Stability of ondansetron hydrochloride in portable infusion-pump reservoirs.

The stability of ondansetron hydrochloride 0.24 and 2 mg/mL when delivered by portable infusion pump at near-body temperature over various time periods was investigated. Nine 100-mL drug reservoirs were prepared, three containing ondansetron hydrochloride 2 mg/mL and six containing ondansetron hydrochloride diluted with 0.9% sodium chloride injection to 0.24 mg/mL. Three of the reservoirs containing the diluted solution were refrigerated for up to 30 days at 3 degrees C before being attached to portable infusion pumps and pumped over 24 hours at 30 degrees C. The remaining six reservoirs were attached to pumps immediately after being filled, and the solutions were delivered for up to 24 hours (the diluted solution; three reservoirs) or up to seven days (the concentrated solution; three reservoirs) at 30 degrees C. Samples were taken initially and periodically and analyzed by high-performance liquid chromatography and with a pH meter. Both the diluted and the concentrated solutions of ondansetron hydrochloride retained at least 95% of the initial drug concentration under all the conditions studied. There was no appreciable change in pH. Ondansetron hydrochloride 0.24 mg/mL was stable when stored for up to 30 days at 3 degrees C and infused over 24 hours at 30 degrees C. Ondansetron hydrochloride 2 mg/mL was stable when infused for up to one week at 30 degrees C.


Ureter injury during laparoscopy-assisted vaginal hysterectomy with the endoscopic linear stapler.

Ureter injury is more common with abdominal hysterectomy than vaginal hysterectomy. Complications during laparoscopy-assisted vaginal hysterectomy cases have not been thoroughly studied. Two cases are presented that highlight urologic misadventures, specifically, ureteral injury, with the endoscopic linear stapler during laparoscopy-assisted vaginal hysterectomy.


Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.

This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.


Melancholic/endogenous depression and response to somatic treatment and placebo.

The authors' goals were to examine the effects of somatic treatment and placebo in patients with and without endogenous/melancholic depression. Before entry into one of four trials of antidepressant drugs versus placebo, 231 patients were assessed as to whether they met Research Diagnostic Criteria for definite endogenous depression and/or DSM-III criteria for major depressive episode with melancholia. These patients were prospectively assessed for subsequent response to antidepressant treatment or placebo. Previous studies of the effect of endogenous/melancholic depression on treatment response were also reviewed. Of the 76 patients with DSM-III melancholia given active medication, 41 (54%) had a complete or partial response, but only 10 (23%) of the 44 patients with melancholia given placebo had a complete or partial response. Of the 76 depressed patients without melancholia given active medication, 46 (61%) had a complete or partial response, and 15 (43%) of the 35 depressed patients without melancholia given placebo had a complete or partial response. Moderately depressed patients with DSM-III melancholia had a significantly better response to active medication than did severely depressed patients with melancholia and showed the greatest difference between response to active medication and response to placebo. The results of the review of previous studies of the effect of endogenous/melancholic depression on treatment response were mixed. Depressed patients with melancholia were not particularly different from depressed patients without melancholia in their responses to antidepressant medication but did differ from patients without melancholia in their responses to active medication versus placebo, particularly if their depression was moderate and not severe. This suggests that patients with DSM-III melancholia may be unresponsive to nonsomatic treatments.


Vomiting after alfentanil anesthesia: effect of dosing method.

This double-blind study correlated the association of nausea and vomiting after alfentanil with its method of administration (bolus dose vs continuous infusion). Of 40 women undergoing lower abdominal gynecologic or laparoscopic surgery, 20 received an intravenous alfentanil (30 micrograms/kg) bolus dose for induction of anesthesia, with subsequent bolus doses of 10 micrograms/kg every 10 min, and 20 received the same induction dose delivered over 1 min, followed by an intravenous infusion at 1.0 micrograms.kg-1.min-1. The infusion group experienced more frequent nausea and vomiting than the bolus dose group (50% vs 30%, respectively; P = 0.0001). Laparoscopic surgery affected the incidence of nausea and vomiting independently of the method of alfentanil administration (75% for laparoscopic vs 17% for incisional procedures; P = 0.0001). Laparoscopy and alfentanil infusion combined synergistically to worsen the incidence of nausea and vomiting. We conclude that alfentanil infusion for laparoscopic surgery entails a high risk for nausea and vomiting.


Ondansetron in the treatment of postoperative vomiting: a randomized, double-blind comparison with droperidol and metoclopramide.

The prophylactic antiemetic efficacy of ondansetron was evaluated in a randomized, double-blind comparison with droperidol and metoclopramide in 66 patients undergoing general anesthesia for dilatation and curettage. Ten minutes before induction of anesthesia, 22 patients received a single intravenous dose of 8 mg of ondansetron, 22 others received 1.25 mg of droperidol, and the remaining 22 received 10 mg of metoclopramide. Anesthesia was induced with 3.3-5 mg/kg of intravenous thiopental and maintained with 65% nitrous oxide in oxygen and 2%-3% enflurane. Postoperatively, the incidence of vomiting was 13% with ondansetron, 45% with droperidol, and 54% with metoclopramide (P less than 0.05; overall chi 2 test). There was no statistically significant difference in the incidence of nausea among the groups. Postoperative sedation and well-being scores were not significantly different among the groups. We conclude that preoperative prophylactic administration of ondansetron is superior to droperidol or metoclopramide in the prevention of emetic sequelae after general anesthesia for dilatation and curettage.


Comparative effects of ketorolac, dezocine, and fentanyl as adjuvants during outpatient anesthesia.

The comparative effects of ketorolac, dezocine, and fentanyl were evaluated in 136 healthy female patients undergoing outpatient laparoscopic procedures according to a randomized, double-blind protocol. Patients received ketorolac (60 mg) or dezocine (6 mg) or fentanyl (100 micrograms, control group) before the start of the operation. A standardized general anesthetic technique consisting of midazolam (2 mg), fentanyl (50 micrograms), and propofol (2 mg/kg) for induction of anesthesia followed by propofol (120 micrograms.kg-1.min-1), vecuronium (1-2 mg), and 67% nitrous oxide in oxygen for maintenance of anesthesia, was used. In the postanesthesia care unit, 61% of patients in the fentanyl group received analgesic drugs for persistent pain, compared with 34% and 25% in the ketorolac and dezocine groups, respectively. Similarly, less postoperative fentanyl (mean +/- SD) was required in the ketorolac (22 +/- 33 micrograms) and dezocine (18 +/- 35 micrograms) groups, compared with the fentanyl (58 +/- 71 micrograms) group. However, 52% of the patients receiving dezocine required antinausea therapy in the postanesthesia care unit, compared with 20% and 18% in the fentanyl and ketorolac groups, respectively. Finally, recovery times were significantly shorter in the ketorolac (vs dezocine) group. Although both ketorolac and dezocine were effective alternatives to fentanyl when administered during outpatient laparoscopy, dezocine was associated with an increased incidence of postoperative nausea and a delayed discharge time compared with ketorolac.


Zones of the lower transverse rectus abdominis musculocutaneous flap based on laser Doppler flowmetry.

Improvement in the reliability of the lower transverse rectus abdominis musculocutaneous flap for breast reconstruction using autogenous tissues has been predicated on a thorough analysis of the vascularization of this flap and methods for its preservation. The arbitrary division of the skin paddle into zones based on relative perfusion has simplified an appreciation of the underlying vascular anatomy. Laser Doppler flowmetry has been used to confirm these anatomical findings and establish a single system based on descending values of observed blood flow. Zone I has been assigned to that region overlying the ipsilateral and zone III the contralateral rectus sheath, whereas zone II corresponds to the ipsilateral and zone IV the contralateral superficial inferior epigastric territory.


Assessment of TRAM flap perfusion using laser Doppler flowmetry: an adjunct to microvascular augmentation.

Any necrosis after reconstruction of the modified radical mastectomy defect using a superior epigastric based unipedicled lower transverse rectus abdominis myocutaneous flap should be unusual. Identification of the marginal flap at risk for this complication is important as this would permit immediate microvascular augmentation to enhance total survival. The dilemma, then, is how to define which flaps would benefit. We believe this is possible using laser Doppler flowmetry as a continuous, noninvasive, objective monitor of flap perfusion. Flow characteristics have been obtained in 16 consecutive transverse rectus abdominis myocutaneous flaps using the laser Doppler, where 2 were shown to have been in jeopardy for major flap loss. After appropriate microanastomoses as indicated, all flaps totally survived as predicted.


[Prevention of liver metastasis by intrasplenic injection of OK-432].

The effects of OK-432 on artificial liver metastasis of tumor-bearing mice were assessed using murine colon adenocarcinoma MCA-38 in C57 BL/6 mice. OK-432 injection into the spleen reduced the liver metastases. In gastro-intestinal cancer patients, the effects of OK-432 injection into the spleen were assessed with functional T cell subsets. The treatment resulted in an increase in the number of cytotoxic T cells, but a decrease in the suppressor T cells. The facts suggested that OK-432 injection into the spleen had an ability to prevent liver metastases.


[Calcium transport in cells of Streptomyces chrysomallus var. macrotetrolidi-- a producer of macrotetrolide antibiotics].

The dynamics of calcium accumulation by cells in batch cultures and by washed cells was defined with a radiotracer procedure for Streptomyces chrysomallus var. macrotetrolidi producing ionophore macrotetrolide antibiotics. It was shown that macrotetrolides added to the cultivation medium could regulate intracellular contents of calcium by participating in cation transport. Moreover, possible functioning of a Ca-ATPase system for the calcium active transport in the streptomycete cells was demonstrated.


[Outcome of patients with Eisenmenger syndrome. Apropos of 62 cases followed-up for an average of 16 years].

In an era when heart-lung transplantation offers a therapeutic option for patients with Eisenmenger's syndrome, it is important to assess the natural history of this condition. With this objective the authors studied 62 patients followed-up by the same cardiologist. The average follow-up period was 16 years, but 22 patients were followed up for over 20 years. The average age at death was 29 years. It differed significantly for genetically normal patients (31 years for 21 fatalities) compared with a population of trisomics (21 years for 6 fatalities). Half the patient population lived for over 30 years. Fourteen of the 27 deaths occurred during the third decade and only 4 before the age of 20. The probability of surviving 10 more years for a 20 years old genetically normal patient was 56%. The causes of death in the 19 cases in which it could be established were: 5 sudden deaths, 4 right heart failures, 3 massive haemoptyses, 3 pulmonary emboli, 2 pneumonias and 2 peroperative deaths. The functional disability was nearly always minimal or mild, enabling the patient to work: 24 of the 45 non-trisomic patients had full-time jobs. Pregnancy was a poor prognosis factor and could be lethal (2 deaths due to pulmonary embolism in the post-partum period). A heart-lung transplantation would only seem to be justified in patients with severe symptoms, polycythaemia, irreversible right heart failure and/or haemoptysis.


[Percutaneous angioplasty of branch pulmonary artery stenosis. A cooperative study].

Fifty balloon angioplasties of branch pulmonary artery stenosis in 34 patients aged 4 months to 20 years, performed in 7 French Centres, were included in this study: they were performed from 1984 to 1991 and concerned severe stenoses which were congenital in 36 cases and secondary to surgery in 14 cases. The criteria of inclusion were: diameter of stenosis less than or equal to 8 mm, right ventricular systolic pressure (RVP) greater than or equal to 50 mmHg, RVP/aortic pressure ratio (RVP/AO) greater than or equal to 50%, and a significant perfusion defect on radionuclide angioscintigraphy. There were no operative complications. The diameter of the stenosis increased by greater than 40% in 23 cases (46%); in only 7 of these cases (14%) did the RVP and RVP/AO ratio decrease by more than 20%, the RVP being less than 50 mmHg, or did the perfusion scintigraphy improve. No cases of restenosis were observed. The reasons for failure are discussed together with the limitations of this study. The respective indications of surgery and angioplasty are not easy to determine for these complicated lesions. New techniques such as the use of stents should improve results.


[Isolated hemangioma of the left ventricle. Value of coronaroangiography for the etiological diagnosis].

A four year old child was admitted for investigation of a cardiac murmur and cardiomegaly. Echocardiography showed a large left ventricular tumour, the extension of which was accurately defined by nuclear magnetic resonance imaging and the etiology confirmed by coronary angiography. Holter recordings showed salvoes of ventricular tachycardia. This is an interesting case because, despite echocardiography and nuclear magnetic resonance imaging, the precise nature of the tumour was revealed only by coronary angiography. This investigation also showed a significant decrease of the left ventricular ejection fraction. It is the only described haemangioma complicated by this type of ventricular hyperexcitability. Therefore, coronary angiography would seem to be necessary in the investigation of isolated myocardial masses which remain unidentified by non-invasive methods.


Baby v mother.

The right of a child born disabled as a result of a negligent act committed by another whilst the child was in utero is a recognized principle of law in the major common law countries. It is also recognized that a child who suffers injuries caused to it due to a negligent act committed prior to conception may also have a right to seek compensation. The right to bring such an action is contingent upon the child being born alive and being able to prove a causal connection between the alleged negligent act and the injuries complained of. However, with few exceptions, such legal actions have to date been taken against third parties whose negligence allegedly caused the injuries complained of. It was only a matter of time before courts would be called upon to consider an action taken against the mother of the child for the mother's alleged negligence causing harm to the child during pregnancy.


Streptokinase morbidity--more common than previously recognised.

Streptokinase is the thrombolytic agent most commonly used for the treatment of acute myocardial infarction. We report eight patients who developed late uncommon adverse reactions to streptokinase probably due to immune complex disease. The clinical manifestations included vasculitic rashes, abnormal renal and liver function tests and a syndrome resembling adult respiratory distress syndrome. Major adverse events with streptokinase such as stroke, bleeding and other allergic reactions, have been previously documented but the morbidity related to delayed reactions has not been widely recognised. These reactions produced significant morbidity resulting in prolonged hospital stay and may need to be considered in the decision to use streptokinase.


Definition of surface-exposed and trans-membranous regions of the (Ca(2+)-Mg2+)-ATPase of sarcoplasmic reticulum using anti-peptide antibodies.

Peptides have been synthesized representing parts of the transduction, phosphorylation, nucleotide-binding and hinge domains of the (Ca(2+)-Mg2+)-ATPase of skeletal muscle sarcoplasmic reticulum (SR), and corresponding to segments of all of the postulated short inter-membranous loops of the (Ca(2+)-Mg2+)-ATPase (residues 77-88, 277-287, 780-791, 808-818, 915-924 and 949-958). A number of antibodies raised to these peptides have been shown to bind to the ATPase, defining surface-exposed regions. Many of these are concentrated in the phosphorylation and nucleotide-binding domains, suggesting that these domains could be exposed on the top surface of the ATPase. The cytoplasmic location of the loop containing residues 808-818 was confirmed by the finding that proteinase K treatment of intact SR vesicles enhanced the binding of antibodies against this segment. These findings support the 10-alpha-helix model of the ATPase. These results also suggest that only inter-membranous loops larger than about 20 residues are likely to be detected by immunological methods in transmembranous proteins. Binding of anti-peptide antibodies to proteolytic fragments of the ATPase has been used to define the domain structure of the enzyme. Some of the anti-peptide antibodies have been characterized by studying their binding to sets of hexameric peptides synthesized on plastic pegs. A wide pattern of responses is observed, with a restricted range of epitopes being recognized by each anti-peptide antibody.


Changes in the adenine nucleotide and inorganic phosphate content of Escherichia coli F1-ATPase during ATP synthesis in dimethyl sulphoxide.

Escherichia coli F1-ATPase contained 2.9 +/- 0.1 mol of adenine nucleotide and 3.1 +/- 0.3 mol of Pi/mol of enzyme. After preincubation with ATP, the nucleotide and phosphate contents were 5.6 and 6.0 +/- 0.5 mol/mol of enzyme respectively. The F1-ATPase was induced to synthesize ATP in the presence of 30% (v/v) dimethyl sulphoxide (Me2SO). The ATP originated from endogenous bound ADP. The bound adenine nucleotide and Pi contents of the enzyme during the time course of ATP synthesis were investigated by using F1-ATPase which had been preincubated with ATP. We show that the process of ATP synthesis in Me2SO involves (i) an initial rapid loss of nucleotide from the enzyme, the process being facilitated by exogenous Pi, (ii) a rapid loss of Pi from the enzyme, at least in the absence of exogenous Pi, (iii) re-binding of a portion of the lost nucleotide, and (iv) synthesis of ATP from bound ADP and exogenous Pi. It is proposed that transfer of the F1-ATPase to the Me2SO medium induces a change in the conformation of the enzyme to a form favouring ATP synthesis.


Nuclear internalisation and DNA binding activities of interleukin-1, interleukin-1 receptor and interleukin-1/receptor complexes.

This paper presents evidence to suggest that interleukin-1 alpha as a complex with its receptor is able to express DNA binding activity. Both the interleukin-1/receptor complex and the interleukin-1 receptor appear to be able to bind to DNA, however interleukin-1 on its own showed no binding activity. Interleukin-1 was found to be internalised into the nuclei of all cells examined (EL4, MEL, HL-60, K562, THP-1 and Jurkat cells). The data suggest the possible modulation of genes by interaction of interleukin-1/receptor complexes with DNA structures.


Inhibition of nerve growth factor-induced B-50/GAP-43 expression by antisense oligomers interferes with neurite outgrowth of PC12 cells.

Substantial evidence has now been gathered for the involvement of B-50/GAP-43 in neuronal development and regeneration. The precise role of this protein, however, is still debated. In an earlier study, a linear correlation between NGF-induced neurite outgrowth and B-50/GAP-43 levels was observed in PC12 cells. To establish the involvement of B-50/GAP-43 expression in neurite outgrowth in these cells, we interfered with the expression by antisense oligomers and measured the outgrowth. In the present study, a B-50/GAP-43 antisense 5'-oligomer interfered both with the NGF-induced increase in B-50/GAP-43 and with neurite outgrowth, whereas an antisense 3'-oligomer was ineffective. We conclude, that in PC12 cells under normal conditions B-50/GAP-43 expression and neurite outgrowth are or become coupled upon NGF-induction, in contrast to the situation in PC12 clones with no or very low B-50/GAP-43 expression.


The mechanism of inhibition of the actin-activated myosin MgATPase by calponin.

Calponin inhibits the actin-activated ATPase of smooth muscle myosin and thus has been proposed as a thin filament-based regulatory component in smooth muscle. To obtain information on the mechanism of inhibition by calponin we have used chemical modification of actin and cross-linking of actin and subfragment 1. Modification of Lys 61 of actin had no effect on the inhibition by calponin of acto-heavy meromyosin ATPase, i.e. different from tropomyosin-troponin. In addition, modification of the acidic N-terminal region of actin did not impair the ability of calponin to bind to F-actin. Finally, calponin was effective in inhibiting ATPase activity of cross-linked acto-subfragment 1. Therefore the mechanism of inhibition by calponin is distinct from troponin-tropomyosin and caldesmon in that it does not involve either the N-terminal acidic region of actin nor the area around Lys 61 and does not fit a simple steric blocking model.


Review articles and publication bias.

Publication bias occurs if the results from studies which have not been published are different from the published ones. From a Bayesian viewpoint, it also concerns non-publication of studies with similar results as the published ones because the strength of the evidence will be influenced. Publication bias complicates the interpretation of reviews and meta-analyses. If favourable results are published more often there will be an overestimation of the effects of a treatment. There have been several attempts to assess the magnitude of publication bias. Unpublished trials could be identified by means of a survey among researchers, and the results could subsequently be compared with the outcomes of published trials. Also, the results from published trials could be compared with trials from a registry. Furthermore, the results from registered but unpublished trials could be compared with those of registered and subsequently published trials. Studies addressing publication bias have shown that it is a serious problem which complicates the interpretation of reviews. In assessments of publication bias other factors must be taken into account. These include the mode of publication: refereed journals, other journals, books, etc. Differences could also be related to the quality of trials. Finally, the source of funding may influence both the results and subsequent publication. Publication bias can only be avoided by registration of all trials before data collection is started; several of such registries have already been installed. Perhaps, if more of such registries exist, reviewers could only use registered trials for their main conclusions. All other information could then be considered sensitive to publication bias.


Replenishment of brain adenosine triphosphate content by morphinan-type N-methyl-D-asparatate receptor antagonists, dextrorphan and dextromethorphan through the activation of adenylate kinase.

The in vitro effects of four N-methyl-D-aspartate (NMDA) receptor antagonists, dextrorphan, (DX, CAS 125-73-5), dextromethorphan, (DM, CAS 125-71-3), dizocilpine (CAS 77086-21-6) and (+/-) 2-amino-7-phosphonoheptanoate (AP-7, CAS 85797-13-3) on rat brain adenylate kinase (AK) have been studied. DM was the most active of the four compounds in increasing rat brain AK activity. DX was slightly less active than DM, while the most potent NMDA antagonist, dizocilpine was somewhat weaker than the above two morphinan analogs (DX and DM). For AP-7, the AK activity was unchanged. The results may indicate that a causal relation cannot be made between the activation of the AK by these compounds and their ability to act as NMDA antagonists. When DX was added, the Km and Vmax values of the enzyme for ADP as a substrate decreased and increased, respectively, possibly reflecting an affinity change for the enzyme-substrate interaction by DX. The observed increase in the AK activity by the morphinan-type NMDA antagonists in vitro might result in their preserving effects on cerebral neuron integrity under the conditions where cerebral energy metabolism is disturbed. This assumption was at least partly confirmed in in vivo tests in which DX, unlike dizocilpine, increased ATP content of the brain in mice under the influence of hypoxia exerted by i.v. injection of KCN.


[Rhodococcus equi infection causing pulmonary malacoplakia in a patient with acquired immune deficiency syndrome].

Rhodococcus equi is a pathogen for some animal species. It can cause opportunistic pulmonary infections in immunocompromised people. The authors describe such an infection that causes malacoplakia in a patient with acquired immunodeficiency syndrome. The likeness between lesions due to Rhodococcus equi and those due to other opportunistic germs as Mycobacterium avium-intracellulare is emphasized.


[Malignant dermoid cyst of the ovary with double tumor cell population, revealed by an umbilical metastasis].

The authors report a case of multiple malignancies (squamous cell carcinoma and carcinoid) arising in a dermoid cyst of the ovary. The tumor being revealed by an umbilical metastasis. They insist on the rarity of this entity and discuss the elements of diagnosis and prognosis through a review of literature.


[Pseudotumor extramedullary hematopoiesis. Report of 3 cases and review of the literature].

We report 3 cases of extramedullary hematopoiesis with a sacrococcygeal, right obturatory hole and paravertebral dorso lumbar locations respectively in 30, 34 and 58 years old patients (two males and woman). A medullary tuberculosis was discovered in one case, a beta thalassemia in the second, and the third was classified as idiopathic. Radiologic picture often permitted to evoke the diagnosis on the aspect of a well limited multilocular tumor especially when there is a paravertebral location as in our third patient. Fine needle punction cytologic examination can permit the diagnosis and avoid surgery, except if complications occur.


Hepatitis B vaccine education programs: what really works?

1. Health care workers need to know that hepatitis B vaccine provides a safe, effective protection for them against a significant occupational hazard. 2. Several theoretical models can be used to design hepatitis B education programs, including motivational theories, the Health Belief Model, and andragogy. Specific recommendations can be made about the plan, format, content, and evaluation of adult education programs about hepatitis B. Federal agencies, including the Department of Health and Human Services and the Department of Labor, have established criteria for hepatitis B education programs.


AIDS education strategies: evaluating the fear response.

1. Despite educational interventions, evidence suggests that negative attitudes about AIDS risk persist among clinical hospital staff. In diverse study populations, associations have been found between psychosocial phenomena and on the job accidents and injuries. 2. This article describes a pilot study to explore whether fearful attitudes of clinicians contribute to the adverse behaviors of needlestick injuries and mucosal splashes. The authors sought to demonstrate whether desensitization therapy would be effective in reducing fear response. 3. A serendipitous finding of the study was that organizational and interpersonal conflict frequently provoked fear and anxiety responses. There is a continued need to examine the domain of AIDS related fears among clinical staff, as well as a need to seek a better understanding of this fear as part of the tensions of organizational dynamics in hospitals. 4. Occupational health nurses working in hospitals are in a unique position to uncover relationships among all types of incidents that may indicate fear and anxiety among clinical staff.


Machine safety: proper safeguarding techniques.

1. OSHA mandates certain safeguarding of machinery to prevent accidents and protect machine operators. OSHA specifies moving parts that must be guarded and sets criteria for the guards. 2. A 1989 OSHA standard for lockout/tagout requires locking the energy source during maintenance, periodically inspecting for power transmission, and training maintenance workers. 3. In an amputation emergency, first aid for cardiopulmonary resuscitation, shock, and bleeding are the first considerations. The amputated part should be wrapped in moist gauze, placed in a sealed plastic bag, and placed in a container of 50% water and 50% ice for transport. 4. The role of the occupational health nurse in machine safety is to conduct worksite analyses to identify proper safeguarding and to communicate deficiencies to appropriate personnel; to train workers in safe work practices and observe compliance in the use of machine guards; to provide care to workers injured by machines; and to reinforce safe work practices among machine operators.


Americans with Disabilities Act: meeting the requirements.

1. Title I of the Americans With Disabilities Act prohibits workplace discrimination on the basis of disability. 2. An employer is required to provide reasonable accommodation so that an otherwise qualified employee can do the job. 3. Physical examinations that seek to determine whether a person has a disability are prohibited. 4. The Equal Employment Opportunity Commission will serve as the enforcement agency for the employment requirements of the American With Disabilities Act.


Occupational injuries: a study of health care workers at a northwestern health science center and teaching hospital.

1. This retrospective study examined the magnitude of the problem of work related health hazards affecting professional and non-professional employees of a state university health science center and hospital. 2. From the 1,513 injury episodes that occurred among the 9,668 employees during the 32 month study period, it was determined that the highest risk categories for both department and job were nursing, housekeeping, food service, and laboratory technicians. 3. Injury rate for females (11.2 per 100 person years) was more than twice that of males (5.1). Injury rates declined from 11.6 per 100 person years at ages 25 to 39 to 3.8 at ages over 60. Puncture wounds (32.7%), mostly by needlesticks, were the most frequently reported injury type, followed by strains and sprains (17.2%), lacerations (12.5%), and contusions (12.1%).


Analysis of trauma intubations.

The timing of trauma patient intubation is dependent on clinical presentation and clinician judgment. We sought to correlate the timing of intubation with the presenting of physiologic parameters and clinical outcome to identify potential quality assurance audit filters. Patients (n = 82) were grouped by timing of intubation: PREHOSPITAL, paramedic intubation; IMMEDIATE, within 10 minutes of arrival; DELAYED, beyond 10 minutes but within 2 hours of arrival; and NONURGENT, beyond 2 hours or at the time of surgery. While mean revised trauma scores and Glasgow Coma Scale (GCS) scores differed for the groups, the mean length of hospital stay and the incidence of aspiration pneumonia were not significantly different. In the DELAYED group, 80% of those who developed aspiration pneumonia had a GCS < or = 13. Patients in the NONURGENT group were older and commonly presented with tachypnea. The survival rate for the NONURGENT group was lower than predicted by the TRISS method (P = .004). A GCS < or = 13 and age greater than 50 years with presenting respiratory rates of more than 25 breaths/min represent potential trauma intubation audit filters.


Atropine administration in experimental electromechanical dissociation.

Atropine can have a place during cardiopulmonary resuscitation (CPR) in the management of asystole, where parasympathetic influence might be excessive. However, the beneficial effects of atropine in electromechanical dissociation (EMD) have not been clearly demonstrated. The authors studied the effects of atropine in combination with epinephrine on an experimental model of EMD in the closed-chested dog. In 15 pentobarbital-anesthetized, mechanically ventilated dogs (mean weight 20 kg), EMD was induced by ventricular fibrillation followed by an external countershock, and was observed for 2 minutes before CPR was started. After 5 minutes of chest compression using a CPR thumper, either atropine 0.5 mg or D5W was administered, and the same injection was repeated every 5 minutes until recovery. Epinephrine 1 mg was administered in alternans. Each dog was submitted to two successive episodes of CPR, using either atropine or D5W, in a randomized order. Of a total of 28 CPRs, five were successful with chest compression alone. In the treatment groups, 10 of 11 were successful with atropine, but only eight of 12 with D5W (P < .01). The duration of CPR was also significantly shorter when atropine was used (9 minutes 56 seconds +/- 14 seconds versus 12 minutes 08 seconds +/- 43 seconds, P < .001). During the recovery period, atropine-treated animals had higher arterial pressure, heart rate, cardiac output and stroke volume. On this experimental model, the administration of high doses of atropine together with epinephrine enhances the recovery from EMD and results in a better cardiac function during recovery.


Pulse oximetry and peak flow as indicators of wheezing severity in children and improvement following bronchodilator treatments.

This study examined the changes from the initial peak flows and oxygen saturations (OSAT) of wheezing children at presentation to the emergency department through their treatment in the emergency department. Data was collected prospectively on 785 patients 5 to 20 years of age during an 11-month period from November 1, 1990, to September 30, 1991. Both the initial OSAT and peak flows were correlated with the number of bronchodilator treatments required in the emergency department and with the need for hospitalization. Both the initial OSAT and the peak flows had a limited ability to predict the need for hospitalization. Oxygen saturation appears to be a valid measure of wheezing severity and is more easily obtained in children of all ages. Following bronchodilator treatment, peak flow results in a larger quantitative improvement than OSAT; however, this difference does not appear to have any significant advantage. Aerosolized albuterol and subcutaneous epinephrine resulted in a similar degree of improvement as measured by peak flow and by oxygen saturation, with clinically similar changes in heart rate.


Improved outcome with early blood administration in a near-fatal model of porcine hemorrhagic shock.

Current recommendations for the preoperative management of hemorrhagic shock include the initial infusion of 2 L of isotonic crystalloid regardless of the severity of hemorrhage. While this approach may be adequate for patients who experience only mild to moderate hemorrhagic insults, it has never been tested in a clinically relevant model of severe life-threatening hemorrhage. The authors used a porcine model of rapidly fatal hemorrhage with a reproducible and relevant physiologic end-point, the absence of vital signs, to test the hypothesis that even brief delays in blood replacement may result in higher mortality rates and worsen hemodynamic and metabolic responses to hemorrhage. Twenty-four immature swine (11-17 kg) were bled continuously at a decelerating rate until the following criteria were met: (1) respiratory arrest, (2) a pulse pressure of 0 and, (3) a slowing of cardiac electrical activity of 15% or more. Resuscitation was begun 1 minute later. The animals were randomly assigned to one of three resuscitation regimens. Group A (n = 8) received shed blood at a rate of 3 mL/kg/min for 10 minutes followed by normal saline (NS) at a rate of 3 mL/kg/min for 10 minutes. Group B (n = 8) received NS at a rate of 3 mL/kg/min for 10 minutes followed by shed blood at a rate of 3 mL/kg/min for 10 minutes. Group C, controls, (n = 8) received NS at a rate of 3 mL/kg/min for 20 minutes. Animals were observed for 30 minutes after resuscitation or until death. Mortality was 25%, 37.5%, and 100% for groups A, B, and C, respectively (P < .05 for group C versus group A or B).(ABSTRACT TRUNCATED AT 250 WORDS)


Continuous central venous oximetry and shock index in the emergency department: use in the evaluation of clinical shock.

Initial therapy of shock in the emergency department (ED) emphasizes the normalization of physiologic variables such as heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) rather than restoration of adequate tissue oxygenation. After hemodynamic stabilization of MAP, CVP, and HR, the authors examined tissue oxygenation as indicated by continuous central venous oximetry (SCVO2), lactic acid concentration, and shock index (SI). Sixteen consecutive nonrandomized patients presenting to the ED of a large urban hospital in shock (MAP < 60 mm Hg, HR > 120 beats/min, and altered sensorium) were initially resuscitated with fluid, blood, inotropes, and/or vasoactive drug therapy to normalize MAP, CVP, and HR. In addition, SCVO2, arterial lactate concentration, and SI were measured after completion of resuscitation in the ED. Eight patients (group no. 1) had inadequate tissue oxygenation reflected by low SCVO2 (less than 65%). Four patients in group no. 1 had elevated arterial lactic acid concentration. All group no. 1 patients had an elevated SI (> 0.7) suggesting persistent impairment of left ventricular stroke work. Eight patients (group no. 2) had normal or elevated SCVO2 (> 65%). In group no. 2, arterial lactic acid concentration was elevated in six and SI in seven patients. Normalization of hemodynamic variables does not adequately reflect the optimal endpoint of initial therapy in shock in the ED. Most (94%) of these patients continue to have significant global ischemia and cardiac dysfunction as indicated by reduced SCVO2 and elevated lactic acid concentration and SI. Systemic tissue oxygenation should be monitored and optimized in the ED in these critically ill patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Acute isopropanol ingestion: pharmacokinetic parameters in the infant.

We describe a case of isopropanol intoxication in a 2-month-old infant. The source of isopropanol and both the route and time of ingestion could be clearly identified. Serial measurements of isopropanol and acetone provided data for calculating their respective elimination half-lives. Isopropanol (half-life = 5.8 hr) clearance was similar to values reported for adults; acetone (half-life = 10.8 hr) was eliminated twice as rapidly as in adults.


Fatal ingestion of boric acid in an adult.

A 45-year-old white man ingested approximately two cups of boric acid crystals dissolved in water in a suicide attempt. Nausea, vomiting, greenish diarrhea, and dehydration occurred shortly thereafter. Two days later, he presented to the hospital with hypotension, metabolic acidosis, oliguric renal failure, a generalized erythematous rash, and several superficial skin abrasions. His condition failed to improve despite intravenous fluids and vasopressors. He later developed atrial fibrillation with a rapid ventricular response and could not be converted to a sinus rhythm. This rhythm deteriorated to electromechanical dissociation, and the patient died 17 hours after admission. The urine and whole blood boric acid concentrations approximately 52 hours after ingestion were 160 and 42 mg/dL, respectively. These results are equivalent to urine and blood boron concentrations of 28 and 7 mg/dL, respectively. A postmortem urine boron concentration was 29.4 mg/dL. The autopsy report listed boron toxicity as the cause of death. This is the only adult reported to die from acute boric acid ingestion in recent years and may be atypical since the patient was untreated for 3 days and presented with dehydration and renal function impairment. This case suggests that lack of adequate urine flow and dehydration increases the risk of boron toxicity.


Adenosine use in pregnancy: lack of effect on fetal heart rate.

The treatment for supraventricular tachycardia in pregnancy is somewhat controversial. Although a variety of medications have been used to terminate this rhythm during pregnancy, all have actual or theoretical drawbacks. Adenosine is a relatively new medication with an extremely short half-life and is effective in the treatment of supraventricular tachycardia. We report a case in which this medication was used successfully during pregnancy. In addition, we found that adenosine had no effect on fetal heart rate in this case.


Angiotensin-converting enzyme inhibitor-induced angioedema: still unrecognized.

Angiotensin-converting enzyme inhibitors are a widely used antihypertensive modality. While they have a favorable side effect profile, there is a .1% to .2% incidence of potentially life threatening angioedema. The edema usually presents in the head and neck, especially the face, lips, tongue, and glottis. Patients may initially be treated with standard anti-allergic therapy; however, the situation may dictate a more aggressive therapeutic approach. The authors present the case of a patient who presented with angioedema 18 times over a 3-year period to qualified emergency physicians before the correct diagnosis of angiotensin-converting enzyme inhibitor-induced angioedema was made. Despite recent literature on the subject, there appears to be a lack of familiarization among emergency department physicians regarding this relatively common adverse effect.


Profound alkalemia during treatment of tricyclic antidepressant overdose: a potential hazard of combined hyperventilation and intravenous bicarbonate.

Two patients with cardiovascular and neurologic toxicity from intentional tricyclic antidepressant overdose received bicarbonate infusions in association with hyperventilation for alkalinization. Both patients developed profound alkalemia. One patient died, and the other patient's alkalemia resolved prior to her death. Bicarbonate infusions have become the standard of care for symptomatic tricyclic antidepressant toxicity. Severe alkalemia (pH greater than 7.60) in other settings has been reported to correlate with higher rates of mortality. Careful monitoring of the pH is imperative when bicarbonate therapy is used. It is probably prudent to keep the pH level in the range 7.45 to 7.60. Capnography may also be useful in monitoring patients during alkalinization.


Hypoglycemia following albuterol overdose in a child.

Acute overdose with beta-sympathomimetics results in transient elevation of blood glucose levels. Hypoglycemia has previously been reported in newborns of mothers following prolonged use of sympathomimetics used as tocolytic therapy. The authors report the first case of symptomatic hypoglycemia in a child, occurring 16 hours after acute albuterol overdose. Hypoglycemia may occur as a complication of acute beta-sympathomimetic overdose, probably as a reaction to acute elevation of blood sugar and resultant hyperinsulinemia. The authors suggest that in children with a large overdose of beta-sympathomimetics, blood glucose levels should be monitored for several hours. In those with marked hyperglycemia, monitoring should be extended until normalization of blood glucose levels.


Changes in the presentation of intussusception.

Intussusception is most often diagnosed in well-nourished 7- to 10-month-old infants, but may be overlooked in older children. From 1985 to 1991, we treated 118 boys and 62 girls ranging in age from 2 months to 15 years (average, 22.6 months). Thirty-seven percent were older than 2 years, significantly more than in earlier experience at this institution. Overall, children with intussusception had a less than average weight (P < .05). The majority of intussusceptions in all age groups were idiopathic. Seventy-three percent of the patients were treated successfully by barium enema. The presence of air-fluid levels on the plain radiograph decreased the success rate of barium enema reduction from 81% to 49%. Barium enema reduction should nevertheless be attempted regardless of the age of the patient or the duration of symptoms, and routine surgical exploration is never recommended.


Whole bowel irrigation in an acute oral lead intoxication.

An 89-year-old man acutely ingested approximately three ounces of a ceramic glaze preparation with a 30% lead oxide content. A blood lead level of 18 micrograms/mL was reported from a sample drawn within 1 hour of ingestion and just prior to gastric lavage. Following lavage, an abdominal radiograph demonstrated lead throughout the small intestine. Whole bowel irrigation was then undertaken and subsequent x-rays demonstrated clearing of all lead in the small bowel. At 16 and 24 hours post-ingestion, blood lead levels rose to 39 micrograms/dL and 42 micrograms/dL, respectively, and the patient then underwent a 5-day course of chelation therapy. This is the first reported case of the use of whole bowel irrigation in an acute lead ingestion. The use of decontamination techniques in acute lead ingestions is reviewed.


Intranasal midazolam as a sedative for children during laceration repair.

We performed a retrospective chart review to determine the onset, duration, safety, and clinical sedative effects of 0.2 to 0.5 mg/kg intranasal midazolam in young children during laceration repair. Of 408 children treated for lacerations during an 8-month period, 42 (10%) received intranasal midazolam. Documentation was adequate for detailed analysis in 40 cases. Data are reported as mean +/- standard deviation and the frequency with 95% confidence limit (CL) estimates. The mean age of the study population was 32 +/- 9 months (range 12 months to 6 years), and the mean body mass was 14.5 +/- 3 kg. Topical or injected local anesthesia was used in 37 cases. Overall, 73% (CL 56% to 85%) of the children achieved adequate sedation. However, those receiving 0.2 to 0.29 mg/kg had adequate sedation in only 27% (CL 6% to 60%) of the cases compared with 80% (CL 52% to 95%) and 100% (CL 79% to 100%) when 0.3 to 0.39 and 0.4 to 0.5 mg/kg respectively were administered. When achieved, sedation occurred within 12 +/- 4 minutes, recovery occurred at 41 +/- 9 minutes, and discharge occurred at 56 +/- 11 minutes. No vomiting or clinically significant oxygen desaturation (defined as a drop of > 4% or to < 91%) was observed. We conclude that intranasal midazolam is a safe and effective sedative for laceration repair under local anesthesia in preschool-aged children. We recommend a dose of 0.3 to 0.5 mg/kg, with treatment failure less likely after 0.4 to 0.5 mg/kg compared with less than 0.3 mg/kg.


Emergency medical systems in Czechoslovakia.

The year 1987 witnessed the "velvet revolution" of Vaclav Havel and the beginning of democratic reform in Czechoslovakia. As the country struggles to build a market-based economy, it maintains a well-developed socialist system of health care that is patterned after the former Soviet system and is free to all (Am J Emerg Med 1984; 2:455-456). Formal private medical practice does not exist. Non-emergency care is provided by multispecialty, primary-care oriented clinics (polyklinka) where after-hours visits are possible due to the presence of on-call physicians. In small towns such an on-call doctor would be a general practitioner, but in large cities an internist, pediatrician, and surgeon might all be available.


Increase of heat loss by wearing gloves and boots in wet-suited subjects working in cold water.

The effect of wearing protective gloves and boots on thermal exchanges of wet-suited subjects in cold water was evaluated. Four male subjects, clad in 5 mm-thick neoprene wet suits and either with or without neoprene gloves (5 mm-thick) and boots (5 mm-thick) were immersed up to the neck in water at 13 degrees C while resting for 3 h or exercising for 2 h. Rectal temperature, oxygen consumption and local (chest, back, upper arm, thigh, forearm, calf, hand and foot) skin temperatures, skin heat fluxes and thermal insulations were determined during immersion. The rectal temperature was not different between conditions but the skin temperature was significantly higher with gloves and boots, especially at the distal extremities (forearm, calf, hand and foot). Consequently, the core-to-skin temperature gradient was reduced by wearing gloves and boots, but the skin heat loss was markedly increased. Calculated overall body insulation was significantly lowered by wearing gloves and boots. These results indicate that in wet-suited subjects resting or exercising in cold (13 degrees C) water, gloves and boots increase the overall rate of body heat loss. Attenuation of cold-induced vasoconstriction is proposed as the mechanism.


[Changes in intracellular pH of working muscle during constant and stepwise incremental load exercise].

In this study, subjects performed wrist flexion in isokinetic manner by using CYBEX dynamometer while their right forearm was attached in a MR magnet. 31P-MR spectra were obtained from wrist flexor muscles before and throughout the exercise. Intracellular pH of muscle was calculated from the chemical shift between phosphocreatine (PCr) and inorganic phosphate (Pi). Fifteen Japanese males volunteered as subjects. They performed two experimental protocols, i. e. constant load test (CT) and stepwise incremental load test (IT). In CT, 10 of the subjects were participated. After 2 minutes rest, wrist flexion of 10, 20, 30, 40 or 50% of maximal voluntary contraction force (MVC) was performed at 2 seconds intervals for 15 minutes. In IT, 14 including 9 of CT were participated. They performed wrist flexion in incremental contraction force of 5 steps from 10% to 50% of MVC for 3 minutes in each step. Changes in intracellular pH of muscle against contraction level show non-linear relationships both in CT and IT. From this relationship we calculated the contraction level at which pH was 6.9 (%MVC6.9). Mean values of obtained %MVC6.9 by CT and by IT were 29.3 and 30.0% of MVC, respectively. And, significant correlation was found between %MVC6.9 by CT and by IT. This result shows that %MVC6.9 was a reproducible index independent of the type of exercise test, i. e. constant or incremental load test, and might reflect the physiological characteristics of the muscle.


[Stability of body composition in boys and girls 12 through 15 years of age].

Although underwater weighing has been regarded as a representative of the criterion reference methods for determining body composition, this technique is cumbersome for screening. The purpose of the present study was to examine the stability of body composition assessed not only by underwater weighting but also by existing bioelectrical impedance equations and skinfold thickness equations during a 4-week period. Ten male and 10 female junior high school pupils, aged 12 to 15 years, volunteered to serve as subjects. Body density (Db) was estimated by underwater weighing (UW), skinfold thickness (ST) method, and bioelectrical impedance (BI) method. The UW was considered criterion reference method. The underwater weight was the heaviest value that was reproduced twice at least among 5 to 10 measurements. Residual lung volume was estimated "in water," with the subject in the sitting position, by a closed-circuit helium-dilution method. The ST equations used for determination of Db were those developed by Nagamine et al., while in the BI method equations proposed by Nakadomo et al. were applied. The Db for boys by UW did not differ significantly during the 4-week period; however, in girls it was significantly lower in the 2nd test (1.0479 +/- 0.018 g/ml) than in the 1st test (1.0500 +/- 0.019 g/ml). Likewise, the Db estimated by ST and BI methods remained unchanged in boys, while in girls it was significantly lower in the 2nd test (BI: 1.0445 +/- 0.010 vs. 1.0389 +/- 0.013 g/ml). Test-retest reliability of all the three methods for measurements conducted 4 weeks apart were statistically significant (e.g. UW: r = 0.99, ST: r = 0.94, BI: r = 0.89 in girls). In conclusion, the validity of Db estimated by these two methods was found to be insufficient when absolute values are required. However, body composition estimates assessed by ST and BI methods for boys and girls may be stable on a relative basis.


Measurement of regional evaporation rate from skin surface by evaporimeter.

The present study was conducted to confirm the validity of an evaporimeter and its measuring condition prior to applying it to the field of clothing physiology, especially for measuring the amount and distribution of the evaporation rate over the human body surface. After calibration of the evaporimeter according to the manufacture's specification, it was checked for its response time and the comparative assessments of the evaporation rate from the skin. The quantitative examination of the evaporation rate in both in vitro water loss and in vivo the evaporation rate from the human skin, clarified that the observed values of evaporation rate were lower than water loss or weight loss of the human body. Although the evaporimeter is a useful device to measure the evaporation rate at regional parts of the human body under natural condition, an additional calibration by an actual in vitro measured water loss should be adopted for the accurate assessments of the evaporation rate.


[Hemispheric differences in letter matching of hiragana and katakana].

The purpose of the present study was to examine the hemispheric differences in letter matching of hiragana and katakana. The stimuli with a pair of each one letter of hiragana and katakana were presented unilaterally to the right or left visual hemifield with a tachistoscope. The subjects were 40 male right handers. They were required to judge whether a pair of letters had the same name or different one. A significant right visual hemifield superiority was observed for both the accuracy of recognition and reaction time. The results suggest that the callosal relay model of Zaidel may be applied to the name matching task.


Type and amount of environmental information in urban scene--basic study on the design of intelligence environment.

Signs have gained importance as an information mechanism that supports the urban activities in signage, and projects are being actively launched in cities. Urban spaces are already filled with multitudes of signs including directories and signboards, calling for organization of signage as a system and not merely as a collection of individual signs. As a first step for tackling with the objectives, the present study noted the type and amount of environmental information presented in the realm of pedestrians. Our study included (1) investigating the type and amount of information available in the streets including underpass; (2) classifying and organizing signs according to the content of information; and (3) analyzing the relation between different types of information, between situations and signs, and continuity of the signs of the same type. The study revealed that there was a (1) deviation in information offered at various spots on a pedestrian route; (2) multitudes of advertisements and installations other than signs were placed at the same spot using the same method as the public signs; and (3) there were qualitative lack of signs despite many signs in the investigated area. The study thus indicated a need for cross-sectional environmental design for information in place of sign designs and delineates several basic requirements for it.


[Development of a new method for calibration of pneumotachograph according to flow rate--evaluation of a computer-controlled-system for assessing respiratory gas exchange using this method].

1) We evaluated the method for calibrating the pneumotachograph according to flow rate by the software on personal computer. Flow volume was detected using the approximated equation (y = 1.294x2 + 0.989x + 35.824, r = 0.976, p less than 0.01) from various mean flow rate and integration of output voltage. The error between syringe volume (21) and the estimated value on the equation was 10 +/- 8 ml (0.48 +/- 0.42%). 2) Using the method described in 1), we developed computer-controlled-system for assessing respiratory gas exchange by mixing chamber method. To evaluate the accuracy of the system as compared with the Douglas Bag method, we measured the gas parameters of the both methods for two male subjects at rest(3 and 5min) and steady state exercise (3 min., 60-240watt). The error between the both methods were within +/- 5% in ventilation(VE), mixed expired O2 (FEO2) and CO2 (FECO2) concentration, and were within +/- 8% in O2 uptake(VO2) and CO2 production (VCO2). There were high positive correlation (r greater than 0.99, p less than 0.01) between the both methods in the all parameters. These results indicate that the system in this study would be practical use, that VE can be measured in only one pneumotachograph, even if the range of flow rate was wide(e.g. from rest to heavy exercise).


[On the daily living and development of infants living in urban and rural regions].

Temporal pattern of daily living behavior and development in infants aged 3-6 yr were compared between urban and rural regions at Fukuoka-prefecture. The present study consisted of questionnaire on behavior of daily living and tests for development in intelligence and motor function. Rural infants got up and went to bed earlier than urban infants. Urban infants with less physical activity were inferior to rural infants in motor skill. It is suggested that manual dexterity and intelligence may be related.


[Human body volume measurement by sulfur hexafluorde-dilution method and its application to human body composition assessment].

The absolutely accurate measurement of adiposity in a living organism is undoubtedly difficult. Although a number of methods have been developed, none has been proven to be both theoretically and empirically an unquestioned validating criterion method for the estimation of human body composition. In the present study, a new method was introduced that is rapid, safe, and relatively simple to administer and has the added advantage of not requiring a measurement of the underwater weight. The procedure involves the direct measurement of body volume by applying a sulfur hexafluoride (SH)-dilution method with the subject only standing in a 375-1 closed chamber (Shimazu BSF-100) that is filled with air and 0.26 liters of SH. Results indicate that body volume (r = 0.998) and body density (r = 0.819) measured by the SH method were highly correlated to those determined by underwater weighing. Reproducibility of body volume was found to be almost perfect (i.e., 0.995) with the regression coefficient of 1.03 and the intercept of -1.5. Variability (CV = 0.7%) in body volume of a 45-year-old reference man measured by SH method was very similar to variation (CV = 0.6%) in mass volume of the 60-1 prototype. The calculated percent body fat (r = 0.851) and fat-free mass (0.962) with some correction of body density were also highly correlated to those determined by underwater weighing. We suggest that SH method may be useful for assessment of human body composition.


Thirty years of research on developmental neurolinguistics.

A body of medically important work has accumulated in the field of developmental neurolinguistics in the 30 years since Lenneberg set forth a research agenda for that field, consisting of the following: (1) the physiologic specialization or endowment for speech; (2) the genetic origin or natural history of vocalization and speech; (3) the nature of prelinguistic behavior, making possible the detection of any environmental (social) influences; (4) the development of motor-speech organization from birth; and (5) the limiting effects of deficient intelligence, hearing, and environmental stimulation. Subsequent study of these questions has established a genetic, neuroanatomic, and functional basis for such outwardly disparate disorders as dyslexia, stuttering, autism, and delayed language. Studies of emergent motor behavior suggest that babbling may index a state of neural maturation favoring expression of spoken languages. Based on studies of the congenitally deaf, mentally retarded, and other clinical populations it is now considered possible to detect early warning signs of developmental language disorders during the first year of life based on analyses of vocal turn-taking, gesturing, and utterance complexity.


Normal values for the two-point discrimination test.

A 2-point discrimination study was conducted with 112 normal children, ages 2-13 years. The goal was to determine the age at which children can reliably cooperate in performing the 2-point discrimination test and to discover the normal values on the fingertips and feet for different ages, as well as to study the changes in these values with age. It was found that from age 6 years and older all children could perform the test and that discrimination ability improved with age, but was only of statistical significance for the feet parameters.


Dysmyelinogenesis in animal model of GM1 gangliosidosis.

Magnetic resonance imaging (MRI), pathologic examinations, and biochemical analyses were performed on 2 different canine mutants with GM1 gangliosidosis (i.e., English Springer Spaniel and Portuguese Water Dog) and on age- and sex-matched controls. Serial MRI studies were also performed on a child with infantile-onset GM1 gangliosidosis. The affected dogs had abnormalities on MRI, including a relative increase in gray matter and an abnormal signal intensity of cerebral and cerebellar white matter observed on T2-weighted MRI. White matter changes on MRI were similar to white matter abnormalities observed in a 15-month-old boy with GM1 gangliosidosis. The weight ratio of white to gray matter from the frontal lobe was markedly reduced. Microscopic examination revealed characteristic ballooned neurons which stained lightly with Luxol-fast blue. The central cerebral and cerebellar folia white matter exhibited pallor and gliosis, while the corpus callosum and fornix stained normally with Luxol-fast blue. Axons appeared intact on Bodian staining. Ultrastructural studies revealed fewer myelinated axons in affected puppies. Total gangliosides in gray matter were elevated. Thin-layer chromatography demonstrated GM1 ganglioside as the predominant ganglioside. The amount of cerebrosides and sulfatides was reduced in the gray and white matter when compared to controls but the ratio in gray and white matter remained unchanged. Immunostaining of neutral glycolipids disclosed increased amounts of stage-specific embryonic antigen-1 glycolipid in gray matter. These findings suggest that canine models for GM1 gangliosidosis are associated with abnormal myelin development which may be similar to the human disease.


Hydrosyringomyelia and diastematomyelia detected by MRI in myelomeningocele.

Magnetic resonance imaging of the spine in 45 patients with myelomeningocele revealed hydrosyringomyelia in 24 and diastematomyelia in two. No patient at initial imaging manifested symptoms referable to hydrosyringomyelia; both patients with diastematomyelia had flaccid lower extremities. One patient developed an upper extremity monoparesis which resolved with syringo-peritoneal shunt placement; no other patient manifested symptoms or required surgery. Ventriculoperitoneal shunt malfunction produced reversible distention of the syrinx in another patient who remained asymptomatic.


Fragile X positivity in Chinese children with autistic spectrum disorder.

Chromosome analysis was performed in 105 Chinese children (96 boys, 9 girls) with autistic spectrum disorder to assess fragile X positivity. Seventy percent of these autistic children were mentally retarded. None of the children in the infantile autism group (N = 75) had fragile X positivity. Two boys in the autistic condition group (N = 30) had clinical features and chromosomal positivity for fragile X syndrome. The low (2%) prevalence rate of fragile X positivity in children with different degrees of expressivity of autistic features may be related to other factors rather than to pure autistic characteristics per se.


Sleep disorders in Tourette syndrome: a primary or unrelated problem?

Sleep disturbances are a common complaint in children with either Tourette syndrome (TS) or attention-deficit hyperactivity disorder (ADHD). Because a significant number of individuals with TS also have ADHD, we attempted to determine whether sleep difficulties reported in TS are a primary problem or are related to the co-occurrence of ADHD. Using a parent-completed sleep questionnaire, data were collected on boys, ages 7-14 years. Three groups, TS-only (N = 57), ADHD-only (N = 21), and TS+ADHD (N = 89), were compared to an age-matched control population (N = 146). The complaint of "poor sleep" occurred in 26% with TS-only, 48% with ADHD-only, and 41% with TS+ADHD; all were significantly different from 10% found in controls. Of 19 sleep questionnaire items, the incidence of problems occurred statistically more frequently in 5 of 19 for the TS-only group, in 6 of 19 for the ADHD-only group, and in 17 of 19 for the TS+ADHD group. Boys with TS+ADHD had many sleep problems which appeared to be related to an arousal disorder. Although the use of medications, especially stimulants and anti-depressants, were different between the TS-only and TS+ADHD groups, this factor did not account for the large discrepancies in sleep disturbance. In boys with TS, sleep problems usually occurred with the co-morbid feature ADHD.


Movement disorders after status epilepticus and other brain injuries.

A retrospective medical record review was conducted of 173 consecutive children hospitalized for acquired brain injuries on a specialized pediatric rehabilitation service. The chart review identified children who developed movement disorders with acquired brain injuries: 8 with status epilepticus, 2 with trauma, and 1 with anoxia. Movement disorders were observed more frequently following status epilepticus (8 of 12) than following other causes of acquired brain injury (3 of 161; P = .0001). Four additional children had severe neurologic deficits following status epilepticus but did not develop movement disorders. The 11 patients who developed movement disorders had choreiform movements predominantly. Even though status epilepticus is a clinical phenomenon resulting from a variety of etiologies, the features of movement disorders in these children were strikingly similar. The pathophysiology of this complication is unknown.


Clinical features for prediction of survival in neonatal muscle disease.

Review of 17 newborns with muscle disease demonstrated that clinical features associated with survival beyond 1 year of age included gestational age of at least 35 weeks and requirement of mechanical ventilation for less than 21 days. In contrast, poor outcome was associated with Apgar scores below 5 at 5 min, pulmonary complications, arthrogryposis, or other congenital anomalies. The incidence of decreased fetal movements, polyhydramnios, hypotonia, and assisted delivery was not statistically different between infants who died early and those who survived beyond 1 year of age. Clinical features of newborns with muscle disease may be useful for prediction of outcome, especially when muscle biopsy abnormalities are nonspecific.


Bilateral periodic lateralized epileptiform discharges in Mycoplasma encephalitis.

Status epilepticus and prolonged coma developed in two patients with respiratory tract infections caused by Mycoplasma pneumoniae. Serial electroencephalography initially revealed bilateral, independent, periodic, lateralized epileptiform discharges. This pattern was replaced several days later by other electroencephalographic abnormalities.


Developmental bilateral perisylvian dysplasia.

Acquired bilateral anterior opercular lesions result in the characteristic Foix-Chavany-Marie syndrome that features expressive dysphasia and pseudobulbar palsy. A developmental congenital variant that represents a restricted disorder of neuronal migration was recently reported. We report a newborn with autopsy-confirmed developmental bilateral perisylvian dysplasia. Polymicrogyria was found on detailed histologic study confirming the only prior pathologic study of this syndrome. The clinical heterogeneity of this disorder with neonatal and childhood modes of presentation is reviewed. Speculation regarding pathogenesis focuses on either a genetically determined selective aberration of neuronal migration or an in utero postmigration vascular accident.


Agenesis of corpus callosum and intraventricular lipomas.

Intracranial lipomas are rare and usually do not have clinical expression. They are located most commonly in the interhemispheric fissure and may also be found in the quadrigeminal, ambient, chiasmatic, interpeduncular, sylvian, and perimesencephalic cisterns. Interhemispheric lipomas may be associated with choroid plexus lipomas. The ultrasonography, computed tomography, and magnetic resonance imaging findings are reported in a neonate with lateral ventricular choroid plexus lipomas and interhemispheric lipoma associated with agenesis of the corpus callosum.


Phenotypic Duchenne muscular dystrophy with C-terminal domain.

We report a patient with X-linked muscular dystrophy who had rapidly progressive muscle weakness and became wheelchair-bound at age 10 years. Clinically, he was diagnosed as having Duchenne muscular dystrophy; however, he was diagnosed as having Becker muscular dystrophy by dystrophin tests using a C-terminal monoclonal antibody. No immunolabelling was observed with a monoclonal antibody against the N-terminal domain. Multiplex polymerase chain reaction analysis revealed the deletion of exons 3-19. The data suggest that the deletion of the N-terminal domain of dystrophin can cause a severe phenotype even when the C-terminus of the protein is well preserved.


Comparison of MRI white matter changes with neuropsychologic impairment in Cockayne syndrome.

The neuropsychologic function and white matter changes observed on magnetic resonance imaging (MRI) in Cockayne syndrome were studied. MRI with T2-weighted sequences revealed periventricular hyperintensity and white matter hyperintensity in all 3 Cockayne syndrome patients examined; in contrast, 8 age-matched controls had no periventricular or white matter hyperintensity. MRI scans were graded according to the severity of periventricular or white matter hyperintensity using a scale applied to an elderly patient population. There was no difference in the severity of MRI white matter changes in these 3 Cockayne syndrome patients, 2 of whom had severe neuropsychologic functions and one a relatively milder one. There was no correlation between neuropsychologic impairment and MRI white matter changes.


Congestive heart failure and cardiac thrombus as first presentations of Friedreich ataxia.

The majority of patients with Friedreich ataxia present with gait ataxia. Congestive heart failure usually is a terminal event. We report a 9-year-old boy who developed congestive heart failure and thrombus formation in the left ventricle at age 5 years and then progressive ataxia as well as other features of Friedreich ataxia; therefore, congestive heart failure and thrombus formation may rarely be the initial findings in Friedreich ataxia.


Transient oculomotor nerve paresis in congenital distal basilar artery aneurysm.

The clinical and pathologic findings of a 10-month-old girl with congenital heart disease who died after rupture of a congenital distal basilar artery aneurysm are reported. The patient developed transient minimal oculomotor nerve paresis 7 days prior to suffering a massive subarachnoid hemorrhage. The finding of transient third nerve dysfunction, particularly in the context of recurrent syncope, should prompt investigation for an intracranial arterial aneurysm.


Warm tub bath after spontaneous rupture of the membranes.

Increasing numbers of pregnant women take a warm bath during labor. Yet few evaluations have addressed benefits claimed and possible risks of this practice. Using retrospective data from a continuing trial at a birth center in Stockholm, we compared 89 women who took a warm bath after spontaneous rupture of the membranes at term with 89 women who had the same interval from spontaneous membrane rupture to delivery and who did not bathe. No statistical difference was observed between the groups with respect to infections, asphyxia or respiratory problems in the newborn infant, or maternal signs of amnionitis. However, a tendency toward more complications was observed in the bathing group. Babies born more than 24 hours after rupture of membranes had significantly lower Apgar scores at 5 minutes in the bathing group than in the control group. As a result of our review of the sparse literature on this practice and the data from this study, we have modified the bathing policy at the birth center from a rather enthusiastic to a more cautious approach. Recommendations about the use of a warm bath in labor will require further investigation, such as randomized trials with large numbers of subjects.


Just another day in a woman's life? Part II: Nature and consistency of women's long-term memories of their first birth experiences.

Twenty women who attended the author's natural childbirth classes between 1968 and 1974 were the informants in this study of long-term memories of their first childbirths. The data from each informant consisted of 1) a labor and birth questionnaire, including an open-ended account of her labor, written shortly after her baby was born; 2) a similar questionnaire and account written in 1988 and 1989; and 3) a transcribed interview during which her memories and perceptions were discussed and any discrepancies between the questionnaires were explored. The questionnaires were compared for consistency of recall, and the interviews consulted for further clarification. Specific memories were excerpted, compared, classified, tabulated, and summarized. Findings were that, years later, women's memories are generally accurate, and many are strikingly vivid, especially of onset of labor; rupture of the membranes; arrival at the hospital; actions of doctors, nurses, and partners; particular interventions; the birth; and first contact with the baby. Most memory lapses or confusion were minor. Evidence of a halo effect was observed as well.


The crisis of pregnancy loss: a team approach to support.

When a pregnancy loss occurs, a woman and her family may require help to facilitate grieving. Several support strategies can be recommended. We established a volunteer, hospital-based perinatal crisis support group that provides intervention, assists clients in moving through the period of disorganization, and offers information and support. Four examples illustrate the work of the group and its collaboration with personnel in other departments and agencies. Guidelines are provided for the establishment of a support team.


Obstetric ultrasound: who should perform sonograms?

Obstetric ultrasound has revolutionized clinical practice by expanding knowledge of fetal growth, physiology, and behavior, and allowing the fetus to emerge as a treatable patient. This dramatic change in clinical practice has not been accompanied by a growth in education or guidelines for the performance of ultrasound studies. This article reviews some of the many professional issues that are still unresolved, such as education, level of care providers, office versus hospital scanning sites, level of ultrasound study, legal issues, obstetrics versus radiology as appropriate specialties to perform sonograms, and implications affecting childbearing women, based on concern for quality care of mothers and babies.


Improving pregnancy outcomes: public versus private care for urban, low-income women.

This study describes the characteristics of women who received maternity care from the Chicago Department of Health or from private practitioners in 1988 and the first half of 1989, and who delivered at the University of Illinois Hospital or Cook County Hospital. The risk of preterm low birthweight for the infants of these women was compared according to source of prenatal care. The likelihood of giving birth to a preterm, low-birthweight infant was significantly greater (odds ratio 3.1, 95% confidence interval 2.3-4.0) for women who received care only from private physicians (n = 530) compared with those who received care entirely from the Chicago Department of Health (n = 2465). This relationship remained after adjustment for race, age, parity, history of adverse pregnancy outcomes, smoking, and use of drugs during pregnancy. We examined alternative explanations for these findings, and concluded that although the role of urban public health departments in the direct delivery of maternity care services continues to be a source of controversy, these institutions remain an important provider of such care for low-income women.


Treatment and outcomes of psychotic patients during pregnancy and childbirth.

This study examined whether particular groups of psychotic women are likely to present management problems during pregnancy and childbirth. The pregnancy courses and outcomes of 22 psychiatric inpatients were reviewed. Schizophrenic women with delusions or psychotic denial about the pregnancy were significantly less likely to detect labor than were nondelusional women. Ability to detect signs of labor and cooperate with labor instructions was significantly more likely in women with bipolar affective disorders than in those with schizophrenic disorders, and was also more likely in those women with severe personality disorders and substance abuse histories. The total patient cohort underwent significantly more cesarean sections than their nonpsychiatric counterparts who delivered at the same hospital. These findings suggest that psychotic women are at high risk for the development of pregnancy and birth complications.


Nausea and vomiting during pregnancy: effects on the quality of women's lives.

More than 70 percent of all pregnant women experience nausea and vomiting during pregnancy, and 28 percent report that symptoms cause them to change their usual activities. We investigated the magnitude of problems that nausea and vomiting impose on the lifestyle of pregnant women and their families. Twenty-seven women who were experiencing different degrees of nausea and vomiting were selected from 147 pregnant women and asked to participate in semistructured telephone interviews. All participants reported changes in family, social, or occupational functioning as a result of these symptoms. Nausea and vomiting can impose substantial lifestyle limitations on pregnant women that can have short- and long-term consequences for them and their families. Both the duration and severity of symptoms were greater for many participants than is generally believed. All participants reported that recumbent rest or dietary alterations provided relief. Caregivers should recognize and validate the need for pregnant women to make changes in lifestyle that will enable them to achieve comfort.


Hmong women: characteristics and birth outcomes, 1990.

Current demographic characteristics and pregnancy outcomes of immigrant Hmong women in a small town in southeastern United States were documented in a retrospective study. Interviews and review of existing records were used to determine prenatal practices and perceived problems. Sixteen health professionals and two women from the community were interviewed, and the labor and delivery records from 1985 to 1990 were reviewed for parity, child spacing, and health status of the women and newborns. The greatest concerns voiced by health caregivers were multiparity and the need for contraceptive compliance. Seventy-eight full-term infants were born to 64 women in five years, with 2 stillbirths. No eclampsia, diabetes, or Rh incompatibilities were noted. Evidence is limited that birth frequency or outcome for Hmong women is a problem. Their perinatal difficulties were thought to be sociocultural rather than medical. Further study of the effects of acculturation on maternal family position, perinatal risks, and birth outcomes is imperative as lifestyle and environment change for these immigrant women.


Case report: survival of an infant with a birthweight of 345 grams.

Infant survival with ever-decreasing birthweights is attainable with recent advances in maternal-fetal medicine and enhanced neonatal intensive care. We report a gestation complicated by severe chronic hypertension and fetal distress necessitating delivery at 26 1/7 weeks. The growth-retarded newborn weighted 345 g (12 oz) and survived with minimal sequelae despite a protracted and complicated neonatal course.


Immunohistochemical analysis of the basal forebrain in Alzheimer's disease.

An immunohistochemical analysis utilizing antibodies to glial fibrillary acid protein (GFAP), microglia, beta-amyloid, amyloid P-component, neurofibrillary tangles (NFT), and microtubule associated protein-tau (MAP-tau) was performed on the cholinergic basal forebrain in Alzheimer's disease (AD). This severely compromised system, which includes the nucleus basalis of Meynert, is largely responsible for the massive loss of cortical and subcortical cholinergic innervation in the diseased state. Our study juxtaposes the basal forebrain immunohistopathology to the hippocampus, amygdala, and entorhinal cortex in AD. Key findings include a progressive degeneration of these cholinergic neurons characterized by the formation of immunoreactively atypical NFT, the loss of intraneuronal lipofuscin, a lack of senile plaque and beta-amyloid deposition within the basal forebrain, and end-stage gliosis without residual extracellular NFT. These structural and compositional differences suggest a unique pathogenesis of the basal forebrain separate from other cortical regions in AD.


Early clinical neurochemistry of CNS-active drugs. Chloral hydrate.

Chloral hydrate was introduced into therapeutics more than 120 years ago, and soon became popular as a somnifacient. It is the first synthetic CNS depressant. Its metabolite, urochloralic acid, was detected early. Studies of the biochemical pharmacology of chloral hydrate have engaged the attention of many investigators in succeeding years. Its mode of action in producing sleep was initially attributed to the possibility that it gives rise to chloroform in vivo. Although this hypothesis did not stand up to scientific scrutiny, it led to efforts to establish how chloral hydrate brings about its action. This seems to be through its reduced metabolite, trichloroethanol. The precise mode of action on the nervous system remains to be worked out.


Debrisoquine metabolism in Chinese patients with Alzheimer's and Parkinson's diseases.

We determined the oxidative phenotype and metabolic ratio of debrisoquine in 96 Chinese patients with Alzheimer's disease (n = 12), Parkinson's disease (n = 55), and using patients with stroke and cervical spondylosis as controls (n = 29). We did not find any difference in debrisoquine metabolic phenotype among Parkinson's disease, Alzheimer's disease, and control patients as judged by chi-square analysis. In addition, the metabolic ratio of all our patients was less than 12.6. The result suggested that Chinese patients with Parkinson's disease and Alzheimer's disease metabolize debrisoquine at a velocity not different from that of their Western counterparts even though the frequency distribution of debrisoquine metabolism phenotyping in these two populations is quite different.


Decapitation ischemia-induced release of free fatty acids in mouse brain. Relationship with diacylglycerols and lysophospholipids.

In this study, the release of lysophospholipids (to depict phospholipase A2 activity) and diacylglycerols (DG) (to depict stimulated hydrolysis of polyphosphoinositides) was related to the decapitation-induced release of free fatty acid (FFA) in the mouse brain. To assay for lysophospholipids, Balb/c mice were injected intracerebrally with either [3H]choline or [3H]inositol for 16 h in order to label their respective phospholipids. These lipids were examined at various times (30 s to 30.5 min) after decapitation. Between 30 s and 1.5 min after decapitation, the rate of FFA release (3 micrograms FA/mg FA in phospholipids/min) was three times more rapid than that between 10 and 15 min (0.8 microgram FA/mg FA in phospholipids/min). FFA released during the initial phase were enriched in 20:4 and 18:0 whereas those released during the latter phase were nonspecific. The DG fatty acids are enriched in 18:0 and 20:4. Ischemia induced a rapid release of DG as measured by its fatty acid content (3.2 micrograms FA/mg FA in phospholipids/min). Unlike FFA, the level of DG reached a plateau after 1.5 min and remained elevated for the entire 30.5 min. In agreement with previous notions indicating the involvement of phospholipase A2 in ischemic insult, steady increases in radioactivity of both lysophosphatidylcholines and lysophosphatidylinositols were observed with time after decapitation. Based on the preferential increase in both 18:0 and 20:4 during the initial time period, the results suggest that poly-PI hydrolysis coupled to DG-lipase may contribute to the initial release of FFA, whereas the FFA released subsequent to the initial phase may be mainly a result of activation of phospholipase A2 acting on phosphatidylcholines and phosphatidylinositols.


Aluminum-induced acute cholinergic neurotoxicity in rat.

In the present study the acute effect of intravenous aluminum chloride (1 mg/kg) on choline acetyltransferase (ChAT) and acetylcholinesterase (AChE) activities of rats was investigated. Aluminum was found to cross the blood-brain barrier (BBB) as indicated by the detection of aluminum in the cerebrospinal fluid (CSF) 30 min after femoral vein injection. Two hours following aluminum injection, ChAT activity in the basal forebrain and hippocampus was significantly reduced by 30% and 22%, respectively, whereas no change was observed in the caudate nuclei. On the other hand, AChE activity was significantly increased by 45% in the caudate nuclei, whereas little change was observed in other brain areas. This report demonstrates that rapid transport of Al across the BBB, and the acute nature of Al neurotoxicity in rats.


The effects of beraprost Na, a stable prostacyclin analog, on animal models of stroke.

We evaluated the effects of beraprost Na (Sodium (+-)-(1R*,2R*, 3aS*,8bS*)-2,3,3a,8b-tetrahydro-2-hydroxy-1-[(E)-(3S*)-3- hyd roxy-4-methyl-1- octen-6-ynyl]-1H-cyclopenta[b]benzofuran-5-butylate, beraprost), a stable and orally active prostacyclin (PGI2) analog with potent antiplatelet and vasodilating properties, on two stroke models, namely sudden death induced by arachidonate (AA) in rabbits and spontaneous stroke in stroke-prone spontaneously hypertensive rats (SHRSP). In the AA-induced sudden death model, 30 min after beraprost administration (1 or 3 mg/kg, po), AA was injected into the rabbit internal carotid artery, and incidence of convulsion and sudden death were assessed. Beraprost decreased both incidence of convulsion and mortality of rabbits. In SHRSP, orally administered beraprost (100 micrograms/kg, twice a day from 56-385 d of age) improved survival rate and decreased incidence of stroke. Preventive effects of beraprost on the two stroke models may have been caused mainly by the improvement of cerebral circulation. These results indicate that beraprost may have potential in the treatment and/or prevention of the cerebral circulatory disorders.


[Morphologic substrates of the ventricular route of secretion and transport of substances in the tubero-infundibular region of the hypothalamus. Ultrastructural study].

Ultrastructural studies of the ependyma of the tuberoinfundibular region of the rat hypothalamus have revealed the existence of intraventricular axonal endings and of cytoplasmic blebs and bulbs that project from the apical surface of the ependymal cells to the ventricular lumen. All these structures account for the processes of ependymal apocrine secretion and the neuroventriculocrinia, and hence the release of biologically active substances into the cerebrospinal fluid (CSF). These substances contained in the CSF must act on the nervous nuclei of the tuberoinfundibular region, such as the arcuate nucleus, which is very important in the neuroendocrine regulation of the anterior pituitary gland. Dilated intercellular spaces among neighbouring ependymocytes of this region, small intraependymal cisternae and, in particular, a lateral prolongation of the infundibular recess, which courses through the nervous tissue between the arcuate nucleus and the median eminence from the vertex of the lateral angle of the infundibular recess, may be the route followed by the CSF from the third ventricle to the tissue compartment of the tuberoinfundibular region. Also studied are the cisternae of the region and the relationships of these with the lateral prolongation of the infundibular recess. Some of these cisternae may be filled by the CSF through the prolongation. In this way, the tissue compartment of CSF would be enlarged, and hence the ventricular route for the secretion and transport of biologically active substances would be potentiated.


Immunocytochemical study of vasopressin-like immunoreactive material in the gastrointestinal tract of the hedgehog Erinanceus europeus.

A study was made of portions of the gastrointestinal tract including the stomach, duodenum, jejunum, ileum, colon and rectum, and the hypothalamus of hedgehogs using the peroxidase-antiperoxidase (PAP) method incubating paraffin embedded sections of 6-7 microns thickness in an anti-arginine-vasopressin serum at a dilution of 1:1000. Vasopressin-like immunoreactivity is present in cells of the epithelial layer of the intestinal mucosa ranging from the stomach to the rectum. In the stomach the numbers of these cells are very small although they increase in the small intestine. However, in the different portions of this latter organ no significant differences can be found. Both, in colon and rectum there are cells with vasopressin-like immunoreactive material although at higher concentrations than in the rest of the gastrointestinal (GI) tract. Immunoreactive material is present throughout the epithelial layer of the mucosa and in general the cells of the mucosa are of the open kind. Using the same antiserum and at similar dilution, both cells and nerve fibres containing vasopressin-like immunoreactivity were observed in hypothalamic sections of this animal species and were used as positive controls. It is concluded that in the gastrointestinal (GI) tract of the hedgehog there is a population of epithelial cells that contain a immunoreactivity vasopressin-like-peptide (referred to as vasopressin-like peptide (AV-LP) whose numbers increase in the distal sense.


[The use of silicone breast prosthesis in Puerto Rico].

To obtain data on the use of gel-filled silicone breast implants in Puerto Rico, a study was undertaken by the Division of Plastic Surgery of the University of Puerto Rico. Questionnaires, designed to obtain information about their breast implant patients, were mailed to the 22 plastic surgeons in Puerto Rico. Sixty-eight percent of the plastic surgeons responded. The collected data showed that 1,682 patients received gel-filled silicone breast implants, of whom breast augmentation accounted for 82%, and post-mastectomy reconstruction for 18%. Capsular contracture occurred in 16% and early complications in 2.5% of the patients. Autoimmune disease was rare (.0006%), as was breast cancer (.0002%). Very few patients in Puerto Rico received polyurethane foam covered breast implants (.005%). The risk of problems associated with breast implants in our Island appears to be very low.


Asymptomatic carcinoma of the endometrium in a patient on adjunctive tamoxifen therapy for carcinoma of the breast.

A case report of a 70 years old female, on tamoxifen for over five (5) years after a left mastectomy and with lymphadenectomy and radiotherapy in whom an asymptomatic adenocarcinoma of the endometrium is reported. Review of the literature suggests this association, however, definitive proof that tamoxifen causes cancer of endometrium has not been fully accepted. The best study in this regards is the one from Radiohemmet Oncologic Centre from Stockholm, Sweden. Patients with cancer of the breast that have been over two (2) years on tamoxifen should be screened with endovaginal sonograms for thickness of endometrium, thickness over 9mm and possibly over 5mm should be investigated with hysteroscopy and fractional uterine curetage.


[Exercise, physical activity and diabetes mellitus].

Vigorous regular exercise is a recommended inclusion in the management of diabetes of persons with diabetes of both types, regardless of age. Benefits can be identified in the physiological (improved cardiovascular fitness, flexibility and muscle toning; in the metabolic and hormonal processes for energy production), as well as psychosocial realms (self-esteem, stress management, socialization opportunities). Considerations of the risks (hyper or hypoglicemia, ketoacidosis, neuropathies or complications os cardiac risks), and contraindications (unplanned weight training in cases with proliferative retinopathy, hypertensión, uncontrolled diabetes) must be part of the exercise prescription and implemmentation. Exercise programs must be fun, varied and comply with exercise physiology principles such as gradual progression in intensity or target heart rate, recommended frequency and duration, regular hydration, and warm-ups and cooling routines. Regular vigorous physical education, sports, regular exercise and active recreational activities can be part of a healthy lifestyle of persons with diabetes.


[Midfacial degloving: an alternative approach to the frontobasal area, the nasal cavity and the paranasal sinuses].

Midfacial degloving can be characterized as an alternative surgical approach for exposing the bony structures of the midface. In combination with transient partial osteotomies the nasal cavities, the paranasal sinuses, the pterygopalatine fossa and the posterior parts of the anterior skull base are easily accessible. Using an intercartilaginous, a transseptal and a circumvestibular incision in the nose and a vestibular incision in the oral cavity the soft tissues of the upper face are mobilized and transposed cranially up to the infraorbital rim, the nasion and the lacrimal sac. Thus one can avoid scar formations in the face. In comparison with the common visible incisions in the face a bilateral exposure of midline structures is possible. The resected bone can be easily replaced and fixed with titanium miniplates for osteosynthesis. The soft tissue glove is replaced. A correct suture technique for readaptation especially in the nasal cavity is most important to avoid a circular stenosis of the nasal aperture. Between 1986 and 1991, 40 patients with various tumors (juvenile angiofibroma, inverted papilloma, esthesioneuroblastoma, squamous cell carcinoma of the maxillary sinus, benign tumors of the pterygopalatine fossa, clivus chordoma) underwent this procedure. Neoplasms and fractures of the anterior frontal skull base, the frontal sinus, the orbital cavity and the zygoma were less accessible due to the unsatisfactory exposure of these regions. Complications and side effects were rare. In five cases, a transient paresthesia of the infraorbital nerve and a facial edema were observed. In one case, a circular stenosis of the nasal aperture required a second plastic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)