[Anti-emetic effect of ondansetron in cisplatin induced nausea and vomiting--a randomized clinical trial].

The anti-emetic effect of ondansetron in cisplatin induced nausea and vomiting was studied in a randomized cross-over trial in 52 patients. The dose of cisplatin was 80-120 mg/M2 iv drip given in 1-3 days. The patients randomly received ondansetron or our routine anti-emetic regimen in the first cycle of chemotherapy. All the patients were crossed-over to the other anti-emetic regimen on the second cycle of the same cisplatin containing regimen. The results showed that ondansetron was superior to our routine anti-emetic regimen in controlling acute nausea and vomiting. 86% of patients treated with ondansetron and 20.4% treated with the routine regimen had a complete or marked response (O-2 emetic episodes). The mean frequency of vomiting were 1.3 times in ondansetron and 8.0 times in the routine regimen (P less than 0.01). Control of delayed emesis was comparable in the two arms. No patient had neurological symptoms in the ondansetron group whereas 4 patients in the routine group had extrapyramidal symptoms.


[Hepatic arterial infusion chemotherapy plus embolization for unresectable liver cancer--a report on 40 patients].

Forty patients with unresectable liver cancer were treated by hepatic arterial infusion chemotherapy plus embolization (HAI+HAE). Thirty-four patients had huge masses and 6 nodular lesions. After HAI+HAE, the frequency of greater than or equal to 50% reduction in tumor size was 67.5% (27/40); that of reduction in marked and partial disappearance of tumor blood vessels was 90% (36/40); and that of marked decrease and normalized AFP was 90.3% (28/31). The mean survival of 12 patients treated solely by HAI plus HAE was 17.2 months, and one of them has been alive for 48 months. Twenty-eight patients became operable following HAI+HAE and 26 of them underwent hepatic resection. Pathologic examination revealed obvious necrosis in most part of the tumor with a few viable cancer cells in the periphery and inflammatory reaction as well as fibrotic proliferation around the necrotic tumor tissue. The authors believe that hepatic arterial infusion chemotherapy plus embolization for the unresectable liver cancer is effective. If satisfactory shrinkage of the tumor is observed, subsequent resection should be contemplated for cure.


[Treatment of proximal biliary duct carcinoma].

During the past 30 years, 21 patients suffering from proximal biliary duct carcinoma were treated by surgery. The resectability rate was 14%. Three patients had radical resection, 2 surgical bypass, 3 surgical catheterization for drainage, 4 PTCD, and 2 intraluminal radiotherapy with Iridium-192 delivered by a remote afterloading system through catheters introduced intraoperatively. The survivals ranged from 3 to 13 months. Due to the proximity of this portion of biliary duct to the hepatic hilus, invasion of the adjacent structures such as the portal vein and hepatic artery is common. Hence, complete resection is difficult and palliative surgical approach is usually adopted. Results of our treatment and review of relevant documents are presented.


[Extracranial meningioma--a report of 6 cases].

Six cases of extracranial meningioma (EM) are reported. In addition to the routine paraffin section and HE stain as examined by light microscope, immuno-histochemical studies with antibodies against vimentin, EMA, CK1, and S-100 were done. One specimen was examined by electron microscopy as well. For subdivision, 4 belonged to meningotheliomatous type and each of the rest belonged to transitional and psammomatous types respectively. According to Lopez's classification, 5 were Type II and 1 was Type III. The significance of Lopez's classification of this tumor in clinical diagnosis and differential diagnosis, in histogenesis and pathogenesis are discussed.


[Photodynamic therapy of nasopharyngeal carcinoma by argon or dye laser--an analysis of 137 cases].

137 cases of nasopharyngeal carcinoma were treated by photodynamic therapy (PDT). Forty-eight and 72 hours after iv administration of 3-5 mg/kg HpD, laser treatment with either argon or dye laser was given. Dye laser (630 nm) with over 350 mw output transmitted through quartz fiber was given to 57 patients. Argon laser (488 nm and 514.5 nm) was delivered to 80 patients. The results were: complete response 76 cases (55.47%) and marked response 47 cases (34.31%), with an over-all marked response rate of 89.78% (123/137). The efficacy and indication of photodynamic therapy for nasopharyngeal carcinoma using various light sources (argon and dye laser) are discussed.


[Treatment of double primary lung cancers in 23 patients].

Twenty-three patients with double primary lung cancers (10 synchronous, 13 metachronous) were diagnosed from 1967-1988 by operation, pathology or cytology. The incidence of double primary lung cancers was 1.5% (23/1527) among all lung cancers patients admitted during the same interval. Ten of these 23 patients (43.2%) received operative treatment. The synchronous double primaries were treated by limited resection. For the metachronous lesions, the first lung cancer was treated by the standard lobectomy and the second lesion by wedgectomy. The average survival time for the synchronous double lung cancers was 13 months which was similar to that of radiochemotherapy. For the metachronous cancers, the 5-year survival of 5 operated patients was 40%. Only one of the other 8 patients as treated by non-operative means survived for more than 3 years. This shows the superiority of surgery to the non-operative treatment. Pathologic classification of the lesions in this series showed that 10 (43%) had identical types with the majority (6 patients) being of squamous-squamous cell type. In the 13 patients (57%) with different pathologic types 7 were of squamous-adenocarcinomas. Diagnostic criteria, operative method and vigilance to the possibility of double primary lung cancers are also discussed.


[Diagnosis of breast cancer by computed infrared light scan].

One hundred and eleven patients with various pathologically proved breast diseases were examined by computed infrared light scan (ILS). The results were compared with those of palpation and X-ray mammography. The correct rate in 50 cancers was 90%, significantly superior to that of X-ray (70%, P less than 0.05). The lower diagnostic rate of X-ray may have been due to higher percentage of younger patients (30-40 years of age) who had higher density in the breast in this group. The criteria of diagnosis of cancers by ILS on the video monitor were: 1. The shadow of the mass- the lower grade of gray-shade implied the possibility of malignancy, and 2. Pattern of the blood vessels around the mass-increase in number, diameter, distortion, a zigzag course or disappearance of blood vasculature suggested malignancy. ILS is considered simple, non-invasive, easy to operate and reliable in the detection of breast cancers.


[Surgical treatment of papillary thyroid carcinoma--report of 437 cases].

Four hundred and thirty-seven patients with papillary thyroid carcinoma were treated from April 1963 to December 1989. The main treatment was surgery which was divided into 4 types: lobectomy combined with neck dissection (RND or MND); total thyroidectomy; isthmusectomy plus lobectomy; lobectomy combined with RND and then followed by contralateral MND. The 10-year survival rates of these four groups were 88.6%, 89.5%, 80% and 80%, respectively. The over-all 5-, 10- and 15-year survival rates were 92.7%, 87.9% and 79.4%. Lymph node metastasis was present in 80%. The authors believe that functional neck dissection is indicated if the number of lymph node is limited and the size is small.


[Analysis of 26,826 patients with tumors in the head and neck].

A series of 26,826 patients with tumors in the head and neck as confirmed by pathology from January 1970 to December 1989 are analyzed. It accounted for 39.5% of all the tumors biopsied in the same interval. In this series, 72.41% was malignant which accounted for 45.77% of malignant tumors in the whole body. For benign tumors in the head and neck, the ratio of male to female was 0.84:1, and for malignant tumors in the head and neck it was 2.4:1. The most frequently involved site by the malignant tumors were: nasopharynx, mouth, maxillofacial regions and neck. The majority (62.65%) of malignant tumors were located in the nasopharynx which accounted for 28.68% of all malignancies, of which the ratio of male and female was 3:1, peak age was 41-50 years, 18 of them was under 10 years of age, the youngest was 1 1/2 years and the oldest was 84 years old. These data showed that malignant tumors in the head and neck regions, especially those in the nasopharynx, are common in Guangxi Province, China.


[Diagnosis and treatment of primary retroperitoneal tumors].

New diagnostic imaging methods could shed much light on the diagnosis and treatment of retroperitoneal tumors. From 1978 to 1988, 98 patients were admitted. Eighty patients were treated by surgery and the diagnosis proved by pathology. In patients with primary malignant retroperitoneal tumors, 27 were completely resected and 18 received palliative resection. Of 18 benign tumors, 16 were completely resected. In these 80 patients, biopsy was done in 17 patients. In patients with malignant tumors, a 5-year survival rate of 14% was obtained. In the resected benign tumors, a 5-year survival of 100% was obtained. Local recurrence was the chief cause of death.


[A 12-year clinical experience of cardiac valve replacement with domestic tilting disc valve prostheses in 1013 cases].

1013 patients with cardiac valve replacement during a 12-year period from 1978 to 1990 were reported. 566 cases were implanted with Shanghai-made tilting disc valve prostheses and 447 with Lanzhou-made (C-L valves). Mitral valve replacement (MVR) in 753 patients, aortic valve replacement (AVR) in 102 and double valves replacement (DVR) in 158. The overall early mortality rate was 6.2% with 4.9%, 7.8% and 11.3% after MVR, AVR and DVR respectively. Follow-up study was made in 3097.43 patient-year (mean 3.26 years). The late death rate was 1.6% patient-years and with 1.4, 1.8 and 3.2 after MVR, AVR and DVR respectively. The incidence of late valve-related complication (% patient-years) were: thromboembolism 0.39, anticoagulant-related hemorrhages 0.77, prostheses failure 0.22, prosthetic valve endocarditis 0.38, periprosthetic leak 0.12, and reoperations 0.38. The domestic tilting disc valve prostheses are considered to be qualified valves with low mortality and satisfactory results.


[A clinical analysis of atrial-ventricular sequential pacing].

Forty one patients were implanted DDD pacemakers (3 cases DDDR) from August, 1983 to July, 1990. 32 males and 9 females. The mean age was 62.3 years (range 32 to 91). 19 patients had coronary artery disease. The indication for pacing was II degrees-III degrees AV block in 16 patients and sick sinus syndrome in 25 patients. During follow-up period there were 2 patients had displacement, 4 patients had undersensing, 3 patients had pacemaker-mediated tachycardia and 3 patients had crosstalk. That was corrected through external programmer. The experience of this operation was discussed.


[Relationship between different patterns of left ventricular hypertrophy and plasma norepinephrine and hemorheology in patients with essential hypertension].

The changes of plasma norepinephrine (NE) concentration and hemorheology in 60 patients with essential hypertension (EH) with different patterns of left ventricular hypertrophy (LVH) were observed. The results showed that a higher value in whole blood viscosity (WBV) at a shear rate of 230-s was found in concentric hypertrophy (CH) group; a significant increase in plasma NE was found in asymmetric septal hypertrophy (ASH) group. It suggests that CH appear to be a compensation adapting to the increase in afterload. Significant increase in plasma NE concentration may play an important role in the development of ASH in addition to the afterload.


[A study on spontaneous closure of ventricular septal defect using 2 dimensional echocardiography].

The results of 2 dimensional echocardiographic (2DE) observation in 73 patients with clinically diagnosed spontaneous closure of ventricular septal defect (VSD) were reported. 2DE showed that aneurysm of the membranous septum formed at the defect portion in 54 patients (74%), tricuspid valve leaflet tissue adhered to the defect portion in 2 patients, coarse appearance of the membranous septum in 8 patients, no defect in 9 patients. There was no shunt flow detected in 59 patients, trivial shunt flow in 14 patients on Doppler echocardiography. All VSD were of the membranous and perimembranous inlet type. The results of this study suggested spontaneous closure of membranous VSD was related to the aneurysmal formation of the membranous septum and adhesion of tricuspid valve tissue.


[Validation of Doppler-derived interventricular pressure gradients in patients with ventricular septal defect comparing with catheterization study].

To evaluate the accuracy of Doppler echocardiography for measuring the interventricular pressure gradient in patients with ventricular septal defect (VSD), Doppler echocardiography and dual catheters were performed simultaneously in 31 cases with VSD ranging from 9 to 40 years old. The systolic jet velocities through VSD were recorded by the continuous-wave Doppler technique and converted to the peak instantaneous pressure gradient (delta Pp) and the mean pressure gradient (delta Pm) using a modified Bernoulli's equation with the aid of computer system. Both left and right heart catheters were performed to record the left (LVSP) and the right (RVSP) ventricular systolic pressure simultaneously. Guided by the color flow image Doppler technique, the tip of the right heart catheter was carefully placed within the jet area of the right ventricle. The following parameters were measured from the ventricular pressure curves, the peak instantaneous pressure gradient (IPG), the peak to peak pressure gradient (PPG) and the mean pressure gradient (MPG). The comparison between delta Pp and PPG yielded an excellent correlation (r = 0.99, SEE = 0.69 kPa). There was a close agreement between delta Pp and IPG (r = 0.99, SEE = 0.64 kPa). However, the correlation between delta Pm and MPG was also high (r = 0.98, SEE = 0.67 kPa). We conclude that Doppler echocardiography offers a reliable technique for measuring the interventricular pressure gradient in patients with VSD.


[Balloon pulmonary valvuloplasty after initial pulmonary valvotomy for pulmonary atresia with intact ventricular septum].

Seven patients with pulmonary atresia and intact ventricular septum have undergone closed pulmonary valvotomy on the early neonatal period (2-6 days) with satisfactory results. Follow-up catheterization showed significant residual pulmonary valve stenosis requiring a second operation. Percutaneous balloon dilatation of the pulmonary valve was successful in 6 cases with the mean right ventricular systolic pressure reduced from 6.8 to 4.9 kPa (50.8 to 37 mmHg) and the mean transvalvular gradient dropped from 5.7 to 2.1 kPa (4.28 to 15.8 mmHg). One case failed and required surgical treatment. The results showed that balloon valvuloplasty could be applied instead of surgery for treatment of selected cases of pulmonary atresia with intact ventricular septum after an initial pulmonary valvotomy.


[Protection on experimental sinus node dysfunction in rabbits with ginsenosides].

This experiment was carried out to evaluate the effect of ginsenosides from stems and leaves (GSL) on the sinus node dysfunction (SND) by observing the changes of the electrophysiological parameters of sinus node in limited period. Anesthetized rabbits were randomly divided into 3 groups. In the acute experiment, GSL, 50 mg/kg, iv, was given to the GSL group (G), n = 12. Normal saline (NS), the same volume, to the control group (C), n = 12. After GSL was administered 30-50 mg/kg.d for 14 days, iv, another data were obtained from chronic experimental group (CE), n = 15. The results show that the parameters, spontaneous cycle length (SCL), maximal sinus node recovery time (SNRTmax), corrected sinus node recovery time (CSNRT) were shorter in G group and CE group than C group respectively (P less than 0.05, P less than 0.01). It was suggested that GSL exerted protective effects on the experimental sinus node dysfunction.


Oral self-administration of pentobarbital by rhesus monkeys: relative reinforcing effects under concurrent signalled differential-reinforcement-of-low-rates schedules.

During daily 3-h sessions two separate pentobarbital solutions were concurrently available to rhesus monkeys under signalled differential-reinforcement-of-low-rates (signalled DRL) schedules of mouth contacts with spouts. The schedules were synchronized so that each time the 30-s DRL interval expired, lights above both spouts were illuminated and a liquid delivery could be obtained either from the left or right spout, but not both. First water and then each of four 'comparison-concentration' pentobarbital solutions (0.0625, 0.25, 1 and 4 mg/ml) were successively available under one schedule for a block of sessions. Concurrently, deliveries of a 'standard concentration' solution were available from the second spout under an identical DRL schedule; the concentration of this standard solution remained constant throughout the testing of the series of comparison solutions. Three pentobarbital concentrations (4, 1 and 0.25 mg/ml) in turn served as the standard concentration. Relative reinforcing effects were directly related to pentobarbital concentration: in general, within pairs of concurrently available pentobarbital solutions more behavior was maintained by the higher of the two drug concentrations. These findings are discussed in the context of previous studies using ratio and interval schedules which have found relative reinforcing effects to be directly related to reinforcer magnitude.


Discriminative stimulus properties of cocaine, alone and in combination with buprenorphine, morphine and naltrexone.

Rats were trained to discriminate a dose of 10.0 mg/kg cocaine from saline. During substitution tests, both cocaine (5.6-10.0 mg/kg) and d-amphetamine (1.0-3.0 mg/kg) produced greater than 80% responding on the cocaine-appropriate level. In contrast, buprenorphine (0.03-0.56 mg/kg), morphine (0.3-10.0 mg/kg) and naltrexone (1.0-10.0 mg/kg) failed to substitute for the cocaine stimulus, up to doses that substantially decreased rate of responding. When the cocaine dose-effect curve was redetermined in the presence of selected doses of buprenorphine, the amount of cocaine-appropriate responding following a low dose of cocaine (1.0 mg/kg) was increased slightly whereas cocaine-appropriate responding following higher doses of cocaine (3.0 and 5.6 mg/kg) was reduced slightly. Responding following the training dose of cocaine (10.0 mg/kg) was not changed. These results indicate that buprenorphine produced only small alterations in cocaine's discriminative stimulus effects and that the nature of these alterations differed depending on the dose of cocaine examined.


The use of plasma levels to optimize methadone maintenance treatment.

The question of the optimal methadone dose during maintenance therapy is controversial. For both philosophical and practical reasons, therapeutic drug monitoring has not been generally used. Some therapists prescribe low doses of methadone more for psychological than pharmacological reasons. This study examines, in 104 methadone patients, the relation between self-rating, observer-rating, urine tests, HIV-1 sero-status, daily methadone doses and plasma levels of methadone. No differences were found between HIV-1 infected and seronegative patients in these respects. The optimal methadone plasma level as judged by self- and observer-rating was more than 150 ng/ml. For oral methadone, the best results are obtained in patients receiving more than 90 mg daily. We found a significant relationship between methadone dose and plasma levels, also in patients who also used illicit drugs. We conclude that therapeutic drug monitoring should become routine in methadone treatment to achieve optimum results, especially in patients who complain of withdrawal symptoms and continue high-risk behaviour.


Antisocial personality disorder, HIV risk behavior and retention in methadone maintenance therapy.

In a sample of 55 consecutive methadone maintenance admissions to our clinic, 42% were diagnosed with antisocial personality disorder (ASPD) using the National Institute of Mental Health Diagnostic Interview Schedule NIMH DIS. Individuals with ASPD exhibited greater risk for HIV infection as defined by more sexual contacts, needle use and equipment sharing. Data at 1 year follow-up were obtained on this group of patients. The objective was to compare the ASPD and non-ASPD groups with regards to demographics, drug abuse history, outcome and retention in treatment. There were no significant differences between the groups on any demographic or treatment outcome variables. Survival analysis indicated that there were no group differences in treatment retention. In conclusion, although there were no differences in treatment outcome between ASPD and non-ASPD groups it is possible that ASPD patients who drop out of treatment will be at higher risk for contracting and spreading HIV within the IV drug using population. These data also suggest that in this population the diagnosis of ASPD using primarily behavioral traits as measured in the NIMH-DIS-III, has little utility in predicting treatment outcome.


The image of self and of the environment in drug abusers: a comparative study using the TAT.

This study attempted to add to our understanding of the heroin abusers' identity problems, using images of the self and the environment. Murray's Thematic Apperception Test (TAT) was applied to a group of male drug users undergoing withdrawal treatment with methadone and also to a group of male, non-drug using controls. The needs of the subjects and the demands of the environment, plus interaction between the two, were compared between the two groups to obtain information about the self and lifestyle. Among the data which emerged, is an increased need for destructive aggression and an environment experienced as coercive and emarginating. Among the interactions we observed coerced imagination, difficulties in identification, personal relationships based on abandonment with persecutory projection of the female figure and a tendency toward immature defences such as avoidance, denial and acting out. This information is discussed in relation to possible means of treatment.


Buprenorphine alone and in combination with naloxone in non-dependent humans.

This study evaluated the effects of concurrent naloxone on the opioid agonist effects of buprenorphine, a mixed agonist-antagonist marketed as an analgesic and under development as a treatment for drug abuse. In a residential laboratory seven non-physically-dependent opioid abuser volunteers received intramuscular buprenorphine (0.4 mg or 0.8 mg/70 kg) alone and in combination with naloxone (0.4 mg or 0.8 mg/70 kg) versus placebo. Buprenorphine produced dose-related opioid agonist effects on physiological and subjective measures. Concurrent naloxone attenuated the opioid agonist effects of buprenorphine. Thus, a combination product of buprenorphine and naloxone may have lower abuse liability than buprenorphine alone.


Elementary schoolchildren's use of alcohol, cigarettes and marijuana and classmates' attribution of socialization.

In each of 2 years beginning in fourth and fifth grades, urban elementary public schoolchildren completed surveys about abusable substance use and health promoting behaviors and completed an instrument that permitted each child to have a socialization score attributed by classmates. A factor weighted 12-item scale was developed from 15 items in three domains (personal, interpersonal and school). The scale was positively correlated over the 2 years and positively correlated with a healthful activities scale in both years. Conditional multiple logistic regression, matching on school classroom, indicated that socialization was negatively associated with use of alcohol without parental permission and cigarettes in both years (grades 4-5, grades 5-6) and with use of marijuana in year 1. Socialization measured in year 1 was negatively associated with cigarette use in year 2 and with onset of use from year 1 to year 2. Shyness, a non-socialization scale item, was negatively associated with use of cigarettes in both years and with use of alcohol without permission and use of marijuana in year 2. Being 'good at sports' was an attribute positively associated with alcohol use without permission and cigarette use in year 2. Results suggest that elementary schoolchildren can ascribe social characteristics to their classmates that are associated with and predict health related behaviors.


Biochemical resistance to development of morphine-dependence in rats: biogenic amines, its receptors and antibodies.

The level of norepinephrine (NE), epinephrine (E) and dopamine (DA) in hypothalamus and blood plasma along with antibodies to NE, DA and serotonin (5-HT) and characteristics of alpha 1-, alpha 2-adrenergic, D2-dopaminergic and S2-serotoninergic receptors in synaptic brain membranes were studied in two groups of rats predisposed or resistant to the formation of physical morphine dependence. The resistant animals were characterized by a significant elevation of DA levels in blood plasma, elevation of antibodies to NE, and by higher concentration of alpha 2-adrenergic receptors in the brain cortex and of D2-receptors in striatum. The affinity of D2-receptors to dopamine in resistant rats also was higher than in predisposed animals. The other parameters studied did not differ significantly between the two groups. These findings suggest that the increased activity of DA and NE neurotransmitter systems can be a cause for the genetic resistance of some individuals among Wistar rats to the formation of physical dependence on morphine.


[Antineutrophil cytoplasmic antibodies in chronic inflammatory bowel diseases].

Serum samples from 83 patients (42 women, 41 men, mean age 41 [19-85] years) with chronic inflammatory bowel diseases (ulcerative colitis: n = 41, Crohn's disease: n = 42) of differing degrees of activity were tested for antineutrophil cytoplasmic antibodies (ANCA) by immunofluorescence microscopy and various ELISA techniques. Seven patients with ulcerative colitis and one with Crohn's disease were suffering from associated primary sclerosing cholangitis. ANCA were detected in 18 sera, 13 from patients with ulcerative colitis (31.7%) and five from patients with Crohn's disease (11.9%). Six of the eight patients with primary sclerosing cholangitis were ANCA-positive. Nine sera showed a cytoplasmic (c-ANCA-) pattern and 9 others showed a partially atypical perinuclear (p-ANCA-) pattern. Among the ANCA-positive sera, ELISA techniques showed that two had antibodies against serine proteinase 3, two against lactoferrin, two against elastase and one against myeloperoxidase. There was no correlation between the anatomical pattern or activity of the disease and the presence of ANCA. The antineutrophil cytoplasm antibodies demonstrable in chronic inflammatory bowel disease appear to be directed against so far unknown antigens. They are particularly frequent in patients with associated primary sclerosing cholangitis.


[Intraoperative transesophageal echocardiography in large heart tumors].

A 46-year-old woman known to have an asymptomatic left atrial tumour suddenly developed dyspnoea, tachycardia (up to 140 beats/min) and a fall in systolic blood pressure to 80 mm Hg, 12 days after an extensive radical operation for metastatic ovarian carcinoma. Echocardiography demonstrated a large left atrial tumour which impaired left ventricular filling. A previously healthy 42-year-old man reported increasing exertional dyspnoea with retrosternal feeling of tightness. A 2/6 systolic murmur was audible over the cardiac apex, a 3/6 diastolic murmur heard maximally over the 2nd intercostal space, and there was a third heart sound. The chest X-ray film demonstrated pulmonary venous congestion and there was an enlarged P-wave in the ECG suggesting left-atrial enlargement. Echocardiography revealed a myxoma-like tumour in the left atrium. A thoracotomy was performed in both patients. Using intra-operative transoesophageal echocardiography, the attachment of the tumour (in both instances a myxoma), the course of the operation and, after tumour removal, normal valvar and cardiac function were demonstrated. In case 2, the echocardiographic findings justified an atypical approach via the right atrium. In both patients removal of the tumour and the postoperative course were without complication.


[The rectus abdominis syndrome].

Three athletes (one female, two males), aged 18-21 years, developed acute abdominal pain, two of them immediately after exercise including abdominal muscle training. The female patient had a pulmonary infection of uncertain cause at the time. The second patient obviously suffered from an allergic or parasitic disease (eosinophilia of 26%). The third patient, a swimmer, had the symptoms in the course of a flu-like infection after drinking about 100 g alcohol. Serum creatinine kinase activity was 7,800-17,500 U/l, making acute muscle damage likely, probably rhabdomyolysis. Ultrasound examination revealed echo-dense areas of the rectus abdominis muscle in two of the patients, in one of them associated with marked muscle swelling. In the third patient ultrasound was unremarkable during a symptom-free interval 8 days after the onset of symptoms. These observations indicate that even during banal infections sport exercise involving special strain on the abdominal musculature should not be undertaken because of the risk of rhabdomyolysis.


[Pseudoxanthoma elasticum. Clinically typical but frequently overlooked].

A 52-year-old man had small yellowish, striated or reticular papules since the age of 5 years. These appeared first on the large flexures, and later on the neck, abdomen, penis and the mucosa of the lips. He developed angina at the age of 47 years. A bypass operation, however, did not lead to complete regression of cardiac symptoms. Four years later, the vision in his right eye deteriorated because of arterial occlusion, and the patient was treated with laser coagulation; he was started on long-term treatment with acetylsalicylic acid (250 mg/d) and calcium dobesilate (1,500 mg/d). Despite this, the vision in his left eye also deteriorated progressively. Fundoscopy revealed bilateral pigmentary changes in the macular region, variations in the retinal arterial diameters and "angioid streaks". Pulses were absent in the right radial artery, the left posterior tibial artery and both dorsalis pedis arteries, but there were no trophic changes or symptoms. The serum total cholesterol (246 mg/dl), triglycerides (177 mg/dl) and LDL-cholesterol (193 mg/dl) were only slightly elevated. The diagnosis of pseudoxanthoma elasticum with typical changes in the elastic fibres was confirmed by elastin staining in a biopsy from one of the lesions.


[The dawn or Somogyi phenomenon? High morning fasting blood sugar values in young type-1 diabetics].

High blood sugar levels in the morning in juvenile type 1 diabetics may be caused by a Somogyi phenomenon (counter-regulation after nocturnal hypoglycaemia) or insulin resistance in the morning hours (dawn phenomenon). To enable differentiation between the two, 1,562 blood sugar profiles (24 h, 3 h, 6 h) were determined in 161 children and juveniles (74 boys, 87 girls; mean age 10.8 [1.0-19.7] years) with type 1 diabetes mellitus. In accordance with the mechanism of the dawn phenomenon there was a close positive correlation between the blood sugar levels in the night and morning (r = +0.696; P less than 0.0001); the mean fasting blood sugar level was about 60 mg/dl above the 3 h value. Low nocturnal blood sugar levels as a possible cause of a high morning blood sugar (greater than 250 mg/dl) was demonstrated in fewer than 1% of profiles. On the other hand, the probability of nocturnal hypoglycaemia rose exponentially in the presence of low morning fasting blood sugar levels. Thus, if the morning level was below 80 mg/dl, the blood sugar levels at 3 h was below 50 mg/dl in 41.2%. This indicates that high morning blood sugar levels result from the dawn phenomenon and require a higher evening dose of slow-release insulin. But if the morning blood sugar values are clearly below 100 mg/dl, the cause may be nocturnal low blood sugar levels and the evening insulin dose should, therefore, be reduced.


[Goiter epidemiology in South Tirol].

To ascertain the prevalence of goitre among schoolchildren in South Tyrol (uncontrolled voluntary iodine salt prophylaxis), the size of the thyroid gland was determined by palpation and ultrasound in 1,013 of 1,224 children, aged 6 to 14 years (547 boys, 466 girls), selected by statistically criteria. At the same time, to assess thyroid function, total and free fractions of T3 and T4, and TSH were measured, while iodine supply was determined by measuring urinary iodine. Stage Ia goitre was diagnosed by palpation in 157 children, stage Ib in 18 and stage II in two (goitre prevalence of 1.97% according to WHO criteria). Mean thyroid volume as determined by ultrasound was 4.26 (0.8-23.4) ml. As expected, it increased with age and body surface area: it was 2.55 +/- 0.49 ml in 6-year olds, 3.83 +/- 0.42 ml in 10-year olds and 6.42 +/- 0.69 ml in 14-year olds. Iodine excretion (143.8 [4.1-984.8] micrograms iodine/g creatinine) indicated adequate iodine supply to the tested subjects. South Tyrol is thus, according to WHO criteria, no longer an endemic goitre area. The voluntary use of iodinated cooking salt and changed food habits have probably effected this change in goitre epidemiology.


[Lemierre's syndrome with splenic abscesses].

A week after onset of a pharyngo-tonsillitis a previously healthy 23-year-old man developed high fever (41.4 degrees C), leukocytosis (12,200/microliters) with marked shift to the left, thrombocytopenia (86,000/microliters) and increased transaminases (GOT 83 U/l, GPT 113 U/l). Chest x-ray film suggested intrapulmonary abscesses with left-sided pleural effusion. The suspected diagnosis of "post-tonsillitis" septicaemia (Lemierre's syndrome) was confirmed by demonstrating anaerobic, fusiform, gram-negative bacteria (Fusobacterium nucleatum and necrophorum) in several blood cultures. Despite antibacterial treatment (amoxicillin/clavulanic acid, imipenem/cilastatin, clindamycin) he had recurrent pain referred to the kidney region and persisting fever. Repeated ultrasound and radiological examinations revealed new foci in the spleen, which were enlarging. Laparotomy with splenectomy performed on day 17 after the begin of treatment confirmed multiple splenic abscesses, but abscess pus and splenic tissue were sterile. After altogether 6 weeks of antibiotic treatment, finally with chloramphenicol, the patient was discharged in a good general state.


[Cardiac involvement in the hypereosinophilia syndrome. the importance of echocardiography in the follow-up].

A 51-year-old man and a 39-year-old woman with the hypereosinophilic syndrome developed a restrictive cardiomyopathy in the course of cardiac involvement. Echocardiography demonstrated typical thrombotic obliteration at the apex of both ventricles. Doppler ultrasound showed changes of impaired filling in both ventricles. Glucocorticoid treatment (prednisone, 85 mg daily) had to be drastically reduced (to 10 mg daily) in case 1, because of the development of a Cushing syndrome. The man died 18 months later of advanced heart failure. In the woman the eosinophil count fell after prednisone administration (1 mg/kg daily) and there was no recurrence. But heart failure due to impaired diastolic filling has persisted so that orthotopic cardiac transplantation has been planned.


[Recanalization of occluded coronary arteries using the Magnum system].

Recanalization procedures with the "Magnum" system were undertaken in 137 patients (113 men, 24 women; mean age 57.1 +/- 8.1 years) with complete occlusion of a coronary artery. The system consists of a 0.021 inch guidewire with a flexible 1 mm diameter olive tip, a double-lumen probing catheter and a Magnarail balloon catheter. Chronic coronary artery occlusion of maximally 3 months was present in 51 patients (37%), for over 3 months in 52 (38%), while the duration of occlusion was unknown in 18 (13%). An acute coronary occlusion was successfully recanalized in 7 patients (5%), while in 9 (7%) it was accomplished when it had occurred during or shortly after a percutaneous coronary artery angioplasty (PCTA). The occlusion was successfully passed in 87 patients (64%); in 15 of them recanalization with another system had failed. The highest success rates were obtained with an acute occlusion (5 of 7; 71%), occlusion of 3 months' duration or less (39 of 51; 76%), and occlusion during PTCA (8 of 9; 89%). The success rates were lower for occlusions over 3 months' duration (25 of 52; 48%; P < 0.05) and of unknown duration (10 of 18; 56%; n.s.). Recanalization after failed recanalization was successfully accomplished by rotation-angioplasty (n = 2) or a standard system (n = 4).--These results indicate that the Magnum system is suitable for recanalizing chronic or acute coronary occlusion. But cardiologists should be capable of using several systems to increase the chances of successful recanalization.


[Lactose intolerance in chronic inflammatory bowel diseases].

In 124 patients with Crohn's disease (69 women, 55 men; mean age 33.7 [11-66] years) and 53 with ulcerative colitis (30 women, 23 men; mean age 36.2 [19-74] years) the incidence of lactose intolerance, as measured by the H2 breath test and blood sugar concentration, was determined prospectively. To exclude abnormal bacterial colonization of the small intestine or rapid small-intestine transit after partial resection of the small intestine as a cause of lactose intolerance, the oro-caecal transit time for lactulose (H2 breath test) was measured. While 21 of 124 patients with Crohn's disease (16.9%) had the expected incidence of lactose intolerance, this was present in only 2 of 53 patients with ulcerative colitis (3.8%; P < 0.05). The lactose intolerance was independent of the site of any inflammatory changes, disease activity and extent of small-intestine resection. Oro-caecal transit time for lactose was similar for all patients. There was no lactose intolerance in two patients with abnormal small-intestinal bacterial colonization.--Because of their considerable diagnostic and prognostic significance, tests for lactose intolerance should be performed routinely in all cases of Crohn's disease or ulcerative colitis.


[Gustatory sweating demonstrated by infrared thermography].

A 35-year-old man, previously healthy except for a grade 1 goitre, sustained a spontaneous left pneumothorax treated with a Bülau drain. When the left pneumothorax recurred 2 months later a left thoracotomy was performed. Two bullae at the lung apex were resected and a pleurodesis performed. After the operation the patient noted hypaesthesia of the dorsum of the left upper arm, mild ptosis of the left eyelid as well as reduced sweat secretion over the left half of the face and the left rib cage. The hypaesthesia improved, but the sympathetic nerve deficits remained. There were no other neurological signs. 9 months later, within one minute of eating a sour apple, the patient developed severe sweating over the left half of the face and the left chest. The reaction was confirmed by infra-red thermography which proved that the skin temperature in the sweating region had fallen to 3 degrees C. The likely cause of localized gustatory sweating is intra-operative damage of the stellate ganglion or its preganglionic nerve connections. Treatment is limited to avoidance of the precipitating gustatory stimulus.


[Stress echocardiography as a routine examination in coronary heart disease].

The value of stress echocardiography in the routine diagnosis of coronary heart disease was assessed in 100 consecutive patients (22 women, 78 men; mean age 57 [32-83] years) scheduled for coronary angiography because of suspected angina. Exercise consisted of bicycle ergometry (n = 50), on the one hand, simulated exercise with transoesophageal atrial stimulation (n = 16), dipyridamole (n = 33) and dobutamine (n = 33) infusions, on the other. 91 patients were successfully tested by at least one of these procedures, while exercise electrocardiography was successfully employed in only 78 (P < 0.05). Stress echocardiography had a greater sensitivity than exercise electrocardiography (90% vs 78%) and specificity (90% vs 73%). Semiquantitative measurement of wall movement distinguished patients without functionally effective stenosis from those with single or multiple vessel disease (P < 0.001). Stress echocardiography thus makes it possible in most cases to demonstrate or exclude functionally significant coronary artery stenoses.


[The analysis of a severe side effect of a cartilage-protective agent by immunological studies].

After 18 intramuscular injections of Arumalon, a 62-year-old woman with degenerative hip-joint changes developed a severe illness with fever up to 39 degrees C, swellings of the finger, hand and knee joints, as well as a local skin rash and changes in the blood (WBC 1900/microliters, platelets 113,000/microliters), and increase in liver enzymes (GOT 83 U/l, GPT 93 U/l, lactate dehydrogenase 693 U/l). Arumalon, a glucosaminoglycan-peptide complex containing a watery extract of bovine cartilage and bone marrow, is used as a cartilage-protecting medication. The close temporal relationship between the injections and the symptoms suggested that the illness was drug-induced. This view was supported by a positive lymphocyte transformation test with Arumalon and its constituents, as well as by the demonstration of Arumalon-specific antibodies in the cultured lymphocyte fluid while the serum was negative for the antibodies. The illness took a protracted course. The patient became completely free of symptoms only after a year on a maintenance dose of prednisone, 15 mg daily. As a local inflammatory reaction was noted at the very start of the Arumalon injections, presensitization against the foreign proteins in Arumalon cannot be excluded. This is also supported by the fact that the specific lymphocyte proliferation was essentially unchanged even after nine months. This case illustrates the importance of careful assessment of increased and repeated manifestations of local reaction during Arumalon treatment, in particular in view of the risk of systemic side effects.


[The accidental aspiration and ingestion of petroleum in a "fire eater"].

A 26-year-old man, practicing for a variety performance as "fire-eater", accidentally inhaled and ingested about 10 ml petroleum. Soon afterwards he developed dyspnoea, an urge to cough, fever up to 39 degrees C and loss of retentiveness. He was treated as an out-patient with doxycycline, 100 mg daily, and aspirin, 500 mg three times daily. While this reduced the dyspnoea, the elevated temperature persisted and he had haemoptysis. Chest x-ray and computed tomography 12 days after the aspiration revealed areas of atelectasis and of liquefaction necroses. Bronchoscopic and cytological examinations showed eosinophilic alveolitis and mucosal necrosis in both main bronchi. The symptoms were improved by two inhalations of beclomethasone four times daily, and systemic treatment with prednisolone, 50 mg daily, together with parenteral antibiotic administration (cefotaxime, 1.0 g twice daily). The focal lung lesions regressed completely within a few weeks. Five months after the aspiration computed tomography merely demonstrated discrete scarring of the previously necrotic lesions. This case illustrates that, even with extensive necrotic lung changes after petroleum aspiration, conservative treatment is justified and likely to be effective.


[Abortions caused by protozoa in agricultural animals].

A review is given on abortions in livestock caused by Toxoplasma gondii, Neospora caninum and Sarcocystis spp. Special emphasis is put on diagnostic procedures. T. gondii is considered to be a major cause of abortions in sheep and goats. Diagnosis is based on the characteristic lesions in the cotyledons, histologic and immunohistochemical examination, and on the detection of specific antibodies in body fluids or serum of aborted fetuses. Whether abortions in swine due to T. gondii are of practical importance is still unclear. The most important causative protozoal agent of abortions in cattle is Neospora caninum. This protozoon was found in 19 per cent of cattle fetuses submitted for examination in USA. Occasionally it was found also in aborted lambs, kids and foals. Diagnosis is based on the histologic or immunohistochemical detection of the parasite. Abortions can be regularly induced experimentally in large and small ruminants and in pigs by the oral inoculation of sporocysts of certain Sarcocystis species. However, under natural conditions abortion due to Sarcocystis was diagnosed only occasionally and only in cattle and sheep. The histologic examination of the fetus and fetal membranes is the only way to diagnose Sarcocystis abortion or neonatal infection at present.


[The helminth fauna of red foxes (Vulpes vulpes Linnaeus 1758) in north Hesse and east Westphalia. 1. Cestodes].

Between November 1989 and June 1990 a total number of 397 foxes were examined for the presence of cestodes. The animals came from the districts of Arnsberg, Detmold and Kassel. In 16.4% of the foxes infections with Echinococcus multilocularis were found, in 28.5% Taenia crassiceps, in 14.4% Taenia polyacantha, in 4.3% Mesocestoides spp., in 3.3% Multiceps multiceps, in 2.5% Hydatigera taeniaeformis, in 0.8% Taenia hydatigena and in 0.3% Taenia martis. Infections with Echinococcus multilocularis very often showed high worm numbers of more than 1000 per fox. The number of worms for the other cestodes mostly varied between one and ten specimen per animal.


[Use of anthelmintics for nematode control in sheep in West Germany: results of a survey].

A survey by questionnaires was performed on 543 (0.9% of all) sheep flocks in western Germany in 1988/89 to obtain informations about deworming practices against gastrointestinal nematodes. The major informations are: Anthelmintic treatments were associated with the reproductive status of ewes and the breeding of lambs in most of the flocks. They were performed at an epidemiologically appropriate time in many cases but were not accompanied by essential management practices. (Pro)benzimidazole compounds were the anthelmintics most frequently used by more than 95% of the farmers; 22% and 13% of the farmers additionally or exclusively administered levamisole/pyrantel and ivermectin, respectively. On average, treatment of ewes and lambs against nematodes was performed 2.5 times and 2.8 times a year, respectively. The mean frequency of deworming differed regionally and was generally greater in pedigree breeding flocks than in commercial breeding flocks; it was significantly affected by the husbandry system, the number of ewes per flock, the size of available pasture and the class of anthelmintics employed. The results of this survey revealed that many German sheep farmers obviously lack an awareness of the rationale of preventive and economic control practices against gastrointestinal nematodes.


[Calcinogenic plants and the incubation effect of rumen fluid].

This paper describes incubation effects of rumen fluid on aqueous extracts of Trisetum flavescens, Solanum malacoxylon, Nierembergia veitchii, and Cestrum laevigatum. Investigation was performed by the rachitic chicken test, parameters determined were the serum levels of Ca, P, and alkaline phosphatase. Extracts of S. malacoxylon, and C. diurnum as well as 1,25(OH)2-VitD3-25-O-glucoside gave (without incubation) an increased activity, while with incubation a small additional effects could be observed. The extracts of T. flavescens and N. veitchii did not show any alteration with or without incubation. Comparable effects were obtained with 1,25(OH)2VitD3-1-O-glucoside, as well as 1,25(OH)2VitD3-3-O-glucoside.


[Viral agents as the cause of reproductive disorders in cattle and available vaccines].

After a review on the viral agents playing a role in diseases of cattle those related to the occurrence in the genital tract are described. They may be causing abortion or local reactions leading to a reduced fertility and/or be of importance for the embryo transfer. Bovine herpesvirus type 1 (BHV1) and the bovine virus diarrhoea virus (BVDV) are the agents most widely distributed in Europe. Both are of economic importance, described in detail and vaccines available discussed.


Studies concerning etiology of sheep-associated malignant catarrhal fever in Europe.

The etiological agent of sheep-associated malignant catarrhal fever (MCF) in Europe has not been isolated directly from sheep. The occurrence of antibodies against the African bovine herpesvirus (BHV-3, WC 11) in cattle and sheep was examined using recently modified indirect immunofluorescence test (IIFT) and neutralization test (NT) methods. Studies revealed that sheep and cattle sera in Europe were free from neutralizing antibodies of BHV-3. The IIFT could not establish the presence of antibodies to African BHV-3 in cattle but revealed that about 22.4% of sheep sera reacted to it. Apart from the well known ovine herpesvirus (BHV-5), occurrence of another herpesvirus in Europe had been expected. This virus is not identical with the WC 11 strain, but it is in antigenic relationship to it. We had for the first time substantial serological evidence to the effect that sheep-associated MCF in Europe is a herpesvirus related to the African strain.


[The relationship between bovine clinical mastitis at the time of parturition and retained placenta].

868 parturitions were examined to determine the relation between the clinical mastitis around partition and the loosening process of the placenta in the bovine. The occurrence of mastitis in heifers and cows around parturition was 18.7%. The frequency of retained placenta in animals with mastitis was significantly higher (p less than 0.01) than that in animals without mastitis influenced the loosening process of the afterbirth. The results support an hypothesis, that mastitis and retentio secundinarum can regard as signs of the decrease in the activity of the immune system.


Oligodendrocytes from jimpy and normal mature tissue can be 'activated' when transplanted in a newborn environment.

Fragments of corpus callosum from P13 normal and jimpy (jp) mutant mice (containing only postmigrating precursors and differentiated oligodendrocytes (ODCs, some of them myelinating soon) have been transplanted into the thalamus of newborn shiverer (shi) mutant mice. The behaviour of transplanted ODCs has been assayed by immunohistochemistry of their myelin basic protein (MBP)-positive myelin synthesized in the host shi brain whose myelin is deprived of this component. ODCs and postmigrating precursors contained in P13 normal corpus callosum survived, migrated out of the graft and myelinated in the shi host parenchyma. The high ratio of positive cases observed was comparable to the one observed in previous experiments using fragments of newborn or embryonic normal tissue. When fragments of jp tissue were used as donors, postmigrating jp ODCs or precursors migrated on long distances out of the graft and synthesized large amounts of myelin as estimated by the size of the MBP-positive myelin patches present in the host shi brain. The extent of migration and the size of these myelin patches were more important than those observed in previous experiments using fragments of newborn or embryonic jp CNS as donors. By contrast, the low ratio of positive cases observed suggested that the survival of P13 jp ODCs or their postmigrating precursors cannot be restored by the newborn shi environment.(ABSTRACT TRUNCATED AT 250 WORDS)


Functional capacities of transplanted cell-sorted adult oligodendrocytes.

Previous work has shown that transplanted dissociated glial cells derived from neonatal rats can myelinate areas of the myelin deficient (md) rat spinal cord. In the present studies we have examined the ability of adult glial cells, either as suspension of mixed glial cells or as 01 positive oligodendrocytes purified by cell sorting, to myelinate md rat axons following transplantation. Mixed glial cell preparations from adult rats myelinated large areas of either, dorsal, lateral or ventral columns. These areas contained clumped, transplanted oligodendrocytes. In addition, preparations containing over 90% 01 positive oligodendrocytes were also capable of myelinating large numbers of axons upon transplantation. These results suggest that adult oligodendrocytes may play an important role in remyelination of the adult CNS.


Co-transplantation of fetal or adult dorsal root ganglia and of autologous peripheral nerve segments to the adult rat spinal cord: extensive reinnervation of the grafted nerves by the transplanted DRG cells.

Intraspinal transplantation of embryonic neurons and of autologous peripheral nerve segments is an essential tool for studying plasticity and repair in the adult mammalian spinal cord. Unlike adult central nervous system neurons, adult dorsal root ganglion (DRG) cells can be cultured in vitro and are assumed to survive transplantation. In the present work, we have co-transplanted adult (and also fetal, for comparison) DRG and peripheral nerve autografts to the cervical spinal cord of the adult rat. Similar results were obtained from both series: fetal as well as adult DRG cells did survive transplantation and nearly half of them grew lengthy axons into the grafted nerves. A few of them were seen to express a calcitonin gene-related peptide. Possibilities of central afferentation as well as of peripheral connectivity of these transplanted neurons is under study.


Maturation and fine structure of thalamic reticular neurons transplanted into the adult rat CNS.

This work was undertaken to determine whether or not cell suspension transplants provide a promising vehicle for the in vivo study of neuronal development. Cell suspensions of rat fetal tissue that contained both reticular (RT) and ventrobasal primordia were transplanted into the excitotoxically lesioned somatosensory thalamus of adult rats. The fine structure of transplanted GABAergic RT neurons that were identified by immunocytochemistry was investigated 5 days to 7 months following transplantation. The dissociation and transplantation of the tissue results in disruption of the extracellular matrix and alteration of cellular interactions which could introduce major changes in neuronal maturation. Our results show that maturation of transplanted GABAergic RT neurons was comparable to normal and that they were able to establish and receive, with one exception, usual sets of connections. In contrast, disruption of the tissue was responsible for the definitive loss of organotypic characteristics and the emergence of abnormal connections, especially synaptic connections from somatosensory afferents, the functional significance of which will be important to determine.


Xenogenic transplantation into newborn rodent brain: neovascularization of the graft by the host.

Neoangiogenesis of transplants implanted into the brains of newborn rodent hosts was evaluated by immunohistochemistry for 2 weeks after the operation. The use of species-specific antibodies directed against mouse endothelial cells demonstrated the respective participation of the host and the donor in the formation of new vessels in the graft after crossed rabbit into mouse and mouse into rat transplantation experiments. We show that blood vessels made by host endothelial cells begin to penetrate the transplant 24 h after grafting, and cross it completely by 72 h. Simultaneously, host astrocytes invade the transplant.


New insight on the factors orienting the axonal outgrowth of grafted Purkinje cells in the pcd cerebellum.

Despite Purkinje cell replacement, leading to the repair of the cortical circuit of the pcd mouse cerebellum grafted with E12 cerebellar primordium, the reestablishment of the corticonuclear projection only occurs for some Purkinje cells and in a small percentage of grafted mice. In order to assess the importance of: (1) competition between host and grafted deep nuclei, and (2) the distance between the implants and the host deep nuclei, new grafted experiments have been performed. In the latter, solid grafts were taken from E13 or E14 donor embryos after removal of the region containing the postmitotic deep nuclear neurons, and randomly positioned at various cerebellar depths. With cortical implants, the absence of donor nuclear neurons is not sufficient to allow the axons of the grafted Purkinje cells that have invaded the host molecular layer to escape the confinement of this layer. The molecular/granular layer interface appears as an almost impassable obstacle, and the granule cell layer as a nonpermissive milieu. With grafts located between the host deep nuclei and the 4th ventricle (deep grafts), the grafted Purkinje cells project massively to the host nuclei, but they are unable to leave the implant and, therefore, they are not integrated in the deficient cortical circuit. Finally, when the grafts positioned in the central white matter (intermediate grafts) disrupt the integrity of the host granule cell layer, some of the grafted Purkinje cells invade the host molecular layer, while most of them remain within the implant. Some axons of the cortically integrated Purkinje cells, using the nearby graft as a bridge, seem able to innervate the host deep nuclei. The latter, in addition, receive a massive projection from the nonintegrated Purkinje cells. These results emphasize the ability of grafted Purkinje cells to specifically innervate their target host neurons, when either there is proximity, or when a permissive microenvironment for their axonal outgrowth is created by embryonic grafted cortical cerebellar neurons, filling the gap between the molecular layer and the deep nuclei of the host.


Raphe grafts in the hippocampus, but not in the entorhinal cortex, reverse hippocampal hyperexcitability of serotonin-depleted rats and restore their responsiveness to fenfluramine.

We compared the effects of embryonic raphe grafted into either the hippocampus or the entorhinal cortex, on the responsiveness of dentate granule cells to stimulation of the perforant path. Raphe grafts in the hippocampus reversed the hyperexcitability of granule cells, resulting from depletion of the serotonergic innervation. Such grafts also restored the responsiveness of the granule cells to application of a serotonin releasing drug, fenfluramine (FFA). In contrast, hyperexcitability was not reversed when the graft was placed in the entorhinal cortex. Furthermore, although some increase in population spike size was observed in these rats after application of FFA, this increase had a response profile which was different from that of control and of lesioned rats that were grafted in the hippocampus. These results suggest that the serotonergic innervation, within the hippocampus and not in the entorhinal cortex, modulates granule cells excitability.


The fate of Schwann cells transplanted in the brain during development.

Purified rat Schwann cells labeled with Hoechst 33342 fluorescent fluorochrome were transplanted into the brain of the newborn shiverer mouse. The grafted cells survived and were able to migrate through the host parenchyma. However, Schwann cell migration was restricted to the grafted hemisphere and to structures adjacent to the graft. With time, Hoechst labeled cells, present at the site of implantation or dispersed in the host parenchyma, decreased progressively in number. Instead, they concentrated along the blood vessels, meninges and ventricles. Despite the presence of Hoechst labeled Schwann cells in white matter tracks during the process of central myelination, Schwann cell myelination could not be evidenced by immunodetection of the peripheral myelin protein or by ultrastructural observation of the typical Schwann cell basement membrane surrounding peripheral myelin. A series of additional transplantations involving Schwann cells of mouse or rat origin, grafted either as cell suspensions or as nerve fragments, demonstrated that transplanted Schwann cells formed myelin around developing host axons only when included in a nerve fragment. Immunodetection of GFAP in astrocytes and type IV collagen in basement membranes as well as electron microscopy showed that reactive astrocytes invaded the grafted area after the first week of transplantation and sometimes formed basement membranes isolating partially the graft from the host parenchyma. During host myelination, astrocytes, which were present in most white matter structures, surrounded grafted cells. Occasionally, they enclosed Schwann cells in basement membranes or encircled host axons. Later, reactive astrocytes were associated with Schwann cells restricted to blood vessel and ventricular walls, and meninges. Our results suggest that in the presence of competitive developing oligodendrocytes, astrocytes are able to limit migration and prevent myelination of Schwann cells transplanted in the newborn shiverer brain. In addition, astrocytes seem to be able to expel the grafted cells and finally exclude them from the host parenchyma.


Type 1 astrocytes fail to inhibit Schwann cell remyelination of CNS axons in the absence of cells of the O-2A lineage.

The extent to which Schwann cells are able to remyelinate demyelinated CNS axons is influenced by the presence of astrocytes. In order to study further the nature of astrocyte control of Schwann cell remyelination in the CNS, cultures containing type 1 astrocytes and a small proportion of Schwann cells, but depleted of O-2A lineage cells by exposure to cytosine arabinoside and complement-mediated immunocytolysis, were transplanted into glial-free lesions in adult rat spinal cord in which the host response to demyelinated axons was suppressed by X-irradiation. Following transplantation of these O-2A lineage-depleted cultures into X-irradiated, demyelinating lesions, there was extensive remyelination of demyelinated axons by Schwann cells, a result which contrasted with those obtained from earlier experiments in which O-2A lineage cells were present within the transplant, and/or recruited from host tissue. This experiment shows that the presence of O-2A lineage cells is required in order for transplanted type 1 astrocytes to organise in a manner which inhibits extensive Schwann cell remyelination of CNS axons.


Transplantation of cultured premyelinating oligodendrocytes into normal and myelin-deficient rat brain.

Cultures of oligodendroglial cells at various stages of maturation, from progenitors to maturing oligodendrocytes, were prepared from neonatal rat brain primary cultures and then were prelabeled in the culture dish with the fluorescent dye, fast blue (FB). Single cell suspensions were grafted into normal or myelin-deficient rat brains. The normal as well as the myelin-deficient in vivo environment allowed cell survival, migration, and differentiation. The FB+ cells expressed the oligodendroglial markers, glycerol phosphate dehydrogenase, galactocerebroside, and myelin basic protein. In the normal rat transplanted cells were identifiable at all times studied up to 24 weeks. Extensive migration of FB+ cells was observed in whole-brain sagittal sections. Our results show that the plasticity of oligodendroglia differentiation, extensively studied in vitro, can now be investigated in the normal and myelin-deficient in vivo environment.


Pulse oximetry monitoring in patients with nasal packing.

Pulse oximetry is a safe, effective method of monitoring for hypoxia in patients with nasal packing. It provides continuous in vivo measurements of the patients' arterial oxygenation in a non-invasive fashion based on the principles of the hemoglobin dissociation curve.


The justifications and controversies of panendoscopy--a review.

The triple endoscopies of direct laryngoscopy, bronchoscopy, and esophagoscopy, commonly known as panendoscopy, are frequent surgical procedures in otorhinolaryngology. Their purpose is to diagnose additional primary malignancies. The incidence of multiple synchronous primary malignancies has been reported between 3% and 13%. This unusually high rate is attributed to the process of field cancerization in which an anatomical region is exposed to a surface carcinogen and multifocal areas undergo irreversible change to multifocal malignancies. The majority of additional malignancies are diagnosed within 2 years of the index tumor's diagnosis, and are most consistently diagnosed within routine panendoscopy. Nevertheless, a significant percentage (40%) of additional primary malignancies present after this time and consequently, long-term follow-up is essential to the timely diagnosis of metachronous lesions. The predominant controversies surrounding panendoscopy involve the comparable diagnostic efficacies between endoscopic procedures and various radiologic studies. Although the operative complications reported for panendoscopy have been minimal, the expense is considerably greater than that of the respective radiologic alternatives. After a critical review of the literature, the use of endoscopy has been found to be superior to CXRs and barium swallows as the principal means of diagnosis of upper aerodigestive tract cancers. Specifically, bronchoscopy with bronchial washings should be obtained via passage of the bronchoscope through the endotracheal tube in order to decrease contamination. Positive washings are significant and demand further evaluation. Negative washings, on the other hand, yield little information.(ABSTRACT TRUNCATED AT 250 WORDS)


Autograft tragal and conchal palisade cartilage and perichondrium in tympanomastoid reconstruction.

Since Utech's introduction of cartilage as a columella in ear surgery in 1969, we have used tragal and conchal autografts for reconstruction of the tympanic membrane and the auditory canal wall in 13,000 cases. As large pieces of cartilage can twist in later years, we place palisaded cartilage fragments with perichondrium parallel to the manubrium of the malleus in type I tympanoplasties and in type II or III procedures parallel to the long process of the incus. The "annulus-stapes plate" in type III tympanoplasties replaces the function of the incus (and malleus), crossing the promontory and reducing adhesions. A "tunnelplasty" keeps the eustachian tube entrance open with the semiring of cartilage ("simmering") apposed to the inside of the annulus, reconstructing the tympanomeatal niche. The "architrave" created rests on the tensor tympani while the palisaded epitympanum and antrum plasty allows ventilation of the antrum. Mastoid obliteration is performed with an autogenous perichondrial transplant to which the palisaded incised cartilage portions adhere, adapting to the underlying structure.


Malignant thyroid lymphoma presenting as acute airway obstruction.

Malignant thyroid lymphoma is an uncommon form of thyroid cancer which most commonly presents in elderly women. Most patients demonstrate a rapidly enlarging mass and may show tracheal deviation on chest roentgenogram. Radioisotopic scanning of the thyroid often demonstrates a "cold" or "cool" process of decreased uptake in the affected area. There is often an underlying lymphocytic thyroiditis process noted. Unfavorable prognosis is related to extracapsular extension, blood vessel wall infiltration, diffuse architectural pattern, and cervical lymph node involvement. We present two unusual cases of thyroid lymphoma presenting with acute airway obstruction and review the literature concerning this subject. One case presented a clinical and radiographic appearance similar to a prevertebral space abscess.


Actinomycosis of the larynx.

Actinomycosis of the larynx is rare. Only seven cases have been reported in the literature. We report a case of actinomycosis of the larynx in a 63-year-old male following radiation therapy for laryngeal carcinoma. The diagnosis of actinomycosis can be made with a biopsy. It is important to distinguish infection from radionecrosis and recurrent carcinoma. Treatment consists of airway control and a prolonged course of antibiotics.


Chondritis of the burned ear: a review.

Seventy-six patients with burns of the ears presented to the Western Pennsylvania Hospital Burn Trauma Center over a three year period. To prevent chondritis, all ears were treated prophylactically with periauricular hair shaving, daily cleaning, avoidance of pressure dressings and Sulfamylon Burn Cream. Chondritis developed in two patients. Aspects of auricular chondritis prevention and treatment are reviewed. Biology of the disease is discussed.


Sexual abuse of children as seen at Kenyatta National Hospital.

A retrospective study of 21 sexually abused children admitted to the Kenyatta National Hospital, Nairobi, Kenya, between January 1984 and December 1985 is presented. The peak incidence of sexual abuse was in the age group of 10-15 years (38.1%) followed by the 5-9 years age group (28.6%). Strangers and people familiar to the child were equally implicated as assailants. Fourteen out of the twenty one (66.7%) victims, presented with injuries ranging from perineal tears (19%), vaginal tears (19%), recto-vaginal fistulae (RVP) (4.8%) and vesico-vaginal-fistulae (VVF) and abdominal haematoma (4.8%). The victims presented to hospital within two days of the event usually accompanied by their mothers.


Unintended conception and unwanted fertility in Gondar, Ethiopia.

This is a report on unintended conception and unwanted fertility in Gondar, Northwestern Ethiopia. The purpose of the study was to explore the extent of the problem and to inquire whether there is a need for fertility regulation. To this end, relatively numerous questions on reproductive history of women aged 15-49 have been raised. Results showed that the proportion of abortion to delivery was 0.3984 to 0.6016 and the ratio of unintended conception to intended conception was 0.4043 to 0.5957. The proportion of unwanted fertility to wanted was 0.4099 to 0.5901. Mean desired interpregnancy interval was substantially higher than actual interpregnancy interval. The relatively high rate of abortion, high proportion of unintended conception and unwanted fertility combined with the wide difference between desired interpregnancy interval and current interpregnancy interval all point to the need for a policy that increases the capacity to regulate fertility.


Neonatal morbidity and mortality at Kenyatta National Hospital newborn unit.

A six month prospective study of neonatal morbidity and mortality of the newborn unit (NBU) at Kenyatta National Hospital is presented. Of the 126 infants delivered in the maternity unit, 967 (30%) ended up in the NBU and 562 (59.8%) were low birth weight (LBW); 79.3% were appropriate for gestational age (AGA), 19.9% were small for gestational age (SGA) while 1.8% were large for gestational age (LGA). The infants with birth weight of < 1500 g and gestation < 32 weeks had the worst prognosis with a mortality of 51.3% and 64.6% respectively. The major causes of morbidity and mortality were immaturity, respiratory distress, infections and perinatal asphyxia. The majority of the deaths (86.8%) occurred within the first week of life. The overall neonatal mortality for this period was 24.6%, but 95.6% of the deaths were preterm while LBW in general contributed to 93.5% of the deaths.


Sickle cell leg ulcers in Ghana.

Twenty five (17 male, 8 Female) sickle cell disease patients with 30 leg ulcers were studied over a 3 year period (January 1985 to December 1987) to provide information on the pathogenesis, course and management. There were 23 patients with homozygous sickle cell and 2 patients with sickle cell haemoglobin C disease. The mean age was 28 years (range 15-44 years). An antecedent history of trauma was obtained in 40% of the patients and 96% had a previous history of leg ulcer. The major site affected (93%) was the skin around the malleoli. In 68% of the patients a single organism was isolated and the commonest bacteria were Pseudomonas species, Staphylococcus aureus, Proteus species and B haemolytic streptococci. The major complications encountered were equinovarus deformity (36%) and chronic periosteitis (32%). The main topical antimicrobial used was Eusol either alone (52%) or in combination with Metronidazole (32%) or honey (12%). Complete healing occurred in 40% of patients, partial healing with deterioration in 16% and no significant change in 44%. Admission and bed rest were the best determinants of complete healing of the chronic ulcers.


Psychosocial effects of sickle cell disease among adolescents.

One hundred and thirty eight adolescents with Sickle Cell Disease responded to a semi-structured questionnaire with respect to their attitudes to Sickle Cell Disease. Bone pain was the most frequent reason for admission into the hospital. Those who had more than three hospital admission for either bone pain, blood transfusion or infection saw themselves as unhappy people. A sense of shame in public, inability to play games of their choice, fear of dying young, and fear of not achieving their goals in life were reasons given for unhappiness. Majority of them appreciated that their parents were concerned about their plight. The need for further research in the area of the attitudes of sicklers is discussed.


Protozoan infections and HIV-1 infection: a review.

Reactivation of latent infection is the principal mechanism relating Toxoplasma gondii and Pneumocystis carinii to HIV. Less common is reactivation in Leishmania donovani, Trypanosoma cruzi, and microsporidian infections. An impaired primary immune response occurs in all these infections, and also with Cryptosporidium and Isospora belli. Association of HIV infection with gut parasites including Giardia lamblia and Entamoeba histolytica, and also with Trichomonas vaginalis infection is likely to be related to sexual modes of contact that favour both HIV and the parasite. The severity of malaria is not definitely associated with HIV, but Plasmodium falciparum infection may favour more rapid evolution of the HIV infection. Both malaria and trichomoniasis favour HIV transmission; the former by necessitating blood transfusion, and the latter by enhancing viral transmission during sexual contact.


Guided dilatation of urethral strictures.

Ten patients with pinhole urethral strictures were treated by introducing a flexible guide wire endoscopically through the stricture then passing flexible hollow dilators over the wire across the stricture. The procedure was successful in 9 out of 10 patients. It inflicts minimal trauma to the urethra and is recommended as a practical substitute for optical urethrotomy where the latter is not available.


Stroke at the prime of life: a study of Nigerian Africans between the ages of 16 and 45 years.

Sixty-seven patients (27.9%) between 16 and 45 years, out of 240 cases of stroke seen over 33 months were further studied with respect to stroke type, aetiological and social factors. The frequency of non-embolic cerebral infarction was 58.2%, cerebral embolism 7.5%; cerebral haemorrhage 17.9%; primary subarachnoid haemorrhage 11.9%. Hypertension was the commonest aetiological factor occurring in 35.8% of the cases. Cervical spine hyperflexion, stenosing carotid arteritis, cocaine ingestion, mitral valve prolapse, non-valvular atrial fibrillation and chorion cancer featured among other less frequent but important factors presenting different diagnostic problems. The frequency of unexplained stroke was under 12%. The authors suggest that previously encountered cervical spine trauma among young stroke cases represent underreporting and that the relationship between young age, grand-multiparity and non-valvular atrial fibrillation be further elucidated.


Management of shoulder dystocia.

Shoulder dystocia is a rare obstetric emergency with which few clinicians have adequate experience. A case which was successfully managed is presented and current management procedures reviewed.


The bacteriology of chronic suppurative otitis media.

Specimens obtained directly from the middle ear under direct vision from 40 patients with chronic suppurative otitis media (CSOM) were investigated quantitatively and qualitatively for aerobes and anaerobes. Twenty one of the 40 specimens yielded aerobes only, 17 yielded a mixed flora of anaerobes and aerobes while only one yielded anaerobes only and the remaining one was sterile. Bacteroides fragilis was the commonest anaerobe and the second single most common bacteria generally present in CSOM. Pseudomonas aeruginosa and Staphylococcus aureus were the dominant aerobic flora appearing in 17 and 14 out of 40 specimens respectively. All pathogens isolated were present in very high counts averaging 10(8) ml of the exudate. The use of systemic anti-anaerobic drug combined with an anti-aerobic drug is worthy of a clinical trial.


Treatment of symptomatic trichomoniasis among adult women using oral nitroimidazoles.

Successful treatment of infections with Trichomonas vaginalis (TV) is difficult because of many confounding factors such as poor abstinence from sex during chemotherapy, lack of standardised chemotherapy, difficulties in understanding transmission patterns and low detection rates among infected individuals. The purpose of this study was to establish the present efficacy of the available drugs at their recommended single or double dosages for Kenya. Adult symptomatic females (age 17-39 years) with positive High Vaginal Swabs but without pregnancy were recruited into the study; and asked to swallow one of the following medicine: nimorazole 2G (Naxogin Farmitalia Carlo Erba, Italy), nimorazole 4G in two equally divided doses 24 hours apart (2GBD), nimorazole 3G, tinidazole 2G (Fasigyn, Pfizer Ltd) and ornidazole 1.5G (Tiberal, Roche, Switzerland). All patients were reviewed 48 hours after the drugs administration and 24 hours after the last dose for the group which received nimorazole 2GBD. 153 patients were recruited into the study. 121 came for follow up out of which 49 were dropped from the study for involvement in sexual intercourse leaving only 72 for the final analysis. Clinical cure was 100% for the group receiving nimorazole 2GBD and nimorazole 3G. Parasitological cure was highest for the group on nimorazole 2GBD (100%) and lowest for the group on tinidazole (50%). Instruction to avoid sex during treatment were withheld from patients. This made it easier during the follow up to pick out and drop from the study those who had had sexual contact.


Diagnosis doubtful: a ten year old follow-up.

In a period of one-year, 81 (1.7%) of the patients admitted to a Neuro-Psychiatric Hospital, Aro, Abeokuta, were discharged undiagnosed. These patients were followed up during a 10 year period and sixty-two were ultimately diagnosed while 19 remained undiagnosed. Sixty-one patients of similar age and sex, treated at hospital during the same period who had a definite diagnosis were studied. Comparison of the clinical features of the two groups showed the absence of nuclear symptoms amongst the study schizophrenics compared with the controls. Among the depressives, the prominence of physical symptoms and agitation differentiated the study group from the controls. Out of the 19 patients who remained undiagnosed, 42.1% could not be traced, and 10.5% had become schizophrenic, and three patients (15%) had died. Review of the clinical features at the initial presentation showed that 29 (72.5%) out of the 40 initially undiagnosed schizophrenics could be placed in the diagnostic category using ICD9 criteria.


Acetylation status using hydralazine in African hypertensives at Kenyatta National Hospital.

In this study, the investigation of hydralazine acetylator phenotype was undertaken for the first time in African hypertensives at Kenyatta National Hospital. A total of 25 randomly selected patients with moderate to severe hypertension (diastolic pressure 105-130 mmHg), participated in the phenotyping study. The phenotyping was done by administering oral standard hydralazine dose of 150 mg/day in three divided doses. The 24 hour urinary MTP/hydralazine ratio was used to categorize patients into slow and fast acetylators. Of the patients studied 69.9% were slow acetylators while 30.4% were fast acetylators. The mean 24 hour urinary MTP/hydralazine ratio for slow acetylators was 1.01 +/- 0.95. This was significantly different from the fast acetylators where the mean 24 hour urinary MTP/hydralazine ratio was 10.6 +/- 4.4 (P < 0.001). The acetylator phenotyping divided the patients into two distinct populations and no further arbitrary method was required to divide the patients into either group.


Hemifacial pain and headache in gasseroma.

A case of severe disabling hemofacial pain in a Tanzanian African caused by gasseroma which was successfully removed is presented and the nature of the illness outlined. Intractable ticdouloureux is mainly due to vascular compression on the fifth cranial nerve or secondary to conditions to the nerve. Diagnosis of gasseroma is mainly by clinical history and examination.


The effect of protein energy malnutrition on morbidity and mortality due to measles at Kenyatta National Hospital, Nairobi (Kenya).

In a study of 7,631 cases referred to the infectious diseases hospital, Nairobi with a diagnosis of measles, 7,447 cases had the diagnosis confirmed. The overall mortality was 17.5 per 1000 cases with 43.51 of all the deaths occurring in all children less than 12 months of age. A nutritional analysis revealed that children whose weight were below 80 of the Harvard median of weight for age stayed in hospital longest and had the highest mortality rate. Measles continues to offer increasing challenge in spite of the intensive vaccination programme presently being carried out.


Severe measles outbreak in western Kenya.

During a measles outbreak investigation in Siaya district clustering of many measles cases were found to be an important determinant for measles mortality. A high proportion of cases were under one year of age. Case fatality rates were higher than previously reported from Kenya, particularly among infants. Vaccine efficacy was 18%. Alternative ways of protecting infants are discussed.


Hunger and malnutrition: the determinant of development: the case for Africa and its food and nutrition workers.

Hunger and malnutrition in Africa have been on the increase since 1960's reaching a climax in the 1980's when over 150 million people were affected by one form or another. Methods so far used to solve the problem do not seem to succeed, but the scientists and leaders in Africa could now take the opportunity to consider and act on the problem in their own way. The formation of an African food and nutrition group to work with others on the problems, could give an impetus to this kind of initiative. A call is made to all African food and nutrition workers to combine efforts to harness Africa resources, which have not been fully utilized in solving the problem.


Plasma biochemical parameters in Nigerian children with protein energy malnutrition.

Eleven plasma biochemical parameters were estimated in a total of 28 children with protein-energy malnutrition (PEM): 7 children each category of marasmus, kwashiorkor, marasmic-kwashiorkor and undernutrition with ages between 8 and 48 months. The estimations were performed on admission and 8 to 24 days after treatment at the Obafemi Awolowo University Teaching Hospitals Complex, Nigeria. Plasma sodium, potassium, chloride, bicarbonate and albumin levels were significantly (p < 0.05) higher after treatment than on admission. Calcium however, showed no significant change. Total protein and cholesterol were significantly (p < 0.05) raised after treatment for all the PEM types except undernutrition and kwashiorkor respectively. Globulin, urea and creatinine were significantly (p < 0.05) raised after treatment for kwashiorkor. These biochemical findings support the claims of clinical improvement in PEM children after a minimum of 18 days of treatment at the OAUTHC in Nigeria.


Nosocomial bacterial infections among children with severe protein energy malnutrition.

The incidence of hospital acquired acute bacterial infections among 164 severely malnourished children admitted to the paediatric wards at the Muhimbili Medical Centre in Dar es Salaam were studied. On admission, ninety two per cent of the patients had at least one form of bacterial infection. During the subsequent two weeks hospital stay, 49% of the patients acquired a new infection. Septicaemia and urinary tract infection (UTI) were the commonest infections. Staphylococcus aureus was the commonest organism in the former, while gram negative organisms, Escherichia coli and Klebsiella species, were predominant in the latter. Pathogens similar to those found from patients were cultured from random samples taken from the floor, beds, towels, sinks and antiseptic containers in the wards. Sensitivity patterns of isolated pathogens to antimicrobial agents showed that S. aureus was highly sensitive to cloxacillin, erythromycin, and gentamicin, while the gram negative organisms were highly sensitive to gentamicin. Our study shows that the problem of nosocomial infection in paediatric wards requires urgent attention. There is a need to institute preventive measures including provision of proper nursing care, maintenance of sterile environment, and reduction of duration of hospital stay.


Comparative aetiology of childhood diarrhoea in Kakamega and Kiambu Districts, Kenya.

Two hundred diarrhoea specimens collected during January to February 1988, from rural children aged 0 to 60 months in Kakamega District were examined for bacteria, parasites and rotavirus. The results were compared with a sample of 184 diarrhoea specimens matched for month of collection, taken from data collected in the same manner from children in Kiambu District. The mean ages of children in the 2 samples did not differ significantly. There were significant differences in the prevalence of specific potential pathogens isolated in the 2 areas. Notably, A. lumbricoides and rotavirus were more common in Kakamega, while G. lamblia, Entamoeba histolytica, Trichomonas hominis, Cryptosporidium sp., Hymenolepis nana and EPEC were more common in Kiambu. There was no difference with respect to prevalence of Campylobacter sp. or Blastocystis hominis. Factors which were probably important in determining aetiological differences included climate, water sources, animal contact and crowding. The differences highlight the fact that general predictions about aetiology cannot be made from isolated studies.


Viral hepatitis in pregnancy.

Fifty pregnant women with viral hepatitis were compared with 31 non-pregnant women with viral hepatitis in a prospective case-control study. The two groups were matching except for the serum bilirubin level and area of residence. Seven pregnant women died while none of the control patients died and the difference between the two groups was significant. More than 80% of the deaths occurred in the third trimester and most of them were post-partum deaths. Except for a higher incidence of pre-term birth, the outcome of pregnancy in the case group was not affected. It is concluded that pregnancy is a risk factor which increases the mortality of viral hepatitis and that viral hepatitis does not affect the outcome of pregnancy except for pre-term birth.


Sickness absenteeism in a Nigerian teaching hospital.

The sickness absence records of employees in a University Teaching Hospital in Nigeria were examined over a period of three years. The health records of the hospital workers showed a preponderance of junior and intermediate workers. An overall proportion of absentee workers was 15.8% with an average of 3 spells of sickness per year per absentee while the duration of sickness per absentee was 5.6 days per year. The younger employees less than 35 years of age and those with short duration of employment with the hospital have significantly higher spells and duration of sickness absence than others. While a lower spell of sickness and duration of sickness absence were observed among nurses, senior employees especially doctors had no records of sickness absenteeism in any of the 3 years of study.


Clinical and pathological features of ovarian tumours in Rivers state of Nigeria.

The pattern and clinical features of 45 ovarian tumours seen in a Southern Nigeria hospital between 1984 and 1987 were examined. The results indicate that germ cell tumours are relatively more common in this part of Nigeria than in North America and Europe. A reduced incidence of surface epithelial tumours was also observed. Most patients with either benign or malignant tumours were less than 40 years old. Two of the five tumours associated with pregnancy were malignant. The ratio of benign to malignant tumours, presenting complaints of the patients and the late stage of most malignant tumours at the time of diagnosis were consistent with what has been observed in other parts of the world.


Histological subtypes of non-Hodgkin's malignant lymphoma in Ibadan.

Immunohistologic analysis of 100 consecutive cases of non-Hodgkin's lymphomas (NHLs) from the Pathology Department of the University College Hospital, Ibadan, show that the majority (75%) of the NHLs are of B-cell origin. The high grade tumours constitute the bulk of these tumours with a paucity of follicular lymphomas. Low-grade lympho-plasmacytic/cytoid lymphomas are not uncommon. The possible role of the overstimulation of the B-cell immune system in the aetiopathogenesis of the B-cell NHL is highlighted. Further detailed studies to find out potential infective aetiological factors in the development of high grade B-cell lymphomas in the environment is suggested.


Tuberculosis in a rural hospital in northern Kenya.

A 9-year survey on tuberculosis control at Sololo General Hospital (Marsabit District) is presented. 700 patients were treated and followed up from 1982 to 1990. The paper deals with the major constraints of TB control in a nomadic population on the borderland with Ethiopia; it highlights the need of the short course regimen and the TB manyatta programme to increase the percentage of cured patients.


Gonorrhoea neurosis.

In two years of clinical practice, the authors saw 47 cases of gonorrhoea of strictly psychological origin--25 patients with anxiety neurosis, 10 with hypochondriasis, 7 with depression, and 5 with paranoid reaction, 25 with impotence initially presented for surgical opinion rather than psychiatric assessment. Socio-demographic factors and 4 clinical details are given, including possible related factors, course, treatment and outcome. Liaison between the veneorologists, surgeons and psychiatrists is strongly advocated.


Exercise-induced asthma (EIA) after walking: a case report.

A case in which exercise-induced asthma (EIA) was provoked at an intensity of less than 100 beats/min is discussed. EIA was provoked by a 12-minute walk test. Earlier tests using walking on other subjects had not produced such a result. It is therefore vital to teach asthmatics to monitor their pulmonary response at regular intervals to avert serious attacks in activities of daily living.


Concurrent adenocarcinoma of the colon and chronic intestinal parasitoses: a case report.

A 25-year-old patient presented with recurrent bloody diarrhoea associated with intestinal parasitoses. Radiography and tissue histology confirmed the diagnosis of an annular colonic adenocarcinoma. The incidence and management of colonic malignancy in young Africans is discussed in the light of its described associationship with protozoal/helminthic parasitoses.


Training in perinatal care--management of patients in labour.

Training in perinatal care involves many different areas, and care around the time of labour forms a core part of training. Our senior residency programme involves 6 months supervised work in the labour ward. During this period, management of spontaneous, induced and augmented labour, methods of fetal monitoring and pain relief are taught. A log book and a check list are maintained to ensure the necessary manipulative and operative obstetric procedures have been followed. Limited scanning experience is provided to enable management of emergencies such as APH, multiple pregnancies, etc. Preparation and presentation of monthly statistics become a responsibility. Daily neonatal ward rounds are performed so that neonatal morbidity in relation to obstetric events are correlated. This exercise provides adequate knowledge to prognosticate and counsel patients whose babies are low birthweight or have malformations. Two to three new research projects are entrusted to trainees in order to acquire skills in writing research protocols, applications for research grants and later to enter research and write manuscripts. Discussion regarding research, working protocols and management problems are carried out after the daily ward rounds. Relevant reference papers or chapters are read, discussed and compiled in a file for further reading and for the benefit of other residents in training. This posting is followed or preceded by 6 months posting in ultrasound, high risk, medical disorder, diabetic and endocrine clinics. They also manage the antenatal and postnatal wards during these 6 months. At the end of 1 year training those interested in fetomaternal medicine do a further 2 years training in these areas at an advanced level.


Postgraduate education in ultrasound diagnosis in obstetrics and gynaecology in Sweden.

The Swedish Society of Obstetrics and Gynaecology has set up principles for systematic postgraduate education in ultrasonography in obstetrics and gynaecology. The education is available at three levels: (1) a basic course; (2) an advanced course; and (3) special courses. The subjects included in each course are described. It is expected that this programme of formal education will lead to improvement in the Swedish gynaecologists' knowledge of ultrasonography.


Care in early pregnancy.

This century has seen marked improvement in perinatal outcomes but prematurity remains a problem the world over. To improve these results requires more attention to early pregnancy or even pre-pregnancy care. Control of pre-existing conditions, improved social behavior in nutrition, smoking cessation and other factors are discussed.


Significance of chorioamnionitis.

In preterm deliveries, we have reported a high incidence (30-50%) of histologic chorioamnionitis (CAM) in the placenta. There is little evidence about the effects of CAM on preterm infants. We investigated the levels of complements and cytokines in the cord blood, the pathological nature of the placenta, the L/S ratio of gastric and tracheal aspirate of each preterm infant at birth, and assessed the biological effects of CAM on them. CAM stimulates the immunological system by cytokine production (IL6 and IL8) and complement activation in the fetus. It has been suggested that CAM may be one of the factor accelerating fetal maturation of the immunological system such as complement activation and immunoglobulin production, and of surfactant synthesis in the lung. On the contrary, CAM may damage the structures along the lining cells in the airway by accumulating polymorphonuclear cells of the infants with Wilson-Mikity syndrome.


Perinatal viral infections.

Among the TORCH agents, the occurrence of rubella and human T-lymphotropic virus type 1 (HTLV-1) in Japan were studied. Rubella epidemics occurred throughout Japan from 1964 to 1969 and from 1975 to 1979. Low prevalences of CRS were observed in northeastern Japan, and high prevalences in southwestern Japan, with the highest in Okinawa. These conditions could be explained by the lower rate of rubella H1 antibody in the female population of southwestern Japan. Time of maternal rubella was in the gestational age interval from 26 to 57 days for cataract, from 25 to 62 days for heart disease and from 16 to 131 days for deafness. HTLV-1 is the causative agent of adult T-cell leukemia. Main route of transmission of this virus is mother-to-child transmission, through breast milk. Among the 311 mother-child pairs in Okinawa, 65 mothers (20.9%) and 10 children (3.2%) were seropositive for HTLV-1. Ten (15.4%) of the 65 seropositive mothers had seropositive children. These children had acquired their HTLV-1 antibodies by the age of 3 years. A significant difference existed between the prevalence rate of HTLV-1 antibodies in mothers and children.


Immunotherapy in perinatal infection.

Though intravenous immunoglobulin (IVIG) have been shown to be beneficial in the treatment of some perinatal viral infections like varicella and possibly cytomegalovirus. The main thrust of interest has been directed towards the prevention and treatment of perinatal bacterial infections. This paper reviews literature published thus far (October 1991) on the use of IVIG in perinatal sepsis.


The training of a neonatologist.

A neonatologist must acquire the basic knowledge of a perinatologist through training in a perinatal centre with close obstetric collaboration. As a clinician, he/she must acquire competence in the medical care of critically-ill neonates through 3 years of neonatal experience following general paediatric training. As an administrator, skills are required in nursery management, regional planning, audit and follow-up of high-risk survivors. Skills are required as an educator for medical/nursing staff and the community. Training as a researcher enables appreciation of perinatal research and appropriate application of scientific advances to clinical practice. He/she must become a person who cares, able to understand psychosocial and ethical issues in neonatology.