Plasma 1,25-dihydroxyvitamin D, insulin-like growth factor-1, calcium, magnesium and phosphorus concentrations in pregnant beef cows and calves from a herd with a known history of congenital joint laxity and dwarfism.

An investigation was undertaken to ascertain the possibility of a relationship between calcium, inorganic phosphorus, magnesium, 1,25-dihydroxyvitamin D [1,25(OH)2D], and insulin-like growth factor-1 (IGF-1) concentrations in blood plasma and occurrence of congenital joint laxity and dwarfism (CJLD) in young cattle. Pregnant cows were fed hay (30 cows) or grass silage (122 cows) during winter months (October 15 to calving in March). Blood samples were taken from cows on seven occasions during the experiment and 48 hours after calving, and from calves at birth, and at seven, 14 and 56 days old. Five per cent of calves born (six of 122) to cows fed grass silage and none born to cows fed hay were affected by CJLD. The diet and health status of calves were not significantly (P greater than 0.05) associated with the plasma concentration of 1,25(OH)2D. The plasma calcium concentration declined with age of the calves (P less than 0.05) but was not affected by the occurrence of CJLD. Plasma phosphorus and magnesium concentrations in calves born to cows fed silage were higher (P less than 0.05) than in those born to cows fed hay. At birth and seven days old, plasma phosphorus concentrations were higher (P less than 0.05) in CJLD-affected calves than in healthy calves but the plasma concentration of IGF-1 was not different (P greater than 0.05). It was concluded that the high plasma phosphorus concentrations in CJLD-affected calves and their dams could be related to the aetiology of the CJLD condition in calves.


Effect of cyclophosphamide immunosuppression on the immunity of turkeys to viral rhinotracheitis.

Turkey poults, free of antibodies to turkey rhinotracheitis (TRT) virus were treated with cyclophosphamide on days 1, 2 and 3 after hatching and vaccinated by eyedrop when 10 days old with a Vero cell-attenuated preparation of TRT virus. No ELISA antibodies to TRT virus developed in the sera of these poults but they were as resistant to virulent virus challenge 21 days later as vaccinated groups which were not cyclophosphamide-treated but produced humoral antibodies. Following challenge with virulent virus at 31 days old cyclophosphamide-treated unvaccinated poults developed a more severe clinical response than untreated birds and had higher virus titres in tracheal swabs. The findings show that the respiratory tract of turkeys may be resistant to TRT despite the absence of ELISA antibodies in the serum.


Protective effects of an oral microencapsulated Mycoplasma hyopneumoniae vaccine against experimental infection in pigs.

Oral microencapsulated Mycoplasma hyopneumoniae vaccines were tested for their ability to prevent mycoplasmal pneumonia in pigs. Eighteen four-week-old specific pathogen free pigs were divided into six groups of three. Each pig of groups 1 to 4 was inoculated intramuscularly with formalin-inactivated M hyopneumoniae in adjuvant and boosted orally 14 days later with four different microencapsulated vaccine microspheres. Group 5 was used as a positive control. All 15 pigs of groups 1 to 5 were challenged at 28 days after the first vaccination by an intratracheal inoculation of pneumonic lung suspension. The three pigs of group 6 were used as a negative control. All four vaccinated groups showed some protection when challenged, but the protection was more solid in pigs boosted with vaccine D (group 4) which contained less porcine serum in the microsphere. The study indicates that oral vaccination with M hyopneumoniae could play a role in prevention and eradication of mycoplasmal pneumonia in the pig.


Tissue distribution of monomeric glutathione peroxidase in broiler chicks.

It is known that there are two kinds of enzymes which show glutathione peroxidase activity, 'classical' glutathione peroxidase and glutathione S-transferase. Recently, a third enzyme was found, monomeric glutathione peroxidase, in broiler chick liver cytosolic fraction. To gain an insight into the possible physiological role of the monomeric glutathione peroxidase, the distribution of this enzyme in other broiler tissues was studied. The monomeric glutathione peroxidase was found in all tissues examined and in erythrocytes. The percentage of the total glutathione peroxidase activity accounted for by the monomeric enzyme ranged from 4 per cent in erythrocytes to 28 per cent in liver. Livers from three avian and two mammalian species contained the monomeric glutathione peroxidase. The contribution of the monomeric enzyme to total glutathione peroxidase activity with cumene hydroperoxide was high in poultry livers, while only trace monomeric glutathione peroxidase activity was found in mammalian livers. Chick monomeric glutathione peroxidase showed high activity toward phospholipid hydroperoxide. Thus, monomeric glutathione peroxidase might be an important enzyme in reducing membrane lipid hydroperoxides in birds.


Effects of age, sex and housing on the trabecular bone of laying strain domestic fowl.

To determine the effects of age, sex and housing on trabecular bone volume, samples were collected from groups of male and female domestic fowl housed in cages or floor pens from four to 60 weeks old. Between 25 and 60 weeks old, trabecular bone volume decreased by 25 per cent in sections of free thoracic vertebrae (T5) from female birds, the loss occurring at an earlier age in caged birds. Over the sample period, TBV in male caged birds diminished by 35 percent, but male floor birds showed no reduction in trabecular bone volume. At 60 weeks, trabecular bone volume was 30 per cent greater in male caged birds and 40 per cent greater in male floor birds than in the corresponding females. In reproductively active females, no trabecular osteoid was observed, indicating no new trabecular bone formation. However, trabecular osteoid was present in two birds aged 60 weeks which had regressed ovaries. Osteomalacia was not seen in any of the bone samples.


Variations in blood flow to and from the bovine mammary gland measured using transit time ultrasound and dye dilution.

Blood flow across the lactating bovine mammary gland was measured by two techniques. The use of transit time flow probes appeared to give flows which correlated well with dye dilution in only one of five cows, although the relative changes in flow were similar between the techniques in four of the cows. Further studies were made on the effect of posture on mammary blood flow using both techniques. The crossover of venous blood from one side of the mammary gland was also studied using the dye dilution technique, and revealed large differences between animals and also with posture. These observations suggest that particular care should be taken when sampling blood from the milk vein of cows, if a representative sample is required. Changes in blood flow with posture may be indicative of a repartitioning of flow within the body, and the physiology of such a mechanism would be of interest in itself. The control of this mechanism may be useful in modifying blood flow to the mammary gland and thus milk yield, since blood flow is related to the level of milk production.


Pyrolysis mass spectrometry of Listeria monocytogenes isolates from sheep.

Forty-eight isolates of Listeria monocytogenes from sheep and silage, involved in five small outbreaks of listeriosis, were compared by pyrolysis mass spectrometry (PyMS). The method clustered isolates from single animals, and showed that epidemiologically associated isolates were closely related to each other. PyMS is a simple technique capable of analysing large numbers of samples daily, and its application in veterinary studies should help to elucidate the epidemiology of listeriosis.


Comparison of endocrine changes and ultrasound as means of identifying ovulation in the bitch.

Twenty bitches were monitored through pro-oestrus and oestrus using both circulating plasma hormone levels and ultrasonic examination of the ovaries. Using luteinising hormone (LH) as being the generally accepted optimum indicator of the day of ovulation, comparisons were made of the accuracy of progesterone and ultrasound to identify ovulation. Progesterone agreed with LH in 12 of 20 bitches and was within one day in seven of the other eight. Ultrasound was less accurate in that only four of the 16 estimates agreed, with a further six being within one day. However, if only the bitches which were examined by ultrasound with the latest equipment were included, while only three of 11 coincided, six of the remaining eight were within one day of the LH estimated ovulation. It is concluded that, at present, of the rapid assessments, the measurement of plasma progesterone is a better estimator of ovulation than ultrasound.


Pathophysiology of ovine trypanosomiasis: ferrokinetics and erythrocyte survival studies.

The haematological changes, erythrokinetics and ferrokinetics of sheep were investigated after infection with Trypanosoma congolense. Following the detection of parasites in blood, the infected sheep developed macrocytic hypochromic anaemia. Studies with 51Cr-red cells, 125I-albumin and 59Fe as ferric citrate 11 weeks after infection revealed that infected sheep had significantly lower mean circulating red cell volumes but higher plasma and blood volumes than control sheep. The infected sheep also had enhanced erythropoietic activity as judged by significantly higher plasma iron turnover rates, faster disappearance of radio-labelled iron and higher iron incorporation rates than control sheep. The rate of disappearance of 51Cr-labelled red cells was greater in infected than in control sheep. It was concluded that the anaemia observed at this stage of infection was due to an increased rate of removal of red cells from the circulation coupled with haemodilution, with no evidence of dyshaemopoiesis.


Immune-mediated disease in the old English sheepdog.

Immunological data are reported from 19 cases of immune-mediated disease recorded in the old English sheepdog breed in Western Australia between 1978 and 1989. The conditions included autoimmune haemolytic anaemia (seven), idiopathic thrombocytopenia (one), Evans' syndrome (five), multiple myeloma (two), systemic lupus erythematosus (one), discoid lupus erythematosus (one) and hypothyroidism (two). The most consistent serological findings were raised serum IgG (60 per cent), depressed serum IgM (60 per cent) and the presence of multiple autoantibodies (anti-red blood cell 78 per cent, antinuclear antibody 44 per cent, rheumatoid factor 19 per cent). An underlying, breed-related disorder of immune regulation may account for these observations.


In vitro studies and in vivo immunisation with the first viral haemorrhagic septicaemia viruses isolated in Spain compared to international reference serotypes.

The first five viral haemorrhagic septicaemia virus (VHSV) isolates found in Spain were examined for in vitro growth characteristics, neutralisation by trout antiserum and immunisation challenge of trout fingerlings by water immersion. The viruses had come from different host species in various geographical locations in different years. Three reference VHSV serotypes (F1, F2 and 23.75) were also included in the study. There appeared to be little relationship between the in vivo delay of mortality or the protection of the immunised trout after challenge and the in vitro characteristics studied. In contrast to the in vitro results, the in vivo delay of mortality suggested a closer relationship of the Spanish VHSV isolates to the F2 serotype than to the F1 or the 23.75 serotypes. If the final protection figures are analysed, however, there could be three or four groups of viruses.


Response of Trypanosoma congolense in goats to single and double treatment with diminazene aceturate.

Diminazene aceturate is one of a limited number of compounds currently marketed for treatment of trypanosomiasis in cattle, sheep and goats. The pharmacokinetics of the compound in goats suggest that double treatment with diminazene aceturate might enhance the compound's therapeutic activity. A study was therefore conducted in goats using two clones of Trypanosoma congolense, IL 3274 and IL 1180, which were previously shown to be resistant and sensitive, respectively, to single treatment with diminazene aceturate. The results indicated that, as compared to single treatment, double treatment with diminazene aceturate at a dose of 7.2 mg kg-1 bodyweight, at either eight or 24 hour intervals, did not greatly enhance the therapeutic activity of the drug. Furthermore, treatment with the same drug dose eliminated infections with T congolense IL 3274 when treatment was administered 24 hours after infected Glossina morsitans centralis had fed, but failed to do so if treatment was delayed until after goats were detected to be parasitaemic. This suggests that failure of T congolense IL 3274 to respond to treatment with diminazene may not be due to drug resistance per se.


Minimized surgery for retinal detachments with segmental buckling and nondrainage. An 11-year follow-up.

A prospective study was conducted of 107 retinal detachments operated on between August 1979 and January 1980, with a complete follow-up period ranging from 11 years to 11.5 years. Proliferative vitreoretinopathy (PVR) stage C1 or C2 was seen in 16 detachments. Surgery consisted of cryopexy and segmental buckling (limited to the area of breaks) with nondrainage. Of the surgical procedures, 71% were radial buckles, 19% circumferential, and 10% radial combined with circumferential buckles. The primary reattachment rate was 92.6%, and 97% after reoperation. During the long-term follow-up period, redetachment occurred in 12.1% of the eyes: 5.6% were classified as early redetachments (between 2 and 4 months), and 6.5% as late redetachments (between 3 and 7 years). Early redetachment was caused by PVR, and late redetachment by new holes. After reoperation, reattachment occurred in 92.6% of the eyes. The predominant cause of final failure was PVR (3.7%). Only one eye had two reoperations. There was a highly significant (P less than 0.001) improvement between preoperative visual function (mean 0.32) and postoperative visual function (mean 0.56) in all 99 reattached eyes during the follow-up period (Mann-Whitney U test).


Clinicopathologic study of idiopathic macular pucker in children and young adults.

Clinically significant idiopathic macular pucker was observed in 11 patients aged 30 years or younger. In these patients, the tissue was well defined and fibrous in appearance, in contrast to the thin, cellophane appearance that is typical of macular pucker in elderly patients. Vitrectomy and epiretinal membrane peeling were performed in each case. Visual acuity improved after surgery in seven cases and worsened in one case, and follow-up data was not obtained in three cases. Recurrent membranes were noted in four cases, two of which detached spontaneously. Ultrastructural studies were performed on the removed specimens in each case. Myofibroblasts, myoblastic differentiation of retinal pigment epithelial cells and fibrous astrocytes, and new collagen formation were more common than in idiopathic macular pucker in older patients. The clinical and ultrastructural features of juvenile macular pucker reflect more rapidly changing, contractile tissue compared with the usually more quiescent features in series involving older patients.


Genetic evidence for variant selection in the course of dilute passaging of mumps vaccine virus.

Mumps vaccine viruses, Leningrad-3 (L-3) strain, harvested at the 8th (8P) and 38th (38P) passage levels, were compared by nucleotide sequencing of the fusion (F) and the phosphoprotein (P) genes, and for replication efficiency in cell culture. Sequencing revealed only one clear base substitution throughout the entire F gene, and no substitutions in the variable 183-nucleotide-long region of the P gene. However, the 8P virus, unlike the 38P variant, contained multiple "ambiguous" nucleotide regions, i.e., additional bases positioned at the level of the principal ones. The 38P variant replicated faster and appeared more homogeneous by its plaque character compared to the 8P virus. The results indicate that the 8P progenitor virus consisted of more than one viral variant and that one of these was selected on repeated passage due to its higher replication efficiency.


Surgical treatment of retinal detachment in the choroidal colobomas.

Seven eyes from seven patients with retinal detachment and choroidal coloboma (with or without optic disc involvement) were treated. The retinal break was always inside the colobomatous area, except in the cases with evidence of peripheral retinal breaks. In order to produce reattachment of the retina, vitrectomy procedures with removal of posterior hyaloid were used. Drainage of subretinal fluid was performed through the break in the area of the coloboma, with simultaneous fluid-air exchange. Previously undetected retinal breaks were identified by inspecting for the presence of schlieren in the colobomatous area during fluid-air exchange. A peripheral scleral buckle was then applied. Argon laser endophotocoagulation was performed, but when the coloboma involved the optic disc, red krypton endophotocoagulation was used. Retinal reattachment was achieved in all cases.


Localization of cauliflower mosaic virus in the cell nucleus of Brassica pekinensis L.

Cauliflower mosaic virus (CaMV) particles were observed in the nuclei of xylem parenchyma cells in Brassica pekinensis L. doubly infected by CaMV and turnip mosaic virus (TuMV). CaMV particles were aggregated in the nucleoplasm but not embedded in viroplasms. This phenomenon was not detected in cell nuclei of mesophyll tissue. Typical features associated with infection by either CaMV or TuMV normally occurred in the cytoplasm of cells of both tissues: two types of viroplasms with embedded CaMV particles and cylindrical inclusions induced by TuMV. Among the main hypotheses which could explain this particular CaMV localization, we checked that it was not the result of the coinfection with TuMV, since we also found CaMV particles in the same place in single infected plants. Other explanations are discussed, including a possible particularity of the infection in xylem tissue or a specific property of an unusual CaMV isolate.


Xanthic scotoma and yellow foveolar shadow caused by a pseudo-operculum after vitreofoveal separation.

The biomicroscopic detection of a small opacity (pseudo-operculum) suspended in front of the normal foveal retina is a sign of vitreofoveal separation. This report concerns five patients in whom slit-lamp illumination of the pseudo-operculum produced a yellow spot (shadow) on the adjacent pigment epithelium. This occurred in two patients who presented because of a small yellow central scotoma. In one patient, the yellow spot and scotoma disappeared after complete posterior vitreous separation. One patient presented because the referring physician misinterpreted the yellow spot as a Stage 1 impending macular hole.


Traction retinal detachment due to preretinal proliferation of surface epithelium.

A seven-year-old boy sustained severe blunt trauma with globe rupture. After repair of the globe and lensectomy and vitrectomy, a fistula was noted along with epithelial downgrowth on the posterior surface of the cornea. Extensive peripheral preretinal membrane formation resulted in traction retinal detachment. The fistula was excised and the preretinal membranes were removed. Pathologic examination of the membrane revealed it to be composed of surface epithelium. Retinal reattachment was achieved with intravitreal injection of silicone oil. This case illustrates that surface epithelium can proliferate on the inner retina and can lead to tractional retinal detachment.


Primary nonfamilial amyloidosis of the vitreous. A light microscopic and ultrastructural study.

Nonfamilial amyloidosis, a form of primary amyloidosis accompanied by vitreous opacity, is a rare condition. Here, a 50-year-old man developed strand-like opacities in the vitreous of both eyes. Pars plana vitrectomy was performed to improve the patient's vision. The vitreous specimens showed typical light microscopic and ultrastructural features of amyloidosis.


Foveal hypoplasia in complete oculocutaneous albinism. A histopathologic study.

Histopathologic and ultrastructural findings in an eye from a patient with complete oculocutaneous albinism are reported. Examination revealed posterior embryotoxon, high myopia, no foveal differentiation, and absence of melanin pigment in all ocular structures. A few nonmembrane-bound electron-dense granules of lipofuscin were present in the iris and retinal pigment epithelial cells.


Comparison of retinal photocoagulation using pulsed frequency-doubled neodymium-YAG and argon green laser.

The photocoagulation effects on retinal and choroidal tissue of the argon green and pulsed frequency-doubled neodymium-YAG lasers were examined in rabbit eyes. In contrast to the continuous wave output of the argon green laser, the pulsed frequency-doubled neodymium-YAG laser produces a series of 1 microsecond pulses emitted at a repetition rate of 10 kHz. The high repetition rate results in pulse averaging, allowing relatively low peak powers to be used while producing average powers capable of thermal tissue effects. Photocoagulation lesions in the rabbit retina were placed in pairs using each of the lasers. Light microscopic comparison of the argon and neodymium-YAG burns revealed morphologically similar lesions for up to 14 days after photocoagulation, with damage predominantly at the level of the retinal pigment epithelium and outer retina. The high repetition rate, pulsed frequency-doubled neodymium-YAG laser produced thermal tissue effects similar to the continuous wave argon green laser.


Comparison of three permanent intraocular magnets.

A comparison was performed of three small-gauge, permanent, rare-earth, intraocular magnets to assist the posterior segment surgeon with the decision as to which magnet to purchase or to use in different clinical situations. The magnetic force was measured at varying distances from the instrument tip using a 1/8-inch steel ball as the test object. There were small differences in magnetic strength between the three instruments that may have clinical significance in certain situations. Two of the instruments had a retractable magnet within an outer sleeve, allowing for controlled attraction and release of a magnetic foreign body by the surgeon.


Retinal cartography. An analysis of two-dimensional and three-dimensional mapping of the retina.

The current two-dimensional (2D) retinal drawing chart is an azimuth equidistant representation of the retina. The distortion produced by this chart was analyzed and compared to other 2D projections, such as stereographic, equal area, and orthographic maps of the retina. Circumferential distortion was calculated for lesions at varying distances from the macula using the azimuth equidistant retinal map and was found to increase exponentially as a function of the distance from the macula. Circumferential distortion was 57.1% at the equator, 88.5% 3 mm anterior to the equator, and 137.8% 6 mm anterior to the equator. A three-dimensional (3D) model of the retinal surface was created using 3D computer assisted design (CAD) software. This 3D model was able to represent retinal lesions such that their true size, shape, location, and orientation were all conserved. Retinal lesions could be viewed from multiple angles and examined in cross section. The use of 3D CAD software coupled with ultrasound or magnetic resonance imaging data has the potential to represent retinal lesions more accurately than current methods.


Regional variation and control of cutaneous gas exchange in bullfrogs.

Previous work has demonstrated regional differences in morphometric diffusing capacity and cutaneous blood flow in anuran amphibians, leading to the prediction of a higher rate of cutaneous gas exchange across the dorsal skin of bullfrogs. Regionally measured cutaneous O2 and CO2 flux rates (MO2 and MCO2) support this prediction: flux rates across the dorsal skin are 15-32% greater than across the ventral skin in both pulmonary ventilating and apneic (anesthetized) bullfrogs. The rates of cutaneous gas exchange were much greater in anesthetized frogs; however, MO2 and MCO2 did not increase in parallel, which decreased the cutaneous respiratory exchange ratio from 3.5 to 2.0 in apneic frogs. Regional differentiation in cutaneous gas exchange suggests the possibility of independent regulation; however, cutaneous MCO2 varied little in response to changes in O2 content above these regions, neither in the anesthetized nor awake bullfrogs. The bullfrogs are able to increase whole body cutaneous gas flux during prolonged apnea but were not able to respond to changes in local O2 content.


Effects of analysis method and forcing waveform on measurement of respiratory mechanics.

The respiratory system has been shown to exhibit nonlinear mechanical properties in the frequency (f) range of normal breathing, manifested by tidal volume (Vt) dependence. Calculations of respiratory system resistance (R) and elastance (E) from pressure-flow measurements during external forcing at a given f may be ambiguous, especially if non-sinusoidal forcing waveforms are used. We evaluated the degree to which R and E depended upon: (1) analysis method (Fourier transform, multiple regression and pressure-volume loop analysis) and; (2) shape of the forcing waveform (sinusoidal, quasi-sinusoidal and step). We measured pressure and flow at the mouth of 5 healthy, awake subjects, relaxed at functional residual capacity, during forcing with the three different waveforms in the normal range of f (0.2-0.6 Hz) and Vt (250-750 ml). During sinusoidal forcing, E and R were not affected by analysis method (P greater than 0.2). With Fourier transform and multiple regression, E was not affected by waveform shape (P greater than 0.05); with loop analysis, E was slightly (less than 10%) higher during quasi-sinusoidal and step forcing than during the sine (P less than 0.05). R was least affected by waveform shape with Fourier transform. We conclude that, in the f and Vt range of normal breathing: (1) respiratory system impedance is 'quasi-linear,' i.e. despite dependencies of R and E on Vt, non-linearities are not large enough to restrict interpretation of R and E at a given f and Vt; (2) it may be possible to measure R and E using non-sinusoidal forcing waveforms available on most clinical ventilators, incurring only modest error.


Inspiratory muscle activity during pulmonary edema in anesthetized dogs.

Pulmonary edema is known to induce a rapid and shallow breathing pattern. However, its effects on the level and pattern of distribution of motor activity to the respiratory muscles is unclear. In the present study we evaluated the effect of oleic acid induced pulmonary edema on the electrical activity of the inspiratory muscles (costal and crural diaphragm and parasternal and external intercostal muscles) in the dog, and related it to the transdiaphragmatic pressure and ventilatory parameters over the course of CO2 rebreathing. Pulmonary edema, reflected by a 7.1 +/- 0.6 wet to dry ratio, decreased lung compliance by 57%, increased pulmonary shunt to 35%, and was associated with a rapid and shallow breathing pattern. When compared at equal levels of PCO2 during CO2 rebreathing before and during edema, ventilation and mean inspiratory flow were increased only at lower levels of hypercapnia and their responses to increasing levels of PCO2 were significantly diminished during edema. Transdiaphragmatic pressures were elevated during edema as compared to control values. The rate of rise of the electrical activity of all inspiratory muscles increased significantly during edema at all levels of PCO2. Peak activity, however, remained unchanged, due to shortening of the inspiratory duration. The EMG responses to progressive hypercapnia were not affected by edema. Pulmonary edema did not change the pattern of breathing and neural output to the inspiratory muscles in vagotomized dogs. We conclude that stimulation of pulmonary proprioreceptors during edema increases neural output to all inspiratory muscles. The neural response to hypercapnia is not altered by edema, and is additive to the vagal input. The ventilatory response to CO2 is blunted during severe edema, due to alterations in lung mechanics.


Menthol in the upper airway depresses ventilation in newborn dogs.

Upper airway cooling depresses ventilation in the newborn dog. Since airway cooling stimulates laryngeal cold receptors and inhibits laryngeal mechanoreceptors, the type of afferent ending responsible for this reflex cannot be easily identified. l-menthol, a specific stimulant of cold receptors in the absence of any cooling, has been used to ascertain the discrete role of upper airway cold receptors in this ventilatory depression. Experiments were carried out in 8 anesthetized 7-14-day-old dogs breathing through a tracheostomy with the upper airway functionally isolated. Constant flows of warm air (37 degrees C), with and without addition of l-menthol, and cold air (25 degrees C) were delivered through the upper airway in the expiratory direction. As compared to warm air trials, cold air and warm air + l-menthol trials greatly reduced ventilation (57.5 +/- 10.7% and 52.8 +/- 11.7% of control, respectively; P less than 0.01) mostly due to a prolongation of Te (291.2 +/- 106.4% and 339.2 +/- 90.0%, respectively, P less than 0.01). Section of the superior laryngeal nerve abolished the response to cold air. However, a residual depressive effect of l-menthol was still present in 3 of 5 animals and was abolished by nasal anesthesia, suggesting the involvement of nasal cold receptors. The results suggest that in the newborn dog stimulation of laryngeal cold receptors, without any concurrent inhibition of laryngeal mechanoreceptors, is a sufficient stimulus to cause respiratory depression.


Hypoxia-induced ANP secretion in subjects susceptible to high-altitude pulmonary edema.

We investigated the effects of acute hypoxia (10% O2) on plasma level of atrial natriuretic peptide (ANP) and pulmonary hemodynamics in five subjects with a history of high-altitude pulmonary edema (HAPE). Plasma renin activity and plasma levels of aldosterone, epinephrine and norepinephrine were also measured. The plasma ANP levels in HAPE-susceptible subjects rose significantly in response to 10% O2 (from 34.8 +/- 5.4 to 51.4 +/- 7.3 pg.ml-1; P less than 0.05), not associated with any increase in either atrial pressure. Compared with six control subjects, the rise of ANP level was greater in HAPE-susceptible subjects (16.6 +/- 4.4 vs 3.9 +/- 1.2 pg.ml-1; P less than 0.05). There was a significant positive correlation between the rise of ANP level and the increase of pulmonary arterial pressure. No significant difference was observed in any of other hormonal responses to acute hypoxia between the two groups. We interpret these results as indicating that the ANP secretory response to acute hypoxia in HAPE-susceptible subjects, which is not mediated by an increase in atrial pressure, may be greater than that in nonsusceptible subjects in association with a greater pressor response of pulmonary circulation.


Effect of increased metabolic rate on oxygen isotopic fractionation.

16O16O is preferentially used over 18O16O (a stable isotope of oxygen comprising about 0.2% of atmospheric O2) as oxygen is consumed during respiration in humans (Epstein and Zeiri, 1988, Proc. Natl. Acad. Sci. USA 85: 1727-1731). To test the hypothesis that oxygen isotopic fractionation is related to the metabolic rate, 8 healthy adults performed 5 min of constant work rate cycle ergometer exercise below and above their anaerobic threshold. Moreover, 3 subjects performed an incremental exercise to the limit of tolerance. Oxygen uptake (VO2) was measured breath by breath. Samples of the exhaled breath for oxygen isotope measurement were obtained at rest and at various times during exercise and recovery. Oxygen isotopic fractionation was determined by isotope ratio mass spectrometry and calculated as the ratio of the degree of fractionation to the oxygen consumed in the breath sample (Z value). For the constant work rate protocol, both low and high intensity exercise resulted in a significant decrease in Z compared to the rest values (P less than 0.01). However, for the high intensity exercise the reduction in fractionation was greater compared to the low intensity protocol (P less than 0.05). For the incremental test, there was a significant negative correlation between oxygen isotopic fractionation and VO2 expressed as percent of the maximal oxygen uptake (r = -0.91, P less than 0.0001). These data suggest that during exercise low-fractionating processes become more important as limiting steps for O2 transport.


Uneven perfusion within single cat muscles: nitric oxide and citrate synthase play no role.

There is an unexplained, marked regional heterogeneity in perfusion within single skeletal muscles both in dogs and rabbits. We asked if a similar distribution of perfusion was present within cat muscles. If present, we wanted to assess the possible roles of nitric oxide (NO) mediated vasodilation and citrate synthase (CS) activity for the regulation of this perfusion pattern. Perfusion was determined in 0.25 g regions within the gastrocnemius muscles by trapping of microspheres. We studied awake or anesthetized cats before and during inhibition of NO-formation using N-monomethyl-L-arginine. The CS activity was determined in homogenates of these regions. The coefficient of variation corrected for the Poisson distribution of microspheres (CVc) for the regional perfusion averaged 0.39. Despite a 25% reduction in perfusion to the whole muscles as compared to control, the uneven distribution of perfusion was not affected by blocking NO formation. Regional perfusion was not correlated to regional CS activity. Even if the regional distribution of CS activity also showed a scatter, mean coefficient of variation corrected for methodological error = 0.20, it was markedly less than that for perfusion. We conclude that neither NO vasodilation nor CS activity play an important role in the regulation of the regional perfusion pattern within single cat muscles.


Liquid volume, Na+ and mannitol concentration in a hypertonic mannitol-Ringer hydrothorax.

In anesthetised rabbits with a 2 ml hypertonic mannitol-Ringer hydrothorax in the right space 30 mM/L mannitol were required for an unchanged volume of the hydrothorax after 60 min. [Na+] in the pleural liquid 10, 30 and 60 min after this hydrothorax was 8, 7 and 5 mEq/L, respectively, lower (P less than 0.01) than the initial one and that in a Ringer-hydrothorax. This seems due to the active transport of Na+ out of the pleural space followed by little water because of the osmotic pressure exerted by mannitol. This finding provides further evidence for an active transport without using inhibitors, and implies that the mesothelium offers an appreciable resistance to small solute diffusion. Mannitol concentration, measured at corresponding times from the activity of labeled mannitol, was 76, 68 and 56%, respectively, of the initial one (24.5 mM/L). From 30 to 60 min 6.5 microM of mannitol left the right space mainly by diffusion. The diffusional permeability of the mesothelium was indirectly assessed from the diffusional outflux of mannitol, the surface of the pleural space, and an estimate of mannitol concentration in the interstitium next to the mesothelium: it is smaller than that found in vitro.


Lung growth in newborn guinea pigs: effects of endurance exercise.

Newborn Hartley albino guinea pigs were exercised daily on a rodent treadmill at 25 m/min, 0 degree grade for a maximum of 1 1/2 h. Groups were exercised for 1, 2 and 3 weeks. Controls were age-matched sedentary animals. A separate group of animals was sacrificed after 12 h of life to establish baseline lung growth data. A morphological and biochemical comparison was made between the lungs of exercised and sedentary animals. No effect of exercise on lung growth was observed. After 2 weeks of exercise animals had diminished somatic growth compared to the controls. The data was pooled from exercised and control guinea pigs at 1 and 3 weeks, at which time there were no differences, in order to obtain normal growth data. The only change between 0 week and 1 week was a slight increase in femur length. Between 1 week (and also 0 week) and 3 weeks there were significant increases in lung volume, lung weight, protein content, inter-alveolar wall distance, mean chord length of alveoli and ducts, and gas exchanging surface area. The guinea pig lung is well alveolated at birth and there was no evidence of subsequent alveolar multiplication. Enlargement of airspaces suggested that lung growth was primarily brought about by dilation. The lack of alveolar multiplication following exercise may be due to the fact the alveoli are fully developed at birth.


Pathophysiology and management of anemia in chronic progressive renal failure.

Hypoproliferative anemia is a predictable and serious complication of progressive renal failure and contributes significantly to the overall morbidity of the uremic state. Until recently, there has been no satisfactory therapy to resolve the anemia. Now the anemia can be explicitly corrected with erythropoietin-replacement therapy, and the clinical debility generally attributable to renal insufficiency can be lessened and retarded. Anemia must no longer be regarded as an intractable consequence of the uremic syndrome and should be managed as conscientiously as the other polysystemic features of uremia.


Nephrocalcinosis caused by hyperparathyroidism in progression of renal failure: treatment with calcitriol.

Nephrocalcinosis is accepted to contribute to the progression of renal failure. We have reviewed evidence that nephrocalcinosis is caused directly by the excess parathyroid hormone produced in renal disease. Evidence that hyperparathyroidism in uremic patients results from calcitriol deficiency and the mechanisms by which this comes about have been discussed. We have shown that renal secondary hyperparathyroidism can be eliminated or substantially reduced without increasing blood calcium using a low-dosage regimen of calcitriol. Decreasing PTH concentrations to or near normal alleviates this hormone's toxicity to many organs, including the kidneys. Potential benefits for the uremic patient include an increase in the quality and length of life. Calcitriol treatment provides a powerful means to reduce PTH concentration in uremic patients that may not be achieved with other methods. Further prospective clinical studies of uremic dogs and cats are warranted to document preservation of renal function and histology during calcitriol treatments.


Patient and renal allograft survival in the late posttransplant period.

Finding the proper balance between too much and not enough immunosuppression is just as important in the late posttransplant period as it is during the first year after transplantation. In general, too much immunosuppression leads to an increase in patient mortality, whereas inadequate immunosuppression can lead to an inordinately high rate of allograft failure (Fig 5). In the late posttransplant period, patient and allograft survival are both critically dependent on the degree of immunosuppression and on the long-term side effects of the agents used to achieve this immunosuppression. Adequate immunosuppression is important in treating and preventing the acute allograft rejection episodes that are common during the first year after transplantation (Fig 6). Some data suggest that the severity of early acute rejection episodes may influence the development of chronic rejection, the most common cause of graft failure in the late posttransplant period. Otherwise, the role of immunosuppression in treating and preventing chronic rejection is unclear. The discontinuation of immunosuppression by noncompliant patients is a major cause of late graft failure. Whether the nephrotoxicity of CsA will also result in graft failure in the very late posttransplant period is still unknown. The agents used to achieve immunosuppression, along with decreased graft function and proteinuria, contribute to hypercholesterolemia, hypertension, and hyperglycemia. These and other risk factors have a negative impact on both graft and patient survival. Thus, immunosuppression is directly, or indirectly linked to most of the common causes of death and graft failure after renal transplantation. Although potent new immunosuppression protocols have increased the rate of short-term patient and allograft survival after renal transplantation, future advances in long-term survival after renal transplantation will depend on improvements that are effective in the late posttransplant period. Currently, the best approach to preventing complications in the late posttransplant period is to maintain a vigilant, comprehensive program of on-going medical care. The minimal amount of immunosuppression required to prevent allograft rejection should be used, while adhering to the principle that it is better to lose the graft than to lose the patient.


[Bone localizations disclosing Hodgkin's disease. Apropos of 11 cases].

The authors report 11 cases of Hodgkin's disease in which the first sign was due to bone involvement. Such observations are rare and raise diagnosis delays (Means: 5, 6 months in this series). Modern medical imaging techniques (scintigraphy, CT scan, magnetic resonance imaging) are very useful to an earlier diagnosis which will be better confirmed by lymph node biopsy given the poor information yielded by osseous cytology and/or histology. The elective localisation in bones belonging to the axial skeleton seems to support the hypothesis of a contiguous osseous involvement from lymphoïd organs in contact with bones. Evolution with chemotherapy and radiotherapy is very similar to that observed in patients without bone involvement.


[Cost effectiveness of Doppler-echocardiography in the diagnosis of deep venous thrombosis of the lower limbs. Theoretical calculation from a prospective series of 511 patients].

The management of deep venous thrombosis has non-negligible financial implications due not only to the high frequency of clinical suspicion--and therefore to the methods used a positive diagnosis--but also to the overall cost of management. To evaluate the expenditure incurred for the diagnostic tests, 511 patients suspected of deep venous lower limb thrombosis were examined clinically, then by Duplex ultrasonography combined with plethysmography. Whenever a suspected phlebitis was detected by this method, or at random if it was not, phlebography was performed. The 185 phlebography/ultrasonography comparisons enabled us to extrapolate the results obtained to all 511 patients and thus to compare the theoretical cost of 4 decisional algorithms according to the diagnostic criteria utilized. Our conclusions were as follows: the clinical diagnosis alone is not cost-effective, whereas Duplex ultrasonography is reliable and, compared with phlebography, saves more than 1,500,000 francs per year, including 1,000,000 francs saved on the global hospital budget in France. Phlebography used in each proximal venous thrombosis for accurate localization of the upper end of the clot does not significantly increase the cost: the annual savings on systematic phlebography are still above 1,200,000 francs, including 800,000 francs to the benefit of public hospitals.


["New cytology" and diagnosis of malignant tumors].

Cytology is an old method of diagnosis: it is the microscopical observation of cells in the aim of their identification, of the recognition of morphological abnormalities to obtain diagnosis or prognosis informations. During the last 20 years, new technics have been developed: 1) Immunocytochemistry permits the identification of the tissue or the organ of which a tumoral cell population is born, the determination of its stage of differentiation, its kinetic and the diagnosis of bone marrow or lymph node metastasis. 2) With in situ molecular biology, it becomes possible to detect, at the cell level, virus, oncogenes or chromosomic abnormalities. 3) Flow and image cytometry are easy means for DNA content determination and for an objective and reproducible cell definition. None of these methods are able, at this time, to replace the cytological analysis, but they are useful, sometimes necessary, for the diagnosis and the prognosis evaluation of malignancy.


[Diagnosis of muscular intolerance during exercise caused by enzyme deficiency in adults].

The exertional muscle pain syndrome in adults is expressed by recurrent episodes of pain and/or episodes of acute rhabdomyolysis, sometimes with transient myoglobinuria or even acute renal failure. The enzymatic origin of this syndrome is suggested by a familial history, by its usual onset during childhood or adolescence, and by its recurrent attacks usually, but not exclusively, caused by exercise. The aetiological diagnosis, suggested by the clinical context and some dynamic tests, is almost always based on good histological and biochemical examinations of the muscle biopsy.


[Lymphedema: is there a treatment?].

More than hundred medical treatments for lymphedema have been described. This very high number shows the evidence of difficulties: lymphatics are very small vessels, under low pression and velocity respondent to spontaneous quiet lymphatic contractions. The treatments can be listed in 3 groups: 1) physiotherapeutic methods, increasing lymphatic flow: cold, field stimulation, manual lymph drainage, intermittent compression, heat; 2) drugs: venous agents (flavone, benzo-pyrone), and intraarterial lymphocytes injection, promoting lymphatic flow or increasing normal proteolysis by macrophages in order to remove trapped proteins from interstitial fluid; 3) surgical procedures subdivided in 2 groups: excisional techniques and bridging drainage techniques; radical or partial excision removes involved subcutaneous tissue, recently by the way of liposuction; Efforts to drain lymphedema by subcutaneous implants, pedical flaps, myocutaneous flaps, omental transposition and intestinal flaps are historical. Microsurgical lymphatic anastomosis to vein (nodo-venous then lymphovenous), and to lymphatic themselves are now performed: lymphatic collectors or venous autografts are interpositioned to by-pass lymphatic blockade with end-to end anastomosis. The free transplantation of a lymphatic flap with its own vascularisation from healthy inguinal nodes to axillary blockade is the last described procedure. Lymphatic anastomosis are not needed. Actually, physiotherapy is always first indicated. Benzo-pyrones are additive drugs. Excisional procedures concern monstruous lymphedema. Microsurgical bridging procedures can be attempted only for secondary lymphedemas. They could be of benefit if physiotherapy and elastic bandages, stockings or sleeves, could then be avoided. Studies assessing independently the efficiency of each procedure are needed.


[Involvement of central nervous system disclosing Waldenstrom's disease: demonstration of intrathecal secretion of immunoglobulin M].

We report the case of a 68-year old woman complaining of disorders of memory and persistent headaches in whom the diagnosis of Waldenström's macroglobulinaemia (WM) was made. Computerized tomography of the brain showed a butterfly-shaped hyperdensity in the splenium of the corpus callosum, with ventricular dilatation. Magnetic resonance imaging displayed high-intensity signals on T2-weighted sequences. Protein immunoelectrophoresis elicited an IgM kappa peak. The CSF was found to contain proteins and lymphocytes in excess, and immunohistochemical staining confirmed the predominance of anti-kappa and the presence of intrathecal IgM secretion. Chemotherapy was temporarily effective on the memory disorders, but the patient died 26 months after the beginning of treatment. Central nervous system manifestations are seldom observed in WM, and they are now grouped under the name of Bing-Neel syndrome. Psychic disorders are rarely reported. It is suggested that IgM secretion plays a predominant role in the pathogenesis of leucoencephalitis, and this is supported by the finding of intrathecal IgM synthesis.


[Constrictive pericarditis in severe seronegative rheumatoid polyarthritis].

Constrictive pericarditis is a rare complication of rheumatoid arthritis, with 78 published cases. We report a new typical case where the pericardial disease was associated with a severe seronegative rheumatoid arthritis of 17 years duration. Constrictive pericarditis generally occurs in men (62.8% of all cases) aged 52.4 +/- 11.5 years. Its clinical features are identical with those of constrictive pericarditis due to other causes. Diagnosis rests on echocardiography and, chiefly, on right heart catheterization. The arthritis is seropositive in 85.7% of the cases, frequently nodular (75%) and advanced. There is no relation between its duration (mean: 9.6 +/- 7.4 years) and the occurrence of the pericardial pathology. The pericardial fluid has no specific abnormality. Histology shows fibrosis and a non-specific inflammatory cell infiltrate. Immunoglobulin and complement deposits in the walls of the pericardial vessels are detected by immunofluorescence. The only treatment is pericardiectomy; without it the disease is constantly lethal.


[Rhabdomyolysis caused by simvastatinin a patient following heart transplantation and cyclosporine therapy].

Hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are cholesterol-lowering agents which may induce rhabdomyolysis. The authors present a case of rhabdomyolysis attributed to simvastatin in a heart-transplant recipient. They stress the probability of a dose-dependent muscular toxicity and the risk of overdosage in patients already under treatment with drugs that interfere with the pharmacokinetics of HMG-CoA reductase inhibitors, notably ciclosporine.


[Role of polyols in the development of diabetic complications. Value of aldose-reductase inhibitors].

The evidence of sorbitol excess in the crystalline lens of alloxan-diabetic rats has led to anticipate the role of the enzyme aldose-reductase in the pathogenesis of the diabetic cataract. In addition, a number of experimental works have more recently shown the involvement of myoinositol deficiency, which probably results from the sorbitol accumulation. These metabolic pathways are most likely implicated in the pathogenesis of diabetic neuropathy and perhaps additionally in that of microangiopathy. The synthesis of several aldose-reductase inhibitors (AR inhibitors) confirmed experimentally these hypothesis. By reducing the activity of the enzyme aldose-reductase, these substances suppress the adverse metabolic consequences of polyol accumulation, myositol deficiency and dysfunction of the Na+/K+ ATPase dependent sodium activity. Although different experimentations showed that the AR inhibitors could prevent in animals the development of experimental cataract as well as the early functional or later anatomic abnormalities of the diabetic retinopathy and nephropathy, the clinical trials did not clearly support these experimental results in humans. On the other hand, the AR inhibitors were proved to exhibit some efficacy in the early stage of diabetic neuropathy and in incipient nephropathy where they delay the development of albustix positive proteinuria. However, the benefit of an early treatment with AR inhibitors should be confirmed by long term prospective studies, which could also assess the safety of these drugs in chronic administration.


[Identification of overtreated hypertension with statistical analysis of 100 consecutive ambulatory blood pressure monitoring].

The data obtained from 100 consecutive ambulatory blood pressure (BP) recordings performed in treated hypertensive patients (60 men, 40 women, mean age 52 +/- 14 years) were analysed to make a choice between several possible definitions of overtreatment and to evaluate the prevalence of patients thus defined as overtreated. Recordings were studied over two periods: diurnal from 9 a.m. to 7 p.m. (100 patients, 37 +/- 5 measurements/patient), and nocturnal from 11 p.m. to 7 a.m. (98 patients, 19 +/- 2 measurements/patient). The patients were first classified on the basis of reference ambulatory BP values according to sex and age. Subnormal levels were found in 25 patients for diurnal SBP, 25 for nocturnal SBP, 13 for diurnal DBP and 33 for nocturnal DBP. Several criteria of overtreatment were then tested, based on the percentile method and on the number of subnormal values: the median DBP was below the 30th reference percentile in 16 patients, and the percentage of subnormal DBP values was above 80% in 18 patients. Clinically, there was little to differentiate these patients from the rest of the population treated. The goal of treatment which, in terms of BP values, is to normalize the ambulatory BP was therefore overshot in 1 out of 5 or 6 patients depending on the criteria adopted. The significance and consequences of overtreatment cannot yet be evaluated.


[How to understand mechanisms of metastases].

The dissemination of malignant cells is the result of successive and complex biological steps. In most cases, physiopathological observations can explain the different cases of metastatic spread observed in clinical oncology. Our knowledge of the biological mechanisms involved in tumoral dissemination is poor. However, recent data have disclosed cellular modifications associated with malignant spread: these observations concern physiopathological aspects of the cytoplasmic membrane of malignant cells, their interconnexion with the stroma of tumors, the characterisation of new genes involved in tumoral progression and viral oncogenic mechanisms involved in cervical neoplasia. These data will yield biological parameters of potential value in assessing the metastatic risk of malignant tumors at the time of diagnosis. In the near future, it should be possible to more accurately select patients for antitumoral therapy and to achieve a better understanding of the cellular mechanisms involved in tumoral progression.


[The glucagonoma syndrome. 3 new cases].

We report three new cases of glucagonoma revealed, 6 to 12 months after its onset, by non-specific and misleading skin lesions associated in all 3 cases with diabetes mellitus, severe deterioration of the general condition and hyperglucagonaemia. Non-invasive methods, such as ultrasonography and computerized tomography (CT), are most helpful to locate the pancreatic tumour. Phlebography with tiered venous blood sampling is useful in difficult cases. A false positive result has been recorded with arteriography. Ultrasonography and CT have yielded two false negative results. The alpha-chain of the chorionic gonadotrophin hormone has limited value in the diagnosis of malignant glucagonoma. Treatment is surgical, but despite it, the prognosis is severe (two of our three patients died), due to the risk of thromboembolism, to cachexia and to metastases that are frequent at the time of diagnosis.


[Infertility in a couple. Focus on the different techniques of medically assisted procreation].

In view of the advent of effective medically assisted procreation (MAP) techniques, it is now more necessary than ever to use the most strict and systematized methods in the management of couples who consult for infertility. The authors present the modalities of this management and review the present MAP techniques which are all based on bringing together the gametes in an optimal environment conditioned by the clinical situation of the couple. The main results obtained are presented under the headings: percentage of success, multiple pregnancies prevention policy and future of the children.


[Pulmonary metastasis of meningioma of the falx cerebri].

We report the case of a woman who had been operated upon for a recurrent meningioma of the falx cerebri which, 22 years after it was discovered, produced pulmonary metastases. Metastases from meningiomas are extremely rare; they affect the lungs in 60% of the cases or, less frequently, the liver or lymph nodes. The factors predictive of secondary dissemination are the site of the tumour, the quality of excision, the histological type (haemangiopericytic meningioma) and the presence of cell necrosis, hypercellularity and strong mitotic activity.


[Apropos of 2 cases of Scedosporium apiospermum nasosinusal infection].

We report two cases of nasosinusal infection caused by Scedosporium apiospermum and involving the nasal fossa in one case and the maxillary sinus in the other. The course of the disease varied according to the patient's immune status. The otherwise healthy patient (case n. 1) was completely cured by surgery, whereas the immunosuppressed patient (case n. 2) had local extension with pseudotumoral symptoms and lysis of the inter-sinusonasal septum; an early surgical treatment combined with local administration of a specific antifungal agent resulted in an apparent cure, but the patient died a few months later. A review of the literature confirms the invasive potential of this fungus which in immunosuppressed patients (by therapeutic immunosuppressants or by a debilitating disease) becomes a dangerous opportunistic organism. Cultures on Sabouraud's medium provide an accurate diagnosis and enable antifungal drugs to be tested, miconazole being the most regularly effective of them. In healthy subjects surgery is the sole treatment of nasal or sinusal lesions, while in all immunocompromised patients it must be combined with an antifungal treatment.


[Myopathy in adults caused by acid maltase deficiency. A trial of treatment with high protein diet].

A 21-year old women with rhizomelic muscular deficit and signs of hypercapnia developed acute respiratory failure. Laboratory tests revealed high creatine kinase activity, and electromyograms showed myogenic patterns with a few myotonic discharges. Biopsy of the quadriceps muscle elicited major vacuolar myopathy with glycogen overload. Acid maltase activity was undetectable in muscular tissue. After 7 months on high-protein diet (1540 calories, 37% proteins) there was no clinical or biochemical improvement. The other published cases of acid maltase deficiency treated with high-protein diet are discussed.


[Identification of persons with high risk of venous thrombosis].

The aim of identification of patients with high risk of deep venous thrombosis is a selective and more efficiency prophylaxis. Deficiencies of coagulation inhibiting and fibrinolytic proteins are implicated in less than 10% of patients. However there are several clinical situations with an increased risk of thrombosis. Thus the characterization of blood abnormalities as screening tests for the diagnosis of patients at risk is an important goal.


[Association of IgA linear dermatitis and non-Hodgkin's malignant lymphoma].

The association between linear IgA dermatosis and neoplasia has been the subject of several publications which suggest that the association is not fortuitous. We report a new case in which a non-Hodgkin's lymphoma was associated with a linear IgA dermatosis and underline the need for full evaluation in search of an associated neoplasia. However, the neoplasia-LAD association is not a true paraneoplastic syndrome since the two pathologies seldom follow a parallel course.


[Renovascular hypertension: diagnostic and therapeutic strategy].

Investigations for renal artery stenosis have been greatly facilitated by advances in imaging techniques. Intravenous digital subtraction angiography is now performed in all patients with progressive, drug-resistant hypertension associated with aorto-iliac lesions or with renal impairment induced by angiotensin-converting enzyme inhibitors. Yet the finding of hypertension with renal artery stenosis is not enough to make the diagnosis of renovascular hypertension, this term being reserved to hypertension reversible by revascularization. The selection of patients who may benefit from revascularization rests on urography to explore the excretory and endocrine functions of the ischaemic kidney, as well as on scintigraphy and measurement of renin levels in renal veins before and after administration of captopril. The functional data are completed by vascular exploration which helps in evaluating the usefulness and safety of revascularization: repercussions of hypertension on target organs and extension of the vascular disease to other territories. Revascularization as first-line treatment consists of percutaneous transluminal dilatation; surgery must be reserved to difficult cases, such as arterial obliteration or failed dilatation.


[Homologies between membrane proteins result in expected or unexpected relations between neuromuscular and erythrocyte diseases].

The advances achieved in biochemistry and molecular genetics have made it possible to demonstrate that the membrane proteins of the erythrocytes belong to protein "families" that are present in most cell membranes and share remarkable structural and functional homologies. Abnormalities of erythrocyte membrane proteins might then totally or partially reflect lesions of other cell membranes that are intrinsically more severe than those of the erythrocytes. Examples of these physiopathogenetic links can be found in congenital diseases where muscular and erythrocytic pathologies coexist. Such are: (1) choreaacanthocytosis supported by molecular abnormalities of the so-called band 3 protein or anion channel; (2) Mac Leod syndrome by deficiency of a membrane protein precursor of Kell antigens; (3) some cases of hereditary spherocytosis associated with qualitative and quantitative ankyrin alterations. Yet, despite the homologies that are known to exist between spectrin and dystrophin, all attempts to use spectrin analysis as marker of Duchenne-Becker muscular dystrophy have met with complete failure, which shows that at this early stage one should refrain from drawing firm physiopathological conclusions from the available data.


[Intravenous immunoglobulins and anti-idiotypic suppression of auto-immunity].

This review summarizes the clinical use of intravenous immunoglobulins (IVIg) in autoimmune diseases and focuses on the mechanisms by which IVIg suppress autoimmune responses. Evidence is presented of a role of IVIg in modulating the regulatory function of the idiotypic network on the expression of the natural and pathological autoimmune repertoires.


[Lipids and lipoproteins in chronic alcoholism. Outcome after alcohol withdrawal].

The plasma lipids and lipoproteins changes observed in chronic alcoholic subjects and their modifications after cessation of drinking were studied in 379 patients admitted for alcohol withdrawal. The modifications were evaluated after one month (n = 348), 6 months (n = 56) and one year (n = 29) of abstinence. A significant decrease of HDL-cholesterol and apo A-I levels was noted after one year. HDL-cholesterol, apo A-I and apo B showed a biphasic variation with significant post-withdrawal changes which became less pronounced after 6 months of abstinence. The authors insist on the need for a prolonged post-withdrawal monitoring of plasma lipoproteins and apolipoproteins levels to evaluate the consequences of cessation of major chronic alcohol abuse. This study shows that the variations of plasma lipids and lipoproteins levels observed in heavy drinkers are similar to those observed in moderate drinkers, whereas the incidence of cardiovascular diseases seems to be higher in the former than in the latter.


[Retrospective study of 594 HIV-1 seropositive patients seen in 8 hospitals of western Paris].

This multicenter retrospective study concerns 594 cases of HIV-1 positive patients. The majority were asymptomatic. Some had Aids-related complex and some had AIDS. They were all seen in seven hospitals of the western outskirts of Paris and in one Paris hospital between 1983 and 1988. There was a predominance of homosexuals and of cases of AIDS in the center of Paris. Intravenous (IV) drug users and asymptomatic cases were more numerous in the city outskirts, a reflection of the populations at risk around each hospital. The proportion of cases of AIDS was lower among IV drug users than among homosexuals or bisexuals probably due to the fact that the viral infection was discovered at an earlier stage in a population contaminated at a later date or to the tendency to ask for the test "systematically" in drug addicts. 22% of the cases were women with a sex ratio of 3.5. HIV infection was attributed to use of intravenous drugs in 51% and to heterosexual transmission in 18% of the women. But the incidence of heterosexual transmission increased significantly, essentially in women. Overall, the incidence of infection by the HIV 1 has decreased since 1986. A number of recent publications seem to indicate the same tendency. But this fundamental observation remains to be validated by further studies. The yearly incidence of AIDS increases. The 5 year calculated actuarial rate of probability of remaining asymptomatic decreased to 40% in 385 initially asymptomatic patients.


[Death in Horton disease. Prognostic factors].

The authors reported causes of death and searched for prognosis factors in Giant Cell Arteritis (GCA). The diagnosis was confirmed by temporal biopsy in all cases. Fourteen patients died during treatment; thirty-six patients had completely recovered (follow up > 6 months after withdrawal of steroid therapy). The commonest causes of death were cardiovascular (n = 7) and digestive (n = 4); they occurred after an average of 195 days of treatment, half of them during the first three months. One death was due to GCA (autopsy) and five deaths were attributed to the treatment with corticosteroids. The prognosis factors were searched for by comparing age, sex, clinical signs, laboratory data before treatment, past medical history in the both series; further more initial dose of Prednisone and the dose after 180 days of steroid therapy were compared in the two groups. The adverse prognosis factors revealed by this study were: advanced age (p < 0.01), previous ischaemic heart disease (p < 0.05) and higher dose of corticosteroids administered at 6 months of treatment (< 0.01).


[Hand disorders in pianists].

During the past 10 years numerous studies have been devoted to the pathology of musicians. A few of these studies exclusively concern pianists. From a questionnaire filled and returned by 44 pianists we were able to determine the type and frequency of the symptoms encountered. Pain and stiffness are the principal symptoms, the 4th and 5th fingers being those most affected. Three pathologies predominate in the literature: overuse syndrome, entrapment neuropathy and functional dystonia. The often long and difficult curative treatment rests on rehabilitation. Training in the fundamental postures the pianists must adopt should enable them to reduce the occurrence of these pathologies.


[Current aspects of paraneoplastic acute polyarthritis].

Paraneoplastic acute polyarthritis (PAP) is a recognized rheumatological entity with semeiological features that are based only on a few published cases. We thought that it would be of interest to review the literature and present the current characteristics of PAP, taking into account only those cases where the acute polyarthritis and a neoplastic disease followed parallel courses. The clinical manifestations of PAP are extremely varied, making it difficult to distinguish this disease from some forms of rheumatoid arthritis, the RS3 PE syndrome or polymyalgia rheumatica. Clinicians must be vigilant when they are faced with a particularly progressive acute polyarthritis in a patient aged over 60, and particularly when this patient's general condition is altered and when fever and a clear-cut inflammatory syndrome are present. In such circumstances, it is mandatory to investigate for an underlying neoplasia.


[Epidemiology and clinical aspects of imported tropical diseases].

The number of people travelling of the tropical countries is in constant progression and today represents about 5% of the population of the developed countries. Mortality is mainly accidental. Morbidity essentially concerns transmissible diseases. Diarrhoeal symptoms occur in 20-55% of travellers, are bacterial in 2 cases out of 3, and can be prevented. Cholera should soon have an efficient oral vaccine. Hepatitis A is frequent in some travellers (2-3%) and can be prevented by vaccination. Hepatitis E is beginning to be observed. Strongyloidiasis can in some cases evolve to serious complications; it may be latent, so should be sought systematically after any visit to the tropics. Most affections on returning to the industrialised world concern paludism of the Plasmodium falciparum type, leading to a still high mortality rate of 400 per year in Europe, while the preventive and curative means available are sufficient. Any fever should therefore be suspected and suitable treatment given. Other causes of fever are acute viral hepatitis, typhoid fever, the arboviroses, and numerous other conditions. Dermatoses represent the third reason for consultation on returning. These mainly concern pruriginous symptoms with filariases and abnormal hosts being evidenced. Furunculous lesions indicate a diagnosis of cutaneous leishmaniosis or myases. Any form of pruritus should suggest a diagnosis of HIV infection, or pruritus should suggest a diagnosis of HIV infection, or particularly trypanosomiasis. The risk of sexually transmissible disease is overall 6-fold higher in tropical travellers; advice before travelling is therefore of paramount importance. Should a seropositive subject travel to the tropics?(ABSTRACT TRUNCATED AT 250 WORDS)


[Destructive polyarthritis in Behcet's disease. Apropos of a case and review of the literature].

The authors report a case of a 37 years old man with Behçet's disease since 7 years who develops a destructive chronic polyarthritis involving wrists, hands and one knee. The parallel evolution between recurrent orogenital ulceration and arthritis added to the absence of other associated destructive rheumatism permit to link this polyarthritis to Behçet disease. In spite of the few reports, the occurrence of destructive arthritis can't exclude absolutely the diagnosis of this affection.


[Inflammatory neuropathies].

Inflammatory neuropathy is the term used for all neuropathies associated with an inflammatory infiltrate of the nerves and/or nerve roots. Broadly speaking, there are two types of inflammatory neuropathies: those caused by an identified infectious agent, and those of uncertain origin for which an autoimmune process is usually blamed. Among the neuropathies of infective origin, leprosy is the most important owing to its frequency and to the physiopathological and therapeutic problems it still poses to clinicians and researchers, since the form and severity of nerve lesions depend on cellular immunity to the bacillus' antigen rather than on the bacillus itself. Retroviral infections, caused by the virus of AIDS more than by the virus of tropical spastic paraplegia, are responsible for numerous neuropathies the mechanisms of which are discussed here. The principal inflammatory neuropathies of uncertain origin are polyradiculitis and its different forms, and the heterogeneous group of neuropathies associated with Sjögren's syndrome.


[Extensive pharyngeal necrosis: an unusual complication of dermatomyositis].

To our knowledge, the occurrence of extensive pharyngeal necrosis in patients with dermatomyositis has not yet been reported. We report such a case characterized by a vast ulceration of the posterior laryngeal wall, extending from the velum palati to the larynx and responsible for both dysphagia and dysphonia. Treatment with an immunosuppressant had no effect on the lesions.


[Osteolytic metastases of breast cancer and biphosphonates].

Three-quarters of breast carcinomas at an advanced stage display metastases, usually of the osteolytic type. Osteolysis results from a predominant increase of osteoclastic activity stimulated by humoral or local factors secreted by cancerous cells. Bisphosphonates interfere with osteoclasts and therefore can reduce the osteolysis. These compounds act through three main mechanisms: physico-chemical inhibition of bone crystal, cytostatic effect on osteoclasts, and in the case of pamidronate, direct or indirect action on the mononucleate precursors of osteoclasts. Three bisphosphonates are now available: etidronate, clodronate and pamidronate. Ten published studies report on their use in breast carcinoma with osteolytic metastases, and without hypercalceamia. Four studies concern clodronate in 54 patients, and six studies concern pamidronate in 128 patients. Intravenous pamidronate seems to be the more effective of the two, with densification of the lytic areas in 25% of the cases. All studies mention a decrease of pain, risk of fracture, hypercalcaemia and new metastatic locations. Side-effects are minimal. Controlled studies are needed to confirm the position of bisphosphonates in the management of malignant osteolysis.


[Case reports of the Kümmel-Verneuil syndrome].

The significance of the complex clinical-radiological diagnosis is demonstrated in three cases of the Kümmel-Verneuil syndrome, the bone scintigraphy allows the demonstration and localisation of the bone process, but in respect to the differential diagnosis the results are unspecific. The CT allows an early and sure demonstration of the intravertebral vacuum phenomenon. In patients with nonspecific vertebral fractures the quantitative determination of the mineral content of the vertebral bones is indicated. The therapeutic decision is determined by the necessity of the biomechanical stabilisation.


[Double heart valve replacement disclosing antiphospholipid syndrome].

In patients with systemic lupus erythematosus (SLE) heart valve lesions are usually discovered at echocardiography; their haemodynamic repercussions are uncommon, and valve replacement is exceptional. We report the case of a woman who had undergone aortic and mitral valve replacement before antiphospholipid antibodies were found associated with 4 ARA criteria of SLE. Histopathological examination confirmed the diagnosis of Libman-Sachs specific endocarditis. The presence of antiphospholipid antibodies leads to a discussion of their role in the physiopathology of the heart valve lesions and vascular accidents that occurred in this patient. The overlap observed between the diagnostic criteria of SLE and those of primary antiphospholipid syndrome is discussed. Heart valve lesions may be one of the modes of access to the antiphospholipid syndrome.


Recurrent benign retroperitoneal lipoma.

A case of a rare recurrent lipoma originating from the perirenal fat is reported. Onset of symptoms (abdominal pain, weight loss, appetite loss, abdominal swelling, nausea, constipation) is late and the treatment is surgical, but postoperative radiation or chemotherapy may be indicated. Ultrasound, CT and NMR scans, pyelograms and barium enemas are the most important diagnostic investigations. Follow-up in these patients is important.


[Prophylaxis of malaria].

The prevention of malaria is based on chemoprophylaxis and protection against the vector. Nocturnal mosquito bites can be avoided by individual and collective measures, while chemoprophylaxis involves the use of various agents according to the place and duration of stay. Three endemic zones can be defined on the basis of chemoresistance. Chloroquine, proguanil and mefloquine are the three drugs used in this setting, the latter being contraindicated for pregnant women and children. Travellers making long stays in areas of low-level chemoresistance and short stays in areas of high-level resistance and for whom mefloquine is contraindicated are advised to take antimalarial drugs at the first signs of potentially malarial fever when medical care is unavailable. Quinine, halofantrine and mefloquine are used for the curative treatment of malaria in areas of chloroquine resistance.


[Cancer of the cervix uteri in young people].

The age-group distribution, risk factors, histopathological aspects, diagnosis, treatment and prognosis of 111 diagnosed and/or treated cervical carcinomas in women aged up to 40 years out of 478 cases with the same diagnosis were reviewed. It is considered that the incidence of 23.2% in this series is situated at the extreme of the high frequencies reported in the literature. Nineteen per cent of the cases were diagnosed in stages O and Ia, a well organize program for early detection being required. In our series, the 5-year survival rate was 73.3%. This finding, although in a small series of cases, supports the opinion that age has no influence upon the prognosis of this disease.


[Acute nosocomial bacterial meningitis. Apropos 27 cases].

Our series includes 27 patients with nosocomial meningitis (22 post neurosurgery and 5 post spinal puncture) of whom 15 with stated etiology (gram-negative bacilli and staphylococcus aureus in equal shares). Under the treatment with chloramphenicol + rifampicin + gentamicin a cure was obtained in 22 cases, improvement in 3 cases and 2 patients died.


[The use of cell cultures in the cytotoxicity testing of dental materials].

On lines of human (HeLa) and monkey (BS-C-1) cell cultures, the cytotoxicity of 15 products of dental use for radicular and coronary fillings, alloys and endodontic antiseptics was analysed. It was found that the simplified method can be used, together with the in vivo and in vitro tests recommended by I.S.O., for determining the bioavailability of dental products.


The timing of violence amongst psychiatric in-patients.

The timing of violence among psychiatric in-patients with reference to the time of day, day, month and season over a four-year period were studied. Most of the violence occurred in the daytime. There was no daily variation, but there were spring and summer peaks of violence. The implications of these findings on staffing discussed.


[Biological markers in the precise diagnosis of chronic alcoholic intoxication--the significance of blood changes].

The frequency of some blood disturbances during chronic alcoholism determined us to extend the biological investigations of alcohol abuse effects on blood figurated elements and hemostasis. The investigation of some series of alcohol addicts revealed clear-cut differences, directly proportional with the quantity and length of intoxication. The obtained results certify a disordered hemostasis, insufficiently elucidated as a possible biological cause of alcoholic states, manifested by alterations of some humoral elements in various forms of chronic alcoholism with mental disturbances.


[The interpretation of the telomic distribution of the pulmonary arterial trunk].

The analytical study of the periodicity of organic processes is of great interest as reflected by the literature. This paper aims at describing the functional implications from the viewpoint of pulmonary functional arterial circulation regularity. In the light of morphological aspects, the pressure falls along a symmetric telomic tree were followed up and compared with the experimentally obtained data.


[A microepidemic of severe tuberculosis in a hospital for chronic neuropsychiatric patients].

Details and considerations on a microepidemic of severe tuberculosis occurring in a hospital for chronic neuro-psychic patients are presented. This episode presents a practical interest by the knowledge of the circumstances of occurrence and progression, clinical-epidemiological features, associated favouring factors (immunodeficiency, absence of a sustained program for tuberculosis investigation) and biologic prophylaxis by BCG vaccinations and revaccinations. Several measures for avoiding such epidemics and, in prospect, of AIDS in the institutions at high risk are discussed.


[Pharmacological studies of sulbactam and its association with semisynthetic beta-lactam antibiotics].

The acute toxicity, local tolerance and pharmacokinetic properties of sulbactame manufactured by the Iaşi Antibiotic Investigation Centre, alone or in association with ampicillin or amoxicillin were tested. Some tests were made comparatively with the product Unasyn--Pfizer. The obtained data show that this beta-lactamase inhibitor has a low toxicity--DL50 i.p. in mice over 4,000 mg/kg, both alone or associated with the two semisynthetic beta-lactamic antibiotics. The local tolerance is good and the serum levels of the above mentioned associations are above towards the tested bacteria and are similar or very close to those of Unasyn. It is believed that the therapeutical use of the association sulbactame + ampicillin or sulbactame + amoxicillin is very useful in the beta-lactamase producing germs infection.


[The physicochemical characterization and therapeutic evaluation of Cicatrol].

Cicatrol ointment with the formula: argentic sulphamethoxydiasine 1 g, bentonite hydrogel 12.5% for 100 g is manufactured at the Microproduction Laboratory of the Faculty of Pharmacy of Iaşi. The one-year physicochemical determinations of the aspect, colour, homogeneity, pH, rheological behaviour and relative viscosity, content in argentic sulphamethoxydiasine as well as "in vitro" antimicrobial activity of Cicatrol showed a good stability and gel properties enabling an uniform and long-term contact with the wound. The clinical investigations carried out until now in patients with burns, varicose ulcers, trophic shank ulcers, superficial phlebitis with atonic ulcerations or wounds with multiple sites revealed its remarkable therapeutic value. As compared to other similar products, Cicatrol by its aseptic properties favours the scarring of any type of wound, a normal skin, without keloid scars being obtained, it also being well tolerated.


[The evaluation of the nitrate and nitrite content of meals in Moldova].

Between 1986 and 1990 the content in nitrites and nitrates of the daily meals in various collectivities in Moldavia was determined. The nitrite content ranged between 1.3 mg. NO2-/day (Suceava) and 7.38 mg NO2-/day (Botoşani) and the nitrate content between 24.93 mg NO3-/day (Suceava) and 92.30 mg. NO3-/day (Galaţi). The content in these poisons of the daily meals in two crèches from Iaşi and Bacău was also analysed, high values for both of them being found in the Bacău crèche. Some measures are suggested.


[The quality assessment of a product with adhesive properties for complete dental prostheses].

A formula of dental adhesive using as an agent responsible for this activity an indigenous product, C.M.C.Na 1080, gelified with preservative solution with added astringent agents was elaborated. The possible interaction between the constituents during preservation and the product qualities by determining the pH, extensibility index, sliding limit tension, antimicrobial activity and certain clinical aspects were evaluated.


[Phthalazinilides. The action of ethyl bromopyruvate on phthalazine].

Our investigation for obtaining carbon-nitrogen stable ilides continued by the synthesis of new phthalazinic derivatives by the action of ethyl brompyruvate. The structure of the obtained products was confirmed by chemical and spectral analyses. The results regarding their antimicrobial action are also presented.


[Our experience in the conservative surgical treatment of coxarthrosis].

The authors present the substantiation of the use of conservative treatment in a series of 163 patients with coxarthrosis operated upon between 1983 and 1990. In 135 of these patients various types of osteotomies were performed: Pauwels valgisation or varus femoral osteotomy (42 cases), McMurray displacement osteotomy (41 cases), varus and displacement osteotomy (19 cases) and Chiari pelvic osteotomy (33 cases). In the remainder of 28 patients tenotomies and hip denervations were performed. The postoperative results, estimated by a strict clinico-radiological survey revealed a marked clinical improvement and radiographically a restoration of joint congruence in about 80% of the cases.


[Dento-periodontal interferences in extended partial anodontia].

In this paper, part of a mixed longitudinal study on the growth and development phenomena in extended partial anodontia, the author, based on the data of the thorough clinical and paraclinical investigations carried out, underlines the implications of this isolated dental anomaly on temporary or impacted permanent teeth as well as on their periodontal support. Thus, 48 patients aged between 4.6 and 30.5 years with various clinical forms of extended partial anodontia were investigated. It resulted that the severity of the dental-periodontal involvement is strongly correlated with the etiopathogenic and clinical features and severity of the anomaly under study.


A new methyl bromide gas generator for inhalation toxicity studies.

A simple generator for methyl bromide gas has been newly developed by us. For inhalation toxicity studies, until now, there have been few generators capable of producing a constant and stable concentration of methyl bromide gas easily because of its high volatility. The principle of this new generator is based on gas-liquid equilibrium. The gas is generated from the surface of liquid methyl bromide in an evaporator made of a Teflon tube. The generator can produce up to 10,000 ppm of methyl bromide gas in a 0.1 m3 exposure chamber, and the concentration of this generated gas is able to be kept within +/- 0.8% over a long period of time. The generator has proved to be useful for investigating the effects of methyl bromide on health in inhalation toxicity studies.


Ethnic differences of the primary gene defect at the cytochrome P-450 2D6.

The cytochrome P-450-dependent monooxygenase system is involved in the metabolism of both endogenous compounds and xenobiotics. The role of these enzymes in toxicological response is exemplified by an autosomal recessive polymorphism at the cytochrome P-450 2D6 debrisoquine-4-hydroxylase locus, which results in the severely impaired metabolism of many drugs [Gough et al. (1990) Nature 347: 773-776]. The prevalence of this polymorphism (poor metabolizer) differs considerably between ethnic groups. Here we analyzed the P-450 2D6 polymorphism in 25 Japanese and 20 Chinese by DNA-based genetic assay using peripheral leukocyte. Although the phenotype of all the normal metabolizers and 79% of the poor metabolizers could be identified in Caucasians, this DNA-based genomic assay could not predict poor metabolizers in both the Japanese and Chinese. These results indicate that the genetic mechanism of the phenotyped poor metabolizer in Orientals is different from that in Caucasians.


[Studies on purine-pyrimidine metabolism (1)--Quantitation of purine-pyrimidine metabolites and allopurinol-oxipurinol in biological fluids].

A reversed-phase high-performance liquid-chromatography method for determining simultaneous quantitation of purine-pyrimidine metabolites, allopurinol and oxipurinol in plasma and urine samples was studied. Separation was optimal with phosphate buffer (10 mmol/l, pH 5.0) containing 1% methanol as an eluent and mu Bondapak C18 as a column. An isocratic separation of a standard mixture of 13 compounds was achieved within 40 minutes with adequate reproducibilities (coefficient of variation: 2.49% for 1.63 mumol/l orotidin-0.12% for 50 mumol/l uridine). A simple ultrafiltration of plasma yielded quantitative recoveries (uric acid: 101.7-107.5%, hypoxanthine: 90.4-102.8%, xanthine: 95.9-99.5%, oxipurinol: 104.4-107.1%, allopurinol: 97.4-103.4%). Compounds were identified by their retention times, absorbance ratios, co-elution with standards and enzymic shifts. In addition to the above compounds, simultaneous quantitation of pseudouridine, uridine, adenine and inosine in the plasma would be possible under the same conditions.


[A descriptive epidemiology on sudden death among workers].

A survey on sudden unexpected death, that is, death within 24 hours from acute onset, among Japanese workers was carried out. Questionnaires were sent to full-time occupational health physicians who were active members of the Japan Association of Industrial Health at the time of the survey. Though 241 doctors answered (response rate: 61.5%), only 53 of them who had had both sudden death cases and the desire to join in this research co-operated in this survey. During the 5 years of observation (from Jan. 1, 1986 to Dec. 31, 1990), 143 cases of sudden death, 141 males and 2 females, were reported. The mean age was 46.5 (S. D. 10.5) for males. The ages of the 2 females were 31 and 44. Onset took place most frequently at home (55%) and most often during sleep (26%). This may be due to the higher rate not only of onset but of death resulting from acute onset at home and during sleep. Similar to the previous findings, a small peak of incidence was found early in the morning (4:00 AM--9:00 AM), although this was not statistically significant. However, the weekly and seasonal variations were a little different from previous reports. In this study, sudden death tended to occur more on Monday, Thursday, Friday, and Saturday (not statistically significant), and as for the seasonal variation, more cases occurred in April, November, and December which were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)


[X-ray examination of the gastrointestinal tract in systemic cutaneous disease].

An X-ray examination of the gastrointestinal tract was performed on 56 patients with systemic cutaneous disease that is often considered associated with internal malignancies. Found were one case of esophageal cancer, two cases of gastric cancer, and two cases of colon cancer. The prevalence of gastric and colon cancer in these patients showed a statistically significant increase compared to the general population. The rate of gastric cancer was 16.26 times higher than the general population and that of colon cancer 32.26. X-ray examination of the gastrointestinal tract in patients with systemic cutaneous disease is useful for detecting malignancy.


[Cutaneous thermal-cooling and -warming detection thresholds in distal extremities of normal subjects].

The cutaneous thermal-cooling and -warming detection thresholds were evaluated on the dorsal side of the right distal forearm and on the dorsum of the right foot in 134 normal subjects (66 men and 68 women) without sensory symptoms and signs, aged from 11 to 87 years by using a Thermal Threshold Tester (Vickers Medical International, England). The normative data for the clinical evaluation of the severity and the pathologic process of the sensory disturbance of the patients were obtained. The data obtained included 1) the mean of each threshold and 2) its upper limit value of 95% confidence interval for each decade. The mean of each threshold was significantly increased with aging (P less than 0.0001). Therefore, the cutaneous thermal-cooling and -warming detection thresholds of the patients with sensory disturbances should be compared with the normative data adjusted for the age of each subject obtained in this study. Based on the evaluation, repeated six times for three weeks, of each threshold of six volunteers (ages from 21 to 66), high reliability of each threshold (intraclass correlation coefficient from 0.78 to 0.96) was observed.


Current status of education and training in occupational health and their development programs in China.

There are 40 post graduate schools of public health in China, from where 1,400 students are graduating every year. Fourteen percent of them are going into occupational health field. A total of about 25,000 specialists are now working in the occupational health field. However, this number is only 1 percent of all health workers in China. Facts on the educational resources in China including responsible institutions and programs for such occupational health specialists are introduced and discussed. Finally a program for increasing the number of occupational health specialists in the Eighth Five-year Plan of China is introduced.


What does a human relationship with the doctor mean?

Previous studies have demonstrated that the human relationship with the doctor is very important. The aim of this study was to describe the specific behaviour in consultations where the patient experiences a satisfying human relationship with the family doctor. 46 consultations with 12 participating general practitioners were video-taped in four health care centres. Afterwards the patients and the doctors, on different occasions, commented on the recorded consultations. The comments were audio-taped. Those comments of the patients which dealt with human relationship to the doctor were analysed. The sequences in the videotaped consultations just before these comments were transcribed and analysed. The study demonstrated that the concrete meaning of human relationship deals with simple and obvious things. The patients want the doctor to take their symptoms seriously; to listen and/or ask questions about the symptoms, and to treat the patient as a real person, not only a patient; to ask questions about other things than the disease, e.g. about the patient's family or work.


A controlled, multicentre trial of manual therapy in low-back pain. Initial status, sick-leave and pain score during follow-up.

101 outpatients with acute or subacute low-back pain were randomly allocated to one of two treatment groups. One group was given standardized conventional but optimal activating treatment by primary health care teams. The other group received manual treatment such as manipulation, specific mobilization, muscle stretching, auto-traction, and cortisone injections. The two groups were similar in most of the pretrial variables, including age, sex, previous low-back pain problems, sick-leave, previous treatment, findings at the physical examination, quality-of-life score, disability rating, and pain score. After one month in the study, the proportion of patients on sick-leave was six times larger in the conventionally treated group than in the group receiving the specific manual treatment. The difference diminished over time but was still significant after eight months. Two slightly different pain scores ("pain at the moment" and "pain during the last weeks"), initially similar in the two groups, diminished in both groups but were significantly lower in the manual treatment group during the study. The group receiving specific manual treatment thus had a significantly better outcome than the group receiving conventional treatment as far as sick-leave and pain score are concerned.


General practitioners' attitudes to oestrogen prescription in the menopause: a national survey in Norway.

A questionnaire was mailed to a random sample of approximately 10% of Norwegian general practitioners (GPs) in order to investigate attitudes to the prescription of hormone replacement therapy (HRT) in menopausal women. Nine short case histories were presented, and the GPs indicated their attitude to oestrogen prescription in each case on a five-step scale. Each case history contained four items that were systematically varied so that the effect of each could be investigated by comparing the answers from case to case. 251 GPs (74%) responded to the questionnaire. The answers indicated restrained attitudes towards prescription of HRT. Smoking and a family history of cardiovascular disease were regarded as contraindications. Angina pectoris was considered a contraindication for local oestrogen application in elderly women with urogenital complaints.


Predictive validity of factors influencing the institutionalization of elderly people with psycho-geriatric disorders.

The predictive validity of certain items was tested with respect to their influence on the institutionalization of elderly people with psycho-geriatric disorders (n = 69). Twelve items measuring both the patient's condition and the exhaustion around the patient were tested. Two outcome measurements were used, the first measuring the number of patients who were institutionalized after the end of 12 months and the second measuring the number of days at an institution during 12 months. The items "Exhaustion of spouse" and "Supervision need" showed the highest correlation with institutionalization and predicted institutionalization, better than items describing the degree of dementia.


Screening of an elderly population in primary care for primary hyperparathyroidism.

In order to assess the diagnostic outcome of a screening for primary hyperparathyroidism (PHPT) in an elderly population, we determined ionized calcium in serum from 368 individuals participating in a health control at Mölnlycke Primary Care Centre (200 women, 168 men; age range 75-95 years); four-fifths of the individuals living in their homes, the remainder in homes for aged or nursing homes. Intact parathyroid hormone was determined in the samples with oinized calcium concentration greater than mean + 3SD of the truncated population sample, and these individuals were also recalled for another blood sample. Moderate hypercalcaemia, probably due to PHPT, was found in eight individuals (2% of the complete sample, 3% of the women), five having neuropsychiatric or neuromuscular symptoms consistent with PHPT. Surgical intervention is probably indicated in only a small proportion of elderly patients. We conclude that optimal benefits in relation to costs of screening for PHPT in old people will depend on the availability of a safe and simple pharmacological treatment that could determine any causal relationship between hypercalcaemia and symptoms.