesterol reduction must be much larger than 5% to be able to reduce the relative risk of CHD substantially and total mortality moderately.


High cholesterol and triglyceride values in Swedish males and females: increased risk of fatal myocardial infarction. First report from the AMORIS (Apolipoprotein related MOrtality RISk) study.

In over 300,000 Swedish males and females aged 20 to 79 years total cholesterol and triglycerides were measured consecutively between 1985 and 1989. In a subsample of about 35,000 individuals apolipoprotein (apo) B (indicating atherogenic) and apo A-I (anti-atherogenic) were also measured. In the age group 40-49 years, 24% of the males and 12% of the females had hypercholesterolemia (> or = 6.5 mmol/L) and 14% and 3%, respectively had hypertriglyceridemia (> or = 2.3 mmol/L). Combined hyperlipidemia occurred in this age group in 7% of the males and in 1% of the females and was more common in males. In the same age group, 21% of the males and 8% of the females had high atherogenic apo B values (> 1.5 g/L). Low apo A-I was found in the whole population (20-79 years) in 13% of the males and in 10% of the females and varied only little with age. In the AMORIS (Apolipoprotein related MOrtality RISk) study these individuals are followed prospectively. The relations between lipids and apo B and apo A-I levels and risk for fatal acute myocardial infarction (AMI) are analyzed to investigate which of these lipids/apolipoproteins best predict AMI either as single determinants or in combination. After a mean observation time of about 22 months there is a 3-6-fold increase in AMI in relation to increasing cholesterol levels in males of 40-59 years. The largest increase was seen in the 40-49-year age group. A similar relationship was also found for triglycerides and AMI.(ABSTRACT TRUNCATED AT 250 WORDS)


The key issues in preventive cardiology.

A number of risk factors/indicators for cardiovascular disease, mainly stroke and coronary artery disease, have been established. Most powerful among the traditional risk factors are hypertension, cigarette smoking and elevated serum cholesterol. All three can successfully be modified by therapeutic intervention, which in turn will result in reduced risks. In recent years several novel risk indicators have been identified. The most powerful of these appears to be increased left ventricular mass, particularly when diagnosed with echocardiographic technique. Again, it is possible to reduce this risk factor, for instance by antihypertensive therapy, but the independent risk reduction attributable to this manoeuvre remains to be determined. Other novel risk indicators are male type adipose distribution, reduced insulin sensitivity and a number of newly detected lipoprotein fractions. At present little is known about the value of intervention against these factors in terms of risk reduction. It can be concluded that a structured concerted effort at reducing established risk factors such as arterial hypertension, elevated serum cholesterol and cigarette smoking is desirable for forming the basis of preventive strategies in cardiology. As regards some of the novel risk indicators, some of which appear more powerful than the old established ones, further research is needed before a clear opinion can be formulated regarding the value of intervention.


Ca(2+)-induced persistent protein kinase C activation in rat hippocampal homogenates.

Protein kinase C (PKC) is thought to play an important role in neuronal function by mediating changes in synaptic strength. Specifically, it has been argued that persistent PKC activation underlies the maintenance of long-term potentiation (LTP) of synaptic transmission in the hippocampus, a model widely used to study mammalian learning and memory. Because the induction of LTP is known to be dependent upon Ca2+ influx into the postsynaptic neuron, we investigated Ca(2+)-dependent mechanisms that operate to elicit persistent PKC activation in the hippocampus. Hippocampal homogenates were incubated with Ca2+ for a brief period and subsequently assayed for persistent changes in basal (Ca(2+)-independent) PKC activity, using the selective PKC substrate neurogranin(28-43) (NG(28-43)). After Ca2+ incubation, basal PKC phosphorylation of NG(28-43) was increased and expression of the increased activity could be inhibited by PKC(19-36), a selective peptide inhibitor of PKC. These data indicate the presence of a persistently activated form of PKC in Ca(2+)-pretreated hippocampal homogenates. The persistently activated PKC was localized to the soluble fraction of homogenates. Generation of the soluble, persistently activated form of PKC was blocked by the calpain inhibitor, leupeptin, suggesting a proteolytic activation of PKC. Column chromatography and Western blots indicated the presence of PKM, a proteolytic fragment of PKC that is active in the absence of calcium, diacylglycerols, or phospholipid cofactors. Thus, Ca2+ induces proteolytic activation of PKC in hippocampal homogenates. This suggests that proteolytic activation is a plausible candidate as a mechanism underlying the persistent activation of PKC associated with LTP.


Selection of cDNAs for phosphodiesterases that hydrolyze guanosine 3';5'-monophosphate in Escherichia coli.

A genetic selection procedure has been developed which makes the growth of E. coli dependent on expression of a cGMP phosphodiesterase cDNA. E. coli does not contain a cGMP phosphodiesterase, and guanine auxotrophs cannot extract the guanine from cGMP. If a functional cGMP phosphodiesterase is introduced, then guaA auxotrophs will grow on cGMP as a guanine source. The method also selects GMP synthetase cDNAs, which complement the guanine auxotrophy directly. Expression of a Dictyostelium discoideum or human heart cyclic nucleotide phosphodiesterase cDNA permits growth of the E. coli guaA auxotroph in the presence of cGMP. Several commercial cDNA libraries were corrupt and contained phosphodiesterase and/or GMP synthetase sequences that were from a contaminating DNA source.


Effect of parathyroid hormone on rat renal calcium/calmodulin-dependent protein kinase II.

Rat parathyroid hormone (PTH) stimulates cAMP-dependent protein kinase and protein kinase C activity in the kidney. However, PTH increases intracellular Calcium in primary cultures of proximal tubular cells. We have investigated the possibility that PTH also stimulates Calcium/calmodulin-dependent protein kinase II (CaM kinase II). We have employed the tandem chromatographic column method, using synthetic peptide as a substrate, to measure the renal CaM kinase II activity. PTH (250 nM) stimulated CaM kinase II activity by about 50% after 15 sec., and activity returned to baseline by 2 min. Calmodulin antagonists significantly impaired the stimulatory action of PTH whereas basal levels of CaM kinase II activity were relatively unaffected. This study demonstrates that PTH does activate CaM kinase II in renal tissue, and suggests another pathway for the actions of PTH in the kidney.


Pronounced differences between native Chinese and Swedish populations in the polymorphic hydroxylations of debrisoquin and S-mephenytoin.

The frequency of poor metabolizers of debrisoquin was low and similar in four different native Chinese nationalities. In a total sample of 695 Chinese subjects, only seven (1.01%) had a urinary ratio between debrisoquin and 4-hydroxydebrisoquin greater than 12.6, which is the antimode between poor metabolizers and extensive metabolizers in white populations. This is significantly lower than the 6.82% found in 1011 white Swedish healthy subjects (p less than 0.0001). Admixture analysis indicated the occurrence of two distributions within extensive metabolizers among both Chinese and white subjects. The mean of the distribution of metabolic ratios among Chinese extensive metabolizers was shifted toward higher values compared with Swedish extensive metabolizers (p less than 0.01). The frequency of poor metabolizers of S-mephenytoin was higher in 137 Chinese (14.6%) than in 488 Swedish (3.3%) subjects (p less than 0.0001). Our findings imply that drugs metabolized by these two polymorphic hydroxylases should be prescribed in different dosages to Chinese and white subjects.


Phospholamban-modulated Ca2+ transport in cardiac and slow twitch skeletal muscle sarcoplasmic reticulum.

The correlation between phospholamban and sarcoplasmic reticulum Ca(2+)-transporting ATPase levels and the magnitude of phospholamban-mediated stimulation of sarcoplasmic reticulum Ca2+ transport was examined in microsomes prepared from rabbit and canine cardiac, slow twitch and fast twitch skeletal muscle. Phospholamban was absent from microsomes prepared from fast twitch skeletal muscle but present at comparable levels in microsomes prepared from cardiac and slow twitch skeletal muscle. Levels of Ca(2+)-transporting ATPase were higher in microsomes prepared from slow twitch skeletal muscle than in microsomes prepared from cardiac muscle, however, and ratios of phospholamban to Ca(2+)-transporting ATPase were several fold greater in microsomes prepared from cardiac muscle than in microsomes prepared from slow twitch skeletal muscle. Stimulation of ATP-dependent Ca2+ transport following phosphorylation of phospholamban by cAMP-dependent protein kinase or incubation with anti-phospholamban monoclonal antibody was observed only in cardiac muscle microsomes. These observations indicate that phospholamban, while present in both cardiac and slow twitch skeletal muscle, may be involved in the hormonal regulation of sarcoplasmic reticulum Ca2+ transport only in the former, and that the lack of phospholamban-mediated stimulation of Ca2+ transport in slow twitch skeletal muscle sarcoplasmic reticulum may result from the lower ratio of phospholamban to Ca(2+)-transporting ATPase in this tissue.


Lipopolysaccharide stimulates phosphorylation of eukaryotic initiation factor-4F in macrophages and tumor necrosis factor participates in this event.

Bacterial lipopolysaccharide (LPS) produces rapid changes in macrophage protein synthesis and function. Phosphorylation of the 25 kDa mRNA cap-binding protein (eIF-4E) in model systems regulates the efficiency of protein synthesis. We report that both LPS and tumor necrosis factor-alpha (TNF-alpha) stimulate phosphorylation of eIF-4E and the p220 component of eIF-4F in bone marrow-derived macrophages. Moreover, anti-TNF-alpha antibodies inhibit LPS-stimulated phosphorylation of eIF-4E and p220 by 43% (+/- 6%) and 50% (+/- 5%), respectively. Our results indicate that LPS stimulates eIF-4F phosphorylation by a TNF-alpha-dependent mechanism, and suggest that phosphorylation of eIF-4F might play a role in the post-transcriptional regulation of gene expression in macrophages exposed to LPS.


Activation of G-proteins induces Ca2+ oscillations with hyperpolarizing K+ currents in pancreatic beta-cells.

Activation of G-proteins by internal perfusion with GTP-gamma-S or external application of carbachol resulted in oscillations of cytoplasmic Ca2+ in isolated mouse pancreatic beta-cells. The Ca2+ transients were associated with the generation of K+ currents sufficiently pronounced to induce marked pulses of hyperpolarization. The oscillatory G-protein response remained largely unaffected when altering the membrane potential. The oscillations became less frequent in the presence of 1 mM neomycin and disappeared when the cells were internally perfused with 100 micrograms/ml heparin. The frequency of the oscillations was positively correlated with the basal level of cytoplasmic Ca2+. Addition of Ca2+ to the internal perfusion medium increased the oscillatory rate and buffering of the ion with Indo-1 or EGTA had the opposite effect. It is concluded that G-protein activation results in cyclic mobilisation of intracellular calcium mediated by inositol-1,4,5-triphosphate and that the basal concentration of cytoplasmic Ca2+ is an important determinant for the frequency of the oscillations.


[Cyclophosphamide--an effective immunomodulator in treating inflammatory rheumatism and severe collagenoses].

After 30 years since the synthesis of cyclophosphamide and 25 years since its first clinical utilization (V.Ciobanu), authors offer an actualized review of the data of pharmacokinetics, pharmacodynamics, pathopharmacology and clinical therapeutics, which make of cyclophosphamide an efficacious, manageable and safe drug in the treatment of the aggressive forms of collagenoses or inflammatory rheumatism. The criteria of therapeutic indication and clinical surveillance are mentioned.


Heterogeneity of hepatic protein tyrosine phosphatases.

We have identified multiple members of the protein tyrosine phosphatase family in three subcellular compartments from rat liver; membrane, cytoskeleton and cytosol. Characterization based on substrate specificity, size, and reactivity with an anti-peptide antiserum against human placental PTP1B indicate the presence of at least three PTPases in Triton X-100 extracts of particulate membranes. Of these, one of 600 kDa possesses characteristics of a transmembrane, receptor-like enzyme. A fourth particulate PTPase (70 kDa) represents a distinct cytoskeletal PTPase. Cytosol contains one main PTPase species which was detected as a 41 kDa protein in Western immunoblots. These data indicate the existence of multiple hepatic PTPases whose differences in structure and subcellular localization may reflect functional heterogeneity.


[Epidemiologic examinations of goiter in the population of the Sejny community].

The study was aimed at the evaluation of incidence of goiter in the population of the community of Sejny. The survey comprising 1520 subjects revealed the presence of thyroid enlargement in 31.8% of the subjects studied, indicating the occurrence of a mild endemy. The facts speaking for this type of endemy are: predominance of cases with goiter of OB or I degree (83%), higher incidence of goiter in women than in men (3.3 times), occurrence of nodular goiter in 12% of cases with goiter, and sporadic appearance of hypothyroidism. Goiter endemy in the population of this area can be attributed to such goitrogenic factors as low level of iodine and high content of calcium in the water, tobacco smoking, and a habit of drinking tap water.


[Epidemiology of thyroid diseases in the population of the Sejny community after the atomic catastrophe in Chernobyl].

The survey carried out in 1990 covering the population of Sejny community, sponsored by the Ministry of Health and Welfare, program MZXVII, demonstrated the occurrence of goiter in 33.6% of studied persons. Such an incidence can rightly be recognized as an endemy. Predominance of cases with small or moderate enlargement of the thyroid (OB and I), low percentage of nodules (18%), and 2.8 times more frequent occurrence of goiter in women allows o characterize the endemy as mild. The percentage of goiter in this population does not differ from that found in this area before the Chernobyl disaster. However a small increase in the incidence of thyroid enlargement in a group of boys of age between 17 and 19 years, and an increase in percentage of nodular goiter in whole population was noted. The questionnaire studies confirmed in addition a high effectiveness of mass iodine prophylaxis introduced after the atomic disaster, especially in the population of developmental age. However, because of the latency period concerning the possible effects, the results obtained will be verified in the course of long-term prospective studies.


[Relationship between thyroid size and urinary concentration of iodine in the population of Bialystok].

The survey carried out in May 1991 in the city of Białystok comprised 308 children of age between 8 and 14 years and 116 young adults. In each of the studied subjects the size of the thyroid was measured by ultrasonography and iodine concentration determined in a randomly voided sample of urine. Body weight and height of the subjects have also been measured. In about 50% of the subjects studied (58.4% of children, 38.5% of men and 58.4% of women) the presence of goiter accompanied by a low urinary iodine concentration (median--2.0 micrograms/ml) was found. A significant negative correlation between the thyroid size and urinary iodine concentration, and lack of relation between the former and TSH concentration, have been found. No relation was observed between the presence of goiter and the inadequate physical development in the children studied. Insignificantly elevated TSH levels without accompanying clinical symptoms of hypothyreosis were observed in 8.7% of children, 3.8% of women and 5.1% of men studied. Higher prevalence of goiter found as compared to the results previously obtained in the same area can be related on the one to the use of more precise methods and on the other to real worsening of the situation due to discontinuation of obligatory iodine prophylaxis in the country more than 10 years ago.


[Behavior of thyroid autoantibodies in persons inhabiting an endemic goiter area].

The study was aimed at investigating the occurrence of thyroid autoantibodies (ATMA and TGA) in persons inhabiting the area of goiter endemy of mild degree. The survey comprised 1508 persons of age ranging from 3 to 68 years. The subjects studied have been divided into the groups taking into account age, sex, degree of thyroid enlargement (according to WHO, 1974), and the characteristics of the goiter. The occurrence of ATMA or TGA antibodies was demonstrated in 17% of the subjects. An increase in the incidence and titer of thyroid autoantibodies with age was observed. The occurrence of thyroid autoantibodies was observed more frequently in the subjects with parenchymatous goiter. No correlation was found between the incidence of the antibodies and goiter size. Thyroid autoantibodies have also been found in 10% of subjects without goiter. The results obtained do not indicate convincingly the role of the thyroid autoantibodies in the pathogenesis of endemic goiter.


[Ultrasonographic pattern and levels of thyrotropin and antithyroid antibodies in patients with recurrent neutral goiter after subtotal thyroidectomy].

The study comprised 65 women (mean age 43 years) with the recurrent goiter after subtotal strumectomy. All patients were subjected to ultrasonographic examination using a sonograph Sonoline LM (Siemens) with 7.5 MHz head. The study was aimed at: 1) assessment of etiology of goiter recurrence, 2) assessment of changes in the thyroid parenchyma, 3) detection of the occurrence of heterogeneous structures, such as nodules, cysts and calcifications. It was found that goiter recurrence appeared mainly in the patients subjected to surgery because of neutral nodular goiter. The observed changes in the thyroid stump, such as heterogeneous structure of parenchyma, generalized cyst-like spaces and nodular structures mainly of mixed type or of solid, normo-echogenic or hyper-echogenic type, were associated with high levels of THS and the presence of antithyroid antibodies in blood serum. In patients with evidently high TSH levels and positive with respect to occurrence of antithyroid antibodies, the nodular structures were more numerous and of larger size. In can be concluded that ultrasonography provides a valuable noninvasive tool for the evaluation of morphological structure of the recurrent goiter.


[Comparative analysis of fine needle aspiration biopsy results performed in the laboratory of thyroid diseases, University School of Medicine in Lodz in 1985-91 with results of postoperative histopathologic examinations].

From 1985 to 1991 there were 5889 fine-needle aspiration biopsies of thyroid performed in our laboratory. 703 cytological diagnoses based on biopsy specimens taken from 679 patients, were compared with the results of postoperative histopathological examinations. There were 14% non-diagnostic biopsies. The statistical analysis was performed considering difficulties in differentiation between follicular adenomas and follicular carcinomas. Difficulties in evaluation of biopsies of cystic lesions were also considered. The results of cytological and histopathological examinations were agreeing with one another in 88% cases. In regard to diagnosis of malignant neoplasms, the sensitivity of the cytological investigation was equal to 63% and the specificity equaled to 90%. While considering detection of papillary carcinomas, the sensitivity was equal to 67%. Our results are in a compliance with the view, that the fine-needle aspiration biopsy is a useful method in a preoperative diagnosis of thyroid lesions.


[Role of chemotherapy in the treatment of anaplastic thyroid cancer --personal observations].

Results of chemotherapy applied in 23 patients with anaplastic thyroid cancer are presented. Chemotherapy combined with local treatment is a suggested therapy for treatment the locally advanced anaplastic thyroid cancer.


[Monitoring of treatment for hypothyroidism with L-thyroxine].

The study was aimed at the evaluation of treatment of hypothyroidism with L-thyroxine administration monitored by the determination of T3 and T4 concentrations. The investigations were carried out in a group of 57 patients with hypothyroidism including 37 patients with autoimmune etiology of hypothyroidism, 12 patients after strumectomy and 8 patients after treatment with 131J. The administration of L-thyroxine at a dose of 2 micrograms/kg/day effectively eradicated all symptoms of the disease and led to the normalization of blood serum T3 and T4 values in the majority of patients with autoimmune hypothyroidism. So the majority of women required the daily dose of L-thyroxine of 100-150 micrograms, and the majority of men 125-175 micrograms. Lower dosage of L-thyroxine (50-100 micrograms daily) was required to attain euthyroid state in some patients with postoperative or postradiation hypothyroidism. Monitoring of the therapy by the determination of blood serum T3 and T4 concentrations greatly facilitated the proper choice of the therapeutic dose of L-thyroxine as the return of the thyroid hormone concentrations to normal usually brought about the complete remission of symptoms of the disease. The exception from this rule was only in the case of patients with arterial hypertension and coronary disease in whom, because of the side-effects, lower dosage of L-thyroxine (usually 50 micrograms daily) must have been applied to attain the optimal improvement. The treatment with L-thyroxine caused much less side-effects as compared to the therapy using the dessicated thyroid preparations (Thyroideum).


[Method for detection of antitubulin antibodies. Results of assays in autoimmune thyroid diseases].

A cytoskeletal protein--tubulin was isolated from the cerebral tissue by the sequential microtubule polymerization and depolymerization technique described by Schelansky. The purity of the isolated protein was verified by SDS polyacrylamide gel electrophoresis. The binding reaction with monoclonal antibodies against various cytoskeletal proteins confirmed the presence of pure tubulin. The isolated tubulin was used as reactant in a solid phase radioimmunoassay for the detection of antitubulin antibodies in tubulin-coated plastic tubes. Antitubulin antibody assays were performed in 20 cases of hypothyroidism and 56 cases of Graves' disease. In 70 percent of cases of hypothyroidism and 50 percent of cases of Graves' disease the levels of antitubulin autoantibodies were elevated. The highest titres of antibodies had some patients with Graves' disease. The antitubulin autoantibodies were of the IgM class.


[Evaluation of a method for determining ACTH concentration in samples of serum obtained by catheterization of inferior petrosal sinuses in diagnosis of Cushing's disease].

A method consisting in the catheterization of lower petrosal sinuses aimed at obtaining blood samples for the determination of ACTH concentration has been applied in diagnostically difficult cases of Cushing's disease. The appearance of ACTH concentration gradient between the blood originating from the immediate vicinity of pituitary and the peripheral venous blood confirmed the hypophyseal etiology of hypercortisolemia. The gradient of ACTH concentration between the two petrosal sinuses made possible the localization of a microadenoma in the anterior lobe of pituitary. The diagnostic conclusions obtained by the above method have been confirmed during the surgery.


Stimulation of rat pituitary tumoral cell proliferation in vitro by tetra- and pentagastrin.

The effects of the active gastrin fragments, penta- and tetragastrin on the incorporation of tritiated thymidine into the rat pituitary tumoral cells were investigated in vitro. The significant stimulation of 3H-thymidine incorporation was observed as an effect of the investigated substances. The putative role of gastrin as an autocrine growth factor active in pituitary tumorigenesis was discussed.


Premature menarche--a legend or a defined clinical syndrome.

The properness of diagnosing the premature menarche as isolated clinical syndrome is often questioned. A long-term observation od 2 girls with premature menarche has been described. A discussion is presented about the role of imbalance within the hypothalamus-pituitary-gonads axis and the role of disturbances in peripheral responsiveness to sex hormones in the patho-mechanism of premature menarche.


Malignant tumours after renal transplantation.

The incidence of malignant tumours in 570 patients with kidney transplants was examined. It was found to be 20-30 times higher than in the average (normal) population. In accordance with the literature, mainly skin cancers were observed, but at variance with these data, the number of lymphoreticular malignancies was small. On the basis of their study, the authors emphasize the oncogenetic effect of immunosuppression. By comparing the conventional (AZA+PRED) and Cyclosporine (CYA+PRED) treatments, they point out that this risk should be taken into consideration even in Cyclosporine therapy which has otherwise a much more favourable effect.


Laparoscopic appendectomy.

This study contains a brief review of the changes in the technique of laparoscopic appendectomy. The authors' experiences with the methods they applied are reported. The authors emphasize on the benefits of laparoscopic appendectomy as opposed to traditional appendectomy, and advocate its wide-range application.


Follow-up examinations of laparoscopic cholecystectomies.

The postoperative complaints of patients having been subjected to laparoscopic cholecystectomy have been studied. Residual gallstones involving clinical symptoms have not been observed. Right subcostal pain, meteorism, and nausea due to faulty diet showed a slight difference in favour of the laparoscopic method when compared to traditional surgery. The laparoscopic method was qualified as excellent by over 95 per cent of the patients.


Esophageal carcinoma study in 83 cases.

The surgical procedures for carcinoma of oesophagus with and without thoracotomy are compared. Since March 1987: 65 patients who were resectable (78.4%) underwent surgical procedures during a 40 months period. The ratio of male to female was 3 to 2, mostly seen in 6th decade (45%) of life. Tumor site: 6% upper 1/3, 46% middle and 48% lower third. The surgical resection procedures were: 53.8% McKeown and Akiyama et al. 33.9% transhiatal (Orringer) the rest Ivor-Lewis and endoesophageal pullthrough E.E.P.T. /24, 25/. No mortality occurred during operations, but fistula was seen in 20% of cases and the most frequent morbidity was pulmonary complications, which was seen 3 times more in procedures including thoracotomy. Increasing the mortality rate also comparing to just one death (4.6%) in transhiatal method. In 24-62 months follow-up period including 3/4 of the cases, the survival was 33.3% for transhiatal Esophagectomy = THE and 34.4% for other procedures (Transthoracic esophagectomy = TTE).


Influence of bile on the severity of acute experimental pancreatitis induced by closed duodenal loop in rat.

The study was performed to assess the ethiological role of bile in acute pancreatitis provoked by closed duodenal loop in rat. In group I a closed duodenal loop was created by method of Nevalainen. A similar operation was performed in group II, but the common pancreatico-biliary duct was ligated just under the liver. In the control group (group C) only the mobilization of duodenum was performed. After 24 hours the mortality rate was 20% in group I, but 0% in group II and C. The amount of ascitic fluid showed significant elevation in group I versus II and group C, and in group II as compared to group C, too. The serum amylase was significantly higher in group I than group II and group C, and in group II was also higher as compared to group C. Serum total protein differed significantly between all groups, while albumin and total calcium were significantly lower in group I than group II, but group II was only slightly reduced versus group C. Histology showed no differences between groups I and II, but both differed significantly from group C. In conclusion bile seems to be an aggressive factor in pathogenesis of acute pancreatitis induced by closed duodenal loop in rat, but other factors may play more important roles.


The technique of obtaining pancreatic segments in dogs: surgical-anatomical aspects.

The technique of obtaining pancreatic segments was studied in 60 mongrel dogs by removing the right pancreatic lobe. At the same time comparative surgical-anatomical examinations were performed for the detection of the vascular variations of the right pancreatic segment. In 83% of the cases the arterious and venous systems were suitable for gaining grafts (Types I-II). In 12% the segment was suitable for grafting only if the venous network had an optimal course (Type III), while in 5% the segment was unsuitable because it did not have a suturable arterial stump (Type IV).


Intraductal papilloma and papillomatosis.

The benign papillary neoplasms of the breast are still controversial topics in general surgery. There are two forms of the benign papillary lesions, solitary intraductal papilloma and multiple intraductal papilloma. These disorders are very rare and their clinical behaviour is different in each case. In this study, two cases of the multiple intraductal papilloma are presented and clinical findings and surgical therapy are discussed.


Case report of a patient with recurrent fibrosarcoma of the thoracic wall.

A case of a patient with recurrent chest wall fibrosarcoma is presented who had her original tumour removed 12 years earlier. The histology of the primary lesion was missed for a localized fibrous mesothelioma. Author reviews the pathology and management of soft tissue tumours of the thoracic wall.


Effect of truncal vagotomy and pyloroplasty on rat gastric mucosal H,K-ATPase and HCO3-ATPase activities.

The effect of truncal vagotomy and pyloroplasty on rat gastric mucosal H,K-ATPase and HCO3-ATPase activities was studied 15 and 30 days past the operation. A significant decrease in gastric body mucosal H,K-ATPase activity occurred 15 days after vagotomy, compared with pyloroplasty (p < 0.05) and non-operated control rats (p < 0.01). A recovery in the enzyme activity on the 30th postoperative day occurred. Gastric body and antral mucosal HCO3-ATPase activity was significantly (p < 0.01) decreased 15 and 30 days after vagotomy and pyloroplasty, compared with pyloroplasty controls. The observed changes in gastric mucosal H,K-ATPase and HCO3-ATPase activities after vagotomy reflect the decrease in gastric acid secretion, as well as the possible changes in mucosal bicarbonate secretion and acid-base status. A gradual recovery in mucosal H,K-ATPase activity after vagotomy may occur.


Biomechanical aspects of femoral stem anchoring during total hip replacement.

Stem instability is the major cause of complications following total hip replacement. To prevent its onset, the authors based their method on Wolff's law of bone transformation. Of the known prostheses, the straight-stem one fitting best to the shape of medullar cavity was chosen and by its sagittal enlargement in three different sizes a new stem collection was designed. Stems providing the closest fit to the medullar cavity were selected by computer-assisted adjustment to three-directional X-ray pictures. The principle seems to be supported by preliminary results.


The effects of cholelithiasis and cholecystectomy on gastric emptying.

In this clinical study, four groups, each consisting of 12 patients are established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy. 1. group: healthy people, 2. group: patients with dyspeptic cholelithiasis, 3. group: patients who have no dyspepsia after cholecystectomy, 4. group: patients whose dyspepsia is continued after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulfur colloid bound with scrambled eggs. Gastric emptying delayed in second (p < 0.001) and fourth (p < 0.005) groups postprandially and not differed in the third group (p > 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy have a close relation with delay in gastric emptying.


Experimental salvage of the spleen. A combined technique of cryosurgery and tissue sealant.

The goal of this investigation has been to improve the safety of intra- and post-operative haemostasis in splenic lesions by a combined technique of tissue freezing followed by the application of collagen fleece and fibrin glue in an animal study. The progression of healing was observed after different periods of time. Grade II lesions were set on the spleens of 15 pigs. The wounds were frozen for 1 m at -60 degrees C with a cryosurgical probe and afterwards sealed with fibrin glue and collagen fleece. In every case, complete haemostasis was achieved intraoperatively. The spleens of 3 animals each were examined microscopically after 2 days, 1, 2, 5 and 6 weeks, respectively. A visceroperitoneal adhesion was observed in only 1 spleen and u-shaped viscerovisceral adhesions in 5 spleens. Superficial coagulation necroses were observed only in specimens removed after 2 days and 1 week, respectively. Complete and safe haemostasis followed by acceptable subsequent healing was achieved using this combined technique.


Loco-regional renewal of malignant melanomas. I. Local recurrence satellites and in-transit nodes.

183 patients with malignant melanoma treated during the period 1972-1987 were studied for the incidence of loco-regional metastasis. All cases were followed up for 5 years following initial treatment. In the "high risk" groups of patients--the setting being based on well-known prognosticators such as tumour invasion, thickness, clinicopathological type and anatomic site--there were significantly more recurrences (p < 0.01) than in the patients with thin lesions. About 91 per cent of the recurrences--except pure model ones to be discussed in an other paper--were discovered within 30 months following tumour excision. Wide excision in itself had no effect upon frequency and incidence of loco-regional renewal. While local recidivae were sufficiently controlled by simple re-excision, most of the "in-transit" metastases need an additional regional lymph node dissection because of the increased rate of micrometastases in the lymph nodes. Survival and treatment modalities are also discussed.


The "Mannit-Ceftriaxon" preparation for elective colorectal surgery.

Authors report their experiences with evaluating the clinical course of 45 patients undergoing elective colorectal surgery. Patients were divided into three groups, depending on the type and method of preparation to operation. The 140 patients in the first group received according to the "traditional" preparation purgatives, enemas, and mycerine + metronidazole prophylaxis. The preparation of the 160 patients involved in the second group was performed by giving mannit solution (10%) orally 12 hours prior to surgery, and a single dose of 2 g ceftriaxon (Rocephin, Hoffman-La Roche) intravenously 2 hours preoperatively. The preparation for the 150 patients enrolled into the third group was done also by giving mannit solution orally, and for antibiotic prophylaxis 2 g ceftriaxon was given intravenously as in the second group, but an additional 500 mg metronidazole was also given at the same time as the ceftriaxon intravenously. The evaluation of the cases proves, that the mannit + ceftriaxon method warrants satisfactory protection for colorectal surgery, and the necessary time interval is only 12 hours. The rate of septic complications and septic death was higher in the first, traditionally pretreated group, than in the other two. The CTX + metronidazole combination used in the third group was not superior to the administration of ceftriaxon alone.


Loco-regional renewal of malignant skin melanomas. II. Regional lymph node metastases and regional recurrence.

The strategy of surgical therapy to treat regional disease in melanoma remains still controversial. The author analyzed 154 of 183 melanoma patients, who could be studied for the usefulness of surgery directed against regional tumour spread. Radical tumour excision combined with elective lymph node dissection (E+eRND) in medium or high risk tumour patients was found superior to therapeutic dissection (tRND) inasmuch 5-year-survival rates were significantly different (p < 0.001). Life expectancy seemed to be further impaired when postdissectional renewal appeared following tRND (5-year-survival rates 31.8 per cent --> 12.7 per cent) or tRND was incomplete.


Conservative surgical management of pancreatic injuries.

Seven cases of pancreatic injuries of various severity ranging from grade I to grade IV treated by closed tube drainage are presented. Only one patient developed pancreatico-duodenal fistula postoperatively which was managed conservatively and closed within four weeks. Simple drainage is a satisfactory method in the treatment of pancreatic injuries.


Surgical male contraception.

After giving a short account on the possible ways of male contraception, the authors outline the administration of surgical sterilization and its professional follow-up based on their own experience. Their suggestions concerning legal regulations aim, on the one hand, at the extension of the topic, on the other hand at supporting the specialists interested in surgical contraception.


Myasthenia gravis: prognostic significance of clinical data in the prediction of post-thymectomy respiratory crises.

Medical records of 170 patients who had undergone thymectomy for myasthenia gravis were reviewed from the point of view of respiratory disturbances. In the group of patients requiring mechanical ventilation for over 24 hours after operation the incidence of high preoperative cholinesterase inhibitor intake, severe bulbar symptoms and severe myasthenia gravis with anamnestic respiratory crisis and cardiorespiratory disease were much higher than in the group of patients who could have their trachea extubation within 24 hours. The presence of a thymic tumour, patients' age over 50 years and the so-called precrisis have revealed differences between the two groups, while the patient groups were identical in mean age, duration of myasthenia gravis and sex distribution. The above clinical data are recommended to be considered in the evaluation of the need for postoperative mechanical ventilation or extubation and preparation of preventive tracheotomy.


Intraoperative estimation of liver blood flow in man.

The intraoperative measurement of the afferent circulation of the liver, namely the hepatic artery flow and portal venous flow was carried out upon 14 anaesthetized patients having carcinoma of the splanchnic area, mainly in the head of the pancreas, by means of transit time ultrasonic volume flowmeter. The hepatic artery flow, portal venous flow and total hepatic flow were 0.377 +/- 0.10; 0.614 +/- 0.21; 0.992 +/- 0.276 l/min, respectively. The ratio of hepatic arterial flow to portal venous flow was 0.66 +/- 0.259. There was a sharp, significant increase in hepatic arterial flow (29.8 +/- 6.1%, p < 0.01) after the temporary occlusion of portal vein, while the temporary occlusion of hepatic artery did not have any significant effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow is a much disputed question, but according to the presented data here, it is unquestionable, that the decrease of portal venous flow immediately results a significant increase in hepatic artery circulation.


Role of surgery in the prevention and correction of hip subluxation and dislocation in cerebral palsy.

Forty-three patients (80 hips) were available for clinical and radiological follow-up. These patients underwent adductor tenotomies separately or in combination with other procedures on the hip, with or without proximal femural correction. The range of abduction in all hips before surgery was 40 degrees or less, and in 54 hips combined with flexion-contracture (10 degrees-50 degrees).


[Expressed emotion: past, present, future].

Expressed Emotion (EE) proved to be the best single predictor of relapse in schizophrenia in 1972. Since then, studies on EE were oriented in three directions: Replication of the original study in different countries, improvement of the methodology and clinical applications. The analysis of different key studies shows that EE is a powerful predictor factor, although it is influenced by other variables such as culture.