Multi-element follow up in biological specimens of hard metal pneumoconiosis.

The movement of Co and the other components of the hard metal in the body fluids, their solubility, their links to the cells and proteins of the body, and their clearance are largely unknown. The first aim of this work is to evaluate whether Neutron Activation Analysis (NAA), a new analytical technique based on the radiochemical separation of samples irradiated in a Nuclear Reactor, may be suitable for studying the movement of elements in tissues or body fluids of workers over time. We have investigated seven hard metal workers, all employed in the grinding process, with NAA studies (single study in two, follow-up in five) of 29 elements on lung tissue, BAL fluid, blood, urine, pubic hair, toenails and sperm. In three, the diagnosis of hard metal pneumoconiosis was easy; in the other four, due to evident bilateral hilar lymphadenopathy, it was difficult to distinguish between pneumoconiosis and sarcoidosis stage II, and the final diagnosis, after pulmonary biopsy, was hard metal pneumoconiosis in three, and sarcoidosis in one. In spite of high potential, NAA gives a number of unexpected results, with apparent controversies and no clear relationship in the evolution of levels of Co, W and Ta: there is no simple explanation for such apparent inconsistencies at present, so that the study of the movement of elements in body fluid sometimes appears disappointing with this technique. Other observations were noted from the data available: 1) the concentration of elements (Co, Ta, W) in lung tissue is far higher than in BAL fluid, but the factor is so variable that BAL fluid cannot be taken as representative of the concentration of elements in lung tissue. 2) High concentrations in tissues or body fluids are indicative for exposure, but not for disease. In the light of available data, there are no levels above which development of disease is inevitable. 3) When the problem is to distinguish between sarcoidosis and pneumoconiosis in exposed subjects, the concentration of elements is of no value, and the pulmonary biopsy is still necessary. However a NAA study may be helpful to confirm the presence of the offending agent, and to avoid pulmonary biopsy in cases where the occupational history is unclear.


Sarcoidosis in Spain.

We review the Spanish literature on sarcoidosis, and describe the most important epidemiological and clinical findings. Recent epidemiological data show a cumulative annual incidence rate of 1.36 per 100,000 inhabitants. The most relevant clinical aspects are the high incidence of Löfgren syndrome (48% of the cases), and the low percentage of cases diagnosed by routine chest X-ray (9%). Findings of intrathoracic and extrathoracic sarcoidosis, biopsy procedures, Kveim test, lung function tests, as well as the activity markers are, in general, similar to those previously described in the literature. The overall prognosis of sarcoidosis in Spain is good.


Sarcoidosis in Tuscany. A preliminary report.

A retrospective study was carried out by a computerized questionnaire in a sample of 109 sarcoidosis patients (43 men, 66 women) diagnosed between 1977 and 1990 in Pisa. 94% of the patients were resident in Tuscany. The onset of disease was earlier in the men than in the women; in 73% of the patients the symptoms were first noticed between February and July with two incidence peaks; 71% of them had never smoked; 10% of patients were symptom-free and the disease was discovered by chance; the other patients (90%) underwent chest X-ray because of joint symptoms (35%), erythema nodosum (34%), cough (28%), dyspnoea (27%), and fever (24%) which was often associated with other symptoms. Symptoms from the respiratory tract was present in 66 patients (61%); 58% of patients were resident in rural areas; the level of education was limited to primary school in 50% of the patients; as to the prevailing working positions, 27% were clerical workers, 24% manual workers, and 26% housewives.


Isolated portal hypertension in sarcoidosis. A report of two Indian patients.

Two patients with portal hypertension due to sarcoidosis are described. While one of them had severe bleeding from varices the other was asymptomatic. Endoscopic sclerotherapy obliterated the bleeding varices and is planned for the other patient if he bleeds.


Symptomatic rib lesions as the primary presentation of sarcoidosis. Report of two cases and review of literature.

Skeletal involvement in sarcoidosis is considered a manifestation of chronic disease. Rib lesions, while rarely reported, have been usually asymptomatic and often associated with vertebral sarcoidosis. Here, we report two patients with symptomatic rib lesions in sarcoidosis. Both patients were black males. In both cases, chest X-rays lacked characteristics of pulmonary sarcoidosis. A definite diagnosis was made on rib biopsies and confirmed by the positive Kveim test. One case was particularly interesting in that low back pain preceded the right hilar adenopathy for many years. This suggests that sarcoidosis involving the bone may occur at early stage of disease, and that low back pain in young male may be the first presentation of sarcoidosis. A literature review of osseous involvement in sarcoidosis reveals that skeletal lesions in sarcoidosis may preferentially manifest in the axial skeleton in some individuals.


The role of integrins in the immune response.

The integrin is one of at least three different families of adhesion molecules. Integrins are heterodimeric cell surface receptors, important for adhesion, migration and cellular interactions of immune cells. There are at least 6 subgroups of integrins, each defined by a common beta submit (beta 1-beta 6) which shares multiple alpha subunits. Among them are the receptors for fibronectin, laminin, vitronectin, as well as the very late activation antigens (VLA 1-6) and the C11/CD18 complex. The role of these molecules in the immune response is discussed with special focus on the beta 2 integrins (CD11/CD8) and their ligand ICAM-1 (CD549).


Effect of cigarette smoking on prevalence of summer-type hypersensitivity pneumonitis caused by Trichosporon cutaneum.

We investigated the effect of cigarette smoking on the prevalence of summer-type hypersensitivity pneumonitis (SHP) caused by Trichosporon cutaneum. In the adult family members of SHP patients, we found that 27 of 41 (65.9%) nonsmokers were SHP patients, compared with 3 of 11 (27.3%) smokers (p less than .05). Also, the prevalence of anti-T. cutaneum antibody was significantly lower in the smokers (p less than .05). A questionnaire provided to 209 SHP patients revealed that the smoking rates of male and female SHP patients were significantly lower (p less than .01) than rates in the normal Japanese population. However, no difference was found in serum anti-T. cutaneum antibody activities or the bronchoalveolar lavage lymphocyte phenotypes for smoking and nonsmoking SHP patients. It was concluded that cigarette smoking had a suppressive effect on the outbreak of SHP, but smoking caused no further suppression after the disease was established.


Robin sequence and a deficiency of the left forearm in a girl with a deletion of chromosome 4q33-qter.

We have investigated a patient with the Robin sequence and a unilateral deficiency of the left forearm. She was found to have a terminal deletion of the long arm of chromosome 4, del(4)(q33). The clinical manifestations of this patient differ from those of 7 previously described patients with a deletion of the same segment.


Brain-oriented intensive care after resuscitation from cardiac arrest.

The 'chain-of-survival' concept has gained general acceptance in the care of cardiac arrest victims. Most standards and guidelines for cardiopulmonary resuscitation, however, focus on the initial links in the chain. We consider appropriate in-hospital care for the survivors a logical extension of the chain of survival. In recent years extensive research activity has probed the pathophysiology and pharmacology of postischemic reperfusion. The present review discusses the current understanding of mechanisms for cerebral damage following global ischemia. Promising pharmacological principles for protection or resuscitation from cerebral ischemia are reviewed. None of them are considered ready for clinical application. Clinical guidelines are proposed, based on the reviewed data and previously published clinical observations. Cornerstones of the proposed brain-oriented intensive care protocol are: (1) hemodynamic monitoring and meticulous treatment of circulatory disturbances, (2) controlled ventilation providing normoventilation and normoxia to all comatose patients, (3) avoiding hyperglycemia and hyperthermia in comatose patients, (4) adequate analgesia and sedation, tempered by the understanding that oversedation impedes neurological evaluation without promoting recovery. An accurate prognosis can usually be made 48-72 h after resuscitation. This permits reevaluation and assignment to an appropriate level of continued hospital care.


Neuroanatomy of the ocular motor pathways.

Oculomotor-related structures in the brain stem extend from the rostral mesencephalon to the hypoglossal nucleus in the caudal medulla. This chapter reviews their location in man, their connections and some basic features of their function; these are summarized in Table 1. In addition to the extraocular motor nuclei (the oculomotor, trochlear and abducens nuclei) the brain stem contains premotor areas responsible for all five different types of eye movements and for gaze-holding. These premotor structures include the riMLF and PPRF for the generation of vertical/torsional and horizontal saccades, respectively. The role of the vestibular nuclei in the VOR and optokinetic responses is well established, and they probably also mediate smooth pursuit eye movements along with the dorsolateral pontine nuclei and the floccular region. In contrast, there is only scanty evidence for the function of the accessory optic nuclei relaying optokinetic information in man. Little is known about the neuroanatomy of the premotor areas for convergence. There is accumulating evidence that the INC and the vestibular and perihypoglossal nuclei are essential for the maintenance of gaze.


Ocular motor dysfunction in stupor and coma.

Ocular motor disorders in stupor and coma are important clinical signs which are easily accessible with observation and a few bedside manoeuvres. Although the manifold signs of ocular motor dysfunction may be confusing to most clinicians, many of the signs can be attributed to clear pathophysiological mechanisms. This holds for conjugate eye deviations as well as for most spontaneous eye movements in coma. Using simple methods to elicit reflex eye movements, in most cases a lesion site within or outside the brain stem can be determined. It is stressed that an exact description and documentation of the ocular motor deficit is necessary. The following key aspects should be included in such a documentation: pupil size and reaction, conjugate or disconjugate eye position, spontaneous eye movements and VOR elicited either by head rotation or caloric irrigation. The latter allows assessment of the ocular motor integrator. The VOR may be intact, indicated by full compensatory eye movements, but the gaze-holding mechanism (integrator) can be defective, thus permitting the eyes to drift back to the primary position.


Cyclorotation of the eyes and the subjective visual vertical.

Pathological CR of the eyes and deviations of the SVV are among the most sensitive clinical brain stem signs. In acute unilateral brain stem infarctions, deviations of the SVV occur in 94% of cases and CR of one or both eyes is found in 88%. Deviations of CR and the SVV are typically ipsiversive with pontomedullary lesions and contraversive with pontomesencephalic lesions. They may involve a complete OTR, the triad of lateral head tilt, skew deviation and CR. There is a directional linkage between CR and the SVV (i.e. either right or left tilt), but the net tilt angles do not always match quantitatively. Pathological CR and deviations of the SVV obviously represent dysfunction of the VOR in the roll plane, which is subserved by both otolith and vertical canal inputs.


Disorders of head-eye coordination.

Head-eye coordination subserves the rapid transference of gaze and between gaze shifts stabilizes fixation on stationary or smoothly moving targets. The coordination involves various combinations of the components of head movement, saccadic eye movements and visual and vestibular slow phase eye movement whose fine tuning may be adjusted, to an extent currently debated, by higher order mechanisms. Disorders of head-eye coordination may result in loss of acuity when slow phases are impaired or difficulty with reorientation if there is difficulty with saccades or head movement. Pathophysiology in the brain stem affecting individual components of eye movement may often be identified with success, particularly for the horizontal system, but the organization of other functions, notably pursuit suppression and vertical movements, are little understood. Similarly little is known about the disorders of the overall pattern of coordination--'gaze types'--including the apraxias, which have been attributed to cortical, basal ganglia or even cerebellar dysfunction and are reported in an almost bewildering variety of diseases. The development of coordination in infancy is a rich field in which there have been few studies with adequate observational techniques. The differentiation between congenital disorders whose severity may subsequently wax or wane, variants on normal development and acquired disorders poses a clinical problem which could largely be resolved with adequate recording techniques. For the future there is the tantalizing promise that once the principles of coordination are understood, we can move on to the more intriguing questions of how a certain 'toss of the head' and 'look in the eye' not only transfer gaze but can also be so meaningful.


Behavioural and neural correlates of vestibular compensation.

Sudden complete loss of input from one labyrinth results in a massive change in behaviour. A vigorous horizontal ocular nystagmus occurs together with postural changes. These dramatic changes are short-lived and within about a week they have almost disappeared. This very rapid recovery has been the basis for the postulation that vestibular compensation is a textbook model for the study of neural plasticity in the central nervous system. Whilst the behavioural recovery is dramatic, quantitative testing reveals the loss and the permanent asymmetry of the system (Table 1). Recordings from single neurones show that many neurones in the ipsilesional VN are silenced by the unilateral loss, but as they start to fire again, so the spontaneous nystagmus declines. The major question which is still unanswered is the cause of the return of the firing of neurones in the ipsilesional VN. The answer may be found by studies of the neurochemistry of the VN using brain slice preparations. This review shows some of the errors which have been made by attempting to infer purely vestibular function from measurements of eye movements when other sources of ocular motor control may operate.


Pathophysiology of rapid eye movements in the horizontal, vertical and torsional directions.

Saccades and fast phases of optokinetic or vestibular nystagmus are rapid eye movements which are generated in the reticular formation of the brain stem. Palsies of rapid eye movement generation therefore always point towards an infratentorial lesion. Two cell assemblies are responsible for the generation of rapid eye movements: the PPRF, which triggers all rapid eye movements and in this sense plays an important coordinating role in addition to generating movements with a horizontal movement component, and the riMLF in the mesencephalon for movements which have a vertical or torsional direction component. As neurone populations are anatomically segregated according to their respective on-directions, focal lesions lead to the loss of rapid eye movements in particular directions (Table 2). Such palsies of rapid eye movement generation which are direction specific can be distinguished from dysmetria, which points towards a cerebellar lesion, or the difficulty to trigger a saccade to a particular target, which can involve cortical systems.


Clinical features and pathogenesis of acquired forms of nystagmus.

Nystagmus is a common finding in patients with disease affecting the brain stem and cerebellum. Basic research into mechanisms that normally control eye movements has led to a better understanding of the pathogenesis of different types of acquired nystagmus. Nystagmus is caused by disorders of the mechanisms that normally function to hold gaze steady: the vestibular system, the gaze-holding mechanism, the visual stabilization system and the smooth pursuit system. Thus, evaluation of a patient's nystagmus requires a systematic examination of each functional class of eye movements. In addition, it is important to determine the direction of the nystagmus for different angles of gaze and head positions, and the effects of monocular and binocular visual fixation upon the nystagmus. Measurement of the nystagmus waveform, using reliable methodology, is often helpful in securing a diagnosis. Such measurements help differentiate acquired nystagmus from congenital forms of nystagmus and from saccadic disorders that lead to instability of gaze.


Nuclear and infranuclear disorders.

Lesions of the brain stem can either affect the nuclei or the fascicles of the third, fourth or sixth cranial nerves and thus produce ocular motor disorders. Lesions of the oculomotor nuclear complex differ from lesions of the third nerve, since the motoneurones in the nucleus are specifically grouped. Similarly, a lesion of the sixth nerve nucleus results in a conjugate gaze palsy and not in an abducens palsy, because of 'interneurones' being intermingled with the abducens motoneurons. Isolated lesions of a nerve fascicle, which is the part of the cranial nerve running through the brain stem, usually cannot be distinguished clinically from lesions of the nerve outside the brain stem unless other brain stem signs are present. In the case of an isolated ocular motor nerve palsy, modern imaging techniques, particularly magnetic resonance imaging, may help to localize the lesion to the brain stem. Most often, however, brain stem lesions also involve structures surrounding the ocular motor nuclei or fascicles, sometimes leading to characteristic eponymic syndromes. In congenital eye movement disorders the pathoanatomical situation is more complex. Since the lesion takes place during intrauterine or early postnatal development, corrective misdirection of neurones occurs in addition to aplasia or hypoplasia of parts of the cranial nerves. Correspondingly, abnormal movements accompanying an attempted eye movement can be observed in some characteristic syndromes.


Smooth pursuit disorders.

Smooth pursuit is a relatively recent eye movement which has developed in frontal-eyed species. The smooth pursuit system is involved during foveal smooth pursuit, the 'rapid' component of OKN slow phase and VOR suppression. The cortical areas controlling smooth pursuit (at the temporo-parieto-occipital junction and in the FEF) send ipsilateral projections onto the pontine nuclei, mainly the DLPN, passing through the anterior part of the midbrain. A midbrain or DLPN lesion results in ipsilateral smooth pursuit impairment (i.e. decreased gain) (Table 1). After the pontine nuclei, all smooth pursuit pathways pass through the cerebellum. They project onto the flocculus, mainly contralaterally (first decussation of the lateral smooth pursuit circuitry), and bilaterally onto the posterior vermis. Eye velocity is encoded in the activity of the floccular Purkinje cells, whereas target velocity is encoded in that of the vermal Purkinje cells. Unilateral floccular lesions and posterior vermal lesions (involving both sides of this structure) result in ipsilateral and bilateral smooth pursuit impairment, respectively. The flocculus sends an ipsilateral inhibitory projection onto the MVN, the y-group nucleus and the SVN, controlling contralateral, upward and perhaps downward smooth pursuit, respectively. Alternatively, the downward smooth pursuit pathway could pass through the dentate nuclei. The MVN sends a contralateral excitatory projection onto the abducens nucleus (second decussation of the lateral smooth pursuit circuitry). These anatomical and physiological characteristics of lateral smooth pursuit pathways, in addition to the results of lesion studies, suggest that, besides the floccular inhibitory Purkinje cell, there is another inhibitory neurone in the circuitry preceding this cell, perhaps within the flocculus itself. The posterior vermis projects onto the fastigial nuclei, which also control smooth pursuit. These nuclei could send efferents to those periabducens cells involved in ipsilateral smooth pursuit. The final part of the pathways involved in vertical smooth pursuit could pass mainly through the BC, originating in the y-group nucleus for upward movement and in the SVN or the dentate nuclei for downward movement. Alternatively, a ventral tegmental tract could transmit upward smooth pursuit signals between the y-group nucleus and the oculomotor nucleus. The MLF also belongs to this vestibulo-oculomotor circuitry, but does not appear to be crucial for vertical smooth pursuit since this eye movement is only partially impaired after MLF lesions. Lastly, parallel to the direct vestibulo-ocular motor nuclei pathways, there are other pathways passing through the brain stem integrators, converting eye velocity signals to eye position signals during all eye movements, including smooth pursuit.(ABSTRACT TRUNCATED AT 400 WORDS)


Internuclear ophthalmoplegia: pathophysiology and diagnosis.

The main findings in unilateral INO are paresis of adduction in the eye on the side of the lesion (for conjugate but not vergence eye movements) and abduction nystagmus in the eye on the side opposite to the lesion. A skew deviation (eye usually higher on the side of the lesion) or a dissociated, mixed vertical-torsional nystagmus, with the eye beating down on the side of the lesion, may also occur. The main findings in bilateral INO are paresis of adduction in both eyes, bilateral abduction nystagmus and, in the vertical plane, impaired gaze-holding, vestibular responses and smooth tracking. Abduction nystagmus in INO may have a number of causes; probably most common are a gaze-evoked nystagmus superimposed on adduction weakness and adaptation to adduction weakness. Most of the findings in INO can be explained by interruption of projections from abducens internuclear neurones, mediating adduction, and from the vestibular nuclei, mediating both canal- and otolith-induced reflexes as well as vertical gaze holding and pursuit. Extension of the lesion to structures near but outside the MLF, or involvement of cell bodies intermixed with MLF fibres, may also be important in the pathogenesis of the abduction nystagmus and the occasional slowing of abducting saccades.


Use of antiplatelet medication for prevention of myocardial infarction and stroke.

Patients who suffer a heart attack can reduce the risk of another attack by 20% by taking 325 mg aspirin daily or every other day. The risk of stroke can be reduced by 50% in patients who experience atrial fibrillation or transient ischemic attacks. Although the benefit of aspirin use in women is controversial, data that suggest that women benefit as well as men are emerging. Antiplatelet drugs should be used only as adjunctive therapy and should not divert one's attention from the more important task of reducing major risk factors, such as smoking, hypertension.


The "chain of survival" concept: how it can save lives.

The AHA Committee on Emergency Cardiac Care recommends that all communities strengthen the four links in the chain of survival: Early Access: Install an enhanced 911 emergency dispatch system. Provide certification training to all emergency medical dispatchers. Develop community-wide education and publicity programs that focus on cardiac emergencies and a proper response by citizens. Early CPR: Implement and support community CPR training programs. In these programs emphasize early recognition, early telephone contact with the EMS system, and early defibrillation. Use training methods that will increase the likelihood that citizens will start CPR. Adopt targeted CPR programs. Implement programs for dispatcher-assisted CPR. Early Defibrillation: Adopt the principle of early defibrillation. Train all emergency personnel who perform basic CPR to operate an automated external defibrillator. Implement more widespread use of automated external defibrillators by community responders and allied health responders. Early Advanced Life Support: Coordinate advanced life support units with first-response units that provide early defibrillation. Develop procedures that combine rapid defibrillation by first-response units with rapid intubation and intravenous medications by the advanced life support units.


Radiographic diagnosis of heart failure.

In the initial evaluation of cardiac patients, valuable information can be derived from the chest radiograph. In general, acute left-sided heart failure is shown by an erate cardiomegaly, cephalization of the pulmonary vascularity, and a mixed type of pulmonary edema. Gross alveolar pulmonary edema with a normal or minimally enlarged heart. Subacute failure is associated with modcardiomegaly, striking cephalization, and interstitial pulmonary edema are hallmarks of chronic left-sided heart failure. Right-sided heart failure is shown by enlarged systemic veins and right-sided chambers as well as pulmonary oligemia. Pleural effusions in heart failure tend to be bilateral or unilateral on the right side.


Atrial fibrillation: conventional wisdom reappraised.

For years the conventional approach to treatment of atrial fibrillation has centered around use of digoxin for rate control and type IA agents for conversion to normal sinus rhythm and has avoided use of anticoagulation therapy for most patients. Current data suggest that new conventions are needed. beta-Blockers or calcium channel blockers should be considered equal to, if not better than, digoxin for rate control. Type IA agents are still the drugs of choice for conversion to and maintenance of normal sinus rhythm, but the newer agents propafenone and flecainide, and perhaps even amiodarone, may be more efficacious if preliminary data are truly indicative of their effect. The use of antiarrhythmic agents requires caution and careful attention to factors that may predispose patients to their inherent proarrhythmic effects. Finally, anticoagulation therapy is no longer reserved for a few patients but should be used in low doses in most patients (when not contraindicated) to lower risk of stroke. This new approach must be challenged as well to minimize the morbidity and mortality of this common clinical problem.


The endothelial cell.

This article reviewed several important functions of the endothelium as they pertain to both normal vascular function and pathology. The endothelium has other functions that were not discussed, including regulation of vascular permeability and elaboration of several growth-promoting and growth-inhibiting factors. It is almost certain that as our knowledge of endothelial cell function increases, other roles of this important cell will be discovered. Many scientists are investigating how endothelial interaction with the remainder of the vessel and blood elements is altered by various vascular diseases. Efforts directed toward correcting or modifying endothelial cell function in these diseases will lead to new and innovative therapeutic approaches.


Is angiotensin II a growth factor masquerading as a vasopressor?

The actions of angiotensin II can be described in terms of the three paradigms listed in Table 1. According to the first paradigm (organ physiology), angiotensin II is a pressor, while the second (cell biochemistry) views it as an extracellular messenger that, by promoting Ca2+ release within cells, causes vasoconstriction and a weak positive inotropic response by the heart. However, neither of these paradigms fully explains the remarkable ability of angiotensin converting enzyme inhibitors to improve the prognosis for patients with heart failure. To account for these clinical effects of angiotensin converting enzyme inhibitors, we will probably need to invoke the third paradigm (gene expression), which views angiotensin II as a growth factor that promotes and modifies protein synthesis. Angiotensin II, therefore, should probably not be viewed simply as a vasoconstrictor with a side effect to promote hypertrophy, but instead as a growth factor that, because it utilizes Ca2+ to mediate its effects on gene expression, also increases smooth muscle tone and myocardial contractility. This view of angiotensin II as a growth factor helps us to understand the clinical benefit of angiotensin converting enzyme inhibitors as arising from inhibition of maladaptive changes in the failing heart (gene expression) as well as from the reduced afterload (organ physiology) that results from decreased smooth muscle tone (cell biochemistry).


Cardiovascular benefits of smoking cessation.

Cigarette smoking causes significant exposure to nicotine, which increases heart rate, blood pressure, and thus myocardial oxygen demand, and to carbon monoxide, which decreases the oxygen-carrying capacity of the blood because of carboxyhemoglobin formation. Cigarette smoking also predisposes the patient to coronary vasoconstriction. Smoking cessation results in the early elimination of nicotine and carbon monoxide from the system and decreases the risks of ischemia based on these mechanisms. Over the long term, smoking cessation results in elimination of the increased risk of myocardial infarction in patients without previous heart disease as early as 2 years after smoking stops. In addition, for patients with known coronary artery disease, smoking cessation results in an increase in HDL level, which may result in a retardation of atherogenesis and reduced cardiovascular morbidity and mortality. It is important for all physicians to reiterate both the short- and long-term risks of cigarette smoking as well as the good news-that smoking cessation results in a substantial, if not complete, reversal of the risk of myocardial infarction and death, particularly for patients with established coronary artery disease. In light of those established facts, efforts to develop more effective methods to help patients quit smoking must be increased so patients can realize these important health benefits.


Diagnosis of pulmonary artery hypertension.

The challenge for the clinician is to detect and diagnose pulmonary artery hypertension early, when treatment can be most beneficial. This can be done only if the clinician looks for pulmonary hypertension and confirms the diagnosis through history taking, physical examination, and electrocardiographic and chest roentgenographic evaluation.


Coarctation of the aorta: difficulties in clinical recognition.

Coarctation can be recognized by physical examination alone early in a person's life, except in instances in which the obstruction is very mild. While some cases remain mild for a lifetime, others become progressively worse during adolescence or adulthood with typical manifestations of upper-extremity hypertension and imperceptible pulses in the lower extremities. It is especially urgent and sometimes difficult to recognize coarctation in infants with congestive cardiac failure just as it is to identify older children and adolescents with asymptomatic but severe systemic hypertension. There may be medical or legal implications in failing to do so.


Hypertension due to renal arterial disease.

Renal arterial disease occurs in 3-5% of patients with systemic hypertension. It is important to determine the type of lesion by arteriography to understand the natural history of the specific disease and to choose appropriate therapy. Some have questioned why arteriography should be performed if an operation or percutaneous transluminal renal angioplasty is not considered. One must keep in mind that if the arteriographic characteristics are known, the specific lesion and its course may be predicted, resulting in better management of the disease. In patients with a unilateral lesion angiotensin converting enzyme inhibitors are efficacious, but calcium antagonists may also be used. However, if therapy does not provide optimum control of blood pressure or the impairment of renal function progresses, then percutaneous transluminal renal angioplasty or surgery should be reconsidered.


Etiology: unknown or ignored?

It is important to determine whether a patient's medical problem is a physiological complication that has resulted from a disease process (such as heart failure that is a complication of calcific aortic valve stenosis) or a structural complication that has resulted from a disease process (such as a stroke due to an embolus from a left atrial thrombus caused by atrial fibrillation in a patient with mitral stenosis). Whereas treatment is available for heart failure and stroke regardless of the cause, the progress of medicine is nullified when treatment is not directed at the etiology of heart failure and stroke. Finally, and most importantly, the identification and treatment of cardiovascular diseases that may cause heart failure and stroke may provide the physician with an opportunity to prevent these serious complications. The New York Heart Association four-part diagnosis (a complete diagnosis) requires the physician to consider all the important aspects of a patient's disease.


Antiphospholipid antibodies and ischemic stroke.

Antibodies directed against phospholipids are highly associated with episodes of venous and arterial thrombosis, which are often recurrent. There seems to be a skewed frequency of cerebral thrombosis when the arterial circulation is affected. Clinical clues that should lead to evaluation for aPL include stroke in a young adult, recurrent thrombosis or miscarriage, and thrombocytopenia. Associated laboratory abnormalities include a biologically false-positive test for syphilis, abnormal antinuclear antibody titers, and a high erythrocyte sedimentation rate. If the activated partial thromboplastin time is prolonged on routine screening and does not correct with mixing studies, a lupus anticoagulant should be suspected. However, more sensitive and specific tests are usually necessary to detect aPL. Many in vitro and more recently in vivo systems strongly suggest that aPL may be directly implicated in the pathogenesis of thrombosis. Optimal management of patients with aPL-associated thrombosis is unknown. The use of aggressive therapeutic management schemes with such agents as warfarin or corticosteroids is sometimes required.


[Metahemorrhagic adrenal pseudocysts: our experience].

Hemorrhagic adrenal cysts are a pathologic entity rarely described in literature. In this paper we present two cases of hemorrhagic adrenal cyst and we discuss about diagnosis and therapy.


[The long-term complications from ileostomy in patients with Crohn's disease and ulcerative colitis].

In the period between 1959 and 1984 at the Surgery Department of the University of Goteborg, ileostomy (after colectomy) was mad in 203 patients affected by chronic inflammatory bowel disease. Patients were followed up prospectively to evaluate the frequency and severity of the complications. The cumulative rate of surgical reoperation was significantly higher in the group of patients with Crohn disease in comparison with those affected by ulcerative colitis. After 8 years it reached 75% in the first group and only 44% in the second. The most frequent indication for surgery reoperation were stenosis and retraction. 83% of the operations were only local not requiring laparotomy. No statistically significant correlation was found for the reoperation rate, the surgical technique, the length of the ileal resection and the post-operative weight gain. Only a systematic and accurate follow-up done by the surgeon and the enterostomist can detect an optimal functioning of the ileostomy. In case of complications which could be surgically corrected an early operation is needed. In most cases this can be simply made by local anesthesia.


[Rectal prolapse and fecal incontinence. A prospective manometric study].

In the present work we have studied two consecutive series of patients who underwent a posterior abdominal rectopexy according to Wells or Ripstein. During the year of follow up no recurrences were observed. Functional results, evaluated according to a protocol, by history of the patient and manovolumetry, shoved an improvement of fecal continence in more than half of the incontinents in both series. However, constipation increased after Wells' rectopexy, while no major changes were observed after Ripstein's rectopexy. We conclude that the first surgical technique may offers worse functional results.


[Sexual dysfunctions after conventional proctocolectomy].

Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. 49% (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion without any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within five years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 24 delivered by caesarean section. 57 men who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about the presence of sexual disturbances and their incidence was studied, 57% of elderly patients (above 40 years old) complained a reduced libido and sexual satisfaction. In younger patients (below 40 years old) 33% complained an impaired quality of sexual ife and 22% complained an impaired sexual satisfaction. However, despite some sexual dysfunction, 56% reported improved sexual life and 67% improved sexual satisfaction. This may be explained by improved general health and increased libido after removal of diseased bowel. The incidence of patients with ejaculatory disfunction (retention or retrograde ejaculation) is 9%. The increased awareness of uro-genital disfunction and therefore their prevention can contribute to the improvement of quality of life and to the rehabilitation of patients with benign diseases.


Immune status of children suffering from minimal change nephrotic syndrome.

Twenty five children suffering from minimal change nephrotic syndrome were studied for immunological alterations at different stages of this disease i.e., onset, relapse and remission. Changes were found mainly at onset and during relapse in the form of altered helper and suppressor cell ratio, depressed delayed cutaneous hypersensitivity reaction, decreased S-IgG bearing lymphocytes with low serum IgG concentration, and increased S-IgM bearing lymphocytes with high serum IgM concentration. Majority of these parameters returned to normal values during remission. Serum IgE was found high at all stages of this. These alterations suggest defects in cell mediated immunity resulting in secretion of some substance which modifies the glomerular anionic charges.


[Malignant peritoneal mesothelioma: its evolution and outlook].

Mesotheliomas are mesenchymal neoplasms which originate in the lining membrane of various serous cavities: pleural, pericardial and peritoneal. Peritoneal mesotheliomas are extremely rare. They are usually seen to middle to old age, predominate in men. We report a case and show the most recent concepts about histology, pathology, diagnosis and medical-surgical therapy of these diseases.


Diagnostic parameters of vascular neoplasms by immunohistochemistry.

Immunohistochemical identification of Factor VIII-related antigen and Ulex Europaeus A-I lectin as endothelial markers were studied in a series of 103 cases, comprising of benign and malignant vascular tumours, and few undifferentiated sarcomas. The results are correlated with that of others in this area and emphasizes the utility of these markers in surgical pathological diagnosis, especially to confirm the difficult diagnosis of angiosarcoma from other poorly differentiated sarcomas.


[Total thyroidectomy in recurrent goiters (anatomicosurgical observations with the operating microscope)].

The relapses of the multinodular goitre, often linked with an insufficient surgical treatment of primitive lesions, make serious problems about the operating technique. The current guidance of surgeons is directed towards the complete thyroidectomy which profits, during the operating time, by the use of microscope to identify and to protect the recurrent nerves. This equipment has to be used by those equipped which know how to use it. In our work we report the results obtained with this technique and it's underlined how the complete thyroidectomy for the benign relapsing goitre could be considered curative towards those cases which present hidden microcarcinoma.


The basics of blood cell counter.

The time has come when a traditional hematologist of a developing country needs to change his frame of mind from time consuming, error prone, not so precise manual methodologies to economical, safe and precise automated procedures. More important is his role as a guide and teacher for his juniors who are exposed to automated laboratories from the beginning of their residency. At this juncture, one needs to be thorough with the principles of instrumentation, different models available, their merits and demerits and how and where these fit with the requirements of the laboratory. The haematologists also must be aware that automation has its own problems, limitations, disadvantages and interfering elements. The article discusses the present state of art.


[The functional and manometric-volumetric results following abdominal rectopexy for total rectal prolapse].

Functional changes after the posterior abdominal rectopexy for the treatment of rectal prolapse are not fully understood. We studied the effects of Wells' or Ripstein's rectopexy on functional characteristics as related to anal sphincter function, rectal volume and sensory function in 21 patients with complete rectal prolapse. We have observed an improvement of continence over 70 per cent in both groups. However, an absent or a decreased call to stool, constipation and evacuation difficulties are the aftermath of Wells' rectopexy, while these complaints appear basically unaffected by Ripstein's technique. Sensory thresholds for sense of filling and urge were significantly raised after Wells' rectopexy even one year after operation, whereas after Ripstein's operation sense of filling was not significantly affected and while sense of urge was increased early postoperatively, it was not significantly changed at one year postoperative control. In conclusion, when fecal incontinence appears associated to a complete rectal prolapse has good chances to improve postoperatively. Preoperative evacuation difficulties seems to be unaffected by a posterior abdominal rectopexy, Wells or Ripstein, but an extensive dissection of the rectum with the division of the lateral stalks, as it is performed in Wells' operation, seems to be a procedure that can create a further burden of problems to the patient and it seems coupled to a manovolumetric elevation of rectal sensory thresholds.


[Phlebographic study of venous incontinence in varicose veins].

Phlebography is a test known for a long time: although by this time it is supported and, in a way, substituted by some substantial and not surgical methods like the doppler test, doppler echography, plethysmography and the duplex scanner. This test makes it possible for us to achieve precise diagnosis rapidly and in an unequivocal way, especially in those cases in which the mentioned methods don't give final results. Nowadays phlebography has to be optimized and adapted to clinical request, in order to provide a through diagnostic result. The purpose of this work is to evaluate the effectiveness of this methodology using a group of selected patients for the test.


Fine needle aspiration biopsy--a critical investigation in thyrotoxicosis.

Four hundred and fifty two patients having clinical features of thyrotoxicosis have been studied for their hormonal (T4, T3 and TSH) content, I131 uptake levels and FNAB at repeated intervals. Four hundred and twenty seven had presented with diffuse enlargement and rest 25 cases with nodular enlargements. Of the primary hyperthyroidism cases 342 (82.4%) were of Grave's disease without exophthalmos and 73 (17.6%) with exophthalmos. T4, T3 and I131 uptake levels have correlated well with the degree of morphological changes as observed on FNAB. Degree of nuclear pleomorphism has correlated well with the duration of disease. Critical evaluation of morphological changes on FNAB has been done in all cases of primary hyperthyroidism being treated with neomercazole and radioactive iodine therapy. Treatment with neomercazole had shown, good correlation between time lag and the retrogressive changes. This was not so in cases treated with radioactive iodine therapy. Various known complications of radioactive treatment e.g. development of hypothyroidism, refractory and recurrent hyperthyroidism, exacerbation of the disease, radiation thyroiditis, and severe degree of dysplastic changes could be demonstrated in some cases on serial aspirations.


Nucleolar organizer regions in smooth muscle and breast tumours.

Paraffin sections of formalin fixed tissues, obtained from patients with smooth muscle and breast tumours, were studied by the silver staining technique to quantitate the Nucleolar Organizer Regions (AgNORs) per nucleus and to assess its significance as an independent variable in predicting the behaviour of these neoplasms. Five benign and five malignant tumours of smooth muscle along with ten benign and ten malignant epithelial tumours of breast were studied. Normal myometrium and breast tissue served as controls. Control, benign and malignant tumours of smooth muscle showed mean AgNOR scores of 2.68, 3.89 and 12.50 per nucleus respectively. Control, benign and malignant tumours of breast showed mean AgNOR scores of 1.75, 7.45 and 12.72 per nucleus respectively. These results suggest that quantitative analysis of AgNORs per nucleus is capable of differentiating benign from malignant lesions of smooth muscle and breast.


Incidence of mycoses in bronchopulmonary disorders.

A total of 274 samples were collected--180 sputum samples, 82 bronchial secretions and 12 pleural aspirates. Main fungus was Candida albicans from sputum (45.5 percent), from bronchial secretions (14.6 percent). Rest were Aspergillus, Alternaria and Helminthosporium. All the pleural aspirates were negative for fungus.


Effect of severity of "risk region" on therapeutic intervention of myocardial infarction size.

Isosorbide dinitrate was tried in 27 patients of acute myocardial infarction (AMI) with the purpose of reduction of infarction size. Overall average effect was not significant. But, it was found that, the small and moderate "predicted infarction size" (PIS) group of patients, were benefitted by the drug therapy. Effectiveness in the therapeutic intervention on ischaemic injury bore an inverse relation with the degree of PIS or the "risk region". Varying "risk region" may be an important factor responsible for the apparent discrepancy between results of different workers regarding therapeutic intervention of infarction size.


Photoprotection of ultraviolet light irradiated E. Coli. B/r cells.

Ultraviolet irradiated E. Coli. B/r cells recover from UV damage when the cells are kept in dark due to dark repair mechanism. Photoprotection by illumination of the cells in near UV light prior to the exposure to UV light increases the capacity of the cells to induce L-arabinose isomerase synthesis in response to inducer, L-arabinose. The survival of the cells is dependent on the UV dose. The increased synthesis of L-arabinose isomerase after photoprotection is due to the amount of cyclic AMP in the cells.


Study on the physico-chemical characteristics of breeding grounds in relation to the population density of Anopheles stephensi.

The present study which was based on the quarterly sampling and estimation of various physico-chemical factors throw light on the three significant points with regard to the population build up of Anopheles stephensi. Slightly alkaline pH is essential for higher population density, lower the salinity, higher the population density and higher amount of free ammonia in the water is accounted for the higher population density of A. stephensi.


Kala-azar in Ballia district, Uttar Pradesh.

Door to door search during 1991 in 85 villages in Ballia district of Uttar Pradesh revealed 29 sporadic cases of Kala-azar in four villages. Epidemiological investigations indicated indigenous transmission in Phulwaria village (PHC: Dubhar) with 25 cases while the remaining three villages showed four imported cases from the endemic states. No kala-azar cases had been reported in Ballia between 1947 and the present investigation. Phlebotomus arqentipes, the known vector of kala-azar in India, was encountered in 10 PHCs including the four villages having kala-azar cases. Regular vigilance in Ballia and the neighbouring districts in Uttar Pradesh bordering Bihar is suggested in view of indigenous transmission detected in one village with multiple infection in families. The presence of high vector density, ambient environmental factors and absence of regular residual insecticidal spray warrant constant surveillance in Kala-Azar prone areas in Uttar Pradesh.


Importance of mean parasite clearance time and recrudescence time and their role in gradation of Plasmodium falciparum resistance.

The present paper describes the relationship of Mean Parasite Clearance Time (MPCT) and Mean Parasite Recrudescence Time (MPRT) in the epidemiology of Plasmodium falciparum. The role of MPCT in grading the resistance of an area has been discussed. Further, MPRT revealed a positive correlationship with the percentage of RI resistant cases, and showed an increase with age. The ratio of MPRT/MPCT is an indicator of stability status of the resistance.


Malarial placental infection and low birth weight babies.

Two-hundred fifty-six mothers and their newborns were subjected to clinical and haematological tests for the evidence of malaria. Placentae of these were examined histopathologically for malarial parasites and malarial pigment. Forty six placentae showed scanty malarial pigment ingested by monocytes. These appearances were associated with focal syncytial necrosis and proliferation of cytotrophoblastic cells. Plasmodium falciparum was found in cord blood of six cases. The mean weight of newborns born to mothers having no evidence of malarial placental infection was 2.763 kg, while mean weight of newborns belonging to infected placentae was 2.143 kg. The difference was highly significant.


Chromosomal translocations and inherited semisterility in the malaria vector Anopheles stephensi Liston.

Anopheles stephensi males were irradiated with 3500 rads of gamma rays at the rate of 140 rads/min to induce chromosomal aberrations. Seven reciprocal translocations were isolated, including four sex-linked and three autosomal. The presence of translocations were confirmed by cytological analysis.


Acute respiratory infections in children: a study of knowledge and practices of mothers in rural Haryana.

In the present study, data were collected on knowledge and practices of mothers in two villages of Block Beri of district Rohtak for devising a standard management plan. In all 304 mothers were interviewed. About 23 per cent mothers recognised pneumonia by fast breathing and 11.2 per cent recognised severe pneumonia by chest indrawing. Only 1.3 per cent mothers knew infective origin of ARI. Although most of them were convinced about continuation of breast feeding, 70 per cent of them were advising food restriction. Use of herbal tea in ARI was widely prevalent and so was the practice of putting warm mustard oil in ear for curing ear pain. Primary Health Centre was the most frequented place for treatment of ARI and mother-in-law was the most important person in taking management decisions for the child.


Relative performance of Organon kit in comparison to Du Pont for confirmatory serological testing of HIV infection by western blot test in sera from blood donors.

A total of 32 specimens with different categories of reactivity by Du Pont Western Blot kit comprising of specimens showing full spectrum of HIV-I antigen specific bands, 19 specimens showing total absence of bands and four specimens showing non-specific bands (without any interpretative importance) were subjected to Western Blot testing by Organon test. Of the nine specimens showing full spectrum of bands by Du Pont the correlation with Organon kit was 100 per cent based on WHO criteria. Four specimens with non-specific indeterminate band pattern by Du Pont failed to show any band in Organon kit, indicating that latter to be more specific.


Evaluation of indirect immunofluorescent antibody test for detection of IgM specific antibodies in malaria.

Indirect immunofluorescent antibody test using Plasmodium falciparum antigen from in vitro culture was evaluated for detecting IgM antibodies in order to determine the feasibility of its application in serodiagnosis of malaria. Test was compared with the already adapted IgG-IIF test using the same antigen. It was found that none of the healthy controls and slide negative fever cases had malaria IgM antibodies whereas 8 per cent of healthy controls and 49.01 per cent of the slide negative fever cases had malaria IgG antibodies. The sensitivity of IgM-IIF test was 94.68 per cent and that of IgG-IIF test was 96.81 per cent. IgM antibodies could be detected very early even on the first day of fever and titre rose gradually with increasing number of days of illness before institution of treatment. The IgM antibodies, being short lasting are able to reflect recent infection. The test although highly sensitive and specific is laborious and expensive. Therefore, it may be used as a serodiagnostic test in advanced laboratories only for confirmation of selected slide negative cases.


Efficacy of bi-annual administration of DEC in the control of bancroftian filariasis.

The efficacy of bi-annual administration of DEC at the dose of 6 mg/kg body weight was evaluated on the microfilaraemia prevalence, density and vector filarial infection rates. Administration of four doses (4 x 6 mg/kg) of DEC significantly (P < 0.05) reduced the microfilaria rate of the community from 6.02 per cent to 2.31 per cent, microfilaria density from 0.66 to 0.17 and infectivity rate of the vector population from 0.8 per cent to 0.39 per cent.


Status of lymphatic filariasis in some select slum clusters of Delhi.

Filaria surveys conducted in some select slum clusters namely Hari Nagar, Yamuna pusht near Vijaya Ghat along the Ring Road and Timarpur in Delhi during 1989, 1991 and 1992 respectively, covering a population of approximately 5000 slum dwellers revealed the presence of bancroftian microfilaria (mf) carriers and disease cases. The mf and disease rates (per cent) in these three slum areas were in the order of 6.3, 2.2, 3.7 and 1.4, 0.5 and 0.1 respectively. The mf density varied from 3.1 to 12.3 per 20 cumm. blood. High ten man hour densities of Culex quinquefasciatus (581) in Yamuna pusht followed by (355) in Timarpur were recorded during entomological investigations. Hari Nagar accounted for least ten man hour density of Cx. quinquefasciatus (160), because collection was made during winter months (November-December). The dissection of Cx. quinquefasciatus did not reveal any human filarial infection except in Yamuna pusht where out of 139 only one Cx. quinquefasciatus was found infective.


Critical appraisal of entomological data of Madhya Pradesh for 1991 and its relevance to the National Malaria Eradication Programme.

Entomological data generated in five entomological zones, of Madhya Pradesh State during 1991 including, Bhopal, Bilaspur, Gwalior, Indore and Raipur were analyzed. The entomological parameters that were studied included per man hour (pmh) density, abdominal physiology and parity status. The inferences were related to i) resting behaviour (exophily/endophily) ii) duration of indoor resting period of mosquitoes iii) man-vector contact iv) efficacy of residual insecticide and v) vulnerability of the area to focal malaria outbreaks. The data chiefly pertains to the putative malaria vector Anopheles culicifacies in all the five zones under study. The studies have brought out that A. culicifacies, traditionally endophilic and endophagic, has demonstrated radical departure in its resting and feeding behaviour. In Gwalior zone the species shows high preference for exophily. In Bhopal and Indore zones there is differential resting behaviour with respect to season. The species shows, for most part of the year exophily but is also endophilic during post monsoon period. In Bilaspur zone the species shows marked exophily and endophagy. Irrigation practices seem to have affected the mosquito population density patterns in these regions as brought out in Indore and Bilaspur zone, where high density pattern is observed between November and February. These findings have obvious implications in selecting the appropriate intervention methods and the period of spray in areas where residual spray is the method of choice for interruption of transmission.


[The correlation between the conventional spermogram parameters and the osmotic resistance tests in patients from among fertile and infertile couples].

It is well accepted that routine semen analysis is a useful tool for valuation of male potential fertility. In our environment, HOST has been recently applied as an additional approach which early detects structural and/or functional alterations of the sperm membranes. We investigated the possible relationship between some semen parameters and HOST in males from A) fertile couples (23-32 years old; n = 11) and B) sterile couples (25-35 years old; n = 171. Sperm concentration, motility, morphology and HOST (semen incubation in hypoosmotic saline solution-sodium citrate and fructose, 150 m0sm/1--, 37 degrees C during 60 min) were evaluated. In HOST determinations, results higher than 60% of swollen cells are considered within the normal range. In our study, sperm from males of B group showed a significantly lower percentage of hyperhydrated cells than those from A group (55.7 + 2.2% and 70.4 + 2.3% respectively; p < .001). In addition, a significant statistical correlation between HOST vs motility or normal morphology was found. On the contrary, we detected no correlation between HOST vs sperm concentration or volume. We suggest that development and application of HOST as a routine, can play an important role in the evaluation and prognosis of an infertile couple.


[Alternatives for closure of the rectal "stump" in Hartmann's operation. A comparative experimental study which includes the resorbable mechanical suture (polysorb)].

Five different kinds of sutures which can be used for closure of the rectal stump in Hartmann's operation are evaluated in the same animal. They are compared at six different phases of the cicatrization process: 7-30-45-60-90 and 150 days. In the analysis, the degree of complete cicatrization is considered as well as the thickness of the cicatriced tissue, and other factors such as persistence of suture material and the result of it. All of the sutures involved accomplished the goal of a good joint of the planes of intestinal suture. Although, two of them, the metal stapler and Polyglactin (Vicryl) in extramucosal surgery fulfill almost in an ideal way the goals concerning security, rare reaction to suture material, and consequently less thickness in the cicatriced tissue (2 x 2 and 1 x 1 mm respectively) as well as complete cicatrization in ninety days. Stapler is performed quicker and in a more aseptic way, but the scar resulting from Polyglactin is smaller. In separate extramucosal points, silk produces a more important tissue reaction with a thicker scar (3 x 3 mm) coming to an end in 150 days. "Albert Lembert" type suture is really far away from being a good mean because it creates an important tissue reaction with a thick scar (3 x 3 mm), with late consolidation (150 days) and granulomatous reaction. Resorbable stapler--Polisorb--has a considerable volume and it causes an important tissue reaction which determines a very thick (4.5 x 4.5 mm) and "unfinished" scar within 150 days; really far away for practical use.


[The configuration of a video signal digitalizing system used in astronomy for radiological applications].

A digital system of video signals of astronomical use was developed to be applied in the field of radiology. The images were obtained from radiologic films by means of a standard video camera. The minimal specifications of the digital images for use in radiology are as follows: a) 2.5 lpm spatial resolution, b) a digital resolution of 8 bits (256 gray levels). Images (194 by 154 mm in size) can be obtained. The software processing was adapted for treatment of the images in radiology.


[Perforated colonic diverticulitis: its diagnosis and treatment. Our experience].

Six cases of perforated diverticulitis are presented that needed urgency surgery. The objective is to consider our guides of diagnosis and treatment towards this pathology and to justify Hartmann's operation as the technique of choice for these cases of generalised peritonitis.


[The prevalence of spinal column pathologies. Preventive measures].

It has been observed that a high percentage of students present problems with the spinal column; this is due to the lack of prevention in the activities of daily life and in hospitals' practice. Added to this, is the presence of a large percentage of alterations of the feet. This coincides with our hypothesis of work, and brings us to suggest the correct positions in the principal postures.


Structural changes induced by He-Ne laser on the chick embryo ovary.

The morpho-histochemical alterations that occur in the chicken ovary at 7 days of incubation after irradiation with He-Ne laser of a potency of 5 mw and at a wavelength of 632.8 nm were studied. The embryos were irradiated for 5 minutes through a window opened in the eggshell and aseptically maintained in incubator for 24 hours. The gonads were dissected out and processed for the following techniques: H/E, PAS, alcian blue, and toluidine blue. The ovaries were formed by a germinative or superficial epithelium, with germ and epithelial cells, and by primary sex cords compressed between them, although separated by a reduced stroma. The cords contained germ cells The surface coat of the germinative epithelium presented a thin layer of PAS positive, alcianophilic at pH 25 and orthochromatic material. Basement membranes and intercord extracellular substance were also PAS positive. Disorganization of the tissue structure was well manifest in irradiated gonads, accompanied by negativization of the histochemical reactions. A lymphocytic infiltration was also found. No structural alterations were observed in germ or epithelial cells. It is concluded that laser radiations would act producing decrease of the mucosubstances associated to the plasma membrane and basement membrane. They would also provoke the appearance of an inflammatory mononuclear infiltration.


Initiation of dialysis: when?

Initiation of dialysis depends upon several parameters including medical and non-medical reasons. Among the medical parameters measured or calculated creatinine clearance from plasma creatinine concentration seems to be the most reliable factor although clinical parameters such as gastro-intestinal disorders, cardiovascular, hematological, neurological manifestations and last but not least general status of the patient tend to play a determinant role in the decision of initiating dialysis. Dialysis is usually initiated for patients with a normalized creatinine clearance of 5 ml/min.1.73 m2 but optional dialysis could be initiated from a normalized creatinine clearance of 10 ml/min.1.73 m2, in case the capability of the patient and the physician to tolerate the burden of uremic syndrome is overcome. Rather than employing dialysis too late, it now seems advisable to initiate dialysis earlier in the course of chronic renal failure. Actually, retrospective analysis of 167 over 625 cases records from 1981 to 1985 and of 178 over 700 case records from 1986 to 1990 in the Department of Nephrology, Necker Hospîtal, plasma creatinine concentration at initiation of dialysis of the two period was 1044 +/- 17 and 981 +/- 13 mol/L respectively, corresponding to a creatinine clearance of 6 and 7 ml/min. It is clear now that management of chronic renal failure patients should be considered as a whole and initiation of dialysis is the end point of this global strategy. Definitely, optimal time for initiating dialysis should take into account various parameters, both biological and clinical as well as associated parameters such as age of the patient and involved systemic disease.


Sinus node automaticity during atrial fibrillation in isolated rabbit hearts.

It is still unclear what role the sinus node may play in the genesis or perpetuation of atrial fibrillation. Therefore, we studied the electrical activity in different regions of the sinus node during atrial fibrillation. In Langendorff-perfused rabbit hearts, paroxysms of atrial fibrillation were induced by burst pacing. Standard microelectrode techniques were used to record transmembrane potentials from different regions of the sinus node. We found that during atrial fibrillation, a high degree (5:1) of sinoatrial entrance block was present that protected the pacemaker fibers in the center of the sinus node against the high rate of fibrillatory impulses. As a result, the true pacemaker fibers in the center of the node were activated with only a slightly higher average rate than during sinus rhythm. Spontaneous diastolic depolarization was still present but was modulated by electrotonic depolarizations due to intranodal conduction block of atrial fibrillatory impulses. Incidentally, phase 4 depolarization resulted in the generation of spontaneous action potentials in the sinus node. However, the high activation rate in the sinoatrial border during atrial fibrillation prevented these spontaneous impulses to exit from the sinus node. Because of the minimal degree of sinus node overdrive suppression (9%) and the presence of concealed automaticity during atrial fibrillation, spontaneous termination of atrial fibrillation was promptly followed by resumption of normal sinus rhythm. During atrial fibrillation, sinus automaticity still is present in the center of the sinus node and hardly overdrive suppressed due to a high degree of sinoatrial entrance block.


[Aldose reductase: physiological role, properties and prospects for regulating activity].

Some properties of aldose reductase isolated from various sources and possible ways of regulation of the enzyme catalytic activity are reviewed. Mammalian aldose reductases are monomeric enzymes with M(r) of 30-40 kDa and a broad substrate specificity towards aldoses. The physiological role of this enzyme consists, apparently, in providing an additional pathway for utilization of glucose and removing toxic compounds carrying an aldehyde group from the cell. Aldose reductase is thought to play a key role in various hyperglycemic states, including diabetic cataract. The kinetics of the aldose reductase reaction is hyperbolic with NADPH and nonhyperbolic with glucose. The rate of the enzyme-catalyzed reaction is determined by the effector binding in the active of inhibitory center of the enzyme. Incubation with substrates leads to the activation of the enzyme which is accompanied by a decrease of the effector binding in the enzyme inhibitory center with a sharp decrease in the sensitivity of the activated enzyme to NADPH concentration changes in the presence of glucose excess. A mechanism underlying the catalytic effect of both native and activated forms of the enzyme is proposed.


[Effect of thyroid hormones and diacylglycerols on sphingomyelin metabolism in liver cell nuclei in rats of various ages].

Sphingomyelin metabolism in liver cell nuclei of rats of various age has been studied. It was found that the level of sphingomyelin hydrolysis in cell nuclei is the highest in young animals, showing a decrease in 24-month-old animals. The age-specific fluctuations in the activity of phospholipase C may be one of possible reasons for sphingomyelinase activity changes in liver nuclei during ontogenesis. It has been shown that thyroid hormones and diacylglycerols control the sphingomyelinase activity in rat liver cells.


[Regulation of aldose reductase activity. Mechanism of action of an activated form of the enzyme].

Activation of bovine eye lens aldose reductase during its incubation with NADPH and glucose was studied. The activated form of the enzyme was isolated, and the rate of glucose reduction measured within a broad range of substrate concentrations. Spectrophotometric titration and equilibrium gel-filtration were used to study the interaction of the enzyme active center with substrates. It was found that the reaction kinetics obeys the mechanism of a quasi-equilibrium binding of substrates with isomerization of the enzyme complexes with nicotinamide dinucleotide phosphates. This activation is accompanied by a transition from non-ordered to highly ordered binding of the substrates. The effect of ligands in the catalytic and inhibitory centers of the activated enzyme on the catalytic reaction was examined. It was found that the activated form of aldose reductase is characterized by a lower affinity of the inhibitory center for the flavonoid, morin. Morin binding not only inhibits the reaction but also prevents the activation of the enzyme.


[Nonenzymatic reduction of methemoglobin by free radical forms of NADH and riboflavin].

Nonenzymatic reduction of methemoglobin (met-Hb) is effectively catalyzed by NADH and riboflavin (RF). At low concentrations of met-Hb the EPR spectra of the ternary complex are characterized by an increased, whereas those at high met-Hb concentrations--by a decreased intensity of the RF semiquinone signal, which suggests that the met Hb reduction by a Leu-form of RF proceeds at a higher rate than that by the RF semiquinone radical. Riboflavin also accelerates the met-Hb reduction by a NADH-Fe2+ or NADH-Fe(2+)-EDTA mixture. It was found that the rate of met-Hb reduction by the organic radical increases in the following order: NAD. < RF H. < RF H2.


[Comparative characteristics of cyclodextrin glycosyltransferases from various groups of microorganisms].

Cyclodextrin glycosyltransferases (CGT-ase, 1.4-alpha-glucanotransferase, cyclizing, EC 2.4.1.19) produced by some thermophilic, alkalophilic and mesophilic bacterial strains, were isolated and characterized. It was shown that thermophilic and mesophilic CGT-ases represent a mixture of alpha-, beta- and gamma-cyclodextrins (CD), alpha-cyclodextrin being the predominant component. Alkalophilic enzymes produce only beta-CD and are able to produce CD not only from starch but also from maltose, melibiose, maltotriose, amylose and amylopectin. The optimal conditions for the catalytic activity of the enzymes were determined. It was found that calcium, magnesium and zinc ions have a beneficial effect on the specific activity of these enzymes. The amino acid composition of the enzymes was studied.


[Kinetics of merthiolate-induced aggregation of human platelets].

Incubation of human platelets (in the form of platelet rich plasma or washed platelet suspension) with sodium merthiolate (ethyl mercuric salicylate inhibiting the arachidonic acid incorporation into phospholipids) induces their irreversible aggregation, which is accompanied by TxB2 synthesis. The merthiolate-induced aggregation has a lag-period of 0.5-10 min, whose magnitude is inversely correlated with the merthiolate concentration. The concentration dependencies of the rate of the merthiolate-induced and arachidonate-induced aggregation are threshold ones; the Hill coefficients are more than 30. The merthiolate-induced aggregation occurs in two phases: a slow phase which is independent of the arachidonic acid cyclooxygenase metabolism and a fast phase which is fully blocked by indomethacin. This aggregation is inhibited by PGE1 and ajoene (an inhibitor of the fibrinogen interaction with the fibrinogen receptor, GPIIb/IIIa). Quantitative and qualitative analyses of the experimental data were performed, using a model which took account of: (a) increase in the concentration of free endogenous arachidonic acid resulting from the inhibition by merthiolate of the arachidonic acid re-incorporation into phospholipids, and (b) existence of a threshold intracellular arachidonic acid concentration needed for the irreversible aggregation of platelets.


[Monomerization of the fragment D dimer of stabilized fibrin by a secretion from the medicinal leech salivary gland].

The salivary gland secretion of the medicinal leech catalyzes the conversion into monomeric form of the fragment D dimer, the product of limited proteolysis of stabilized fibrin. Analysis of N-terminal sequences revealed identical fragments for the D-dimer gamma-gamma-chains and the D-monomer gamma-chains formed via this reaction and established the presence of only one N-terminal amino acid (Ser). These results provide evidence for the preservation of integrity of the polypeptide chains during monomerization of the D-dimer.


Frontal lobe degeneration of non-Alzheimer type.

In a longitudinal prospective study of dementias, several hundred cases have been examined from a clinical, brain imaging, neurochemical and neuropathological point of view. Frontal lobe degeneration of non-Alzheimer type (FLD) was the second most common primary degenerative dementia found in about 10% of the material. FLD has a consistent pathology and a characteristic clinical picture, which have been described by several independent research groups. The cortical degeneration mainly involves frontal or frontotemporal grey matter, without the circumscribed or knife-blade atrophy seen in Pick's disease. The degeneration involves predominantly frontal areas, including the insula and cingulate gyrus in its anterior parts. The striate body is normal or only slightly altered. The pathological changes are non-specific, with neuronal loss, slight gliosis and spongiosis but none or few senile plaques, tangles, congophilic vessels or Pick cells. Pathological changes are in some respects similar to those in amyotrophic lateral sclerosis. FLD is a slowly progressive dementia with personality changes, lack of insight, disinhibition, stereotypy and later apathy. There is also progressive dynamic aphasia which ends in mutism and amimia. Memory, spatial ability and receptive language functions are comparatively spared. Psychotic symptoms, emotional reactions, hypochondriasis and a Klüver-Bucy-like syndrome are sometimes observed. Electroencephalography is normal, at least during the early stage, while functional brain imaging such as regional cerebral blood flow reflects the frontal pathology. It is possible to achieve early diagnosis and differentiation from Alzheimer's disease and cerebrovascular dementia by clinical examination with neuropsychological assessment supported by brain imaging, and in the future probably various biological markers. The aetiology is unknown but there is a positive family history for dementia of similar type in about 50% of post-mortem verified cases.


Lewy body dementia.

Lewy body dementia is common. It presents either with cognitive impairment and neuropsychiatric disturbance followed by parkinsonism or as dementia complicating established Parkinson's disease. It is unusual both in its pathological features and in its clinical manifestations. Although both overlap to some extent with those of Alzheimer's disease, Lewy body dementia is at least potentially recognizable during life. Some of its manifestations can be ameliorated by established methods, and it has pathological and neurochemical features which offer some hope for the development of useful palliative therapy. Major progress towards effective treatment is, however, likely to depend upon an improved understanding of the molecular mechanisms underlying its aetiology.


Nonresponsiveness of the rat liver to alkylating carcinogens given by gavage.

Carcinogenic alkylating agents administered orally are metabolized in the liver and alkylate DNA in liver cells of rats and hamsters. They frequently, but not always, induce liver tumors, in addition to tumors of other organs. Directly acting alkylating agents, such as alkylnitrosoureas and alkylnitrosocarbamates, rarely induce liver tumors, although they alkylate DNA in liver cells. The methylating agents nitrosodimethylamine and azoxymethane induce high incidences of liver tumors in rats when given in drinking water, but few or no liver tumors when given by gavage, although the total dose and the weekly dose were the same in either regimen. In contrast, methylnitrosoethylamine and nitrosodiethylamine give rise to liver tumors in rats in high incidences whether given by gavage or in drinking water. Sharp differences are also observed with other nitrosamines, such as those containing a propyl group with an oxygen substituent in the 2-position. These discrepancies indicate that, in addition to alkylation of DNA, pharmacokinetics of dosing and distribution and other reactions of the carcinogen are the dominant factors in determining the development of tumors in the liver.


QSARs for monosubstituted phenols and the polar narcosis mechanism of toxicity.

Eighty 2-, 3-, and 4-position monosubstituted phenols representing various substituents were evaluated for relative toxicity, log IGC50(-1), with a short-term static protocol in the Tetrahymena population growth inhibition bioassay. Quantitative structure-activity relationships (QSAR) were examined using the 1-octanol/water partition coefficient (log K(ow)) and ionization constant (pKa) as independent variables. Four derivatives did not elicit the measured response at saturation. Five derivatives revealed altered high-performance liquid chromatography spectra with time. None of these derivatives were included in QSAR development. In addition, the carboxyl and nitroso derivatives were detected as statistical outliers. The model log IGC50(-1) = 0.6655 (log K(ow)) - 0.1464 (pKa) + 0.2206, n = 67, r2 = 0.909, s = 0.212, was found to be an excellent predictor of activity of phenols which elicit their toxic response by the polar narcosis mode of action. For the most part the tested derivatives showed little abiotic loss over the duration of the bioassay.


Regulation of existing chemicals under TSCA: information disclosure as the route to reducing risk and increasing available data.

The Toxic Substances Control Act (TSCA) empowers the Environmental Protection Agency (EPA) to regulate risk associated with the use of existing chemicals and the introduction of new chemicals into commerce. Due to a number of concerns, however, the authority to regulate existing chemicals under TSCA has enjoyed limited success. A more generic and flexible approach is needed to achieve significant risk reduction for existing chemicals. This paper presents a frame-work for a generic approach to the regulation of existing chemicals. Under this framework, EPA would officially recognize that the distribution of chemical substances without evaluating and communicating to the user how to avoid operationally undesirable exposures represents an unreasonable risk to health or the environment. Acting under the authority of TSCA, EPA would then generically require suppliers to communicate acceptable exposure levels and information regarding safe use. This framework is consistent with the express policy of TSCA, which states that development of data with respect to the effects of chemical substances and mixtures on health and the environment should be the responsibility of manufacturers and processors of chemicals. The approach outlined here is consistent with and complements initiatives of the Office of Toxic Substances (OTS) and would enable OTS to accomplish some of the fundamental goals of TSCA.


Emergency exposure limits: a guide to quality assurance and safety.

Emergency exposure limits (EELs) are necessary in disaster prevention, preparation, and repression. Occupational EELs are available for many chemicals, but are of low toxicological adequacy. An animal experimental EEL of high toxicological adequacy available for many irritant chemicals is the concentration causing a 50% decrease in respiratory rate (RD50). The most outstanding EELs for the general population are the emergency response planning guidelines (ERPGs). A theoretical framework for a three-limit system is developed by the European Chemical Industry Ecology and Toxicology Center (ECETOC). ECETOC found over one order of magnitude variation between assessments of several companies. Nine selected EELs were classified in three clusters of increasing degrees of seriousness of health effects. There was little consistency within clusters, making it impossible to combine EELs. It is recommended to develop a toxicologically adequate EEL in an intercontinental context with cooperation of industry and (supra)national regulatory bodies. ERPGs can be taken as a start. The framework developed by ECETOC can be used to improve the limit setting procedure. A 5- to 10-year update should become part of the procedure. Attention should be devoted to the use of expert judgment. The minimal uncertainty in EELs should be expressed by presenting ranges instead of single values.


A quality process for chemical product risk assessment.

One cannot manage a health or environmental risk of unknown dimension. Thus, the rational and cost-effective control of any risk lies first in its reasoned assessment. The assessment of risk is a scientific endeavor which embodies the intellectual use of information to reach a determination or assignment of an ascribed level of danger. It is, however, a decision process and approach whose details are substantially value laden. As such, it is potentially subject to a myriad of subjective interpretations from individuals with special interests and perspectives. Given this nature, it is incumbent upon those responsible for risk assessment in any organization to formulate a broad-based scientific consensus regarding the principals of quality assurance for the risk assessment process in their organization. This paper attempts to outline a rational and prudent consensus-based system for the quality assurance of risk assessment concerned with the danger to human health and the environment posed by the use of chemical products. We present it as a model that we hope could be accepted and implemented.


Lectin binding patterns in benign and malignant lesions of the breast.

The binding patterns of a panel of eight lectins were studied in twenty eight breast lesions, consisting of ten cases of fibroadenoma, three cases of cystosarcoma phyllodes, five cases of fibrocystic disease and ten cases of infiltrating duct carcinoma by light microscopy. The eight lectins viz. PNA, WGA, RCA, SBA, UEA I, LTA, LCA and Con A were tested on paraffin sections using the Avidin Biotin Peroxidase Complex technique. PNA, RCA and UEA I showed a consistent positivity in benign and malignant lesions. The binding was localised mainly along the apices of mammary ductal epithelial cells in the benign lesions. In contrast, the malignant cells showed a considerable variation in staining patterns like diffuse cytoplasmic, membranous, and vacuolar. No definite correlation was seen between the intensity of binding and the histological grade in infiltrating duct carcinoma except in the case of Con A which was seen to bind more intensely to poorly differentiated tumours. The diagnostic significance of these patterns have been discussed.


Clinical utility and monitoring of breast cancer by circulating immune complexes.

Circulating immune complexes (CIC) were estimated in 22 patients of breast carcinoma, 25 healthy control volunteers and 10 follow-up cases after mastectomy by polyethylene glycol precipitation (PEG pptn) test and Latex agglutination inhibition (LAI) test. CIC levels increased with advancing stage of breast carcinoma. Significant increase in CIC levels was observed in stage II (p < 0.01), followed by highly significant increase in stage III and IV (p < 0.01) as compared to the control group. Sharp decrease in CIC levels was observed three months after radical surgery in 9 post-operative patients. One patient remained seropositive by both tests, followed by a fatal outcome after four months follow-up. Seropositivity for CIC by PEG pptn test in patients of breast carcinoma was 72.72 percent as compared to 81.81 percent by LAI test. Combination of both tests increased total CIC positivity by 90.9 percent. Clinical utility and prognostic significance of CIC in monitoring breast carcinoma patients has been demonstrated by our study.


Myocardial changes in neonates dying of asphyxia neonatorum.

Ten neonates, asphyxiated at birth, were studied by Apgar score, ECG ischaemic score grading (ECGisg), Cardiothoracic (CT) ratio, biochemical parameters like CPK, CPK-MB fraction during life; and they were subjected to postmortem study with particular attention to the changes in the heart. The study revealed that 7 out of 10 asphyxiated neonates showed variable evidences of myocardial damage; but the extent of damage though well correlated with biochemical parameters, did not correspond well with the extent of asphyxia and the survival period. In rest 3 cases, myocardial damage was not overt though there was evidence of asphyxia and evidence of myocardial damage in the form of elevated CPK-MB level. These patients probably had died of "Biochemical Lesion" as described by Rudolf Peter.


Effect of H37Ra on PHA-induced migratory inhibition of leucocytes in patient of tuberculosis.

Eighty nine cases of active pulmonary tuberculosis were classified into four stages depending on the clinical extent of disease. Leucocyte migration inhibition test (LMIT) was done using mitogen phytohaemagglutinin (PHA) and H37Ra specific antigen. Normal PHA responses were observed in all clinical stages while specific immune response in relation to inhibition of leucocyte migration decreased from stage I to stage IV. Effect of H37Ra on PHA induced release of lymphokine was studied by mixing the two and comparing the percentage migratory inhibition of the mixture with that of PHA alone. Increased or decreased values with mixture compared to those with PHA alone were regarded as enhancement or inhibitory effect respectively. Median percentage effect of H37Ra on PHA induced migratory inhibition was found to be inhibitory in first three stages and controls while enhancement effect was observed in stage IV. A total of 22 cases in all stages showed enhancement effect while 48 cases showed inhibitory effect. The possible mechanism of enhancement or inhibitory effect are discussed.


Glomerular alterations in idiopathic haematuria--ultrastructural and morphometric analysis.

Re-evaluation of kidney biopsies has been done along with morphometric analysis of glomerular basement membrane thickness (G.B.M.) in 41 cases of idiopathic haematuria, in whom the initial routine light, immunofluorescent and electron microscopic examination had not shown any significant alterations. Extreme attenuation of G.B.M. (mean thickness of 2581 +/- 488 A) had been found in thirty one patients in contrast to mean GBM thickness of 4295 +/- 470 A found in control group. Absence of any history of familial haematuria in these patients distinguished them from hereditary nephropathies and hence categorized under the term thin basement membrane nephropathy. Follow up of these patients for upto 8 years had shown persistence of symptoms without further deterioration of renal function as well as morphology.


Fine needle aspiration cytology (FNAC) in the diagnosis of solid renal masses--a study of 92 cases.

Percutaneous fine needle aspiration cytology (FNAC) was employed as preoperative diagnosis in 92 solid renal masses from June, 1984 till December, 1990. Ultrasonography guided FNAC was employed in 26 lesions. There were 79 malignant tumours, 3 benign tumours, 6 lesions were inflammatory and only necrotic material was seen in 4 cases. Correlation with histopathology showed diagnostic accuracy of 91.3%. There were two false positive reports. No complication was encountered in this study.


Meningococcal meningitis in Ludhiana.

A retrospective study was carried out at Dayanand Medical College & Hospital, Ludhiana (Punjab) during the period from January 1985 to June 1990 to know the incidence of meningococcal meningitis. Meningococcal etiology was established in 170 (49.41%) cases out of 344 cases of bacterial meningitis. Out of 170 cases of meningococcal meningitis, 74 (43.52%) were positive only by smear examination, 90 (52.94%) were positive both by smear as well as culture and there were six (3.52%) cases which were positive only by culture. The organisms were sensitive to most of the common antibiotics including penicillin, chloramphenicol, ampicillin and sulphadiazine.


Present phage types and antibiotic susceptibility of salmonellae.

A total of 168 strains of Salmonella were isolated in the Command Pathology Laboratory (WC) Delhi Cantt during the year 1990. Out of this, 143 were Salmonella typhi, 17 Salmonella paratyphi A, 7 Salmonella typhimurium and 1 Salmonella manhattan. The commonest phage type and biotype of Salmonella typhi was type E1 and type 1 respectively. The dominant biotype of Salmonella paratyphi A was type I. There was a very high degree of multidrug resistance of most of the strains. But all the strains were sensitive to ciprofloxacin and norfloxacin.


Testicular proteins and DNA in experimental fluorosis.

Experimental fluorosis was induced in young male albino rabbits by exposing them to 0, 5, 10, 20 and 50 mg of NaF via subcutaneous injections for a period of 3-1/2 months. The testicular structural, nuclear and total proteins were significantly depleted in all test groups of animals as compared to the control. There was a significant (p < 0.001) reduction in the testicular DNA after drug administration. The relevance of these results in experimental fluorosis has been discussed.


Bacterial flora of the endometrium in infertile women from Manipal.

Endometrial curettage specimen culture of 140 infertile women showed 64 (45%) organisms. Mycobacterium tuberculosis 8 (5.7%) and Anonymous mycobacteria 14 (10%) were the commonest organisms isolated. Among the anonymous mycobacteria, following species were isolated M. scrofulaceum 10, M. kansasii 2, M. fortuitum 2. Gram positive and gram negative organisms were isolated from 42 (30%) specimens of the endometrium; 76 (54%) of the endometrium specimens were sterile.


Nutritional modulation of immunity to infection.

PEM of varying grades constitutes an important nutritional deficiency disorder of young children. Several immune mechanisms are found to be impaired in severely malnourished children thus making them victims of the vicious cycle of infection and malnutrition. Early impairment of neutrophil function triggers the vicious cycle and this emphasizes the need for prevention and early treatment of acute infections in children. Often based on the observations made in severely malnourished children, doubts have been expressed about the success of vaccination programmes in communities where malnutrition is widespread. But the humoral and cell mediated immune responses which are essential for adequate response to the various vaccines are found to be satisfactory among the undernourished children who constitute the major segment of the beneficiaries of such programmes in the communities. These observations help in strongly recommending the implementation of vaccination programmes in such communities and thus prevent severe malnutrition. Severe malnutrition, though often amenable for rehabilitation in the hospital, however, leaves certain permanent immunological sequelae and thus prevention of severe PEM in young children is important.


[The safety of geriatric anesthesia].

Perioperative abnormalities and complications were reviewed in 556 geriatric patients retrospectively to assess the safety of geriatric anesthesia. Preoperatively, the percentages of cases with cardiovascular and pulmonary abnormalities were 49.6% (276 cases) and 21.8% (121 cases) respectively. 77 percent of out patients (428 cases) were in the ASA class II physical status. The most common intraoperative complication was blood pressure instability and the incidence was noted to be of 34.8% (130 cases) with general anesthesia and of 15.8% (26 cases) with regional anesthesia. With general anesthesia, incidence for postoperative events such as non-fatal complications (i.e., sore throat and eye dryness), cardiovascular abnormalities and pulmonary disorders were found to be 39.0% (146 cases), 22.2% (83 cases) and 6.2% (23 cases) respectively. With regional anesthesia, the most common postoperative event was blood pressure instability (incidence: 21.2%, 35 cases). Total mortality rate of the first 15 postoperative days was 2.0% (11 cases). Mortality rate in elective and emergency surgery was 1.1% (5 cases) and 6.8% (6 cases) respectively. Causes of death were mainly related to illness deterioration (cancer and infection) or location of surgery. Death due to anesthetic mishap was nil in this study. Most geriatric patients had more than one system or one organ dysfunction before operation. Cardiovascular instability was the most common intraoperative complication. Postoperative mortality correlates closely with the preoperative ASA physical status. Mortality rate was significantly higher in emergency cases than in elective cases. A thorough pre-operative assessment and proper perioperative management are mandatory in geriatric anesthesia.


[Intramuscular meperidine for the prevention of shivering in spinal anesthesia].

Intravenous meperidine 25mg has been employed effectively to treat shivering following regional anesthesia and general anesthesia. The study was designed to evaluate the effectiveness of intramuscular meperidine for the prevention of shivering in spinal anesthesia. The series consisted of 60 patients who were divided into 2 groups with 30 patients in each, undergoing lower abdominal or lower extremity surgery. All patients were given diazepam 0.1mg/kg i.v. for anxiolysis when they came to the operating room. In a double blind and randomized fashion, patients in the study (meperidine) group received meperidine 25mg IM (= 0.5ml). In the control group 0.9% N/S 0.5ml IM was given instead. All patients received spinal anesthesia 15 minutes later. Measurement of the levels of sensory loss to pinprick was made. The ambient temperature and the rectal temperature were continuously monitored to evaluate the effect of the change in body temperature on shivering during operation. The degree and the occurrence of shivering were carefully evaluated and recorded by a blind-trust observer. There was no significant difference in maximal analgesic level, ambient temperature and change of rectal temperature during operation between the groups. Shivering occurred in 17 patients (56.7%) in the saline group with an onset time of 7.9 +/- 2.5min following spinal anesthesia. In the meperidine group, shivering occurred only in 3 patients (10%) with an onset time of 54 +/- 29.5min after spinal anesthesia. There was a significantly lower incidence of shivering in the meperidine group than in the saline group (p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)


Neonatal status in cesarean section under epidural anesthesia with supplementary oxygen.

Simple O2 mask has been used in patient under regional anesthesia for increasing the FiO2, especially in the aged and the pregnant. The relationships between maternal FiO2 and umbilical arterial (UA) and venous (UV) PO2, PCO2, pH, and neonatal Apgar score were studied in 45 patients receiving Cesarean section under epidural anesthesia. 2% xylocaine 18-20 ml with adrenaline 1:200,000 was used to attain the sensory level of T-4. Patients were allocated randomly into three groups. Group I, acting as a control group, breath only room air during the course of anesthesia. Group II was breathing through a simple face mask with an oxygen inflow of 6L/min. Group III was breathing oxygen with a flow rate of 10L/min through a simple face mask. UA and UV blood samples were collected separately at the time of delivery for blood gas analysis. The 1-min, and 5-min Apgar scores were recorded also. Mean values of the UA blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--16.50 mmHg, 20.20 mmHg and 19.50 mmHg; PCO2--49.20 mmHg, 48.10 mmHg and 50.3 mmHg; pH--7.31, 7.30 and 7.30. Mean values of the UV blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--28.6 mmHg, 36.9 mmHg and 36.5 mmHg; PCO2--38.20 mmHg, 38.80 mmHg and 40.40 mmHg; pH--7.36, 7.36 and 7.34. There was a significant increase in UA and UV PO2 when using a simple O2 mask (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)