Grading the severity of chronic pain.

This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.


Predictive factors in advanced cancer pain treated only by analgesics.

Analgesic response, incidental pain and pain mechanism were evaluated in order to predict the chances of pain relief in advanced cancer patients. In an observation period of about 2 months, 130 patients were followed at home until death using only a pharmacological approach to control pain according to the WHO ladders. Ninety-eight patients were considered. Pain relief was considered good if less than moderate. Pain was assessed during the course of examinations (2-3 a week) by independent observers. If other techniques were needed the result was considered negative. The patients were tested with an NSAID (Diclofenac) and assigned to group 1 if the pain became slight in 3 days. If the response was negative, a 4-day trial with opioids was started. If the pain was slight the patient was included in group 3, otherwise in group 5. Every patient belonging to these groups but with incidentical pain was included in groups 2, 4 and 6, respectively. For each group a subdivision was made according to the pain characteristics. There was a progressive worsening in pain relief in groups 4, 5 and 6, suggesting a good correlation between response to the drugs and future chances of pain control in a period of 2 months. This study demonstrates that incidental pain reduces the possibility of pain control (50%) with the exclusive administration of analgesics in patients with a mean life expectation of about 2 months. This negative influence is counterbalanced by the possible individual response to analgesics administered sequentially during a 1-week period (85.8% good pain relief with NSAID, 74% with opioids).(ABSTRACT TRUNCATED AT 250 WORDS)


Validity of the Sickness Impact Profile Roland scale as a measure of dysfunction in chronic pain patients.

This study examined the reliability and validity of the Roland scale (taken from the Sickness Impact Profile: SIP) as a measure of dysfunction among chronic pain patients. One hundred forty-four subjects completed the SIP when they were screened for admission to an inpatient pain management program. One hundred sixteen subjects were subsequently re-administered the SIP at admission to inpatient treatment. A 3-month post-treatment administration of the SIP was performed for 52 of these subjects. Roland scale scores were calculated from the SIP for each patient. Test-retest stability coefficients indicated that the SIP Roland scale was generally as reliable as the SIP Total, Physical, and Psychosocial scale scores. Consistent with previous research, correlational analyses indicated that the SIP Roland scale is strongly associated with the SIP Physical but not the SIP Psychosocial scale. The SIP Roland scale and the other SIP scales demonstrated similar sensitivity to changes associated with multidisciplinary inpatient treatment for chronic pain. Finally, the pattern of relationships between the SIP Roland scale and several pain-related measures supported the concurrent validity of the SIP Roland scale. The results of the analyses were very similar for patients presenting with and without low back pain. The study supports the reliability and validity of the SIP Roland scale items for assessing dysfunction of chronic pain patients with pain in sites other than the low back as well as those with low back pain.


Does a regional nerve block change cutaneous perception thresholds outside the anaesthetic area? Implications for the interpretation of diagnostic blocks.

The present study was performed on pain-free subjects and patients to analyse if local anaesthetics (LA) normally used for nerve blocks in the orofacial region resulted in generalised changes in cutaneous somatosensory perception thresholds outside the territory of the primarily blocked nerve. Five subjects received an intra-oral nerve block and 5 patients received epidural anaesthesia, serving as a reference group considering the larger amounts of LA used in this latter type of anaesthesia. No differences (after vs. prior to LA) were detected regarding thresholds to tactile, cold, warmth or heat pain stimuli in skin areas outside the regions directly blocked. This was also true for the difference limens between warm-cold thresholds. Our data do not indicate any generalised influence on tactile, thermal and pain perception thresholds in pain-free subjects.


The role of ischaemia in the analgesia which follows Bier's block technique.

The effect of 30-min tourniquet ischaemia (Bier's block) on the antidromic homolateral left median nerve sensory potential (SP) and on the bilateral sympathetic skin response (SSR) was studied in 6 healthy volunteers. The SSR was provoked both acoustically and by electrical stimulation of the median nerve; the latter stimulus was also used to provoke the SP. After 28 min of tourniquet ischaemia, the electrical stimulus failed to provoke the SP and bilateral SSR, indicating blockade of the afferent limb of the reflex. The acoustic SSR was unaffected by ischaemia, and thus the efferent limb of the SSR was not blocked, indicating that ischaemia does not affect the post-ganglionic efferent C fibres. These findings confirm that 30 min of ischaemia blocks A beta afferent fibres but does not block efferent C fibres. Thus the analgesia following Bier's block alone, in some patients with sympathetically maintained pain, most likely results from the ischaemic blockade of sensory A beta fibres, confirmed both acoustically and by electrical stimulation of the median nerve.


Chronic back pain, acute postoperative pain and the activation of diffuse noxious inhibitory controls (DNIC).

The effect of the presence of either chronic or acute clinical pain on pain threshold and on the nociceptive flexion reflex (RIII) threshold was studied. The experimental pain sensation and the flexion reflex were evoked by trains of short electrical pulses. It was hypothesized that both kinds of clinical pain would be able to induce 'diffuse noxious inhibitory controls' (DNIC) and thereby raise the 2 experimental thresholds. Patients with chronic low back pain, patients with postoperative pain from oral surgery, and pain-free subjects were tested in 3 conditions: during baseline, after i.v. administration of a placebo, and after i.v. administration of naloxone. In comparison with 2 pain-free control groups, the 2 pain groups had a significantly higher pain threshold in all conditions. However, the RIII threshold was not significantly elevated in chronic or acute pain patients compared to controls. Naloxone had no effect on the RIII or pain threshold in any of the groups. It is concluded that the increased pain threshold which is frequently found in chronic pain patients, and which could be confirmed in the present study, does not result from a DNIC effect. The adaptation level theory offers an alternative explanation. Also, the acute postoperative pain in this study did not seem to induce DNIC. Because other forms of acute pain have been found to be effective in activating DNIC, future research should establish which pains are and which pains are not effective.


Symptoms of impairment, disability and handicap in low back pain: a taxonomy.

The functional consequences on everyday living which result from chronic low back pain commonly require services which are difficult to access. This deficiency in meeting the needs of these patients is partially explained by inadequacies in clinical assessment. Medical evaluation may be exhaustive, but frequently the assessment of physical and psycho-social dysfunction at the personal and family level is inadequate. In low back pain, as with most chronic ailments, there is no agreed-upon taxonomy of the functional consequences of the disorder upon which to establish a comprehensive clinical appraisal. In this paper a taxonomy is presented for the impairments, disabilities and handicaps which result from chronic low back pain. The taxonomy has been based on data from a survey of 74 individuals with low back pain and is structured generally according to the International Classification of Impairments, Disabilities and Handicaps (WHO 1980). The taxonomy is proposed as a conceptual framework and vocabulary for both clinical practice and research. The taxonomy is not a measurement instrument nor does it indicate the frequency of occurrence of disabilities. A classification is basic to the advancement of scientific understanding, and usage of a standard vocabulary such as this plays an important role in establishing a responsive health service capable of meeting the needs of the population with chronic low back pain.


Spatial summation in human thermal pain perception: comparison within and between dermatomes.

Spatial summation of thermal pain has recently been reported when stimulus presentations were restricted within a single dermatome. The present study examined whether the magnitude of spatial summation of human thermal pain perception would vary when stimuli were presented within vs. between adjacent dermatomes. Noxious contact heat stimuli from 43 degrees C to 51 degrees C (5 sec duration) were applied to the forearm using areas of 0.21-2.10 cm2. Subjects rated the intensity and unpleasantness of pain using visual analog scales. For stimuli from 45 degrees C to 51 degrees C, there was a significant increase in ratings with increasing stimulus area for both intensity and unpleasantness. When two thermodes were used simultaneously in adjacent dermatomes, the ratings did not differ significantly from those for the same stimulus area in a single dermatome. We conclude that spatial summation both within and between dermatomes plays a significant role in thermal pain perception across the range from threshold to tolerance.


Akathisia after long-term epidural use of droperidol: a case report.

Droperidol has both anti-emetic and neuroleptic properties and its epidural administration has been reported (Naji et al. 1990). Its side effects when administered via this route are not known. We report a case of long-term (2 months) epidural administration of droperidol to a cancer patient who was receiving epidural morphine and who manifested nausea and vomiting. Akathisia developed progressively and subsided 72 h after droperidol was discontinued.


Treatment of inflammatory, neuropathic and sympathetically maintained pain in a patient with Sjögren's syndrome.

We present a case of Sjögren's syndrome with a painful peripheral neuropathy where pain control required both anti-inflammatory and sympatholytic treatments. This case suggests that the pain in some inflammatory disorders with nerve injury may have a component mediated by an alpha adrenergic receptor.


Self-mutilation following brachial plexus injury sustained at birth.

Self-mutilation after deafferentation injuries has been reported only rarely in adult humans. This behavior has been found to be similar to that observed in animals that have been subjected to experimental deafferentation. We present a child with a brachial plexus injury sustained at birth who began to bite her analgesic digits. Self-mutilation behavior in humans is reviewed and its relevance to current deafferentation pain animal models is examined. This behavior in humans further validates the current animal model of deafferentation pain.


Effects of acetaminophen and antipyrine on non-inflammatory pain and EEG activity.

Antinociceptive effects of the 2 (each 1000 mg, orally) non-steroidal anti-inflammatory drugs (NSAIDs) acetaminophen (paracetamol) and antipyrine (phenazone) were investigated with a non-inflammatory experimental pain model in 32 healthy volunteers. Phasic pain was induced by intracutaneously applied brief electrical pulses (20 msec). Pain ratings, cerebral potentials and the EEG delta power were measured in response to the stimuli. Unspecific effects upon the vigilance system were evaluated by spontaneous EEG, auditory evoked potentials and reaction times. The investigation was performed as a placebo-controlled, double-blind crossover study. Blood samples were taken to monitor the plasma concentrations of the active agents. Ninety minutes after medication the 2 NSAIDs produced similar effects upon all pain-relevant target variables, although the mean plasma concentration of antipyrine (15 micrograms/ml) was approximately twice that of acetaminophen (7.5 microgram/ml). Both NSAIDs reduced pain ratings by 6%, late cerebral potentials by 19%, and stimulus-induced delta power of the EEG by 21%. The antipyrine effects emerged earlier, in agreement with its faster kinetics. Both NSAIDs could be differentiated by their effects upon spontaneous EEG activity. Whereas acetaminophen mainly enhanced the power in the theta range, antipyrine predominantly depressed the alpha frequencies. None of the drugs influenced auditory evoked potentials and reaction times. The central effects of acetaminophen and antipyrine are discussed with respect to antinociception and decrease in vigilance.


Allodynia evoked by intrathecal administration of prostaglandin F2 alpha to conscious mice.

The intrathecal administration of prostaglandin F2 alpha to conscious mice resulted in spontaneous agitation and touch-evoked agitation (allodynia) in the animals. The maximum allodynia induced by prostaglandin F2 alpha was observed at 10-15 min after intrathecal injection, and the response did not disappear by 120 min. Prostaglandin F2 alpha produced allodynia over a wide range of dosage from 0.1 pg to 2.5 micrograms/mouse. Dose dependency of prostaglandin F2 alpha for allodynia showed a skewed bell-shaped pattern, and the maximal allodynic effect was observed at 1.0 microgram. This allodynia was dose-dependently relieved by alpha 1-adrenergic (methoxamine), alpha 2-adrenergic (clonidine), and A1-adenosine (RPIA) agonists. Clonidine was 1.5 orders of magnitude more potent than methoxamine in blocking prostaglandin F2 alpha-induced allodynia. The blockade by clonidine was dose-dependently reversed by the alpha 2-adrenergic antagonist yohimbine but not by the alpha 1-adrenergic antagonist prazosin. These results demonstrate that prostaglandin F2 alpha administered intrathecally induces allodynia in conscious mice and that the allodynia involves the alpha 2-adrenergic and A1-adenosine systems. Because this allodynia has a clear resemblance to the characteristics of chronic pain in patients with causalgia and reflex sympathetic dystrophy, prostaglandin F2 alpha may be involved in allodynia observed with these disorders.


Pain threshold in diabetic rats: effects of good versus poor diabetic control.

Pain threshold was assessed via tail flick latency in streptozotocin diabetic rats following a 1-month period of either good or poor diabetic control. Additionally, tail flick latencies were determined under test conditions of euglycemia (60-120 mg/dl) and hyperglycemia (greater than 250 mg/dl) for both groups of diabetic rats. Conditions of hyperglycemia resulted in a significant decrease in tail flick latency in diabetic animals maintained in good as well as poor diabetic control. However, tail flick latencies for animals in the good but not in the poor diabetic control group increased when animals were euglycemic at the time of testing. Animals in the poor diabetic control group continued to have reduced tail flick latencies even after acute normalization of blood glucose levels. These results suggest that chronic states of hyperglycemia that attend prolonged periods of poor diabetic management may lead to persistent alterations in pain threshold. In contrast, the reduced pain threshold of rats maintained in good diabetic control was reversed by a normalization of blood glucose levels. These findings provide evidence for two patterns of hyperalgesia in diabetic rats: (1) a readily reversible form in well-maintained diabetic rats that is altered by reducing circulating blood glucose levels to control values and (2) a more persistent form found in poorly controlled diabetic rats that does not respond to acute normalization of blood glucose.


Duplex scanning evaluation of internal carotid stenosis. Improved detection of early lesions.

New criteria for the interpretation of duplex scanning waveforms were compared with those devised by Blackshear and Strandness and revealed an improved grading of internal carotid stenosis in early lesions. The ratio of peak frequency minus first zero slope frequency divided by the peak frequency (a-b/a ratio) was found to be of no value in the discrimination between normal and any grade of carotid stenosis. The new criteria depend upon the to dental presence of spectral broadening on the upstroke of systole to differentiate between normal and abnormal, spectral broadening throughout the systolic phase above the end diastolic frequency to determine greater than 15% stenosis, peak frequency greater than 4kHz to indicate greater than 50% stenosis and the absence of a Doppler signal to indicate occlusion. Comparison with two plane selective carotid angiography revealed a Kappa statistic of 0.8 +/- 0.02 using the new criteria compared with 0.65 +/- 0.03 using the established criteria of Doppler waveform analysis.


The LMI test in colon, breast and lung cancer long survivors.

Cell-mediated immunity towards tumour antigens (cytosols) of the same histotype and site was evaluated by means of the LMI test in long survivors after surgical resection of adenocarcinoma of the colon, infiltrating ductal carcinoma of the breast, and squamous-cell carcinoma of the lung. A positive migration index (MI less than 85.0) was observed in 17/65 (26.2%) colon survivors, 7/18 (38.9%) breast survivors, and 1/19 (5.3%) lung survivors. 24.5% of all long survivors displayed an immunological memory of the antigen to which they had been exposed.


Prognostic value of Pugh's modification of Child-Turcotte classification in patients with cirrhosis of the liver.

The Child-Turcotte classification, as modified by Pugh et al., was recorded on diagnosis in 598 completely followed patients with cirrhosis of the liver. The variables that comprise the Pugh classification are ascites, encephalopathy, serum albumin, serum total bilirubin, and prothrombin time. The Pugh score categorized in three classes (class A = score 5 or 6, class B = score 7 to 11, class C = score 12 to 15) separates the series into three groups of approximately equal size with significant differences in median survivals (p less than 0.005) and in survival curves (p less than 0.0001). The characteristics of simplicity, availability, low cost and good discrimination power make the Pugh classification a very useful method to estimate prognosis in patients with cirrhosis of the liver.


On extravisceral soft tissue sarcomas. Effectiveness of radiation treatment and problems of radiotherapy and radiosurgical treatment.

A series of 355 extravisceral soft tissue sarcomas is presented with reference to the effectiveness of radiation treatment for each histological type and the problems of radiotherapy and surgical treatment. Liposarcoma was the most radiosensitive soft tissue sarcoma. By utilizing all types of treatment and especially radiosurgery with postoperative radiotherapy, the percentage of disease-free patients after a minimum of 3 years from treatment varied from 27% to 52.9% for the different types of sarcoma. Nevertheless, in most cases the effectiveness of radiotherapy was unpredictable. It was found that doses varying from 52-60 Gy, with 2 Gy for each of 26-30 applications within 6-8 weeks, were sufficient for radical treatments. In relation to unpredictability of radiotherapy results, it was concluded that preoperative was more advisable than postoperative treatment owing to the possibility to prove the effectiveness of radiotherapy. Postoperative treatment is useless in nonradiosensitive cases and might negatively affect surgical modalities.


Evaluation of skin laceration repair by tissue adhesive in the pediatric emergency room.

The effectiveness of skin laceration repair by tissue adhesive has been evaluated, by comparison also with thread suture and steristrip application, in 926 0-15-year-old patients referred to the Emergency Room of our Institute during 1988. Tissue adhesive has been carried out more frequently in younger children and in some wound localizations especially at the face. At follow-up good aesthetic and functional results were observed. The rare complications, being related to incorrect choice of site application, can be avoided by following appropriate directions for use. Considering the compliance of the patients and their family, this non invasive technique of repair seems to be particularly suitable in childhood.


Recent developments in neurosurgical spinal cord monitoring.

In a review 8 years ago, the then current status of intraoperative spinal cord monitoring (SCM) was discussed. Concerning future developments, that article concluded that the major challenge lay in (a) the improvement of the reliability and clinical relevance of somatosensory evoked potential (SEP) monitoring, where the incidence of false-negative and false-positive results had to be reduced, and (b) the application of new techniques like motor evoked potential (MEP) monitoring, which might turn out to be a method complementary to the SEP approach. Since that time, there has been a considerable amount of newly published results from intraoperative SCM, although clinical articles on exclusively neurosurgical SCM are rare (Table I). A selective literature search for the present review (primarily for the time from 1988 to 1992) yielded more than 200 citations. Eighty-one studies entered into the final evaluation; among these were 3 conference proceedings, 6 book chapters, and 10 review articles. Further, 40 clinical articles, and 22 articles on experimental work were counted. In particular, experimental studies in animals have given support to clinical monitoring by exploring the usefulness of new stimulation and recording techniques. This reappraisal only considers recent work on SEP and MEP in neurosurgical SCM with some experimental studies relevant to clinical SCM. Spinal cord monitoring in orthopaedic surgery is not evaluated in this review for reasons detailed in the article.


Importance of oesophageal manometry in the diagnosis of oesophageal motility disorders. Report of two cases.

Two cases of dysphagia, in which radiology led to an incorrect diagnosis, are described. In case I the X-ray barium swallow showed only minor oesophageal dilatation with no apparent delay in emptying or abnormality of the cardias, yet achalasia was diagnosed by oesophageal manometry. In case 2, although the barium swallow strongly suggested achalasia, manometry showed a less severe motility disorder characterized by lower oesophageal sphincter dysfunction and normal peristalsis. Correct diagnosis obtained with manometry was supported by the different clinical course of the two patients during a 2 year follow up. Oesophageal manometry should always be performed when radiology and/or the patient's history suggest the presence of a motility disorder of the oesophagus since a correct diagnosis is essential for appropriate treatment and follow-up.


Heterogeneous derangement of cellular sodium metabolism in Bartter's syndrome. Description of two cases and review of the literature.

The basic tubular alteration present in Bartter's syndrome is still a subject of controversy. The possibility that a generalized defect in transmembrane ion transport underlies the disease has been extensively investigated. Previous evaluations of cellular sodium metabolism in Bartter's patients showed extremely variable findings. In the present study we have examined in red blood cells of two patients with Bartter's syndrome the intracellular Na+ and K+ concentrations, the activity of ouabain-sensitive Na+/K+ pump, furosemide sensitive Na+/K+ cotransport, Na+/Li+ countertransport, and the rate constant of Na+ and K+ passive permeability. We have compared these values with those of a control group. Ouabain-sensitive Na+/K+ pump activity was decreased in both patients, whereas Na+/Li+ countertransport was activated. One of the patients also exhibited markedly decreased intraerythrocyte K+ concentration and decreased furosemide-sensitive Na+/K+ cotransport. The other had increased Na+/K+ cotransport activity and Na+ passive permeability. Intracellular Na+ and passive permeability to K+ were normal in both subjects. Our results are partially consistent with previously reported observations, and indicate the existence of heterogeneous alterations of erythrocyte sodium transport systems in patients with Bartter's syndrome. Although some of these alterations could be secondary to the electrolyte metabolism derangements of this disease, others might be genetically transmitted and could cause the different renal tubular defects shown in Bartter's disease so far.


Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago.

Mortality, morbidity, health, functional, and psychosocial outcomes were examined in 834 individuals with long term spinal cord injuries. All were treated at one of two British spinal injury centres: the National Spinal Injuries Centre at Stoke Mandeville Hospital or the Regional Spinal Injuries Centre in Southport; all were 20 or more years post injury. Using life table techniques, median survival time was determined for the overall sample (32 years), and for various subgroups based on level and completeness of injury and age at injury. With the number of renal deaths decreasing over time, the cause of death patterns in the study group as it aged began to approximate those of the general population. Morbidity patterns were found to be associated with age, years post injury, or a combination of these factors, depending upon the particular medical complication examined. A current medical examination of 282 of the survivors revealed significant declines in functional abilities associated with the aging process. Declines with age also were found in measures of handicap and life satisfaction, but three quarters of those interviewed reported generally good health and rated their current quality of life as either good or excellent.


Histoplasmosis in an HIV-negative Italian man with mycosis fungoides.

The authors deal with a case of Histoplasmosis in a 50 yr old Italian man without any history of risk exposure to HIV infection and suffering from mycosis fungoides. Although this infection is rare in Europe and particularly in Italy, this case suggests the possibility that soils capable of supporting the saprophytic fungus growth are present even out of the endemic areas.


An audit of five years' experience of pregnancy in spinal cord damaged women. A regional unit's experience and a review of the literature.

In a retrospective review of pregnancy and delivery in 8 spinal cord damaged women managed at Hexham General Hospital Spinal and Maternity Units between 1986 and 1991, antenatal complications included urinary tract infection, anaemia, constipation, suspected deep venous thrombosis and pressure sores. Five of the 8 patients had adductor spasms. Autonomic hyperreflexia occurred in 2 patients in the antenatal period, and in one patient in the postpartum period. Four patients were delivered by caesarean section, and 4 of the 8 patients had breech presentation of the foetus at delivery. The perinatal outcome was good.


Traumatic injury to the spinal cord. Prevalence in Brazilian hospitals.

Traumatic spinal cord lesions have a worldwide high morbidity and mortality, and in many developed countries the problem has received special attention, based on epidemiological studies. In Brazil these studies have been restricted to institutional data. In 1988 a survey conducted by the Integrated System of Traumatology and Orthopaedics, covering 36 public hospitals from 7 Brazilian capitals, revealed a point prevalence of 8.6% (108 patients) with spinal cord injury, aged from 6-56 years; 81% were men. The most frequent causes were traffic accidents (42%), firearms (27%) and falling from heights (15%). The main complications were pressure ulcers (54%) and urinary infections (32%).


Tracheal bronchus associated with bronchiectasis. Case report.

The authors describe a case of ectopic tracheal bronchus (TB) in a 42 years old female. This TB presented bronchiectasis determining various episodes of inflammation in the pulmonary district depending on it. The result of those episodes was atelectasis and fibrotic alterations of the superior right lobe. The mean diagnostic procedure was bronchography. Surgical treatment was performed (superior right lobectomy) with a good result controlled in a 5 year follow-up.


Traumatic spinal cord injuries in Turkey.

Spinal cord lesions have various aetiologies, and trauma is one of the leading causes. Patients with spinal cord injuries (SCI) often have motor, sensory and autonomic dysfunctions and require a multidisciplinary rehabilitation programme. In this study 1694 SCI patients were investigated, including the frequency, and the distribution by age, sex, profession, aetiology, clinical status and year of occurrence. Traumatic SCI is more frequent among males than females and among those between the ages of 15 and 39 years. Regarding the aetiology, traffic accident comprised 35.41% of the total cases, the second most common cause was falls with 29.51%, and the third was high velocity bullet wounds: 21.95%.


A clinical exercise system for paraplegics using functional electrical stimulation.

A low cost clinical exercise system was developed for the spinal cord injured, based on a bicycle ergometer and electrical stimulation. A pilot project was conducted, using the system, to examine the effects of stimulation induced cycling in long term paraplegics. The project comprised 2 phases of exercise, a strengthening phase involving a 12 week programme of electrical stimulation to the quadriceps and hamstrings and a 12 week cycling phase. Physiological, morphological and biochemical parameters were measured for each subject, at the beginning of the programme and following each phase. Results showed that a programme of stimulation induced lower limb exercise increased the exercise tolerance of all patients, as determined by a progressive increase in exercise time, cycling rate and exercise load. The enhanced exercise tolerance was a result of increases in local muscle strength and endurance. Increases in thigh muscle area and joint range of motion were recorded and all incomplete subjects reported an improvement in functional capabilities and general wellbeing.


Tracheostomy in spinal cord injured: frequency and follow up.

Among 600 traumatic spinal cord injured (SCI) patients admitted during a 20 year period, 67 had a tracheostomy performed (11.2%). Of these 67 patients 46 had a cervical SCI. A concomitant thoracic trauma had occurred significantly more often in the group with thoracic or lumbar SCI than in those with a cervical SCI. The period from injury to tracheostomy was 0-48 days (median 4.4 days), and from tracheostomy to decannulation 3-167 days (median 31 days). At follow up 20 (30%) had died, primarily because of respiratory problems. Of the remaining 47 patients, 43 (91%) responded to a follow up questionnaire 3.5-21.7 years (median 10.4 years) after the injury. In the follow up 53% reported never to have had any inconvenience or trouble related to the tracheostomy. The major inconvenience among the others had been of cosmetic origin (28%), and 3 had had a surgical revision for this reason. At the time of follow up 9 patients (21%) still had certain complaints, primarily described as difficulty in swallowing. Minitracheostomy might in the future reduce the number of these complications.


Cystic cord lesions and neurological deterioration in spinal cord injury: operative considerations based on magnetic resonance imaging.

In a retrospective review of 94 consecutive patients with past spinal cord injury referred for magnetic resonance imaging (MRI) for the evaluation of new neurological symptoms, 59% were found to have cystic spinal cord lesions. Twelve of these patients underwent surgical cyst drainage, half having presented with increased myelopathy, and half with ascent of the neurological level. All of the operated cysts were greater than 2 cm in diameter (mean 15.8 cm), and 4 had areas of signal void indicating turbulent flow. All 12 patients had clinical improvement following surgery. The future prospective use of MRI in patients with longstanding spinal cord injury may prove valuable in the identification of patients with syrinx formation, at risk of developing neurological deterioration, who may benefit from early cyst drainage. At present, however, the decision to operate on these patients should be based primarily on clinical criteria.


Electromyographic registration of diaphragmatic fatigue during sustained trunk flexion in cervical cord injured patients.

When performing forward trunk flexion, cervical cord injured (CCI) patients exhibit continuous and high EMG activity in the diaphragm and elevated abdominal pressures. This study addressed the question whether the trunk flexion manoeuvres cause such a high force development in the diaphragm that this muscle shows EMG signs of fatigue. Six patients with complete cervical cord lesions were tested sitting in their own wheelchairs. The tension-time indices obtained when patients were sitting in a relaxed position were moderately to markedly higher than in normal subjects. The force developed during trunk flexion averaged 30% of the maximal transdiaphragmatic pressure and was accompanied by clear EMG findings of diaphragmatic fatigue in all patients except one. The acute diaphragmatic load in certain CCI patients may well produce ischaemia and increase the risk of tissue impairment. Therefore, there appears to be a need for differing strategies in the short and in the long term treatment of CCI patients; longitudinal evaluation of main diaphragmatic function may be useful for an adequate amount of respiratory muscle training.


Solitary spinal osteochondroma causing neural syndromes.

Three cases of solitary osteochondroma of the spine are reported. Two presented with cervical myelopathy and one with radiculopathy. Plain radiography or tomography is adequate for the diagnosis in the majority of cases; nevertheless, a CT scan or MRI is of immense help in planning surgical treatment. The radiological features of spinal exostoses are reviewed.


Pathogenicity of Actinomyces israelii and Arachnia propionica: experimental infection in guinea pigs and phagocytosis and intracellular killing by human polymorphonuclear leukocytes in vitro.

Strains of Actinomyces israelii and Arachnia propionica, isolated from clinical cases of failed endodontic therapy, were examined for: (i) their ability to survive and establish themselves in the soft connective tissue that grew into subcutaneously implanted tissue cages in guinea pigs; (ii) cell-surface hydrophobicity; and (iii) phagocytosis and killing by human polymorphonuclear leukocytes (PMNs) under aerobic and anaerobic conditions. Bacteria were inoculated into the tissue cages in guinea pigs and the cage contents were retrieved after 1, 7, 14 and 21 d for culturing and light and electron microscopy. Both bacterial species showed substantial decline in the number of bacteria by day 7 after the inoculation. Thereafter, the A. israelii strain recovered and, by day 21, had started to increase in number. Light and electron microscopy revealed the formation of typical actinomycotic colonies. A. propionica, on the other hand, continued to decline in number during the entire period of experimental infection and did not form colonies. Both strains were hydrophobic, readily phagocytosed and were efficiently killed by human PMNs under aerobic and anaerobic conditions in vitro. These results suggest that the pathogenicity of A. israelii is due to its ability to establish characteristic cohesive colonies consisting of branching filamentous organisms that are enmeshed in an extracellular matrix. It seems that the organisms existing in such colonies can collectively evade destruction and elimination by host phagocytic cells, whereas in vitro suspensions of the bacteria are easily phagocytosed and efficiently killed by PMNs. With respect to A. propionica, further investigations are necessary to understand its pathogenicity.


Chronic peroral immunization of conventional laboratory rats with mutans streptococci leads to stable acquired suppression of salivary antibodies.

Prior investigations have demonstrated that salivary antibody responses to mutans streptococci are dose-dependent and temporary. The purpose of this study was to evaluate the stability of antibody suppression established by mutans streptococci. Streptococcus mutans 6715-15 was provided in food to conventional rats for 18 weeks. Antigen was withdrawn for 10 weeks and then resumed for an additional 6 weeks. Saliva and serum from nonimmunized controls and from experimental rats were tested with a quantitative enzyme-linked immunosorbent assay for IgA and IgG antibodies to whole bacterial cells and to soluble antigen. Results show that salivary antibodies were stimulated by primary peroral immunization, that IgA was the dominant isotype and that IgA antibodies were primarily directed against soluble antigen. This study also shows that immunity is not maintained, even while challenge continues, and that once suppression is established, immunized animals do not recover their ability to respond, even if exposure is stopped for 10 weeks before re-exposure.


Assessment of the cariogenic potential of Streptococcus mutans strains and its relationship to in vivo caries experience.

Strains of Streptococcus mutans isolated from the plaque of 6 subjects were studied using an in vitro model to determine whether differences in their cariogenic potential could be detected, and if so, whether the results correlated with the caries experience of the individuals. Each strain was incubated with a bovine enamel slab and 5% (w/v) sucrose for 24-h periods. The acidogenic potential was assessed by pH measurement and analysis of acid anion production. Microradiographic and microdensitometric assessment of the enamel, together with measurement of the change in calcium concentration of the reaction mixture were used to determine the demineralizing potential of each strain. Significant differences in cariogenic potential were found between some of the strains tested, and correlations were found between 3 of the test parameters and the decayed-missing-filled-surface score of the individuals. The results suggest that the caries experience of individuals may be related, to some extent, to the cariogenic potential of their S. mutans strains.


Purification and properties of sorbitol-6-phosphate dehydrogenase from oral streptococci.

The activity of sorbitol-6-phosphate (S6P) dehydrogenase (S6PDH) and the sorbitol transport system were studied in strains of the oral streptococci Streptococcus gordonii, Streptococcus mitis, Streptococcus sanguis and Streptococcus mutans. Genetically transformed (to ferment sorbitol) strains and their DNA donors were included. S6PDH was purified by anion exchange chromatography and gel filtration. The purity of the enzyme was confirmed by polyacrylamide gel electrophoresis. The purified enzyme from all the strains exhibited Michaelis-Menton saturation kinetics. The Km values for nicotinamide-adenine dinucleotide (NAD) and S6P ranged between 0.03 and 0.21 mM and 0.07 and 0.20 mM respectively. The relative molecular weights of the native enzyme were 229,000 for one donor-transformant pair (S. sanguis and S. gordonii), 107,000 for the other pair (S. mitis and S. gordonii) and 129,000 for S. mutans. The molecular weights of the S6PDH subunits ranged from 26,000 to 28,000. The pH optima (greater than 8.5) and the amino acid composition (15 amino acids examined) were similar for the S6PDH from the different strains. However, the chromatographic and electrophoretic patterns as well as the Km values for NAD and S6P were the same only between the S6PDHs from the strains within each donor-transformant pair. Purified S6PDH from S. mutans also exhibited low mannitol-1-phosphate dehydrogenase activity. Sorbitol-grown decryptified cells of all the strains phosphorylated sorbitol in the presence of phosphoenolpyruvate but not in the presence of adenosine triphosphate (ATP). ATP-mediated phosphorylation of glucose was observed with the same strains when grown on glucose. No evidence for a non-phosphotransferase transport system was found for sorbitol in any of the strains.(ABSTRACT TRUNCATED AT 250 WORDS)


Mechanism of water-insoluble glucan synthesis in Streptococcus sobrinus.

Synthesis of water-insoluble glucan (IG) by 1,3-alpha-D-glucan synthase from Streptococcus sobrinus was examined using methylation analysis. The purified enzyme was incubated with sucrose and dextran T2000 (DT2000) for a given time and only IG was harvested by centrifugation. The remaining supernatant was incubated again, and IG was obtained. By repeating the above method using the residual supernatant, we obtained 5 varieties of IG precipitated in different periods. These IGs were methylated and examined using gas chromatograph mass spectrometry. The DT2000 water-insolubilized in the early reaction stage tended to have a highly ramified structure, with 1,3-alpha-D-glucan on a 1,6-alpha-D-glucan chain as the main chain. On the contrary, the DT2000 water-insolubilized in the late stage tended to have sparse side chains of 1,3-alpha-D-glucan which elongated with incubation. Specifically, the greater the number of side chains, the sooner the DT2000 was insolubilized. These results suggest that water-insolubilization of the water-soluble glucan not only depends on the increase of the ratio of 1,3-alpha-glucoside linkages to 1,6-alpha-glucoside linkages but also on the degree of branching of the 1,3,6-alpha-branched glucoside linkages.


Processes involved in the regulation of urease levels in Streptococcus salivarius by pH.

Urease levels in Streptococcus salivarius are regulated by pH. There is either increased synthesis at low pH (5.5) or enhanced degradation at neutral pH, suggested by urease instability during stationary phase. To establish which mechanism predominates, protein synthesis was inhibited by chloramphenicol (CAP) in cultures grown at pH 5.8, 6.8 and 7.3. There was no significant urease degradation detectable in mid-exponential and early-stationary phase at any pH. Urease degradation occurred in both control and CAP cultures later in stationary phase, but with a faster rate of decline in the low pH culture. After CAP addition there was detectable assembly of urease from pools of post-translational subunits to give an approximately 20% increase in enzyme. Above pH 7, 0.1% cysteine inhibited urease synthesis but not growth, and evidence was obtained for O2 inhibition of growth and urease synthesis. Regulation of urease levels in S. salivarius by pH primarily involves an effect on urease synthesis. There may be cross-regulation between pH control, anaerobiosis-controlled enzyme regulatory circuits and thiols.


Stimulatory effect of bicarbonate on the glycolysis of Actinomyces viscosus and its biochemical mechanism.

The effects of bicarbonate on acid production by 4 human strains of Actinomyces viscosus were estimated under anaerobic conditions. The rate of acid production was accelerated by bicarbonate 3-4 times as much as that without bicarbonate. The analyses of intracellular glycolytic intermediates, NAD and NADH revealed a decrease in NADH:NAD ratio and an increase in the level of 3-phosphoglycerate in the cells when bicarbonate was present. Furthermore, when bicarbonate was available, malate dehydrogenase and fumarate reductase in the succinate pathway were expected to function as NADH-oxidizing enzymes in addition to lactate dehydrogenase. These observations indicate the efficient regeneration of NAD in the presence of bicarbonate. Thus, the stimulation of A. viscosus glycolysis by bicarbonate was thought to stem from the activation of glyceraldehyde 3-phosphate dehydrogenase (G3PDH) by the decrease in the level of NADH, because NADH was a strong inhibitor of G3PDH in this microorganism.


DNA probes for detection of cariogenic Streptococcus mutans.

Streptococcus mutans has been identified as the principal etiological agent in human dental caries. Therefore, the specificity and sensitivity of 3 potential gene probes derived from S. mutans GS5 have been examined as potential reagents for detecting the cariogenic bacteria. The gene probes derived from the cloned gtfB, gtfD and ftf genes were examined in Southern blots with a panel of representative oral bacteria. The gtfB and ftf genes were apparently specific for S. mutans under high-stringency hybridization conditions. However, the gtfD gene fragment did cross-hybridize with the DNA from other mutans streptococci. These results suggest that gtfB and ftf gene fragments may be used as specific probes for S. mutans.


Immunochemical and structural characterization of the antigenic polysaccharide from Eubacterium saburreum T18.

An antigenic surface polysaccharide produced by Eubacterium saburreum strain T18, isolated from human dental plaque, was purified from formamide extract of whole cells. Methylation analysis, Smith degradation, optical rotation data and nuclear magnetic resonance spectra demonstrated that the purified antigen was a homopolysaccharide composed of D-glycero-D-galacto-heptose (Hep.) residues. The structure of the repeating unit in the polysaccharide was: -[----6)-[alpha-Hep.furanosyl-(1----4)]-beta-Hep.pyranosyl- (1----6)-[alpha-Hep.furanosyl-(1----2), alpha-Hep.furanosyl-(1----4)]-beta- Hep.pyranosyl-(1-)4----6)-beta-Hep.pyranosyl-(1----. No heptose residues were acetylated. Immunodiffusion reactions in agar gel suggested that the immunodeterminant of the antigenic polysaccharide was D-glycero-D-galacto-heptofuranosyl residues as branched nonreducing terminals.


A comparison of three methods for estimating dental plaque removal from individual teeth.

The purpose of this study was to determine the efficiency of dental plaque removal, in vitro, by physical force. Of the 3 methods used, turbidity was the most sensitive for measuring microgram amounts of plaque. Air-dried weight and dental plaque imprint assays (DPIA) complemented turbidity measurements by providing a weight standard and a new method for visualizing plaque bacterial structure before the stained imprint was transformed into numerical data. The amount of dental plaque removed from a tooth by physical force can be measured and described as a percentage of the total removable plaque on that tooth.


Suppressive effect of soluble factor(s) derived from Prevotella loescheii ATCC 15930 on proliferation of human lymphocytes.

Soluble sonic extracts of Prevotella loescheii caused a dose-dependent inhibition of human peripheral blood lymphocyte proliferation by mitogen and of the proliferation of a leukemic cell line, BALL-1, when assessed by DNA synthesis (3H-thymidine incorporation). RNA (3H-uridine incorporation) and protein (3H-leucine incorporation) synthesis were similarly altered after exposure to the extract. There was no effect on cell viability as measured by either trypan blue exclusion or extracellular release of the cytoplasmic enzyme lactate dehydrogenase. Preliminary characterization indicates the suppressive factor(s) derived from P. loescheii to be a protein since it is heat-labile and trypsin-sensitive. The factor eluted in a peak on a high-pressure liquid chromatography gel filtration corresponding to a molecular weight of approximately 32,000. Since black-pigmented anaerobic rods have been implicated in the pathogenesis of periodontal disease, the data suggest that P. loescheii contributes to the disease process by suppressing lymphocyte function.


Laminin binding to Prevotella intermedia.

The interaction of laminin (Lm), a basement membrane protein abundant in the periodontium, with 66 strains of Prevotella intermedia isolated from diseased pockets, was tested in a 125I-labeled protein binding assay. The mean binding value was 28% of the total protein added. The binding significantly increased to 35% when the environmental pH decreased from 7 to 6. The Lm interaction was characterized in a highly binding (about 65%) strain, OMGS105. The binding was rapid and required about 1 min and 1-2 h for 50% and 100% equilibrium respectively. The 125I-Lm binding was maximum in the pH interval 3.0 to 6.5 and could not be displaced by unlabeled Lm or inhibited by other proteins and carbohydrates. The interaction was stable in the presence of NaCl or urea (concentrations up to 4 M) but was dissociated by > or = 1 M KSCN. The Lm-binding component was thermolabile and sensitive to proteolytic enzymes. Sodium dodecylsulfate-polyacrylamide gel electrophoresis and Western blot analysis revealed a approximately 62 kDa Lm-binding protein, both in the whole cell extract and the outer membrane preparation. Weaker binding was also observed to other proteins. These data establish the ability of P. intermedia to interact with Lm via certain cell surface proteins, a property that might contribute to the colonization of this bacterium in the periodontal pocket.


Strain identification of Actinobacillus actinomycetemcomitans using the polymerase chain reaction.

A molecular assay that distinguishes among strains of the periodontal pathogen Actinobacillus actinomycetemcomitans was developed by identifying DNA restriction site polymorphisms in the highly variable transcribed spacer region between the 16S and 23S ribosomal genes. The polymerase chain reaction (PCR) was used to amplify this region from genomic DNA using primers within conserved regions of the 16S and 23S genes. This amplified region was digested using a series of restriction enzymes and electrophoresed. Examination of restriction fragment length polymorphisms obtained by separate digestion with RsaI and NciI allowed the 7 strains examined to be divided into 4 genetic groups. This assay provides a more precise and reproducible method of strain identification than whole genomic methods and should be useful as a method for studying the epidemiology of A. actinomycetemcomitans strains in human subjects. The genetic variability detected supplies strong evidence that direct sequence analysis of the region could provide extremely precise and potentially definitive identification of strains.


Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis in subgingival plaque of adolescents with Down's syndrome.

Levels of Actinobacillus actinomycetemcomitans, Capnocytophaga and Porphyromonas gingivalis were determined in subgingival plaque samples from 37 adolescents with Down's syndrome and 37 healthy controls matched with respect to age and sex. Gingival inflammation, supra- and subgingival calculus, periodontal pockets ( > 4 mm) and alveolar bone loss were registered. Alveolar bone loss was more frequent in Down's syndrome subjects (32%) than in the controls (3%). A. actinomycetemcomitans was detected in the subgingival plaque in 35% of the Down's syndrome adolescents and in 5% of the controls. On site level, A. actinomycetemcomitans and Capnocytophaga were more frequent in the subgingival plaque samples of Down's syndrome children than in those of controls. Comparing Down's syndrome subjects positive or negative for A. actinomycetemcomitans and Capnocytophaga, no significant differences were found in terms of gingival inflammation, periodontal pockets ( > 4 mm) or number of sites with alveolar bone loss. The results indicate an altered microbial composition of the subgingival plaque of Down's syndrome subjects compared with healthy controls, with higher frequency of A. actinomycetemcomitans.


Enterococci in human periodontitis.

Enterococci are potential pathogens in many human body sites. This study determined the subgingival occurrence and the in vitro antimicrobial susceptibility of enterococci in 100 persons with early-onset periodontitis and 545 persons with advanced adult periodontitis. Subgingival microbial samples were collected with paper points, transported in VMGA III and plated onto anaerobic enriched brucella blood agar or selective Enterococcosel agar (BBL Microbiology Systems). Enterococcal speciation was performed using commercial micromethod kit systems. In vitro sensitivity was determined using a commercial kit system and an agar dilution assay. Subgingival enterococci occurred in 1% of early-onset periodontitis patients and in approximately 5% of adult periodontitis patients. Enterococcus faecalis was the only enterococcal species recovered, and all but one isolate belonged to the same biotype. In vitro antimicrobial sensitivity testing revealed subgingival enterococci resistant to therapeutic levels of penicillin G, tetracycline, clindamycin and metronidazole, but relatively sensitive to ciprofloxacin and amoxicillin/potassium clavulanate (Augmentin). Enterococci may populate periodontal pockets as superinfecting organisms and, in heavily infected patients, may contribute to periodontal breakdown.


Experimentally induced infection by oral anaerobic microorganisms in a mouse model.

A mouse model was developed to study the abscessogenic potential of pure and mixed cultures of oral anaerobes associated with infections of endodontic origin. Maximum subcutaneous lesions were seen on their backs between 3 and 14 d after inoculation. Strains of Fusobacterium nucleatum, Peptostreptococcus anaerobius, and Veillonella parvula were pathogenic in pure culture. A mixed culture of F. nucleatum with either Porphyromonas gingivalis or Prevotella intermedia was significantly more pathogenic than F. nucleatum in pure culture. Histopathological examination of tissue sections from control mice injected with India ink in the medium demonstrated a pathway of particulate migration from the backs of the mice to their abdomen.


[The effect of the vole subspecies of the plague microbe on the viability of Callopsylla caspia fleas].

When infected with cultures of plague microbe reared at 28 C the experimental fleas showed no reliable differences in the mortality as compared to control ones. By contrast, the infection with agent cultures reared at 37 C as well as the infection on agonizing white mice caused a statistically reliable increase in the mortality in insects of both sexes. In the groups of fleas infected on white mice the most intensive mortality was observed during the first 24 hours after the infectious feeding that, apparently, is connected with the effect of toxins present in the blood of agonizing animals.


[A finding of Blastocystis galli (Rhizopoda, Lobosea) in domestic turkeys].

Blastocysts tentatively assigned to the species Blastocystis galli were found in the turkey Meleagris gallopavo from Tajikistan and Uzbekistan. Length and width of blastocysts from turkeys vary in a wider range (2.5--55.1 x 2.5--51.3 mkm) than length and width of blastocysts from hens. The shape of blastocysts varies from round and oval to ellipsoid and amoeboid.


[The parasite-host specificity of the itch mite Sarcoptes scabiei (Acariformes: Sarcoptidae) in man and animals (a review of the literature)].

The primary parasitic relations between the itch mite Sarcoptes scabiei (L.) and man are confirmed indirectly by the presence in the family Sarcoptidae of close genera, members of which parasitize primates. Judging from the composition of domestic and wild animals-hosts, the source of their infection with S. scabiei was man that gave rise to numerous forms of mites specific to individual species of hosts or their related groups belonging to different taxonomic ranks. Three types of host relations and, accordingly, forms of sarcoptosis are suggested at the infection from an alien host: pseudosarcoptosis, temporary self-curable and typical lingering sarcoptosis. The ways of reinfection, invasiveness of stages of the mite and clinical picture for each form of the disease are analyzed.


[The characteristics of the ixodid tick-vertebrate animal parasitic system].

The parasitic system ixodid tick (parasite)--vertebrate animal (host) is relatively stable in space and time. Equilibrium state in the system is maintained at the low levels of the hosts' infection and moderate intensity of their immunity. Parasite sensitizes the host's organism at the stage of feeding on antigens of its saliva and the host develops different degrees of resistance preventing the subsequent individuals of ticks from normal feeding. Antitick immunity is species specific. Its intensity is defined by the species belonging of the parasite and host, intensity and intervals between infections, availability of "anti-immune mechanisms" in tick and by many other factors, which are realized at the feeding stage. Regulation of the number of ticks, depending on their abundance in the host's population, is attained due to the oversparse, close to negative binomial distribution on hosts. This mechanism functions on the principle of feedback, so that at the excessive number of the parasite some individuals in the host's population, which are especially subjected to infection, do not cope with parasitic burden and die. However, ticks, which failed to finish their feeding and represent a disproportionately great part of the whole parasite's population, die together with them and the parasitic system quickly restores its stability. In anthropocoenoses and ecosystems at different stages of anthropogenic transformation mutual regulation mechanisms of the parasite and host number break down. As a consequence, extremely high rises in the number of ticks and epizootics of agricultural animals associated with them can occur.


[The penetration of Sporozoa into host cells].

The analysis of morphological and functional peculiarities of sporo- and merozoites as disseminative stages of the sporozoan life-cycle is given. Penetration of parasites into the host's cells is a complex multistepped process very similar to the induced but not completed phagocytosis. As a result of that process the formation of the integrated cell system, which consists of the host's cell and the unicellular parasite takes place.


[The characteristics of the helminth community in the Turkmen kulan (Equus hemionus)].

The helminth fauna of 24 kulans from Askaniya-Nova and Badkhyz was studied. 42 species of helminths were found, 34 of which belong to strongylids. The helminth species composition of kulan is similar to that of other species of horses. This is a result of an intensive parasite exchange in the historical past when numerous populations of different Equidae species made long seasonal migrations over steppe inter-river lands of Asia and grazed for some time on common pastures.


[Microsporidians in bloodsucking Aedes (O.) cataphylla mosquitoes in Ukraine].

The paper reports the results of studies on Microsporidia from the bloodsucking mosquito Aedes cataphylla for the period from 1974 undertaken in the Kiev and Chernigov Provinces of the Ukraine. A new species, Amblyospora cataphyllus sp. n., is described from larvae of the mosquito. Living spores oval or elongate-oval, 6.3--7.5 x 4.5--5.0 (most commonly 6.8 x 4.8) microns, fixed spores oval, 5.6--6.9 x 3.8--4.8 microns. Mucocalyx becomes distinct around spores in 10 to 15 days after the preparation is made. Spontaneously ejected polar tube 125 microns long. Exospore smooth or undulate, 170 to 310 nm thick, endospore 60 to 160 nm. Polaroplast elongated and curved, its 1/3 is composed of closely situated plates and 2/3 of more widely arranged ones. Polar tube anisophyllous, forms 18 to 20 spires in a spore, of which 3 to 5 spires form basal area and 14 to 16 form distal area (of them 1-2 most thick spires form intermediate area). Nucleus large, in a shape of half-ring. In living spores posterior vacuole crescentic, in fixed ones it is strongly deformed together with hind pole of spores. Sporogony of Microsporidia takes place in larvae of mosquitoes of both sexes. Infection extensiveness of IV stage larvae is 10%.


Klippel-Feil syndrome.

Nurses working with orthopaedic clients and pediatric populations may be the first to recognize the classic triad of Klippel-Feil syndrome: short neck, limitation of neck motion, and low occipital hairline. Klippel-Feil syndrome is a congenital malformation of the cervical vertebrae, with limited treatment options. Client/family education is vital to monitor and maintain function and to prevent neurologic deficits resulting from the fusions, accidents, or trauma.


Total elbow replacement.

Elbow joint replacement is performed primarily in patients with severe elbow pain and elbow joint destruction caused by rheumatoid arthritis. The capitellocondylar implant is the prototype of the nonconstrained elbow resurfacing implant. Successful total elbow joint replacement can result in pain relief and improve rotation and flexion of the arm. Outpatient and inpatient nursing intervention in coordination with occupational therapy promotes optimum function.


Developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH), formerly known as congenital dislocation of the hip (CDH), is a term used to describe a variety of abnormalities of the hip in development. The treatment options are diverse depending on etiology, degree of dislocation, and age of the child when diagnosis is made. This article provides the reader with a knowledge base to assist with early diagnosis, treatment, and nursing care of the client with dislocations and subluxations of the hip. Presented are the definitions, diagnostic techniques, treatments, and nursing diagnoses and interventions for the client with DDH and for the child's family.


After Cruzan: the "values base" to advance directives.

Technologic advances produce ethical quandaries for health care professionals and the public. Often difficult decisions must be made about treatment. In light of the 1990 U.S. Supreme Court's ruling in the case of Nancy Cruzan, health care decisions surrounding life-sustaining treatment may be affected. National attention is refocused on advance directives (the living will and durable power of attorney for health care decisions). This article considers the possible need for additional "clear and convincing" evidence of the patient's wishes regarding these directives. Included is a Value History Form that provides an avenue of expression for patient values and beliefs.


Expression of the T-cell receptor in HIV infection.

Expression of the T-cell receptor (TCR) was investigated on peripheral lymphocytes in 270 samples from HIV+ patients at different stages of infection. TCR is composed either of an alpha and a beta chain, or, in a smaller subset of T-cells, of a gamma and a delta chain, closely associated with CD3. The numbers and percentages of positive cells were established using monoclonals to the alpha and delta chains of TCR. The values of alpha-TCR positive cells were constantly lower than those observed for CD3, with a mean of 53% (+/- 19%) versus 66% (+/- 17) respectively for asymptomatic patients or patients with persistent generalized lymphadenopathy, and of 36% (+/- 19) versus 46% (+/- 21) for patients with AIDS disease. There was no compensatory increase in the number of cells expressing delta-TCR. These data demonstrate a new alteration of the immune system in HIV infection, which appears to occur early in this disease.


[Value of serum immunoglobulin assays in early myocardial infarction].

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.


[Value of quinolones in the treatment of lower respiratory tract infections caused by intracellular organisms, excluding mycobacteria].

In vitro studies of quinolones against intracellular pathogens responsible for lower respiratory tract infections have shown that growth inhibition varies with the strain and with the drug. Following administration of quinolones, drug levels in the lower respiratory tract are similar to or greater than serum levels. Quinolones penetrate readily into cells. The effectiveness of quinolones in lower respiratory tract infections has been demonstrated in both in vitro intracellular infection models and in vivo animal models. These data show that quinolones are a valid therapeutic alternative for lower respiratory tract infections due to intracellular organisms.


[Fibronectins].

Fibronectins are complex glycoprotein macromolecules whose molecular weight is 440 kilodaltons. These proteins, found throughout the body, are soluble in biological fluids and insoluble in connective tissue. They contribute to tissue morphogenesis through multiple interactions with cells and extracellular matrix components. Fibronectins play a key role in cell attachment and remodeling during embryonic development, in cell migration and anchorage during wound healing, and in immune responses. This review discusses the structure of fibronectins, their integrin cell receptors, their biologic properties and their implications for diseases.


[Relationship between left and right ventricular function in experimental acute focal ischemia].

Experiments were conducted on rats to record the parameters characterizing the real and maximally accessible function of the left and right ventricles in acute focal ischemia of the myocardium of these parts 5, 20, 40, and 60 minutes after ligation of the corresponding coronary artery. It was established that disorders of synchronism in heart activity are greater in injury to the right than in those to the left ventricle.


[Effect of a drug isolated from the heart on the bioenergetics of cardiomyocytes in hypoxia and ischemia].

It has been established that cordialin inhibits selectively succinic acid oxidation and intensifies the exudation of a NADH2 substrate which is energetically more advantageous, and in this way has a favorable effect on energy metabolism, evidence of which is increase of the ATP content in the myocardium. Cordialin correction of the biologic energy of cardiomyocytes in hypoxia and ischemia prevents the accumulation of lipid drops in the cells of the peri-infarction zone, which reflects the high intensity of the processes of fatty acids beta-oxidation. As a result of this glycolysis activation is unnecessary (which is confirmed by high glycogen content, both of a qualitative and quantitative character, in the myocardium and low concentrations of glucose and lactate in the blood) and, consequently, the sequelae of acidosis are prevented.


[Role of the opioid system in prevention of ischemic disorders of cardiac rhythm during adaptation to cold and physical exertion in rats].

It was found that adaptation of rats to cold and physical exercise prevented ventricular fibrillation caused by occlusion of the left anterior coronary artery. Adaptation to cold or only to physical exercise did not prevent ventricular arrhythmias. A significant increase of the beta-endorphin content in the hypophysis and hypothalamus was demonstrated in all adapted rats. An increased content of meth-enkephalin (ME) in the myocardium was found only in rats adapted to cold and physical exercise. It is suggested that increase of the myocardial ME content is of essential significance in the antiarrhythmic action of adaptation.


[Mechanisms of the protective action of neoton in immune heart diseases].

An attempt was made to reveal some membrane mechanisms of the protective effect of phosphocreatine (Neoton produced by the Schiappare firm, injected intravenously in a dose of 500 mg/kg) predominantly on the endothelium of the coronary vessels and the cardiomyocytes. Local immune damage to the left-ventricular myocardium was produced by intracoronary injection of anticardiac antibodies. Morphological and biochemical studies showed damage to the membrane of endotheliocytes and cardiomyocytes: reduced activity of Na-Cametabolism and Na-, K-ATPase. The obtained data bore evidence of the protective effect of phosphocreatine in immune damage to the heart, which was realized on the level of the endotheliocyte and cardiomyocyte membranes.


[Changes in function of sarcoplasmic reticulum and myocardial phospholipid content in immune heart damage].

The effect of acute cytotoxic reaction in the heart on Ca transport activity in the sarcoplasmic reticulum and the phospholipid content of the myocardium was studied. A single intracoronary injection of anticardiac serum reduced Ca, Mg-ATPase activity and the Ca energy-dependent transport but caused no changes in membrane permeability to Ca. As the result of immune damage the content of phospholipids--cardiolipin and phosphatidylethanolamine--in the myocardium reduced.


[Correction of tetramethylthiuram disulfide-induced damage to the myocardium by cardiac peptides].

Standardized complex of low-molecular peptides from the heart, cordialin, stimulates functional activity of cardiomyocytes and mobilizes their protective mechanisms against the effect of the industrial and agricultural poison tetramethylthiuram disulfide (TMTD). The cardioprotective effect of cordialin is most marked in the restoration period when it was administered after TMTD damage to the cardiomyocytes.


[Antistress and cardioprotective properties of the synthetic analog of endogenous opioids dalargin in experimental burn trauma in rats].

The author studied the effect of Dalargin on the dynamics of experimental burn trauma in Wistar rats, which was evaluated according to values of lethality, the level of stress ulcero-erosive affection of the gastric mucosa, and the degree of functional activity of an isolated perfused heart. The antistress effect of Dalargin, consisting in limitation of ulcer formation in the gastric mucosa, was determined by dose-temporal characteristics which made it possible to develop the optimal schemes of Dalargin administration in the treatment of a burn trauma. This was manifested by reduced lethality among the experimental rats compared to that among the controls and marked limitation of stress ulcer formation and by significantly diminished cardiodepressive effect of burn toxemia. Besides, the protective effect of Dalargin was connected with the direct formation of resistance to hypoxia of the myocardium of rats with burns.


[Dose-dependent effect of diltiazem on some lipid metabolic parameters in hemorrhagic shock in cats].

The possibility of modulating the phospholipid composition in the plasma membranes of hepatocytes and adipocytes by the calcium channel blocker diltiazem was studied on a model of hemorrhagic shock. Diltiazem injection facilitated normalization of phosphatidylinositol metabolism in the hepatocyte plasma membranes. Injection of a high dose of diltiazem was attended by a rise of the phosphatidylethanolamine level. Only low doses of diltiazem caused a normalizing effect on the phospholipid composition of adipocyte plasma membranes. A low dose of diltiazem caused a reduction in the content of very low density lipoproteins in venous blood, while a high dose reduced the content of low density lipoproteins.


[Role of the sympathetic nervous system in the formation of indomethacin-induced hemorrhage and ulceration of the stomach in albino rats].

The authors studied changes of electrical activity of the gastroduodenal smooth muscles, sympathetic efferent impulses in the postganglionic branches of the celiac plexus and macro-morphology of the gastric mucosa during the development of indomethacin gastropathies. By the end of the 3rd hour and later after the injection of the drug (15, 30 mg/kg) progressive inhibition of impulses and basal rhythm of gastric smooth muscles was encountered in intensified electrical activity of the duodenal smooth muscles, as well as destructions in the gastric mucosa even to the development of ulcers (6-24 hours). It is concluded that the development of indomethacin hemorrhages and ulcerations along with other factors is caused by excitation of the sympathetic nervous system attended by phasic changes of the sympathetic efferent impulses and electrical activity of the gastroduodenal zone.


[Effect of stress on translocation on the glucocorticoid receptor complex into the nuclei of rat hepatocytes].

The effect of 24-hour immobilization stress on the translocation of glucocorticoid-receptor complex into the nuclei of hepatocytes was studied in experiments on male Wistar rats weighing 150-180 g. The level of translocation of the steroid-receptor complexes was appraised by incubation (0 degree C, 1 hour) of hepatocyte nuclei (6 x 10(-6)) with a glucocorticoid-receptor complex which was obtained by preliminary saturation of diluted hepatic cytosol with triamcinolone 3H-acetonide (80 nM) for 3 hours with adsorption of unbound labeled steroid. Translocation of the glucocorticoid-receptor complex of hepatic cytosol of rats subjected to stress occurred in a significantly less number into the hepatocyte nuclei of intact rats than into those of rats which had suffered stress. In contrast, translocation of the glucocorticoid-receptor complex of hepatic cytosol of intact rats into the nuclei of hepatocytes of stressed rats was significantly higher than translocation into hepatocyte nuclei of intact rats. It is concluded that the level of inhibition and activation of translocation in the cytoplasm of hepatic cells increases in stress.


[Antioxidant liver enzymes in chronic liver disease].

Biopsy of the liver of 73 patients with chronic affection of the hepatobiliary system was conducted to study the enzymatic system of inactivation of the active forms of hepatic oxygen according to the stage of the chronic process. Reduced activity of superoxide dismutase and catalase and disruption of their relationship in chronic active hepatitis were revealed. Significantly diminished rate of inactivation of superoxide radicals was encountered in fibrosis and primary biliary cirrhosis. The informative importance of the catalase/NADP H-peroxidase index in appraising chronic affection of the hepatic tissue is shown. It is concluded that the interrelation of the antioxidative enzymes as a system of antioxidant protection of hepatocytes is impaired in chronic diseases of the liver.


[Ultrastructure of erythrocytes with diminished flow properties and their role in the development of microcirculatory disorders under extreme conditions].

The deformability (D) of erythrocytes and their ultrastructure in the microcirculatory channel of vital tissues of the organism were studied in experiments on rabbits in two types of extreme conditions: staphylococci toxicosis and the postischemic syndrome. Erythrocyte deformability in each of these extreme conditions occurred in the late phase of the process and was manifested by destruction of the ultrastructural organization of the membrane matrix and the cytoplasm of cells in the microvessels. Destruction of the erythrocyte membranes was linked with their disintegration into micro- and macro-fragments (in staphylococci toxicosis) and separation of membrane areas in the form of microvesicles (in the postischemic syndrome). Damage to the erythrocyte membrane and cytoplasm may be considered to be one of the typical manifestations of the organism's response to extreme effects accompanying the phenomena of disseminated intravascular clotting.


[Status of the erythron during growth of induced tumors].

The authors conducted complex (with the use of radionuclide, cytospectrophotometric, electron microscopic, interfermometric, and other methods) examination of the morpho-functional condition of the central and peripheral erythron links in rats during the development of tumors induced by 20-methyl-cholanthrene administration. It was found that increased hemolysis of mature circulating red cells plays the principle role in the pathogenesis of anemia developing in the experimental animals. The early periods of the hemolysis may be detected in the latent period of cancerogenesis.


[Mechanisms of post-traumatic anemia].

Diminution of hemolytic anemia in animals with bilateral nephrectomy was demonstrated in experiments on rats and dogs with trauma (24-hour crush syndrome). The mechanism of early posttraumatic erythrodieresis is linked with the effect of humoral hemolytic factors and injury to the poorly-stable red cell population during passage through the renal vessels of the animals 24 hours after the traumatic damage.


[Rate of progress of chronic renal insufficiency during low-protein diet].

The rate of progress of chronic renal insufficiency (CRI) under conditions of a diet with a moderate protein content and during a free diet was studied in 40 children with tubulointerstitial renal diseases and glomerulonephritis by determining the dependence of reciprocal serum creatinine on the time. A low-protein diet had a positive effect on the rate of CRI progress in children with tubulointerstitial diseases of the kidneys. The prognostic error--the difference between the foretold and the true period of time to the "death of the kidney" was 12% on the average.


[Effect of sodium fluoride on bone tissue regeneration in hypodynamia].

It was demonstrated in rat experiments that a nonsupported position of the extremity attained by exarticulation of the leg in 10 to 40 days leads to a sharp inhibition of posttraumatic regeneration of bone tissue. Daily injection of 0.4 mg/100 g sodium fluoride, which was used in the clinic for the prevention and treatment of osteoporosis, inhibited still more the regenerative processes both under conditions of hypodynamia and also when the supporting function of the extremity was maintained.


Myths about childhood obesity.

Childhood obesity is a multifactorial and complex disease. Myths such as those that we have described may distract our patients from the underlying behaviors that contribute to the disease or may deflect the blame perceived by obese patients and their parents. Myths that suggest that the obese are inactive, eat differently, or eat more junk food suggest that obese individuals are socially deviant and justifies the intense discrimination directed against them. The myth that obesity represents an untreatable disease helps free health-care professionals from the responsibility to understand and care for obese children. Dispelling the myths about childhood obesity represents a critical step in prevention and treatment.


Allergy, intolerance, and other adverse reactions to foods.

Adverse reactions (sensitivity) to foods are categorized as either allergic (immunologic) or intolerance (nonimmunologic). Some medical conditions caused by intolerance reactions have immunologic features, but these have not adequately explained the basis of these conditions. Idiosyncratic, toxic, and anaphylactoid reactions may resemble allergic reactions clinically even though they are not based on specific immunologic events. Complaints about adverse reactions to foods are common but most cannot be reproduced by challenge studies. This fact reflects the transient nature of many of these reactions and should prompt the pediatrician to be objective when diagnosing chronic or persisting conditions. Without objectivity, dietary avoidance measures potentially can have profound nutritional and psychosocial consequences. Negative skin-prick tests with foods have a high negative predictive value to rule out IgE-mediated mechanisms being operative. Skin-prick testing with cow's milk and hydrolysate formulas is useful in distinguishing mild "topical reactors" from the more severe "systemic reactors" and in selecting "hypoallergenic" formulas for their management. However, the DBPCFC is the "gold standard" that helps distinguish between reality and strongly held erroneous beliefs. This diagnostic test has established cow's milk, egg, peanut, and soybean as the foods most commonly responsible for allergic and intolerance reactions in children. The principles of management of these food-related conditions are similar. However, each food presents unique management issues to the pediatrician.


Incorporating nutrition into pediatric practice: physicians and dietitians working together to improve children's health.

Clinicians are needed to include nutrition in the routine care of infants and children in office practice. Physicians play an important role in assessing nutritional status, diagnosing nutritional problems, providing a rationale for treatment, prescribing, performing brief counseling, referring to other resources if needed, and following up on the progress of their patients. Registered dietitians are the consultants of choice to assist pediatricians in the care of patients with nutrition-related disorders and are skilled in providing pediatric health promotion and disease prevention information. Consultant dietitians in the community can be found through contacting the local department of health or local hospital outpatient department. The American Dietetic Association also maintains a list of consulting dietitians throughout the United States. Funding mechanisms for engaging dietetic services vary from contracting with dietitians in private practice, local health departments, or hospital outpatient clinics, to employing dietitians on-site to provide counseling services in the office. Availability for third party payment for nutrition services varies with insurance carriers, individual policies, and region of the country. Incorporating nutrition into pediatric practice is important. Together, physicians and dietitians can work together to improve children's health.


Risk and prevention of youth suicide.

The rate of fatal suicide attempts among males rose dramatically between 1950 and 1980 and has continued to rise significantly during the 1980s among 15- to 19-year-old youth. Nonfatal suicide attempts, although far more frequent among females, appear to share similar risk factors with completed suicide. The most important preconditional risk factors for both fatal and nonfatal suicide attempts are a history of a previous attempt, major affective and conduct disorders, chronic substance abuse, and a history of personal losses, including experience of suicide attempts by peers and family members. Risk factors for the acute precipitation of an attempt include the acute disruption of an interpersonal relationship, alcohol intoxication, and access to firearms. Preventive efforts can be enhanced by pediatricians both in the office and the community. Clinical case finding of individuals thought to be at high risk will continue to identify some potential victims. Families with household firearms should be counseled regarding the risk of firearm injury and death, particularly in a home with an individual with other risk factors. Community campaigns to improve the mental health of youth and to reduce firearm ownership may hold future promise for the reduction of the unacceptable morbidity and mortality associated with adolescent suicide attempts.


The ABCs of pediatric LFTs.

Liver function tests (LFTs) are an essential assessment parameter when evaluating a child's liver function. This article reviews the interpretation of LFTs and summarizes physioanatomic considerations.


Living with chronic pediatric liver disease: the parents' experience.

Parents' perceptions of living with a child with serious, chronic liver disease were explored using a qualitative methodology. Six central themes emerged from interview transcriptions: beginning, sense of inadequacy and guilt, pain and stress, lack of control, taking control, developing a personal philosophy, and uncertainty and fear of the future.


Impact of the child's liver transplant on the family: maternal perspective.

This study's purpose was to examine the impact of the child's liver transplant on posthospitalization family adaptation. The family adaptation model provided the framework. Social support was the only variable significantly correlated with family adaptation.


Pediatric discharge planning.

This article will review the discharge planning process and discuss five significant distinctions specific to children that must be considered in order to provide quality care. These distinctions are: recognizing differences in pediatric diagnoses, delivering care to children of varying developmental levels, selecting appropriate resources, accessing educational interventions, and financing health care.


Leech therapy: new procedures for an old treatment.

Experiences of pediatric ICU nurses as they cared for a child requiring leech therapy are described in this article along with the clinical conditions and therapy of the case. The nurses' ambivalence about participating in what seemed to be an archaic therapy and how they had to put such feelings aside to support the family are explained.


Acyclovir in the treatment of chickenpox.

Although chickenpox is a highly contagious disease affecting 90% of susceptible persons exposed, its morbidity and mortality in healthy patients is minimal. Treatment of chickenpox with oral acyclovir appears to decrease the number of pox lesions and shorten the duration of new lesion formation. Most importantly, children treated with acyclovir begin to feel better soon and had fewer systemic signs and symptoms of chickenpox (fever, fatigue, loss of appetite). However, the greatest mortality from chickenpox is seen in the immunocompromised patient, or in elderly patients with zoster (shingles) due to reactivation of latent varicella infection. Therefore, prevention of varicella is necessary to decrease mortality from the varicella-zoster virus. It is hopeful that the varicella vaccine will be licensed in the U.S. for routine immunization of healthy children within the next year. While its general use will not eliminate either chickenpox or zoster, there will be a considerable decrease in the morbidity and mortality caused by this agent as a result of routine immunization.


Selecting a home care agency.

Selecting a home care agency must be a collaborative effort on the part of families and the discharging facility. Guidelines for selecting home care providers eases the transition from the acute care facility to home.


Far above rubies: the founders of Every Child By Two.

The Every Child By Two Campaign was formed by Rosalynn Carter and Betty Bumpers, spouses of prominent elected officials, in response to the rapid increase in measles cases in the United States in 1990. They have sought to create a network of community leaders that will act to get children immunized now and will influence legislation to ensure that children under two will be fully immunized in the future.


Personalizing professional goals.

Goal setting is an essential step toward personal and professional freedom. If we are interested in bringing our lives into balance so that our professional goals and personal goals are integrated, we must be willing to do the necessary work of self-discovery.


A study of diagnostic reasoning in pediatric nurses.

To examine the data collecting and interpreting phases of the diagnostic reasoning process used by practicing pediatric nurses and to determine: (a) types of information deemed important for planning nursing care; (b) the functional health patterns addressed; and (c) frequency of validation of early hypotheses. Thirty-four registered nurses who attended continuing education pediatric nursing workshops were asked to analyze a written simulated case study discussing maternal-infant interaction. Diagnostic cues in the case study were based on a framework that consisted of a clinical nursing model of maternal-infant interaction and selected nursing diagnoses. Open-ended questions were used to examine subjects' attention to and interpretation of these cues. All subjects identified information related to the child's physical needs and the mother's responsibility to meet those needs as important for planning nursing care. There was less attention given to the interaction of mother and child. The most common response was identification of cues associated with five functional health patterns (29.4% of subjects). The functional health pattern, coping-stress tolerance, was addressed least often, although all nurses identified cues associated with role relationship. Only 38% of the subjects identified the need for validation of early hypotheses. The findings support the need for further research on the diagnostic reasoning of pediatric nurses. Recommendations include methods to enhance pediatric nurses' collection and interpretation of data specific to the pediatric clinical setting.


SIDS and infant positioning: implications for critical care.

This article will briefly review the literature that led to the AAP's recommendations of supine and side-lying positions for infants and explore the challenges and the controversy associated with changing standards and practices. It will discuss specific considerations for the critical care nurse and suggest points to consider in implementing any practice changes for seriously ill or critically ill infants.


Nursing interventions aimed at reducing risks of SIDS.

While researchers do not fully understand the causes of SIDS, there appears to be growing consensus that SIDS is most probably a multi-etiological phenomenon. Research literature regarding the prone sleeping position as a possible risk factor for SIDS will be discussed as will proposed etiological mechanisms related to this hypothesis. Implications of this new data for pediatric nursing practice will also be examined.


Intussusception reduction 1991: an international survey of pediatric radiologists.

A detailed survey of intussusception reduction practices at the International Pediatric Radiology '91 meeting in Stockholm yielded 78 responses from radiologists representing 21 countries on six continents. Results indicates a striking lack of conscensus on basic technical issues such as the type of contrast material or reducing agent, the pressure limits for reduction, the use of balloon-tip tubes, the role of sedation, manipulation of the abdomen during reduction, and duration of symptoms beyond which reduction would not be attempted. For example, while gas reduction has been strongly promoted in the literature during the late 1980's, only 34.7% of the respondents indicated that this was their principle choice of reducing agent. Among technique choices which produced significant correlations with outcome, it is noteworthy that pooled data suggest an eightfold increase in perforations among those using gas rather than liquid for reduction. Also, although 53.8% of respondents use parenteral sedation at least part of the time, those who reported using it regularly had significantly lower success rates than all other radiologists. This study provides a current sampling of international opinion in a subject of importance to all pediatric radiologists; and by linking the response with reported outcomes suggests opportunities for further investigation.


The current radiologic management of intussusception: a survey and review.

To determine what practices are being utilized in the management of intussusception, a survey was sent to chairpersons of 64 Pediatric Radiology departments in the United States and Canada. There was a 92% response rate. Barium is used in 97% of departments and is the most commonly used contrast-agent in 64%. Water-soluble contrast is used in 83% of departments and air in 50%. In high-risk patients, water soluble contrast is used in 71% of departments, air in 28% and barium in 24%. Glucagon, pre-exam antibiotics, and pre-exam sedation are not used regularly in a majority of departments. The radiologic management of intussusception is more varied than only a few years ago. Use of water-soluble contrast and air have increased, while barium use is less routine.


A new syndrome? Unusual facies, hooked clavicles, 13 pairs of ribs, widened metaphyses, square shaped vertebral bodies and communicating hydrocephalus.

Two strikingly similar twin sisters presented with characteristic facial anomalies and distinctive radiographic findings. The occurrence of this unique pattern of malformations in two sisters with unaffected parents suggests recessive inheritance. They most likely represent a previously unrecognised malformation syndrome.


Subspecialization in pediatric radiology.

Within radiology there is an increasing trend towards specialization in North America [1]. Although some radiologists still consider themselves as generalists, every radiologist has eliminated some aspect of imaging from his repertoire [2]. Within some specialty areas of radiology further subspecialization is beginning to take place. This subspecialization is being affected by conflicting forces, some of which are pushing us towards increased subspecialization in our daily clinical work, while other forces are inhibiting such subspecialization.


Cyclic direct radionuclide voiding cystography: increasing reliability in detecting vesicoureteral reflux in children.

The purpose of this study was to establish the sensitivity of cyclic direct radionuclide cystography (RVC) in detecting vesicoureteral reflux (VUR) in infants and small children, and to compare it to the conventional (one cycle only) RVC. 428 patients (856 renal units) were admitted to the study from January 1991 through March 1992 and all had a cyclic RVC. The age of the patients ranged from 4 months to 7 years. The overall agreement of both cycles in detecting VUR in this study was 45%, the lowest being in detecting VUR I (36%), and the highest in detecting VUR III (86%). If we had used a conventional RVC (the first cycle only), 17 (29%) VUR I, 50 (36%) VUR II and 3 (9%) VUR III, which were detected in the second cycle only, would have been missed. We conclude that cyclic RVC detected 43% more VURs than the conventional (first cycle only) RVC, and would therefore recommend its use as a standard procedure instead of the conventional RVC.


Esophageal perforation by a tooth in child abuse.

A unique case of child abuse in a six-year-old Hispanic girl is reported. In this case, a tooth avulsed and swallowed during an episode of physical abuse and/or sexual abuse, caused an esophageal perforation resulting in a retropharyngeal abscess and mediastinal abscess containing the tooth. Although traumatic esophageal injuries in child abuse have occurred, the presence of a tooth within the mediastinal abscess is an unique manifestation of child abuse.


Diagnosis of congenital antral web by ultrasound.

Historically, the first case of congenital prepyloric membrane in an infant was documented in 1933 [1]. Since then cases have been reported only sporadically in the literature [2-8]. This is a case of congenital antral web which was identified by real-time ultrasonography, confirmed by barium meal study, and proven at gastrotomy.


Congenital hemangiopericytoma of the duodenum.

Hemangiopericytomas are vascular tumors of pericyte origin. Although the majority of cases have been found in adults, a small percentage have been found to be congenital, most involving the subcutaneous tissues. Gastrointestinal involvement is exceedingly rare. All of the congenital tumors were found to be benign. We report a case of congenital duodenal hemangiopericytoma in a neonate which was locally invasive.


Comparison of computerized digital and film-screen radiography: response to variation in imaging kVp.

A controlled prospective study, in an animal model chosen to simulate portable neonatal radiography, was performed to compare the response of the Philips Computed Radiography (CR) system and conventional 200 speed film-screen (FS) to variation in imaging kVp. Acceptable images were obtained on the CR system over a very wide kVp range. In contrast the FS system produced acceptable images over a narrow kVp range. This ability suggests that the CR system should eliminate the need for repeat examinations in cases where a suboptimal kVp setting would have resulted in an unacceptable FS image. CR technology should therefore be ideally suited to portable radiography especially in situations where selection of correct exposure factors is difficult as in the neonatal nursery.