Primary hypertrophic pyloric stenosis in the adult.

A case is reported of a 55 year old male patient with primary hypertrophic pyloric stenosis who was subjected to distal gastrectomy. Adult hypertrophic pyloric stenosis is an uncommon condition which is usually misdiagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal and endoscopically by appearances resembling those of the cervix. This condition is probably congenital although aetiology has not been established. In the absence of symptoms, no clinical treatment is required. However, surgical intervention is advocated, when stenosis gives rise to symptoms, there is a suspicion of malignancy, or the ulceration due to the disease. Distal gastrectomy with gastroduodenostomy is the treatment of choice.


Treatment of peptic ulcer disease with furazolidone.

Furazolidone (FZ) has been used in China as a treatment of peptic ulcer disease for about 20 years. Clinical and experimental studies suggest that it has good short-term and long-term effects on both human and animal ulcers. The ulcer healing rate is related to the dosage and course of treatment. The healing rate of a high dose, 2 week course is about 70-75% and the relapse rate after 3 years is 9.5%. The adverse reactions to FZ are not severe, and are well tolerated in most patients. However the mutagenic studies of several biological systems indicate that it has a mutagenic effect, but the mutagenic and carcinogenic effects on humans and animals remain questionable, because FZ has been biotransformed into other metabolites. The mechanisms of FZ in the treatment of peptic ulcer disease are not fully understood, perhaps partly due to the monoamine oxidase (MAO) inhibitory reaction and partly to the antibacterial activity to Helicobacter pylori (HP). The long-term effects of FZ are still not clear.


Design and validation of a critical care simulation model.

The high costs of building, equipping, and staffing critical care beds, coupled with more restrictive reimbursement policies, are forcing hospital administrators to seek ways for determining accurately the number of critical care beds needed. Existing critical care bedsizing models do not capture the complexity of today's critical care environment, nor have they been formally validated using actual hospital performance data. The study described herein was designed to address these needs. A GPSS/H simulation model was developed and validated, and includes the flow of patients through the study hospital's operating rooms, post-anesthesia recovery unit, three intensive care units, and two intermediate care (stepdown) units.


Assessing the impact of patient care policies using simulation analysis.

Simulation models are ideal for assessing the performance of strategic, tactical, and operational policies for hospitals. Simulation can validate a proposed policy, uncover fallacies of a proposal, or determine the sensitivity of the response to a policy change. A simulation model was developed to analyze the complex interactions comprising patient placement processes, beginning with patient arrivals and continuing through discharge. The model reflects current and potential patient assignment policies at a major southeastern general hospital. The system developed was utilized to assess proposed policies for the hospital. The simulated results of the hospital policy proposals, as well as other proposals, demonstrate the usefulness of simulation analysis in hospital policy decision-making.


ASTERIKS--a management game for hospitals.

ASTERIKS is a PC-based management game dealing with scheduling and sequencing operations in hospital departments. The game uses a process-oriented approach for simulation. The purpose of the game is to support training of hospital staff in this field as a necessary prerequisite for economic efficiency and for patient and staff satisfaction. The players have to first define their goals. During the game the teams can lay down operational routines in their hospitals, change their appointment systems and make staff and investment decisions. ASTERIKS' interactive design allows for immediate feedback to the players once the planning and simulation phases have been finished. Results include patients and staff satisfaction, treatment quality, utilization of resources and the length of stay.


RURALSIM: the design and implementation of a rural EMS simulator.

Why were these applications of simulation technology unsuccessful? Parochialism, the volunteer nature of EMS planning, and limited regional commitment to resolve such complex problems at the local level all combined to present significant barriers to implementation. Political factors which posed the most significant barriers included: conservative attitudes concerning the funding and regulation of EMS activities by local governments; general opposition to governmental intervention in the private sector; strong resistance to mandatory standards for EMS; jurisdictional disputes between EMS-related agencies; lack of cooperation between the local governments; competition between prehospital-care providers and between hospitals; overemphasis on local jurisdictional boundaries in the planning and delivery of services; and the allocation of EMS resources, such as ambulances, according to political priorities, rather than more objective criteria. Based upon the results of the four field tests, the following observations are relevant: 1. RURALSIM is a very complex simulator. While every effort was made to assure generalizability, for any given situation, it required extensive modification and tailoring. The result was a model capable of handling a rather diverse set of situations, but one that could not be turned over to the general public for use. To implement RURALSIM required the participation of the University of Pittsburgh research team. The newer simulation languages now available alleviate this problem somewhat. 2. RURALSIM's complexity was needed to examine the different alternatives proposed by local planners. It was particularly needed in order to simulate each region's existing system. Such "base-line" simulations were required in order to achieve face validity and provide a basis for comparing alternatives. 3. With hindsight, a major weakness was the limited amount of face-to-face interaction between local planners and decision makers and the University of Pittsburgh staff. Only two trips to the region were budgeted. This proved to be insufficient and placed too much responsibility for model interpretation and analysis on the local contractors. 4. In none of the four test sites did the contractors and/or local health planners have the authority, influence and/or incentives necessary to develop regional EMS systems. In particular, none of the contractors were in the position to be decision makers, nor was there ever only one decision maker. This is not a criticism of the contractors, who did their best under difficult circumstances. Rather, it is a criticism of the state of eMS system development in the US in the early 1980s. There were few examples where regional systems developed successfully in the face of serious opposition from local interests.(ABSTRACT TRUNCATED AT 400 WORDS)


An introduction to patient flow simulation for health-care managers.

Simulation of patient flow is a remarkably useful management tool. With today's software for personal computers, simulation is no longer just for academics and consultants. Senior and mid-level managers should actively seek out simulation as a problem-solving technique. This article provides health-care managers with the fundamental knowledge needed to individually initiate simulation studies of their departments.


A cost-accounting system used in a hospital-related laundry facility.

A laundry facility supplying linen to several hospitals needs to keep a good account of the numbers of different types of linen which enter and leave its premises so as to allocate the costs fairly and equitably among member hospitals. This task is made difficult by the problem of errors in counting due to high volume, different sizes and shapes of linen pieces, and human error in sorting. An electronic counting system has been installed in the premises to facilitate the process of counting, and this paper describes an approach for correcting the counting errors by applying factors that account for the inherent error in the system. These factors are estimated from sampling the contents of the sorted linen and statistical analysis of the resulting data. An efficient sampling scheme is proposed.


Identification of spinal cord polypeptides related to glial fibrillary acidic protein (GFAP).

Spinal cord cytoskeletal preparations from three different mammalian species contain several polypeptides in the SDS-PAGE molecular weight range 100-220 kDa which are recognized by all members of a panel of antibodies to glial fibrillary acidic protein (GFAP) and by anti-IFA, a panspecific intermediate filament protein antibody. The polypeptides are not recognized by antibodies to other intermediate filament proteins or to ubiquitin. The proteins coelute with GFAP in ion-exchange chromatography, cosediment with GFAP under filament assembly conditions, produce similar chemical digest patterns and have an amino acid profile close to that of pure GFAP, all properties expected for covalent GFAP multimers. Further experiments provide evidence for the existence of such multimeric complexes in vivo.


Induction of c-jun expression in vagal motoneurones following axotomy.

Using in situ hybridization, we have measured c-jun mRNA expression in the caudal medulla oblongata of the rat following sectioning of the cervical vagus nerve. Twenty four hours after either unilateral cervical vagotomy or nodose ganglionectomy, motoneurones in the ipsilateral dorsal motor nucleus of the vagus and nucleus ambiguus expressed increased (2-3 fold) levels of c-jun mRNA. After 7 days, c-jun mRNA expression was further elevated to levels 8-10-fold higher than basal. These results demonstrate an unusual, long-lasting activation of a member of the 'leucine zipper' class of immediate early gene, and suggest that immediate early genes such as c-jun may be responsible for the regulation of the expression of structural protein and neuropeptide genes that have been demonstrated to occur following nerve injury.


Free radicals induce gene expression of NGF and bFGF in rat astrocyte culture.

Hydrogen peroxide (H2O2) is a type of active oxygen species produced mainly in blood by inflammation, ischemia or anoxia. Treatment of rat neonatal cortical astrocytes in culture with 0.2-1.0 mM H2O2 which is lethal for hippocampal neurons, increases nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) mRNA content in a time dependent manner. H2O2 also increases c-fos mRNA expression, which is probably involved in the gene regulation of both NGF and bFGF. Maximal induction was reached after 6 h of incubation (5.7-fold increase in NGF and 2.4-fold induction of bFGF mRNA). Hydrogen peroxide induced bFGF and NGF gene expression suggests that neurotrophic factors in astrocytes could be induced by lesion, consistent with their protective function in the CNS.


Photochemical stroke and brain-derived neurotrophic factor (BDNF) mRNA expression.

In situ hybridization and Northern blotting were used to study the expression of brain-derived neurotrophic factor (BDNF) mRNA in the rat brain following photochemical stroke. A focal thrombotic lesion of the sensorimotor cortex was produced by intravenously injecting the light-sensitive dye rose bengal and exposing the skull to a controlled beam of light. Four hours after the light exposure the level of BDNF mRNA was increased in the hippocampus and cortex ipsilateral and perifocal to the lesion. The stroke-induced BDNF mRNA increase was prevented by the non-competitive glutamate receptor blocker dizocilpine (MK-801). The results indicate that the activation of N-methyl-D-aspartate (NMDA)-sensitive glutamate receptors is involved in the stroke-triggered stimulation of BDNF mRNA increase.


Persistence of individual dendritic spines in living brain slices.

A number of theories on the cellular basis of learning and memory propose that long-term changes in synaptic strength are encoded by changes in the properties of dendritic spines. Such theories imply that individual spines retain their identity over time. Using a new technique for fluorescent labelling of synaptic structures together with confocal microscopy, we have found that the appearance of individual spines on viable cells remains unchanged over observations periods of up to 5 hours. Even in slices exposed to kainic acid at concentrations that abolished synaptic transmission, groups of spines remained identifiable on cells clearly damaged by the toxin. The robust persistence of individual spines demonstrated here establishes an essential prerequisite for their potential role as mnemonic elements.


The cell adhesion molecule L1 has a specific role in neural cell migration.

L1-transfected L cells show a markedly enhanced ability for neuronal cell binding and promotion of neuron migration compared with control L cells. Further, when purified L1 was used as a culture substrate for neurons, it was found to promote neuronal adhesion and enhance the speed of migration of cerebellar neurons from reaggregated cultures, indicating that it is involved in a determinant step of neural cell migration.


Developmental and lesion induced cell death in the rat ventrobasal complex.

Naturally occurring and lesion induced neuronal death have been studied in the developing rat thalamus. Natural cell death was present from embryonic day (E)19 until postnatal day (P)8 with a peak occurring at birth. Counts of total neurones indicated a postnatal loss of 27%. Unilateral section of the infraorbital nerve at birth was associated with increased cell death in the contralateral thalamus; this was maximal at P2 and continued until P10. Counts of neurone numbers showed a reduction of about 24% of neurones on the contralateral side. A smaller, more transient decrease was seen ipsilaterally. The lesion induced cell loss was associated with a decrease in volume of the ventrobasal complex, with minimal reduction in cell density.


Barrelfield expansion after neonatal eye removal in mice.

We investigated the effect of neonatal eye removal on the tangential extent of the barrelfield in mice. Areas were measured in drawings made from tangentially cut Nisslstained sections of somatosensory cortex. We compared areas of 29 barrels, corresponding to 29 mystacial vibrissae, between adult mice enucleated at birth (n = 13) and their intact littermates (n = 13). Multivariate analysis of variance showed that the barrelfield was larger in enucleated mice. This expansion was mainly due to the increase in areal extent of the barrels corresponding to the dorsalmost row of vibrissae, and of a set of barrels corresponding to rostral vibrissae near the nose and mouth. Evidently, early enucleation has a significant cross-modal effect on the somatosensory cortex.


Auditory attention and selective input modulation: a topographical ERP study.

Event-related potentials (ERPs) were recorded in subjects receiving tones (left ear 300 Hz, right ear 6000 Hz) at a rapid rate and trying to detect occasional higher-pitched stimuli in a designated ear. ERPs to attended stimuli showed enhanced negative amplitudes whose topographical distribution differed from that of the exogeneous N1 component. Moreover, the latter was considerably larger for low than high tones, whereas the attention effect had similar amplitudes for the two tones. Consequently, the attention effect, even when perfectly coinciding in time with N1, does not seem to be caused by modulation of the exogeneous N1 but rather by a separate process activated by attention. This suggests that attention does not modulate initial stimulus representations in audition.


Modification of apomorphine-induced behaviour following chronic swim exercise in rats.

Four week swim exercise schedule (45 min day-1, 6 days each week) in rats led to a significant adaptive change in functional responsiveness of dopamine receptors (auto-receptors) in the nigrostriatal and mesolimbic system that was evident from the modification of behavioural responses elicited by a low dose of apomorphine, a direct acting dopamine receptor agonist. Thus, a remarkable increase in yawning response, development of full blown stereotypy, as well as profound attenuation of locomotory and hypothermic response was observed in exercise-trained rats as compared with the non-exercise group (control), following intraperitoneal administration of 0.3 mg kg-1 of apomorphine.


Change in Fos-like immunoreactivity in the suprachiasmatic nucleus in the adult male rat.

The circadian change in the number of the Fos-like immunoreactive (IR) cells in the suprachiasmatic nucleus (SCN) was examined in the adult male rats, whose eyeballs were enucleated two months before sacrifice. Their circadian rhythms were determined by their locomotor activity. They were sacrificed in the middle of the active phase or inactive phase. Then brain sections were cut for immunocytochemistry for Fos. A marked increase in the number of the Fos-like IR cells was observed in the inactive phase in the SCN, whereas no such increase was observed in the supraoptic nucleus. These results indicate that, in the SCN, Fos expression was changed with endogenous circadian rhythm in the free-running rat.


Electrophysiological mapping of body representation in the cortex of the blind mole rat.

The cortex of the blind mole rat (Spalax ehrenbergi) was explored for somatosensory responses with special reference to an extension into the occipital cortex which serves vision in sighted mammals. Head and body representation was similar as in other rodents or mammals. However, the somatosensory area extended far into the occipital cortex. No responses to auditory or visual stimulation were found caudal to the somatosensory area. However, auditory responses were recorded in an area lateral to and slightly caudal to the head representation. It is concluded that in this naturally blind animal the area normally occupied by the visual cortex serves somatosensory function.


Brain neurite-stimulating protein promotes formation of mechanosensory endings in sensory neuron.

In the present study we have shown that in the organotypic culture of dorsal root ganglia (DRG) of 10-11 day-old chick embryos, the neurite-stimulating protein (NSP) from bovine brain promotes the development of branching mechanosensory endings. The light and electron microscopic observation revealed that the morphological features of these sensory endings are similar to those in vivo. A mechanical stimulation of these endings elicited bursts of impulses in the sensory neurons.


The effect of morphine on core and skin temperature in rats.

The temperature of the tail skin is an important factor determining tail-flick latency to noxious radiant heat in rats and mice. The temperature of the skin may also be important in determining the behavioural response in the formalin test. Morphine in low and moderate doses strongly affected the core and tail skin temperatures, preventing the increase in tail skin temperature normally observed during testing. For the correct interpretation of the results of several tests of nociception, it is important to know how treatment influences the temperature of the skin, to be able to correct for this confounding factor.


Distribution of putative odour receptor proteins in olfactory epithelium.

To investigate immunohistochemically the spatial localization of putative odour receptor proteins, we synthesized a polypeptide which corresponds to a region of a putative odour receptor protein, I3, and raised an antibody to the peptide. In rat olfactory epithelium, the antibody specifically recognized cilia of a small subset of olfactory receptor neurons, suggesting that the odour receptor protein is localized selectively in the cilia. Olfactory receptor neurons having immunoreactive cilia were distributed sparsely throughout the epithelium. This suggests that receptor neurons expressing a similar odour receptor protein are probably distributed similarly in the epithelium.


Perception of timing of movement-onset in a simple reaction time task.

Subjects judged verbally on temporal order between pressing a switch and a marking sound (MS) in a simple reaction time paradigm. They were uncertain when sound preceded movement by less than about 60 ms or followed it by less than 130 ms (transient zone--TZ). The point of subjective equality (defined by 0.5 probability of correct judgements of temporal order of sound and switching onsets) and the median of TZ were shifted about 60 and 35 ms prior movement onset, respectively. Estimating mutual timing of movement preparation and execution and sensory delays, these shifts correspond to the simultaneity of onsets of MS and proprioceptive feedback in the brain. Thus the results suggest about proprioceptive origin of perception of active movement onset.


Voltammetric study of 8-OH-DPAT effect on the raphe-trigeminal 5-HT system.

The effect of i.p. administration of the selective 5-HT1A agonist 8-hydroxy-2-(di-N-propylamino) tetralin (8-OH-DPAT) (100 micrograms kg-1) has been investigated by in vivo 5-hydroxyindole electrochemical (peak 3) detection in the nucleus raphe magnus (NRM) and medullary dorsal horn (MDH) of acute anaesthetized and unanaesthetized freely moving rats. 8-OH-DPAT induced a small but significant decrease in peak 3 in the NRM and MDH of anaesthetized rats. In freely moving animals, a similar small effect was observed at both NRM and MDH levels. With reference to similar in vivo studies demonstrating differential responsiveness of ascending serotonergic systems to 8-OH-DPAT, it is concluded that the serotonergic NRM-dorsal horn system is slightly affected by this 5-HT1A agonist.


HIV and the brain: evidence of early involvement and progressive damage.

AIDS is often accompanied by progressive encephalopathy and 'subcortical' dementia, but there is uncertainty regarding how early the brain involvement may begin in the course of HIV infection. This study used a cognitive auditory 'oddball' paradigm to elicit sensory and cognitive event related potential (ERP) components from healthy controls and from patients at different stages of HIV infection. Sensory component latencies did not differ between groups, but cognitive components showed progressive delays corresponding to increasingly severe clinical stages of HIV infection. The earliest changes were found among asymptomatic HIV + patients, suggesting that this test is a sensitive indicator of early subclinical CNS damage. In contrast, neither frequency analysis nor nonlinear dynamical analysis of the EEG showed differences between healthy controls and patients.


5,7-DHT facilitated lordosis: effects of 5-HT agonists.

The role of 5-HT (serotonin) in regulating lordosis was investigated by combining peripheral administration of the 5-HT agonists 8-OH-DPAT (8-hydroxy-2-[di-N-propylamino]tetralin) or TFMPP (1-[m-trifluoromethylphenyl]piperazine), with intrahypothalamic application of the 5-HT neurotoxin 5,7-DHT (5,7-dihydroxytryptamine). The 5-HT1A agonist, 8-OH-DPAT, significantly inhibited lordosis in 5,7-DHT-treated and non-treated rats. TFMPP, an agonist at 5-HT1B and 5-HT1C receptors, significantly facilitated lordosis in 5,7-DHT-treated and non-treated rats. Our results show that both inhibitory and facilitatory influences of hypothalamic 5-HT on lordosis, are modulated via postsynaptic receptors.


Acyl-(acyl-carrier protein) hydrolase from squash cotyledons specific to long-chain fatty acids: purification and characterization.

Acyl-(acyl-carrier-protein) hydrolase (EC 3.1.2.14) releases fatty acids from the end-product of fatty acid synthesis in plastids for the subsequent synthesis of glycerolipids in the cytoplasm. Isoelectric focusing of chloroplast stroma proteins from squash cotyledons suggested that there were at least three isomeric forms of acyl-(acyl-carrier-protein) hydrolase having pI values of 4.5, 5.3 and 7.8. The pI 4.5 and pI 5.3 forms showed maximum activity at pH 9.8 whereas the activity of the pI 7.8 form increased within the range 6.2 to 10.2 but no optimum was seen. The pI 4.5 form was purified 100,000-fold from squash cotyledons. The highly purified fraction contained two polypeptides, whose molecular masses were estimated to be 35 kDa and 33 kDa by SDS-PAGE. It is suggested that the 33 kDa polypeptide was a degradation product of the 35 kDa polypeptide. Oleoyl-(acyl-carrier protein) was the preferred substrate of this enzyme over palmitoyl- and stearoyl-(acyl-carrier protein), whereas lauroyl-(acyl-carrier protein) was nearly inactive. These results indicate the enzyme is specific for long-chain acyl-(acyl-carrier protein).


Multiple ocs-like elements required for efficient transcription of the mannopine synthase gene of T-DNA in maize protoplasts.

Regulatory elements controlling transcriptional activity of the mannopine synthase 2' promoter (mas 2') were defined by analysis of deletion mutants in transient expression assays in maize protoplasts. Deletion of the region between -305 and -290 containing sequence similarity to the octopine synthase (ocs) promoter element reduced activity by 67% compared to wild type activity. Less than 1% of the activity remained in 5' deletions downstream of -153. Inclusion of various heterologous enhancer-like sequences immediately upstream of position -325 increased activity by up to 7.5-fold. Insertion of the -325 to -275 sequence alone, or in combination with heterologous enhancer-like elements, restored activity of some of the 5'-deletion mutants. Restoration of activity was not obtained with mutants deleted past position -127. Our results suggest that a single class of nuclear proteins from maize interact with high affinity at elements designated mas b (-306 to -275; mas 1' element), d (-127 to -108), and e (-82 to -39; mas 2' element) as well as the 20 bp element from the ocs promoter. Although the binding site at mas d only appears to accommodate a single protein, this element has the potential to make a weak, but positive, contribution to the activity of the mas 2' promoter. The binding of nuclear proteins could not be demonstrated at mas a and c, both of which showed limited homology to the ocs element. Mutational evidence suggested that mas a and c may also contribute to mas 2' transcription.


Cloning and characterization of cDNAs coding for Vicia faba polyphenol oxidase.

Three cDNA clones were isolated which code for the ubiquitous chloroplast enzyme, polyphenol oxidase (PPO), from Vicia faba. Analysis of the cloned DNA reveals that PPO is synthesized with an N-terminal extension of 92 amino acid residues, presumed to be a transit peptide. The mature protein is predicted to have a molecular mass of 58 kDa which is in close agreement to the molecular mass estimated for the in vivo protein upon SDS-PAGE. Differences in the DNA sequence of two full-length and one partial cDNA clones indicate that PPO is encoded by a gene family. Analysis of the deduced amino acid sequence shows that the chloroplast PPO shares homology with the 59 kDa PPOs in glandular trichomes of solanaceous species. A high degree of sequence conservation was found with the copper-binding domains of the 59 kDa tomato PPO as well as hemocyanins and tyrosinases from a wide diversity of taxa.


Temporal and spatial regulation of a novel gene in barley embryos.

The temporal and spatial pattern of expression of a novel barley gene is described. The gene has been identified through the differential screening of a cDNA library constructed to poly(A)+ RNA of zygotic embryos. Transcripts corresponding to the cDNA, pZE40, become abundant in the non-axial tissues of the developing embryo within 8-10 days after anthesis, when steady-state levels are high in the scutellum, coleoptile and coleorhiza, with the exception of the scutellar epithelium. This expression pattern is maintained throughout maturation of the embryo until levels eventually decline as the grain desiccates. On germination, there is a transient re-appearance of mRNA to pZE40, with accumulation specifically restricted to the scutellum of the seedling. In situ hybridization has enabled the detection of transcripts elsewhere in the barley plant, in highly localized groups of cells. The timing and cell specificity of expression suggests the gene product is involved in the synthesis and/or transport of metabolites.


Organization and expression of a phycobiliprotein gene cluster from the unicellular red alga Cyanidium caldarium.

We have sequenced a plastid gene cluster from the unicellular red alga Cyanidium caldarium which is located downstream from the psbA gene and contains, in the following order, genes for a beta-allophycocyanin-like protein (apcB'), a putative 9.5 kDa allophycocyanin linker protein (apcL9.5) and a putative 29 kDa phycocyanin linker protein (cpcL29). The apcB' and apcL9.5 genes are organized in the form of an operon. The cpcL29 gene is transcribed monocistronically from the opposite strand of DNA. Both transcription units are probably terminated at a 25 bp inverted repeat 3 and 5 bp downstream of the stop codons of the apcL9.5 and cpcL29 genes, respectively. The levels of both transcripts are greatly reduced in the dark as is the psbA transcript. Downstream from the phycobiliprotein gene cluster two open reading frames (ORFs) were found which are homologous to ORFs from plastid DNAs and cyanelle DNA of Cyanophora paradoxa. Sequence homologies between genes analysed in this study and corresponding genes from cyanobacteria, chlorophytic plastids and cyanelles point to a large phylogenetic distance between the plastids of Cyanidium and cyanobacteria and other plastid types.


Cloning and characterization of a pathogen-induced chitinase in Brassica napus.

A chitinase cDNA clone from rapeseed (Brassica napus L. ssp. oleifera) was isolated. The cDNA clone, ChB4, represents a previously purified and characterized basic chitinase isozyme. The longest open reading frame in ChB4 encodes a polypeptide of 268 amino acids. This polypeptide consists of a 24 amino acid N-terminal signal peptide, a cysteine-rich domain and a catalytic domain. The primary structure of the mature ChB4 shows a low degree of identity with class I and II chitinases, 43-48% and 35%, respectively. In contrast, ChB4 shows 62% identity to a basic sugar-beet chitinase and 63% identity to an acidic chitinase from bean. The expression of chitinase messenger RNA (mRNA) in response to infection with Phoma lingam (Tode ex. Fr.) Desm. was examined by northern hybridization and scintilation counting. A differential induction was seen between resistant and susceptible cultivars where 3-fold higher chitinase transcript levels were estimated one day after inoculation in resistant as compared to susceptible cultivar. This difference diminished eight days after inoculation. Southern hybridization analysis indicates that the chitinase is encoded by a small family of genes.


Import and processing of the precursor of the Rieske FeS protein of tobacco chloroplasts.

cDNA clones encoding the precursor of the Rieske FeS protein of tobacco chloroplasts have been characterised and shown to derive from two different genes. The 5' ends of the corresponding transcripts have been cloned using primer extension and PCR. The nucleotide sequences of the cDNAs (and their 5' extensions) predict precursors for the tobacco proteins which differ in 4 amino acid residues out of a total of 228 residues and show high homology with the pea and spinach precursors. The tobacco precursor proteins contain N-terminal presequences of 49 amino acid residues which lack 17 amino acid residues present at the N-terminus of the spinach presequence. The 26 kDa precursor obtained by transcription and translation of one of these cDNAs in vitro was efficiently imported and correctly processed to the mature 20 kDa protein by isolated pea or tobacco chloroplasts. The precursor was also processed to its mature size by a peptidase present in the stroma of chloroplasts.


Biosynthesis of active spinach-chloroplast thioredoxin f in transformed E. coli.

The recently cloned gene for spinach chloroplast thioredoxin f was subcloned in a modified pKK233-2 expression vector and used for transformation of Escherichia coli cells containing the Iq plasmid. After induction with IPTG (isopropyl-beta-D-thiogalactoside) the transformed cells produce the chloroplast protein in large amounts as insoluble deposit within the cell. The protein has been solubilized, purified and analysed for activity. It shows no difference in catalytic activity from native spinach chloroplast thioredoxin f. Its electrophoretic behaviour suggests that the native thioredoxin f may have a different N-terminus than was assumed on the basis of the protein sequencing results.


Isolation and sequence analysis of the genomic DNA fragment encoding an aspartic proteinase inhibitor homologue from potato (Solanum tuberosum L.).

A genomic DNA clone encoding an aspartic proteinase inhibitor of potato was isolated from a lambda EMBL3 phage library using the aspartic proteinase inhibitor cDNA as a hybridization probe. The gene has all characteristic sequences normally found in eucaryotic genes. Typical CAAT and TATA box sequences were found in the 5'-upstream region. In this part are also two putative regulatory AGGA box sequences located. In the genomic sequence there are no intron sequences interrupting the coding region. An open reading frame of the gene encodes a precursor protein of 217 amino acids which shows high percent identity with the aspartic proteinase inhibitor cDNA.


Vicilin-like seed storage proteins in the gymnosperm interior spruce (Picea glauca/engelmanii).

A seed storage protein cDNA was characterized from a library of interior spruce (Picea glauca/engelmanii complex) cotyledonary stage somatic embryos. The deduced amino acid sequence predicts a 448 amino acid (50 kDa) polypeptide with 28-38% identity with angiosperm vicilin-like 7S globulins. XXC/G codon usage is low (47%) relative to monocot angiosperms while pairwise comparisons show that spruce, monocot, and dicot vicilins are approximately equal in amino acid divergence. Although small by comparison, the spruce vicilin contains an N terminal hydrophilic region characteristic of angiosperm 'large' vicilins. Genomic Southern blotting predicts that the cDNA is encoded by a gene family.


cDNA cloning and gene expression of the major prolamins of rice.

A full-length cDNA (pS 18) encoding the 16 kDa rice prolamin composed of 158 amino acids was sequenced. Analysis of N-terminal amino acid sequence of a major rice prolamin indicated that an 18 amino acid signal peptide was removed from 16 kDa precursor prolamin to form the 14 kDa prolamin during seed development. Synthesis of the 16 kDa precursor prolamin began around 8 days after flowering (DAF), increased remarkably at 8-11 DAF and gradually reached maximum levels with the maturation of rice seeds.


Molecular cloning of the gene encoding developing seed L-asparaginase from Lupinus angustifolius.

A genomic sequence encoding Lupinus angustifolius L-asparaginase has been obtained, and is the first report of this gene from a plant source. The 3.2 kb of DNA sequenced contains a 1136 bp 5' flanking sequence, four exons and three introns. Intron-exon borders were mapped by comparing the genomic sequence with that of a L. arboreus cDNA. Primer extension analysis revealed transcription start sites 16 bp and 13 bp 5' of the initiating ATG for L. angustifolius and L. arboreus, respectively. The 5' flanking region contained sequences associated with seed-specific expression.


Isolation and characterization of a cDNA encoding a 3-hydroxy-3-methylglutaryl coenzyme A reductase from Nicotiana sylvestris.

A cDNA library from freshly isolated mesophyll protoplasts of Nicotiana sylvestris was differentially screened using cDNAs from leaves, leaf strips submitted to the same stress as protoplasts during the isolation procedure, and cell suspension cultures. One of the selected clones (6P2) was found to encode a putative polypeptide highly homologous to previously characterized 3-hydroxy-3-methylglutaryl coenzyme A reductases. The C-terminal region of the polypeptide was highly conserved whereas its N-terminal region including the trans-membrane domains and the linker was more variable. Apart from protoplasts, the 6P2 gene was found to be expressed in apexes, anthers, roots, and in stressed leaf strips after 24 h of culture, during the hypersensitive reaction to viral infection and after HgCl2 treatment. This pattern of expression is consistent with a role in plant defence mechanisms.


Sequence and organization of a 7.2 kb region of wheat mitochondrial DNA containing the large subunit (26S) rRNA gene.

We report the sequence of a 7.2 kilobase pair DNA fragment containing a copy of the wheat mitochondrial gene (rrn26) that encodes the mitochondrial large-subunit ribosomal RNA (26S rRNA). The mature 26S rRNA was determined by direct RNA sequencing to be 3467 nucleotides long, and to share a 5'-terminal pentanucleotide (5'-AUCAU), thought to be important in post-transcriptional processing, with the wheat mitochondrial small-subunit (18S) rRNA. Two other prominent features of the sequence were noted. First, upstream of rrn26 are located two tandem copies of a 70 base pair element containing a putative mitochondrial promoter motif (TCGTATAAAAA). Second, downstream of rrn26 is a sequence element that, if transcribed, would produce an RNA with a secondary structure resembling that of tRNAs but differing sufficiently from the latter structure to preclude any transcript from functioning normally in translation. These upstream and downstream sequence elements may play a role in the expression of rrn26 in wheat mitochondria.


Sequence comparison of two highly homologous phycoerythrins differing in bilin composition.

Genes encoding the alpha and beta subunits of class II phycoerythrin from Synechococcus sp. strain WH8103 were cloned and sequenced. The deduced amino acid sequences were compared to class II phycoerythrin from Synechococcus sp. strain WH8020 and found to share 92% identity, yet the proteins differ in the bilin isomer (phycoerythrobilin versus phycourobilin) bound to two of the six chromophore attachment sites. Amino acid residues which might contact the bilin at each of the two variable sites were inferred by sequence alignment with phycocyanins. Putative bilin-contacting residues differing between the two phycoerythrins were identified which may determine bilin specificity.


Particle bombardment-mediated transient expression of a Brazil nut methionine-rich albumin in bean (Phaseolus vulgaris L.).

Bean (Phaseolus vulgaris L.) mature embryos were transformed using biolistic methods with a plasmid containing 2S albumin and beta-glucuronidase structural sequences, both under the control of the 35S CaMV promoter. We have shown that chimaeric tissues could be obtained and that both structural sequences were expressed to similar levels.


The tomato nia gene promoter functions in fission yeast but not in budding yeast.

A fragment comprising 1 kb of the 5' region and the 81 first nucleotides of the coding region of the tomato nitrate reductase nia gene was placed in translational fusion with the lacZ reporter gene. This construct was introduced in budding and in fission yeast using a derivative of the Saccharomyces cerevisiae/Schizosaccharomyces pombe autonomously replicating vector pUZL. Beta-galactosidase activity was detected in S. pombe but not in S. cerevisiae. Primer extension experiments show that in fission yeast transcripts are initiated at the same starting point as in tomato, indicating for the first time that a plant promoter can be correctly recognized in fission yeast.


Validation of a patient satisfaction system in the United Kingdom.

This paper describes the results from a study to assess the validity of a patient satisfaction system used extensively in the United Kingdom. The study involved over 700 interviews with patients. The face, content, discriminant and construct validity have been tested. The discriminant and construct validity were judged to be satisfactory and there was some evidence of face validity. The results suggest that this system has the ability to reveal differences in satisfaction between hospitals. The findings from the study are being used to modify the questionnaire design in order to improve the system's ability to indicate which aspects of the service require improvement.


Continuous improvement of nursing practice: experience in Québec.

Health care professionals must be accountable for the quality of their practice and self-regulating professional organizations have the responsibility to ensure that the public receives the best possible care to which it is entitled. Québec's legislation mandates professional corporations to supervise the practice of their members. The nursing profession comes under that legislation and, at l'Ordre des infirmières et infirmiers du Québec, a program of professional inspection has existed since 1976. The philosophy of this program is based on individual and collective responsibility of nurses towards the continuous improvement of their practice and the enhancement of the quality of care they provide. Standards and criteria of competence were elaborated with the participation of groups of nurses, validated by large samples of the population and distributed to all nurses. Evaluation tools were devised and have progressed over the years. The concepts of self-evaluation (Bandura, Am Psychol 33: 344, 1978; Bandura, Prentice Hall, 1986; Knox and MacKay, Nurs Papers/Perspect Nurs 4: 17, 1982) and of self-managed collective development (Payette, Rev québécoise Psychol 5: 104, 1984) have inspired the program, allowing nurses to identify their needs, set priorities and determine their plan of action. A study to evaluate the impact of the program is now in progress. This article will describe the conceptual framework, the method of evaluation, its application, the reactions of nurses as well as some of the results observed concerning the improvement of practice and of quality of care.


A pilot project on quality assurance in nursing care in the state of Schleswig-Holstein, Federal Republic of Germany.

As a direct result of the law passed in Germany requiring the practice of quality assurance in health care which has been in effect since 1 January 1989, the Institute for Health Systems Research in Kiel piloted a project on quality assurance in medicine in 12 hospitals in Schleswig-Holstein from September 1989 to February 1991. Two procedures for measuring the quality of nursing care were also developed in two of these hospitals. These procedures were oral care aided by nursing staff and oral care carried out by nursing staff. The pilot project was then evaluated by the Institute. An extension of the medical side of the project to cover all 80 hospitals in Schleswig-Holstein was planned to begin on 1 January 1992. As far as the nursing side is concerned, approximately 10 procedures will be developed and tested in eight hospitals.


Specifying quality in health and social care.

Two popular ways of specifying the quality of health and social care are explained. Examples are used to illustrate: (a) the mission statement/minimum standard method; and (b) the aim/objective method. Strengths and weaknesses of these approaches are highlighted by using a writing-style analyser, and an evaluation model from the literature. Ways of correcting some of the weaknesses are suggested.


Is blood pressure measurement with a standard cuff reliable?

This study compares blood pressures measured with a standard cuff (rubber bag 12 x 35 cm) with concomitantly measured intra-arterial pressures in 48 subjects. With the standard cuff, and using a diagnostic cut-off limit for diastolic hypertension of 90 mmHg, 15/48 patients were found to be hypertensive, whereas only 4/48 had intraarterial pressure above 90 mmHg. Thus, the specificity of the non-invasive method was only 75%. If higher diagnostic cut-off limits were used, e.g. 95 mmHg, specificity increased to 84%, and with lower cut-offs specificity was 63% for 85 mmHg and 52% for 80 mmHg. A specificity of only 75% is very poor for a method commonly used in screening examinations and may lead to considerable over-diagnosis of mild hypertension.


Effectiveness of the daily record review at the medical emergency room department in a French teaching children's hospital.

We evaluate the effectiveness of the daily record review (DRR) of 4393 ambulatory medical patients seen at the emergency room department of a teaching pediatric hospital in Paris between 8th January and 11 March 1991. For these patients, 137 potential quality problems were found, 117 of them remaining after discussion with the junior. For 80 of the 117 confirmed problems (68.4%), the reviewing senior estimated that sufficient advice had been given to the child's usual caretaker or health care provider and (or) the children returned to seek medical advice when indicated. Experts proved the procedure to be reliable: they detected a problem for 36% of the cases with potential quality problems and for only 2% of a sample of control records considered without potential quality problems after the DRR.


Preoperative evaluation in non-cardiac surgery: cardiac risk assessment.

Nine hundred and ninety patients, ages 20 years or older, undergoing non-cardiac elective surgery were prospectively studied to identify high cardiac risk preoperative factors in a case-mix population and to assess cardiological risk. The prevalence of major cardiac complications was 2.3%, including 0.8% mortality. Univariate analysis showed that: age; history of chest pain; dyspnea; hypertension; presence of systolic murmur and third sound; diastolic pressure greater than 95 mmHg; electrocardiogram left ventricular hypertrophy; cardiothoracic ratio greater than 0.5 and valvular calcifications are associated with cardiac complications (p = 0.001-0.02), with low sensitivity (range: 14-38%) and high specificity (range: 85-98%). Cardiological referral was required for 169 patients (17%) that showed a higher prevalence of cardiovascular diseases (85%) and of cardiac complications (5.3%). Cardiologists required further tests for 13 patients (7.7%) and modified therapy for 93 (55%). High cardiac risk patients are identified preoperatively in current practice and cardiological referral is frequent; further studies are mandatory to evaluate the most effective and efficacious procedures.


Quality of care in residential homes: a comparison between Israel and Florida.

This paper reports on two studies of the quality of care in long-term care institutions for the elderly, one in Israel and one in Florida, which used the tracer methodology developed by the JDC-Brookdale Institute of Gerontology for examining quality of care in such institutions. A tracer is a well-defined and frequently occurring problem which has a known treatment. Tracers from the medical, nursing and psychosocial areas of care were used in the studies. Data were collected by multidisciplinary teams of medical and paramedical personnel who examined and interviewed elderly residents, interviewed staff members, conducted observations, and reviewed records. Differences inherent in the two study groups--such as in cultural norms and organizational systems--were taken into consideration, and the instruments were adjusted accordingly. The tracer method proved to be a feasible method for assessing quality of care in both locales. Findings regarding 12 tracers show that for units previously assessed as either good or poor/mediocre by surveyors, good units consistently scored higher than poor/mediocre units in quality of care. Florida scored higher for quality of care in the medical area, and Israel in the nursing and psychosocial areas.


A nationwide quality assurance program can describe standards for the practice of pathology and laboratory medicine.

An important component of quality assessment is the analysis of peer group comparisons, although little data are available for evaluation. We developed and tested six interinstitutional quality indicators related to Pathology and Laboratory Medicine among 36 institutions. Results showed that the mean frequency of intraoperative frozen section consultations (6.0%), sensitivity of fine needle aspiration cytology diagnosis (87%), nosocomial infections (5.0%) and average cross-match to transfusion ratio (2.1%) was comparable with previous studies, but the range of values was large. The median stat laboratory turnaround time of approximately 1 hr for CSF cell count, glucose, protein and gram smear was considerably longer than expected from previous investigations, and was longer for larger institutions. Analysis of serious laboratory reporting errors showed the lowest number detected by individuals working in transfusion medicine, and highest numbers among hematology workers. We conclude that interinstitutional comparison of data from quality assurance programs can be used to describe performance standards related to the quality and effectiveness of care.


Antigen presentation in the skin: modulation by u.v. radiation and chemical carcinogens.

The skin provides an excellent model to investigate antigen presenting cells (APC) particularly using contact hypersensitivity responses. The skin has its own distinct APC of which Langerhans cells (LC) are the best characterized. Fluorescein isothiocyanate (FITC) has proved a useful reagent with which to follow antigen-labeled APC to draining lymph nodes, where they bind to T lymphocytes. Cluster formation appears to be a necessary component of the APC-T cell interaction. Both u.v. radiation and chemical carcinogens are able to alter LC in the skin, resulting in immunological tolerance when antigen is presented through such treated sites. The changes in APC function are linked mainly to the tumor promoting action of carcinogens. The nature of the APC that trigger suppressor circuits and the potential chemical mediators involved are discussed. These studies have important implications for the immunobiology of the skin and for cutaneous carcinogenesis.


Antigen processing in the mucosal immune system.

The mucosal immune system is concerned with host defense along the moist surfaces of the body which have contact with the external environment. These sites contain specialized lymphoid structures which contain precursors for IgA-synthesizing B lymphocytes and immunoregulatory T lymphocytes which will determine whether oral tolerance or a strong immune response develops against antigens administered orally. The key step to antigen processing in the gastrointestinal tract involves its initial uptake from the gut lumen by specialized follicle associated epithelium called 'M' cells. M cells originate from adjacent crypt epithelium and are interspersed between the absorptive epithelial cells in the follicle-associated epithelium. M cells cells have short, irregular microvilli, are closely associated with lymphocytes, do not have a prominent terminal web, and have only weak alkaline phosphatase activity but strong nonspecific esterase activity. M cells do not express surface MHC class II (HLA-DR) antigens. These cells take up macromolecules, viruses, bacteria and protozoa within 30 minutes from the initial presentation of the antigen to the intestinal lumen. After the initial uptake of antigen by M cells, the antigens are transported into the follicular areas to be processed by dendritic cells and brought into close contact with the antigen-specific precursors for IgA secreting plasma cells. The final result of M cell processing is the production of a vigorous secretory IgA response and local cell-mediated immunity with suppression of a systemic IgG, IgE and delayed-type hypersensitivity to orally-administered antigens.


Antigen uptake and presentation by dendritic leukocytes.

Dendritic leukocytes are required for the initiation of T cell mediated immune responses. These cells, in different stages of maturation, are distributed throughout lymphoid and most non-lymphoid tissues. Immature cells may be localized predominantly within non-lymphoid tissues, and are responsible for endocytosis and processing of antigens. Inflammatory mediators are thought to promote their maturation and migration, via lymph and blood, into secondary lymphoid tissues. Here the mature cells present foreign peptide-MHC complexes to T cells, and deliver unique signals for T cell activation (immunostimulation). Within the thymus, however, these cells may be important for inducing T cell tolerance to self peptide-MHC complexes.


Macrophages as accessory cells in the in vivo humoral immune response: from processing of particulate antigens to regulation by suppression.

The ability of macrophages to act as accessory cells for the antigen mediated stimulation of T lymphocytes has been unequivocally established in in vitro experiments. However, in vivo experiments are required to investigate whether the in vitro abilities of cells reflect their in vivo function. In order to study whether or not macrophages are required for the induction of antibody production in vivo, a liposome mediated macrophage elimination technique has been developed. Results obtained until now, have confirmed the role of macrophages in the induction of the antibody response against particulate antigens. However, macrophages are not required for the induction of the response against soluble antigens. Contrarily, in various organs they seem to regulate the latter response by suppression.


Follicular dendritic cell and ICCOSOMES in germinal center reactions.

The development and destination of immune complex coated bodies (ICCOSOMES) was investigated at the ultrastructural level in the germinal centers (GC) of murine lymph nodes after secondary-immunization with horseradish peroxidase. Immediately after a booster injection, large amounts of immune complex (IC) were trapped on the surface of the cytoplasmic extensions of follicular dendritic cells (FDC). Cytoplasmic extensions, consisting mainly of FDC processes with associated IC, formed complex lamellar labyrinth-like structures (LBS). We describe here morphological changes of LBS. Lamellar or stationary LBS before the injection sequentially changed into distorted, filiform, glomerated and transitional LBS. Around day 1, IC-coated cytoplasmic extensions developed into glomerated LBS (G-LBS) which were invaginated into their own cytoplasmic ends, which swelled up to several microns in diameter. Around day 2, tufts of the glomerated LBS were unlaced and dispersed as (ICCOSOMES) in the interstitium. Some ICCOSOMES were endocytosed by germinal center cells (GCCs) and transported to the Golgi apparatus and perinuclear space. These ICCOSOME-bearing GCCs were B220-positive and some produced specific antibody (spAb) in the perinuclear space indicating they are in the B cell lineage. ICCOSOME-ingesting GCCs are thought to be able to process the antigen and present it to T cells. This may be important in the development of plasma cells and memory cells which developed from the GC B cells.


Targeting antigens to antigen presenting cells.

Antigen may be targeted to antigen presenting cells (APC) by conjugating the antigen to monoclonal antibodies directed against surface molecules on APC. By now several laboratories have shown that immunotargeting enhances humoral responses, depending upon the targeted ligand or cell type, with low doses of antigen and without the use of adjuvants. There is also preliminary evidence that the method may be used to bias immune responses in desired directions, possibly also to induce tolerance. In addition to its use as an experimental tool for exploring immune reactions the method could in the future also be clinically important, e.g. in vaccination. In this article we give a brief account on work so far published with this novel method and discuss possible mechanisms behind its immunopotentiating effects.


Alterations of the p53 gene in Philadelphia chromosome-positive leukemia including chronic myelogenous leukemia and acute leukemia.

We analyzed the structural alteration of the p53 gene, by Southern blotting with conventional and/or pulsed-field gel electrophoresis, in patients with Philadelphia chromosome-positive leukemia (chronic myelogenous leukemia; CML, 34 cases and acute leukemia; AL, 5 cases). We found an alteration of the p53 gene in one of 5 AL patients. Loss of heterozygosity was detected in two CML patients with i(17q) chromosome, but we could find no other alterations in the remaining CML patients.


Coexistence of diabetes insipidus and idiopathic thrombocytopenic purpura.

Diabetes insipidus (DI) is a disorder characterized by polyuria, polydipsia and increased thirst [1] while pituitary DI is a syndrome that is known to result from deficient release of the antidiuretic hormone (ADH) [2,3]. Trauma to the neurohypophysis (operational or accidental) is the most common cause of DI. Primary or metastatic intracranial tumors are the second most common cause of DI. Among the less frequent causes are the granulomatous lesions or infections of the central nervous system, drugs and vascular lesions [2]. In 30-40% of the patients, there is no identifiable cause (idiopathic DI). Idiopathic thrombocytopenic purpura (ITP) is an immunologically mediated destructive thrombocytopenia. The clinical diagnosis is made after excluding the presence of other disorders that are known to be associated with shortened platelet survival [4]. In this paper two cases of DI and ITP are described.


Comparative effects of G-CSF, GM-CSF and IL-3 on cytosine arabinoside- and daunorubicin-mediated cytotoxicity of acute myeloid leukemia cells and normal myeloid progenitors.

We carried out an in vitro study on the combined effects of three CSF (G-CSF, GM-CSF and IL-3) plus the cycle-specific chemotherapeutic drugs [cytosine arabinoside (Ara-C) and daunorubicin (DNR)] on the proliferation and cytotoxicity of blasts and clonogenic cells (CFU-AML) in the AML-193 cell line, in AML patients and in normal bone marrow CFU-GM. The number of surviving blasts and/or DNA synthesis in blasts treated with CSF plus Ara-C or DNR was greater than those treated without CSF in the AML-193 cell line, and in some AML patients. On the other hand, the Ara-C- and DNR-mediated cytotoxicity of CFU-AML was not abrogated by CSF in any instance, but rather, it was significantly enhanced by all the CSF in the majority of instances. Although the enhancement was clearer when Ara-C was used, compared with DNR, there were no significant differences among the enhancing effects of the CSF. Under the same culture conditions as those for CFU-AML, all of the CSF significantly enhanced the Ara-C-mediated cytotoxicity of day 7 normal CFU-GM, although to a lesser extent than in CFU-AML. However, none of the CSF significantly affected the Ara-C-mediated cytotoxicity of day 14 normal CFU-GM or the DNR-mediated cytotoxicity of day 7 or day 14 normal CFU-GM. These results suggest that in the selection of a strategy entailing combined use of cycle-specific drugs plus CSF to increase the antileukemic effectiveness of chemotherapy in AML, G-CSF is preferable to GM-CSF or IL-3, since it has fewer potential clinical side effects, and that, furthermore, DNR may be as useful as Ara-C.


Immunosuppressive factor produced by a B cell line derived from an adult T cell leukemia patient.

The immunosuppressive activity of culture supernatants from human T cell leukemia virus type I (HTLV-I)-infected cell lines was examined in vitro. Culture supernatants of both a HTLV-I-infected B cell line, IWS, established from an adult T cell leukemia (ATL) patient and a T cell line, MT-2, suppressed lymphocyte proliferative responses to stimulation with the mitogens phytohemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM). The immunosuppressive factor was not cytotoxic for lymphocytes and did not inhibit the spontaneous growth of ATL cells. It inhibited interleukin-2 (IL-2) production by PHA-stimulated T cells and it arrested PHA-stimulated T cells at the G0/G1 phase of the cell cycle and inhibited entry into the S phase. Furthermore, the factor significantly inhibited the expression of CD3, CD4, and IL-2 receptor (IL-2R) alpha-chain (CD25) on PHA-stimulated T cells. These results suggest that the immunosuppressive factors produced by HTLV-I-infected cell lines might function in the regulation of normal lymphocyte proliferative responses, and that they could play some role in the induction of the immunodeficient condition observed in ATL patients.


In vitro proliferative and differentiated responses of lymphoma cells to PHA and IL-4 in a patient with intermediate lymphocytic lymphoma.

We carried out in vitro B cell colony assays, with phytohemagglutinin-P (PHA-P) and IL-4, on B cells from one intermediate lymphocytic lymphoma (ILL) patient and four chronic lymphocytic leukemia (CLL) patients. Peripheral blood B cells from the ILL patient responded to PHA and IL-4, they proliferated, and differentiated into cells with plasmacytoid cell morphology. They lost the CD19 surface antigen after 10 day co-culture with PHA and IL-4. The bone marrow of this ILL patient contained atypical plasma cells with multiple nuclei. Peripheral blood B cells from the four CLL patients responded to PHA, but IL-4 did not increase PHA-induced B cell colony formation in these cells. The CLL cells did not differentiate into plasma cells, and they were clearly different from the ILL cells in morphology, as shown by scanning electron microscope examination. Since this study was performed on cells from only one ILL patient, further examination of cells from many patients might be necessary to confirm the difference between ILL and B cell-type CLL.


Mediastinal diffuse large cell lymphoma of B-cell type with azurophilic granules.

A case of diffuse large cell lymphoma of B-cell type with unusual azurophilic granules is reported. Lymphoma occurred primary in the upper anterior mediastinum and was suggested to be of thymic origin. Histologically, lymphoma cells showed diffuse proliferation and were large in size, frequently with multilobulated nuclei. In imprint preparations stained by May-Giemsa, most lymphoma cells had basophilic cytoplasm with azurophilic granules. Cytochemical studies showed the granules to be negative for PAS, peroxidase, acid phosphatase, and beta-glucuronidase. Electron-dense granules and electron-lucent granules were found on ultrastructural analysis. The cells were characterized as B-cell type by immunophenotypes of L26+, CD20+, CD21-, CD22+, and PCA1+, the possession of surface monotypic IgA kappa immunoglobulin, and a genotype of immunoglobulin heavy and kappa light chain gene rearrangements.


Ultrastructural analysis of platelet-like particles from a human megakaryocytic leukemia cell line (CMK 11-5).

Ultrastructural observations were performed to further characterize the human megakaryocytic leukemia cell line, CMK, and its subclone, CMK11-5. We found that particles derived from CMK11-5 cells had cytoplasmic projections and no nucleus, and that some particles contained alpha granules. Incubation with ADP induced fibrinogen receptors on the surface of these particles. Furthermore, the particles had glycoprotein Ib antigen on their surfaces, and attached nonreversibly to rabbit aortic subendothelium, showing associated morphological changes similar to those observed in normal platelets. CMK and CMK11-5 are the first megakaryocytic cell lines that have been found to release particles that have some of the same functions as normal platelets. In particular, CMK11-5 seems to be a useful model for studying megakaryocyte function.


Replacement therapy in a patient with congenital prekallikrein deficiency undergoing surgery.

A patient with congenital prekallikrein (PK) deficiency underwent left endonasal radical ethmoidectomy and nasal polypectomy after receiving a transfusion of 6 ml/kg body weight of fresh frozen plasma (FFP). His plasma PK activity was under 1% before transfusion, and 46% after transfusion. The patient had no bleeding tendency during operation, but bled extensively from the wound 7 days after operation. At that time, his plasma PK activity was 3%. Since the bleeding could not be stopped simply by plugging his nasal cavities with tampons, he was given 3 ml/kg body weight of FFP. As a result, his nasal bleeding rapidly decreased. No clinical sign of thrombotic complication was observed throughout the clinical course.


Myelodysplastic syndrome in a patient with a unique constitutional chromosome abnormality t(2;11) (q31;p13).

We present a case of myelodysplastic syndrome (MDS), which developed into an overt leukemic phase in a 15-year-old female with a rare constitutional abnormality [46,XX,t(2;11) (q31;p13)]. The patient entered complete remission after 3 months of chemotherapy. On chromosome analysis during remission, the t(2;11) (q31;p13) abnormality was detected in all metaphases of both the bone marrow cells and PHA-stimulated peripheral blood lymphocytes. Her father also had the same karyotype. This case seems to be of value as a reference for the study of the significance of constitutional chromosome abnormalities in MDS.


N-RAS activation in the terminal stage of undifferentiated chronic myeloproliferative disease.

The relationship between activation of the N-RAS gene and the leukemic progression of undifferentiated chronic myeloproliferative disease (UCMPD) was investigated in a 71-year-old male. Hematologically, it was difficult to differentiate the UCMPD from chronic myelogenous leukemia. Chromosomal analysis revealed no Philadelphia chromosome (Ph1-), and DNA analysis revealed no BCR rearrangement (BCR-) either at the beginning or in the terminal stages of the disease. We performed a tumorigenicity assay, using NIH3T3 cells, and molecular analysis, using the polymerase chain reaction (PCR) and direct sequencing. The DNA of leukemic cells at the beginning of the leukemic progression did not show any abnormalities, but at the terminal stage of the disease the DNA showed a point mutation in codon 12 (GGT----GCT) of the N-RAS gene. Interestingly, a codon 13 mutation (GGT----GTT) was also detected by tumorigenicity assay. These observations suggest that the activated N-RAS gene contributes to the hematologic progression of UCMPD.


[Color-coded duplex sonography (angiodynography)].

Colour-coded duplex sonography is a relatively new method of diagnostic imaging. Compared with conventional duplex sonography it has advantages in respect of simplicity and speed in several applications. The main application of colour-coded duplex sonography is for the detailed demonstration of a limited area. A comprehensive demonstration of blood vessels remains the province of angiography. Clinical applications include vessels in the neck, lateral soft tissue anatomy of the neck, arteries and veins in the extremities, haemodialysis shunts, transplanted kidneys and acute abnormalities in the scrotum. In the abdomen the method is of only limited application.


[The course of the disease in endocrine orbitopathy. Magnetic resonance tomographic documentation].

MR imaging of the orbits was performed in 59 patients with untreated Graves' ophthalmopathy (follow-up exams were performed in 11 patients). T2-relaxation times of eye muscles were calculated and correlated with duration of disease. Elevated T2 times indicating eye muscle edema were found even if ophthalmopathy had been existing for more than one year. MRI documented specific eye muscle changes and transformation of oedema to fibrosis and fatty degeneration. MRI thus allows for standardized planning of therapy and follow-up in patients with Graves' ophthalmopathy.


[The nuclear magnetic resonance tomographic differentiation of osteoporotic and tumor-related vertebral fractures. The value of subtractive TR gradient-echo sequences, STIR sequences and Gd-DTPA].

42 patients with known malignancy and vertebral compressions underwent MRI. Sagittal T1-weighted spin-echo images pre and post Gd-DTPA, out of phase long TR gradient-echo images (GE) and short T1 inversion recovery images (STIR) were obtained at 1.0 T. The results were confirmed by histology (6/42) or clinical data (28/42) and follow up MRI studies (8/42). In 39 of 42 cases a correct differentiation between osteoporotic and tumorous vertebral compression fractures was possible by quantification and correlation of SE and GE signal intensities. Gd-DTPA did not improve differential diagnosis, since both tumour infiltration and bone marrow oedema in acute compression fracture showed comparable enhancement. STIR-sequences were most sensitive for pathology but unspecific due to a comparable amount of water in tumour tissue and bone marrow oedema. Susceptibility-induced signal reduction in GE images and morphologic criteria proved to be most reliable for differentiation of benign and tumour-related fractures. In the rare cases of single and nearly complete vertebral compressions with complete loss of bone marrow, differentiation with MRI was not possible.


[Dynamic functional MRT of the cervical spine].

To obtain functional studies of the cervical spine, a device has been developed which allows MRI examinations to be carried out in five different degrees of flexion. T1 and T2* weighted FFE sequences were used. Dynamic functional MRI was performed on 5 normals and 31 patients (5 disc herniation, 4 whiplash injuries, 6 spinal canal stenoses, 14 laminectomies and spinal fusions, 2 rheumatoid arthritis). The relationship of the spinal cord to the bony and ligamentous components in different degrees of flexion was particularly well shown in whiplash injury, spinal stenosis and postoperative situations.


[The value of MR tomography in acute shoulder dislocations].

24 patients up to two weeks after primary traumatic shoulder dislocation were examined at 0.5 and 1.5 T. Surgical and/or arthroscopic correlation was available in 13, CT-arthrographic correlation in 16 patients. A joint effusion allowing sufficient evaluation of the capsulolabral complex was present in 21/24 (87.5%) cases. 11/14 patients with combined dislocated detachments of the glenoid labrum and capsular lesions were subsequently operated upon. Marrow edema of the humeral head was found in 16/19 Hill-Sachs lesions and in 4/5 fractures of the greater tuberosity. Two patients presented with a lesion of the long biceps tendon associated with rotator cuff tears and were also subsequently operated upon. MRI performed shortly after primary traumatic shoulder dislocation allows a comprehensive evaluation of the intraarticular lesions and decisively influences further therapy.


[Adhesive (retractile) capsulitis of the hip joint in diabetes mellitus. An x-ray histomorphological synopsis].

Adhesive (retractile) capsulitis of the hip joint is a rare complication (association) of (juvenile) diabetes mellitus. The clinical features, plain radiographic and CT findings and histomorphological appearances of this condition are described and attention is drawn to changes in the elastic tissue in the fibrosed capsule. Three diagnostic radiological features have been defined; in their presence, arthrography or diagnostic arthroscopy need not be performed.


[The radiological findings in adamantinoma of the long tubular bones].

The radiological findings of adamantinomas of long bones are described in 22 patients. The diagnosis was confirmed by a team of experts (pathologist, radiologist, orthopaedic surgeon) of the "Bone tumour study group" at the German Cancer Research Center. There were 12 male and 10 female patients aged 5 to 67 years (most commonly in the second and third decade). In 21 patients the tibia was involved and in one patient the fibula. The tumour was nearly always in the diaphysis (20 cases). The most striking radiological feature was a diaphyseal lesion confined to the bone showing multicentric translucencies. The latter showed surrounding or central ring shaped or focal areas of increased density. The lesions tended to be longitudinal, averaging 11 cm (between 3 and 25 cm). All lesions showed a sclerotic margin separating it from normal bone, at least over part of the lesion. Expanding lesions were mostly separated from the soft tissues by a bony rim (18 cases).


[Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load].

Complex corrective osteotomies in the lower extremities require precise preoperative planning. Fifty patients (37 male, 13 female) with an average age of 31 years (13 to 61 years) who had suffered fractures of the lower limbs and had been treated by osteosynthetic or conservative methods were studied, using a GE 9800 Quick CT; accurate and reproducible measurements of the angles of torsion of the femur and tibia were obtained. Digital images were produced to standardise the planes of measurement and to measure the length of the limb. The normal extremities of patients older than 18 years showed internal torsion of -20.4 +/- 9 degrees of the femur and external torsion of 33.1 +/- 8 degrees of the tibia. The most important clinical measurement is the intra-individual difference of the torsional angles. Amongst normals this is 4.3 +/- 2.3 degrees in the femur and 6.1 +/- 4.5 degrees in the tibia. Consequently, only angles greater than 9 degrees in the femur and 15 degrees in the tibia should be regarded as abnormal. Radiation exposure was measured by a LiF-thermoluminescence dosimeter on an Alderson phantom. Skin dose was 6.3 +/- 1.2 mGy and gonadal dose for females was 2.5 +/- 0.3 mGy and for males 0.7 +/- 0.1 mGy.


[Magnetic resonance tomography in pulmonary hypertension].

We examined 23 patients with pulmonary hypertension of varying aetiology by MRI and compared the results with those of right heart catheterisation. The best correlation was obtained between right ventricular mural thickness and mean pulmonary pressure (R = 0.91, p = 0.001). There was significant correlation (R = 0.85, p = 0.001) for the diameter of the inferior vena cava, which was dilated in all patients with pulmonary hypertension. There was no significant correlation between mean pulmonary pressure and the diameters of the superior vena cava or the main pulmonary artery branches (R = 0.55 and 0.75 respectively, p less than 0.05). Amongst functional measurements there was a correlation between right ventricular ejection fraction and mean pulmonary artery pressure (R = 0.71, p = 0.001). There was no correlation between right ventricular end-systolic and end-diastolic volume. In all patients with pulmonary hypertension, dynamic flow sensitive gradient echo sequences showed the presence of tricuspid insufficiency. A further semiquantitative criterion for the presence of pulmonary hypertension in 4 patients (17%) was an abnormal signal from the main pulmonary artery in early to mid-systole shown on T1-weighted transverse sections.


[Extrinsic allergic alveolitis in CT and HR-CT].

The CT changes on conventional and high-resolution CT in 14 patients with exogenous allergic alveolitis (EAA) were analysed retrospectively. There were 8 patients with clinically subacute disease, 5 patients in a chronic stage and 1 patient with acute EAA. The appearances and their distribution were examined. Seven of the 8 patients in the subacute stage showed a ground glass pattern and multiple nodules of less than 2 mm. All patients in the chronic stage showed a combination of fine infiltrates, small nodules and irregular linear densities; distortion of the pulmonary pattern was present in 3 cases. The patient with acute EAA showed diffuse dense areas of consolidation in both lungs as well as multiple nodules and a ground glass pattern. The CT appearances of EAA correspond with the basic micropathology and, within the clinical context, permit diagnostic classification.


[The value of the x-ray findings in the follow-up of the adult respiratory distress syndrome. A retrospective analysis].

Serial chest x-rays of 23 ARDS patients, taken in an 24 hour interval, were retrospectively analysed. Radiographic patterns of ARDS were divided into five stages and were related to corresponding parameters of respiratory status. Characteristic findings on chest x-ray films occurred after a short latency period following the clinical onset of ARDS. There was a close relationship between the time of maximum radiographic changes and maximum loss of lung function. The progression through successive radiologic stages was in many cases accompanied by a significant deterioration of functional parameters. Distinction between survivors and non-survivors was achieved while considering maximum radiographic abnormalities. The results suggest significance of serial chest x-rays in diagnosis and course estimation of ARDS.


[Magnetic resonance tomography (MRT) in pleural diseases. A comparison with CT and histopathological findings].

The MRI and CT appearances in 48 patients with histologically confirmed benign and malignant pleural abnormalities were compared retrospectively. Abnormal pleural changes were shown in 47 out of the 48 patients by high signal intensity of the pleura in T2-weighted sequences and in contrast enhanced T1-weighted sequences on MRI. CT showed abnormalities in 45 out of 48 patients. Delineation of pleural and pulmonary changes by CT was possible in 13 out of 23 cases, and pleural disease from effusions in 15 out of 28 cases. T2-weighted MRI was successful in 14 out of 23 and 4 out of 28 cases, respectively. T1-weighted images after contrast were successful in 20 out of 23 and 22 out of 28 cases, respectively. Indications of malignant pleural disease were the presence of mediastinal or circumferential involvement or involvement of the entire pleura, thickness of more than 10 mm and nodular changes. The most reliable sign of malignancy was infiltration of the thoracic wall and the diaphragm; this was better demonstrated by MRI (18 out of 19 and 2 out of 2 cases) than by CT (14 out of 19 and 0 out of 2 cases).


[The tilted screen-cassette ("grid cut-off" effect). A problem of bedside thoracic diagnosis].

Tilting of a grid during portable radiography leads to uneven exposures, and errors greater than 3 degrees can lead to errors in interpretation. Differentiation from abnormal findings can be made by recognising exposure difference of extrathoracic comparable areas. The difficulties caused by tilting of the grid can be reduced by increasing the film focus distance and by using suitable grids. A new cassette holder with an integrated balance makes it possible to correct tilting of the grid rapidly and effectively. This results in improved image quality which can be applied not only to conventional exposure systems but is also of advantage when using digital methods.


[Magnetic resonance tomography as the basis for biomechanical analysis. The simulation of the birth process as an example of the expanded information potentials of segmental imaging procedures].

A method is presented that enables the use of (static) informations from magnetic resonance imaging (MRI) for (dynamic) biomechanical analysis. Using a specially developed software MRI pixel matrices are colour-coded and--according to the principle of same density--line data are created. After sectional attribution of the resulting polygons a three-dimensional mesh of so-called finite elements is created which can then be used in deformation analysis. This method is exemplified by a project dealing with the simulation of birth mechanics, which is finally aimed at validating the results from radiologic pelvimetry. First analyses show that even under foetal head moulding conditions, being considered as normal, such sensitive structures as the cerebellum, brain stem as well as the ventricles with the plexus chorioidei are to be found within the maximum isobars within a range of 104-140 N(10.6-14.3 kp).


[99m-Technetium-mercaptoacetyltriglycine (MAG3) for the demonstration of the kidney changes following extracorporeal shockwave lithotripsy. A prospective study of 117 patients].

Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for urinary calculi. 117 patients were studied prospectively with 99mTc mercaptoacetyltriglycine (MAG3) before and after ESWL. 79 (66%) of the 119 kidneys treated had abnormal findings. Of these 63/119 (53%) had abnormal scans. 41 (65%) had focal lesions with a delayed intrarenal transport. The remaining 22 had a diffuse delay of intrarenal transport. A loss of relative renal function of 3% and more compared to the pretreatment values was observed in 50/119 (42%) patients. 99mTc MAG3 should be done routinely together with radiologic tests (CT or MRI) before and after ESWL to select the patients at risk for post ESWL hypertension.


[The technic of adrenal biopsy. Ultrasound versus CT as the guidance method].

Forty-seven needle biopsies of the adrenal glands have been performed under ultrasound or CT guidance. The aim was to clarify the best guidance method, the best approach, the choice of biopsy needle and possible complications. Analysis of the results provided the following answers: 1. A mass in the right adrenal can be biopsied under ultrasound control by a transhepatic approach. Small lesions of the left adrenal are best approached under CT guidance. In these cases a subcostal angled approach is advised. 2. Cutting biopsy needles provide better results than aspiration biopsy needles. 3. The complication rate of adrenal biopsies is very low if thin cutting needles are used.


[The demonstration and staging of bladder carcinoma. A comparative study between magnetic resonance tomography, computed tomography and radioimmunoscintigraphy].

The purpose of the present study was to compare the effectiveness of MRI, CT and radioimmunoscintigraphy in the staging and detection of bladder cancers in 28 patients. We distinguish two groups: Group I included the tumour stages CIS-T3A and the second group the deep infiltrative tumours T3B-T4. MRI was slightly superior to CT in respect of tumour staging (75% correct results as compared to 63%). No understaging occurred with MRI, whereas in 22% of the cases the stage of the tumour was underestimated using CT diagnostics. Overstaging occurred in 25% of the MRI and 15% of the CT-diagnostics, respectively. RIS cannot distinguish the tumour groups, and hence this method is useful only for the detection of the primary tumour and metastases. In 77% of cases the tumour was detected and in 15% the tumour could be safely excluded.


[Failed sclerotherapy trials with the V. spermatica interna. A retrospective analysis in 1141 patients with idiopathic varicocele].

From July 1988 until December 1990 1141 patients with left-sided idiopathic varicocele underwent phlebography of the spermatic internal vein, and percutaneous sclerotherapy with sodium morruate (Varicocid) was intended to be performed. In 125 of these patients sclerotherapy was not feasible. The reasons for this were analysed in a retrospective study. According to the anatomical situation of the spermatic vein, there were significant differences in technical success. In case of incompetent valve of the spermatic vein at the renal origin (type I, 2A, 3, 4A), selective probing and following sclerotherapy was possible in 97%. Anatomic variations with competent valve of the spermatic vein (type 0, 2B, 4B) led to difficulties in selectively probing the vessel, and sclerotherapy was feasible in only 72.7%. In these angiographically difficult cases, spasm of the spermatic vein and/or perforation prevented sclerotherapy in 29 of 125 patients.


[Catheter-induced vascular lesions: a comparison of the diagnostic value of Doppler color sonography versus angiography].

One hundred and thirty-two patients with suspected lesions of the femoral arteries following diagnostic and/or therapeutic cardiac catheterisation were studied by colour Doppler sonography (CDS) and digital subtraction angiography (DSA) and the results were compared. CDS was unable to demonstrate 5 out of 23 av fistulae. Intra-arterial DSA showed all av fistulae found at operation. CDS showed lower reliability (95%) than DSA (100%) for the demonstration of pseudoaneurysms. CDS can indicate hematoma and thrombi in pseudo-aneurysms and their exact extent is better shown by sonography. Arterial dissections (2 cases) and intra-luminal thromboses or occlusions of the femoral artery (4 cases) are shown equally well by the two procedures.


[Percutaneous aspiration embolectomy of the popliteal artery].

Twenty-eight patients (17 women, 11 men, average age 67 years, range 40-85 years) with embolic occlusions of the popliteal arteries were treated by aspiration embolectomy. 6 patients were in clinical stage IIb and 22 in stage III. In 25 of the 28 patients the occlusion was treated successfully. Complications could be treated non-surgically at the same time. 2 of the patients died within the first week of cerebral emboli, 2 further patients suffered recurrent emboli in the treated extremity during the first month. 17 patients who were followed up for six months were free of recurrences.


[The regional blood flow in intracranial tumors: a comparison of HMPAO-SPECT with a newer magnetic resonance tomographic procedure].

We compared the value of gadolinium-enhanced first-pass MRI perfusion studies and HMPAO-SPECT for the assessment of regional cerebral blood flow in a prospective study of 23 intracranial tumour patients. In five tumours with homogeneous hypoperfusion and eight tumours with homogeneous hyperperfusion, tumour blood flow patterns in MRI and HMPAO-SPECT were similar. By contrast, in ten patients with inhomogeneous tumour blood flow pattern only MRI was able to differentiate between tumour areas with no or low flow, tumour tissue with high flow, and perifocal oedema with reduced flow. In HMPAO-SPECT, these inhomogeneous tumours were represented as areas of homogeneously reduced tracer retention corresponding to different tumour constituents and perifocal oedema. In conclusion, the high spatial resolution of MRI enables a detailed analysis of tumour blood flow.


[Intracranial tumor-like lesions in children and young adults with multiple sclerosis].

Atypical early manifestations of multiple sclerosis (MS) are common in children and young adults. 6 patients (aged 5 to 33 years) were examined by MR because of confusing neurological manifestations. In addition to small MS lesions there were also large intracerebral lesions which, however, did not occupy additional space but which looked more like tumours or abscesses. The lesions were sharply demarcated cystic formations with margins that enhanced with contrast. The diagnosis of these lesions presents difficulties, the differential diagnosis including MS and its variants, neoplastic, infectious and vascular processes. MR can provide valuable diagnostic information.


[The determination of cerebral dopamine (D2) receptor density by using 123I-IBZM-SPECT in Parkinson disease patients].

An alteration of the dopaminergic nigrostriatal system is believed to be the main pathogenetic factor of Parkinson's disease (PD). We report on our initial results on the determination of the post-synaptic dopamine-D2-receptor binding of 123I-IBZM in patients with PD. Drug-native patients showed a significantly higher IBZM binding in the basal ganglia as compared to patients on specific dopaminergic medication. Age, duration of the disease and the severity of the disease do not seem to influence the IBZM-receptor binding. We conclude that 123I-IBZM-SPECT is an extremely useful tool for the evaluation of the functional state of cerebral dopamine-D2-receptors.


[The clinical value of magnetic resonance tomography in cystic space-occupying lesions of the mouth floor].

11 patients with cystic lesions of the floor of the mouth were examined by MR imaging. Coronal slices provided an optimal visualisation of the lesions, but axial and sagittal slices added important information with regard to the exact topographic relationship between tumour and muscles. In particular, the mylohyoid muscle could be defined as a key structure. T1-weighted sequences enabled best visualisation of anatomic details, whereas T2-weighted sequences facilitated the primary diagnosis of cystic lesions. The contrast agent Gd-DTPA did not add information of significant diagnostic value. Our results indicate that MRI allows an exact visualisation of location and extent of cystic lesions and their relationship to surrounding muscles. We conclude that MRI is of high value in planning the operative strategy.


[The magnetic resonance tomographic differential diagnosis between reactively enlarged lymph nodes and cervical lymph node metastases].

A prospective study was carried out involving 27 patients to determine whether MRT can distinguish between lymph node metastases and reactive lymph node enlargement. The results of MRT were compared with the pathological findings. Using T1 and T2 weighted sequences and proton density sequences it was not possible to differentiate between reactively enlarged lymph nodes and lymph node metastases. Following the administration of Gd-DTPA the observation of central hypo-intensity with marginal hyper-intensity is a reliable sign of a lymph node metastasis. Using the criterion of length greater than 10 mm for lymph node metastases results in a specificity of 32% and sensitivity of 75%. The use of the sonographic maximal/cross measurement quotient > 2 in the axial/coronary/sagittal dimension improves specificity and sensitivity to 94%.


[Magnetic resonance tomography and magnetic resonance angiography in lymphangiomatosis].

Generalised lymphangiomatosis is a rare benign congenital abnormality of the lymphatic vessels with a complex pattern. 3 patients with different types of lymphangiomatosis were studied by MRT and MRA and histopathologically. All patients had multiple organ involvement in the abdomen, the skeleton and the skull. The basis in each case was lymphangiomatosis of capillary-cavernous, cystic or cavernous type. The results of MRT and MRA in diagnosing splenic, vascular and skeletal changes correlated accurately with operative findings and with the histopathological classification. In summary, MRT combined with MRA and using paramagnetic contrast media are the diagnostic methods of choice for the investigation of generalised lymphangiomatosis with multiple organ involvement.


[Ultrasonic velocity measurements at weight-bearing and non-weight-bearing sites of the peripheral skeleton. The effect of physical activity in soccer players].

Ultrasound transmission velocity at the appendicular skeleton is determined by elastic properties of the bone as mass density. We evaluated ultrasound transmission velocity at the os calcis of both feet and at the proximal phalanges of DII and DIII of both hands in 51 male subjects. 28 of them were professional soccer players of the 1st German division, 11 subjects performed non-professional exercise in various athletic organisations regularly and 12 did not exercise at all. A significant difference in the speed of sound could be seen at os calcis, where the soccer players had higher velocities than the other groups. The differences between the groups at the upper and lower extremities suggest that changes in ultrasound transmission velocity are not only affected by structural changes in the aging skeleton, as it might be suggested by age differences, but by exercise. Physical exercise can change the properties (structure and/or density) of weightbearing bone and this can be detected by measuring ultrasound velocity.


[Lipid peroxidation in emotional stress in rats: correlation with parameters of open field behavior].

TBA-reactive products were measured in the brain, liver, and heart of Wistar rats in control conditions and after 24 h immobilization. Animals were subjected to the open field test before and after the immobilization. Behavior patterns, gastric mucosa alterations and MDA accumulation in organs suggested that immobilization as well as food and water deprivation were all strong stressor stimuli. Initial open field behavior characteristics were significantly correlated with MDA contents in various tissues under emotional stress.


[Phrenic blood flow in cats with closed abdominal cavity].

By means of ultrasonic method, used in acute experiments on cats with closed abdominal cavity under nembutal narcosis, the authors studied the linear and volumetric blood flow velocity in left phrenic artery, the resistance of vascular bed of the phrenic artery, systemic blood pressure, respiration excursions during asphyxia, hypoxia, infusion of some biologically active substances. It was shown, that shortening of the diaphragm has definite influence on the blood flow and resistance of the vascular bed of the phrenic artery; the degree of the decrease of the blood flow in inspiration (on relation to the value of the blood flow in expiration, that passed as 100%) does not differ significantly in quiet and intensive respiration. Under the influences, the resistance of vascular bed of the phrenic artery decreases, the linear and volumetric blood flow increases, that indicates large reserve of the vascular bed of the phrenic artery for the increase of the blood flow.


[Sex differences in response to stress in conscious and anesthesized rats during surgical stress].

Adrenal and plasma corticosterone levels under conditions of preoperative stress (removal from animal to experimental rooms, removal from a home cage, handling, weighing and injecting with saline) were more than 2-fold higher in female rats than in male ones. Females, compared with males, showed more pronounced decrease in corticosterone responses to preoperative stress and laparotomy under nembutal anesthesia, which blocked stress-induced emotional activation. One hour after recovery from anesthesia laparotomized females but not males, demonstrated a significant (5-fold) increase in plasma corticosterone level. The absolute values of plasma corticosterone in laparotomized females, compared with males, were 2-fold lower under anesthesia but 2-fold higher after recovery from anesthesia. It is supposed that in females, compared with males, stress-induced emotional tension plays more considerable role in endocrine stress responses. This provides higher adrenocortical sensitivity to stress in conscious female rats than in male animals.


[Interactions of mast cells and leukocytes in increased vascular permeability in the focus of inflammation].

On the model of acute infectious peritonitis in rats it is shown that the mast cell depletion affected the inflammatory focus vascular permeability mainly in the immediate phase of its increase. Leukopenia inhibited the permeability both in the immediate and delayed phases. The combined depletion of mast cells and leukocytes not only inhibited the degree of vascular permeability increase but strongly affected its kinetics during exudative phase of peritonitis. The results indicate that in the natural conditions of inflammation the mast cell-leukocyte interaction in the vascular permeability increase takes place.


[Resistance and capacity function of blood vessels of the brain during activation of its cholinergic mechanisms].

Blood from the cat donor was perfused into the haemodynamically isolated cat brain. The changes of the vascular resistance and their capacity during the pharmacological activity of the endogenic cholinergic mechanism on the introduction of phosphacol into the bloodstream were investigated. Research has shown that the reduction of the activity of cholinergics leads to a decrease in pressure in the arteries of the brain and to an increase of the intercellular fluid absorption, caused by the neurogenic cholinergic influences. The possibility of a mediator realisation of the cholinergic influences on the brain vessels is discussed.


[Contents of aldosterone and electrolytes in blood plasma and the myocardium of rats after single physical exertion during acute alcoholic intoxication].

It was proved in experiments with male Wistar rats that acute alcohol intoxication caused significant changes in electrolytes balance in blood plasma and myocardium remaining for a long time after ethanol injection. SPL test makes it possible to reveal inadequate reaction of blood plasma aldosterone in alcohol injected rats. This fact may be considered as the fact of involving extracardiac component of compensation of myocardial functional insufficiency conditioned mainly by electrolyte unbalance. The tolerance to physical loading is significantly higher in alcohol injected rats than in intact animals.


[Effects of chronic experimental stress and endogenous opioids on histophysiological parameters of the thyroid gland].

In adult rabbits stress was modelled by electrostimulation of the hypothalamus ventromedial nucleus (15-hour-long session during 30 days) and medulla's raphe big nucleus which is one of the central places of the opioid peptides synthesis was irritated. It is revealed, that under stress thyroid gland responds by serum T3 increase in comparison with control animals with statistically significant variability of the T4 profile. Chronicity of the emotional agitation involves destructive changes in the thyroid parenchyma the hurting effect of the negative emotional factor is expressed less during opioid peptides complex activation. It is suggested that there are its own stress-limiting mechanisms in thyroid gland.


[Biochemical bases of ftorafur-potentiating effects of perfluorodecalin, inducer of cytochrome P-450 dependent microsomal monooxygenases].

Activity of cytochrome P-450-dependent monooxygenase system is significantly lower in hepatoma H-2-73 and Lewis lung carcinoma-bearing mice as compared to that in control animals. An inhibition of the cytochrome P-450 system was observed after the injection of ftorafur. Treatment of the mice with perfluorodecalin markedly increased the antineoplastic activity of ftorafur determined by a loss of the leucocytes and of the weight hepatoma H-2-73- and Lewis lung carcinoma resistant to ftorafur alone.