[Space maintenance following the premature loss of temporary teeth].

Despite contemporary techniques, we still don't have the ability of saving all deciduous teeth in their place on the dental arch until the time of physiological loss. A premature loss of temporary teeth interferes with the harmony of the adult dentition. The principal consequence of this premature loss is crowding, caused by migration of the adjacent teeth. This article ames to guide our policies in the decision making process whether or not maintaining space, in causes of premature loss of one or more deciduous teeth.


Poorer is riskier.

To examine the relationship between economic well being and health status, two economic concepts were explored: the permanent-income hypothesis and the transitory-income hypothesis. A regression analysis of time-series mortality data for the period of 1950-1988 was conducted. The regression results indicated that the total mortality rate is negatively associated with permanent income and positively associated with the transitory income. Results are also reported for the 8 major causes of death in the United States. The implications for risk analysis are discussed.


Risk to groundlings of death due to airplane accidents: a risk communication tool.

During the period 1975-85 in the United States the 70 year lifetime risk of dying from being hit by an airplane when the individual is on the ground was 4.2 per million people. In contrast to many other risks used for comparison purposes, risk to those on the ground from an airplane crash is not a function of our own skills; is not optional; provides no benefit to anyone involved; and is not an act of nature. As a risk comparison tool it also has the useful characteristics of being something about which we can agree that regulatory action, such as control of airplane use and traffic, is warranted; but that no significant change in personal behavior, such as living in the basement to protect against dying from a plane hitting the home, is commensurate with the extent of risk.


Risk, statistical inference, and the law of evidence: the use of epidemiological data in toxic tort cases.

Toxic torts are product liability cases dealing with alleged injuries due to chemical or biological hazards such as radiation, thalidomide, or Agent Orange. Toxic tort cases typically rely more heavily than other product liability cases on indirect or statistical proof of injury. There have been numerous theoretical analyses of statistical proof of injury in toxic tort cases. However, there have been only a handful of actual legal decisions regarding the use of such statistical evidence, and most of those decisions have been inconclusive. Recently, a major case from the Fifth Circuit, involving allegations that Benedectin (a morning sickness drug) caused birth defects, was decided entirely on the basis of statistical inference. This paper examines both the conceptual basis of that decision, and also the relationships among statistical inference, scientific evidence, and the rules of product liability in general.


Biological markers of environmental and ecological contamination: an overview.

An approach, using biomarkers (biological responses) for assessing the biological and ecological significance of contaminants present in the environment is described. Living organisms integrate exposure to contaminants in their environment and respond in some measurable and predictable way. Responses are observed at several levels of biological organization from the biomolecular level, where pollutants can cause damage to critical cellular macromolecules and elicit defensive strategies such as detoxication and repair mechanisms, to the organismal level, where severe disturbances are manifested as impairment in growth, reproduction, developmental abnormalities, or decreased survival. Biomarkers can provide not only evidence of exposure to a broad spectrum of anthropogenic chemicals, but also a temporally integrated measure of bioavailable contaminant levels. A suite of biomarkers are evaluated over time to determine the magnitude of the problem and possible consequences. Relationships between biomarker response and adverse ecological effects are determined from estimates of animal health and population structure.


The application of bioassays in risk assessment of environmental pollution.

Increased contamination of the environment by toxic chemicals has resulted in the need for sensitive assays to be used in risk assessment of polluted sites. Traditional tests are useful to detect and measure concentrations of chemicals in the environment and in tissues. However, physicochemical assays possess deficiencies that impair their use in evaluating complex environmental contamination. We have developed cytogenetic procedures, including chromosomal, micronucleus, and flow cytometric assays, to assess the mutagenic damage of petrochemicals and low-level radioactivity on indigenous terrestrial and aquatic wildlife populations. These procedures are sensitive to the perturbation of DNA that results from exposure to mutagenic contaminants in both field and laboratory studies. The use of natural populations of animals in biomonitoring, combined with traditional chemical assays, will ultimately provide sufficient information to estimate the risk to human health and environmental quality from anthropogenic pollution.


Reassessing benzene cancer risks using internal doses.

Human cancer risks from benzene exposure have previously been estimated by regulatory agencies based primarily on epidemiological data, with supporting evidence provided by animal bioassay data. This paper reexamines the animal-based risk assessments for benzene using physiologically-based pharmacokinetic (PBPK) models of benzene metabolism in animals and humans. It demonstrates that internal doses (interpreted as total benzene metabolites formed) from oral gavage experiments in mice are well predicted by a PBPK model developed by Travis et al. Both the data and the model outputs can also be accurately described by the simple nonlinear regression model total metabolites = 76.4x/(80.75 + x), where x = administered dose in mg/kg/day. Thus, PBPK modeling validates the use of such nonlinear regression models, previously used by Bailer and Hoel. An important finding is that refitting the linearized multistage (LMS) model family to internal doses and observed responses changes the maximum-likelihood estimate (MLE) dose-response curve for mice from linear-quadratic to cubic, leading to low-dose risk estimates smaller than in previous risk assessments. This is consistent with the conclusion for mice from the Bailer and Hoel analysis. An innovation in this paper is estimation of internal doses for humans based on a PBPK model (and the regression model approximating it) rather than on interspecies dose conversions. Estimates of human risks at low doses are reduced by the use of internal dose estimates when the estimates are obtained from a PBPK model, in contrast to Bailer and Hoel's findings based on interspecies dose conversion. Sensitivity analyses and comparisons with epidemiological data and risk models suggest that our finding of a nonlinear MLE dose-response curve at low doses is robust to changes in assumptions and more consistent with epidemiological data than earlier risk models.


The use of generalized estimating equations for risk assessment in developmental toxicity.

This paper reviews and compares several approaches to fitting dose-response models to developmental toxicity data. The main issue of interest is how to appropriately account for litter effects. Among the approaches reviewed are Beta Binomial models, models that attempt to characterize the litter effect through the use of covariates, and models that avoid the complication of correlated offspring by modeling "affected litter" rather than fetus-specific outcomes. Finally, we discuss our recommended approach, which is to use Generalized Estimating Equations, or quasi-likelihood. We give a number of reasons for preferring the latter and illustrate its application with an example.


A content analysis of written behavior management programs.

A method is described for assessing the elements of individual behavior management programs. The content analysis, consisting of 24 items covering the general categories of behavior specification, objectives, program procedures, data collection, and quality assurance, was applied to 141 written behavior programs of two large institutions from different regions of the United States. These data can be utilized readily to establish a data base for program evaluation at both the individual and institutional levels. In addition, to provide a measure of validity, the items included in the content analysis were rated by experts in the treatment of severe behavior disorders. General strengths and weaknesses of the programs, and of the content analysis itself, are discussed in light of their implications for program implementation and evaluation.


Assessment and training of functional conversation behaviour.

Measures for the assessment of initial, dyadic conversations are critically reviewed, and an alternative approach is described. The Verbal Interaction Analysis System is illustrated by two case studies featuring mildly to moderately intellectually disabled adults. These studies show how the VIAS provides an index of competence and assists in the development of specific treatment strategies. Social validity is examined in each case, and suggestions are made for improvements to the VIAS.


Components of personal competence and community integration for persons with mental retardation in small residential programs.

This study identifies components of personal competence and community adjustment in a national sample of persons with mental retardation living in residential facilities of six or fewer residents. Factor analysis of 65 variables yielded an 8 principal component solution that accounted for approximately half the total variance in the observed variables (49%). The eight identified components of personal competence and community adjustment were labeled (1) Self Care and Functional Personal Living Skills, (2) Community Living Skills, (3) Home Living Skills, (4) Problem Behavior, (5) Community Training Goals and Objectives, (6) Recreation/Leisure Activity, (7) Family Contact/Relationships, and (8) Community Assimilation and Acceptance. The implications of reducing potentially hundreds of indicators of personal competence and community adjustment into relatively few broad internally consistent composite constructs are discussed.


Translation, cultural adjustment, and validation of a measure of adaptive behavior.

This paper investigates whether a measure of adaptive behavior, which has been developed and validated in western countries, could be successfully adapted to a nonwestern country, Indonesia. The purposes of the study were to (a) delineate procedures for cross-cultural adaptation and validation of adaptive behavior measurement, (b) create an operational version of an instrument in an Indonesian setting, and (c) investigate the validity of the resultant instrument by studying whether it had the same psychometric properties as its United States counterpart. The results are discussed in terms of the usefulness of the methodology employed for ascertaining the worth of any operationalizations of constructs and themes borrowed from other cultures that will form the basis for educational program development and individual pupil assessment.


[De Quervain's tenosynovitis. Transversal scar and fixation of the capsular flap].

The authors report 62 cases of De Quervain tenosynovitis treated from 1983 to 1990 by the same surgeon. The de Quervain's tenosynovitis is an inadequation between the volume of the abductor pollicis longus and the extensor pollicis brevis and their tunnel above the radial styloid process producing a mechanical tenosynovitis. This disease occurs mostly in women with an average age of 47 and almost never before the age of 30. Clinically the patients have pain and swelling above the radial styloid process. Most of the surgeons know today this disease, nevertheless complications may occur (Abductor pollicis longus luxation, disgratious enlargement and adhesion of the scar). The transversal incision provides a less disgracious scar. As the tendinous pulley is opened frequent anatomical variations of the tendons are found. A ventral capsular flap fixation with a subcuticular continuous suture is made. This fixation prevents any ventral luxation. Radial nerve neuromas or neuritis is constantly looked for. The authors expose and analyse the statistical data of this intervention's results with a 6 month minimal and 7 years maximal follow up.


[Quintus varus supraductus. Results of the surgical treatment by cutaneous graft, internal capsulotomy and external transfer of the extensor of the 5th toe].

The overlapping fifth toe has often a congenital origin. It may be isolated or associated with an another pathology, congenital or acquired, but the relationship between them. Cannot be ascertained. The overlapping fifth toe is responsible for an esthetic deficit and/or a functional discomfort, it justifies a correct surgery. Twenty-one feet in 16 patients aged from 2 to 30 years (especially between 5 and 15 years) have been operated on and reviewed after a mean follow-up of 4 years. The technic associated a cutaneous dorsal Z-plasty on the cutaneous retraction a medial and dorsal capsulotomy of the metatarso-phalangeal joint, an external transfer of the fifth extensor tendon or its tenotomy and, in 10 cases, a plantar skin resection 19 results were excellent, one fair result and one failure. The condition of a stable result seems to be based on a complete and spontaneous correction of the deformity at the end of the operation.


[Localizations of histiocytosis X in bone].

Histiocytosis X is still of unknown origin. Its clinical patterns are various and it is above all a bone disease of children, mostly boys. It is a tumoral condition basically benign but with a strong tendency toward dissemination and destruction. Its natural history is unpredictable. The authors have reviewed 37 cases after a 44 months mean follow-up for bringing up a better understanding of the role of orthopedic surgery. The diagnosis was always based on biopsies looking for at least two basic signs out of four possible ones. Scintigraphy was used to detect other locations. MRI was used to evaluate the effect of treatment. In single eosinophilic granuloma, curettage was associated with biopsy. Local injections of corticoids may help in spinal locations. In disseminated forms, surgical treatment should be little aggressive, limited to a biopsy of the most superficial lesion. These forms should be treated by radiotherapy corticotherapy and chemotherapy, as well as the aggressive lesions, the extensive ones, the threatening ones and those which are not accessible.


[Remodeling of the spinal canal after comminuted fracture of the spine. Apropos of a case].

A burst fracture of T 12, without neurological impairment, was treated by plaster cast. Prior to treatment, there was a significant narrowing of the spinal canal, due to posterior displacement of a bone fragment. This was not modified by treatment, as the narrowing was unchanged on the second CT scan, done eight days later. At 17 months, there was no more narrowing on the CT scan, as a consequence of vertebral body remodeling. The patient had no pain and performed several sport activities.


[Dislocation of the tibialis posterior tendon].

The authors report a case of traumatic dislocation of the tibialis posterior tendon on the medial malleolus. They describe the treatment applied and made a review of the literature about this rare pathology.


[Idiopathic chronic retraction of the deltoid muscle. Apropos of 3 cases].

Three cases of a previously undescribed condition of idiopathic, non-progressive deltoid muscle contracture are reported. The clinical features are presented as also the management of the cases. Intra-operative appearance of the fibrotic band responsible for the pathology is described. The relevant literature is reviewed. Though such cases are rare, they show striking features which enable them to be distinguished from other causes of scapular winging. Surgical excision of the band confers lasting correction of the deformity.


[Osteochondritis dissecans of the acetabulum. Apropos of a case].

Osteochondritis dissecans acetabuli is a rare affection. The observation presented is one of a 23 year old man, who presented hip blockages in external flexion rotation. X-ray only allowed to find a sequestrum in the acetabulum by tomography-Arthroscanner confirmed the osteochondritis without cartilage rupture. Arthroscopy eliminated a cartilage lesion and directed towards a cavity filled by spongious bone through an extra articular approach.


[Cement wedge replacing iliac graft in tibial wedge osteotomy].

The authors report their experience in substituting cement for full-thickness iliac crest wedge in medial tibial wedge osteotomy using buttress plate fixation. A review of 107 osteotomies performed between January 1985 and March 1989, demonstrated that using cement wedge do not expose to any special complication and raise the accuracy of frontal mechanical axes correction. At last, cement wedge seems not to evolve as a stranger corpus able to give long or mean terms complications; it perhaps make unnecessary bone substitute or allografts wedges.


[Congenital asymmetrical pelvis. Clinical, radiological study and outcome].

In congenital pelvic obliquity, there is a restricted abduction in one hip and an abduction contracture in the other. This association has been considered as a cause of acetabular dysplasia with progressive subluxation of the hip opposite to the abduction contracture. The clinical and radiological study of 120 children with an average follow-up of 3 years and 3 months permitted to demonstrate that two different types exist: the simple types (93 cases) without dysplasia, which never developed progressive subluxation and must not be treated, and the pelvic obliquities with dysplasia-subluxation-dislocation (27 cases) which have to be treated if the decentration of the hip opposite to the abduction contracture is marked. Distinguishing between these two types may be difficult because the X-ray is nearly never strictly correct because of the pelvic obliquity. This work leads to a better comprehension of the acetabular dysplasias who are subdivided into pseudodysplasias, secondary dysplasias and primary dysplasias. In the screening for the detection of congenital dislocation of the hip, it is essential that a pelvic obliquity be recognised because it constitutes a sign of hip at risk. Then, the clinical research of instability could be completed by echographic study in the two or three months or by radiographic study after 3 months in order to have a very precise diagnosis and apply the best treatment.


[Surgical treatment of dislocations and subdislocations of the hip in patients with cerebral palsy by femoral and pelvic osteotomy].

Fifty-one skeletally immature cerebral palsied (C.P.) children with 70 subluxated or dislocated hips were treated by conservative methods: femoral osteotomy (65 hips), pelvic osteotomy (52 hips) and arthrotomy when necessary (19 cases). 31 children were less than 10 years of age when operated on (mean 6 years, 6 months), 20 children were more than 10 years of age (mean 13 years, 13 months); mean follow-up was 4 years. Reduction and coverage were achieved and maintained in all patients, except for 6 redislocations: a pelvic obliquity was neglected in 3 cases; femoral shortening was not performed in 2 cases. Post-operative course was difficult in eldest patients with pain and stiffness but functional result was acceptable at follow-up in all cases except redislocations. Open reduction was related to a higher rate of postoperative rehabilitation problems. Modeling of previously deformed femoral heads and improvement of hip mobility were consistently seen at last follow-up, except for 3 redislocations. It is concluded that conservative methods are quite advisable in CP children and adolescents. Hip reduction should be preferred to femoral resection even in adolescent.


[Caput valgum in children. Natural history and treatment of a series of 17 hips that reached skeletal maturation].

The growth disturbance of the superior end of the femur which is related to a superior lateral epiphysiodesis of the femoral neck is known as caput valgum (C.V.). Most often, it appears after the treatment of a congenital dislocation of the hip (C.D.H.) which can also produce many other growth disorders of the hip. Fifteen children (seventeen hips) presenting similar evolution and morphological abnormalities have been reviewed. We performed nine surgical procedures most of the time for painful hips because of excentration of the femoral head. When the bone maturity was acquired all hips except two (sequelae of infections) were asymptomatic with femoral heads well covered. When discovered or suspected, this disease needs of careful follow-up. When operative treatment is necessary, we think that it has to be a pelvic surgery. We performed 4 times a triple pelvic osteotomy; 3 times a Chiari osteotomy; and twice a hip shelf arthroplasty. Those operative treatments have always been done with good results in our review.


[Neurological complications of surgery for spinal deformities].

The aim of this study was to precisely analyse the physio-pathogenic mechanisms, bring to light the risk factors, and find a more practical way of proceeding in spinal surgery. Out of 667 spinal instrumentation surgical operations carried out between 1980-1989, we found 33 (4.8 per cent) neurological complications and have divided them into 2 groups: 7 peripheral complications, 26 cord and central complications. After further analysis, especially of the cord complications (2.5 per cent), we were able to pick out the factors which influence the rate of neurological complications and their evolution: secondary aetiology and the kyphotic composition of spinal deformation, and above all the notion of cord at risk. The delay of cord complications and especially the relation between the severity of the neurological syndrome and its evolution is extremely important. Somesthesic evoked potential monitoring confirmed that per operative diagnosis of a cord injury is possible. The steps to take when confronted with neurological complications, depend on the results of many examinations: pre and post-operative neurological evaluations electrophysiological exploration of the cord and neuro radiological explorations (myelography, scanner and IRM). This helps to complete aetiology and eliminate mechanical causes, which are the only positive indications of iterative surgery. The problems of instrumentation removal in emergency and the legal-medical aspect brought on by this type of complication are discussed.


[Administration of lysine acetylsalicylate and meperidine in acute postoperative pain].

Postoperative analgesia is insufficiently done due, among others, to the undesirable effects of analgesic agents. The aim of this study was to analyze the effects of the simultaneous administration of opiates (meperidine) and AINES (lysine acetylsalicylate, ASL). We studied 160 patients during the immediate postoperative phase. All of them underwent programmed surgery with the same general anesthetic technique. Patients were allocated into 8 groups of treatment: A) ASL 900 mg and 1.800 mg/8 h, B) ASL 900 mg and 3.600 mg/8 h, C) ASL 900 mg and meperidine 100 mg/8 h, D) ASL 900 mg and 1.800 mg/8 h together with meperidine 100 mg/8 h, E) meperidine 50 mg and ASL 1.800 mg/8 h, F) meperidine 50 mg and ASL 3.600 mg/8 h, G) meperidine 50 mg and 100 mg/8 h, and H) meperidine 50 mg and 100 mg/8 h together with ASL 1.800 mg/8 h. The effects of analgesic agents were evaluated on the basis of patient's appreciation of the degree of pain and relief and on the basis of an observer who did not know the therapeutic regime administered. Results were compared according to the analysis of variance in a graded factorial design. A p value less than 0.05 was considered significant. The degree of pain was significantly lower in groups C, D, G and H (specially in G and H) than in the remaining groups, but there were no significant differences between them. The lowest pain relief was observed in groups A, B, E and F. The highest attenuation of pain was achieved in groups G and H. The highest attenuation of pain was achieved in groups G and H. The observer considered that the two latter groups were those with the highest pain relief, followed by groups C and D. The remaining patients failed to show appreciable improvement. Nausea and vomiting only occurred in some patients after administration of a bolus of meperidine. There were no other secondary effects. The best degree of postoperative analgesia is achieved after administration of continuous infusion of meperidine 100 mg/8 h. Simultaneous infusion of ASL 1.800 mg/8 h did not improve the analgesia obtained with a bolus of 900 mg of ASL nor with a bolus of 50 mg of meperidine. Secondary effects were only nausea and vomiting and coincided with the administration of a bolus of meperidine.


[Postoperative analgesia using the intravenous PCA technique. Results in the first 400 patients treated at a general hospital].

PCA (patient controlled analgesia) has represented a remarkable advance in the treatment of postoperative pain. In this work we describe our experience with this analgesic technique. One hundred patients undergoing thoracic and abdominal surgery were selected after giving information to the medical and nurse personnel. Pharmacologic agents used in this study were morphine (intravenous PCA) and fentanyl (epidural PCA). Starting of the perfusion pump was done by the anesthesiologist at the Recovery Unit and the treatment was continued by the nurse. Every morning the patients were visited and the degree of analgesia was recorded according to the following score: 1: no pain, and 5: intolerable pain. An anesthesiologist was permanently available. Later on, this study was expanded to 400 patients including other types of surgery. Mean duration of the treatment was 60 hours. The amount of analgesics administered varied among patients and was greater during the first postoperative hours specially in the group of patients treated with fentanyl. The mean degree of pain was 1.5 (grade 1 in 37.5% of cases and grade 5 in 3.5% of patients). Secondary effects were only nausea and vomiting. Inconvenient features of the technique were: patient's difficulties in the management of the technique (3 cases), and spontaneous loss of the program (1 case). Patient's acceptance of the technique was good. PCA analgesia has been successfully introduced in our hospital since it is effective, safe, easy to manage.


[Thalassemic syndromes and anesthesia].

Thalassemic syndromes are produced by a quantitative defect in the synthesis of globin chains of hemoglobin. They are classified according to the severity of the clinical picture and to the type of globin chain that is affected. Physiopathology, clinical picture, and treatment of thalassemias are discussed in this work. Thalassemia minor does not create, in general, anesthetic problems. In cases of thalassemia major one should consider not only problems derived from the severity of the anemia it self, but also those related to transfusional therapy, and to bony malformations that may disturb tracheal intubation. Discussion on the management of homozygotic thalassemia during the pre, per, and postoperative phase completes this revision.


[Comparative analysis of the criteria for surveillance and monitoring in anesthesia, resuscitation and pain therapy. Recommendation of the Sociedad Española de Anestesia y Reanimación].

One part of morbidity and mortality associated with anesthesia is due to accidents. It is thought that an additional monitoring can prevent and avoid most of anesthetic accidents. In order to improve patient's safety and quality of anesthesia, Harvard University hospital approved in 1985 the rules for intraoperative monitoring. These were adopted by the American Society of Anesthesiologists (ASA) in 1986. In line with this procedure, professional associations of several countries pronounced their own rules. SEDAR did it in 1989. The purpose of this study was to compare spanish rules with those of America (Harvard and ASA), Australia, England and France. Comparative analysis revealed that the spanish norms are more extensive since they include not only the intraoperative anesthetic activities, but also those related to recovery, pain, and obstetric anesthesia. However, it has some deficiencies such as the lack of a periodical revision, and of an adaptative period and assistance to the anesthesiologist provided by auxiliary personnel. Successful points were the recognition that pulse oximetry is essential, the preoperative verification of all material, and, more importantly, is the only one that considers essential capnography in the assessment of ventilation and pulse oximetry during regional anesthesia and postoperative phase. Spanish norm is comparable to that of the other countries considered in this study. It shows important successful points and at the same time some significant deficiencies.


[The introduction of chloroform anesthesia in Madrid. Notes for studying its history].

Until present, the introduction of chloroform anesthesia in Madrid has not been specifically studied by any author. Therefore, knowledge of the events related to this happening is lacking. We have studied this chapter of our history by analyzing primary documents and articles published at the daily press, political press, and scientific journals of Madrid during 1847 to 1848. This investigation allowed us to follow the most relevant news dealing with the discovery of the drug and with its first experimental and clinical applications in Madrid. Based on the present bibliographic material we could establish a chronologic report of all surgical interventions using chloroform that were performed in Madrid. We conclude that albeit surgeons in Madrid were not the first to use chloroform in Spain, they were, however, the ones who most extensively used it. Their contribution was of relevance in the settlement of the new anesthetic agent in Spain.


[Tracheal rupture during a transhiatal esophagectomy without thoracotomy. Intra- and postoperative treatment].

We report the case of a male patient with a carcinoma of the upper third of the esophagus who presented a tracheal rupture during a transhiatal esophagectomy. The clinical picture was characterized by a severe alteration of the ventilatory function that required selective intubation and, later on, a right thoracotomy for repairing the tracheal lesion. After surgery the patient was treated at the Recovery Unit. He received high-frequency mechanic ventilation (jet ventilation type) during nine days in a attempt to decrease the risk for dehiscence of the tracheal suture and to ensure an adequate oxygenation and hemodynamic control. The clinical course was favourable.


[Pain caused by brachial plexus injury during coronary revascularization. Report of 3 cases].

We report three cases of injury of the brachial plexus after coronary revascularization surgery. During the postoperative phase all patients presented plexopathy involving the left C8 and D1 roots. The symptoms were pain, paresthesia, and motor deficits. The proposed mechanisms for injury of the brachial plexus during cardiac surgery are: hyperabduction of the arm, direct traumatism produced by the needle during catheterization of the internal jugular vein, and traction and compression associated with sternal retraction. In the three patients we ruled out alterations during cannulation of the internal jugular vein and malposition of the arms. We think that in our cases the fundamental mechanism was an excessive and assymetrical opening of sternal and Favoloro's separators that were used in all cases during dissection of the left internal mammary artery. We conclude that injury of the brachial plexus can be minimized by reducing the opening of both separators and by placing Favaloro's separator in a lower position.


[Experience with the Du Pen epidural catheter in chronic cancer pain].

We evaluate the results obtained with the use of Du Pen's epidural catheter in a series of patients with chronic oncologic pain. There were 27 patients with neoplasms of different etiologies who received a total number of 30 catheters. Inclusion criteria were established. All patients received bolus of morphine chloride free of conservers. Follow-up controls were carried out at least every week and consisted on the evaluation the dosage efficacy, dose adjustments, catheter condition, physical activity, neurologic state, and requirements of adjuvant medication. The documented use of the 30 catheters implanted in this study lasted up to 1452 days with a mean of 48.5 days. There were no complications related to catheter insertion. However we observed complications related to the use of the catheter: reflow at the site of catheter implantation in 4 cases, infection of the external (one case) and internal (one case) catheter route without antibiotic resolution, and infection of the epidural space responding to antibiotherapy without catheter withdrawal in one patient. Twenty patients died. Mortality was not attributed to catheter complications in any case. The present study confirms that placement of the catheter is technically easy and provides an efficacious opiate analgesia with minimal complications.


[Epidemiology of head traumas. "Barcelona" data base. Objectives, design and analysis of 584 cases].

Descriptive analysis of some features in patients with cranio-encephalic traumatisms (CET) admitted to our hospital and collected in a data base, in order to establish the prognosis of the lesions and apply the most appropriate diagnostic and therapeutic procedures. Since July 1987 to June 1989 we collected data on 584 patients with CET who presented the following selection criteria: consciousness level lower than 13 points in the Glasgow scale and/or pathologic computerized tomography. According to the consciousness level (Glasgow scale) on admission, patients were classified into three groups: slight CET (Glasgow 15-13), moderate CET (Glasgow 12-9), and severe CET (Glasgow < 9). The traumatic mechanisms were divided into 8 categories (occupant, pedestrian, motorbike, aggression, labor, drop, sporting, cyclist). According to the main lesion we considered the following diagnoses: subdural hematoma, epidural hematoma, cerebral contusion (s), diffuse lesion with normal computerized tomography and/or subarachnoid hemorrhage, cerebral congestion, and diffuse axonal lesion. Results were evaluated six months after using the Glasgow scale. The mean age of patients with slight CET was 37.7 +/- 22.1 years, those with moderate CET 31.7 +/- 22.6 years, and those with severe CET 30.8 +/- 21.6 years. Four hundred and forty-two were men (75.6%). The time period between the accident and hospital admission could be determined in 512 cases (87.6%). Severe CET arrived to the hospital (4.8 +/- 7.3 hours) earlier than the other groups (6.6 +/- 11.9 hours in moderate CET and 14.2 +/- 23 hours in slight CET). Most of patients, 488 (83.5%), were referred from another hospital, whereas the remaining cases came directly from the accident place. Traumatic mechanisms according to the previous categories were: occupant 145 (25%), pedestrian 112 (20%), motorbike 104 (18%), cyclist 2 (0.003%), labor 39 (7%), drop 154 (27%), sporting 7 (1%), aggression 10 (2%). Percentage of traffic accident was higher in patients with severe CET (74.6, 64, and 47% in severe moderate, and slight CET, respectively). The main lesions were: acute subdural hematoma, 72 (12.3%); cerebral contusion, 207 (35.4%); epidural hematoma, 88 (15%); normal computerized tomography/subarachnoid hemorrhage, 87 (14.8%); swelling, 17 (2.9%); diffuse axonal injury, 74 (12.6%); and the remaining, 39 (6.6%) had other lesions such as hydrocephalus fracture-sinking, etc. Mortality was 44.2, 12.2, and 3.7% respectively in severe, moderate, and slight CET. Data base may contribute to establish the prognosis of CET and to determine the efficacy of therapeutic procedures as well as that of diagnostic and investigational methods.


[Comparative study in pediatric inhalation anesthesia. Clinical characteristics and anesthetic complications with halothane and isoflurane].

Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane). We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications. Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane. Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.


[Treatment of spasticity with intrathecal baclofen].

Severe spasticity, according to Lance's definition, is a manifestation of superior motoneurone injury syndrome which is characterized by increased stretching tonic reflexes, osteotendinous hyperreflexia, and release of propioceptive reflexes. Baclofen (a beta-4 chlorophenyl derived from gamma-amino-butyric acid) was firstly administered by intradural route in humans by Penn and Kroin in 1985 for the treatment of severe spasticity of muscular and central origin. We report the results obtained in eleven patients with severe spastic picture, six of medullar origin and five of central origin who were treated with intradural administration of baclofen using an implanted programmable continuous perfusion system (Synchromed 8611H). The age of patients ranged from 12 up to 58 years. Six were males and five females. The duration of the treatment ranged from a maximal period of 36 months to a minimal period of 12 months. The initial dose of baclofen varied from 50 micrograms/day to 144 micrograms/day. The better results were obtained in patients with spasticity of medullar origin. The most marked beneficial effects were the reduction of spasms elicited, or not, by external stimuli. In all cases the doses of baclofen had to be progressively increased, leading to a mean final dose of 235.6 micrograms/day, with a maximal dose of 480 micrograms/day and a minimal dose of 144 micrograms/day. Baclofen administered by intradural route is more effective than administered by orally and the required doses were lower. Intradural administration was effective even though the oral route was unsuccessful.


[Some Spanish contributions to anesthesiology at the end of the XIXth century].

At the end of the XIXth century some original, although poorly known, Spanish contributions were made on the field of inhalational general anesthesia that are important for the history of our specialty in Spain. The purpose of this work is to report the Spanish contributions to inhalational general anesthesia made during the chronological period that coincides with the locus-regional anesthetic techniques grown after the appearance of cocaine in 1884.


[Regional blockage for arterial blood pressure control during placement of head holder in neurosurgery].

To achieve a hemodynamic stability in neurosurgery during placement of the craniostate, we compared the effects of blocking frontal and occipital nerves with supplementary doses of fentanyl with the effects observed after subcutaneous infiltration of craniostate fixation points. We studied 34 patients with intracranial masses programmed for craniotomy who were randomly allocated into three groups. Group I received fentanyl 3-5 micrograms/kg, 5 minutes before implantation of craniostate; Group II was treated with subcutaneous infiltration of mepivacaine 2% at craniostate fixation points; and Group III underwent blockade of frontal and occipital nerves. Mean arterial blood pressure was measured at baseline, immediately before craniostate placement, and during the maximal rise induced after placement of the craniostate. Mean arterial blood after craniostate placement was significantly higher in Group I than in Group II (p < 0.01), and higher than in Group III (p < 0.05). Blockade of frontal and occipital nerves is a useful method for maintaining hemodynamic stability during craniostate placement in neurosurgical patients.


[Study of thyroid function in the organ donor during brain death].

To determine the thyroid function in organ donors undergoing cerebral death and evaluate the effects that these possible alterations may exert on the early function of renal graft. Prospective study. Hormonal analysis when: 1) the diagnosis of cerebral death was made and 2) before organ extraction. Fifteen organ donors with cerebral death. Twenty-nine patients who received the kidneys of these donors. Neurotraumatologic Unit at the University Hospital Marques de Valdecilla. Referring center. All donors showed low T3 and T4 values. Values of T4 and IT4L were significantly lower during the second determination (p < 0.05). Eighty percent of donors showed increased T3r values. TSH was low in 73% of cases. Dopamine requirements in donors or the incidence of acute tubular necrosis in recipients were not significantly higher in donors with lowest T3 values. The hormonal picture observed in the donors of this study is more characteristic of a "ill euthyroid syndrome" than a real hypothyroidism. The low values of T3 in donors is not associated with higher requirements of inotropic agents, nor with a higher incidence of acute tubular necrosis in renal grafts.


[Prophylaxis with dantrolene sodium in 2 patients with susceptibility to malignant hyperthermia].

We report 2 patients programmed for elective surgery who were considered susceptible to develop the malignant hyperthermia syndrome. The first patient had two familiarly antecedents of death produced by postanesthetic malignant hyperthermia, whereas the second patient suffered a clinical picture compatible with this syndrome during tonsillectomy, although followed a favourable recovery. The preoperative study including measurement of muscular enzymes, isoenzymes, and muscular biopsy was normal. In both patients an intravenous prophylactic treatment with dantrolene 2.5 mg.kg1 was undertaken before surgery. The first patient underwent hysterectomy under intradural anesthesia with bupivacaine 0.5%. The second patient had a maxillary fracture which was treated with osteosynthesis under general anesthesia. During the intervention and the postoperative follow-up, both patients were free of signs related to malignant hyperthermia. We conclude that prophylaxis with dantrolene is necessary in patients susceptible to develop the syndrome of malignant hyperthermia.


[Local anesthesia of the knee for arthroscopic surgery. Our experience in 1,000 cases].

We performed local anesthesia of the knee for arthroscopic surgery in 1,000 patients who were diagnosed of meniscopathy, chondropathy, or block of the knee. We established two anesthetic times. The first consisted of an intraarticular administration of 40 ml of a mixture containing bupivacaine 0.5%, lidocaine 0.5% or prilocaine 1%, and adrenaline 1:200,000. The second was extraarticular and consisted of a local infiltration at the sites of entrance of the arthroscope or instrumental material with lidocaine 0.5% or prilocaine 1%, with adrenaline 1:100,000. We kept a latency period of 10 to 15 min, time required for setting up the arthroscopic procedure. Ischemia was systematically avoided. With this technique the following surgical treatments were performed: meniscectomy, curettage of articular cartilage, synovectomy, plica sections, and extraction of free bodies. Tolerance to surgery was excellent in 32.3% cases, good in 46.5%, regular in 16%, and bad in 5.2%. In no cases more complex anesthetic techniques were undertaken. We conclude that the anesthetic technique used in this study is appropriate for arthroscopic surgery of the knee and allows to perform ambulatory surgery. The procedure is not useful in cases of ligament reconstruction, regional infection, and rupture of the articular capsula. Although the anesthetic technique is easy some factors should be considered before indication of the procedure such as a careful selection of the patient, skillfulness of the surgeon in performing the arthroscopy, and the accuracy of the preoperative diagnosis.


[Thrombosis of intrathoracic veins. A complication of venous catheterization for temporary hemodialysis].

Venous thrombosis of large vessels is a common complication, generally asymptomatic, that may occur during central venous catheterization for temporal hemodialysis. We report 2 cases of intrathoracic venous thrombosis which were suspected because of the difficulties occurring during catheterization of a new venous approach during dialysis. Both cases were diagnosed by angiography.


[Efficacy of topical administration of lidocaine through a Malinckrodt Hi-Lo Jet tube in lessening cough during recovery from general anesthesia].

To achieve tracheal anesthesia during intubation, an endotracheal tube was purposely designed. The tube had multiple laser-induced perforations in its lower portion produced that allowed administration of the local anesthetic in a pulverized form. We evaluated the efficacy of lidocaine 2% in preventing cough during recovery from general anesthesia. The goal of this study was to perform a topical anesthesia of the hypopharynx, larynx, and trachea. This attenuates the laryngeal reflex occurring during anesthesia recovery and therefore, prevents from potential complications. Sixteen patients ASA I-II underwent surgery with general anesthesia. They were prospectively studied following a randomized double blind protocol. The control group received saline infusion (n = 6) whereas the experimental group (n = 10) was treated with lidocaine. At the end of the anesthesia period, the presence of cough was treated with the test solution. In 90% of cases treated with lidocaine, cough disappeared in about 30 seconds and patients tolerated the endotracheal tube until extubation was performed. All patients who received saline solution presented cough until extubation.


Nitrobenzylthioinosine binding cooperativity in chromaffin tissue membranes.

The nucleoside transporter present in chromaffin tissue membranes has been studied by [3H]nitrobenzylthioinosine (NBTI) binding. This ligand presents a high affinity, with a Kd value of 2.1 +/- 0.2 nM and a Bmax of 1.7 +/- 0.2 pmol/mg protein. From the Scatchard and the semilogarithmic graphical representations a positive cooperativity was deduced, with a Hill coefficient of 1.7 +/- 0.4. In displacement studies of NBTI by the non labelled compound, the Hill coefficient was also higher than 1 (1.44 +/- 0.11) in the presence of ATP. This nucleotide seems necessary to maintain the number of high affinity binding sites.


[Effect of the level of sexual receptivity on plasma estradiol and the ovulatory response during the postpartum period in the rabbit].

The relation between plasma estradiol 17-beta mean levels (E2), sexual receptivity and ovulation response, as well as the evolution of E2 from day 29 of pregnancy until day 11 of postpartum in rabbits, was studied. The results suggest a direct relation between plasma E2 mean levels and high or low sexual receptivity. With a determined plasma E2 concentration was not able to predict sexual receptivity. The best ovulation response was obtained in rabbits of high or medium receptivity treated with 20 micrograms or 40 micrograms of GnRH. High plasma E2 mean concentrations were detected on day 1 and 9 postpartum. The evolution of E2 levels from day 29 of pregnancy until day 11 postpartum suggests that day 9 is the most favorable breeding day, when rabbits are to be submitted to a semi-intensive reproduction management.


Potentiation by epidermal growth factor of the in vitro HCG stimulation of testicular steroidogenesis in hamsters.

Epidermal Growth Factor (EGF) has been reported to stimulate or inhibit steroidogenesis in murid Leydig cells depending on the experimental conditions used. In the present study, testicular fragments from an adult cricetid rodent, the Syrian hamster, were incubated with various doses of mouse EGF (0-2.0 micrograms/ml media), in the presence or absence of HCG (0-12.5 mlU/ml media). Although EGF alone did not affect in vitro testicular steroidogenesis, it significantly potentiated the HCG-induced elevation of the accumulation of testosterone and 17-hydroxyprogesterone in the media. In contrast, the effect of HCG on media progesterone concentration was not affected by EGF. Since in the Syrian hamster intracellular calcium loading functions as a gonadotropic stimulus, the present results could be a consequence of the EGF-induced increase in cellular calcium levels.


Morphofunctional changes in gastrointestinal tract of rats due to cafeteria diet.

Female rats fed a cafeteria diet from birth developed obesity at 60 days of age and their stomach, small intestine and caecum were enlarged when compared with controls, i.e. these regions had greater food storage capacity. In spite of the enlargement, these regions had similar or reduced weight and linear density, which is seen as proof of reduced mechanical performances. Cafeteria diet produced increased glucose duodenal absorption in older animals unlike the typical reduction known in controls. Tryptophan absorption was maintained high in adulthood, compensating for the low structural nutritive properties of the cafeteria diet. The results are interpreted as an adaptation to the cafeteria diet effects and properties: the characteristic overeating of foodstuffs with greater energy density, lower mechanical requirements and lower structural nutritive value than pelleted chow.


On the multiplicity of sugar transport systems in guinea pig jejunum.

A study has been made in everted sacs of guinea pig jejunum to see if the two transport systems of glucose analogues characterized at the brush border membrane vesicles are operative. The transport kinetics of D-galactose and alpha-methylglucoside up to 80 mM concentrations has been studied, as well as the mutual inhibitions between them at low and high concentrations of the substrate and at different concentrations of the inhibitor. Low temperature (20 degrees C) inhibits galactose transport at 0.1 mM (70%) and 40 mM (78%) concentrations. A mass transfer coefficient, KD, somewhat higher for galactose than for alpha-methylglucoside, was obtained when the transport component was abolished by phlorizin. The transport of D-galactose and alpha-methylglucoside seemed to be compatible with the function of one system shared by both substrates, which presents greater affinity for alpha-methylglucoside. The functional existence of two systems of active transport at the brush border of guinea pig was not evidenced in intestinal preparations of whole tissue, due perhaps to the effect of the unstirred water layers. However, differences in KD values and some results of the mutual inhibitions may suggest a second system.


Conformational changes of S-1 related to its dissociation from actin.

The peptide pattern obtained after proteolysis of S-1 with trypsin was different in the absence or presence of anions. The affinity of tryptic and undigested S-1 for anions (CN-, SCN- or HCO3-) was different, as reflected by the altered values of Ki or Ka obtained from ATPase activity measurements. Anions CN-, SCN-, HCO3-, or PPi induced dissociation of actomyosin when added to acto-S-1 or acto-heavy-meromyosin. Among nucleoside di- and triphosphates, only triphosphates were effective with regard to the dissociation. The results suggest the existence of a regulatory site of cationic nature on S-1, which might be involved in the dissociation of actin from myosin.


[Photoperiod variations of various blood biochemistry constants in the rabbit].

Biochemical blood parameters generally show fluctuations during the day. The aim of this study is to determine the variations of the following parameters: hemoglobin, glucose, triglycerides, ASAT, ALAT, urea and creatinine in New Zealand white (NZW) rabbits, kept under five different circadian rhythms (12/12, 14/10, 10/14, 16/8, 8/16, light/dark). These parameters were analyzed by using a reflection photometer (Reflotron). Most results are found within the physiological range for this species but there are significant differences among cycles. These findings could be explained by the dependence of the biochemical blood parameters on the light/dark cycle. It can be concluded that the most useful cycle to find fewer variations of the biochemical blood parameters in NZW rabbit is 12/12 light/dark cycle.


[25 years Heidelberg Rehabilitation Center for Spinal Cord Injuries--retrospect and prospects].

In the framework of a commemorative gathering and scientific symposium in November 1991, an account was given of the 25 years of service of the Rehabilitation Centre for Spinal Cord Injured Persons of the Heidelberg Orthopaedic University Hospital Foundation. Tribute was at the same time paid to the lifework of Kurt Lindemann, former director of the Orthopaedical University Hospital and rector magnificus of the Heidelberg Ruperto Carola University, in memory of the 25th anniversary of his death in 1966. Encouraged by the father of SCI rehabilitation Sir Ludwig Guttmann, of Stoke Mandevillehospital, England, Kurt Lindemann had taken the initiative for establishing this centre and prepared its opening in 1966. Comprising a clinical department, the Ludwig Guttmann House, and a department for vocational-social rehabilitation, the Kurt Lindemann House, the centre has since enabled provision of all measures required for comprehensive rehabilitation of spinal cord injured women, men and children--starting at the day of injury till full resettlement of this population in family, occupation, and society. Erected a quarter century ago, the centre has in the last two years been brought up to date architecturally and structurally; further measures for implementing the most recent state of the art in rehabilitating spinal cord injured patients lie ahead.


[Clinical rehabilitation of the spinal cord injury patient--is the Guttmann concept still valid?].

The focus of Guttmann's treatment concept had been to set up a comprehensive rehabilitation system, aimed not only at saving the life of a person with paraplegia or tetraplegia but at giving it meaning as well. Progress made in the fields of rescue services, anaesthesia, intensive medicine, in spinal surgery, neurourology and diagnostics (CT, MRI) as well as in pharmacology, have decisively enhanced the possibilities of clinical rehabilitation, and have in some respects entailed deviations from Guttmann's classical treatment principles. Moreover, the patient population has changed in profile in the course of time, due to better chances of survival also in high-level tetraplegia, greater numbers of higher-age SCI patients and of patients with non-traumatic SCI (tumours, metastases, infections). A higher life expectancy achieved by better possibilities as regards prevention and treatment of SCI-related complications, new challenges for the future emanate from age-related diseases occurring in addition to the spinal lesion.


[Neuro-urology--development of a new focus in rehabilitation of the spinal cord injured patient].

While preservation of renal function continues to be the primary objective in the urological care of spinal cord injured patients, new treatment principles have resulted in increased attention being given also to restoration of lost urinary continence, a goal shared by the patient as well. The fact that intermittent catheterization has stood the test also for the long-term management of micturition, as well as the development of effective medication for hyperreflective detrusor relaxation have resulted in a treatment concept that enables 70 percent of those treated to achieve dry intervals between catheterizations. Effective electromiction is today enabled by the sacral anterior root stimulator (Brindley), with continence ensured by sacral deafferentation performed at the same time; both measures have proved successful at medium term. Bladder augmentation is another operative measure for controlling detrusor hyperreflexia. Neurogenic urinary stress incontinence can be tackled successfully by implanting an hydraulic sphincter system (Scott). Both the advantages and the possible disadvantages or risks of these new management concepts are set out, dealing also with their indications. Successful treatment of erectile dysfunction is possible today, and inseminable sperma can be obtained in some 40 to 50 percent of the spinal cord injured patients.


[Management of the spinal cord injured patient--hospital routine or principles of comprehensive rehabilitation?].

Based on her own experience in the rehabilitation of spinal cord injured patients, the author describes the nursing service's self-concept and its development over the past 25 years, as well as changes in its working conditions inter alia entailed by technical advances. Requirements are posited, which are considered indispensable for comprehensive rehabilitation, specifically with regard to the aftercare necessary for the person with SCI in the domiciliary situation.


[Integration of patient exercise/physical therapy in the rehabilitation team].

Described is the position of physiotherapy in the rehabilitation of persons with spinal cord injury, starting out on the assumption that physiotherapy lays the foundations for functional rehabilitation, enabling the other disciplines to build up on. Ideally, the treatment approach is not confined to a single concept, but several treatment modalities should equally be available. Physiotherapy must be integrated into the overall team approach. This can only be achieved on the basis of mutual respect, as well as physiotherapy staff continuity which enables broad knowledge and experience to be built by physiotherapists.


[Between creativity and functional use--development and determination of the status of ergotherapy in rehabilitation of the spinal cord injured patient].

In the 60s, Occupational Therapy (OT) with spinal cord injured patients had primarily been based on manual activities, aimed at improving functional levels. Gradually, attainment of the highest possible level of independence became a central emphasis of OT care. While creative development of the patient seemed to conflict with this foremost objective of independence, practical experience in the meantime has taught that creative activity can be an avenue toward independence. Also, the OT regimen for SCI patients has for several years now been extended to include computer-based technology for functional treatment as well as prevocational measures.


[Responsibilities of clinical psychology in rehabilitation of patients with severe physical handicaps].

Rehabilitation is a process intended to lead from disablement to enablement. This process must begin at the very onset of an impairment, with close cooperation of the rehabilitee with all the specialties involved, as well as among these specialties, being an indispensable prerequisite. Clinical psychology is one of these specialties, its primary emphases are diagnostics, counselling, therapy, research, staff training and further education, as well as organizational, operational and institutional counselling. To take part in shaping a more humane world is a task of psychology in research, theory, and practice.


[...and after the clinic? Reflections on domestic-familial rehabilitation and management of the spinal cord injured patient].

Both from a personal and professional perspective, considerations are presented concerning the domiciliary-familial rehabilitation of persons with spinal cord injury. The field of tension present within the living community affected by the disability (parents/children, partners, children/parents) is examined, the various specific strains, physical, mental, social-societal, are outlined. The problems entailed as regards autonomy/dependence, intimateness/distantness, lover, mother/father, and avoiding/facing conflict, are analyzed, and possible solutions suggested.


[2.7 million unemployed--nonetheless occupational rehabilitation of patients with severe physical handicaps?].

The concept of rehabilitation initially is defined as it is understood in the Federal Republic of Germany today. The potential opportunities and risks inherent in an outcome-oriented notion of rehabilitation are set out in light of its historical development. The reasons for unemployment among severely disabled persons are analyzed from various perspectives, dealing furthermore with the manner the vocational rehabilitation system is responding. Also mentioned are the difficulties where our system is working only to a limited degree, as well as the consequences this entails. Further, reasons are given to substantiate that the rehabilitation of severely disabled people remains an important and meaningful task in our country notwithstanding current unemployment.


[Progress, detours, errors--social legislative aspects of the development of rehabilitation].

Any person threatened by the onset of disability has a right to the assistance needed to integrate in work, career, and society (section 10, Book 1 of the Social Code). A highly sophisticated system of legal provisions and pursuant administrative competencies, eligibility requirements and benefit provision modalities seeks to fulfill this entitlement. The system of available services is subject to on-going development, with adjustments necessary in response both to medical advances and labour market or technological developments. The adjustment process is limited by the economic resources available, which may restrict the scope of what is considered feasible regardless of what might be possible or desirable. To avoid becoming entangled in the "jungle" of its own system of competencies and eligibilities, a rehabilitee-centred rehabilitation approach must seek to make even better use of the manifold opportunities of rehabilitation legislation in light of the individual case at hand and based on professional cooperation. Any further development of rehabilitation legislation will moreover have to pay attention to those persons for whom occupational integration is no longer, or not yet, possible, in order to face up to future social challenges.


[Handicap--negative variant of the "normal"--or else? Comments on the problem of attitude to deficits in rehabilitation and ethical principles].

Uncertainty as to what exactly is comprised by disability is quite frequently encountered not only in the general public but also among rehabilitation workers. The "normal" is deemed the desirable, and "disability" turns into its negative counterpart. Attention is focussing on the deficits that appear on measuring and comparing. A critical discussion of deficit orientation in education and care of disabled persons is needed. Isolated identification of and attendance to deviations must be overcome by interdisciplinarity and team work, in order to pay due respect to the person as a whole, to his or her social and personal identity. Also, fundamental issues of the current ethics discussion in special education arise in this context. Shown on the example of J. J. Rousseau, reference to philosophical or educational "authorities" may turn out to be misguided.


[25 years rehabilitation. Questions--answers, unanswered questions--retrospective answers].

Starting out from the 10th World Congress of the International Society for Rehabilitation of the Disabled, held 1966 in Wiesbaden on the subject of "Industrial Society and Rehabilitation", social-legislational developments are out-lined, among them the 1971 accident insurance coverage for pupils, the 1974 rehabilitation harmonization act, and the 1975 extension of social insurance coverage to disabled persons working in workshops for the disabled; problems yet unsolved in the structured system of social protection are pointed out. The problem of "early rehabilitation", still to a very great extent unresolved, is dealt with in the context of the present distinction between "acute medicine" und "rehabilitation" facilities. In rehabilitation of persons with chronic mental illness, numerous models have been developed; a generally accepted, and available approach however has not emerged so far. For ensuring care quality and continuity, the urgent need for community-based availability of the "rehabilitation team" is underlined, and interdisciplinary further education efforts are demanded for all professions in the team, both in facility- and community-based service delivery.


[Combined vocational education and industrial management--presentation of a cooperative project for improved integration of adolescents with learning handicaps].

Major structural labour market changes, i.e. dramatic losses in job opportunities for unskilled labour and continually rising levels of job requirements facing skilled workers on the one hand and an increasing demand for skilled workers on the other, are entailing enhanced job opportunities for disadvantaged societal groups, at the same time however also increasing the occupational risk of these populations, among them the learning disabled. The vocational training centres having for more than a decade been gaining experience in the vocational and social rehabilitation of this latter group, the project outlined is intended to make even better use of their potential. The main objectives of the project are: 1. optimizing the vocational training centres' range of placement-focussed measures by: intensifying industrial training periods, coordinated "start up" support on occupational entry, post-placement services; 2. transfer of the vocational training centres' technical knowledge and experience into industry-based training by: follow-along support services ("ausbildungsbegleitende Hilfen"), workshops on the initial vocational training of learning disabled young adults, and other forms of cooperation. Apart from reaching the goals outlined, the project is expected to give new impulse to the day-to-day practice of the vocational training centres as well as to generate even greater networking of the centres with their industrial environments.


[The favorable effect of group housing on the occupational performance of psychiatrically handicapped patients].

A cohort of psychiatrically disabled persons was investigated to determine whether work performance changed after entry into a residential commune. Both before and after entering the commune, a differentiated spectrum of work opportunities graded according to performance requirements had been available. A clear enhancement of work performance was found following entry into the residential commune. In a further step, variables associated with above- or below-average increases in work performance were identified. On the whole, the results underscore the value of residential communes in the vocational rehabilitation of psychiatrically disabled persons.


[Changes in health status and attitude due to sports with rheumatic disease patients].

A six-months sports programme had been implemented to analyze the impact of movement, play and sports on the physical situation of persons having rheumatism, their mental well-being and attitudes towards sporting activities. 41 patients participated in the programme, attending training sessions in a fitness studio once a week. The sports programme contained general endurance training, functional and strengthening exercises, elements of gymnastics and play, as well as relaxation techniques. The following assessment tools were used: Measurement of Patient Outcome (MOPO) scales, sports questionnaire, and the STEP test. It was found that participants' health status, both physical and mental, had been influenced in a positive manner, with proof being provided of reduced levels of anxiety, depression, and pain. Moreover, attitudinal changes toward sports appear to have resulted, suggesting persistent motivation to engage in sporting activity.


Transcriptional mapping of the promoter of the aminoglycoside acetyltransferase gene (aacC9) of neomycin-producing Micromonospora chalcea.

We have studied the promoter of the gene encoding aminoglycoside acetyltransferase (aacC9) in neomycin-producing Micromonospora chalcea. S1 nuclease mapping showed that the transcription initiation point of this gene is at the translation start point, with no evidence of a conventional ribosome-binding site. The aac of paromycin-producing Streptomyces rimosus forma paromomycinus shows the same characteristic; there is no homology in the promoter regions of the two genes, whereas the coding sequences are very similar.


Structure/function relationships in the Escherichia coli mannitol permease: identification of regions important for membrane insertion, substrate binding and oligomerization.

The Escherichia coli mannitol permease (EIIMtl) of the phosphoenolpyruvate-dependent phosphotransferase system is a 68-kDa membrane protein that carries out the concomitant transport and phosphorylation of D-mannitol. Previous studies indicated that there are ca. 6 membrane-spanning helices within the N-terminal half of the protein, while the hydrophilic C-terminal half was shown to be exposed in the cytoplasm. In the present study, an analysis of C-terminally truncated EIIMtl mutants showed that proteins from which only the cytoplasmic domain has been deleted were present in the membrane at > or = 50% the amount of the intact protein. However, deletion proteins smaller than ca. 34 kDa were present in the membrane at only about 20% the amount of the intact protein. We also constructed a plasmid that encodes the first 43 amino acid residues of ELLMtl fused to residues 378 to 637 (the C-terminal domain). The corresponding protein was associated with the cytoplasmic membrane. These results show that the first 43 amino acid residues of the N terminus are sufficient for membrane localization, although the region comprising the last 2 membrane-spanning helices appears to be important for maximum stability and/or efficient membrane insertion of the complete N-terminal domain. Further studies of these deletion proteins showed that binding of mannitol to the permease occurs even if the entire cytoplasmic domain is absent, but is abolished if the last putative membrane-spanning region is removed. Finally, regions of the protein within the membrane-bound domain were identified that influence the oligomerization state of the protein. These results further define domains of this multifunctional transport protein that are important for membrane insertion, stability, substrate binding and oligomerization.


Bacteriocin-like activity of Bacteroides fragilis group isolated from marmosets.

The ability of strains of the B. fragilis group, isolated from the oral cavity and intestine of marmosets, to produce bacteriorin-like substances in solid medium, in terms of auto-, iso- and heteroantagonism, was evaluated. Antagonistic activity was exhibited by 52% of the intestinal strains, 3 of which showed autoantagonistic activity. Three out of 9 oral strains isolated, tested against themselves, showed simultaneous isoantagonism to 4 indicator strains; but not autoantagonism. The same 9 oral strains, when tested against 16 reference strains, revealed interspecific activity only against 2 Gram-positive microorganisms. Higher activity, evaluated by the size of the inhibition halo, was observed in BHI-S agar, and greatest inhibition was obtained after 72 h of incubation.


Catabolic pools in Escherichia coli.

Methods are described for measuring soluble pool magnitudes in steady-state or exponentially growing cultures, and for distinguishing between anabolic, catabolic and total metabolic pools within cells. These methods were applied to the measurement of pool magnitudes for several amino acids and other precursors in Escherichia coli THU. Our results support the independence of the magnitudes of total metabolic pools and growth rate in steady-state cultures. Our results also show that the total metabolic pool size is much larger than previously published estimates, which failed to include the contribution of catabolic pools. The average value of the total soluble material in exponential-phase cells is estimated to be 8 to 9% of the cell dry mass; pool values could be almost twice as large during midcycle because of the known increase in the magnitudes of protein and RNA precursor pool during the cell cycle.


Evaluation of a chemiluminescent DNA probe assay for the rapid confirmation of Listeria monocytogenes.

A Listeria monocytogenes-specific, acridinium-ester-labelled DNA probe was evaluated in a chemiluminescent homogeneous protection assay (HPA) for the rapid confirmation of suspect L. monocytogenes colonies from blood agar plates. The HPA uses an acridinium-ester-labelled chemiluminescent DNA probe in a free-solution hybridization format. After the DNA probe hybridized with the target ribosomal RNA, the acridinium label on the unhybridized probe was inactivated by a chemical differential hydrolysis step. Formation of a hybrid between probe and target was detected in a luminometer after the addition of a detection reagent. The assay can be completed in 30 to 45 min and allows for simultaneous processing of several (50-100) samples. The probe showed 100% sensitivity and 100% specificity for L. monocytogenes when evaluated in the HPA against L. monocytogenes, other Listeria species and other Gram-positive bacteria. The lower detection limit of the HPA was between 10(4) and 10(5) cells. In an evaluation with 296 bacterial colonies isolated from food, the HPA colony confirmation showed 100% agreement with conventional biochemical characterization. HPA will be useful for the rapid confirmation of L. monocytogenes isolated from food and clinical specimens.


Contribution of high-performance liquid chromatography to the identification of some Corynebacterium species by comparison of their corynomycolic acid patterns.

Reverse-phase high-performance liquid chromatography of corynomycolic acids provided a specific pattern for each Corynebacterium species studied. These data suggest that a fast and reproducible procedure is now available for bacteriological identification at the genus and at the species level of corynomycolic-acid-containing bacteria. Mass spectrometry analysis of post-column collected fractions provided the order of elution of some corynomycolic acids and isomers and showed the high specificity of the chromatographic assay which could be used for the routine bacteriological identification of some species belonging to the genus Corynebacterium.


Heterogeneity in restriction patterns of Gardnerella vaginalis isolates from individuals with bacterial vaginosis.

This study was undertaken to resolve the genetic make up of Gardnerella vaginalis present in bacterial vaginosis (BV). DNA from several G. vaginalis isolates from within and between individual BV patients were compared by BamHI, ClaI and EcoRI restriction endonuclease analysis (REA) followed by a restriction fragment length polymorphism (RFLP) study, utilizing a 5.7-kb BamHI G. vaginalis ATCC14018 DNA probe. Four G. vaginalis isolates from one patient (GVP-062) were composed of 3 different biotypes (biotypes 3, 5 and 8), and while the REA mirrored the biotype, in RFLP studies at least 3 isolates had DNA fragments in common. All of the isolates from 2 other patients (GVP-063 and GVP-072) represented a single biotype (biotype 2), but under REA and in RFLP studies, the isolates GVP-063 differed from GVP-072. An opposite case existed with the isolates GVP-072 (biotype 2) and GVP-065 (biotype 5), which appeared similar under REA and in RFLP studies. Finally, reisolates after 8 weeks (GVP-080) from a BV patient (isolates GVP-065) representing the same biotype (biotype 5) differed under REA and in RFLP studies. Thus, lacking any unique DNA fingerprint, G. vaginalis occurring in BV represents a (genetically) mixed population.


Novobiocin, brilliant green, glycerol, lactose agar: a new medium for the isolation of Salmonella strains.

We describe a medium, novobiocin, brilliant green, glycerol, lactose (NBGL) agar, for the routine isolation of Salmonella strains from stool samples. The NBGL agar principle involved the use of the antisaprophytic effect of brilliant green and novobiocin. Glycerol and lactose were added in order to distinguish between Citrobacter and Salmonella. NBGL was used in parallel with salmonella-shigella (SS) and Hektoen (H) agar for culturing 2,853 stool samples, of which 184 were confirmed to be salmonellae. NBGL showed a high sensitivity: 94% in direct plating compared to 74% (p < 10(-3)) and 65% (p < 10(-5)) for H and SS, respectively, and 96% in enrichment broth plating vs. 83% (p < 10(-4)) and 86% (p < 10(-3)), respectively, for H and SS. In direct plating using NBGL, 95% of black-centred colonies were confirmed to be salmonellae (vs. 31% and 36%, H and SS). In enrichment plating using NBGL, this figure was 82% (vs. 26% and 28%). The results suggest that NBGL agar is advantageous for the isolation of non-Typhi H2S+ salmonellae.


Evaluation of synthetic pseudo cord-factor-like glycolipids for the serodiagnosis of tuberculosis.

A number of glycolipids were evaluated in an ELISA test for their serodiagnostic usefulness in tuberculosis. One hundred and twelve (112) sera belonging to bacteriologically confirmed TB patients, patients with pathologies other than tuberculosis and healthy individuals were examined against several synthetic "mirror" pseudo cord factors (analogues of trehalose-6,6'-dimycolate or TDM) using natural cord factor and another recently described natural glycolipid (SL-IV) of Mycobacterium tuberculosis as control antigens. Analysis of the results shows that all synthetic "mirror" pseudo cord factors, except one with a short 8-carbon chain, were better recognized by the sera of tuberculosis patients than natural cord factor, with sensitivity and specificity values in the ELISA test similar to those reported for M. tuberculosis species-specific SL-IV. Of all antigens tested in this study, BDA. TDA, a bis(N,N-dioctadecylamide) of "trehalose dicarboxylic acid", [(alpha-D-glucopyranosyluronic acid) (alpha-D-glucopyranosiduranic acid)], showed the highest serodiagnostic discriminating power (93% sensitivity and specificity). We postulate that either these artificial molecules are cross-reactants of similarly structured native glycolipids of M. tuberculosis or that they bear closer resemblance to actual phagosome-lysosome-modified antigens than to native mycobacterial ones.


Identification of sulpholipid I by thin-layer chromatography in the rapid identification of Mycobacterium tuberculosis.

A simple, rapid and reliable thin-layer chromatography method for the detection of the 2,3,6,6'-tetraacyl trehalose-2'-sulphate (sulpholipid I) from Mycobacterium tuberculosis was described. The method was found to be satisfactory as an aid in the rapid identification of M. tuberculosis in clinical laboratories.


Relation between the number of sperms to be deposited and pregnancy rate in tubal insemination in rabbits.

Pregnancy rate of tubal insemination with semen diluted to concentrations of x10(0) to x10(7) was studied in rabbits. The animals were laparotomized under general anesthesia, and 0.05 ml of diluted semen was injected with a glass capillary from the tubal fimbria into the oviduct. The semen was obtained from mature male rabbits by means of an artificial vagina and diluted to concentrations between x10(0) and x10(7). One hour after the insemination, ovulation was induced by administration of hCG. Six experimental groups were set up according to the semen concentrations. In the x10(0), x10(2), x10(4), and x10(7) groups, newborn rabbits were obtained. The best pregnancy rate was obtained with the x10(2) groups, in which 10(5) level of sperms were deposited. The newborn rabbits were normal not only morphologically, functionally, but also in chromosomal examination. The results suggested that tubal insemination with a small number of sperms could be applied in sterility due to oligospermia in human.


Long term monitoring of immunoreactive endothelin-1 and endothelin-3 in ventricular cerebrospinal fluid, plasma, and 24-h urine of patients with subarachnoid hemorrhage.

Endothelins (ETs), peptides that were originally isolated from endothelial cells, have extremely potent and long-lasting vasoconstricting effects on cerebral vessels in vitro and in vivo. Observations that astrocytes produce these peptides and that their ET production can be stimulated, e.g. by thrombin, and potentiated via a self-enhancing autoregulatory mechanism may have shed new light upon the pathogenesis of cerebrovasospasm (CVS). ETs are present at low levels in normal human cerebrospinal fluid (CSF). Few and contradictory reports exist on ET levels in subarachnoid hemorrhage (SAH)-associated CVS. We monitored ventricular CSF, plasma, and 24-h urine levels of immunoreactive endothelin-1 (ET-1) and endothelin-3 (ET-3) in seven patients with SAH, who did (five) or did not (two) develop CVS in the course of their disease, as well as in two patients with different conditions (acoustic neuroma/postoperative meningitis; hydro-/hematocephalus) over 7-19 days. A distinct peak of both ET-1 and ET-3 in CSF of patients with SAH coincided with clinically documented signs of CVS and was absent in CSF of patients with SAH but no CVS. CSF levels of ET-1 and ET-3 displayed a striking parallelism in all subjects. Plasma ET-1 levels were essentially in the normal range. ET-3 was not detectable in plasma under our assay conditions. The excretion profiles of ET-1 and ET-3 in 24-h urine revealed again a predominantly parallel behavior of the two peptides. Interestingly, patients with high ET levels in CSF showed simultaneous peaks in urinary ET excretion, expressed as nanograms per gram of creatinine. Our findings support an association of ETs with the pathogenic events following SAH. The well-documented effects of these peptides on cerebral vessels suggest they are mediators rather than markers of disease.


Hemodynamic effects following intraperitoneal infusion of pancreatic ascites fluid.

Severe necrotizing pancreatitis is accompanied by release of hemorrhagic ascites fluid (HAF), which is thought to be related to the occurrence and frequency of cardiocirculatory and pulmonary failure as a consequence of acute pancreatitis. The purpose of this study was to evaluate the role of HAF due to these systemic complications. Experiments were performed in 25 pigs (mean b.wt. 22 +/- 1 kg) under general anesthesia and mechanical ventilation. The animals received 50 ml/kg b.wt. i.p. of either physiologic saline solution (control CO, n = 9) or hemorrhagic ascites fluid (HAF, n = 16). HAF was obtained from 16 pigs with pancreatitis induced by intraductal infusion of bile salt. Eight animals in the HAF group were pretreated with indomethacin (10 mg/kg i.v. INDO/HAF). All animals were followed up for 6 h. Mean arterial pressure, cardiac output, and stroke volume fell significantly in the HAF (-25%, -27%, -27%) and in the INDO/HAF groups (-24%, -20%, -17%) as compared with controls (-6%, -6%, -6%). Also, left ventricular end-diastolic pressure (LVEDP) decreased by 52% and 48% in both HAF recipient groups, whereas LVEDP was unchanged in the control group. Myocardial contractility (Vmax) remained unaltered in all experimental groups. No significant differences in gas exchange and lung dry/wet weight ratio were observed. Lipase and PGI2 of the unpretreated HAF group rised to 203% and 198% in arterial blood at 6 h compared with unaltered levels in the control group. No increase of prostanoid concentrations was detected in the indomethacin-pretreated group, whereas lipase increase by a comparable extent as in the HAF group. We conclude that the early consequences of HAF are mainly characterized by systemic hypotension due to hypovolemia.


Increase of S-(1,2-dicarboxyethyl)glutathione in regenerating rat liver.

Changes in the level of S-(1,2-dicarboxyethyl)glutathione (DCE-GS) with time were determined during regeneration of rat liver after partial hepatectomy. The DCE-GS level increased in regenerating rat liver, reaching a maximum level (4.7-fold) on day 2 and reverted to the normal level in 1 week. During the liver regeneration process, the activity of DCE-GS-synthesizing enzyme in the liver retained its control level, while the level of glutathione--a substrate of the enzyme in the liver--fluctuated in parallel with that of DCE-GS.


Changes in membrane-bound hydrolases by metronidazole in rat renal brush border.

The antiprotozoal drug metronidazole, when administered orally at a dose level of 100 mg/kg body wt. daily for 7 days to rats, brought about significant elevation of renal brush-border-membrane-bound hydrolytic enzymes, such as alkaline phosphatase, maltase, sucrase, and leucine aminopeptidase (LAP). Kinetic analysis of the enzymes (substrate saturation) indicated that the drug produced an increase in the maximum of apparent initial enzyme velocity (Vmax), while the substrate affinity constant (Km) remained unaltered. These changes were not recovered to the normal level even after the drug regimen was stopped and the animals were allowed to recover for a period of 7 days. Lipid analysis of brush border membrane (BBM) revealed a significant elevation in the cholesterol, phospholipid, and ganglioside levels, while no marked change was recorded in triglyceride, free fatty acid and plasmalogen. Study of the temperature-dependent parameters of the enzymes showed that metronidazole induced a shift in the transition temperature (To) in LAP with nearly total reversibility in the recovery group. No such change was seen in the other enzymes. However, there also was a lowering in the energy of activation (Ea) below To, which returned to normal after the treatment was withdrawn.


Recently described scrapie-like encephalopathies of animals: case definitions.

Since 1986, naturally occurring scrapie-like encephalopathies have been described in the United Kingdom in domestic cattle, in five species of captive exotic bovids and in domestic cats. The disease in domestic cattle, bovine spongiform encephalopathy, has been characterised by all currently available diagnostic criteria as a transmissible spongiform encephalopathy or 'prion' disease, and has been shown to have a dietary origin. The pathology in the other species is also entirely consistent with the scrapie-like diseases. The contemporaneous occurrence in the UK of such disease in these species suggests a close epidemiological association. The diagnostic criteria of the scrapie-like encephalopathies of animals are reviewed in the light of experience with the recent extension of their natural host range.


Clinical equine dysautonomia and autonomic neuron damage.

Damage to the neurons of selected autonomic ganglia was quantified in relation to the severity of the clinical signs shown in acute, subacute and chronic cases of dysautonomia (grass sickness). No connection between the clinical severity of acute or subacute dysautonomia and the amount of neuronal damage in the superior cervical, stellate and coeliaco-mesenteric ganglia could be demonstrated. However, a higher proportion of normal neurons were found in chronic cases. Jejunal submucosal neuronal damage was correlated with clinical severity but further work is required to confirm this finding and to establish how widespread the alimentary neuronal lesions are in dysautonomia of different severities.


Improved isolation of rinderpest virus in transformed bovine T lymphoblast cell lines.

Bovine T lymphoblast cell lines transformed by the protozoan Theileria parva were compared with bovine kidney (BK) and Vero cells for their ability to isolate various strains of rinderpest virus from tissues and infected secretions. All of the strains of rinderpest virus that were tested, including attenuated cell-culture, caprinised and lapinised vaccines, and both mild and virulent pathogenic strains, readily induced syncytial cytopathic effect (cpe) in T lymphoblasts. The cpe could often be detected within one day of inoculation of lymphoblasts, whereas it took three to 14 days to appear in Vero and BK cells. Using lymphoblasts it was possible to reisolate rinderpest virus from nine of 42 swabs collected from three cattle experimentally infected with an isolate from a recent outbreak of mild disease whereas the same swabs yielded only one reisolate on BK cells. It was also possible using the lymphoblasts to detect infectious virus in the ocular, nasal and oral secretions of goats and rabbits infected with caprinised and lapinised virus, respectively. Peste des petits ruminants virus appeared to grow as rapidly as rinderpest virus in the lymphoblasts whereas canine distemper virus readily induced cpe on first passage but less readily on subsequent passage. Measles virus induced relatively little cpe when inoculated into lymphoblasts and did not appear to passage in these cells. The lymphoblasts are easy to maintain in culture and since they rapidly recovered 11 isolates from 37 diagnostic samples could prove useful in laboratories carrying out rinderpest diagnosis.


Anaerobic microflora associated with the pars oesophagea of the pig.

In healthy pigs aged one to 35 days significant populations of microorganisms (5.5 to 6.9 log10 viable count cm-2 of the tissue) were found, by strict anaerobic techniques, to adhere to the pars oesophagea. The genera of anaerobes which were isolated included Actinomyces, Bifidobacterium, Clostridium, Lactobacillus, Peptostreptococcus, Streptococcus and Veillonella and facultative anaerobes included Escherichia, Klebsiella, Staphylococcus, Streptococcus and yeasts. The microbial population adhering to the pars oesophagea varied little from birth till after weaning and Lactobacillus, Clostridium and Eubacterium predominated. There were generally small numbers of facultatively anaerobic microorganisms in the pars oesophagea of healthy sucking or weaned pigs but large numbers of anaerobes, particularly Lactobacillus. In the pars oesophagea of sucking and weaned pigs with diarrhoea, large numbers of facultative anaerobes were frequent but Lactobacillus were also present in large numbers.


Bracken poisoning and enzootic haematuria in cattle in China.

Acute bracken poisoning and enzootic haematuria are believed to have occurred in cattle in China for a long time. It is only in the past 10 years, however, that these diseases associated with the consumption of bracken ferns have been studied in detail and this paper reviews these recent studies. Based on a large scale survey, both conditions were found to be serious problems with a wide geographical distribution, especially in the mountainous regions of southwest China. Epidemiological and experimental work revealed that two species of bracken ferns, Pteridium aquilinum and Pteridium revolutum, were associated with these diseases, but the latter seems more important in China.


Effects of clinically occurring chronic lameness in sheep on the concentrations of plasma noradrenaline and adrenaline.

Plasma adrenaline (AD) and noradrenaline (NA) concentrations were measured by high performance liquid chromatography with electrochemical detection in blood samples from control and lame sheep. The lame sheep suffered from naturally occurring foot rot and showed behavioural characteristics normally associated with chronic pain. The lame sheep were scored both for impairment of gait and pathology of the foot and divided into mild and severely affected groups. Both the mildly and severely lame group showed a significant increase in plasma AD and plasma NA which tended to persist even after clinical resolution of the condition. The measurement of plasma AD and NA may provide information which can be used to assess animals experiencing chronic pain, when taken in conjunction with other parameters, such as nociceptive thresholds and plasma hormone levels.


Changes in the spontaneous and evoked electrical activity in the brain of hens during stunning with 30 per cent carbon dioxide in argon with 5 per cent residual oxygen.

Changes in the somatosensory evoked potentials (SEPs) and spontaneous electroencephalogram (EEG) in hens were investigated during stunning with a mixture of 30 per cent carbon dioxide in argon with 5 per cent residual oxygen. The results showed that the SEPs were lost on average in 17 seconds (maximum 28 seconds), which is similar to the 19 seconds (maximum 32 seconds) reported while stunning hens with a mixture of 30 per cent carbon dioxide in argon with 2 per cent residual oxygen. The spontaneous EEG showed suppression and a quiescent phase at 14 and 58 seconds, respectively. It is concluded that a mixture of 30 per cent carbon dioxide in argon with 2 per cent residual oxygen would be ideally suited for batch stunning chickens and any inadvertent increase in the residual oxygen level up to 5 per cent in the stunning atmosphere would not lead to inadequate stunning or recovery of consciousness before neck cutting.


Administration of levothyroxine to euthyroid dogs does not affect echocardiographic and electrocardiographic measurements.

The effects of a replacement dose of levothyroxine on electrocardiographic and echocardiographic parameters in euthyroid dogs were examined. Two-dimensional guided M-mode echocardiograms and electrocardiograms were obtained before and after administration of levothyroxine (0.5 mg m-2 twice a day) to 10 euthyroid dogs for a period of eight weeks; four untreated dogs acted as controls. The resting serum total thyroxine concentration was significantly increased in treated dogs during weeks 4 to 8. There were no significant differences in any of the echocardiographic or electrocardiographic measurements resulting from treatment.


Comparative immunoelectrophoretic analysis of Echinococcus granulosus, Taenia hydatigena and Taenia pisiformis cyst fluid antigens by hyperimmune rabbit sera.

Cyst fluid antigens of Echinococcus granulosus, Taenia hydatigena and T pisiformis were examined by electrophoresis using homologous and heterologous hyperimmune rabbit sera to these antigens. While arc 5 forming antibodies were identified in sera from rabbits immunised with E granulosus and T hydatigena cyst fluids, antibodies responsible for forming precipitating antigen B band were detected in rabbit antisera to E granulosus, T hydatigena and T pisiformis antigens. T hydatigena cyst fluid appears to contain antigen similar to E granulosus antigen 5 and probably antigen B while T pisiformis cyst fluid has mainly an antigen close to hydatid antigen B.


Effects of nicarbazin on sugar intestinal absorption in rabbits.

Nicarbazin is an anticoccidial drug, used mainly in birds, which can also be used in rabbits. It has been shown to produce several effects, such as inhibition of growth and feed efficiency in poultry. The aim of the present work was to determine whether nicarbazin alters intestinal absorption of sugar. Results obtained show that nicarbazin decreases D-galactose accumulation in the jejunal tissue and increases mucosal to serosal transepithelial fluxes of this sugar, in both cases in a dose-dependent way. Furthermore, nicarbazin seems not to modify the sugar diffusion across the intestinal epithelium. The drug also stimulates the sugar uptake in brush border and basolateral membrane vesicles. The results suggest that in rabbits nicarbazin increases sugar intestinal absorption mediated by carriers.


Indirect myosin immunocytochemistry for the identification of fibre types in equine skeletal muscle.

The histochemical ATPase method for muscle fibre typing was first described by Brooke and Kaiser in 1970. However, problems have been found with the subdivision of type II fibres using this technique. To determine whether indirect myosin immunocytochemistry using anti-slow (5-4D), anti-fast (1A10) and anti-fast red (5-2B) monoclonal antibodies with cross reactivity for type I, II and IIa fibres, respectively, in a number of species, could identify three fibre types in equine skeletal muscle, data on fibre type composition and fibre size obtained using the two different techniques were compared. Results indicate that different myosin heavy chains can coexist in single equine muscle fibres. Type I and type II fibres were identified by immunocytochemistry, but subdivision of type II fibres was not possible. Although the percentage of type I and type II fibres was not significantly different for the two techniques, a few fibres reacted with both the 1A10 and 5-4D antibodies.