[Unsustained ventricular tachycardia and accelerated idioventricular rhythm--clinical and electrocardiographic features].

To compare clinical and electrocardiographic characteristics of Nonsustained Ventricular Tachycardia (NSVT) and Idioventricular Accelerated Rhythm (IVAR). We studied 155 patients, 113 men and 42 women, with mean age 54 +/- 14 retrospectively, of these, 108 had NSVT and 47 IVAR. The arrhythmias were defined as follows: NSVT-more than 3 ventricular consecutive beats with an heart rate superior to 110 b/m and lasting less than 30 s.; IVAR-3 or more ventricular consecutive beats with an heart rate equal or superior to 50 and lower than 110 b/m, lasting less than 30 s. We evaluated clinical data (symptoms, functional class and anti-arrhythmic therapy), electrocardiographic data (rhythm, changes in conduction and repolarization) and ventricular function (with ECO, Radionuclide Angiography or Ventriculography). In the Holter recording (ECG-H), we analysed the presence of associated ventricular arrhythmias, their electrocardiographic characteristics (number of episodes, number of beats per episode, previous arrhythmia rate, morfology, regularity) and the relations of the arrhythmia with symptoms. Analysis of underlying pathology showed in both groups, the importance of coronary artery disease (44.5% vs 40%) followed by valvular heart disease (24% vs 27.6%) and cardiomyopathy (22.2% vs 17%) respectively to NSVT and IVAR. Only in the NSVT group there were patients without cardiac pathology (3.6%). Comparing with one control group of our department, this distribution was substantially different (p less than 0.0001). All IVAR episodes were assympthomatic compared with 90% of NSVT. Ventricular premature beats were found in all NSVT patients and in 90% of IVAR patients, and were frequent (greater than 10/h) in 79% and 60%, couplets in 84% and 53% respectively (ns). The previous rate of the arrhythmia was 85.3 +/- 20 b/m in NSVT against 68.7 +/- 14 in IVAR (p less than 0.0001). We found left ventricular disfunction in 60% of NSVT patients and in 63.7% in IVAR patients, being serious in 35% and 39% respectively. The follow-up was of 18.5 months (1-72) and posterior evolution showed 14.8% and 17% of deaths with no relation to the arrhythmia, although in NSVT the number of complexes and episodes were related with the ventricular disfunction (p = 0.02 and p = 0.05). Both arrhythmias appeared in patients with similar clinical and arrhythmic setting and identified a population with structural cardiopathy, bad function and poor outcome.


[Young men's views on health and health promotion].

The purpose of the research was to describe views on health and health promotion of young men. A survey was made of a sample of 150 selected from a group of men aged under 30 years whose employment placed them within the scope of the government service occupational health scheme. The results presented here are derived from a questionnaire that had a response rate of 70%. The results show that these men had a broad outlook on matters of health as a whole. An open question was used to elicit views on health. Almost all the subjects mentioned physical and psychological well-being. The major factor the observation of healthy living habits was adequate, properly internalized information. The most important motive for healthy living habits was their current well-being. The research provides information for the development of health education within the scope of the government service occupational health scheme.


[Transesophageal echocardiography. Experience at the Pulido Valente Hospital (the first 50 cases)].

The use of echocardiography is increasingly important in the evaluation of cardiac patients. The results of the First fifty examinations of the Department of cardiology (Hospital de Pulido Valente). We evaluate the contribution of the T-E-E on the therapeutic decisions of these patients. The clinical condition for which T-E-E were particularly appropriate were: embolism detection, evaluation of Mitral valvular regurgitation and prosthetic function, detection of vegetations in patients with suspicion of bacterial endocarditis, detection of intracardiac shunts. The examines were conclusive in 88% of the patients.


[Job stress and well-being of care providers: development of a standardized survey instrument].

The main aim was to develop a standardized survey instrument for measuring job stress and well-being in hospital settings. The actual study group consisted of 349 workers from medical bed wards, first aid unit wards and bed wards for gynecology and obstetrics in a middle-sized hospital in the Helsinki region. Based on the factor analysis of separate questions, the following content areas were chosen for the job stressor scales: haste at work, problems in interpersonal relations at work, problems in occupational collaboration with others, too much responsibility, safety and health risks, lack of appreciation, troublesome patients, and lack of equipment and resources. Content areas for well-being scales and items were general job satisfaction, strain symptoms, perceived mental and physical work load. The reference values of the questionnaire and reliabilities for the scales were calculated. The application and further development of the questionnaire was discussed.


[Knowledge and skills of newly graduated nurses].

Nursing education was recently reformed in Finland. By now nurses who have graduated from the new programmes have already entered nursing practice. The purpose of this study is to describe the following two aspects: 1) How do the newly graduated nurses assess their own skills and knowledge on completion of their nursing studies and what is their assessment four months later? 2) What skills and knowledge did the nurse managers expect the nurses to have and what, in fact, did they discover when the new nurses began their work in practice? The data were collected by questionnaires, measuring the competencies of professional nurse (Clayton 1983) from a sample (N = 30), which consisted of registered nurses (response rate was 67%), specialized in medical-surgical nursing, and their nurse managers. The nurses had graduated from two different colleges of nursing. Data were analysed by the means and differences of the means. On completion of their studies the nurses felt that their best skills and knowledge were related to the hygienic care of the patient, while their weakest area was in implementing specialized care. In their assessment made four months after graduation the nurses felt that in terms of the different areas of nursing practice their skills and knowledge had improved to some degree. The nurse managers, on the other hand, expected the newly graduated nurses to have better skills and knowledge than what was actually discovered. Furthermore, the nurse managers were clearly more critical in their assessment than the nurses themselves.(ABSTRACT TRUNCATED AT 250 WORDS)


[Collaborative decision-making by patient and nurse in nursing practice].

The topic of this study was the collaborative decision-making of patients (n = 302) and nurses (n = 253) and it is a part of an international research project. The data were gathered from the surgical and medical wards of two Finnish hospitals by means of a questionnaire. The results showed participation in decision-making by patients to be uncommon and the collaborative decision-making by patient and nurse together also occurred seldom.


[Clinical significance of hypercholesterolemia in the elderly].

Hypercholesterolemia is known as a cardiovascular risk factor for the non elderly man. But it still remains the controversy about the significance of dislipidemia on the aged. The authors discuss the problem and suggest a therapeutic approach following the European Consensus Conference Guidelines.


[Echocardiography-guided temporary implantation of electrode catheters: an alternative with reliable results even during prolonged use].

Two-dimensional echocardiography (2D-ECO) evaluation as an alternative guidance technique during temporary pacing wire placement. Prospective evaluation of implantation and pacing parameters. Admission from the Emergency Room and patients studied in the Cardiology Department of the Hospital Distrital in Faro. Twenty patients with indication for temporary cardiac pacing during, at least, twelve hours (H). Fluoroscopy equipment shouldn't be readily available for implantation. The mean ages of the 20 pts. (14 men and 6 women) were 71.90 +/- 2.12 years. All pts. had a temporary pacing lead implantation under 2D-ECO guidance. Indications for cardiac pacing were: second or complete atrioventricular block (17 pts.), new onset bifascicular bundle branch block during anterior acute myocardial infarction (1 patient) and sick sinus syndrome (2 pts.). The transvenous route of approach has been the right internal jugular in all the cases and venipuncture time accounts for the calculation of total implantation time. Ventricular capture was achieved in all pts., with stable stimulation thresholds. The mean implantation time was +/- 9.21 minutes and the mean acute stimulation threshold 0.33 +/- 0.20 V and 0.65 +/- 0.35 mA. The mean voltage of the intracavitary QRS was 11.15 +/- 2.95 mV and the mean lead resistance was 851.33 +/- 194.04 Ohms. The mean utilization time of the pacing leads was 95.15 +/- 87.49 H and the mean stimulation threshold during lead explanation was 0.85 +/- 0.47 mA. The only complication appearing during our study has been one lead dislodgment (5%), 72 h after implantation, placed again with the guidance of 2D-ECO and used during 216 H without further complications. Subcostal 2D-ECO window alone was used in 85% of the pts. but in the remaining (15%), it was insufficient and an apical window was needed too. The 2D-ECO was an efficient alternative technique of guidance during temporary lead placement, ensuring satisfactory longterm pacing and sensing. Our results indicate that 2D-ECO may be the best alternative control for urgent lead implantation whenever fluoroscopic facilities are remote or logistically not convenient.


The Entner-Doudoroff pathway: history, physiology and molecular biology.

The Entner-Doudoroff pathway is now known to be very widely distributed in nature. Biochemical and physiological studies show that the Entner-Doudoroff pathway can operate in a linear and catabolic mode, in a 'cyclic' mode, in a modified mode involving non-phosphorylated intermediates, or in alternative modes involving C1 metabolism and anabolism. Molecular and genetic analyses of the Entner-Doudoroff pathway in Zymomonas mobilis, Escherichia coli and Pseudomonas aeruginosa have led to an improved understanding of some fundamental aspects of metabolic controls. It can be argued that the Entner-Doudoroff pathway is more primitive than Embden-Meyerhof-Parnas glycolysis.


[Heart failure in the elderly (from diagnosis to therapy)].

After some considerations about the importance of heart failure on the elderly, the medical literature about epidemiologic and necropsy data on etiologic forms of heart failure, is reviewed. The importance of the associated pathologies to heart failure on the elderly is evaluated in what the diagnosis and treatment of this syndrome is concerned. We characterize the physiopathologic types of heart failure on the elderly. We refer how important is to recognize the treatable forms of heart failure, mainly the aortic valve stenosis.


Microbial breakdown of halogenated aromatic pesticides and related compounds.

Considerable progress has been made in the last few years in understanding the mechanisms of microbial degradation of halogenated aromatic compounds. Much is already known about the degradation mechanisms under aerobic conditions, and metabolism under anaerobiosis has lately received increasing attention. The removal of the halogen substituent is a key step in degradation of halogenated aromatics. This may occur as an initial step via reductive, hydrolytic or oxygenolytic mechanisms, or after cleavage of the aromatic ring at a later stage of metabolism. In addition to degradation, several biotransformation reactions, such as methylation and polymerization, may take place and produce more toxic or recalcitrant metabolites. Studies with pure bacterial and fungal cultures have given detailed information on the biodegradation pathways of several halogenated aromatic compounds. Several of the key enzymes have been purified or studied in cell extracts, and there is an increasing understanding of the organization and regulation of the genes involved in haloaromatic degradation. This review will focus on the biodegradation and biotransformation pathways that have been established for halogenated phenols, phenoxyalkanoic acids, benzoic acids, benzenes, anilines and structurally related halogenated aromatic pesticides. There is a growing interest in developing microbiological methods for clean-up of soil and water contaminated with halogenated aromatic compounds.


Protein secretion in Pseudomonas aeruginosa.

The Gram-negative bacterium Pseudomonas aeruginosa secretes many proteins into the extracellular medium. At least two distinct secretion pathways can be discerned. The majority of the exoproteins are secreted via a two-step mechanism. These proteins are first translocated across the inner membrane in a signal sequence-dependent fashion. The subsequent translocation across the outer membrane requires the products of at least 12 distinct xcp genes. The exact role of one of these proteins, the XcpA protein, has been resolved. It is a peptidase that is required for the processing of the precursors of four other Xcp proteins, thus allowing their assembly into the secretion apparatus. This peptidase is also required for the processing of the precursors of type IV pili subunits. Two other Xcp proteins, XcpR and XcpS, display extensive homology to proteins involved in pili biogenesis, which suggests that the assembly of the secretion apparatus and the biogenesis of type IV pili are related processes. The secretion of alkaline protease does not require the xcp gene products. This enzyme, which is encoded by the aprA gene, is not synthesized in a precursor form with an N-terminal signal sequence. Secretion across the two membranes probably takes place in one step at adhesion zones that may be constituted by three accessory proteins, designated AprD, AprE and AprF. The two secretion pathways found in P. aeruginosa appear to have disseminated widely among Gram-negative bacteria.


Immunoglobulin prophylaxis during intensive treatment of acute lymphoblastic leukemia in children.

60 children with acute lymphoblastic leukemia were sequentially randomized at the time of diagnosis: Immunoglobulin (Endobulin, Immuno) was administered intravenously to 30 patients at a dose 100 mg/kg/week during the first 3 months, followed by 2 x 200 mg/kg/month immunoglobulin during the 4., 5., 6. months. No immunoglobulin was administered to the control patients. We studied the effect of immunoglobulin prophylaxis on the number of days with fever, number of cases with bacteriologically proved infections, length and frequency of antibiotic therapy. Our data confirm the efficacy of immunoglobulin prophylaxis during the intensive phase of leukemia therapy in children.


Smith-Lemli-Opitz syndrome in siblings.

This paper presents two brothers with incomplete expression of the Smith-Lemli-Opitz syndrome. A definite diagnosis, made after the birth of the second child, could only be reached when the clinical features of both patients were combined.


Severe hypoglycaemia and cardiovascular autonomic dysfunction in type I diabetic children treated with intensified conventional insulin therapy.

To assess the relationship between severe hypoglycaemias and autonomic dysfunction, five cardiovascular tests (resting heart rate, hyperventilatory arrhythmia, standing/lying heart rate ratio, orthostatic decrease in blood pressure, and increase in blood pressure during sustained handgrip) were performed in a 1-yr prospective study of 34 insulin-dependent diabetic children treated with intensified conventional insulin therapy (ICIT). There were twelve severe episodes in 7 diabetic children, and the remaining 27 patients had no severe hypoglycaemia. The hypoglycaemic group had a longer duration of diabetes than the nonhypoglycaemic group (5.4 SD 2.5 years vs. 2.8 SD 2.2 years, p less than 0.02). The hyperventilatory arrhythmia in the hypoglycaemic group in comparison with the nonhypoglycaemic group was significantly decreased (before ICIT: 16.1 SD 3/min vs. 24.4 SD 5/min, p less than 0.01; 1 yr thereafter: 17.3 SD 3/min vs. 26.0 SD 5/min, p less than 0.01). The hypoglycaemic group showed a pronounced orthostatic decrease in blood pressure compared to the nonhypoglycaemic group (before ICIT: 13.2 SD 4 mmHg vs. 6.0 SD 4 mmHg, p less than 0.01; 1 yr thereafter: 12.3 SD 4 mmHg vs. 5.6 SD 4 mmHg, p less than 0.01). Three or more abnormal cardiovascular test results were found in patients of the hypoglycaemic group who showed abnormal hyperventilatory arrhythmia and abnormal orthostatic decrease in blood pressure simultaneously, whereas such a coexistence was not found in the nonhypoglycaemic group. These observations may support the view that diabetic children and adolescents with autonomic dysfunction are susceptible to severe hypoglycaemia during ICIT.


Sex hormone binding globulin (SHBG) in children with obesity.

Serum sex hormone binding globulin (SHBG) concentration of children with obesity was measured and relationships between SHBG level and body mass index (BMI), waist hip ration (WHR), serum insulin, C-peptide, thyroid hormones (thyroxine--T4, triiodothyronine--T3/ sexual hormones (testosterone--T, oestradiol--E2) were investigated. Significant negative correlations were found between SHBG concentration and BMI, serum insulin, C-peptide concentration; significant positive concentrations were found between BMI and serum insulin, C-peptide concentration. Thyroid hormone and sexual hormones did not associate with SHBG levels. These results suggest that insulin hypersecretion has an important role in determining the reduction of SHBG production in obesity.


Determination of hair trace elements in childhood celiac disease and in cystic fibrosis.

Applying proton-induced X-ray emission authors investigated the hair trace element contents in 10 children with acute celiac disease after 3 to 6 and 12 months long gluten-free diet; in 9 children with cystic fibrosis and in a control group (6 children) of the same age. There was no difference in Cu, Fe, Ca, Cl values between the examined groups. The Zn contents of the hair are significantly low in the group with acute celiac disease after a short-term diet and also in the group with cystic fibrosis, the data approach the normal range only after a year's diet. The significant rise of hair potassium contents is well indicated in patients with acute celiac disease and this rise may be due to the destruction of cell cuticles. In case of cystic fibrosis there is no significant rise of hair potassium value.


In vitro motility investigations and electron microscopic observations on children's upper urinary tract muscle wall.

This study was performed as a part of a longer research programme on urinary tract smooth muscle layer in children. All the children whose samples were investigated underwent surgery for urinary tract malformations. Specimens were taken from different segments of upper urinary tract during surgical intervention. Specimens were investigated by either in vitro motility tests or electron microscopy or both of them. Basic patterns of tissue strips were recorded after incubation of varying duration and then tested by administering neurotransmitter agents like noradrenaline and acetylcholine-bromide. Microstructure of samples were examined electron microscopically. Investigations were performed in order to find correlation between microarchitecture and motility patterns of urinary muscle wall. Factors influencing urinary muscle motility, characteristic features of impaired musculature and its possible regeneration are discussed too. Microhistological deteriorations inhibit spontaneous smooth muscle motility but muscle contractility proved by administering noradrenaline and acetylcholine-bromide remained in some extent. Taking into consideration that smooth muscle is able to regenerate and rebuild close contacts pediatric surgeon and urologist should spare kidney parenchyma as far as it is possible.


Maternal weight gain and birth weight.

The data of first 1000 non-malformed, mature (greater than or equal to 2500 g) singletons of participants in the Hungarian Family Planning Programme were evaluated. The mean maternal weight gain during pregnancy was 13 kg which was modified by the body weight of women. Maternal weight gain exceeded 13 kg in 54% of pregnant women. There was a positive correlation between maternal weight gain and birth weight which was calculated as 26.6 g/kg.


[Feeding problems in severely handicapped children].

Nineteen patients with severely handicapped children were divided into 3 groups; tube-fed patients (group 1, n = 8), oral-fed patients with dysphagia (group 2, n = 3) and oral-fed patients (group 3, n = 8). Clinical symptoms, past history, cranial CT, EEG, blink reflex and auditory brainstem response were evaluated in these patients. All patients of group 1 and 2 could not control head or sit by themselves. They needed naso-oral suction. However, nasal airway, intubation and tracheostomy were necessary only in group 1 patients. Five out of 8 patients of group 3 could control head and sit by themselves. No one needed naso-oral suction. CT revealed ventricular dilatation or prominent destructive lesions in group 1. However, patients of group 2 and 3 showed the lesions of mild to moderate degree. EEGs showed poorly developed background activities or electrical status epilepticus in group 1, while they showed relatively well-developed background activities with less prominent paroxysmal discharges in group 2 and 3. R2 component of blink reflex was absent bilaterally in 90% patients of group 1 and 2, while unilateral R2 at least was present in group 3. Feeding problems in severely handicapped children were affected by combination of cerebrum and brainstem involvements. Examination of cranial CT, EEG and blink reflex was useful to determine the method of feeding.


[Speech development test for one-year-old infants: I. Test content].

A new speech development test was prepared for one-year-old infants. The test consists of three parts: test I, II, and III. The overall test originally comprised a total of 98 test items (47 for Test I, 32 for Test II and 19 for Test III). Test I (for pre-speech language) Section 1 Situation of language i) Differentiation of information to be communicated ii) Comprehension of speech-related situation (Initiation of "signe", and comprehension of objects and events by means of speech) Section 2 Development of symbolizing function (Development and transformation of ability to handle and manipulate objects) section 3 Representing the function of language (First utterance, and acquisition of meaningful words after first utterance) Test II (for speech comprehension) Ability to name concrete objects, and to relate objects to their uses and functions; comprehension of words representing spatial concept such as quantity, number and dimensions, as well as words representing color or position. Test III (for speech expression) Ability to verbalize or name concrete objects, and to verbalize the conduct and state of a person. For infants, language is an objective to be achieved, while for adults it is the mean of thinking and communicating. Despite this difference the scope of this test comprises two major aspects common to the language-related experience of infants and of adults: pragmatics and vocabulary.


[Speech development test for one-year-old infants: II. Test statistics].

The test result of language ability for infants of second year of life was examined statistically. In descriptive statistics, average score, standard deviation, and proportion of right answers for all test items for each age group subjects were included. Then factor analysis was carried out to determine the structural characteristics of the test. The analysis revealed that test pertains of the following five stages. First two stage of five were overlapped with the previously reported result for pre-speech language test for infant within one year of life. Then, the stage was determined as follows; (4) Initial language acquirement and differentiation of language functions (5) Speech increasing stage (increase of spontaneously uttered words and understood words related to persons and objects) (6) Differentiation of expressed words (expression of words differentiated to suit objects) (7) Understanding of words representing actions or conditions (8) Understanding of words representing uses or functions, and verbalization of words representing actions or movements In spite of the fact that six and seven stage represent the same development level in term of chronological age, they were distinctive into those which achieve speech understanding earlier (stage 7), and others whose development centers on speech expression (stage 6). Then reliability and validity was performed. Reliability: (1) As to homogeneity, the reliability coefficients were calculated on the 60 test items by Spearman-Brown's odd-even method. (2) As to inter-rater reliability, Pearson's product movement correlation coefficient was calculated based on the results produced by two separate experienced testers. (3) As to test stability, reliability was determined through repetitive testing.(ABSTRACT TRUNCATED AT 250 WORDS)


[Ataxic cerebral palsy and brain imaging].

Five cases diagnosed as having ataxic cerebral palsy were presented with their brain imaging. Case 1, a 3-year-old-girl had been floppy since 7 months of age and began ataxic walk with spastic legs from 18 months of age. MRI revealed generalized atrophy of cerebellum (especially in anterior superior part) and slight atrophy of pons. Her mother also had ataxia with spastic legs of early onset. She and her mother were thought to have an early-onset inherited non-progressive cerebellar ataxia syndrome. Case 2, a 8-year-old-girl had ataxic walk since 17 months of age. MRI revealed cerebellar atrophy especially in anterior superior part. Case 3, a 10-year-old boy was floppy since 4 months of age and suspected as ataxic at 4 years of age. He could walk only with cruches. He had dwarfism and cataracts since 4 years of age. CT and MRI revealed generalized spino-ponto-cerebellar atrophy. Final diagnosis was Marinesco-Sjörgren syndrome. Case 4, a 10-year-old girl had opisthotonus and floppiness since 4 months of age. She could walk only with cruches. CT and MRI revealed generalized spino-ponto-cerebellar atrophy. Case 5, a 8-year-old boy showed head nodding and nystagmus since 4 months of age. He started ataxic gait at 8 years of age. He could vocalize only single sound for speech. MRI revealed cranium bifida and agenesis of anterior medullar velum. Ataxic cerebral palsy is the term often used to describe very different conditions, the clinical picture starts as hypotonia and changes into the ataxic symptoms in a few years.(ABSTRACT TRUNCATED AT 250 WORDS)


[Quantification of electroencephalogram continuity by 24-hour recording in very premature infants].

We aimed to quantify electroencephalogram (EEG) continuity for 24 hours in very premature infants. A total of 122 days of continuous two-channel EEG recordings were performed in 28 premature infants from 26 to 33 weeks of conceptional age (CA). None of the infants showed any evidence of neurological impairments during the course of their hospitalizations and showed normal neurological outcome. The 24-hour EEG recording was divided into 5.5-minute periods. The EEG of each period was classified into five EEG categories according to EEG continuity, and the percentage of each of them during the 24-hour recording was calculated. The percentages of continuous and continuous dominant EEG categories were increased with increasing CA. On the other hand, the percentages of discontinuous and discontinuous dominant EEG categories were decreased with increasing CA.


[Relationship between developmental prognosis and changing picture of postural findings in early infancy among early treated children].

We followed 93 infants prospectively who were treated because of moderate and severe grades of cerebral coordination disturbances since less than 6 months of age. They were divided into 3 groups according to developmental prognosis at 4 years of age; normal 44, mental retardation 18, and cerebral palsy 31. We compared the postural findings in supine and prone position, and 7 postural reactions at the first examination with those at discharge about 50 days after the first examination. We assessed the changing pictures of postural findings as improved, not changed or worsened. We analyzed the relationship between the changing pictures of postural findings during the short period in early infancy and the developmental prognosis among the 3 groups. The normal group showed improvement in a larger number of items than the other two groups. The findings of cerebral palsied children showed poor improvement, and more postural reactions changed to be more pathologic than those in the other two groups. Among the cerebral palsied children, ambulatory cases showed better improvement than those who could not crawl. But we found no significant difference between ambulatory and crawling children. This study demonstrated that assessment of changing pictures of postural findings in early infancy was helpful to predict developmental prognosis.


[N-isopropyl-p-[I123] iodoamphetamine single photon emission computed tomography (I123-IMP SPECT) and child neurology].

We studied the clinical usefulness of I123-IMP SPECT in 50 pediatric patients with CNS disorders, which were categorized into the convulsive disorder group (n = 20), the cerebrovascular disorder group (n = 10), the acute encephalopathy or CNS infection group (n = 10), the metabolic or degenerative disorder group (n = 6), the congenital abnormality group (n = 2) and the migraine group (n = 2). The findings obtained were compared with those of cranial CT. I123-IMP SPECT revealed abnormal findings in 45 out of the 50 patients (90%), although cranial CT showed abnormal findings in only 24 patients (48%). This difference was statistically significant (p less than 0.01). In all groups except the migraine, we could find abnormal findings in more than 90% of the patients. Out of 28 patients without focal findings on the initial CT scanning, I123-IMP SPECT showed focal abnormalities in 26 patients (93%). Moreover in many patients with focal neurological abnormalities, we found focal abnormalities of I123-IMP SPECT related with neurological abnormalities of the patients. From these findings, we think I123-IMP SPECT might be better to CT scanning in examining a localized lesion. It was found that in many patients with focal abnormalities in CT scanning, I123-IMP SPECT showed larger abnormalities in CT scanning. By using I123-IMP SPECT we might be able to study the blood perfusional state surrounding the abnormal area shown by CT. In 3 patients with acute cerebrovascular disorders, I123-IMP SPECT revealed abnormal findings 3 to 11 days earlier than cranial CT.I123-IMP SPECT might be useful for early recognition of the pathological state.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of frontal lobe epilepsy presenting with gelastic seizures].

We described a 9-year-old boy with frontal lobe epilepsy presenting with gelastic seizures. CT-scan showed mild widening of the left sylvian fissure. Abnormal findings in the left frontal operculum were detected by both MRI and SPECT. Attacks mainly consisted of gelastic seizures with comfortable feeling followed by screaming with fear. Administration of anticonvulsants resulted in reducing the frequency and severity of seizures. Finally the patient had brief laughter attacks only. In the present case, the clinical course suggests that the gelastic seizures does not occur by way of the spreading of epileptic discharges to the temporal or hypothalamic region; rather it might occur as a focal symptom of the frontal region.


[A case of cardiac arrest encephalopathy in athetotic cerebral palsy].

A 25-year-old woman with cerebral palsy of spastic quadriplegia and athetosis showed typical cardiac arrest encephalopathy on neuropathology. The etiology of cerebral palsy was perinatal origin including prematurity, asphyxia and hyperbilirubinemia. Ventricular premature beats had developed since about 20 years of age. Muscle tone also increased with aging and symptoms of vago-vagal reflex were occasionally observed after eating. At 25 years, cardiac arrest occurred and cardiopulmonary resucitation was done immediately. She remained unconscious with absent corneal reflex and irregular respiration. EEG or auditory brain stem response showed flat activity. She died of respiratory failure 53 days after the episode of cardiac arrest. Neuropathology showed bilaterally symmetrical necrosis in the superior colliculi, gracilis nuclei, cuneate nuclei and spinotrigeminal nuclei accompanied with severe necrosis in the cerebrum and cerebellum. These findings in this adult case of total asphyxia were compatible with those observed in total plus partial asphyxia in the neonates. This discrepancy may be due to difference in cerebral maturity. Children or young adults with athetotic type cerebral palsy have a high risk of sudden death. Sudden cardiac arrest seems to play an important role in sudden death of these patients.


[Infantile spasms in monozygotic twins with Smith-Lemli-Opitz syndrome type I].

Monozygotic twins with Smith-Lemli-Opitz syndrome who developed infantile spasms were presented. They were the result of the first full-term pregnancy of non-consanguineous parents. They had following abnormalities: marked growth and developmental retardation, congenital heart disease, light brown hair which is rare in Japanese, small dolichocephaly, hypertelorism, anteverted nostrils, micrognathia, hypospadias and shawl scrotum. The cranial MRI showed the delayed myelination of occipital lobe. As far as we could review published reports, we were unable to find other report on monozygotic twins having the Smith-Lemli-Opitz syndrome.


[MRI as an aid for diagnosis of infantile neuroaxonal dystrophy].

We experienced a 5-year-old girl, who had presented with nystagmus and psychomotor regression since 1 year old. No clinical diagnosis had been made despite various examinations including lysosomal enzymes and muscle biopsy. Her brain magnetic resonance imaging (MRI) revealed increased a T2 signal in bilateral cerebellar hemisphere. Recently this MRI finding was reported as a typical feature of infantile neuroaxonal dystrophy (INAD). Then we performed the second biopsy from her peripheral nerve, and diagnosed her as having INAD. It was suggested that MRI was a useful aid for the diagnosis of INAD.


Alkaline phosphatase inhibitors as labels of DNA probes.

A new approach to nucleic acid labeling was developed by preparing bifunctional reagents containing, in addition to the DNA-linking group, a competitive inhibitor of the chromogenic enzyme alkaline phosphatase. The nucleic acids labeled in such a way were able to bind themselves to the enzyme, whose activity was restored in the presence of a chromogenic substrate. Five phosphonic-acid-containing reagents were synthesized and coupled to linearized pBR322 plasmid DNA by different condensation methods. Eight probes thus obtained were assayed in a modified dot-blot detection procedure obtaining the best nucleic acid detection sensitivity of 25 pg. Finally, five of the above probes were tested in hybridization experiments, reaching sensitivity of 50 pg.


Direct DNA hybridization screening of primary yeast transformants in the construction of targeted yeast artificial chromosome (YAC) libraries.

A simple and inexpensive method for direct, large-scale DNA hybridization screening of primary yeast colonies following introduction of foreign DNA into Saccharomyces cerevisiae by spheroplast transformation is presented. An optimally thin layer of standard regeneration agar containing the transformed spheroplasts is spread on selective plates using carefully controlled temperature conditions; the colonies regenerate initially within the thin layer of hardened regeneration agar, but as they grow, greater than 90% of them break the surface and become accessible to direct lifting and screening methods. The technique avoids the manual or mechanized picking of transformants from within the regeneration top agar, does not require specialized (and often expensive) regeneration matrices such as alginate or low-melting-point agarose, and yields transformation efficiencies and screening results identical to those obtained using the standard spheroplast transformation protocol. We demonstrate the utility of this method for the construction of a targeted human-YAC library from a hamster hybrid cell line that contains chromosome 13 as its only human DNA.


Detection of individual human chromosomes by chromosome in situ suppression hybridization using PCR-amplified bacteriophage library probes.

We used the polymerase chain reaction (PCR) to prepare chromosome-specific probes from the bacteriophage lambda library LAO1NS01, prepared at the Los Alamos National Laboratory from flow sorted human chromosome 1. By using oligonucleotide primers flanking the EcoRI insertion site of the Charon 21A vector, we were able to amplify the human sequences preferentially in the library up to 9.1 kb (maximum insert size). The product of the PCR reaction was nick translated with incorporation of biotinylated residues and used with fluorescence in situ hybridization to observe metaphase chromosomes by fluorescence microscopy. This technique allows for a relatively easy method for preparation of chromosome-specific library probes for "chromosome painting." The quality of the results obtained by this method compares favorably to those obtained by using bulk-purified library inserts. This method offers potential advantages in terms of cost and ease of use.


Microleakage evaluation in amalgam restorations used with bases.

Marginal leakage in amalgam restorations often precedes the development of secondary caries. One potential way to improve the marginal seal of such restorations, and thus minimize the risk of caries development, is to apply a glass-ionomer base prior to amalgam placement. This study compared microleakage resistance among amalgam restorations placed with and without light-cured glass-ionomer base materials. Preparations were made in extracted human molar teeth. Four groups were studied, including copal varnish, which was used as a control. All specimens were restored with amalgam. Results indicated significantly greater leakage at the cavity wall/base interface for restorations with a copal varnish cavity liner than for those with a glass-ionomer base. Leakage differences among bases were also found at the amalgam/base interface. Best results were obtained with a dual-cure resin-based system. These samples showed minimal leakage at both the cavity wall/base and the base/amalgam interfaces. These findings suggest that light-cured glass-ionomer bases can be effective in the prevention of microleakage in amalgam restorations.


Addition of fresh amalgam to existing amalgam: microleakage study.

The purpose of this in vitro study was to determine whether adhesive lining materials reduce microleakage in amalgam restorations, and to observe the degree of microleakage at the interface between freshly placed (new) and existing (old) amalgam. Forty-eight specimens were used in the experimental groups. The materials used to study microleakage in this investigation were: copal varnish, a dentin bonding agent (Clearfil New Bond), and a 4-META adhesive (Amalgambond). No significant difference in microleakage was found at the interfaces between freshly placed and existing amalgam. Significantly less microleakage was noted in specimens using the 4-META adhesive and the dentin bonding agent as compared to specimens in which no lining material was placed. Significantly less microleakage was noted in specimens using the 4-META adhesive compared to specimens using cavity varnish.


Bonded silver amalgam restorations.

Although silver amalgam is a strong, stable, technique-insensitive material, its use requires the removal of more intact tooth structure than adhesive materials in order to provide long-term retention. Thus remaining tooth structure is weakened rather than strengthened. Bonded silver amalgam restorations, on the other hand, have excellent retention, don't require pins, strengthen remaining tooth structure, eliminate the likelihood of cuspal fracture, and eliminate postoperative sensitivity.


Bonding fresh amalgam to existing amalgam: a shear and flexural strength study.

The purpose of this study was to compare the shear and flexural strength obtained when various adhesives or liners were used to bond freshly placed amalgam to existing amalgam. The adhesives used in this study were the following: cavity varnish, 4-META adhesive (Amalgambond), and a dentin bonding agent (Clearfil New Bond). After samples were fabricated, shear bond strengths were determined by using an Instron Testing Machine, and flexural strengths determined using a Material Test System (MTS) testing machine. All test groups produced shear and flexural strengths less than one half of the control group. The dentin bonding agent and the 4-META adhesive produced significantly higher shear and flexural strengths than the test group in which no lining material was used.


Amalgam as a restorative material: is there anything new?

The properties of a new, dispersed-phase amalgam containing admixed indium (Indisperse) are reviewed. Laboratory tests show that the addition of indium significantly improves the strength and the resistance to creep and corrosion of the amalgam, and that mercury release from the amalgam is markedly reduced. A 5-year clinical study shows a lower frequency for marginal breakdown for Indisperse compared to other dispersed-phase amalgam containing no admixed indium.


Addition of fresh amalgam to existing amalgam utilizing various adhesive liners: a SEM study.

The purpose of this study was to observe the interfaces between (1) dentin and amalgam and (2) freshly placed amalgam and existing amalgam using various adhesive liners. Specimens were randomly assigned to four equal groups for liner placement: Group I--control, no liner used; Group II--copal varnish; Group III--4-META adhesive; Group IV--dentin bonding agent. After liner placement and amalgam replacement, specimens set for 24 hours and were then thermocycled in 0.5% basic Fuchsin dye, sectioned, and SEM analyses performed. Microgaps appeared in a disjointed fashion at the interface between freshly placed and existing amalgam. The 4-META adhesive appeared to establish a bond between amalgam and tooth structure and, thus, diminished the microgap between amalgam and dentin.


Hydrolysis of 4-META/MMA-TBB resins: a myth.

Recently, it has been erroneously reported that adhesive bonds to various substrates produced with 4-META/MMA-TBB type resins degrade by hydrolysis. This paper dispels this myth. The author cites a number of independent research studies indicating that bonds mediated by 4-META/MMA-TBB systems are extremely stable when subjected to extensive thermocycling in a wet environment.


Bleaching teeth: history, chemicals, and methods used for common tooth discolorations.

This article reviews the history of bleaching teeth to lighten tooth color. The last 2 years have seen a dramatic increase in new bleaching methods and bleaching chemicals. The following categorizes bleaching chemicals and methods in relation to their use in treating common tooth discolorations. Special attention is given to home bleaching methods.


Vital bleaching agents and oral antiseptic: effect on anaerobic bacteria.

This in vitro study compared the antimicrobial effect of several at-home bleaching agents and an oral antiseptic against anaerobic bacteria that are commonly found in the oral cavity. Zones of inhibition produced by Rembrandt Lighten Bleaching Gel, Opalescence, and Peroxyl were measured and compared. All the materials produced zones of inhibition with the five bacteria used in the study.


Bleaching and/or porcelain veneers: case reports.

Four case studies are presented in which the concept that bleaching, porcelain veneer restorations, or a combination of both constitute a conservative treatment approach for discolored, malformed, malaligned, and worn dentition. These treatments can be used effectively not only for aging dentitions, but also for the very young, which makes them an attractive treatment modality.


At-home bleaching system: effect on gingival tissue.

This study evaluated the effects of an at-home vital bleaching system on gingival responses over a 6-week period. Objective measures were utilized to measure and monitor gingival inflammation over this period of time. Vital bleaching was performed as follows: (1) bleaching gel in a prefabricated mouthguard and (2) an ad-mix technique--bleaching gel and toothpaste in a 1:1 ratio. In addition a control group used a placebo in a prefabricated mouthguard. The at-home vital bleaching system produced no adverse gingival tissue responses. Furthermore, the at-home vital bleaching system helped produce a therapeutic effect on inflamed gingival tissues over the course of the study.


Double-blind whitening Night-Guard study using ten percent carbamide peroxide.

The conservative technique of professionally dispensed and supervised, home-administered vital bleaching is now a routine treatment in the dental profession. This double-blind study evaluated the Rembrandt Lightening Gel and Whitening Toothpaste for shade change, colorimeter shade change. As well, it evaluated soft tissue health by periodontal probing, plaque index, and bleeding index. A patient questionnaire evaluated perception of whitening, perception of oral hygiene, average hours per day, and average days per week. Bleaching trays were worn over a 4-week period. The bleaching system showed definitive whitening effects as evaluated with the Vita shade guide and the colorimeter. The bleaching system had no deleterious effects on the soft tissue. The Rembrandt toothpaste alone demonstrated two-shade lightening. This vital bleaching system shows definitive whitening of the teeth in short periods of time with no adverse effects.


Vital bleaching: a new light-activated hydrogen peroxide system.

With ever increasing interest in cosmetic enhancement of dentition by dentists and patients alike, this article introduces a new light-activated bleaching system that adds up to total patient satisfaction and reduced chair time. The chairside application of hydrogen peroxide 30% was effective in lightening a moderate case of tetracycline staining. The uniqueness of this system allows the practitioner complete control within an office setting, and it provides the patient with an immediate result. The ease of application and strict supervision of a dentist has allowed this system to satisfy recent watchdogs of the Federal Drug Administration.


Microleakage between glass-ionomer cement and composite resins.

This study investigated the microleakage between glass-ionomer cement and Silux or Herculite with and without Scotchbond 2. Cavities were prepared in polymerized composite resin samples and "restored" with a glass ionomer cement with and without Scotchbond 2. The samples were thermocycled and immersed in 0.05% crystal violet solution for 2 hours, then embedded in clear casting resin, sectioned, and examined with an optical microscope. The results indicated that a high degree of dye penetration was found in samples of GC and Silux, and GC and Herculite without Scotchbond 2. The use of Scotchbond 2 significantly reduced the degree of dye penetration, but did not completely eliminate dye penetration.


Shear bond strengths of resin adhesive cements to dentin and Ni-Cr-Be alloy.

Two adhesives, Super Bond and Panavia, were evaluated for shear bond strength to dentin. Twenty human teeth were used for each adhesive. Bonding sites were prepared in dentin (600 grit) and the adhesives applied according to the manufacturers' instructions. Bond strengths were determined with an Instron testing machine at 24 hours. Super Bond developed the strongest bond of 21.59 +/- 3.91 MPa. Panavia produced a lower bond strength of 2.68 +/- 1.45 MPa. Statistically, Super Bond was found to have a stronger bond than Panavia. The same two adhesives were applied to Ni-Cr-Be specimens and compared to Comspan. Twenty Rexillium III specimens were used for each adhesive at 24 hours and 20 for thermocycling. The metal specimens were ground flat (600 grit) and then air abraded with 50-micron aluminous oxide. The adhesives were applied to the metal surface in accordance with the manufacturers' instructions. One group was tested at 24 hours while the second group was tested after thermocycling (2,500 cycles at 6 degrees C to 60 degrees C). At 24 hours, Super Bond had a significantly stronger bond than the other materials. Comparison of the 24-hour to thermocycled bond strengths found Comspan had a significant increase in bond strength, Panavia had no significant change and Super Bond had a significant decrease in bond strength. After 2,500 thermocycles, Comspan, Panavia, and Super Bond were not significantly different in bond strength.


Restoring the worn dentition.

Strong dental materials and dental porcelains are providing dentists with restorative opportunities that are more conservative because they require less destruction of healthy tooth structure and yield a more esthetic result. In cases of severe wear due to attrition, abrasion, and erosion, this process can be stopped, restoring the esthetics and function by using proper techniques and materials. The case report described in this article demonstrates the conservative restoration of severe wear due to attrition and erosion. Teeth were lengthened, wear was restored, and further wear was ceased by using a combination of bonded porcelain, a heat, light, and self-cure resin system, and a new glass-ionomer restorative material. The result was a strong, durable restoration (that required no anesthesia) with high esthetics.


Total etch technique and cavity isolation.

In the total etch technique for chemically adhesive composite restorations, the phosphoric acid penetrates only 10 microns or less into the vital dentin with the dentinal tubules being filled with the odontoblast processes. The acid is completely removed by subsequent air-water jet spray washing. The tubule apertures are perfectly sealed by the protective bonding agent layer with the resin tags adhering to the tubule walls and the resin-impregnated dentin surface. Isolation of the cavity from moisture contamination is required for only less than a few seconds after drying the etched cavity until the bonding agent coating and after this coating until the composite resin placement. Such a short time for isolation is quite easy even without a rubber dam when a trained assistant is cooperating.


Ranking of facial profiles among Asians.

The purpose of this study was to determine the facial profile preferences in a sample of 1,189 Asian teenagers (aged 15.3 +/- 3.2 years). Five facial profile types were computer-generated by trained personnel (orthodontists and oral maxillofacial surgeons) to represent distinct facial types. Subjects were asked to rank the profiles in descending order of attractiveness. The ranking was as follows: orthognathic profile, bimaxillary retrusive profile, bimaxillary protrusive profile, mandibular retrognathic profile, and mandibular prognathic profile. The differences in rank scores between all the profile types were statistically significant (p < 0.05). Assessment of profile types among lay personnel could provide clinicians an indication into the relative attractiveness among profile types and health care workers in treatment prioritization among dysmorphic facial types.


Therapeutic performance of nasal and paranasal operations in recent years.

In this survey of the postoperative therapeutic performance of 555 cases of nasal surgery, particularly conservative fiberscopic endonasal sinusectomy, it was found that conservative nasal operations accounted for 87.8% of the entire sample population and the therapeutic effects, (in terms of subjective symptoms) were found to be favorable in 91.5% of cases. These results suggest that conservative nasal operations will become the dominant form of nasal surgery in the future.


Repair of porcelain/metal restoration with resin bonded overcasting.

Porcelain occasionally fractures from ceramometal fixed partial dentures following final cementation. Repair of these porcelain fractures can be a challenging task. When the problem occurs on anterior teeth, it is especially difficult because the repair must not only be durable, but esthetically pleasing as well. Although composite resins can be used for some repairs, it is often difficult to match the color and texture to the surrounding intact porcelain. In addition, the bonding between the resin and porcelain is susceptible to margin leakage, which may ultimately cause an esthetic failure. Techniques involving a cemented porcelain-fused-to-metal overcasting have often been successful in restoring the fixed partial denture to form and function. Although the esthetic result of a porcelain/metal overcasting can be quite successful, retention of the overcasting is sometimes poor. The compromised retention and resistance form is due to lack of interproximal walls on the underlying fractured unit. To improve the retention of the overcasting, the following technique of tin plating the overcasting and fractured unit prior to cementing with a composite resin cement is presented.


Porcelain to dentin bond strength with a dentin adhesive.

Adhesion of porcelain to dentin may be important in those cases with little remaining enamel. The purpose of this study was to determine the bond strength of porcelain to dentin using a dentin adhesive (All-Bond) and compare it to the enamel bond strength. Sixty human molar teeth had either a dentin or enamel bonding site prepared by flat grinding to a 600 grit. The teeth were divided into three groups of 20 each. Sixty porcelain cylinders were prepared, hydrofluoric acid etched on one end and silane treated. Twenty of the cylinders were bonded to enamel, 20 bonded to dentin with a dentin adhesive to be tested at 48 hours, and 20 bonded to dentin with a dentin adhesive to be tested after 24 hours of thermocycling (800 cycles at 6 degrees C to 60 degrees C). The specimens were tested in an Instron at a crosshead speed of 0.5 mm/minute. The following bond strengths were found: enamel (19.0 +/- 2.9 MPa), dentin at 48 hours (14.4 +/- 5.4 MPa), and dentin after thermocycling (10.1 +/- 3.8 MPa). When this data was subjected to statistical analysis (ANOVA), there was a significant difference between the groups. A Scheffe's test found that the dentin-porcelain bond at 48 hours was stronger than the thermocycled group, and that the enamel bond was significantly stronger than the two dentin bonds.


Diastema preservation in resin-bonded fixed partial dentures.

The etched-metal, resin-bonded fixed partial denture has evolved rapidly from its origination as an extracoronal splint. Technologic advancements in both resin chemistry and retentive surface etching techniques have markedly improved the quality of the prosthesis. Today, resin-bonded fixed partial dentures are an effective, conservative means of replacing missing teeth when specific contra-indications--long spans, insufficient sound enamel, malocclusion, pathologic occlusal habits--are identified and avoided. A universally-accepted standard preparation does not exist for resin-bonded fixed partial dentures; rather, common principles of tooth reduction are agreed upon by most authors. This case report details necessary modifications in typical preparation and framework design that must be included to maintain a midline diastema when such spacing is required or preferred by the patient.


In vitro effect of topical fluorides on sealant materials.

The purpose of this study was to determine by visual inspection and by scanning electron microscopy (SEM) whether commercially available, topical, acidulated phosphate fluoride (APF) and neutral sodium fluoride (NaF) agents cause surface roughening of five sealant materials: two unfilled resins, two filled resins, and one glass-ionomer material. In addition, the effect of treatment with 1.23% APF and sonification on weight of an unfilled and a filled sealant was compared to treatment with controls. Unfilled sealants exhibited no surface changes visually or on micrographs following any treatment. Filled sealants and the glass-ionomer sealant exhibited visually apparent changes depending on the treatment. SEM inspection of filled sealants with visually apparent changes showed loss of filler particles whereas the glass-ionomer sealant exhibited apparent destruction both of the matrix and the filler particle. No significant differences in weight were found between sonicated and unsonicated specimens. However, significant loss of weight was found with filled sealant specimens, but not unfilled sealant specimens, treated with 1.23% APF gel as compared with the specimens treated with water. The results of this in vitro study indicate that preventive therapies that combine use of topical fluorides and sealants may cause deterioration of filled sealants and glass-ionomer sealant material, but not unfilled sealants.


Surgical management of midfacial fractures.

A brief overview has been given about types, diagnostics and therapy of midfacial fractures. The ENT-surgeon should play an important and active role in the treatment. In extended cases interdisciplinary cooperation will give better results.


Fireside conference 19. Wegener's granulomatosis and lethal midline granuloma.

In summary, Wegener's granulomatosis is a systemic illness that is characterized pathologically by necrotizing granulomatosis and vasculitis. Lethal midline granuloma is not a pathological term. Lethal midline granuloma is a clinical term, and in reality, lethal midline granuloma has been proven to be polymorphic reticulosis and not Wegener's granulomatosis. Polymorphic reticulosis is now understood to be a T-cell lymphoma. Further study of these malignant lymphomas has shown that these T-cell lymphoproliferative disorders may be causally associated with Epstein-Barr virus. Although there is strong association between autoantibodies against cytoplasmic constituents of neurophils and monocytes in patients with active Wegener's granulomatosis, the exact pathogenic mechanism in Wegener's granulomatosis and the etiology is still unknown. IgG-C-ANAC (C-ANAC stands for Classical/Cytoplasmic Anti-Neutrophil Cytoplasm Antibodies) increases with increasing disease activity from undetectable levels to up to 95% of active Wegener's granulomatosis patients. Rhinologic symptoms in Wegener's granulomatosis include progressive nasal obstruction, bloody rhinorrhea with crusting, and vague pain and tenderness of the nasal dorsum. Usually these patients have mucosal ulcerations of the nose with or without a septal perforation. Other areas of the head and neck can be involved, and they include orbital, otologic, oral, and subglottic involvement. Hallmarks of malignant lymphoma (polymorphic reticulosis) when it involves the upper airway include rapid localized destruction of the nose, orbit, paranasal sinuses, and hard palate. Treatment for Wegener's granulomatosis includes antimicrobial agents in addition to a regimen of cyclophosphamide and glucocorticoids. The treatment for malignant lymphoma (polymorphic reticulosis) is primarily radiation, especially when confined to one site.


Nasal airway resistance and nasal sensation of airflow.

Nasal obstruction is a common symptom which is most frequently associated with an increased nasal airway resistance. However it is important to appreciate that the objective measurement of nasal airway resistance does not always correlate with the subjective perception of the degree of nasal obstruction. Damage to trigeminal sensory nerve endings can cause a sensation of nasal stuffiness without any change in nasal airway resistance and similarly inhalation of menthol can cause a subjective improvement in nasal sensation of airflow without any change in nasal resistance.


[Surgical techniques of combined operations on coronary arteries and arteries of the lower limbs].

Experience has been accumulated in the department in the surgical treatment of 165 patients with combined affections of the coronary arteries and the arteries of the lower limbs. One-stage operations were conducted on 14 patients due to clinically severe ischemia of the heart and limbs. A bifurcation aortofemoral shunt with an aortocoronary shunt was formed in 2 patients. In the other cases an aortocoronary shunt without or with resection of a heart aneurysm and various types of aorto-iliac-femoral and femoropopliteal reconstructions were performed. No hospital mortality was encountered. The surgical techniques of combined operations are described in detail. It is concluded that such surgical interventions should be conducted only in highly-qualified institutions possessing rich experience both in coronary and in vascular operations.


[Effect of different types of pharmacocryocardioplegia on the occurrence of cardiac rhythm and conduction disturbances in the early postoperative period in patients with ischemic heart disease].

109 patients who underwent operation for formation of an aortocoronary shunt (ACS) were divided into 3 groups according to the method of introducing a cardioplegic solution and reperfusion. Thirty-five patients (group 1) underwent antegrade cardioplegia and direct reperfusion. Thirty-seven (group 2) were subjected to mixed antegrade-retrograde cardioplegia. Group 3 consisted of 37 patients with myocardial protection accomplished by the same method as in group 2, but retrograde perfusion was with warmed oxygenated blood through the right atrium was conducted before removing the clamp from the aorta. The effect of various types of pharmacocryocardioplegia on the appearance of new disorders of rhythm and conductivity in the early postoperative period after ACS formation was analysed. The frequency of sinus tachycardia was less in group 3 (24%) than in groups 1 and 2 (51 and 51%, respectively, p less than 0.05). We obtained no statistically significant differences in the frequency of other types of arrhythmias in these 3 groups. However, the number of transient bundle-branch blocks and disorders of intraventricular conductivity (8.1 and 10.8%, respectively) in group 3 was also less than that in groups 1 and 2 (p less than 0.05) and their regression was faster. We believe that combined anterograde-retrograde cardioplegia applied together with retrograde reperfusion with warmed oxygenated blood is most effective not only in protection of the conduction system of the heart but also in protection of the right- and left-ventricular myocardium.


[Proximal anastomosis in surgery for Leriche's syndrome].

The author analysed the frequency of different variants of atherosclerotic affection of the aortoiliac-femoral segment in 300 patients who underwent operation. With consideration for these data, the surgical tactics and techniques of proximal anastomosis in aortofemoral shunting (prosthetics) in 216 patients with variants of Leriche's syndrome are appraised. In most patients the operation may be carried out through an extraperitoneal approach. The choice of the type of proximal anastomosis in aortofemoral shunting (prosthetics) should be guided by the character of the affection, the condition of the branches of the abdominal aorta, and the necessity for revascularization of one or both extremities in one stage. The chosen tactics and techniques of the operation made it possible to preserve 86.1% of the vascularized extremities.


[Evaluation of arterial insufficiency of the lower extremities according to oxygen transport values in the treadmill test].

The authors studied the possibility of evaluating peripheral arterial insufficiency according to the values of oxygen transport (consumption and oxygen debt) in the multistep treadmill test. Sixty patients with angiographically recognized affection of the vessels and 38 healthy individuals (controls) were examined. Both values were found to reflect the severity of arterial insufficiency of the lower limbs. The oxygen debt value was most informative in its evaluation. The degree of arterial insufficiency may be evaluated according to the level of the load in the treadmill test at the moment of inadequate oxygen debt occurrence.


[Emergency thoracoscopy in the diagnosis and treatment of complicated chest injury ].

Emergency thoracoscopy was undertaken in 111 patients with complicated closed chest trauma and in 67 persons with penetrating knife wounds of the chest. Thoracoscopy in patients with closed chest trauma revealed pneumohemothorax in 53, pneumothorax in 42, and hemothorax in 10 cases, in 4 patients the hemothorax was coagulated. Penetrating injuries were complicated by pneumohemothorax in 30, by pneumothorax in 21, and by hemothorax in 16 cases. From the results of thoracoscopy, emergency thoracotomy was found to be indicated in 11 patients with penetrating chest wounds. Endoscopic electrocoagulation of the wounds of the lung and thoracic wall was conducted in 28 patients with a closed trauma and in 26 persons with penetrating injuries, laser coagulation was performed in 10 cases with closed trauma and in 8 patient with knife wounds, medical glue was applied for occlusion of surface ruptures of the lung in 11 cases. No complications of thoracoscopy occurred. The therapeutic methods of thoracoscopy with the use of high frequency electric current, NIAH-laser radiation are described. It is concluded that the inclusion of thoracoscopy in the complex of therapeutic and diagnostic measures in patients with complicated chest trauma is expedient.


[Effectiveness of hyperbaric oxygenation in the treatment of postresection bronchial fistulas].

The article discusses the results of treatment of 84 patients with postresection tuberculous pyothorax and bronchial fistulas with hyperbaric oxygenation session (HBO) included in the complex of therapeutic measures. As a result, the bronchial fistulas closed in 30 (35.7%) patients, the diameter of the fistulas reduced markedly in 20 (24.3%) patients, the bronchial fistulas failed to close in 40% of cases. As the result of HBO therapy the count of red cells and lymphocytes increased, leukocytosis and eosinophilia reduced, the ESR diminished. The content of ALT transaminase, sugar, total protein and bilirubin decreased. The migration index for all immune antigens in the reaction of leukocyte migration inhibition and in the nitro blue tetrazolium test increased. HBO promoted the efficacy of radical operations by 29.4% as compared to that in the control group of the similar patients.


[Comparative studies of immunologic characteristics in plasmapheresis and hemosorption in patients with purulent diseases of the lungs and pleura].

The article deals with the comparative characteristics of the changes in immunological indices in 40 patients with non-specific purulent diseases of the lungs and pleura when plasmapheresis and hemosorption were included in the complex of therapeutic measures. The changes were found to be hetero-directional in character: a non-specific effect of immunostimulation in hemosorption, and immunodepression, particularly marked in the first 24 hours, in plasmapheresis. The post-aggressive reaction after plasmapheresis is either absent or delayed significantly, which makes it possible to conduct detoxification in extremely grave conditions of the patients without making the mechanisms of the post-aggressive reaction operative, as observed in performance of hemosorption.


[Diagnosis and treatment of mediastinal neoplasms and cysts].

Possessing experience in the treatment of 314 patients with tumors and cysts of the mediastinum, the authors discuss problems of their diagnosis and surgical treatment. The patients' ages ranged from 7 to 64 years. Tumors were recognized in 216 (68.8%) and cysts in 98 (31.3%) patients. The radiological method, including computed tomography, is the main method for the diagnosis of mediastinal tumors and cysts. The presence of a pathological structure in the mediastinum is an indication for surgery independent of the development of complications. Operations for tumors and cysts of the mediastinum must be carried out in specialized medical institutions because they are complicated surgical interventions.


[Prevention and treatment of infectious complications in myocardial revascularization].

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.


Attitudes to medical care, the organization of work, and stress among general practitioners.

Eighty five volunteer general practitioners in Lothian region recorded clinical and contextual information on 21,000 consultations during 1987-88. During their recording sessions they reported their perceived levels of stress using a previously validated scale. Subsequently, 80 of the doctors completed a previously validated multi-dimensional scale about their attitudes to patient care. Three attitude subscales (psychological orientation, appropriateness of consultations and responsibility for decisions) correlated with processes of care previously identified as indicators of good care. The 20 doctors who scored most highly on these patient-centred scales recorded self-perceived stress in 27% of their consultations compared with 11% of the consultations of the 33 doctors who scored lowest on these scales. Among the 20 most patient-centred doctors those booking patients at eight patients per hour or more reported stress at twice as many consultations as those with a longer booking interval; doctors whose preferred working styles conflicted with their booking patterns reported stress in up to 62% of consultations. Doctors with a higher patient-centred orientation find their work more stressful. Longer booking intervals remove much of that stress, particularly when doctors' preferred style of consulting requires them to spend more time at individual consultations. Previously described work stressors offer a theoretical explanation for a problem which is important for both doctors and patients.


Patient access to general practitioners by telephone: the doctor's view.

Few general practitioners have extensive daytime telephone contacts with patients. Forty nine general practitioners responding to a postal survey who reported handling a mean of nine or more calls a day were interviewed about their experiences. The nature of telephone contacts with patients and the organizational strategies employed to minimize disruption to surgeries were explored. Views on the rewards and frustrations of being accessible by telephone and its impact on other aspects of workload were also sought. Recommendations are made for practices contemplating extending telephone access for patients.


Evaluation of the use and usefulness of telephone consultations in one general practice.

In one practice with 14,000 patients an advice line was set aside at designated times to enable patients to speak directly to a doctor on the telephone. The aim of this study was to determine who used the line, why they called, the conditions callers presented with, the action taken by the doctor and whether patients and doctors thought the service was a good idea. A total of 277 calls were made during the five month study period. Responses to a questionnaire were received from doctors for all 277 calls and from 152 patients. It was found that most calls lasted about three minutes. Most of the callers (59%) were known to the doctor taking the call. Users of the advice line were most likely to be women, married people and people with children. Equal numbers of calls were received about new and existing problems. The most frequent reason for calling was to obtain the result of a test (21% of calls). The most frequent diagnosis by the doctors was chronic complaints for which the patient was already receiving treatment (19%). The data from patients and doctors were similar. In 30% of cases callers were advised to take medicine, mostly a prescription to be collected (16%), while a few callers received a home visit (7%). Doctors thought they provided reassurance in 26% of cases while callers thought they had received reassurance in 43% of cases. If the advice line had not been available three quarters of the respondents would have made an appointment and 13% would have asked the doctor to make a home visit.(ABSTRACT TRUNCATED AT 250 WORDS)


Postgraduate education allowance: general practitioners' attendance at courses outwith their region.

A study was undertaken to investigate the number of doctors attending postgraduate education courses outwith their own region. During the one year study period general practitioners from the west of Scotland obtained 2262.0 half-day sessions accredited for the postgraduate education allowance from 335 different courses outwith their region and 10 different distance learning programmes. Four hundred and thirteen doctors from the west of Scotland region (22.6%) attended courses in other areas and 85 doctors (4.6%) participated in 258.6 half-days of distance learning. More than half of the education sessions (56.0%) were in the category of disease management. Sixty four doctors (3.5%) attended 10 or more half-day sessions outwith their region. Almost half the courses were in England and 32.5% of courses were in south east Scotland. Over the same period 122 doctors outwith the area attended 263 different courses in the west of Scotland region. Despite concern regarding the removal of travel and subsistence contributions for postgraduate education activities, general practitioners are attending education courses outwith their region.


Attitudes to and perceived use of health care services among Asian and non-Asian patients in Leicester.

A random sample of 449 Asian patients and 447 non-Asian patients were interviewed at home in their preferred language using a personally administered questionnaire comparing attitudes to and perceived use of health care services in Leicester. The overall response rate was 89.6%. There were differences in the responses of the Asian and non-Asian populations. With respect to communication, language as a barrier appears to be a diminishing problem among Asian patients in Leicester. However, Asian patients reported finding it more difficult to gain access to their general practitioners than non-Asian patients. More Asian than non-Asian patients would have preferred direct access to consultants and most respondents from both populations felt they should be able to request a hospital opinion from their general practitioner. More Asian patients disliked management of illness by telephone than non-Asian patients, the latter feeling that telephone advice could save them a trip to the surgery, or their general practitioner a home visit. However, both groups regarded home visiting as essential. Asian patients disliked deputizing services more than non-Asian patients, and there was some support for 24 hour surgeries, particularly among the Asian population, with doctors working in shifts. As Asian patients appear to differ from non-Asian patients with respect to attitudes and perceived need for health care services, this type of survey may form the basis for the more rational planning of health care delivery to ethnic minority patients in the future.


Is there still a role for benzodiazepines in general practice?

Opinion on benzodiazepines has moved from optimism after their entry onto the market to disillusionment over their potential for dependence. Legal proceedings against manufacturers of benzodiazepines, health authorities and doctors will be taking place this year. Nonetheless, just over 18 million prescriptions for benzodiazepines were issued in 1990, most of which came from general practice. Is there any role left for this group of drugs? This review addresses the issues of dependence on an withdrawal from benzodiazepines and weighs up the evidence for their present vilification.


Using a computer database to record and evaluate a school screening service.

School screening has been taking place in New South Wales since 1907. The need for better monitoring of the school health service to determine the outcome of the screening process has been advocated frequently. This paper reports on the development of a computerized surveillance system which allows school screening to be evaluated on an ongoing basis. The results of the first year's use of the programme on a study population of children first screened in 1989 in a northern metropolitan area of Sydney demonstrate that the system is practical and effective when used by people with little or no prior computer knowledge. It plays a role in both improving follow-up of the screening process and the assessment of the service. The prevalence rate of new defects found was four per 100 children screened. Issues raised about the screening process from the data collected are also discussed.


Factors influencing parental compliance following school entry health screening.

This study investigated the factors influencing parental action on behalf of their child following a school entry health screening failure. It was predicted that compliance with recommendations to seek further assessment would be related to the screening process variables and the number of barriers to compliance parents faced and that these barriers, and hence compliance, would be influenced by the socio-economic status of the family. It was also expected that when schools were differentiated on adversity factors, the type of school attended would be related to compliance. Results from a sample of parents (n = 1231) showed that the parental non-compliance rate to a referral of their child for further assessment following health screening was 26.1%. Non-compliance was related to both screening process knowledge and satisfaction and the type of barriers to compliance parents experienced. Although the type and number of barriers experienced by parents was related to socio-economic status, the results of correlational and discriminant function analyses indicated that the barriers most strongly related to compliance (e.g. partner's views, time pressure, more serious problems to worry about) were not related to socio-economic status nor type of school attended. These findings provide valuable information for child health service providers as well as those involved in policy making and planning in the general area of community health services.


Searches for matched and closely matched related and unrelated bone marrow donors undertaken in a single paediatric unit.

Information regarding the likelihood of finding suitable marrow donors is limited. In order to determine this potential, all patients who received their primary care at a single paediatric institution over a 9 year period and in whom tissue typing studies were initiated are reviewed. Forty-five (31.3%) of 144 patients had a sibling who was human leucocyte antigen (HLA) identical. A further 16 (11.2%) patients had immediate or more distant relatives who were either HLA identical (2.7%) or matched for five of six HLA antigens (8.3%). The possibility that a parent was closely matched with the patient was suggestive from the typing of siblings alone in only half the cases. Unrelated HLA matched donors were identified in four (27%) of 17 bone marrow bank searches. Overall, a potential related donor was identified within the family for 42% of patients and this figure rose to 45% when successful marrow bank searches were included. It can be concluded that initial typing should include both the parents and siblings. If a suitable donor is not found then an extended family and/or bone marrow bank search will identify additional suitable donors in a significant number of families.


Health problems and health checks in school-aged children with Down syndrome.

A survey by parent questionnaire and interview was carried out to determine the frequency of health problems in 204 children with Down syndrome. Seventy-two children (35.3%) had a congenital heart defect. Refraction had been performed on 196 and 68 (34.6%) of these had a refractive error. A diagnosis of 'glue ear' had been made in 112 (54.9%) and in 12 (11%) of these permanent hearing loss was present. Significant ill-health over the previous 12 months consisted of cardiac failure (two children), more than three upper respiratory tract infections (24 children), bronchitis (eight children), pneumonia (two children) and asthma (seven children). A neck X-ray had been performed in 172 (84.3%) and had demonstrated the presence of atlanto-axial instability in 12 (7%) of these. One hundred and thirty-two (64.7%) of the children had been tested for hypothyroidism in the previous 18 months and this had been found in four (3%) of these children. The implications of these and other findings are discussed in relation to parental counselling and planning of routine health checks.


Motorcycling attitudes and behaviours. II. 14 and 15 year old adolescents.

Of 846 adolescents interviewed near their 15th birthday, 51% could drive a motorcycle. A further 13% intended to learn. Drivers reported friends (mean age 16.5 years) as the most common source of instruction. Forty-four per cent of drivers and 69% of intending learners planned to apply for licences. Thirty-five per cent of the sample had driven or ridden as passengers on a motorcycle on-road in the past year and 85% of these had worn a helmet on the last occasion. The commonest cause of injuries to motorcyclists resulting in hospitalization (lower limb injury) was correctly identified by 52% of the sample. Fear of injury was the reason given for not learning to ride by 55% of confirmed non-drivers. Fifteen medically treated motorcycling injuries were reported for a 2-year recall period. Females reported significantly less exposure and less use of protective clothing than males. The issues of initiation, training, constraints on use and preventive strategies are discussed.


The role of a saliva control clinic in the management of drooling.

This paper describes a saliva control clinic which has been established at the Royal Children's Hospital, Melbourne. A team involving two speech pathologists, a paediatrician, a plastic surgeon and a dentist has assessed and managed 68 young people over a period of 2 years. Treatment options have included behavioural programmes, trial of oral appliances, medication and surgery. This multidisciplinary approach has been useful in developing assessment techniques and formulating recommendations.


The association of thyroid dyshormonogenesis and deafness (Pendred syndrome): experience of the Victorian Neonatal Thyroid Screening Programme.

Between 1977 and 1989, the Victorian Neonatal Thyroid Screening Programme detected five subjects with thyroid dyshormonogenesis and sensorineural deafness. These patients have been diagnosed as having Pendred syndrome. In two of the children, thyroid function tests which were initially abnormal at birth returned to normal spontaneously without treatment. However, hypothyroidism subsequently recurred and the children required thyroxine therapy. These two children could have been mistakenly diagnosed as having transient hypothyroidism. The detection of five patients with Pendred syndrome illustrates the importance of audiological assessment in all babies with thyroid dyshormonogenesis in whom there is increased uptake of isotope on thyroid scanning. In our experience, hearing loss in patients with Pendred syndrome may be progressive over time, so that repeated audiological assessments are necessary.


Citrobacter freundii septic arthritis.

Septic arthritis in an 8 month old infant due to Citrobacter freundii was treated successfully with a third generation cephalosporin. Infections due to Citrobacter are uncommon in this age group and are almost unknown as a cause of septic arthritis.


Case studies in adolescent deliberate self-harm.

Four adolescents admitted to a general paediatric ward at a teaching hospital with deliberate self-harm were reviewed. Their initial psychosocial assessment was noted together with their subsequent course 12 months later. Despite an extensive assessment by a multidisciplinary team during the initial admission, follow-up 12 months later revealed that each subject appeared to have ongoing problems. This outcome raised doubts as to the appropriateness and effectiveness of a prolonged hospital admission in their initial assessment. The difficulties encountered with their management are highlighted.


DT-diaphorase activity correlates with sensitivity to the indoloquinone EO9 in mouse and human colon carcinomas.

The indoloquinone EO9 exhibits promising in vitro and in vivo antitumour activity. EO9 is metabolised to DNA damaging species by DT-diaphorase in vitro. In the present study DT-diaphorase specific activity was 16 fold higher in the mouse adenocarcinoma MAC 16, a tumour which is quite responsive to EO9 in vivo, compared with levels in the more resistant mouse adenocarcinoma MAC 26. This order of responsiveness is the reverse of that seen with the most active of the clinically used agents in these tumours [chloroethylnitrosoureas and 5-fluorouracil (5-FU)]. In addition, when the in vitro sensitivity of two human colon carcinoma cell lines was compared, EO9 was 15-30 fold more active in the DT-diaphorase rich HT29 line than in the enzyme-deficient BE cell line counterpart. These results are consistent with the hypothesis that DT-diaphorase expression may be a major determinant of the sensitivity of tumours to EO9. This should be considered in the clinical development of the drug.


Differences in the level of DNA double-strand breaks in human tumour cell lines following low dose-rate irradiation.

It is now well accepted that differences exist in the intrinsic radiosensitivity of human tumour cells although the molecular basis of this is still unclear. Current evidence suggests that of the lesions induced in DNA by ionising radiation, double-strand breaks (DSB) are the most closely linked to cell death. In this study, levels of DSB were measured by neutral filter elution under conditions of both repair inhibition and maximum recovery and compared with clonogenic survival curves for high (HDR) and low dose-rate (LDR) irradiation in human carcinoma lines of differing radiosensitivity. Four human lung carcinoma lines were used, two small-cell (SCLC; HC12 and HX149) and two non-small cell lines (NSCLC; HX147A7 and HX148G7). Cell survival was measured by soft agar and monolayer colony-forming assays as appropriate and a large variation in sensitivity of the cell lines was seen (alpha values of 0.06 to 0.56 Gy-1). We have previously reported that the damage induced at high dose rate does vary in these cell lines but not in a way which correlates with their cell survival response [5]. Following irradiation to 15 Gy at low dose rate essentially no DSBs were detected in any of the four lines but at 70 Gy the more sensitive SCLC showed more residual damage than in the more radioresistant NSCLC lines. The prime determinant of the difference between the LDR and HDR damage curves is likely to be repair occurring during irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)


No correlation between ras, c-myc and c-jun proto-oncogene expression and prognosis in advanced carcinoma of cervix.

55 patients suffering from stage III or IV carcinoma of cervix were treated with two pulses of neo-adjuvant chemotherapy prior to radical radiotherapy. 51% (26/51) had a partial response. The initial response to chemotherapy is associated with significantly better long-term survival. The 3-year survival of chemotherapy responders is 62% against 21% for non-responders (P = 0.009 log-rank test). To detect possible differences in oncogene expression in biopsy specimens taken from responding and non-responding patients, paraffin-fixed material was immunocytochemically stained for the expression of the protein products of ras, c-myc and c-jun proto-oncogenes. The frequency of oncogene expression was ras 80.4%, c-myc 45.1% and c-jun 39.2%. There was no statistically significant association between oncogene expression, time to local recurrence or development of metastases or survival.


Screening of new anticancer agents in vitro using panels of human cell lines derived from non-seminomatous germ cell tumours and transitional cell carcinomas of the bladder.

Metastatic testis tumours are cured in over 80% of patients using combination chemotherapy, and this hypersensitivity is retained by the cells in vitro. To determine whether differential toxicity to testis tumour cells is useful in the screening of novel anticancer agents, we compared the toxicities of 12 compounds against panels of human bladder and testis tumour cell lines using a clonogenic assay. The compounds had screened negative against P388 in vivo, and had been retested using the human tumour colony forming assay (HTCFA) and in selected cases against human tumour xenografts. NSC 339004, chloroquinoxaline sulphonamide, was 7-fold more toxic to testis tumour than bladder cancer cells, comparing the mean of the concentrations reducing colony-forming ability by 70%. This was the only one of the compounds selected by the HTCFA shown to have clinical activity. Compound R was selectively toxic to the bladder cancer cells, and might be of value as an intravesical agent. These data indicate that panels of testis and bladder cancer cell lines might be a useful addition to the disease-oriented screening programme.


Downmodulation of c-myc expression by interferon gamma and tumour necrosis factor alpha precedes growth arrest in human melanoma cells.

After in vitro incubation of melanoma tumour cells Cmel453A with either recombinant interferon gamma (rIFN-gamma) or tumour necrosis factor alpha (rTNF-alpha) a dose-dependent inhibition of cell growth occurred; when both cytokines were added, a synergistic action was observed. Inhibition of DNA synthesis, as measured by [3H] thymidine incorporation, occurred after 6 h of incubation with rIFN-gamma or rTNF-alpha, and this action was potentiated when the two cytokines were applied simultaneously. Within 1 h, the level of c-myc mRNA in tumour cells had already decreased by, respectively, 60% (S.D. 7) and 25% (S.D. 7); the combined addition of the cytokines resulted in a greater reduction of c-myc mRNA than by each cytokine alone. Downregulation of c-myc expression is an early event, occurring hours before the actual inhibition of outgrowth. Thus, in melanoma cells like Cmel with a high constitutive expression of the c-myc oncogene, the antiproliferative action of rIFN-gamma and rTNF-alpha may be mediated by an inhibition of the expression of c-myc.


Flavone acetic acid induced changes in human endothelial permeability: potentiation by tumour-conditioned medium.

Flavone acetic acid (FAA) causes significant regression of larger established tumours in murine in vivo systems. This in vivo effect of FAA has been shown to include a vascular component. In an effort to elucidate the mechanism of action of FAA, we have studied the effects of FAA on the permeability of human endothelium in vitro. Monolayers of human umbilical vein endothelial cells (HUVEC) grown on polycarbonate filters were incubated in 1 mg/ml FAA for 120 min at 37 degrees C. During the first 60 min, there was a 6-8-fold increase in permeability; this was followed by a return to control levels even in the continued presence of FAA. In contrast, in the presence of tumour conditioned medium, FAA caused a rapid 6-fold increase in permeability which did not subsequently return to control levels. The permeability changes which occurred under the latter conditions were accompanied by a rapid contraction of the cytoskeleton. The permeability of monolayers of human melanoma cells was unaffected by FAA.


Pharmacological purging of syngeneic bone marrow ex vivo: effect of treatment with doxorubicin and lonidamine on normal and leukaemic cells of DBA/2 mice.

The in vivo effect of in vitro treatment with doxorubicin plus lonidamine on normal and leukaemic cells was investigated in a mouse model of syngeneic bone marrow transplantation. Different numbers of L5178Y tumour cells or normal bone marrow cells alone, or mixtures of bone marrow and leukaemic cells were incubated with doxorubicin (0.25, 0.5, 0.75, 1 microgram/ml) and/or lonidamine (50 micrograms/ml) and reinfused in DBA/2 mice. Lonidamine potentiated the cytotoxic effect of doxorubicin dependent on doxorubicin dosage and tumour cell concentration. Survival after injection of 10(4) in vitro-treated tumour cells was 42% for doxorubicin 0.75 micrograms/ml alone versus 100% for the combination with lonidamine and 50% for doxorubicin 1 microgram/ml alone versus 100% combination. Reinfusion of normal bone marrow incubated with doxorubicin alone or in combination with lonidamine in lethally irradiated mice did not occur in 12-14% of mice injected, indicating that the repopulating ability of stem cells was spared. These data suggest the potential usefulness of lonidamine in ex vivo purging of bone marrow before autologous bone marrow transplants in haemopoietic malignancies.


Anti-neoplastic action of peritoneal macrophages following oral administration of ether analogues of lysophospholipids.

Inflamed lesions of normal and cancerous tissues induce activation of phospholipase A in plasma membranes resulting in the release of various decomposed products of membranous lipids. Oral administration in mice of dodecylglycerol (DDG), a synthetic alkyglycerol, and an alkyl ether analogue of lysophospholipids, 1-0-octadecyl-2-0-methyl-rac-glycero-3-phosphocholine (ET-18-OCH3-choline) efficiently activated peritoneal macrophages for enhanced Fc-mediated (fragment crystallisable) ingestion of red blood cells and direct cytotoxic action on retinoblastoma tumour cells. The activated macrophages not only inhibited tumour cell growth, but also markedly induced cytolysis of tumour cells. The antitumour capability of the macrophages was substantiated by luminol-enhanced chemiluminescence. These findings suggest that dodecylglycerol and ET-18-OCH3-choline administered orally retain their ability to induce a high level of macrophage activation and tumour cytotoxicity, just as occurs with intraperitoneal administration. Thus, these compounds have potential practical application in chemotherapy and immunotherapy of the tumour, which could be accomplished by simple oral rather than parenteral administration.


Cell proliferation kinetics of human gastric carcinoma: an immunohistochemical study with a monoclonal antibody against DNA polymerase-alpha.

Cell proliferation kinetics of human gastric carcinoma were studied immunohistochemically using a monoclonal antibody against DNA polymerase-alpha (Pol-alpha). The distribution patterns and percentages of proliferative cells were examined in cases with various histological types of gastric carcinoma and compared with those of normal epithelium of the gastric foveolae. Pol-alpha-positive epithelial cells were localised at the isthmus of the normal foveola, while Pol-alpha-positive cancer cells were distributed irregularly in the cancer nests. The percentage of Pol-alpha-positive cells (%PPC) was significantly higher in the carcinoma [mean (S.D.) 41.6 (12.9)%] than in the normal foveola [24.8 (6.4)%] (P < 0.01). Also, the intestinal-type carcinoma showed a relatively higher %PPC [44.9 (12.0)%] than the diffuse type [36.2 (15.1)%] (P<0.05), and the %PPC of signet ring cell carcinoma was extremely low [7.3 (2.2)%] (P< 0.01). Pol-alpha-positive cancer cells were observed most abundantly in the lamina propria of the mucosa. They decreased in number with the depth of cancer infiltration down to the subserosa.


High-dose rapid schedule chemotherapy for disseminated neuroblastoma.

In a high-dose schedule for disseminated neuroblastoma, eight courses of chemotherapy were administered every 10 days, regardless of myelosuppression, to eradicate tumour cells rapidly and reduce emergence of drug-resistant clones. Relatively non-myelotoxic vincristine and cisplatin were alternated with high-dose cisplatin-etoposide and cyclophosphamide-etoposide. Of 12 evaluable patients, there were 1 complete (CR), 3 very good partial (VGPR), 5 partial (PR) and 3 mixed responses (MR) 100 days after starting treatment. 6 out of 9 achieved a bone marrow CR at 40 days. 9 of 11 primary tumours were completely resected, after which 4 patients had CR, 3 VGPR (bone scan alone being abnormal), 4 PR and 1 mixed response (MR). Myelotoxicity was the major adverse effect. The only death was due to fungal infection. Clinically important renal dysfunction occurred in 3 patients. 4 had convulsions and 4 temporary hypertension. This schedule produced a rapid response and its toxicity, though serious, was manageable. Further evaluation is warranted.