Screening of white middle-class US infants with the Wolański Gross Motor Evaluation.

The purpose of this study was to evaluate the appropriateness of the Wolański Gross Motor Evaluation (WGME) to screen Triangle Area (North Carolina, US) infants for developmental delay. Eighty full-term, white infants were tested once each and five infants were followed longitudinally using the WGME. The results of the study revealed that the Triangle Area infants scored significantly higher than did the Polish infants with whom the study was normed at three and six months of age, but not at nine and twelve months of age. At three and twelve months scores differed between males and females, with females scoring higher than males. No significant differences according to gender occurred at six or nine months. Longitudinal subjects did not remain in any single channel of development on either the existing WGME grids or on grids fabricated from the cross-sectional data from this study. The WGME grids would not be appropriate for use with American infants as they now stand. Further research is needed to develop appropriate scoring methods, as well as provide validity and reliability information.


Biocompatibility and IOL.

"Biocompatibility": meaning, investigation and importance for intra-ocular lenses. As PMMA isn't as biocompatible as initially thought, one searches for other materials on the one hand and tries to modify the surface of the PMMA on the other. For the latter only the HSM (heparin surface modifying) technique is currently used.


Stellar corneal rupture and secondary glaucoma after squash trauma in a keratotomized eye.

We report an unusual dramatic case of stellar ocular rupture after squash blunt in a recently keratotomized eye through weakened keratotomy scars. The early secondary glaucoma, the tension generated by the surgical sutures of the wounds and the use of systemic and topical steroids could explain the reopening of two incisions initially unperforated and the delayed healing procedure. We also stress the benefits of wearing protective eye glasses when playing squash, as well as a strict legislation in Belgium in such an eye-threatening sport.


[Neurosurgical approach to orbital tumors].

The transcranial approach to the orbital tumors consists of a subfrontal route after frontal or frontotemporal craniotomy to allow epidural access to the orbital roof. This approach is used for all tumors with intracranial extension as well as for tumors located in the apex of the orbit or medial to the optic nerve in the posterior part of the orbit.


Chemical and thermal lesions in the orbital region.

In severe chemical and thermal burns the surroundings of the globe are frequently affected. Longstanding inflammatory reactions and severe scar formation around the globe are consequences from such damage. Lids, tarsi, conjunctival and subconjunctival tissues down to the fornices and the anterior orbit are destroyed. Beside medical therapy various operations are necessary to restore an environment for the globe to allow its survival.


Hyperthyroidism, ophthalmoplegia and unilateral mydriasis.

Clinical description of a 33 years-old woman, with hyperthyroidism, admitted to the emergency unit with external bilateral ophthalmoplegia and left mydriasis, unreactive to light. The external ophthalmoplegia is proven to be due to myasthenia. The left mydriatic pupil demonstrates features typical for Adie's tonic pupil. The association of a tonic pupil with an auto-immune disease is infrequent. The axiom that internal ophthalmoplegia in a patient with external ophthalmoplegia excludes myasthenia gravis should be reevaluated.


Dysthyroid orbitopathy: invasive treatment and the value of radiotherapy.

In this retrospective review of 29 patients with severe dysthyroid orbitopathy, the authors compare 3 invasive therapeutic modalities corticosteroids, radiotherapy and surgical orbital decompression) with special emphasis on the role of radiotherapy.


Non-invasive diagnosis of the localisation of the fistula in dural carotid shunt: a case presentation.

An illustrative case is reported to demonstrate the possibilities of MR-angiography in carotid -cavernous fistula (CCF). This new non-invasive technique may be useful in the diagnosis and follow-up. If an embolisation is anticipated conventional angiography is still necessary because of the higher spatial and temporal resolution.


Experimental approach to surgical treatment of lacrimal insufficiency by microvascular submandibular salivary gland autotransplantation.

When compared to the parotid duct transposition, the microvascular submandibular salivary gland autotransplantation presents the advantage of providing a more viscous tear substitute, and a basal flow rate unaffected by meals. If future attempts to re-innervate the graft are successful, this procedure could be promising in restoring an acceptable lacrimal function in severe xerophthalmia.


Surgery on the extra-ocular muscles after orbital fracture.

We analyzed the files of 61 patients presenting with diplopia due to orbital fractures. Thirty-four patients needed a primary orbital reconstruction and this diminished the complaints of diplopia in most cases. In only 5 cases additional ocular surgery on the extra-ocular muscles was indicated. Of the 27 patients who did not require orbital surgery, 5 underwent extra-ocular muscle surgery to diminish diplopia. We present our guidelines for treatment, based on forced duction testing, ocular motility, primary position and field of binocular single vision.


Treatment of posterior eye segment complications after perforating trauma.

168 perforating trauma cases that underwent vitreoretinal surgery in our hospital over a two year period were reviewed. A uniform surgical concept was applied in those severely injured eyes. Showing posterior eye segment complications that required vitreoretinal surgery and having at least light perception were the only two criteria to be eligible for this study. The anatomic and functional results in different trauma groups are discussed as well as indications and duration of silicone oil tamponade.


Retinal periphlebitis and retinal pigment epithelium changes associated with multiple sclerosis: a report of two cases.

Two patients with definite MS and no significant visual loss are presented, because of the marked bilateral sheathing of retinal veins, and diffuse pigmentary changes in the first patient, and the previously unreported paravenous pigmentation with bone corpuscular configuration in the second patient. The lesions in the second patient are similar to paravenous retinitis pigmentosa. We assume that the RPE lesions may be secondary to perivasculitis, which is not uncommonly seen in MS patients.


Short term results with excimer laser-photo-refractive keratectomy.

The results at three months after photo-refractive keratectomy surgery (PRK) with the Meditec Mel 60 laser are discussed. A total of 86 eyes (18 hyperopes and 68 myopes) were followed. The predictability of +/- 1D in the myopia group of less than 6D was 86% and it was 68% in the myopia group of more than 6D. The predictability of +/- 2D was 96% in the group below 6D, and in the group of more than 6D it was 85%. In hyperopia, the mean refractive change was 2.7D and 44% of eyes were between +/- 1D at three months after Excimer laser surgery.


A long term clinical trial of carteolol in the management of glaucoma. Belgian Carteolol Study Participants.

Carteolol is a nonselective beta-blocker with intrinsic sympathomimetic activity (I.S.A.). A multicenter trial was started to check if the theoretical advantages of this new drug could also be confirmed in a clinical setting. The intraocular pressure (I.O.P.), the visual field and the adverse reactions were evaluated at day 8, 60, 360 and 960. The results of this study demonstrate that carteolol effectively lowers the I.O.P. with minimal adverse side effects in previously treated as well as untreated patients.


Blindness following paranasal sinus surgery: a report of two cases.

Two cases of blindness following paranasal sinus surgery are presented. The first patient, a 38-year old man, developed a delayed massive haemorrhage, after bilateral sphenoethmoidectomy. This hemorrhage could be stopped by electric cauterisation under endoscopical control. During this reintervention the patient developed total blindness of his right eye, and a restriction of the inferotemporal left visual field. The second patient, a 10-year old girl, developed, after bilateral spheno-ethmoidectomy for isolated sphenoiditis, total blindness of the left eye and paralysis of the ipsilateral extraocular muscles. According to the literature, blindness secondary to paranasal surgery is mainly due to retrobulbar hemorrhage. In the first case blindness was due to a direct cauterisation of the optic nerve, after perforation of the lamina papyracea. In the second case, blindness was probably due to a hemorrhage in the orbital apex.


Structural, hemispheric theory of eye, movements and its confirmation by dynamic orbital magnetic resonance imaging.

Two models of eye-movements are in competition with each other: the cardanic suspension (Listing law 1845) and the socket-joint (structural-hemispheric theory 1986). The dynamic orbital MRI demonstrates arguments for the latter which is based upon anatomy and physiology.


Pathogenesis and treatment of the ophthalmopathy associated with Graves' disease.

The pathogenesis and etiology of the ophthalmopathy associated with Graves' disease still remains to be elucidated. There is, however, general consensus that the extraocular muscles are the principal site of the autoimmune response and that the main changes are in the interstitium. The primary target seems to be the fibroblasts which are stimulated as a result of cytokine release by the activated T-cells that accumulate in the muscles. Increased production of glycosaminoglycans and collagen by fibroblasts, attracts water to the interstitium and produces interstitial oedema. The frequent association of Graves' thyroid disease and ophthalmopathy favours the hypothesis of antibodies cross-reacting with antigens of orbit and thyroid. Although cross-reactivity is very attractive, the nature of the involved antigen remains unknown. Since Graves' ophthalmopathy is an autoimmune disorder, many immunomodulatory agents have been used in the treatment of this disorder. Anti-inflammatory and immunosuppressive treatment modalities will be reviewed.


Congenital Marfan syndrome with contractures. A clinicopathological report.

Children with CMC present with blue sclerae, megalocornea, hypoplastic and translucent irides, miosis and high myopia. The lenses may be dislocated as in familial Marfan syndrome but they are often in place and microspherophakic. The clinical history of a boy with CMC is presented. Pathological examination of the eyes showed megalophthalmos with thinned sclera, anomalies of the chamber angle and iris, ill-developed ciliary body and choroid and a small in situ lens.


The use of the first locally manufactured epikeratolens for keratoconus in Leuven.

We adapted a lathe to the production of keratolenses. A cornea is mounted on a chuck and frozen at minus 40 degrees C. Hereafter we can cut the desired posterior radius and diameter. The first plano keratolens produced was used to correct keratoconus. The favourable result encouraged us to manufacture keratolenses for the correction of refractive errors.


Memory complaints, memory disorders and focus localization in patients with partial epilepsy.

Our study aimed at analysing effects of epileptic foci on memory function in patients with partial epilepsy. Twenty-eight patients with spontaneous memory complaints and psychometrically established memory disorders were assessed by 21-channel electroencephalography recorded both during cognitive testing and during 99mTc-HMPAO single photon emission computed tomography (SPECT). Computed tomography (CT) was performed on the same day. None of the epilepsy-related factors (seizure type, seizure frequency, type of epilepsy, age at onset of the seizures, type of antiepileptic treatment) could be related directly to severity or type of memory impairment (classified into the categories 'global', 'verbal' and 'non-verbal'). Remarkably, this study found no significant relationship between EEG focus localization and severity of measured memory impairment. Most areas with hypoperfusion on the SPECT were found in the group with global (severe) amnesia, typically with a right frontal localization. Abnormalities on CT were predominantly found in the same group, however, with a right-sided parietal localization. An unanticipated finding was that the majority of temporal CT and SPECT lesions were found in the group with relatively better memory performance.


Vigabatrin in adults with poorly-controlled epilepsy and learning disabilities.

Twenty-two adult patients with uncontrolled epilepsy and severe learning difficulties were included in an open study of vigabatrin. Patients were all in residential care and had experienced at least 12 seizures during the previous 12 months despite all attempts to optimize antiepileptic drug (AED) treatment. Following a 4 month baseline period, vigabatrin 500 mg twice daily was added to the current AED treatment and the dose increased according to response, up to a maximum of 4 g/day. Ten patients achieved a reduction in seizure frequency of more than 50% during this 4 month dose titration phase. Two patients had no seizures during the baseline period. For the 30 patients with seizures during the baseline period the median improvement in seizure frequency with the addition of vigabatrin was 49% (P = 0.014). The response rate was higher for patients with partial seizures than for those with generalized seizures. Ten patients continued with vigabatrin while the dose of one of their other AEDs was gradually reduced and successfully withdrawn in three patients. Adverse events were reported in 20 patients during the 64 week study period. The most frequently reported events were sedation (8 patients), aggression (4 patients), agitation (3 patients) and ataxia (3 patients). No patients were withdrawn from the study as a consequence of adverse events. Vigabatrin was therefore an effective add-on therapy in 45% of these difficult-to-treat patients and allowed reduction of other AED treatment in a small number.


MRI findings in epileptic patients on vigabatrin for more than 5 years.

Although vigabatrin is a promising new antiepileptic drug, its safety has been challenged by the report of dose-dependent central nervous system myelin vacuolation in some preclinical animal studies. Since it has been shown that vacuolation is associated with specific magnetic resonance imaging (MRI) findings in rats and dogs, MRI of the brain was performed in 11 patients with complex partial seizures who had been receiving vigabatrin for 64-78 months (mean 74.0 +/- 5.0 sd) as additional treatment for epilepsy, with a cumulative exposure ranging 4200 to 9360 g. In no case did MRI show white matter changes similar to the pathological findings of microvacuolation observed in animals. These results would appear to confirm that current doses of vigabatrin do not cause myelin vacuolation in humans, even for treatment periods of longer than 5 years.


Vigabatrin in the treatment of complex partial seizures.

We report the effect of vigabatrin on seizure frequency in 13 severely drug-resistant patients with intractable complex partial seizures (CPS) with or without secondary generalization. Patients were followed for a 3-month period before vigabatrin administration to establish a 'baseline'. Six patients became seizure free for 2-3 weeks immediately after starting vigabatrin. In seven patients a transient (4-6 weeks) increase in seizures above baseline occurred, which was attenuated by vigabatrin dose increments. After 3 months, the mean baseline CPS frequency was reduced from 7.75 +/- 1.18 (median 8, range 2.6-16) to 2.77 +/- 0.7 (median 1, range 0-7). At 6 months a > 50% improvement remained in seven patients. After 12 or more months CPS frequency returned to baseline in four patients, improved (by 25-62.5%) in four and deteriorated in three. One patient who was seizure free lost control at 16 months. Other effects were drowsiness (3), weight increase (3), diarrhoea (1), depression (2) and mood elevation (2). Four patients discontinued vigabatrin; one because of severe depression, three owing to lack of efficacy. Three patients have undergone and two are awaiting neurosurgery for their epilepsy. Thus, CPS frequency progressively deteriorated toward baseline in all patients, however, secondary generalizations were abolished in four and reduced in two.


University students with epilepsy: a study of social aspects.

Improved control of epilepsy has permitted an increasing number of young persons with epilepsy to attend university. This study was designed to assess the impact of epilepsy on their education, employment, family and social life. We studied fifteen randomly selected full time university students, aged 20-28 years, who had a well documented history of partial or generalized epilepsy. One third still had seizures, over 90% were taking antiepileptic medication and all were followed by a neurologist. Interviews were conducted according to a standard open-ended questionnaire lasting 1.5 hours. After an initial adjustment period, most did not feel that epilepsy constituted a handicap to their education. They learned about epilepsy, did independent research and one quarter chose careers in the health sciences. Most reported occasional negative experiences, but were reluctant to interpret this as evidence of discrimination. All felt that they had had equal opportunities at school and at work. They were selective about imparting knowledge about their seizures to students, staff and employers, but did not hide their epilepsy. Subjects had high vocational aspirations and academic motivation reflecting good intelligence and previous educational achievements. Their positive attitude, enthusiasm and denial of difficulties were striking. This reflects improved seizure control as well as family and social support in this group of young people.


Central and peripheral benzodiazepine receptors in rat brain and platelets: effects of treatment with diazepam and clobazam.

Tolerance to the effects of benzodiazepines (BZ) may be mediated by changes in benzodiazepine receptors (BZRs). Peripheral BZRs (in brain and platelets) and central BZRs (in brain) were measured in rats following intraperitoneal administration of diazepam and clobazam each for 4 and 12 days. BZRs were measured by binding assays using [3H] PK 11195 (peripheral) and [3H] flunitrazepam (central) as radioligands. Diazepam, but not clobazam, increased peripheral BZR numbers in platelets (both P < 0.005), but not in brain, after 4 and 12 days' treatment compared with appropriate controls. Neither drug altered central BZR affinities or numbers in rat brain. BZ effects on peripheral BZRs in platelets cannot be extrapolated to predict changes in brain receptors, either peripheral or central.


Does chloroquine cause seizures? Presentation of three new cases and a review of the literature.

Three cases are reported of patients developing seizures whilst taking chloroquine. Recently, eight such cases have been reported elsewhere. A review of all patients described in the literature is given. Possible relationships between chloroquine and the occurrence of seizures are discussed and further studies recommended. At present we feel there is no need to restrict prescription of chloroquine to patients with a history of epilepsy.


Liver function tests in persons receiving anticonvulsant medications.

Liver function tests were carried out in 206 adults and children taking anticonvulsants to ascertain the prevalence of biochemical abnormalities in asymptomatic patients. It was observed that serum gamma-glutamyl transpeptidase was elevated in 74.6% of patients, alkaline phosphatase in 29.7% and alanine aminotransferase in 25.2% of cases. These figures are similar to those previously reported in the literature and probably reflect hepatic enzyme induction by the anticonvulsants. It is suggested that there is no value in the routine performance of liver function tests in patients with epilepsy. However, such patients should be informed of the symptoms of hepatic dysfunction and asked to report for liver function tests should they have such symptoms.


Epilepsy: patient perceptions of their condition.

The objective of this study was to ascertain the perceptions of people with epilepsy about their condition. Nine hundred and eight questionnaires were sent to members of epilepsy associations, with a 45% response rate, and 625 questionnaires were sent to neurologists for their patients to complete, with a response rate of 16.5%. The results reinforce and extend previous observations that there is an ongoing need for educating health care professionals and persons with epilepsy about the condition. Matters pertaining to driving, the unpredictability of seizures, lack of employment and cognitive difficulties were of major concern to the respondents. The present data also highlighted the vexed relationship between stress and seizure control, which needs to be further investigated. These data should be of value to doctors and other health care professionals in their dealings with people with epilepsy. It should also provide epilepsy associations with data upon which they might be able to plan education services.


Epileptic fits or infantile masturbation?

Two infants, one girl, 5 months old, and one boy, 6 months old, presented with rhythmic and sustained motor activities of a stereotyped nature accompanied by moaning and grunting, facial flushing and altered awareness. The episodes occurred frequently and were initially believed to be epileptic. Normal electroencephalograms during the fits, lack of response to antiepileptic medication given to one child and careful reviewing of videotape recordings, enabled us eventually to diagnose the 'seizure-like' episodes as masturbatory activity.


Hot-water epilepsy in an adult: ictal EEG, MRI and SPECT features.

Reflex epilepsy constitutes a rare form of epileptic seizures. We observed a 20-year-old man who presented with seizures induced by immersion in hot water. The trigger stimulus was specific. Contrast CT scan and MRI were all normal, not revealing any structural lesion. Ictal EEG recorded during a hot bath showed focal epileptic discharges in the left temporo-occipital area. Interictal SPECT showed a hypometabolism in the same cerebral region. Neuroimaging studies were rarely performed in this uncommon type of epilepsy. Nevertheless, in our case the result of the SPECT suggests a localized functional disturbance in the emergence of the disorder.


The language of epilepsy.

The various names of epilepsy in European languages are reviewed. It is shown that they reflect the beliefs and misconceptions that were entertained in the past about the disease.


Applications of molecular physics 'biotechnology' to the rational design of an improved phenytoin analogue.

This study exploits molecular physics, in conjunction with a large scale computing environment, as a tool for understanding the clinical phenomenology of phenytoin (PHT) toxicology at a molecular level and for employing this understanding in an attempt to design improved drugs. The application of molecular physics techniques, such as quantum mechanics and molecular force field calculations, to the process of rational anticonvulsant drug design remains virtually unexplored. A 3-step strategy for applying these techniques to the design of an improved PHT molecule is presented. Step 1 employs quantitative structure-activity relationship calculations on 80 PHT analogues to ascertain the portion of the PHT molecule necessary for bioactivity (i.e. the 'bioactive face' of PHT); the N3-C4(O)-C5-R fragment of PHT was identified as the bioactive face. Step 2 employs molecular modelling studies to determine the portion of the PHT molecule necessary for the teratogenic, mutagenic and connective tissue toxicities of PHT (i.e. the 'biotoxic face'); the C2(O)-N3 fragment of PHT was identified as the biotoxic face. Step 3 experiments design an 'improved' PHT analogue, which maintains the bioactive face while eliminating the integrity of the biotoxic face; 2-deoxy-5,5-diphenylhydantoin was designed and synthesized as the improved PHT analogue. This compound had biological activity equivalent to PHT, but was unable to bind to nucleic acids or to chelate metals involved in connective tissue metabolism.


Memory effects following carbamazepine monotherapy in patients with complex partial epilepsy.

To evaluate the memory effects of carbamazepine (CBZ) monotherapy, a relatively large computerized neuropsychological test battery, specially developed to assess the properties of different memory systems, was administered to a group of patients with epilepsy in a pre-test--post-test control group design. Consistent with previous findings, the results show that CBZ treatment does not induce any general important or consistent negative signs of memory dysfunction. However, the epilepsy group as such demonstrates a relative inability to carry out more complex working memory tasks and they are also slower in simple long-term memory access tasks. Finally, the detailed findings suggest that CBZ plasma concentration levels within the therapeutic range are highly and negatively associated with short-term recency, which is a novel finding.


Memory and attention in newly diagnosed epileptic seizure disorder.

Interictal disturbances of memory and attention were evaluated in 74 adults with newly-diagnosed untreated epileptic seizures and no other known brain pathology. In approximately 30% of the patients with cryptogenic seizures, the average memory and attention scores indicated subtle dysfunction compared with normal control group. The patients had difficulties in tasks requiring memory, sustained attention and flexible mental processing, whereas they had normal attention span, simple speed of tracking and simple psychomotor speed. The memory difficulties may be related to attentional dysfunction leading to impaired or slowed initial encoding of memory trace, and also to a deficit in storing process and hippocampal dysfunction. These findings could have important implications for establishing criteria for identifying patients who develop chronic epilepsy and who thereby would benefit from early therapeutic intervention.


Sexual abuse and psychiatric symptoms in an epileptic population.

One hundred and seven consecutive patients attending the outpatient epilepsy clinic at a teaching general hospital were assessed by clinical interview for a history of sexual abuse. Questionnaires dealing with overall psychiatric symptomatology i.e., (SCL-90), (TSC-40) and depression (ZSRDS) were also used. The majority of subjects were single (60%), living at home (76.6%) and had an average age of 29 years. The mean duration of epilepsy was 18.8 years and the seizures were controlled with medication in 65.2% of patients. Ten (9.3%) of the subjects had been sexually abused. This frequency of sexual abuse is lower than in the general population and among psychiatric patients. The specific form of sexual abuse consisted of sexual intercourse (n = 4), fondling (n = 4) and oral sex (n = 2). The sexually abused subjects had significantly higher scores on the anxiety subscale of the SCL-90 and depression score on the ZSRDS than non-abused subjects.


Epileptic seizures induced by sexual abuse. Pathogenic and pathoplastic factors.

Previous sexual abuse is now thought to be a common cause of non-epileptic seizures (pseudoseizures). However, since sexual abuse is common, a previous history of sexual abuse may also occur in people with actual epilepsy. We present six patients in all of whom sexual abuse may, by acting as a stressor in the already predisposed, have precipitated epilepsy and in some of whom the abuse may have affected the actual experiences of the epilepsy itself: all but one of the patients had partial seizures.


Therapeutic drug monitoring improves seizure control and reduces anticonvulsant side-effects in patients with refractory epilepsy.

The benefit to patients of an on-site antiepileptic drug monitoring service, in which physicians' decisions were recorded before and after the concentration became available, have been assessed retrospectively. In 109 patients with refractory epilepsy monitored on three (n = 61) or four (n = 48) occasions between 1986 and 1990, one or more assay result was rated as 'unexpected' by the consulting doctor. In 51 of these, revision of the dose was undertaken as a consequence (active group). Their clinical outcomes were compared with those of the other 54 patients in whom the initial management plan was left unchanged (passive group). Median seizure frequency decreased in both groups, but this was statistically significant only for the actively treated patients [active group: first visit 1 (0 to 26) seizures/month, last visit 0 (0 to 19) seizures/month, P < 0.01, 95% CI -2 to -0.5; passive group: first visit 2.5 (0 to 57) seizures/month, last visit 1.5 (0 to 44) seizures/month, NS, 95% CI -1 to +10]. The number of patients reporting one or more episodes of drug-related toxicity also favoured the actively managed patients (active group 25%, passive group 56%, P < 0.01). Within this selected group of patients, the anticonvulsant concentration was a better guide to clinical management than the physician's assessment.


Absence epilepsy: early prognostic signs.

We have studied 124 children with typical absence epilepsy. The onset of symptoms was in 12% under 4 years, in 51% between 4-8 years and in 37% above 8 years. The F:M ratio was 2:1 in children under 4 years versus 1:1 above 8 years. Absences alone occurred in 82% and absences followed or preceded by generalized tonic-clonic seizures (GTCS) in 6.5% and 11%, respectively. Simple absences were not seen in children under 4 years and were more frequent (14%) in the 4-8 years age group. Family history was positive for epilepsy in 20% and febrile convulsion in 7%. Sixteen percent had a positive past history of febrile convulsions. All patients showed bilateral, synchronous spike-wave discharges from 2.5 to 4 c/s. Lateralized spikes, spike-slow wave complexes were found in 27%. Photosensitivity was present in 18% and was marked in 12%. Monotherapy with sodium valproate or ethosuximide (91% SV) was successful in 85% of patients with absences alone and 68% of the absences with GTCS. Only 2% were not fully controlled either on monotherapy or polytherapy. Treatment was withdrawn in 41 patients and 13 relapsed. We have identified four factors associated with relapses: (a) poor initial response to treatment, (b) lateralized focal EEG abnormality and/or marked photosensitivity, (c) the evolution to myoclonic epilepsy, and (d) early withdrawal of AED (< 3 years).


Juvenile myoclonic epilepsy of Janz: clinical observations in 60 patients.

We studied 60 patients with juvenile myoclonic epilepsy (JME). There was a high positive family history for epilepsy (33.3%). Age at onset of epilepsy ranged from 4 to 18 years with an average of 13.9 years. 88.3% of patients were seizure-free. The most effective drug was valproate. In eight patients drug withdrawal was attempted but all patients relapsed during a follow-up period of 1 year. Video-EEG studies were performed in eight newly diagnosed patients; myoclonic jerks were recorded in five patients.


Diagnostic value of electroencephalography in arteriovenous malformations.

Arteriovenous malformations (AVM) are usually located superficially in the subcortical white matter, and seizures are one of the frequently seen presenting features of AVM. The diagnosis of AVM is confirmed with various neuroimaging techniques. The present study comprised six patients presenting with seizures and headaches, referred to the neurodiagnostic unit to rule out/confirm epilepsy. All patients showed epileptiform activity on electroencephalography (EEG). Further investigations, such as angiography supplemented with computed tomography (CT) showed AVM. EEG is usually not considered a valuable diagnostic tool in AVM, but our results support the finding that EEG is an extremely reliable investigative tool, and should be supplemented with angiography and CT scan for better localization of AVM.


A matter of fried onions.

In the 1946 film 'A Matter of Life and Death', complex partial seizures were portrayed in detail and with surprising accuracy. This study was conducted to determine the nature of the medical collaboration in the preparation of the film as well as the reasons why the creative team of Michael Powell and Emeric Pressburger included these details, but elected to make them invisible to all but those with medical educations.


[Place of microvascularized tissue transplants in emergency treatment of multiple trauma of the limbs. Excluding reimplantation].

When we evoked the indications of microsurgery in Traumatology, at first, we think reimplantations performed in emergency and also secondary management of soft tissues or complex defects. In fact, we resort to microsurgery in many other circumstances. Early microsurgical reconstruction of complex trauma of the extremities yield better results than delayed free flaps. In 7 cases, free flaps were performed on the lower extremities, in 2 cases on the upper extremities. Many advantages are credited with this offensive attitude which requires an appropriate organisation of the Departments of Traumatology, the intimate collaboration of surgeons called orthopedic or plastic surgeons, improperly divided by too administrative compartmentalization of the surgical specialties.


[Prognosis in surgical treatment of cancer of extra-hepatic biliary ducts].

This work reports a retrospective multicenter study of the treatment and prognosis of 746 patients with gall bladder cancers and 684 patients with extrahepatic biliary duct cancers. Gallbladder cancers: Adenocarcinoma was encountered in 92.6% of cases, 107 were limited to the gallbladder. Removal was possible in 27% of the patients. Overall operative mortality was 21%. Overall survival at one year was 14%. The projected five-year survival for cancers limited to the gall bladder treated by simple cholecystectomy was 93% for noninvasive, "in situ" cancers. The survival was 18% with mucosal involvement, and 10% with extension to the gall bladder wall. Extrahepatic biliary duct cancers: Adenocarcinoma was encountered in 99.7% of assess; 40 were limited exclusively to the biliary ducts. 384 involved the upper 1/3 segment of the biliary duct, 86 the middle 1/3, and 121 for the lower 1/3. Cancers involving two or more of these segments were encountered in 93 cases. Removal of the cancer from these four locations was possible in respectively 30%, 50%, 50% and 7% of cases. Overall operative mortality was 27.7% and after removal: 13.5% for the upper biliary duct segment, 18.1% for the middle 1/3, and 20% for the lower 1/3. The mortality was 25% for cancer that involved two or more of these segments. Analysis related to age demonstrated a postoperative mortality of 16% in patients less than 70 years of age and 59.1% after 70 years. The five-year survival after surgery was projected to be 12% for cancers of the upper 1/3 segment, 15% in middle and 30% in the lower 1/3.(ABSTRACT TRUNCATED AT 250 WORDS)


[Desmoid tumors: diagnostic and therapeutic difficulties. Apropos of an unusual case].

This observation has been previously reported as a multifocal and recidivant desmoid tumor. The first time, the patient was operated on for a desmoid tumor situated on his left thigh. He was reoperated on fourteen years later for a recurrent tumor implanted on the same place and a new one on the right arm. Recently bilateral pulmonary tumors were discovered. As far as this evolution was concerned, its exceptional pattern induced a new analysis of the microscopic data and the diagnosis of fibrohistiocytic sarcoma was established. This observation suggest to the authors some comments about the difficulty of diagnosis and therapy of such soft tissue tumors.


[Disabling rectocele: rectal plication by perineal approach. Apropos of 20 cases].

Rectocele is a frequent rectal static disorder. Its usual clinical manifestation is a distressing outlet obstruction. Surgical treatments actually proposed are based on a trans-anal approach. Perineal approach has specific interests as shown on a consecutive series of 20 patients operated on between January 90 and January 92. The surgical modalities were, after mobilization of the recto-vaginal wall, careful concentric folding of the rectocele followed by suturing the rectal fascia and pre-anal levatorplasty without associated colpectomy. Results (mean follow-up: 15 months) showed: 1) anatomic correction obtained in 18 cases, without local complications, but one dyspareunia, 2) restoration of normal rectal evacuation in 16 cases. The 4 functional failures were observed in patients with associated anorectal disorders (anismus, colon inertia).


[Lumbar sympathectomy for arteritis. A reliable and (almost) seventy year-old technique].

The old procedure of lumbar sympathectomy has long been the only chance of avoiding amputation for arteritic patients. Its field of application has shifted as reconstructive surgery and medical therapy made progress, and it is no longer the only solution and has more precise indications. Proper evaluation of its chances of success according to the individual situations allows establishing its potential and limitations. This simple procedure, entailing no risk for the future, deserves remaining among the available means for the treatment of arteritis, despite its age.


[Patelloplasty for extensive lesions of the patellar cartilage].

We have been able to review 100 cases of patelloplasty for extensive lesion of the patellar cartilage with an average follow up of 5 years. The technic for the procedure is described. The study of the results (64% of good and very good results) allow us the emphasize the criteria for best indications and technic. We prefer this technic to patellectomy or femoro-patellar prothesis in the cases of symptomatic degenerative arthrites with patellar excentration with special mention on the fact that it does not cut bridge to further procedure on the knee.


[Laparoscopic cholecystectomy. Apropos of 450 cases].

450 successive celioscopic cholecystectomies (May, 1990-April, 1992) are reported for 312 cases of uncomplicated gallstone (69%) operated electively and 138 cases operated in emergency, including 120 cases of acute cholecystitis, 17 cases of biliary pancreatitis and 1 case of angiocholitis. Immediate conversion into laparotomy was required in 10 cases (2.2%) either for technical reasons (1.1%) or because of lithiasis of the common bile duct (1.1%). The stay in hospital lasted an average of 2.2% days for elective admission and 3.3 days for emergent admission. The average operating time was 65 minutes (75 minutes until May, 1991, and 55 minutes between May, 1991 and April, 1992). Preoperative retrograde cholangiography was performed in 67 cases and intraoperative cholangiography in 16 cases. Second surgery was required for suture in one case because of cholerrhagia in a secondary duct of the gallbladder bed. This cholerrhagia would not have been amenable to simple aspiration. One patient (0.2%) died of myocardial infarction at D + 10. Complications include 4 cases of pulmonary embolism, 3 cases of cystic biliary fistula without second surgery and 4 cases of umbilical hernia. A more peculiar case is that of a patient admitted 5 months after surgery for gangrenous acute cholecystitis. This patient was admitted for fever and epigrastric pain. He had a very low-flow duodenocutaneous fistula of uncertain origin. This patient was not operated again. This may not be a complication connected to celioscopic surgery. Celioscopic cholecystectomy is superseding conventional cholecystectomy. Surgeons' efforts should strive at eliminating operative errors, reducing postoperative morbidity, improving techniques and instruments, teaching celioscopic surgery and extending its indications to other intraabdominal operations.


[Right and left laparoscopic colectomy. Apropos of 10 cases].

Ten successive cases of celioscopic colectomy are reported (5 right and 5 left colons). Colectomies were made for diverticular disease in 6 case and for cancer in the remaining cases. The patients ages range from 52 to 80 years, with an average of 72 years. The average duration of surgery is 92 minutes. The stay in hospital lasted from 5 to 7 days with an average of 6 days. All patients resumed fluid feeding on the 3rd postoperative day and solid feeding on the 4th to 6th day. None of them received analgesics later than 48 hours postoperatively. There was no mortality. Only one complication was noted in the form of urinary retention. In our opinion, colectomy with celioscopic video surgery currently has a definite role to play and, owing to technical and instrumental progress, colectomy can be performed without complementary laparotomy, at least for the left colon.


[Cancer of the cardia. Prognostic factors and treatment].

Pronostic of carcinoma of the esogastric junction is worsened by the potential two-way route of spread in case of lymph node metastasis: mediastinum and abdomen. During the last 10 years the authors observed 71 cases of adenocarcinoma of the gastric cardia, including 7 cases of linitis plastica. Histopathologic and clinical follow-up data are presented. The aims of the study were to evaluate prognostic factors and to define the best surgical treatment. There were mainly elderly patients with a poor physical status. Ten patients did not undergo surgery (14%). Among 57 patients undergoing radial resection (80.3%), total gastrectomy and upper polar esogastrectomy were performed in respectively 29 and 28 cases. The carcinomas were truly located to the gastric cardia in only 37 cases (65%). Operative mortality was 12.3%, not depending of the surgical technique. All patients five-year survival rate was 10.2%, improving to 15% in case of curative resection. The value of lymph node metastasis (80.7% of the patients) as a prognostic factor depended of the proximal or distal localization of the nodes. A positive surgical margin (15.7% of the patients) was a poor prognostic factor with a 6.9 months mean survival. The authors conclude that an aggressive surgical approach is worthwhile, because of the carcinoma invasion (nodes, margin), but not always possible (poor physical status).


[Carpal tunnel syndrome in hemodialysed patients. Analysis of 110 surgically-treated cases].

The retrospective study of this homogeneous series of 110 carpal tunnel syndromes in 70 patients on hemodialysis shows the usual severity of symptoms (right thenar amyotrophy in 56% of cases, advanced nerve lesions in 66%). Synovitis plays a major role, as demonstrated by the frequency of clicking fingers (45%), and requires synovectomy that allows thoroughly exploring the carpal tunnel and removing a highly aggressive element against tendons. In this study, fisculae do not seem to have the generally admitted importance, but it requires surgical caution. Two thirds of patients were followed up for an average of 3 years. Apart from 3 recurrences, the control of pain is good but sensorimotor recovery is long and often incomplete, which is in favor of earlier surgery.


[Surgical repair of primary or recurrent inguinal hernia by prosthesis and polypropylene plug].

This paper reports about experience with the cure of 2,000 primary hernia by the insertion of a patch, and of 1,400 recurrent hernias with obturation and a plug. All operations were performed under local anesthesia and with short hospitalization. There was almost no recurrence (2/2,000) of primary hernias, and only 1% for recurred hernias.


[Experimental heterotopic transplantation of the liver with anastomosis of the portal vein to the distal end of the splenic vein].

A model of heterotopic liver transplantation had been studied. The graft was laid under the recipient liver and the portal blood flow was supplied by anastomosis with the distal part of the splenic vein. Both liver can then receive portal blood through two parallel portal circulation. Liver function of transplant was satisfactory at three months after transplantation. Their had been no alteration of the recipient liver during the same period.


[Effect of chronic electric stimulation on colonic motricity. An experimental model. Results].

The study of direct electrical stimulation of the colon in 10 dogs allowed establishing a significant decrease in motor activity at the level of the stimulated segment, a nonsignificant decrease upstream and a significant increase downstream. The mechanism of intestinal response to stimulation remains hypothetic: there probably is a local release of neuromediators.


[Calculation of optimized and individualized hip prosthesis. A study of feasibility].

As logical consequence of a series of basic research studies on human femoral bones with unipodal support and under static stress, performed with physicomathematic modelling methods (finite-elements method) then confirmed by direct visualization of deformations resulting from such stress using holographic interferometry, the authors have worked on the definition of an optimized and individualized hip prosthesis. Thick CT sections digitized with a table and entered into a specially programmed computer allowed three-dimensional modelling of the femur as a volume, i.e. with its external contour and its medullary canal, and therefore of the implantable space. The prosthesis was then defined taking a number of hypotheses into account: necessity to regularize cortical bone spicules inside spongious bone, which are so often present opposite the rough line, partial machining at the level of the calcar, reduced tail length, presence or absence of collar. Thus an optimized and individualized prosthesis was defined. A prototype corresponding to a given femoral bone could then have been produced. However, the authors found it preferable to use simulation with computer synthetic images to check easy insertion and removal.


[The molecular diagnosis of hereditary diseases. In memoriam Dr. Eduardo Aguirre Pequeño].

Accordingly, we have established in our unit a DNA diagnosis laboratory and have started molecular genetics and epidemiological studies of several inherited diseases. We have started with cystic fibrosis, muscular dystrophy and hemophilia A. We practice the molecular diagnosis with both, Southern transfer and the polymerase chain reaction, using either direct (detection of mutations) or indirect (restriction fragment length polymorphisms) approaches. With the studies we have so far carried out, we have been able to provide genetic counseling and gained valuable information on the type and frequency of mutation associated to these diseases in our region.


[Dermatosis cinecienta. A clinico-pathological study of 20 patients (1989-1990)].

Ashen dermatosis (D.C.), or dyschromic perstans erythema, is a chronic dermatosis, which is asymptomatic and practically exclusive in Latin-American countries. Its clinical characteristics have been well defined (blue-gray patches), as well as its nonspecific histopathologic patterns; its etiology is unknown. This paper studies 20 patients suffering from ashen dermatitis. There was a majority of female patients, the dermatosis was disseminated, bilateral and symmetric. It is different from pigmented lichen although the histopathologic patterns is similar.


[Distraction as a stimulus of bone formation].

In orthopaedics limb length discrepancy and bone lost from infection are more frequent and difficult to resolve at the moment G. Ilizarov showed new bone formation with slow distraction stimulation in a well vascularization an rigidly fixed bone. Good patient selection, surgical technique, complete post-operative care and patient collaboration are necessary to get excellent or good results. This paper involves 50 patients, 39 with limb lengthening and 11 with infection and bone loss. We obtained excellent and good results in 37 cases of lengthening and 10 in the second one. At the moment the complications with external fixators may be used and we advised their use.


[The history of the first "voluntary" oral hydration center in Mexico (1959)].

There are some historic facts about the "First Center for Voluntary Oral Rehydration" begun 1959 at Hospital Infantil de México (Children's Hospital) was clearly demonstrated useful, 508 infants with diarrhea were treated. 90.94% were cured and dehydration corrected. Antibiotics were not much useful. Oral rehydration is considered the method of choice to begin treatment of the patient with gastroenteritis.


Histopathology of community acquired chronic hepatitis C. The Sentinel Counties Chronic Non-A, Non-B Hepatitis Study Team.

As part of a study of community-acquired non-A, non-B hepatitis, liver biopsy specimens of 29 anti-HCV positive and four anti-HCV negative patients were evaluated in order to characterize the histopathologic changes of chronic hepatitis C. Liver biopsies were performed 6 to 46 mo after onset of the disease and repeat biopsies were obtained in 10 anti-HCV positive patients. The histologic diagnoses were chronic persistent hepatitis (45%), chronic active hepatitis (35%), and chronic lobular hepatitis (21%). Irrespective of the tissue diagnosis, the majority of the patients showed characteristic histologic abnormalities in the liver, particularly damage of the small and medium-sized bile ducts (76%), lymphoid aggregates in portal tracts (45%), enlarged macrophages (48%), and steatosis (31%). In 59% of the patients, two or more of these histologic abnormalities were combined. Similar histologic changes have previously been observed in non-A, non-B hepatitis, but only uncommonly in hepatitis A or hepatitis B. We conclude that the histopathologic findings in chronic hepatitis C are highly characteristic, although not pathognomonic.(ABSTRACT TRUNCATED AT 250 WORDS)


Lymphoid interstitial pneumonia not associated with HIV infection: role of Epstein-Barr virus.

The polymerase chain reaction (PCR) method was used to determine the presence of Epstein-Barr virus sequences in seven cases of pulmonary lymphoid interstitial pneumonia not associated with HIV infection. Evidence of Epstein-Barr virus genome was found in three of six cases in which beta-globin gene, used as an internal control for the integrity and amplifiability of the tissue DNA, could be detected. These results suggest that Epstein-Barr virus infection is not always required for the development of lymphoid interstitial pneumonia.


Ki-1 (CD30) expression in differentiation of lymphomatoid papulosis from arthropod bite reactions.

Lymphomatoid papulosis (LP) is an uncommon cutaneous T-cell lymphoproliferative disorder that can mimic arthropod bite reactions clinically and histologically. Erythematous, crusted papules and nodules occur mainly on extremities of young adults and, when biopsied, display a superficial and deep perivascular infiltrate characterized by atypical lymphocytes and scattered eosinophils. Arthropod bite reactions may show an identical histologic pattern. It has been suggested that up to 10% of patients with LP will eventually develop lymphoma. We examined biopsies from 10 cases of LP and six cases of arthropod bite reactions diagnosed by clinical history and prolonged follow-up, with BerH2, an antibody directed against the Ki-1 antigen (CD30) and found it to be useful in helping distinguish between the two entities. All cases of LP examined showed scattered Ki-1-positive large, atypical lymphocytes in the dermis. In the arthropod bite reactions, there was virtually no staining with BerH2 antibody. This suggests that the abnormal activated T-cells, which comprise the cellular infiltrate in LP, are not present in arthropod bite reactions.


"Signet Ring" sinus histiocytosis mimicking metastatic adenocarcinoma: report of two cases with immunohistochemical and ultrastructural study.

The axillary lymph nodes from two patients with invasive breast carcinoma showed "signet ring" histiocytosis with sinusoidal distribution of cells having prominent cytoplasmic vacuolization which simulated metastatic adenocarcinoma. Immunohistochemical studies confirmed the histiocytic nature of the signet ring cells and eliminated the possibility of metastatic adenocarcinoma. Electron microscopy in one case revealed lipid within the cytoplasmic vacuoles. The etiology of this reactive change is unknown; however, a history of previous surgery involving the chest wall may be causally related with disruption of adipose tissue. Prior to ipsilateral mastectomy both patients had undergone a contralateral mastectomy for mammary carcinoma. Signet ring sinus histiocytosis is a reactive sinusoidal proliferation that can mimic metastatic carcinoma, but close inspection will usually reveal the histiocytic nature of the cells.


Detection of hepatitis C virus RNA sequences by polymerase chain reaction in fixed liver tissue.

Currently, the most reliable method for the diagnosis of hepatitis C virus (HCV) infection is the detection of viral sequences by the reverse transcription double polymerase chain reaction (RT/PCR) in serum or liver samples. We demonstrate here that noncoding region sequences (NT) of HCV were amplifiable by RT/PCR in guanidinium extracts of formalin-fixed (for 6 to 48 h), paraffin-embedded liver sections of patients with chronic hepatitis C. In contrast, core and nonstructural region sequences of HCV were not detectable in fixed tissues by PCR amplification. Boiling of routinely processed tissue sections in water containing Chelex-100, a method for extraction of amplifiable hepatitis B virus DNA, was not successful. The amount of nucleic acid extracts from fixed liver sections needed for amplification of NT region sequences was over 1000 times larger than that of extracts from frozen tissue. This method will be useful for diagnostic and investigative studies of HCV infection.


DNA ploidy and karyotype in recurrent and metastatic soft tissue sarcomas.

To study mechanisms involved in evolution of soft tissue sarcomas, we compared DNA ploidy and karyotypes at different stages of their disease in two patients with myxoid liposarcomas (MLS), one with a fibrosarcoma (FS), and two with rhabdomyosarcomas (RMS). None of the MLS samples revealed clearcut histologic changes in later samples as compared to their primaries, and the DNA ploidy in all samples was diploid. In one patient karyotypes at four different times during the 19 yr of his disease all revealed a t(11;12) (p15;q13), but additional clonal chromosomal abnormalities occurred only in later recurrences. In another patient the karyotypes obtained in the 26th and 28th yr of his disease were similar and included the t(12;16) (q13;p11), characteristic of MLS. A comparison with karyotypes of six other MLS patients at different disease stages suggests that the presence of a t(12;16) may correlate with less aggressive clinical behavior. The histology of the FS remained low-grade and the DNA ploidy diploid. The karyotype, however, showed evolution. In both MLS and FS, chromosomal changes thus seem to be a more sensitive marker for tumor progression than histologic changes or DNA ploidy. In one embryonal RMS, karyotypes obtained 7 and 11 yr after the primary diagnosis were different but clearly had a common "progenitor." In one alveolar RMS, the primary and the synchronous lung and lymph node metastases all revealed a t(2;13). The findings in RMS suggest that polyploidization is an early event in tumor evolution, especially in the alveolar subtype, which may be followed by additional chromosomal changes. In addition, DNA ploidy was measured in eight other RMSs. Among the RMSs the embryonal subtype was characterized by DNA aneuploidy, whereas three of the alveolar cases were in the tetraploid range and one was peridiploid. In local recurrences and in metastases changes in DNA index were observed in half the cases.


Signet cell melanocytic lesions.

Malignant melanoma can produce diagnostic problems for the histopathologist because of its protean histologic patterns. The recently recognized signet cell pattern can be particularly confusing and must be distinguished from adenocarcinoma, tumors of vascular endothelium or adipose tissue, lymphoma, and epithelioid smooth muscle lesions. We report four new cases of signet cell melanoma and illustrate this pattern in primary as well as metastatic sites. In addition, we document the signet cell pattern in benign nevi for the first time, expanding the concept of this pattern to melanocytic cells in general. The differential diagnosis of signet cell melanoma and its mimics is discussed and the utility of immunohistochemical stains in this diagnosis is stressed.


Morphometric quantitation of tumor necrosis in stage 1 non-small cell carcinoma of lung: prognostic implications.

We objectively examined the extent of tumor necrosis by computer-assisted morphometry in 28 patients with surgically resected Stage I non-small cell carcinoma of lung. Fourteen of the 28 patients were long-term survivors (mean survival after diagnosis 94 mo) and 14 were short-term survivors (up to 62 mo after diagnosis). The extent of tumor necrosis was determined by means of a computer assisted digitizing system. The two sample t test and the two-tailed Wilcoxon rank score tests were used for statistical analysis of comparison of the extent of tumor necrosis between the two groups of patients. This morphometric study showed that the extent of tumor necrosis was significantly associated to the probability of long-term survival, with long surviving patients having a lesser degree of tumor necrosis (t = 2.75, p < 0.02, 2 sample t test, two-tailed, df = 26). These findings reaffirm previous subjective data, derived from pathologist assessment of tumor necrosis, and suggest that morphometric evaluation of tumor necrosis may play a useful adjunct role in predicting prognosis of carcinoma of lung.


p53 protein expression in transitional mucosa and adenocarcinomas of the colorectum.

Transitional mucosa, the nonneoplastic mucosa adjacent to colorectal adenocarcinomas, exhibits some morphologic and histochemical abnormalities. It is unclear, however, whether transitional mucosa is a preneoplastic or reactive phenomenon. Though normal p53 functions as a tumor suppressor, p53 gene alterations have been proposed as a step in malignant transformation, and aberrant p53 protein expression has been described in a high percentage of colonic adenocarcinomas. Since p53 protein normally has a short half-life, immunohistochemical detection of the protein is considered to be evidence of abnormal p53 expression. We analyzed p53 protein expression immunohistochemically on frozen tissue samples of transitional mucosa, normal mucosa, and tumor from 20 cases. In all 20 cases the transitional mucosa and normal mucosa failed to express p53, while 13 of 20 adenocarcinomas showed positive immunoreactivity characterized by intense nuclear staining. There was no correlation between tumor stage and p53 expression. The absence of staining for p53 protein in TM does not support the theory that transitional mucosa is a preneoplastic phenomenon.


Patterns of basement membrane laminin distribution in nonneoplastic and neoplastic thyroid tissue.

Laminin, a major basement membrane component, is typically absent or partially lost around the epithelial elements of most invasive carcinomas. To evaluate the distribution of laminin in both primary and metastatic thyroid tumors, we studied 14 benign thyroid lesions (eight adenomas, two Graves' disease, two Hashimoto's thyroiditis, one adenomatous hyperplasia, one nodular goiter), 20 carcinomas (seven papillary, six tall cell variant, four follicular, three Hürthle), and eight metastases (five tall cell variant, three follicular) utilizing a polyclonal antibody against highly purified, nidogen-free laminin. All benign lesions showed positive, linear immunostaining along basement membranes. Partial loss or absence of laminin was seen in the solid areas of all types of thyroid carcinomas examined; well-differentiated papillary and follicular tumors, as well as papillary and follicular areas of more poorly differentiated neoplasms, maintained linear laminin immunostaining in the papillary cores beneath the epithelial cells and around follicles. A similar correlation between laminin deposition and architectural organization was seen in metastatic lesions. Hürthle cell carcinomas had a unique fragmented, pericellular immunostaining pattern around individual tumor cells, suggesting uncontrolled laminin synthesis. Our findings suggest that preservation of laminin production in thyroid tumors reflects their degree of differentiation and that absence of laminin correlates with lack of structural organization rather than reflecting invasive and metastatic potential.


A fetal testis with intratubular germ cell neoplasia (ITGCN).

A fetal testis with abnormal germ cells similar to the cells of intratubular germ cell neoplasia (ITGCN) or so-called carcinoma in situ is presented. Elective abortion was performed in week 18 of the pregnancy of a 26-yr-old woman, because of 21 trisomy (Down's syndrome) at amniocentesis. At microscopical examination abnormal germ cells were found, similar to those occurring in the adult testis and with the same distribution as those described in ITGCN in children with dysgenetic gonads and with androgen insensitivity syndrome. PAS positivity and placental-like alkaline phosphatase (PLAP) was demonstrated in the abnormal germ cells. The finding indicates that the first event of germ cell tumor oncogenesis may take place before birth, in utero or even before. The occurrence of ITGCN in Down's syndrome has not been reported previously but is likely to occur, as there is evidence that these patients have increased risk of developing germ cell tumors.


Characterization of the topography of Epstein-Barr virus infection in human immunodeficiency virus-associated lymphoid tissues.

A highly sensitive in situ hybridization methodology for Epstein-Barr virus (EBV) RNA was used to determine the topography of EBV infection in 16 cases of human immunodeficiency virus-associated lymphoid tissues. Four lymphomas, 11 persistent generalized lymphadenopathy (PGL) lymph nodes, and one lymphoepithelial cyst were studied. The pattern of EBV infection was diffuse in all lymphoma cases and predominantly interfollicular in PGL nodes. No discernable pattern of infection was present in the lymphoepithelial cyst. Germinal center cells were also infected in seven of the PGL cases, and this pattern predominated in one case. Double labeling immunohistochemistry/in situ hybridization studies on four cases of PGL indicated that the EBV infection was primarily involving B-lymphocytes, but rare infected T-lymphocytes were also identified. These studies further clarify the pattern and cellular site of EBV infection in human immunodeficiency virus-related lymphoid disease.


Enzymatic treatments on paraffin blocks for DNA flow cytometry.

The Hedley method for DNA ploidy analysis on paraffin-embedded tissue allows retrospective studies of large numbers of common and rare tumors for which treatment, progression, and outcome are known. However, the technique is cumbersome and has many variables, only some of which can be controlled at the time of laboratory analysis. We performed DNA ploidy analyses on two blocks from two islet cell tumors and on five blocks from two colon carcinomas. Sections of 50-microns thickness were deparaffinized in xylene, rehydrated in graded alcohols and in distilled water, and disaggregated with various enzymatic treatments: 0.05% pepsin (30 and 90 min), 0.5% pepsin (30 and 90 min), 0.05% protease (60 min), and 0.1% protease (60 min). The cell suspensions obtained were filtered, washed in PBS, and visually evaluated in a hemocytometer. Nuclei were treated with RNAse (0.1%) and stained with 50 micrograms/ml propidium iodide. Results were evaluated with the following criteria: (a) recovery of DNA aneuploid and/or G2M cells (cell-cycle analysis and visual evaluation); (b) coefficient of variation of the major peak (DNA diploid or DNA aneuploid depending on the case); (c) amount of debris (background events and visual evaluation); (d) mean channel for the G0G1 peak; (e) event rate; and (f) G2M/G0G1 ratio. The best results were observed with 0.05% protease when there was tissue necrosis and hence cell fragility, with 0.1% protease when there was significant tissue fibrosis, and with 0.05% pepsin (90 min) when there were intact cellular specimens without fibrous entrapment. The original procedure using 0.5% pepsin for 30 min produced less cell recovery, and histogram quality similar to or worse than these modifications in all cases studied.(ABSTRACT TRUNCATED AT 250 WORDS)


Antigen diffusion and uptake: a caveat in immunohistochemical interpretation.

Thyroglobulin was demonstrated by monoclonal immunohistochemistry in the cytoplasm of renal cell carcinoma cells metastatic to the thyroid gland. This was attributed to release of thyroglobulin from injured native thyroid with diffusion and uptake by tumor cells. Previously reported cases of this process in tumors in thyroid, skeletal muscle, and lymphoid tissue are reviewed. Interpretation of the significance of demonstrated antigens in tumor cells, especially those that are constituents of invaded native tissues and only focally present, should be interpreted with caution and in conjunction with other histologic evidence.


Research by pathologists not funded by external grant agencies: a success story.

The paradigm of pathology research as an endeavor among grant-funded principal investigators resulting in first-author publications is unsupported by quantitative examination of author profiles extracted from the scientific literature. Publications in six pathology journals (Modern Pathology, American Journal of Surgical Pathology, Human Pathology, Acta Cytologica, Archives of Pathology and Laboratory Medicine, and American Journal of Clinical Pathology) and three general science journals (Science, New England Journal of Medicine, and Proceedings of the U.S. National Academy of Sciences) were reviewed. Twenty articles per journal from each of three years (1987, 1989, and 1991) were examined (a total of 520 articles). Of these, 295 articles were first-authored by a member of a department of pathology. Of the 295 articles first-authored by a member of a pathology department, 47 (16%) articles listed competitive grant support. Of the grant-supported articles, 20 articles listed NIH support, but only four had an NIH-supported principle investigator as the first author of the article. Unfunded research represented the vast majority (84%) of work produced by pathologists. A review of the ISI Citation Index showed that those articles written by funded pathologists averaged 8.7 (S.D. 7.8) citations per article, compared to 10.4 (S.D. 12.1) citations per article for unfunded pathologists. Results suggest that unfunded research accounts for the majority of pathology research activity as well as their resulting literature citations.


Excessive collagen formation in fibrolamellar carcinoma of the liver: a morphological and biochemical study.

We have studied the excessive deposition of extracellular matrix in a patient with fibrolamellar carcinoma of the liver. The collagen matrix was predominantly composed of collagens I, III, and V. Since specific mRNAs for collagens I and III were detected by in situ hybridization, we also provide evidence that the fibroblastoid stromal cells were the major source of this collagen. Occasionally, also tumor cells could be shown to express collagen III-mRNA. Furthermore, some tumor cells showed positive signals for TGF-beta 1, while isolated stromal cells expressed interleukin-6. This cytokine expression may probably be related to the altered control of collagen gene expression.


Bilateral massive ovarian leiomyomata in a young woman: a case report with review of the literature.

We report a case of ovarian leiomyomata, bilateral and massive, in a 21-yr-old woman. Primary leiomyoma of the ovary is a very rare tumor and is usually small, unilateral, and concomitant with uterine leiomyomata. To our knowledge, this is the first report in the English literature of bilateral ovarian leiomyomata. We document the smooth muscle origin of the tumors with immunohistochemical studies that show appropriate staining with antibodies to vimentin, muscle specific actin, desmin, smooth muscle actin, and collagen type IV. The available literature is reviewed. The characteristics of both typical and atypical ovarian leiomyoma and theories of its origin are discussed.


[Contribution of 99mTc MAG3 in hypertension in an elderly subject with renal artery thrombosis].

To ascertain the responsibility of renal artery thrombosis for the genesis of arterial hypertension, the methods available are not sufficiently sensitive and reproducible, and the residual revascularization maintained by a vicarious arterial network is not easy to demonstrate. Renal scintigraphy with technetium 99m-labelled mercaptoacetyltriglycine (MAG3) was performed in 4 old and severely hypertensive male patients with chronic thrombosis of one renal artery. With this tracer the thrombotic kidney was detected lately and weakly at the vascular and nephrographic stages. When the functions of both kidneys were compared, that of the affected kidney was always estimated at less than 5%. At the excretory stage a residual activity could be detected in the kidney with renal artery thrombosis. Owing to the specific biophysical behaviour of the tracer, MAG3 scintigraphy coupled with arteriography and assays of plasma renin activity in the veins contribute to the decision concerning nephrectomy.


[Dominant polycystic renal disease. Study of 105 cases].

The study concerns 105 cases of dominant polycystic kidney disease. Affected relatives were observed in 65% of patients. The clinical features that leads to diagnosis were lumbar pain in 37.5% of cases, renal failure in 24.6% of cases and hypertension in 15.1% of cases. Hypertension was observed in 46.7% of cases and it seems that its onset is independent of chronic renal failure. Its frequency is of 55.1% when only kidneys were affected and of 21.4% when the liver was affected too. The progression of chronic renal failure is influenced by hypertension.


[Malignant lymphoma of the testicles].

Between January 1980 and January 1990, a tumour of the testis in 12 of our patients was found to be a non-Hodgkin's malignant lymphoma (NHL). Age varied from 16 to 83 years, with 9 of them aged over 50. In 7 cases the pretherapeutic evaluation disclosed one or more other visceral sites of the tumour, and in 6 cases the tumoral diameter reached or exceeded 10 cm. Staging according to the Ann Arbor classification was: IE: 3 cases; IIE: 1 case and IV: 8 cases. The histological type assessed according to the international classification was: lymphoblastic (2 cases), small cell non cleaved of Burkitt's type (1 case), immunoblastic (2 cases), large cell diffuse (3 cases), mixed diffuse (3 cases), small lymphocyte diffuse (1 case) and unclassifiable (1 case). Seven patients underwent orchiectomy which, in 3 of them, was not followed by any other treatment. Nine patients were put on polychemotherapy which was intensive in 6 cases. Median survival was 30 months. Four patients, all treated intensively, are now in persistent complete first remission. This study confirms that NHL of the testis is rare and its malignancy in almost every case is either high or intermediate grade NHL. It occurs predominantly in elderly men. Advance prognostic factors are often present at diagnosis. However, the advent of intensive polychemotherapy seems to have transformed the course of the disease as well as that of other aggressive NHL's in more common sites.


[Omeprazole and liver functions].

Omeprazole is the first of a new class of drugs (proton pump blockers) approved in the United States and in Europe for its high efficiency as an inhibitor of gastric acid secretion. Omeprazole is a drug for short term use in patients with acid-peptic disease. A limited prevalence of hepatotoxic effects is reported by some authors (transitory rise in serum aminotransferase level) and it may be prescribed in patients with chronic liver disease although slower metabolism and greater bioavailability are observed. Omeprazole interacts with the cytochrome P-450 system in the liver: inhibition of several liver mono-oxygenases activities (inhibitory effect on diazepam, phenytoin and R-warfarin metabolism with prolonged elimination); induction of P-450 (IA1 and IA2) enzymes that may potentiate the hepatotoxic effect of phenacetin and acetaminophen or increase the tumorigenic effect of chemical carcinogens (polycyclic aromatic hydrocarbons, arylamines, aflatoxin). This latter concern is unfounded as based on a false extrapolation from the results of in vitro studies to those of in vivo situations. However, although omeprazole has proved to be remarkably free of side effects, postmarketing surveillance is recommended for potential interaction with other drugs that are known to be metabolized by the same liver enzymes.


[Abdominopelvic actinomycosis in pseudo-tumoral form: diagnosis by ultrasonography-guided biopsy].

The authors report a case of abdominopelvic actinomycosis, a rare bacterial infection. This case is exceptional for its clinical tumoral expression with fistulization through the skin, and for its rapid diagnosis by ultrasonically-guided needle biopsy. The clinical, bacteriological, histological and therapeutic aspects of actinomycosis are detailed.


[Right cardiac insufficiency disclosing systemic mastocytosis].

The authors report the case of a 54-year old woman presenting with right cardiac failure in whom the diagnosis of contemporaneous cutaneous-systemic mast cell disease was made. The cardiac symptoms regressed concomitantly with the vasomotor manifestations of the mast cell disease. Following a review of the principal mast cell mediators, the cardiovascular manifestations of the disease are studied and pathogenetic hypotheses are being put forward.


[Jejunal perforation by cholesterol embolus: a case treated surgically].

A case of ischaemic jejunal perforation which could be attributed to mesenteric cholesterol emboli is reported. The jejunal pathology had been preceded by other, more classical sites of systemic cholesterol embolization that occurred immediately after arterial catheterization in this male patient with aneurysm of the abdominal aorta. Emergency segmental resection of the jejunum was performed with satisfactory immediate results. Histological examination of the operative specimen confirmed that the perforation was caused by cholesterol emboli. Cholesterol embolization of the intestine may have various clinical consequences which are reviewed by the authors.


[Acute ischemia of an arm manifesting Buerger's disease. Predisposing role of anorexia nervosa].

Peripheral vasomotor disorders, notably acrocyanosis, are frequent in anorexia nervosa, but ischaemic accidents are unknown. We report the case of a 32-year-old woman with a 10-year history of anorexia nervosa, who developed acute ischaemia in one of her upper limbs. In this particular case several aetiological factors may be considered: Buerger's disease, of course, as the patient smoked and had an abnormal arteriography, but also hypercholesterolaemia, thrombocytosis and disorders of platelet aggregation.


[Bony involvement of the calcaneum in sarcoidosis. A case report].

Bone lesions of sarcoidosis occur in 10 to 15% of the cases, most often involving the extremities. These frequently corticosteroid-dependent lesions worsen the prognosis of the disease. We report a case of sarcoidosis of 14 years duration in a 58-year old woman who presented with a bone lesion strictly localized to the calcaneum. To our knowledge, such lesion has not previously been reported.


[Ptosis and asthenia manifesting a mitochondrial myopathy].

We report a case of mitochondrial myopathy discovered in a 55-year old woman who was being investigated for the cause of her asthenia. Physical examination showed ptosis of the upper eyelid and proximal muscle deficit. Histological examination of a muscle biopsy disclosed rare fibres with mitochondrial aggregates. Biochemical exploration of muscle tissue revealed a double enzyme deficit involving complexes I and IV of the respiratory chain. Clinical improvement was obtained after the patient was put on coenzyme Q10. We conclude that a diagnosis of mitochondrial myopathy must be considered in patients, including middle-aged adults, presenting with muscular asthenia.


[Acute interstitial nephritis with uveitis. A case report].

Dobrin et al described in 1975 the first case report with acute renal failure due to tubulo-interstitial nephritis accompanied by uveitis and an inflammatory syndrome. The young adults are frequently involved and the complete resolution is usually obtained after corticosteroid treatment; this contrasts with the tendency towards relapse of the uveitis. The etiology and the pathogenesis of this syndrome remain unknown. We report the case of a woman which the renal function was incompletely reversible with corticosteroids.


[Benefits of corticosteroids in the treatment of Horton's disease and rhizomelic pseudopolyarthritis: advantages and inconveniences. A meta-analysis].

Although corticosteroid treatment is clearly beneficial to patients with temporal arteritis, its exact risk/benefit ratio in these old and side effects-prone patients is unknown. We have thus surveyed that available French and English literature, in order to pool the published series and to evaluate the iatrogenic potential of corticosteroids in this situation. We selected 11 series, yielding a total of 1008 patients. A treatment failure resulted in the death of the patient in five cases. Twenty-seven patients became blind, but only 2 under treatment. The side-effects involved 29% of the patients and are responsible of 29 deaths (2.9%): osteoporosis was the main problem, followed by femoral head necrosis and muscle wasting. Gastroduodenal ulcers were uncommon and generally benign; sigmoid colon diverticulitis was infrequent but dangerous; some infectious complications were noted (herpes zoster, tuberculosis, etc...); high blood pressure and diabetes were common problems. Psychiatric side-effects were rare. Thus, the unwanted effects of corticosteroids in the treatment of temporal arteritis are relatively infrequent and generally not severe, except osteoporosis. They should be systematically prevented by appropriate diet and treatments (e.g., calcium, potassium, and vitamin D supplements).


[Respective prevalences and frequencies of Horton's disease and rhizomelic pseudopolyarthritis. Epidemiological study in the Loire-Atlantic department using a general practice research network (RESOMED 44)].

Using a research network of general practitioners (Resomed 44) representing the 20th of all GP's in the Loire Atlantique region and distributed at random according to district, age and sex made it possible to evaluate the respective prevalences of temporal arteritis (TA) and polymyalgia rheumatica (PMR) in all the systemic immune diseases listed. Among these diseases, rheumatoid arthritis was the most frequent (35.39%). TA (18.8%) and PMR (18.54%) had about the same prevalence. For each of these diseases the year/physician prevalence was evaluated at 0.11, which means that the probability for each GP to see 1 TA and 1 RP at once in 10 years. At the time of the survey, 52.9% of TA patients and 78.8% of PMR patients were surviving. GP's alone follow up more TA's and PMR's than the other systemic immune diseases.


[Treatment of scapula alata with a new surgical technique].

By analysing the various surgical procedures used in the management of scapula alata, the author describes a personal technique where scapula is fixed to the 7th rib with the shot palmar tendon. For the stabilisation of the scapula, its inferior angle introduced under the great dorsal is sutured with strong catgut, the needle entering from under the depth of muscle and emerging on its posterior aspect where catgut ends are knotted.


Management of perineal impalement injuries.

Between 1975 and 1990, 18 cases of sphincter and pelvic floor injuries, of which 7 isolated and 11 part of severe polytraumas, were treated. Thirteen cases benefited from primary repair. Colostomy was required in 9 cases due to the complexity of lesions, in other 5 cases the wounds drainage and colostomy were undertaken. Secondary repair was done after 2-6 months. The functional results in 11 patients indicate a good continence in 6 of 7 cases with primary repair. The results of secondary repair are satisfactory.


[The prosthetic saddle in physiognomic reconstruction of the dental-alveolar arches].

The investigation of 2087 patients with partially extended, subtotal and total edentations who presented to the Clinic of Dental Gnathoprosthetics of Iaşi made possible the assessment of the role and importance of prosthetic saddle in the physiognomic restoration in such patients. By applying the modern clinical and technical methods of designing and making the gnathoprosthetic apparatus, the physiognomy of dento-alveolar arches according to actual exigencies and observing the dento-facial harmony can be achieved.


[Physiognomic reconstruction of the dental arches in emergency treatment].

The gnathoprosthetic treatment in emergency is now a compulsory step in solving the esthetic problems raised by the affections of stomatognathic system (coronary lesions, edentation) localised in visible areas of dental arches. Nowadays, the state of stress induced by these affections can be relieved by an immediate and highly physiognomic treatment, a method at hand being the Scutan mask. Excellent technic results can be obtained by using conformators obtained by thermoplasticizing and vacuumating, in current use in our clinic.


[Clinical variability in partial and extensive anodontia].

In a longitudinal study, 48 patients aged between 4.6 and 30.5 years with various degrees of partially extended anodontia were investigated clinically and paraclinically for 4 years. The changes in occlusal function in the context of clinical variability of partially extended anodontia will also induce, finally, a change in the fundamental craniomandibular relation.


[Therapeutic means and methods in recurrent pleurisy].

During a 10-year interval (1981-1991), at the IIIrd Medical Clinic of Iaşi 960 cases with pleural effusion, of which 768 (80%) non-recurrent and 192 (20%) recurrent, were diagnosed. The etiology in the latter cases was malignant (40%) and non-malignant (60%). Proper treatment methods for limiting or suppressing the recurrent pleurisies proved to be imperative. Thoracocenteses cause protein and electrolyte depletion which aggravate the general state and hasten the unfavourable evolution of the etiological affection. This is the reason why besides the general etiopathogenic treatment, a local pathogenic treatment (cytostatic, anti-inflammatory) and especially pleurodesis are compulsory. The intrapleural administration of cortisone is efficient in the case of recurrent autoimmune pleural effusions but is worthless in the malignant ones. In the latter situation, the intrapleural cytostatic treatment should be first attempted and, in case of failure, the development of pleural symphysis by external radiotherapy or injecting talc into the pleural space should be made. In the terminal stage of cardiac insufficiency or liver cirrhosis with recurrent pleural effusion, the pleurosymphysation is not indicated; a sever edematous-ascitic attack may occur or become aggravated by the pleural irritative process due to this method.


Etio-pathogenic views on transsexualisms (TS).

Starting from the analysis of six cases of transsexualism (TS) the authors performed complex investigations of all sex levels and identified primary T.S. (disturbances of sexual differentiation), secondary TS (sexual perversions, sexopathy). This distinction appears to the authors as unavoidable for ethico-pathological and legal drive in view of the implications of T.S.--implications able to be analysed from standpoint.


Psychopathological relationships in depressive illness.

The evolution of the clinical concepts regarding depressive syndromes underlines the need for correlating the epidemiological, clinical and etiopathogenic data for elaborating the classification, quantification and psychopathologic assessment systems. The psychological investigation, complementary to clinical examination and adapted to patient's subjective condition, requires an improvement of its methods in view of bringing more information necessary for stating the differential psychodiagnosis and for a proper psychotherapy. The analysis of motivations and the psychopathologic relationships in the depressive states render evident the factorial complexity and the need of a clinical, psychological, genetic, biochemical, experimental and therapeutic approach. Thus, a bio-medical and psychotherapeutic approach will improve the clinical research and psychopathologic assessment. The psychodiagnosis and psychotherapy, as elements of clinical care, make possible the clearing up of the therapeutic possibilities in the complex approach of personality, promoting the psychoprotective comprehension and the state of mental health.


[Experimental data on epithelial factors modulating bronchial reactivity].

A tracheobronchial smooth muscle reactivity study on isolated guinea pig tracheal rings was done. The presence of two different factors active on smooth muscle, an inhibiting one, as well as an activating one was identified. Generated on different pathways, the epithelial derived relaxing factor is a cyclooxygenase dependent prostaglandin, while the activating epithelial factor seems to be a thromboxane derivate.


[The transient ischemic attack, between diagnosis and treatment].

The transient ischemic attack (TIA) in cerebral circulation in 161 patients is studied. The causes and favouring factors are analysed, arterial hypertension and dyslipidemias representing 70% of the factors that might be incriminated in the physiopathology of TIAs. The paraclinical and therapeutic results demonstrate that in over 30% of the cases the etiology could be explained by "the multiple defect theory", the importance of transcranial Doppler in the diagnosis and prognosis of TIA, especially in the young patients, being underlined.


[Preliminary data on possibilities for the early detection of risk for primary liver carcinoma in chronic HBsAg carriers].

The investigations on the risk of hepatocarcinogenesis in the HBsAg chronic carriers have suggested that the early detection of primary liver carcinoma requires epidemiological and laboratory follow up of their state of health. The preliminary results of the comparative investigations of 103 HBsAg carriers detected among blood donors and 93 controls without HBsAg are presented. Epidemiological inquiries, clinical examinations and laboratory tests (HBsAg, serum alpha-fetoprotein, alkaline phosphatase, gamma-glutamyltranspeptidase, glutamic-pyruvic transaminase, proteinogram, siderophilin, immunoglobulins M, A, G) were carried out. Elevated levels of alpha-fetoprotein, alkaline phosphatase and gamma- glutamyltranspeptidase were recorded in carriers as compared to controls (38.8% and 86%, respectively). The elevation of the levels of liver damage markers was significantly correlated, in the HBsAg carriers, with the carrier state over 3 years and less with the age-group. In the case of two carriers with elevated levels of alpha-fetoprotein (> 600-> 1,000 ng/ml) ultrasonography confirmed the suspicion of primary liver carcinoma.


[Two decades of epidemiologic surveillance of the evolution of viral hepatitis in Iaşi County (1971-1990)].

The results of epidemiological observations on the evolution of viral hepatitis in the Iaşi district in the interval 1971-1990 are presented. A mean morbidity of 251.2 cases/100,000 inhabitants, this being in most years under the national mean, was found. In 75.9% of all cases the infections caused by hepatitis viruses affected the age-groups 1-14 years, indicating a high incidence of hepatitis A... Hepatitis B had a more increased incidence in the children aged 0-1 year, then it decreased but was present in all age groups. Although recorded all year round, increases in the incidence of viral hepatitis A were noticed during fall and winter seasons, prevailing in the children and teenagers collectivities.


[Glutathione and the redox index in different types of cellular oxidative stress. I. Acrylonitrile (ACN) poisoning].

The professional poisoning with acrylonitrile of some subjects induced a significant decrease of reduced glutathione (81.30%), redox ratio reduced glutathione/oxidized glutathione (90.74%) and "Benzi-redox index" (55.84%) but an increase of oxidized glutathione level (112.6%) as compared to normal controls (100%). This proves the occurrence, in time, of the cellular oxidative stress and/or were obtained.


The spread of X-linked shifting gene responsible for G-6-PD deficit in series of 13,710 subjects from 4 districts of Moldavia.

Between 1985 and 1989, a sample of 13,710 subjects (5,825 males and 7,885 females) from the Vrancea, Bacău, Neamţ and Suceava districts were examined for the presence of this pathological gene, 32 male hemizygotes and 13 female heterozygotes and homozygotes being detected. The incidence of G-6-PD deficit in the hemizygotes was of 0.55%. The investigations carried out in the shifting gene carriers' families revealed the way deficit is transmitted to offsprings. Hemizygotes get it from their mother while the female homozygotes either from their mother or father. The frequency of G-6-PD deficit of 0.55% in a population sample of 13,710 subjects is within the limits established by Marcu and Schneer for our country (0.1-1.8%). By comparing the frequency of 0.55% in the Vrancea, Bacău, Neamţ and Suceava districts which formerly had an increased incidence of malaria (Galaţi - 4.01% and Huşi - 5.94%) its low value could be explained by the absence of malaria factor.


[A population study on the possible involvement of trace minerals in water in cardiovascular diseases].

Starting from the hypothesis of a possible protection exerted by oligominerals in cardiovascular diseases, 660 water sources were analysed as to their content in mineral matter. It resulted that the population drinks a very hard water with a low content in zinc, manganese, copper and chromium oligominerals. By correlating these characteristics with the mortality rate by cardiovascular diseases, low in the territory under study, it became evident that no association between these factors can be made, the relative protection being probably due to other factors.


[Environmental pollution studies of fluorine coming from industry].

Fluorine in optimal concentration prevents dental caries, while an excess or deficiency in it may lead to pathologic alterations which make fluorine be one of the environmental pollutants the concentration of which is limited by health standards. This investigation, carried out in the area of an aluminium plant, showed the presence in excess of fluorine and fluorine-containing dusts in the atmospheric air, determining an increased fluorine content in the ground and vegetal cultures of the respective area. Negative effects of these noxae upon vegetation and animals were noticed.


[Analytical study of theophylline-rutozide (TR-1722)].

A compound obtained by the semisynthesis of theophylline and rutozid was analysed elementary and physicochemically. The performed analyses showed that it was 7-rutozidil-is-propanolen-theophylline.


[Morbidity from various causes in rural children in the Republic of Moldova].

Child morbidity in the rural areas of the Republic of Moldavia was evaluated based on the data of attendances for medical care and complex medical examinations performed in 7,434 children aged between 0 and 14 years from five districts of the Republic. The age-group, sex and disease-groups distribution of morbidity are presented. These data were compared with the results obtained in other areas of the former Soviet Union. Measures for lowering the morbidity in the rural children of the Republic of Moldavia are suggested.


[Antimicrobial activities of organic zinc compounds].

Taking into account the competitive action of zinc towards other ion essential for pathogenic germs metabolism, the complex erythromycin-zinc, zinc salts of sulfamethoxydiazine, sulfanilamide, sulfacetimide, sulfathiazole as well as the Mannich basis of sulfamethoxydiazine were synthetized. The antimicrobial action towards gram-positive, gram-negative pathogens and fungi was tested by the classic diffusiometric method. An increased antimicrobial action for the Mannich basis of sulfamethoxydiazine and for the zinc salt of sulfamethoxydiazine, alone or in association with metronidazole--chemotherapeutic agent used in the infections with anaerobic organisms was found. A significant antimicrobial action was also found for the complex erythromycin-zinc and zinc salts of sulfacetimide and sulfathiazole.


[The synthesis of new pyrrolidone derivatives with psychotropic action].

The synthesis of ten new heterocyclic compounds obtained by the addition of pyrrolidone to heterocumulenes and its condensation or of its sodic derivative with acid chlorides is presented. The synthetized pyrolidonic derivatives were subjected to a preliminary study for determining their possible psychotropic action. The pharmacological screening evidenced a significant hypothermisante and neurodynamic-nootropic action of some synthetized compounds.


[New derivatives of pyrazolo- and tetrazolobenzoquinolines with antimicrobial action].

The conditions for obtaining and the properties of some new diazabicyclic compounds is the new step in our investigation on the benzocynoline derivatives. The structure of the new compounds was confirmed by elementary (C, H, N) and spectral analyses. The antimicrobial tests evidenced that part of the newly synthetized compounds have a good antifungal action.


[Methodology for quality control of an ointment with antivaricose properties].

A personal formulation of an ointment with antivaricose properties is presented. A methodology for the physicochemical and rheologic control, including all parameters required by the standards for ointments quality control, was designed. The analyses showed that the ointment is stable in time, has a thixotropic consistency and behaviour and does not require special preservation conditions.


On hypotensive action of some imidazoline derivatives of sulphonamidated aryloxyalkylcarboxylic acids.

New imidazolines derived from sulphonamidated aryloxyalkylcarboxylic acids have been tested for their antihypertensive action and toxicity. The obtained results attest a remarkable biological action, low toxicity and a good absorption in oral administration.


Experience with vaginal reconstruction utilizing the modified Singapore flap.

Many types of vaginal reconstruction have been described, and we have employed several with varying degrees of success. All we have used seem to have drawbacks. In April 1989 Wee and Joseph from Singapore described a technique using neurovascular pudendal-thigh flaps as islands. Initially we used the procedure as described. Later we modified the approach by releasing the labia majora, allowing them to retract somewhat anteriorly, and rotating the flap into position. This procedure has been used in eight patients, in some instances under the most adverse circumstances in patients who have undergone multiple procedures and heavy irradiation (including intraoperative radiation) besides experiencing postoperative leakage of urine. Though we have had dehiscence and problems with infection and drainage in some of our patients, no flap has failed, contour is exceptionally good, and potential for function is satisfactory. The procedure requires less time and produces better results than any other technique employed by us in the more than 30 vaginal reconstructions we have carried out. The technique will be illustrated and clinical cases will be presented.


Luteal phase deficiency: effect of treatment on pregnancy rates.

Luteal phase deficiency is thought to be a cause of female infertility. Nevertheless, little agreement exists concerning either its diagnosis or its treatment. To address the latter question, we reviewed the English literature and examined the effect of treatment on pregnancy rates. One randomized controlled trial found a statistically insignificant benefit of treatment with progesterone suppositories or oral dehydroprogesterone versus no treatment (relative risk 1.9; 95% confidence interval 0.4 to 8.1). Three other comparative studies also showed no statistically significant benefit. Case-series reports (before-after studies) claiming benefit failed to account for the effect of regression to the mean. The benefit of treatment for luteal phase deficiency has not been established. Uniform case definitions and randomized controlled trials of adequate power are needed to resolve this problem.