Evaluation of diagnostic tests using relative operating characteristic (ROC) curves and the differential positive rate. An example using the total serum bile acid concentration and the alanine aminotransferase activity in the diagnosis of canine hepatobiliary diseases.

The value of a diagnostic test depends on most cases on its ability to discriminate between patients with and without a certain disease. One way of evaluating a diagnostic test is to use the relative operating characteristic curve (ROC curve) and the differential positive rate (DPR). The ROC curve displays the relationship between the true positive ratio and the false positive ratio for a range of cutoff values and it can be used to compare various diagnostic tests under equivalent conditions (equal true positive ratios or false positive ratios) and over the entire range of cutoff values. The DPR is the difference between the true positive ratio and the false positive ratio at various cutoff values and it can be used to obtain the cutoff value associated with the highest sensitivity and specificity. The purpose of this study was to describe the evaluation and comparison of diagnostic tests using ROC curves and DPR. Eventually, the positive and negative predictive values were used to assess the differences between the sensitivity and specificity obtained when the upper limit of the reference interval, or the optimal cutoff value indicated by the DPR, was used as cutoff value. To illustrate the methods, the 2 h post-prandial total serum bile acid concentration (PSBA) and the alanine aminotransferase activity (ALAT) in the diagnosis of primary or secondary hepatobiliary diseases in dogs were used. The ROC curves showed, as expected from previous studies, that PSBA was superior to ALAT in diagnosing dogs with hepatobiliary diseases. Using DPR, the optimal cutoff value for PSBA was suggested to be 15.48 mumol/l. Compared to the traditionally used cutoff value of 22.24 mumol/l, no decisive difference in the positive predictive values were observed. However, the cutoff value of 15.48 mumol/l appeared to produce higher negative predictive values compared to a cutoff value of 22.24 mumol/l. Seemingly, ROC curves and DPR are simple methods useful to the evaluation of diagnostic tests and due to the simplicity, there seems to be a great potential for these methods in the evaluation of diagnostic tests in veterinary medicine.


[Comparative studies of diagnostically significant enzymes in plasma, udder lymph and milk of healthy cows and cows with udder diseases].

Different secretions (colostrum, milk, dry udder secretion) of every quarter, peripheral lymph from superficial lymph vessels of the mammary gland and blood from the V. epigastrica superficialis were obtained in 43 cows at different stages of lactation. In these samples the activity of 5 enzymes (LDH, NAG, AP, LAP, GGT) was determined. Levels of LDH and NAG were highest in blood plasma and udder lymph. Levels of LAP, AP and GGT were highest in milk increasing in this order. LDH, NAG, AP and LAP were correlated in both compartments. Changes of the functional state (dry or colostral period) and tissue disturbances of the mammary gland were accompanied by marked changes of enzyme activity in the secretions, but were without obvious influence on enzyme levels in blood plasma and udder lymph.


Inhibition of D-galactose transport across the small intestine of rabbit by zinc.

Zinc is an essential trace element necessary to life. Many metallo-enzymes involved in the metabolism of carbohydrates, lipids, proteins, and nucleic acids require zinc for their functions. The aim of this study was to characterize how zinc acts on the intestinal sugar absorption in rabbit. Results obtained show that zinc decreases both D-galactose accumulation in the jejunum tissue, and mucosal to serosal transepithelial flux of this sugar, in a dose-dependent way. Furthermore, zinc seems not to modify sugar diffusion across the intestinal epithelium. The inhibition of intestinal sugar transport by zinc seems to be of a competitive type and it is reversed in high proportion with dithioerythritol (thiol groups protector). The results suggest that zinc decreases carrier-mediated intestinal sugar absorption.


Effect of niacin supplementation on the concentration of niacin in rumen and duodenal digesta and in whole blood of sheep.

1. Niacin concentrations in rumen liquor, duodenal digesta and blood, and daily duodenal flow of niacin were measured in four wethers which were fed an oatstraw grain concentrate diet (with normal niacin content) or an oatstraw maize diet (with low niacin content). The effect of an intraruminal supplementation of 2 mmoles nicotinic acid (NIA) or nicotinamide (NAM) on concentrations of NIA and NAM in gastrointestinal contents and blood and on daily duodenal flow of NIA and NAM was studied. The animals were equipped with rumen fistula and duodenal re-entrant cannulae. 2. NIA concentration in strained rumen liquor was 384 and 264 nmol/ml and daily duodenal flow of niacin was 616 and 528 mumoles/d in animals fed normal or low niacin diet, respectively. Intraruminal administrations of 2 mmoles of NIA or NAM raised NIA concentration in strained rumen liquor for approximately 6 h. About 20% of the administered dose of NIA or NAM passed out of the rumen and resulted in a 41% increase in daily duodenal flow of niacin. The remaining 80% of the administered dose of NIA or NAM disappeared from rumen liquor without being washed out. 3. Supplemented NAM was rapidly hydrolyzed to NIA and ammonia when administered into the rumen. 4. NAM concentration in blood appeared to be unaffected by the dietary content of NIA or by niacin supplementation. 5. The NIA concentration in strained rumen liquor was positively related with niacin content of the diet. Increases in duodenal flow of niacin had no marked effect on concentration of NAM in blood. It appeared that feeding diets with different NIA content affected apparent niacin synthesis in the rumen.


[B-mode, M-mode and Doppler sonographic findings in mitral valve insufficiency of horses].

B- and M-mode echocardiography was performed on 38 horses. 34 patients had systolic heart murmur with the point of maximal intensity over mitral valve. Additionally, 17 of these patients were examined with the pulsed wave doppler echocardiography (Vingmed 200). In 26 patients with cardiac murmur and in 4 patients without cardiac murmur a mitral valve insufficiency was diagnosed by echocardiography. In 8 horses with a systolic murmur over mitral valve M- and B-mode evaluation could not reveal a haemodynamic importance of the murmur. The diagnosis of MVI was based on a dilation of left atrium with or without additional dilation of left ventricle on one hand and with a regurgitation of blood into left atrium found by pulsed wave doppler on the other hand. In 6 extremely dilated hearts a "real" ostium of regurgitation was detected as a direct echocardiographic finding in B-mode. Good correlations existed between echocardiographically evaluated changes of heart dimensions and autopsy measurements in 10 cases. The prognosis seems to be poor if systolic murmurs coincide with dilatation of left atrium and left ventricle, regurgitation of blood into left atrium or with a high degree dilation of left atrium without changes of left ventricle chamber size. In hearts with little to medium dilated left atrium without changes of left ventricle dimension and additionally a regurgitation into left atrium the prognosis seems at least to be cautious. Echocardiography is an available diagnostic help in evaluation of the importance of systolic murmur with the point of maximal intensity over the mitral valve especially in completion by pulsed wave doppler.


[The diagnosis of listeria encephalitis in ruminants using cultural and immunohistologic methods. II. Immunohistologic studies in formalin-fixed paraffin sections].

The unlabelled peroxidase-antiperoxidase (PAP)-technique was compared with the avidin-biotin-peroxidase-complex (ABC)-technique in the identification of Listeria antigen in formalin-fixed paraffin sections of 58 ruminant brains, 44 of which showed histopathological lesions typical for listeric encephalitis. Rabbit hyperimmune serum, obtained by immunization with a Listeria monocytogenes strain of serotype 1/2 a, served as primary serum in the immunohistochemical investigations. The antiserum was tested for specificity using formalin-fixed smears of various bacterial species. Listeria antigen was demonstrated in 40 of the 44 brains with histopathological CNS alterations, as seen in listeriosis, using the ABC method, whereas their identification with the PAP method only succeeded in 34 of the brains. Despite the higher dilution of the primary antibody, the ABC method distinguished itself further, in comparison with the PAP method, through more intense immunohistochemical staining of Listeria antigen. Listeria spp, could be isolated from 46 of 52 brains, which were also examined bacteriologically. They could be isolated from 14 brains, which showed no histopathological lesions indicative of listeriosis. In contrast to this, Listeria antigen was only detected immunohistologically in brains with typical histological listeric CNS alterations. In three cases the presumptive histological diagnosis could not be confirmed immunohistologically.


Immunohistochemical and ultrastructural investigation of granular cell tumours in dog, cat, and horse.

Six canine, one feline and one equine granular cell tumours (GCTs) were investigated electron microscopically and immunohistochemically. The tumours were tested for reactivity with monoclonal antibodies against vimentin and desmin and with polyclonal antibodies against cytokeratin, S-100 protein, glial fibrillary acidic protein (GFAP) and neuron specific enolase (NSE). All GCTs were characterized by their PAS positive cytoplasmic granules in light microscopy, which in electron microscopy appeared as lysosome-like granules. In each case two canine GCTs were stained by the antibody against cytokeratin, vimentin and S-100 protein. Cells of the equine GCT showed reactivity with the antiserum against S-100 protein. In the feline GCT no reactivity with any of the antibodies tested was observed. These differences of the immunohistochemical reactions of GCTs suggest a nonuniform histogenesis of GCTs in domestic animals. The reactivity of the tumour cells with the antiserum against NSE is discussed.


Experimental dermatophilosis.

The histopathologic features of an experimental dermatophilosis of rabbit skin were described. The strain of Dermatophilus congolensis used for the experimental infection was obtained from the unique isolation and cultivation of this actinomycete from the ulcerous leg lesion of one male patient. Further strains in experiment came from the collections of type cultures. The experimental infection was characterized as an exudative and crustal dermatitis with acanthosis and subcorneal abscesses. Branching hyphae and clusters of coccoid bodies were found mostly in the parakeratotic layer and infrequently in the abscesses. Both the coccoid bodies and the hyphae were Gram-positive. The hyphae were acid-fast but the coccoid bodies were non-acid-fast. The fine structure of hyphae and coccoid bodies, namely of those with flagella, was also described by means of a transmission and scanning electron microscope.


Acidification of the colonic mucins following polyvalent colonization of the germ-free rat.

Colonic mucins of germ-free (GF) and conventional rats (CV) were compared. After isolation by gel filtration on Sepharose CL-4B and purification by density gradient centrifugation, the content of isolated colonic mucins was estimated by determination of PAS positive carbohydrates. Purified mucins were subjected to carbohydrate and amino acid analysis and separated into mucin subclasses by ion exchange chromatography. While the total amount of colonic mucins was not statistically different in GF and CV animals, analysis of carbohydrate composition demonstrated an increased amount of sialic acid in CV rat mucin. This was in accordance with results of ion exchange chromatography, revealing a significant higher amount of negative charged mucin subclasses in CV mucin, compared to the germ-free counterpart. The results of amino acid analysis were similar in both groups. The compositional differences in carbohydrate moieties are attributed to modulations by the intestinal flora. A selective bacterial degradation of the neutral mucin subclasses and modifications in the mucin composition due to a stimulated synthesis are discussed.


A direct plating method for monitoring the contamination of Listeria monocytogenes in silage.

Twenty-two silage samples were analyzed for the presence of L. monocytogenes using five Listeria selective plating media, with and without previous selective enrichment step. L. monocytogenes was recovered from 3 samples by both procedures, but direct plating allowed the quantification of Listeria population. Two of these positive samples were implicated in outbreaks of listeriosis in sheep; the L. monocytogenes population in these samples was about 10(6) cells/g. The L. monocytogenes population in the other positive sample was 10(3) cells/g. Direct isolation of L. monocytogenes was only possible from LPM, PALCAM and LSAMm media. MOX and LSM media were not selective enough to allow direct Listeria isolation. In our hands, LSAMm was the most suitable plating medium for the direct isolation and specific quantification of L. monocytogenes from silage employing a red blood cells overlay technique.


Isolation and characterization of immunoglobulin binding proteins from Staphylococcus intermedius and Staphylococcus hyicus.

125-I-IgG binding activities were observed with 15 (17%) of 90 S. intermedius isolates from dogs and 39 (95%) of 41 S. hyicus isolates from pigs. Binding activities were not detected with S. hyicus isolates from cows. The IgG binding proteins of 2 S. intermedius, 2 S. hyicus, and protein A from S. aureus Cowan I were isolated from their cell surfaces. The proteins precipitated with IgG preparations from human, rabbit, pig, dog and horse, but not with IgG from cow, mouse and chicken. This indicated that these IgG binding proteins could be classified as type I receptors. In addition, the isolated proteins from all 3 staphylococcal species precipitated with polyclonal chicken anti-protein A antiserum. SDS-PAGE, Western blotting and gel isoelectric focussing of the proteins revealed numerous bands in the 42,000 D range and acid isoelectric points. The isoelectric point of the isolated proteins from both S. intermedius cultures was slightly more acidic than those from S. hyicus and S. aureus. The present results indicate a close functional and antigenic similarity, if not identity, between IgG binding proteins of S. intermedius and S. hyicus, and protein A of S. aureus.


In vitro antibacterial activity of the lactoperoxidase system towards enterotoxigenic strains of Escherichia coli.

The lactoperoxidase-thiocyanate-hydrogen peroxide (LP) system inhibited the growth of enterotoxigenic Escherichia coli strains responsible for scouring in neonatal and post-weaning piglets. An enzymatic system for hydrogen peroxide generation (glucose oxidase, GO; 0.1 U/ml) and a chemical source (sodium carbonate peroxyhydrate, SCP; 90 mg/l) were used in the LP system to test 19 strains in a 6-h growth assay at 37 degrees C. Only three strains were highly sensitive to the LP/GO system, while all exhibited significant growth inhibition with the LP/SCP system. Hydrogen peroxide alone had less effect than the complete system. The bactericidal activity of the LP/GO system towards a previously resistant strain was greatly increased by increasing the level of glucose oxidase in the system by three- or five-fold.


[The tenacity of Bordetella bronchiseptica in the air].

The survival time of Bordetella bronchiseptica (phase I and III) has been determined at a temperature of 21 degrees C and 27 degrees C and at a relative humidity of 32%, 58% and 76% in a rotating aerosol chamber. The highest survival time (118.8 min half-life time) has been found at 21 degrees C and 76% relative humidity in B. bronchiseptica (phase I). An increasing temperature (from 21 degrees C to 27 degrees C) causes a lower survival time. The phase I strains react more sensitive to this changing of environment than phase III strains. An increase of relative humidity leads to a higher survival time concerning phase I strains. In contrast phase III strains of B. bronchiseptica react with an increasing survival time. On the basis of the detected half-life time one must suppose an aerogenous distribution of the germ in all stages of animals, especially in intensive husbandry.


[The neuronal electrical responses of the superior cervical ganglion in the rabbit to nociceptive skin stimulation].

The patterns of tonic activity in the neurons of rabbit superior cervical ganglion at rest and during noxious stimulation of the skin were studied using intracellular recording. According to reflex changes in the activity patterns, all neurons studied were classified into three groups. Cardiac rhythmicity is more pronounced in the neurons of the second type than in those of the first type. The magnitude of the cardiac rhythmicity in both types of neurons was reduced after noxious stimulation of the skin. In the third type of neurons the cardiac rhythmicity was absent. In some neurons slow excitatory and inhibitory postsynaptic potentials appeared resulting from skin stimulation.


[The visual cortex "on command": 2 modes of operation of neuronal mechanisms (a topical article)].

Orientation tuning (TO) of 152 single units in the 17th area of cat cerebral cortex was studied under different contrasts of the light bar flashed in RF (2.3, 10 and 100) and also under local and general anaesthesia (Sombrevin, 4 mg/kg or Nembutal, 35 mg/kg). An invariance of preferred orientation to contrast or anaesthesia was revealed in 40-50% of cells. Noninvariant cells shifted significantly their preferred orientation on 22-90 degrees. Invariant units more often have a simple RF, more sharp OT and preferred horizontal and vertical orientations. Under the low-contrast conditions or under general anaesthesia, noninvariant neurons shifted their preferred diagonal orientations. Different role of the two neuronal groups in detection of the reper (horizontal and vertical) and other orientations in a normal conditions (high-contrast, alert state) in comparison with their behavior under worse conditions (low-contrast, narcosis or sleep) is discussed.


[The evolutionary problems of the family of human and animal macroglobulins].

Studies have been made on physicochemical and immunochemical properties of macroglobulins, as well as of associated with pregnancy glycoproteins, from human subjects, mammals, birds, fishes and invertebrates. It was shown that these proteins exhibit similar composition, structure and capacity to bind proteinases inhibiting the latter. Using immunochemical methods, reactions of antigenic identity of these proteins were investigated. A hypothesis of evolutionary formation of macroglobulin family is discussed.


[The distribution and properties of the Mg2(+)-ATPase in the membranes of functionally different muscles in the hen].

From striated (m. pectoralis and myocardium) and smooth (myometrium) muscle tissues of hen, by means of differential centrifugation with Ca-oxalate loading, membrane preparations were obtained with high activity of Mg(2+)-ATPase, i.e. a marker enzyme of tubular membranes of T-system of skeletal muscles. Some properties (pH and temperature optima) of this enzyme were investigated and compared to those of Ca(2+)-ATPase from membranes of the sarcoplasmic reticulum. It was shown that in all the investigated muscles, Mg(2+)-ATPase is associated with membrane fraction which in its density corresponds to tubular membranes of T-system. Activation of this enzyme is characterized by similar optimal levels of pH (7.2) and temperature (25 degrees C). The activity of Ca(2+)-ATPase in the membranes of the sarcoplasmic reticulum, in contrast to that of Mg(2+)-ATPase, is observed in more narrow bands of pH and temperature, exhibiting tissue specificity. The data obtained, indicating a possibility of chromatographic separation of these enzymes, confirm their biochemical individuality.


[The effect of the domestication of Norway rats and silver foxes on the serotonin S1A- and S2-receptors of the brain].

The specific radioligand binding of serotonin 5-HT1A and 5-HT2 receptors was determined in the frontal cortex and in the hypothalamus of Norway rats and silver foxes. Aggressive wild rats and silver foxes and animals selected for many generations for nonaggressive behavior towards man (domestication) were compared. The binding of the 5-HT1A receptors was found to be significantly higher in domesticated Norway rats and lower in domesticated foxes than in aggressive animals. The specific binding of the 5-HT2 receptors was found to be similar in aggressive and domesticated animals, both in rats and foxes. The data obtained indicate the involvement of 5-HT1A receptors in the hypothalamus into the process of domestication.


[The prevention of the translocation of intestinal microflora after the rescue of an organism from a terminal state].

In experiments on guinea pigs, the animals were resuscitated from clinical death caused by the acute loss of blood and subsequently treated intragastrically with enterosorbents: activated carbon fibrous material, alone and in combination with polymyxin B, polyphepan (a lignin derivative), polymethyloxan hydrogel and the sorbent Enterocat. In the animals, not treated during the postresuscitation period, a high population level of enterobacteria and Gram-positive aerobic cocci was registered in the contents of the small and large intestines and their translocation to mesenteric lymph nodes, liver, spleen and blood was observed. The amount of lactobacilli in the small intestine was decreased. Enterosorbents were found to decrease a high population level of intestinal microflora, to prevent the translocation of Gram-positive aerobic cocci and to inhibit the penetration of enterobacteria through the enteric barrier in the postresuscitation period. Combined use of activated carbon fibrous material with polymyxin B proved to be most effective for the elimination of enterobacteria.


[The hypometabolic effect of the blood plasma from a hibernating suslik Citellus undulatus. Neokyotorphin activates cardiac and respiratory activities in the suslik during arousal from hibernation].

The effect of intraabdominal injection of the blood serum from ground squirrels Citellus undulatus obtained at various stages of the baut has been studied on the level of oxygen consumption in albino mice. The strongest hypometabolic effect exhibited the blood plasma from animals at the beginning of the baut. The onset of baut was used in further experiments on C. undulatus for investigation of activating effects of neokiotorphin (Thr-Ser-Lys-Tyr-Arg) which was earlier found in the brain of the ground squirrel. It was shown that intraabdominal injection of this peptide to hibernating animals facilitates their arousal stimulating both the cardiac activity and respiration. The strongest effect was noted with neokiotorphin of [D-Ser] 2-modification which is more stable to proteolysis.


[The hypnogenic effects of delta sleep-inducing peptide (DSIP) analogs: a comparative study in rabbits and rats].

Hypnogenic effects of 3 DSIP analogs with a higher stability against aminopeptidase activity have been studied in rabbits and rats using intraventricular administration (injections and infusions). An analog (D-Ala-2) DSIP augmented slow wave and paradoxical sleep within the 5th, 8th and 11th hours of the recording period. An analog (D-Val-2) DSIP made the same within the 8th and 10th hours, and hexapeptide (D-Ala-2) DSIP (1-6) increased sleep during the 1st, 3rd, and 5th hours. Both nonapeptides augmented sleep in rabbits as well as in rats, though hexapeptide produced this effect in rabbits only, that might be related to some difference in distribution and colocalization of endogenous DSIP-like peptide in the pituitary of two rodent species. It may be suggested that hypnogenic activity of DSIP analogs is determined by the structure of administrated molecule, being mediated by such hormones as GRF and CLIP.


[The structural-functional changes in the cells of Francisella tularensis strain 15 Gaĭskiĭ during cultivation and sublimational drying].

Instrumental methods of investigation were used for the demonstration of changes in the fatty acid composition of F. tularensis, strain 15 Gaĭskiĭ, during cultivation in solid culture medium, storage after lyophilization, as well as changes in the functioning of the system of membrane-dependent enzymes of the respiratory chain and in the permeability of cell wall membranes by water molecules and NADH after lyophilization. A relationship between the survival rate of F. tularensis cells after lyophilization and stimulation of their endogenic respiration with NADH and succinate was revealed. An increase in residual moisture from 6 to 10-12% was found to intensify the process of lipid peroxidation during the storage of lyophilized F. tularensis cells of strain 15 Gaĭskiĭ.


[The phenomenon of tachyphylaxis in the pathogenesis of an experimental infectious process].

Experiments on mice have revealed that the development of experimental purulent infection is accompanied by a considerable increase in the nonspecific resistance of the animals to additional infection with unrelated bacteria (the effect of tachyphylaxis). Morphologically, this is manifested by the rapid limitation of the focus of inflammation at the site of inoculation of the superinfecting agent. The state of the phagocytic apparatus is of great importance for this phenomenon as disturbances in the macrophage activity caused by the injection of carrageenan abolish the protective effect of primary infection. The phenomenon of tachyphylaxis has been shown to play a certain role in the prevention of the septic generalization of the process and in resistance to superinfection.


[The structural-functional characteristics of the rostral sections of the neocortex in Chiroptera].

Studies have been made on the connections of rostral neocortex in bats in order to reveal connections with the structures of the auditory sensory system the existence of which is indicated by evident specific responses to ultrasound in the form of synchronization reaction. It was shown that dorsolateral parts of the rostral neocortex receive topically organized projections from the thalamic nuclei VPL and VL. Connections with the auditory cortex and suprageniculate nucleus are not evident. Afferents of the medial wall of the rostral cortex originate from the thalamic nuclei MD and AM. Possible pathways of auditory afferentation to the dorso-lateral part of rostral neocortex are discussed.


[The excretion of Shigella antigens in persons recovering from dysentery].

Shigella antigens can be detected in the excreta of convalescents after dysentery for a long time. Most frequently these antigens occur in feces, less frequently in urine and rarely in saliva. According to indirect data, S. flexneri 1-6 antigens can be detected in excreta for a longer period after convalescence than S. sonnei antigens. When antigen indication is used for the diagnosis of dysentery and epidemiological analysis is carried out, one should bear in mind the length of the agent persistence in the body, related to Shigella type.


[A neuromorphological analysis of the motor area of the cerebral cortex in rat pups subjected to prenatal exposure to normal and pathological blood serum].

Morphological quantitative and qualitative analysis of the pyramidal neurones in the motor cortex of rat puppies after administration of the blood serum from human donors with central motor disorders reveals the dependence of the quality and quantity of neurones from the effect of corresponding blood sera. Pathologic blood serum decreases the number and induces degradation of dendritic organization of the pyramidal neurones. The effect of the blood sera on quantitative and qualitative properties of the pyramidal neurones in rat puppies depends on the age of donor infants with central motor disorders. Blood serum from newborn babies with motor dysfunctions significantly decreases the number of labeled pyramidal neurones and results in degradation of dendritic organization, whereas sera from 11-13-year infants only insignificantly affect these characteristics.


[The interrelation of the immunity status and intestinal microbiocenosis in young children with acute respiratory organ diseases].

The immune status and the state of intestinal microbiocenosis have been studied in 70 young children with acute respiratory diseases. As revealed in this study, in 85.7% of cases bronchopulmonary diseases are accompanied by disturbances in phasic fluctuations of the immune status and intestinal microbiocenosis. The possibility of repeated acute respiratory infections is predetermined by the intensity of manifestations of immune disturbances and intestinal dysbiocenosis, these two phenomena being directly interrelated. The use of eubiotics jointly with immunostimulants is proposed for the treatment of children with acute bronchopulmonary pathology combined with the unbalance of the immune status and intestinal dysbacteriosis.


[The etiological structure of shigellosis in the former USSR--an indicator of the activity of the main routes of infection transmission].

The data on the etiological structure of Shigella infections in the USSR in 1988-1989 are presented. The study showed the dominating role of S. flexneri with S. sonnei also retaining great importance in Shigella infections. The process of the liquidation of S. dysenteriae and S. boydii infections began in some large cities. The domination of dysentery caused by S. flexneri and a high typhoid rate, particularly in Central Asia, were due to poor water supply of the population. The spread of dysentery caused by S. sonnei was completely independent of the water factor. The decisive role in the transmission of S. sonnei in infective doses was explained by decentralized milk supply.


[A system for the operative management of hospital infections in maternity hospitals].

A system for controlling the epidemic process of hospital infections in maternity hospitals and departments of infant pathology has been created. The specific feature of the proposed method is the prospective character of epidemiological surveillance: from the cause to the effect, and not vice versa. This is achieved by using the results of follow-up of the preconditions of the epidemic process activation (preterm delivery, gestosis, dry labor, birth injuries in mothers and infants) and the precursors of the beginning aggravation of the epidemic situation (the level of the contamination of infants with hospital microflora). Early information in this respect will help foresee the possible activation of the epidemic process of hospital infections and take necessary measures when infant infection rate is just elevated.


[The organization of pulse trains in the dorsal hyperstriatum of hens in relation to the afferent input in ontogeny].

Analysis of background multicellular activity of neuronal populations in the dorsal hyperstriatum of chick embryos and baby-chicks, incubated either in darkness or under periodic illumination, revealed an impulse volley structure which is characterized by onset of discharges which follow each other in a form of small series at close intervals. These series originally may be observed in the background activity of the left dorsal hyperstriatum in "illuminated" chick embryos at the 19th day of incubation, and only at the 1st day after hatching--in the right dorsal hyperstriatum of embryos, "illuminated" although they are present in both left and right dorsal hyperstriatum in embryos incubated in darkness, the difference being presumably due to asymmetric input of visual afferentation to this structure. Series of impulse volleys with repeating intervals are considered as a reflection of the activity of local microsystems of neurons which exhibit cyclic structure and which are capable to maintain stable impulse activity in its intrinsic system of connections, which is one of the elements of a mechanism of synaptic stabilization and formation of organized neuronal complexes.


[The type subtyping of meningococci by means of whole-cell immunoenzyme analysis].

In this work the method of the whole-cell enzyme immunoassay, used for the serotype-subtyping of meningococci by means of specific monoclonal antibodies, is described. High specificity of the method, the simplicity of the assay procedure and evaluation of its results, as well as the availability of this method for practical use, have been demonstrated. The results of this investigation confirm the importance of the evaluation of type-subtype appurtenance of reference and laboratory strains used in experiments. Study of 72 meningococcal strains obtained from patients has revealed their polyclonal character in respect of their type-subtype signs.


[The effect of phospholipids on the adhesive properties of bacteria].

The present work shows that choline-containing phospholipids (lysophosphatidylcholine and lyso-1-alkyl-sn-glycerophosphocholine) inhibit the adhesion of some strains: Bacterium bifidum 1, B. adolescentis MC-42, B. longum B. 379M, Staphylococcus aureus P 209 and Klebsiella pneumoniae 52. Phosphatidylcholine produces no effect on the adhesiveness of these strains, while platelet activation factor stimulates adhesiveness only in strain S. aureus 209. The stimulating or inhibiting action of phospholipids on the adhesive process of microorganisms depends on the species of bacteria and on the concentration of reagents.


[The use of immunoenzyme analysis in the diagnosis of candidiasis in patients with different variants of hemoblastosis].

A total of 84 blood sera taken from patients with tumors of the hematopoietic system, among them 63 blood sera from patients with candidiasis and 21 blood sera from patients without symptoms of Candida infection have been tested in the enzyme immunoassay (EIA). This assay has been found suitable for the diagnosis of the visceral forms of candidiasis in patients with acute leukemia and hematosarcoma. EIA has proved to be an inadequate method for the detection of Candida infection in chronic lympholeukemia patients, as well as in patients with acute leukemia and hematosarcoma, suffering from such local forms of candidiasis as candidiasis of the oral cavity.


[An increase in the immunogenicity of bacterial antigens under the influence of one of the derivatives of muramyl dipeptide].

As revealed in animal experiments, glucosaminylmuramyl dipeptide (GMDP), the synthetic analog of muramyl dipeptide, when introduced intraperitoneally in a single injection or orally, exhibits adjuvant activity with respect to Citrobacter 0-antigens, Shigella flexneri and enhances the protective properties of dysentery and pertussis vaccines. The stimulating properties of GMDP depend on its dose, the route of its administration, the time elapsed after its administration, its ratio to the concomitant doses of bacterial antigens and to the dose of the virulent culture used for challenge.


[The role of tumor necrosis factor and interleukin-1 in forming resistance in experimental Q fever].

Preliminary injections of human recombinant tumor necrosis factor (TNF-alpha) and interleukin 1 (IL-1 beta) increases the resistance of guinea pigs to Coxiella burnetii. The increase of this resistance depends on the dose of cytokines and the time of their inoculation.


[The macrophagal-lymphocytic interaction of heterochronic cells in the induction of delayed hypersensitivity].

The influence of senescence on the functional activity of lymphocytes and macrophages in the induction of sensitivity to tuberculosis has been studied in experiments on 226 CBA mice. The study has revealed that after the injection of BCG old animals exhibit decreased capacity for the formation of delayed hypersensitivity, and their lymphocytes, transplanted to recipients, induce a lower level of hypersensitivity. Joint incubation of lymphocytes and macrophages from animals of different ages has shown that immunological defect appearing with age is localized in lymphocytes, while the antigen-presenting function of macrophages remains basically unchanged.


[The clinical assessment of the immune status of patients with acute Flexner shigellosis].

A total of 192 patients with Flexner's dysentery 1 have been examined. As a result, sharply pronounced unbalance of cell-mediated and humoral immunity factors has developed in the acute period of dysentery, reaching its maximal manifestations in severe course of the disease. In case of a tendency to a prolonged course of dysentery at the period of convalescence, essential shifts in immunological characteristics persist and the infective agent is repeatedly isolated.


[Superoxide dismutase activity in representatives of the genus Francisella].

Superoxide dismutase (SOD) activity has been registered in representatives of the genus Francisella. The electrophoretic mobility of the enzyme and a number of its isoforms in F. tularensis are linked with the subdivision of this species into several subspecies. Avirulent and noncapsular variants of F. tularensis are characterized by a higher SOD activity than the initial virulent strains. Attempts to detect catalase activity in F. tularensis have failed.


Daytime sleepiness: a risk factor in community life.

The prevalence of daytime sleepiness and background factors associated with it were investigated in a study carried out at the UKK Institute. The inquiry took the form of a questionnaire mailed to 1600 people of middle age. Daytime sleepiness was found to be associated with disturbed night sleep. Women were more tired than men, but men slept more frequently during the day. Those suffering from tiredness complained of poor health more than other respondents. Traffic accidents and other mishaps attributable to tiredness had occurred in 1.3% of cases, and almost 5% of male respondents had dozed off while driving at least five times in their lives. The findings indicate a need for increased attention to disturbance of sleep and daytime sleepiness in routine health screening.


Immunological and gadolinium-DTPA MRI evaluation of relapsing remitting multiple sclerosis.

The levels of lymphocytes, blood lymphocytes subsets (CD3+, CD4+, CD8+, DR+, CD25+, CD4+, CD45RA+, CD4+, CD29+ cells) and sIL-2r of 10 patients affected by relapsing-remitting multiple sclerosis were serially studied. The identification of the activity of the disease was made by gadolinium-DTPA (Gd-DTPA) MRI. The immunological determinations and the MRI of the brain and spinal cord were performed every 14th day for a period of three months. No significant difference of the immunological values were found between the presence and the absence of Gd-DTPA enhancing areas, except lymphocytes (p < 0.05). These immunological parameters, evaluated in the peripheral blood, are not a marker of disease activity in relapsing-remitting MS patients.


Depression in the early phase of MS: influence of functional disability, cognitive impairment and brain abnormalities.

This study investigated the relationship between depression, physical disability, cognitive deficit and brain abnormalities on magnetic resonance imaging (MRI) in patients with early MS. Eighteen relapsing-remitting MS patients were evaluated: depression was diagnosed according to DSM-III R and measured by the MMPI depression subscale, physical disability was assessed by using the Kurtzke Expanded Disability Status Scale (EDSS) and cognitive functions by means of an extensive neuropsychological test battery. A neuroradiologist blinded to clinical findings quantified cerebral lesion on MRI. Weighted brain area lesion score were developed according to number and size of cerebral lesions. On the basis of DSM-III criteria, six patients were classified as having major depression, seven patients had minor depression and five patients were without depressive symptoms. No significant differences were found among the three groups on both neuropsychological performances and weighted MRI lesion scores. However patients with major depression exhibit greater physical disability than the other MS subgroups. A significant correlation was found between MMPI depression subscale and physical disability. This study suggests that at least in the early phase of MS, depression appears more related to the physical disability than to the severity of pathological brain involvement.


Sensory and movement-related cortical potentials in nociceptive and auditory reaction time tasks.

The processing of a sensory stimulus leading to a simple motor command was studied with scalp-recorded long latency cortical potentials in humans. Two sensory modalities were tested in their ability to activate descending motor pathways: auditory stimuli and painful cutaneous stimuli produced by a CO2 laser. Subjects were asked to react to stimuli with voluntary index finger movements. The stimulus-related and movement-related cortical potentials were recorded simultaneously with five midline electrodes on the scalp. The auditory reaction time, measured from the stimulus to the onset of electromyogram (EMG), was faster (150 ms) than the laser reaction time (350 ms). The onset of EMG of finger movements occurred only after the first negative components following auditory or laser stimuli but before the positive components. The latency from the auditory negativity to the onset of EMG was about 50 ms and the latency from the laser negativity to the onset of EMG was about 110 ms. This finding indicates that not only the peripheral afferent conduction but also central processing takes longer in a pain-related somatosensory task than in an auditory task. The frontal peak of Motor Potential (fpMP), a cortical potential related to the sensory feedback from movement, occurred with a constant latency after the onset of EMG (100 ms) and was unaffected by the task.


Abduction nystagmus in internuclear ophthalmoplegia.

Direct current electro-oculography revealed abduction nystagmus with hypermetric abduction saccades in 35 of 64 patients with unilateral and 55 of 66 patients with bilateral internuclear ophthalmoplegia. Slowing of abduction saccades occurred in 27 unilateral cases, mainly ipsilateral to the paretic eye, and in 36 bilateral cases. Abduction nystagmus with hypermetric abduction saccades of normal velocity is explained by an increased phasic innervation adjusted to adduction paresis. Slowed abduction saccades are attributed to impaired inhibition of the medial rectus muscle. Superposition of impaired medial rectus inhibition and increased phasic innervation best explains abduction nystagmus with slowed hypermetric (6 unilateral and 23 bilateral cases) or normometric abduction saccades (9 unilateral and 5 bilateral cases).


Treatment of myotonia with antiarrhythmic drugs.

The effects of disopyramide, phenytoin, mexiletine, and tocainide were compared in 30 patients with myotonic disorders. The severity of myotonia was assessed by clinical and electromyographic criteria at the end of each treatment phase lasting four weeks. Mexiletine (MXT) and tocainide (TCD) were found to be the most potent antimyotonic agents. The antimyotonic efficacy of MXT and TCD is explained by their fast-blocking effect on voltage-dependent sodium channels in the muscle membrane. The benefits of myotonia control with pharmacological agents must be weight against the risk of therapy in the individual patient. Because of the risks of hematologic problems, TCD is not recommended by us for the treatment of myotonia.


Brain energy metabolism studied by 31P-MR spectroscopy in a case of migraine with prolonged aura.

The brain and skeletal muscle oxidative metabolism of a patient with prolonged aura was studied by phosphorus magnetic resonance spectroscopy. We found that the phosphocreatine to ATP ratio in brain was reduced, while the inorganic phosphate to phosphocreatine ratio and the calculated ADP concentration were increased. The phosphorylation potential and percentage of maximal rate of ATP synthesis were also altered. Intracellular pH and inorganic phosphate concentration were normal. In muscle we found a low post-exercise recovery of phosphocreatine. These data indicate an impairment of energy oxidative metabolism both in brain and muscle.


Screening for unruptured familial intracranial aneurysms. A decision analysis.

Decision analysis is used to assess the decision to screen for unruptured intracranial aneurysms (IAs) in two affected families, and to formulate guide-lines for similar decisions. Four strategies are compared: "no screening", "screening directly", "screening twice", and "screening later". Intravenous and intra-arterial digital subtraction angiography techniques (iv-DSA, ia-DSA) are considered. Life years lived with and without disability are computed for each strategy. Loss of life expectancy with and without discounting and quality correction is used as an outcome measure. "No screening" is the preferred strategy when population based estimates of the prevalence of IAs are used. Thus, the results of this analysis provide no justification for screening patients without a familial history. But a physician who thinks that the risk of an IA is increased may rightly decide for screening, especially when the patient is aged 40 to 60. Ia-DSA is preferable over iv-DSA. A scenario analysis suggests that screening with magnetic resonance angiography is only slightly better than with ia-DSA, because the complication rate of screening plays a minor role in the analysis.


Superior sagittal sinus thrombosis and pulmonary embolism: a syndrome rediscovered.

Pulmonary emboli as a fatal complication of superior sagittal sinus thrombosis was once well recognized in the literature but appears to have been forgotten. The sagittal sinus appeared to be the source of pulmonary emboli in previously reported cases. Even in patients with no evidence of systemic thrombosis, but who have sagittal sinus thrombosis, the possibility of dislodging pulmonary emboli should be strongly considered. We report a case of nontraumatic sagittal sinus thrombosis complicated by multiple pulmonary emboli and a fatal saddle embolism, likely originating from the thrombosed sinus. Our review of the literature between 1942 and 1990 yielded 203 cases of intracranial venous thrombosis. The overall mortality rate was 49.3%. In 23 cases (11.3%), the venous sinus thrombosis was associated with pulmonary emboli and in these the overall mortality rate was 95.6%. In the 203 cases in our review, those patients who received anticoagulation therapy also had a statistically significant better outcome. Therefore, the presence of pulmonary emboli in association with sagittal sinus thrombosis mandates a sober assessment of the need of anticoagulation therapy in the absence of obvious contraindication.


Western blotting analysis in patients with MS using human brain vessels as antigen.

Serum samples from patients suffering from multiple sclerosis, other neurological diseases and normal controls were screened by "western blotting" for antibody directed against proteins of human brain vessels purified from a post mortem brain. A small number of sera contained autoantibodies against some of the proteins of the brain vessels, particularly in patients suffering from MS, epilepsy and migraine. The significance of these results is discussed.


Evidence for an altered dopamine beta-hydroxylase activity in migraine and tension-type headache.

Sympathetic dysfunction is often present in migraine. It has been suggested that serum dopamine-beta-hydroxylase (D beta H) can be taken as an index of peripheral sympathetic activity. We studied the serum D beta H activity in migraine with and without aura and in tension-type headache patients compared with healthy control subjects. The serum D beta H activity was significantly lower in migraine and tension-type headache patients than in the control group. No significant difference was observed among the three groups of patients studied. These findings suggest that patients with migraine and tension-type headache have a sympathetic hypofunction that may play an important role in the pathogenesis.


Intermediate syndrome due to prolonged parathion poisoning.

A parathion-poisoned patient with prolonged cholinesterase inhibition due to impaired hepatic metabolism and urinary excretion is reported. An intermediate syndrome characterized by respiratory paresis, weakness in the territory of several motor cranial nerves and of proximal limb and neck flexor muscles, persisted for 3 weeks. During this whole period, cholinesterase remained markedly reduced. Serial EMGs with repetitive nerve stimulation pointed to a combined pre- and postsynaptic disorder of neuromuscular transmission. Electron microscopy of an intercostal muscle biopsy showed focal degeneration at the poorly branched postsynaptic folds, and was considered to be nonspecific.


Magnetic resonance imaging findings in lupus ataxia.

We present a 47-year-old white woman who had a definitive diagnosis of systemic lupus erythematosus (SLE), and developed cerebellar ataxia of sudden onset. MR imaging showed changes characteristics of cerebellar infarct. Due to the absence of vascular risk factors and to the previous diagnosis of SLE, we postulate that the cerebellar infarct is related to SLE. We are not aware of previous descriptions of the MRI findings in lupus ataxia.


The scientific basis of treatment of idiopathic thoracic scoliosis.

The three-dimensional shape of the scoliotic spine must be understood and in particular the lordotic lateral profile addressed before successful derotation can be achieved. It is important that the thoracic kyphosis be recreated, firstly so that the spine can be untwisted, and secondly to bring the thoracic spine once again behind its axis of rotation thus preventing postoperative buckling with the remainder of growth. Stiffer curves require preliminary anterior multiple discectomy with growth plate excision and reshaping of the apical vertebral bodies. The deformity rapidly collapses into himself and 75% of the total correction occurs spontaneously before the second instrumentation stage. The most rigid curves require that the spinal column be shortened at bone level and Leatherman's two-stage wedge resection is ideal for this purpose. For very young spines posterior fusion is both illogical and harmful and it is essential that the growth of the front of the spine be arrested by multiple discectomy and end-plate excision. Posterior instrumental recreation of the thoracic kyphosis without fusion in a "trolley-like" procedure allows continued posterior spinal growth.


The Alici spinal system in the surgical treatment of scoliosis.

The Alici spinal system is an instrumentation used for correction and fixation of various deformities of the spine. Idiopathic scoliosis is the most important indication. Scoliosis is a complex deformity in the frontal, sagittal and axial planes, and this system provides perfect correction in all three planes. Furthermore, it permits stable fixation and can be used for both anterior and posterior spinal fusions. The indications for the anterior Alici spinal system are: mature thoracolumbar or lumbar curves of more than 40 degrees, progressive immature thoracolumbar or lumbar curves of more than 35 degrees, painful mature lumbar curves, paralytic or congenital lumbar or thoracolumbar curves, and mature lumbar curves of more than 40 degrees in thoracolumbar double curves. The indications for the posterior Alici spinal system are: immature thoracic curves of more than 40 degrees, progressive thoracic or thoracolumbar curves of more than 35 degrees, and paralytic and congenital curves. During the last two years, 92 scoliosis patients underwent spinal fusion with Alici spinal instrumentation. Scoliosis was idiopathic in 58, congenital in 20, paralytic in 12, and 2 cases were caused by neurofibromatosis. Twenty-four of the patients underwent 2-stage anterior and posterior fusions. In the remaining 68 patients only posterior fusion was performed. The mean follow-up was 14 months (range, 6-24 months). Preoperatively, the mean curves of the idiopathic, congenital, and paralytic groups were 54.7 degrees, 57.8 degrees, and 83 degrees, respectively. In the idiopathic group the mean correction was 93% with anterior instrumentation, and 74.4% with posterior instrumentation.(ABSTRACT TRUNCATED AT 250 WORDS)


Results of CD operation in idiopathic scoliosis.

In order to evaluate the use of the CD system in scoliosis and kyphosis surgery we performed a partly retrospective, partly prospective study of our patient group. A total of 38 CD operations was performed in the period November 1986 until February 1991. In this group were 24 patients with idiopathic scoliosis, 4 male and 20 female, average age at operation 18 yrs 10 mo (12 yrs 10 mos-42 yrs 2 mos). In 22 patients follow-up was 6 months or more. In the right thoracic curves (n = 22) the preoperative Cobb angle was 59.5 degrees (48 degrees-90 degrees). The average angle after operation was 25.2 degrees (6 degrees-50 degrees), at 6 months 30.7 degrees and final curve 33.8 degrees (12 degrees-55 degrees) 20.1 months postoperatively (9 mos-48 mos). This is 43.2% correction with a loss of correction in the postoperative period of 14.4%. Left high thoracic curves were stiffer with a correction of only 12.8% in 3 patients at 18.3 months. In 4 patients with double curves a first stage Zielke operation was done before the CD operation. The mean curve of 67.8 degrees (45 degrees-108 degrees) was corrected to 20.5 degrees postoperatively with a final correction of 66.1% in 3 patients at 27 months. Without the preceding Zielke operation the mean curve of 44.5 degrees was corrected to 24 degrees at 6 months in 2 patients (46.1% correction). Derotation was evaluated clinically with the Bunnell method and measurement of gibbus height (14 patients had the derotation maneuver, 2 partial and 6 not).(ABSTRACT TRUNCATED AT 250 WORDS)


Segmental evaluation of the surface and radiological deformity after Cotrel-Dubousset (CD) instrumentation for King type II and III. adolescent idiopathic scoliosis (AIS): surgical and etiological implications.

In this paper we report the segmental effects of CD in each of the three planes of deformity (frontal, transverse and sagittal) in 35 children with AIS (King types II and III) treated by Cotrel-Dubousset instrumentation. Patients were examined preoperatively and in follow-up at 8 weeks and one year, and 15 patients were also examined at two years. Back shape was appraised segmentally as angle of trunk inclination (ATI) at each of ten levels by ISIS and the Scoliometer. The radiographs were measured nonsegmentally for Cobb angle, apical vertebral rotation and spinal balance, and segmentally for both vertebral rotation and tilt (frontal and sagittal plane), and in the rib cage for rib-vertebra angles (RVAs).


Technetium-99m-diphosphonate, gallium-67 and labeled leukocyte scanning techniques in tibial nonunion.

On the technetium-99m bone scan the vast majority of nonunion cases show an intense tracer uptake at the fracture site, as do fractures undergoing normal healing. Therefore static bone scintigraphy usually does not contribute to the diagnosis of nonunion. One of the main causes of delayed fracture healing is infection. Increased blood flow and blood pool as demonstrated during the first and second phases of a 3-phase bone scan are consistent with an inflammatory reaction but are not pathognomonic for infection. A gallium-67 scan is indicative of infection if Ga-67 uptake exceeds Tc-99m uptake on the bone scan. The most specific tracers for infection however are leukocytes labeled with indium-111 or technetium-99m.


Deep decortication in nonunion of shaft fractures.

For many years we have used the "petal" technique of Jarry and Uhthoff in all cases of delayed union or nonunion of long bones. With a chisel or a gouge, cuts are made in the cortical surface of the bone on both sides of the fracture line, and numerous scales are lifted but remain attached at the base, like the petals of a flower. Depending on the cortical thickness, the petals are 2 to 4 mm thick. The surface area of the bone is increased and the haversian canals under the cortical surface (and the blood vessels) are cut open, exposing numerous areas of well-vascularized and highly osteogenetic tissue on all of the exposed surface of the bone. We were able to retrace 26 cases treated in this way between 1968 and 1988. Different types of fixation were used, depending on type and location of the fracture, but sometimes also because we preferred not to change the fixation that had been applied before the patient was referred to us. All fractures united after one operation, in 3 to 18 months. In one case of nonunion of the ulna, with bone loss by gunshot wound, the fracture united, but a stress fracture through a screw hole occurred distally to the fracture site. It did not unite and reoperation was refused. In most cases we have added autogenous spongiosa only grafts, but we think now that their use is questionable in many instances. This technique is quite similar to the subperiosteal decortication of Judet or the shingling technique as described by Forbes.(ABSTRACT TRUNCATED AT 250 WORDS)


The fibula pro tibia procedure in the treatment of nonunion of the tibia.

We reserve the fibula pro tibia procedure for infected nonunions or for cases that already have been subjected to one or more other methods of treatment. The fibula pro tibia procedure is a technically simple one-stage procedure. The site of the pseudarthrosis is not exposed; hence there is less risk of recurrent infection. Consolidation was achieved in 75% of our cases. The objective findings are positive: consolidation after an average of one year. Knee mobility is normal in most cases, and ankle mobility is only slightly decreased. In most cases the angular deformities are clinically acceptable. All infections have cleared.


Locking graft in the treatment of tibial pseudarthrosis.

Despite modern treatments of tibial fractures, we still have nonunions. In case of failure we used a method of treatment which has become less popular over the last decades. A rectangular inlay graft is harvested from the anteromedial tibial surface. The graft, measuring about 12 to 15 cm long, is placed over the nonunion with 2/3 of its length on one side and the remaining third on the other side. The graft is turned 180 degrees and fixed with four lag screws in the original donor site. Postoperatively, we place a nonweight-bearing cast for 3 months. The results are quite satisfactory for both nonunions and difficult multi-operated nonunions.


Corrective osteotomy for mal- and nonunion of the tibia using the posterolateral approach.

An analysis of the results of 9 patients with a post-traumatic malalignment of the tibia, treated by an osteotomy and immediate bone grafting through a posterolateral approach is presented. Fixation was obtained with an external fixator in 8 cases and with a fibular plate in one case. Union was obtained in all cases after an average of 4.8 months. A significant improvement in the malalignment was obtained, especially in the frontal plane and somewhat less in the sagittal plane. Permanent sequellae due to the procedure were not noted.


Vascularized bone transfer for tibial pseudarthrosis. Part I: Vascularized fibula transplantation. A report of 4 cases in the treatment of traumatic bone defects of the tibia.

The limited experience of reconstruction of four cases of large tibial defects with free vascularized fibular grafts is presented. Healing occurred in three of the four patients, and one developed a distal pseudarthrosis. One graft fractured twice but healed with a hypertrophic callus.


Vascularized bone transfer for tibial pseudarthrosis. Part II: Vascularized bone and muscle transfers. Exclusive free fibular bone graft.

The techniques of vascularized transfer of a bone segment, or of revascularization of a conventional bone autograft by a pedicle or a microsurgical muscular flap represent one of the most significant advances made during the last years for the treatment of large bone defects of the tibia with associated skin injury. The authors present their experience with 16 cases, including 5 microsurgical transfers.


The etiology and pathogenesis of idiopathic scoliosis.

Idiopathic scoliosis is a complex three-dimensional deformity and in the thoracic region the essential lesion lies in the sagittal plane in the form of an area of inappropriate lordosis. The thoracic kyphosis is normally protected from buckling by being behind the axis of spinal column rotation but when the thoracic lordosis develops it brings the apical region anterior to this axis and thus under compression with resultant buckling failure of the spinal column. The condition of idiopathic thoracic scoliosis is the opposite to idiopathic hyperkyphosis (Scheuermann's disease), the latter being rotationally stable and not moving out of the sagittal plane. The two frequently co-exist in the same spine with thoracic hyperkyphosis above an area of lumbar lordo-scoliosis. There is a spectrum of normal lateral profile and flat backs at the one end are in danger of buckling (lordo-scoliosis) while round backs at the other end of the spectrum are in danger of being defined as Scheuermann's disease. There is no requirement for a specific pathological process. Engineers describe only two ways in which a flexible column can fall into mechanically-angular collapse (kyphosis) and column buckling (lordo-scoliosis). A number of factors favour column buckling (Euler's law) and thus the bigger a deformity the more likely it will be to continue progressing and the taller and more slender the column the more likely it will be to fail and this we see in our patients with idiopathic scoliosis. Not only is lordosis the essential lesion but it is also the primary abnormality which can be demonstrated in children before lateral curvature and rotation develop.


Antibiotic penetration into bone in relation to the immediate management of open fractures: a review.

Bone is a vascular structure, which is capable of responding to changes in the systemic circulation. Antibiotics carried within the systemic circulation reach the capillaries in bone, and depending on molecular size, pass through the capillary walls to enter the fluid space. Following an open fracture, contamination with pathogenic organisms can occur both at the moment of injury, but also in the hospital, which is a particular problem in grade III fractures in which extensive soft tissue damage can occur in combination with an exposed wound. Antibiotics administered intravenously can be measured in bone by both bioassay and radioactive isotope techniques and are shown to reach bone in effective concentrations. It is apparent that short-course high-dose antibiotic therapy is appropriate for open fractures, and need not be continued as long as the normal fracture-healing process continues. However if infection in bone develops, further surgery is important to remove new dead tissue to allow adequate antibiotic penetration into bone. Thus antibiotics are useful when combined with effective surgical management, but do not on their own offer the only answer to management of the patient.


The use of gentamicin-PMMA chains in the treatment of infected tibial nonunion.

Local antibiotic therapy with gentamicin-PMMA chains and external fixation permit effective simultaneous therapy of both components of infected tibial pseudarthroses: sequestering osteomyelitis and pseudarthrosis. The local concentrations of gentamicin which can be achieved by implantation of gentamicin-PMMA chains are far above the MIC of most common pathogens. This form of local antibiotic therapy is superior to any form of systemic antibiotic therapy. The gentamicin-PMMA chains serve as well as space holders for the bone graft to promote bone consolidation in the absence of infection. The results can be improved by successful management of the soft tissue damage often associated with tibial pseudarthrosis. Pedicled or free muscle graft with microvascular anastomosis is the method of choice.


Treatment of bone and soft tissue defects in infected nonunion.

In the treatment of infected pseudarthroses the general principles of osteitis treatment are applied. This includes radical excision of pseudarthrotic and infected bone tissue, and of diseased surrounding soft tissue. External fixation devices are the preferred method of stabilization of the bone. Based on the data of a retrospective study of 31 Papineau procedures, 65 local flap transfers, and 46 free flap transfers we found that the Papineau procedure works in minor bone and soft tissue defects. Unstable scar formation is a major disadvantage of this method. Local muscular flaps are indicated in the treatment of soft tissue defects in the proximal and medial portions of the lower leg. A prerequisite for free flap transfers is the availability of trained personnel and suitable technical equipment. The option is limited by the patient's vascular situation. This kind of tissue transfer seems to be superior to other methods. For the substitution of bone defects corticocancellous bone transplantation may be used. A promising alternative method to deal with extensive bone defects is osteogenesis produced by callus distraction.


The treatment of reflex sympathetic dystrophy syndrome: current concepts.

Reflex sympathetic dystrophy syndrome is the currently accepted term for a disorder that has previously appeared in the literature under a confusing array of designations: causalgia, Sudeck's atrophy, algoneurodystrophy, shoulder-hand syndrome, etc. The disorder, which was first described in 1864, is characterized by pain, swelling, limited range of motion with associated signs of vasomotor instability, trophic skin changes and patchy bone demineralization. It appears as an exaggerated response of an extremity to injury: trauma, infection, phlebitis or numerous other lesions. In 35 per cent of the RSDS patients, no precipitating event can be identified. The rational treatment of these patients should be based on a thorough understanding of its pathogenesis. While the optimal management is still controversial, there is a consensus that the best results will be achieved if treatment is started early and adapted to the clinical stage of the disease. The role of physical therapy is still debatable. Sympathetic interruption, corticosteroids, calcitonin, beta-blocking agents and more recently bi-phosphonates have been advocated. Proper management may result in the prevention of crippling sequelae.


Advances in osteogenin and related bone morphogenetic proteins in bone induction and repair.

Bone matrix is a repository of growth and differentiation factors as demonstrated by the induction of local cartilage and bone formation in rats. The bone inductive activity, termed osteogenin, can be dissociatively extracted, and it was isolated by heparin affinity, hydroxyapatite and molecular sieve chromatography. Osteogenin has been purified to homogeneity from bovine bone matrix and the sequences of several tryptic peptides have been determined. The sequences were similar to portions of the amino acid sequence deduced from the cDNA clone of bone morphogenetic protein-3 (BMP-3). The carboxyl-terminal quarter of osteogenin has sequence identity to the corresponding regions of two related proteins BMP-2A and BMP-2B. The bone inductive proteins are members of the TGF-beta superfamily, by virtue of the location of the highly conserved cysteines in their carboxyl-terminal region. Osteogenin and related BMPs initiate cartilage and bone formation in vivo. The study of the mechanism of action of these proteins will add considerable new information on the molecular signals controlling endochondral bone formation. In vitro data indicate that osteogenin stimulates the expression of the osteogenic and chondrogenic phenotypes. Our results demonstrate their profound influence on proteoglycan synthesis and degradation in bovine cartilage explant cultures. High affinity specific binding sites have been identified in both MC3T3 cells and articular chondrocytes. In vivo experiments demonstrate the efficacy of primate osteogenin in restoring large calvarial defects in adult baboons, establishing a primary role for osteogenin in therapeutic initiation and promotion of osteogenesis.


Pathogenesis of idiopathic scoliosis. The Nottingham concept.

There is no generally accepted scientific theory for the etiology of idiopathic scoliosis. Hence, current treatment is pragmatic and not based on knowledge of causation of the deformity. In Nottingham, we have evaluated data from studies of the hips, pelvis, spine, rib cage and trunk muscles in scoliotic (pre- and post operative) and control patients, cadavers and a mechanical model to formulate a new theory of etiology for idiopathic scoliosis (figs. 18 & 19 of ref. 15). Evidence is summarized for the view that idiopathic scoliosis results, in part, from a developmental abnormality in the central nervous system creating rib-vertebra angle asymmetry which leads to a cyclical failure of mechanisms of rotation control in the trunk; these involve rotation-inducing (pelvic) and rotation-defending (discal, ligamentous and costal) mechanisms acting mainly in gait. The mechanical breakdown of rotation occurs in association with a lateral spinal curvature and a lordotic segment to create the initial deformity of idiopathic scoliosis. Then, growth, both abnormal (secondary to vertebral hyper-pressures) and normal (linear spinal growth) with gravity adds to the initiating and continuing neuromuscular mechanisms to augment curve progression. This theory views the spine in the wider perspective of function in the trunk, evolution and development, all in relation to bipedalism. The goal of etiological research is ultimately to base a treatment on some knowledge of causation of the deformity.


Magnetic resonance imaging (MRI) of the ankle and hindfoot.

While Magnetic Resonance Imaging (MRI) has become a routine diagnostic method to deal with pathology of the knee, little has been published about foot and ankle lesions. This is probably due to the anatomic complexity of bone and ligamentous structures of these small joints, necessitating the use of very thin slices from various orientation planes (orthogonal and oblique planes). A special technique is needed allowing a 3-dimensional (3D) analysis, using inframillimetric slices and more sophisticated equipment than for 2-dimensional (2D) MRI (high fields with good homogeneity, specialized image processors...). An initial potential indication of the method is the precise diagnosis of lateral ligamentous components in severe sprains. MRI may determine if surgical therapy is needed. The ligamentous components are reconstructed along their specific planes thanks to the 3D method. Furthermore, assessment of the ligamentous damage is also possible in chronic ankle instability (elongation, fibrotic appearance...). Thanks to the multiplanar approach, associated lesions of articular cartilage can be revealed in ankle sprains. The high sensitivity of MRI in slight modifications of medullary bone allows the early diagnosis of "occult" fractures (not seen on conventional radiographs), osteonecrosis, osteochondrosis and reflex sympathetic dystrophy syndrome. Finally, MRI easily displays all ankle and foot tendons and fascia and is particularly helpful in depicting partial tears and postoperative complications.


Calculation of 3-D deformity in scoliosis by standard roentgenograms.

The standard radiological diagnosis of advanced scoliosis consists of roentgenograms of the total spine in anterior-posterior and lateral views. The deformity of the spine is measured by using the Cobb angle, thus only giving the projected angle of deformity, without showing the true 3-dimensional aspect. The 3-D calculation of the deformity is relevant to diagnosis and therapy of scoliosis. In this paper we define angles according to the Cobb definition, evaluate them trigonometrically and show them in two tables. These angles allow the 3-dimensional deformity in scoliosis to be calculated using the standard roentgenograms in two perpendicular views. This procedure enables us to avoid techniques costly in time and effort in hospital routine, such as stereo radiography, computer-analysis or 3-dimensional reconstruction of CT- and MRI-investigations.


Measurement of body surface topography using an automated imaging system.

An automatic computer imaging system for recording body surface topography has been developed on a microcomputer-based image processing system. The computer processes fringe patterns generated on the surface of the trunk and reconstructs the complete 3-dimensional form of the surface. From the topographic reconstruction, clinical parameters of scoliotic deformity such as Angle of Trunk Inclination are calculated at a number of levels from the upper thoracic to the sacral region. These multiple level measurements illustrate the change in deformity over the trunk and correspond to measurements obtained using conventional tactile devices on patients.


Plaster casts for the correction of idiopathic scoliosis.

The authors report their experience in conservative management of idiopathic scoliosis treated in the last 10 years with the Risser localizer cast method. The conclusion is that this method, alone or in combination with braces, is still a particularly effective therapeutic means in the correction of both angular deviation and rotation, provided that a rigid protocol is followed.


Brace treatment in idiopathic scoliosis.

A German multicenter study with consequent long-term follow-up of patients with idiopathic scoliosis after Milwaukee brace treatment in one out of seven Orthopaedic Clinics showed that brace weaning at the bone age of Risser 4 is followed by early loss of curve correction. According to Oberthaler et al. patients, who were furnished with a brace as outpatients, are inclined to practice a part-time wearing with different brace free intervals. In a longterm follow-up study of 328 patients with idiopathic scoliosis treated at the North German Scoliosis Center in Cuxhaven 123 compliant patients were examined 4 1/2 years after brace weaning. All were asked to wear their braces 23 hours a day and were weaned only at Risser 4-5 or Risser 5. The control rate was 93%. A gain of correction between 9 and 22% was the result. We analysed the composition of the group of 81 noncompliant patients. As far as we could find out the percentage of really non-compliant patients was only 19% compared with a total of 212 patients, who had finished their brace treatment at least 5 years ago. Eight patients (4%) with prebrace values of over 40 degrees Cobb had to be operated, though they were compliant. Based on these results, strict brace treatment in progressive idiopathic scoliosis is recommended, unless no more physiologic way of treatment is available.


The conservative management of Juvenile Idiopathic Scoliosis.

Juvenile Idiopathic Scoliosis is not a single diagnostic entity but comprises a number of different types of scoliosis. Although detected in the juvenile years, the study of 56 cases shows that in the majority the onset of the scoliosis can be traced back to infancy. It is proposed that the aim of conservative treatment should be to eradicate the deformity and not be content with preventing progression. The principle of using the child's growth as a corrective force to eradicate the deformity is described. An outline of early treatment by corrective plaster jackets is given.


Spinal cord monitoring. State of the art. Results in Harrington and C.D. instrumentation for scoliosis.

In scoliosis surgery, it is of paramount importance to obtain extensive correction of the curve without compromising the integrity of the spinal cord. Up to now, the wake-up test has been used for the intra-operative assessment of spinal cord function. Besides the fact that the test only provides a single evaluation, it is also encumbered with some potential hazards related to the anesthetic procedure. An additional problem arises when the technique is applied in psychiatric patients. An alternative approach is the continuous recording of evoked potentials obtained from sensory stimulation. The method permits uninterrupted intra-operative monitoring of the neurological status of the cord.


Distortion-product otoacoustic emissions in neonates: normative data.

Distortion-product otoacoustic emissions (DPOEs) are otoacoustic emissions evoked by two pure tones and used in order to provide a frequency specific assessment of the mechanical properties of the cochlea. This paper first reports complete input-output DPOE functions for audiometric frequencies between 867 Hertz and 8 kHz in a normal neonate population (normative data). DPOE results were analyzed as a function of evoked otoacoustic emission (EOE) properties. Neonates having normal EOEs have large DPOEs. DPOE amplitudes in neonates are larger than in adults. Neonates with atypical EOE frequency spectrum without low frequency components had normal DPOE input-output functions only for high frequencies (above 2 kHz). DPOEs could be useful, in association with EOEs, to precisely evaluate the auditory peripheral function in neonates.


Steady-state evoked potentials to amplitude modulated tones in the monkey.

A frequency-specific, objective assessment of hearing thresholds is required for use in subjects unable to perform behavioural audiometry. One such method using steady-state evoked potentials (SSEPs) in response to amplitude-modulated tones was evaluated in an experimental animal, the macaque monkey. An amplitude-modulation frequency of 165 Hz was found to produce optimum response detection in the anaesthetised animal. Auditory thresholds determined by a computerised automatic response detection system accurately reflected behavioural thresholds previously described in this species.


A comparison of speech perception of cochlear implantees using the Spectral Maxima Sound Processor (SMSP) and the MSP (MULTIPEAK) processor.

The Spectral Maxima Sound Processor (SMSP) is a portable speech processor which has recently been developed at the University of Melbourne for use with multiple-electrode cochlear implants. In this processor, the six largest outputs (maxima) of 16 bandpass filters are used to stimulate the cochlea on a place basis at a constant rate. This speech processing strategy has been compared with the MSP(MULTIPEAK) strategy, in which four electrodes are selected for stimulation in every glottal pulse period. The study was undertaken on four postlinguistically deaf adults. The results show that, for this group of subjects, the performance of the SMSP processor was significantly better than that of the MSP(MULTIPEAK) processor for the recognition of closed-set vowels and consonants, open-set monosyllabic words, and open-set sentences in noise, when using electrical stimulation alone. The SMSP mean scores were: vowels 91.3%, consonants 74.9%, words 57.4%, and sentences in noise 78.7%. The MSP(MULTIPEAK) mean scores were: vowels 76.3%, consonants 59.4%, words 39.9%, and sentences in noise 50.0%.


Ultrastructure of cultured marginal cells of the guinea pig cochlea.

Explants of stria vascularis and spiral ligament of guinea pig cochlea were kept in primary culture. On the explant, proliferating marginal cells advanced by 15 microns/day, suggesting that in vivo defects of the strial epithelium can be covered by new marginal cells. The marginal cells growing in the cell culture dish had a diameter of 12.8 +/- 0.7 microns and formed an epithelial monolayer. Adjacent cells were connected by desmosomes and tight junctions. The cells were uniformly polarized. The apical membrane had small invaginations and numerous microvillus-like extensions, and the convoluted lateral membrane interdigitated with adjacent cells. The basal infoldings were smaller in cultured cells than in vivo; mitochondria were dispersed in the entire cytoplasm rather than concentrated in basolateral infoldings. The basal membrane infoldings of cultured marginal cells did not interdigitate with underlying fibroblast-like cells. Marginal cells were separated from underlying fibroblast-like cells by a fluid-filled space which was sometimes enlarged, leading to the formation of "domes" in the otherwise planar epithelium.


Prostaglandin synthesis by the lateral cochlear wall under streptomycin influence.

The synthesis of 4 prostaglandins (PGs), PGD2, PGE2, PGF2 alpha and PGI2, detected as 6keto PGF1 alpha in the guinea pig lateral cochlear wall (LW) was investigated under streptomycin treatment. Animals underwent daily injections of the antibiotic at dosages of 20, 100 and 200 mg/kg body weight. Prostaglandins were detected 1, 5 and 10 days after drug administration using radioimmunoassay. Under aminoglycoside administration a general reduction of PG-synthesis was evident, which was highest for PGI2. Already after 5 days of treatment the PGI2-synthesis was decreased down to 50% under the lowest drug dosage. The highest antibiotic dosage induced an abrupt decline of PGI2 synthesis, down to 26%, in animals with the longest duration of treatment. The significant synthesis reduction of PGI2 was followed by PGE2. The reduction of PG-synthesis seems to be influenced rather by duration than dosage of drug administration. The decreased synthesis of PGs under streptomycin treatment is interpreted as an inhibition of cell membrane phospholipids, the phosphoinositides. This assumption becomes plausible since the phospholipids represent endogenous precursors of the PG-synthesis.


Characteristic ionic composition of endolymph is maintained in cultured inner ear.

Inner ear anlagen from mouse were explanted on the 16th gestational day (gd) and cultured for 5 days, i.e. corresponding to the time of birth. By using energy dispersive X-ray technique an elemental composition characteristic for endolymph was found within the membranous labyrinth of the explants. The sodium to potassium ratio in the endolymphatic space of the cultured inner ears corresponded to endolymph of the 16th gd fetus in vivo. There was no difference in the endolymph compartment between the cochlear and vestibular halves of the in vitro specimens. Differences in Na to K ratio between endolymph of the inner ears and the surrounding medium were statistically significant. Thus, endolymph-regulating mechanisms are active also under organ culture conditions, although not fully optimal.


Experimental interruption of the endolymphatic duct and its effect on the DC potential in the endolymphatic sac.

The endolymphatic sac (ES) of the guinea pig was isolated from the remainder of the inner ear by means of surgical interruption of the endolymphatic duct (ED). The DC potential in the ES lumen and the morphology of the ES were studied using glass micro-electrodes and a light microscope at various time intervals after the interruption of ED. The DC potential did not significantly change 1 h postoperatively, compared to findings in the non-operated ear, but a significant decrease of the DC potential was observed after 1, 3 and 7 days postoperatively. A histologically-stainable substance in the ES lumen was enhanced on the operated side. The isolated ES shows a disturbance of mechanism(s) maintaining the DC potential and there is a secretion of a stainable substance into its lumen.


Absorption of horseradish peroxidase in the endolymphatic sac: ultrastructural cytochemistry using a new electrophoretic technique.

Using a newly developed injection technique, the absorption of horseradish peroxidase (HRP) in the endolymphatic sac (ES) of the guinea pig was examined by light and electron microscopy. HRP (molecular weight: 40,000; molecular diameter: about 5-nm) was directly injected into the lumen of the ES by electrophoresis after the recording of a direct current potential in the ES lumen. Both the macrophages floating in the ES lumen and the epithelial cells in the intermediate portion of the ES absorbed intraluminal HRP. The macrophages internalized the intraluminal HRP at a higher rate than the epithelial cells, suggesting that macrophages play a major role in macromolecular absorption in the ES. It was considered that the macrophages took up intraluminal HRP by phagocytosis, while the epithelial cells of the intermediate portion took it up by pinocytosis. In contrast, the epithelial cells in the proximal portion of the ES absorbed little HRP. No penetration through the junctional complexes between epithelial cells was observed in either the intermediate or the proximal portion at any interval after the injection of HRP. This finding indicates that these junctional complexes are impermeable to intraluminal HRP.


Experimental basis for lidocaine therapy in cochlear disorders.

In order to further our basic understanding of the effects of lidocaine hydrochloride in the inner ear, cochlear potentials and blood flow (CBF) were assessed after intravenous (i.v.), anterior inferior cerebellar artery (AICA), and local round window (RW) lidocaine administrations in guinea pigs and rats. Lidocaine RW applications produced a dose dependent decrease in compound action potentials (CAP) and cochlear microphonics (CM). The sensitivity changes were more pronounced at high frequencies. These findings suggest that lidocaine has specific pharmacological action in the inner ear other than simple anesthesia of the auditory nerve. The basal turn endocochlear potentials (EP) were not altered by topical lidocaine, implicating altered organ of Corti function following local application of lidocaine. RW applications of lidocaine had no effect on CBF or systemic blood pressure (BP). I.v. infusions caused substantial reductions in BP. In the case of systemic infusions the percent changes in CBF were equal to and accountable by the BP changes. The microinfusions (50 mg/ml, 100 nl/min) through AICA produced a 30%, long lasting increase in CBF. However, neither systemic lidocaine nor AICA infusions had an effect on CAP or CM. These findings indicate that systemically given lidocaine may not cross the blood-cochlear barrier and that the cochlear electrophysiological effects due to lidocaine when given locally are partly mediated by direct influence on cochlear hair cell function; they also suggest that lidocaine-induced interference with active ion transport in the lateral wall or an influence on CBF are not contributing factors.


Suboccipital acoustic neuroma surgery: results of decentralized neurosurgical tumor removal in Denmark.

From 1979 to 1990, a series of 59 patients with 59 acoustic neuromas were operated on in five departments of neurosurgery by at least five different neurosurgical teams, employing the suboccipital approach. Perioperative mortality rate was 8.5%. Complications including hematoma, ventricular hemorrhage, meningitis, hemiparalysis, abducens nerve paralysis, recurrent nerve paralysis, postoperative wound infection and CSF leak were observed in 21 patients (35.6%). Total tumor removal was not possible in 17 patients (28.8%). Converting the postoperative facial nerve function to House-Brackmann (HB) classification, 34 patients (57.6%) were regarded as HB 6. Reconstruction of the facial nerve was attempted in 19 patients (32.2%). Attempts at hearing preservation were unsuccessful in all patients. Failure to attain better results and the importance of centralized treatment of acoustic neuroma are emphasized.


The middle ear as a baroreceptor.

Under pressure in the middle ear is thought to be important in the pathogenesis of chronic otitis media with effusion and its sequelae, but the cause of the under pressure and the mechanisms responsible for regulation of the normal middle ear pressure are a matter of debate. Numerous studies have examined the effect of large pressure changes on the ear; however, the ear's sensitivity to smaller pressure changes has received little attention. This study examines the sensitivity of the ear to atmospheric air pressure changes induced in the external ear canal. It is concluded that the normal ear is a very sensitive pressure receptor, and that the sensation is probably registered by stretch receptors in the tympanic membrane. Pathological changes in the tympanic membrane are associated with impaired baroreceptor function. The implications of these findings in the physiology of the ear and the regulation of middle ear pressure are discussed.


Expression of sialic acids in the developing murine tubotympanum.

Sialoglycoconjugates in the developing murine tubotympanum were characterized using lectin histochemistry with wheat germ agglutinin (WGA), Limax flavus agglutinin (LFA), Sambucus nigra agglutinin (SNA), Maackia amurensis agglutinin (MAA), peanut agglutinin (PNA), and neuraminidase treatment. WGA, LFA, MAA, and neuraminidase-PNA labeled epithelial goblet cells, glandular mucous cells, and cell surfaces of adult and newborn murine tubotympanum. SNA did not label any secretory components. PNA labeled secretory cells and cell surfaces of the fetal tubotympanum without neuraminidase treatment. After birth, these secretory cells and cell surfaces were labeled with PNA only after neuraminidase treatment. These results revealed that: Sialoglycoconjugates are produced from glandular mucous cells and epithelial goblet cells and are present on cell surfaces and within the mucous blanket; their terminal tri-saccharide linkage appears to be the sequence Neu5Ac(alpha 2-3)Gal(beta 1-3)GalNAc; sialic acids appear before birth and gradually increase; terminal galactose residues are masked by sialic acids after birth.


A study of the photoelectrical signal from human nasal cilia under several conditions.

The movement of normal human nasal cilia was analyzed. Ciliary beat was recorded by means of a phase-contrast microscope equipped with a photodetector. The electrical signal was analyzed as follows: i) a power spectrum was calculated in order to measure ciliary beat frequency (CBF), ii) the beat cycles were averaged and the standard deviation of the waveform was computed to determine signal consistency (SC), and iii) the ratio of the duration of the smooth to that of the steep part of the cycles was measured. This was done under three different conditions: 1) normal or "initial", 2) after induction of "function loss", and 3) after "salbutamol stimulation". At "function loss," the cilia beat slower and with less harmony. CBF decreased from an average of 9.0 Hz in the "initial" condition to 5.8 Hz. SC decreased from an average of 5.7 to 1.9. After "salbutamol stimulation", average CBF was partially restored to 7.7 Hz, while average SC increased to 4.4. These findings indicate that in ciliary function studies, SC, as a measure for ciliary beat harmony, may be introduced alongside CBF as a second valuable parameter. In this study we were not able to identify different phases in the signal that might be used as a third parameter to indicate the effective and the recovery stroke.


Nasal peak flow rate records in work related nasal blockage.

Eleven patients, who had symptoms of blocking nose in relation to exposure to airway irritants in their work environment, and 11 control subjects recorded nasal and bronchial peak expiratory flow rates (PEFRN and PEFRB) during a working week. In contrast to the control subjects the patients demonstrated a pattern of gradual decrease in PEFRN during the working week with restitution during the subsequent weekend and a different day rhythm in PEFRN during working days from days off. The changes in PEFRB were similar but less pronounced. The results indicate that the symptoms of nasal blockage can be visualized by following the PEFRN during a working week and that the changes in PEFRN may have a relationship to different environmental exposures.


Ciliary beat of cultured human respiratory cells studied with differential interference microscope and high speed video system.

The ciliary beating of upper respiratory tract cells cultured on cover glasses was studied by using differential interference microscope equipped with high speed video. By culturing the cells on collagen coated cover glasses, objectives with higher magnifications could be used. With this system we could evaluate not only ciliary beat frequency, but also amplitude, wave form, orientation and synchrony of ciliary beating. Also some structural anomalies such as compound cilia and tide cilia bundles could be recognized. Ciliary beat frequency measured from 1,026 ciliated cells was 20.6 +/- 4.7 Hz (mean +/- SD). The orientation of ciliary beat directions was random and the mean standard deviation for measured angles was 73.0 degrees +/- 28.9 degrees (mean SD +/- SD). When the ciliary beat frequency was 20 Hz, the time used for effective phase was 0.022 +/- 0.002 s (mean +/- SD), and 0.028 +/- 0.004 s (mean +/- SD) for the recovery phase of beat. This system is advantageous for studying ciliary function because all parts can be studied simultaneously with higher magnification, and the effects of chemical physical mediators can be studied without disturbing effects of the autonomic nervous system or secretory cells. Also, the same cells could be observed before and after challenge with test medication and thus evaluated more accurately.


Danger areas of the posterior rhinobasis. An endoscopic and anatomical-surgical study.

In 52 cadaveric half-heads, an endoscopic sphenoethmoidectomy was performed. Then, an anatomical preparation with registration of specific data like bulging of the optic canal, thickness of the bony wall covering the optic nerve and the internal carotid artery was achieved, followed by histological sections in specially selected cases. Thus the two key areas of major surgical hazard in the posterior rhinobasis could be clearly demonstrated: the immediate topographic relation of the optic canal and the internal carotid artery to the lateral wall of the sphenoid sinus and the cells of the posterior ethmoid respectively. Onodi cells of varying degrees were found in 42% of all cases. The thickness of bony wall over the maximum bulging of the optic canal averaged 0.28 mm. Bony dehiscences could be demonstrated in 12% of the cases. The technique of data acquisition, the anatomical and histological findings as well as their clinical and surgical relevance are discussed.


Developmental changes in expression of a calcium-binding protein (spot 35-calbindin) in the Nervus terminalis and the vomeronasal and olfactory receptor cells.

The detailed localization of spot 35-calbindin and its ontogenic change were studied in Nervus terminalis, the vomeronasal organ and the olfactory epithelium of the rat by immunohistochemistry. At the embryonic days 12 and 13 (E 12-13), calbindin-immunoreactive cells were found in the outermost layer of the presumptive olfactory bulb and within the olfactory placode. At E 14 to the postnatal day 1 (P 1), intense calbindin-immunoreactivity was localized in ganglionated fiber bundles of Nervus terminalis coursing through the mesenchymal spaces on both sides of the nasal septum. Nervus terminalis decreased the immunoreactivity abruptly after P 1 and it showed no distinct immunoreactivity for calbindin at P 7 and thereafter. On the other hand, numerous receptor cells in the olfactory epithelium and the thicker vomeronasal epithelium exhibited weak to moderate immunoreactivity for calbindin at E 18-P 1. Their immunoreactivity decreased in intensity progressively after P 7 and no distinct immunoreactivity for calbindin was detected in most of the receptor cells, whereas moderate immunoreactivity was detected in most of the vomeronasal and olfactory nerves at P 28 and P 63.


Neuropeptide Y in the rabbit maxillary sinus modulates cholinergic acceleration of mucociliary activity.

The distribution of neuropeptide Y (NPY)-immunoreactivity was investigated in the rabbit maxillary sinus and adjacent ganglia. A moderate supply of NPY-containing nerve fibers occurred around seromucous glands and a denser supply around small blood vessels. Only a few immunoreactive nerve fibers were seen beneath the epithelium. Double immunostaining showed that vasoactive intestinal peptide (VIP) coexisted with NPY in the nerve fibers surrounding blood vessels and seromucous glands. NPY-containing nerve cell bodies were numerous in the superior cervical ganglion, and moderately numerous in the sphenopalatine ganglion. The finding of NPY-containing neurons in the latter parasympathetic ganglion suggests that NPY may influence the cholinergic regulation of mucociliary activity. The effect of NPY on the mucociliary activity of the maxillary sinus in connection with cholinergic stimulation has therefore been investigated in vivo using a photoelectric technique. At dosages of 2.5 and 5.0 micrograms/kg, the ganglionic stimulant nicotine bitartrate, which increases mucociliary activity by a cholinergic pathway, accelerated mucociliary activity by 28.0 +/- 7.5% and 36.8 +/- 6.2%, respectively. In the same experiment repeated during infusion of NPY (0.1 microgram/kg/min), the increase in mucociliary activity was reduced to 10.8 +/- 2.3% and 28.9 +/- 7.1%, respectively. Infusion of NPY did not affect the stimulating effect on mucociliary activity by bolus injections (0.1 and 0.5 microgram/kg) of the cholinergic agonist, methacholine. It is concluded that NPY-like immunoreactivity is present in nerve fibers in the rabbit maxillary sinus and in neurons in the sympathetic and parasympathetic ganglia that supply the nose and paranasal sinuses. NPY attenuates the effect of nicotine on mucociliary activity, probably via a prejunctional mechanism, and may act as a modulator of cholinergic regulation of the mucociliary system.