Analysis of the autonomous replication behavior in human cells of the dihydrofolate reductase putative chromosomal origin of replication.

Chinese hamster genomic DNA sequences from the region downstream of the dihydrofolate reductase (DHFR) gene reported to contain a chromosomal origin of bidirectional DNA replication (OBR-1) were tested for their ability to support autonomous DNA replication in human cells. A 13.3 kilobase fragment containing OBR-1 and surrounding sequences supported replication in short-term and long-term replication assays, while a 4.5 kb fragment containing OBR-1 did not support substantial replication in either assay. These results are consistent with our previous observations that large fragments of human DNA support replication, while smaller fragments are less efficient. The replication activities of plasmids containing OBR-1 were no greater than those of randomly chosen human fragments of similar size. Furthermore, two-dimensional gel analysis of plasmids containing OBR-1 indicated that initiation does not preferentially occur within the OBR-1 region. These results suggest that in the context of autonomous replication, the DHFR sequences tested do not contain genetic information specifying site-specific replication initiation. Possible implications of these results for chromosomal replication are discussed.


TGA cysteine codons and intron sequences in conserved and nonconserved positions are found in macronuclear RNA polymerase genes of Euplotes octocarinatus.

The gene sequences of the second largest subunits of RNA polymerases I and II of Euplotes octocarinatus, RPA2 and RPB2, were determined and compared to the respective known sequences of Saccharomyces cerevisiae. The similarity of the derived polypeptide sequences permitted their assignment to the respective polymerases and allowed the comparison of the zinc binding regions. In frame TGA codons were detected, which are likely to encode conserved cysteinyl residues in the putative zinc-finger region of the RPA2 gene. They were also found in other positions in both the RPA2 and RPB2 genes. The RPB2 gene contains a 30 bp intron close to the 5'-end of its coding region. The 5'-ends of the coding regions of all three genes encoding the largest subunits of the three different polymerases were also analyzed. The zinc finger structures again show the use of TGA codons for conserved cysteinyl residues in two of the genes. An N-terminal intron is located in the RPB1 gene at a conserved position as compared to the respective genes of several other eucarya.


Transcriptionally driven cruciform formation in vivo.

We studied the formation of d(A-T)n cruciforms in E.coli cells by probing intracellular plasmid DNA with chloroacetaldehyde followed by fine analysis of modified DNA bases. d(A-T)16 sequences were inserted into specifically designed plasmids either upstream of a single trc promoter, or between two divergent trc promoters. We found that in both cases, induction of transcription by IPTG leads to the transition of the d(A-T)16 stretch into a cruciform state. In the case of two divergent promoters, we observed cruciform formation even without IPTG. Enhanced cruciform formation correlates with the elevation in promoter activity as defined by the opening of the promoter at the -10 to +2 positions. We conclude that transcriptionally driven negative supercoiling provokes cruciform formation in vivo.


Three distinct RNA sequence elements are required for efficient apolipoprotein B (apoB) RNA editing in vitro.

Apolipoprotein B (apoB) mRNA is edited in rat liver and intestine to convert a CAA glutamine codon to a UAA translational stop codon by the direct conversion of cytidine to uridine at nucleotide 6666. We have proposed the 'mooring sequence' model for apoB RNA editing, in which editing complexes (editosomes) assemble on specific apoB mRNA flanking sequences to direct this site-specific editing event. One sequence element (approx. nts 6671-81, the presumed 'mooring sequence') has been previously identified as necessary for editing. We have identified two additional sequence elements which are necessary for efficient editing: (1) a 5' 'Regulator' region which modulates editing efficiency and (2) a 'Spacer' region between the editing site and the 3' mooring sequence, whose distance is critical for efficient editing. Utilizing this data, we have induced editing at a cryptic site and have defined a 22 nucleotide 'cassette' of specific apoB sequence which is sufficient to support wild-type levels of editing in vitro in a background of distal apoB RNA sequence.


Genetic effects of oxidative DNA damage: comparative mutagenesis of 7,8-dihydro-8-oxoguanine and 7,8-dihydro-8-oxoadenine in Escherichia coli.

A single 7,8-dihydro-8-oxoguanine (G8-OXO; 8-hydroxyguanine) adduct in the lacZ alpha gene of bacteriophage M13 DNA induces a targeted G-->T transversion after replication in Escherichia coli (Biochemistry, 29, 7024-7031 (1990)). This mutation is thought to be due to the facile formation during DNA synthesis of a G8-OXO.base pair, where G8-OXO is in the syn conformation about the deoxyglycosyl bond. A related modified purine, 7,8-dihydro-8-oxoadenine (A8-OXO; 8-hydroxyadenine), is an abundant product found in irradiated and oxidized DNAs. Similar to G8-OXO, as a mononucleoside A8-OXO assumes the syn conformation. This work has assessed the relative mutagenicities of A8-OXO and G8-OXO in the same experimental system. A deoxypentanucleotide containing A8-OXO [d(GCT-A8-OXOG)] was synthesized. After 5'-phosphorylation with [gamma-32P] ATP, the oligomer was ligated into a duplex M13mp19-derived genome at a unique NheI restriction site. Genomes containing either A8-OXO (at position 6275, [+] strand) or G8-OXO (position 6276) were denatured with heat and introduced into E.coli DL7 cells. Analysis of phage DNA from mutant plaques obtained by plating immediately after transformation (infective centers assay) revealed that G8-OXO induced G-->T transversions at an apparent frequency of approximately 0.3%. The frequency and spectrum of mutations observed in DNA sequences derived from 172 mutant plaques arising from the A8-OXO-modified DNA were almost indistiguishable from those generated from transfection of an adenine-containing control genome. We conclude that A8-OXO is at least an order of magnitude less mutagenic than G8-OXO in E.coli cells with normal DNA repair capabilities.


PCR amplification of tandemly repeated DNA: analysis of intra- and interchromosomal sequence variation and homologous unequal crossing-over in human alpha satellite DNA.

Tandemly repeated DNA can comprise several percent of total genomic DNA in complex organisms and, in some instances, may play a role in chromosome structure or function. Alpha satellite DNA is the major family of tandemly repeated DNA found at the centromeres of all human and primate chromosomes. Each centromere is characterized by a large contiguous array of up to several thousand kb which can contain several thousand highly homogeneous repeat units. By using a novel application of the polymerase chain reaction (repPCR), we are able to amplify a representative sampling of multiple repetitive units simultaneously, allowing rapid analysis of chromosomal subsets. Direct sequence analysis of repPCR amplified alpha satellite from chromosomes 17 and X reveals positions of sequence heterogeneity as two bands at a single nucleotide position on a sequencing ladder. The use of TdT in the sequencing reactions greatly reduces the background associated with polymerase pauses and stops, allowing visualization of heterogeneous bases found in as little as 10% of the repeat units. Confirmation of these heterogeneous positions was obtained by comparison to the sequence of multiple individual cloned copies obtained both by PCR and non-PCR based methods. PCR amplification of alpha satellite can also reveal multiple repeat units which differ in size. Analysis of repPCR products from chromosome 17 and X allows rapid determination of the molecular basis of these repeat unit length variants, which appear to be a result of unequal crossing-over. The application of repPCR to the study of tandemly repeated DNA should allow in-depth analysis of intra- and interchromosomal variation and unequal crossing-over, thus providing insight into the biology and genetics of these large families of DNA.


The histone mRNA 3' end is required for localization of histone mRNA to polyribosomes.

The final step in mRNA biosynthesis is transport of the mRNA from the nucleus to the cytoplasm. Histone genes from which the 3' stem-loop has been deleted are transcribed to give RNAs with heterogeneous 3' ends. These RNAs are localized in the nucleus and are stable. Addition of the histone 3' processing signal either on short (< 250 nts) or long (> 1000 nts) transcripts restores 3' processing and transport of the mRNA to the cytoplasm. In addition chimeric histone-U1 snRNA genes which produced RNAs with either histone or U1 3' ends were analyzed. Transcripts which ended with U1 snRNA 3' ends were not efficiently localized to polyribosomes. However, transcripts containing the same sequences including the snRNA 3' end followed by the histone 3' end were present in the cytoplasm on polyribosomes. Taken together these results suggest that the histone 3' end is required for export of histone mRNA to the cytoplasm and association of the mRNA with polyribosomes.


Heterochromatin protein 1, a known suppressor of position-effect variegation, is highly conserved in Drosophila.

The Su(var)205 gene of Drosophila melanogaster encodes heterochromatin protein 1 (HP1), a protein located preferentially within beta-heterochromatin. Mutation of this gene has been associated with dominant suppression of position-effect variegation. We have cloned and sequenced the gene encoding HP1 from Drosophila virilis, a distantly related species. Comparison of the predicted amino acid sequence with Drosophila melanogaster HP1 shows two regions of strong homology, one near the N-terminus (57/61 amino acids identical) and the other near the C-terminus (62/68 amino acids identical) of the protein. Little homology is seen in the 5' and 3' untranslated portions of the gene, as well as in the intronic sequences, although intron/exon boundaries are generally conserved. A comparison of the deduced amino acid sequences of HP1-like proteins from other species shows that the cores of the N-terminal and C-terminal domains have been conserved from insects to mammals. The high degree of conservation suggests that these N- and C-terminal domains could interact with other macromolecules in the formation of the condensed structure of heterochromatin.


Inactive O6-methylguanine-DNA methyltransferase in human cells.

A plasmid encoding a recombinant human O6-methylguanine-DNA methyltransferase (MGMT) fused to a fragment of the bacteriophage lambda N protein has been constructed. The fusion protein retained methyltransferase activity when expressed at high levels in E.coli and was purified to essential homogeneity by a simple procedure. Antisera raised against the purified fusion protein recognized MGMT in western blots of extracts of human cells. For most cell lines, there was a quantitative relation between the amount of immunologically detectable MGMT protein and enzyme activity. However, four cell lines contained detectable MGMT protein despite having no measurable methyltransferase activity. Additionally, a HeLa line contained considerably more immunoreactive MGMT protein than could be accounted for by its methyltransferase activity. Thus, some cells contain significant amounts of inactive MGMT. Preliminary characterization of the inactive protein in HeLaS3 cells indicated that it has some properties in common with MGMT methylated at the active cysteine residue.


In vivo specificity of EcoRI DNA methyltransferase.

The EcoRI adenine DNA methyltransferase forms part of a bacterial restriction/modification system; the methyltransferase modifies the second adenine within the canonical site GAATTC, thereby preventing the EcoRI endonuclease from cleaving this site. We show that five noncanonical EcoRI sites (TAATTC, CAATTC, GTATTC, GGATTC and GAGTTC) are not methylated in vivo under conditions when the canonical site is methylated. Only when the methyltransferase is overexpressed is partial in vivo methylation of the five sites detected. Our results suggest that the methyltransferase does not protect host DNA against potential endonuclease-mediated cleavage at noncanonical sites. Our related in vitro analysis of the methyltransferase reveals a low level of sequence-discrimination. We propose that the high in vivo specificity may be due to the active removal of methylated sequences by DNA repair enzymes (J. Bacteriology (1987), 169 3243-3250).


Holding the Mississippi River in place and other implications for qualitative research.

Holding back a river is used here as a metaphor and five suggested "tributaries" are suggested with the purpose of acknowledging the situated context that qualitative nurse researchers may wish to journey upon. Our nursing knowledge base must include the human experience. We need to become oriented to a world of meaning. Meaning will enlighten and give direction to our nursing practice. The unexamined taken-for-granted approach misses the essential structures of being. Those essential structures of being are what might actualize the possibilities of new ideas, new directions, new designs, new life, birth.


Love and work: oncology nurses' view of the meaning of their work.

Phenomenological interviews with 23 nurses and more than 200 hours of participant observation on units of one cancer hospital were conducted to obtain a better understanding of how nurses caring for patients with cancer view their work. When asked to discuss a "critical incident" that captures the essence of oncology nursing for them, most nurses described acute physiologic emergencies. A few nurses described psychosocial needs and explained how they had helped or were unable to help patients and families deal with these needs. A major theme in these incidents was how they related to the nurses' own lives. These findings suggest the need to provide nurses with support and an opportunity to discuss their work. Oncology nurses appear to be motivated by a deep concern for patients and families that creates tremendous stress when conditions such as poor staffing, excessive use of registry nurses, and unexpected crises occur. The task orientation of these nurses also seems to be based on their fundamental concern for patient welfare.


The role of the self in adjustment to cancer in elderly women.

One way that people may adjust to illness is through a redefinition of the self, especially with respect to the relationship between ideal self and actual self. To investigate psychological adjustment in community-dwelling elderly women, women with cancer (n = 17) were compared to women with other health problems (n = 30) based on measures of psychological distress and well-being, actual self, ideal self, and the discrepancy between actual self and ideal self. Women with cancer scored no differently than other women on measures of psychological well-being, psychological distress, and actual self, but their ideal-self ratings were lower. The positive adjustment of women with cancer may be the result of their ability to lower their ideal-self expectations, thereby reducing self-discrepancies that can result in psychological distress.


Psychosocial functioning of adolescents with cancer: a developmental perspective.

This literature review summarizes research conducted over the past 25 years that investigated the psychosocial functioning of adolescents with cancer. The research is divided into two conceptual areas that have been investigated by researchers in the disciplines of medicine, psychology, and nursing. One area is the impact of cancer on developmental processes in the adolescent period, and the second area is coping strategies and styles of adolescents with cancer. Studies examining the effects of cancer on the adolescent's self-esteem, general psychosocial development, and perception of control also have been included. The article concludes with a summary of findings, suggestions for future research endeavors, and implications for nursing practice.


Failure to master early developmental tasks as a predictor of adaptation to cancer in the young adult.

The ability of young adults to adapt to living with a cancer diagnosis and to negotiate the healthcare system is influenced by their level of maturity. If adolescent developmental tasks have been unresolved or pathologically resolved, they are likely to be reenacted during the various stages of the malignancy. Retrospective review of case histories that illustrate the diverse ranges of adaptation to life-threatening illness indicates that success or failure in achieving ego autonomy and continuity in adolescence significantly influences the young adult's capacity to cope with the malignancy. Psychosocial assessment of the young adult patient and spouse, with attention to childhood, adolescent, and family history, will assist the oncology nurse in predicting the individual's capacity for adapting to the illness and complying with treatment. This developmental information will allow clinicians to modify interventions to compensate for earlier stage deficits.


Consent forms: how to determine and improve their readability.

This study investigated the reading level estimates of cancer clinical trial consent forms from actively accruing studies at the Medicine Branch and the Clinical Pharmacology Branch of the National Cancer Institute. Forty-four consent forms were analyzed using the SMOG formula. Readability levels ranged from grade 12 to grade 17.5 (mean = 14.3). The conclusion was that these consent forms were written above most subjects' reading levels. The usefulness of consent forms could be improved significantly by using readability formulas, applying rewriting techniques, and being aware of subjects' comprehension levels. This paper suggests a number of strategies that nurses can use to enhance comprehension of the information contained in informed consent documents.


Analgesic decision-making skills of nurses.

Administration of analgesics is a common nursing intervention for providing pain relief to patients with cancer. A sample of 177 nurses participated in a study to examine their decision-making skills when analgesic orders were changed. Nurses were given four clinical vignettes and reference materials to assist them in responding to the vignettes. Twenty-six percent of 708 responses provided by the nurses were answered correctly. Twenty-nine percent of the sample answered all four vignettes incorrectly. The majority (44%) answered only one vignette correctly. No statistically significant differences were found between correct answers and type of work setting, academic preparation, number of patients with cancer cared for per week, number of years employed as a nurse, recent clinical experience with the analgesics used in the vignettes, or the use of reference materials. These findings raise concerns that patients requiring analgesics may not receive an amount that adequately relieves their pain or avoids unnecessary toxicity.


Patient education for fatigue.

Although fatigue is a frequent complaint of patients undergoing cancer treatment, specific self-care activities are seldom addressed in patient education materials. To fill this void, a patient education tool was developed, with a special emphasis on the management of fatigue. Testing is under way with a large population of patients with cancer.


[Physiology of pubertal maturation].

Most important features of puberty are described. The puberty is the age of development of sexual characters. In females it appears between 10 and 15 years +/- 1 year whereas in males signs of puberty are visible between 11 and 15 years. In our country menarche appears at the mean age of 12 years and 2 months +/- 1 year and 2 months. Precocious puberty in females is that which appears before 8 years and 6 months and in males before 10 years. Delayed puberty is that which appears in females after 15 years and in males after 16. Nowadays is possible to keep off puberty when it is too soon by means of an analogous of LH-RH and as the result the subject reaches a better statural growth. The puberty should not be confused with the adolescence which is characterized by psycho-social maturity.


[Physiopathologic and therapeutic aspects of persistent fetal circulation. Review of the literature and personal histological observations].

Persistence of the fetal circulation (PFC) is a syndrome characterized by failure of the cardiocirculatory system to adapt successfully to postnatal life. Its typical feature is persisting right-left shunt across fetal channels which determines cyanosis refractory to oxygen treatment. PFC can simulate cyanotic congenital cardiopathy. It has two forms: a primitive form and secondary one due to various causes especially perinatal asphyxia. Both forms have a common pathogenesis consisting of hypertension of the pulmonary arterial circulation. This article reviews the physiology of the main prenatal and postnatal circulatory characteristics and the factors which regulate the pulmonary circulation. It also reports the latest findings on PFC physiopathology and treatment indicating the prognostic factors and future perspectives.


[Fever as periodic disorder].

Slight, moderate but also high rises in temperature, excluding other causes of fever, can be considered symptoms of periodic syndrome originating by hypothalamic centers as soon as headache, recurrent abdominal pains, growing pains, dizziness, kinetosis. These rises aren't uncommon, but often aren't considered important and this few statistics are available. The Authors present 16 case reports of fever as periodic symptom and discuss how common factors exist in the mechanism of hyperthermia and other clinical signs of periodic syndrome (ex. migraine) but they are generally modulated differently so that disturbance of temperature regulation predominates in the first case, pain in the second.


[Neuropsychologic development of small for gestational age preterm infants: follow up at 12-36 months of age].

We followed 94 preterm infants (G.A. < 37 weeks) small for gestational age (SGA) born from 1980 to 1987 in Pavia and admitted to the Neonatal Intensive Care Unit of S. Matteo Hospital (Pavia). A control group matched for gestational age of 94 preterm appropriate for gestational age (AGA) was also studied. Neurological examination was carried out at 40 weeks postmenstrual age and at 3, 6, 9, 12, 24, 36 months of age with the method of Amiel-Tison and Grenier (1986). Psychomotor development was assessed using Brunet-Lezine's Scale until 1985 and after Bayley Scales of Infant Development. Intrauterine mortality was 23.40% in the SGA group and 5.32% in the AGA group (p = 0.0003); neonatal mortality was 18% in the SGA group and 6.62% in the AGA group (p < 0.01). 42 SGA (80.8%) and 58 AGA (79.5%) were completely normal (group A) at 36 months, but SGA infants showed transient neurological abnormalities (TNA) more frequently than the control group (30.7% vs 6.8% - p < 0.001). 5 SGA (9.6%) and 10 AGA (13.7%) had minor abnormalities (group B); no SGA children and only one AGA had diplegia (group C); 3 SGA (5.8%) and 4 AGA (5.5%) were considered to have severe handicap (group D) SGA children had a higher incidence of epilepsy (3.8% vs 0) than AGA (group E). These results show that in our group of SGA preterm infants the union of intrauterine growth retardation and prematurity compromise the possibility of survival.(ABSTRACT TRUNCATED AT 250 WORDS)


[Neuropsychological follow-up of children with phenylketonuria treated early].

We evaluated, yearly, the neuro-psychological development in 16 out of the 27 children with phenylketonuria detected via neonatal screening in the years 1980-90. 14 children had the classical form, while 2 had "variant" type of phenylketonuria. Development quotients always were slightly lower in patients than in controls, but the greatest difference was seen at 1 year of age (92.5 +/- 6.7 vs 101.6 +/- 2.2). At age 6 years, 4 children out of 11 had a IQ equal or below 90.2 of them had neonatal asphyxia, while the others showed, after age 2-4, constantly elevated phenylalanine levels. Four children had a bad metabolic control, as from the age of 2-4 year, and only 1 of them showed a normal IQ at 6 years of age. Regression analyses were used to determine the best predictors of IQ. Parents' social level stood out as the best predictor of IQ at 6 years of age. If this parameter was excluded, phenylalanine level, especially at age 4, best predicted IQ. The following variables had no influence: age at start of diet (they were all begun on diet within the first month of life), pre-diet phenylalanine levels and phenylalanine levels at 1 year of age (all children were, at this age, on good control), DQ (Development Quotient) at age 1. A high percentage (10 out 14) of hyperactive and psychologically instable children was also found, but with no correlations with IQ levels.


[Rheumatic fever from 1960's to 1990's. Case records in 2 hospitals of the Lombardian area].

An epidemiological study of rheumatic fever (RF) has been done. Incidence and prevalence of RF observed in Monza Hospital from 1964 to 1990 and in Como Hospital from 1980 to 1990 both show a progressive reduction. An exception to this trend was observed in 1986 in Monza in 1985 in Como. The percentage of carditis in pediatric age is high (60-70%), often associated with arthritis and chorea. However carditis clinical picture seems nowadays less severe, probably because in the past the diagnosis was delayed. Sice 1980 no death were observed due to RF or related cardiac involvement. Relapses and residual valvulopathies are significantly reduced only when penicillin prophylaxis was correctly performed.


[Edema in acute diffuse glomerulonephritis, rheumatic peliosis and epidemic parotitis].

The Authors present a substantial series of infant APING in which the venous blood gas analysis shows poor use of oxygen, due to a probably reduced cellular combustion associated with low pCO2, high pH, which are characteristic of arterial blood travelling through anastomotic paths and preferential channels at the microcirculation level. They emphasize the contemporaneous increase in volemia, even with oedema present, and the poor permeation of the capillary wall found with the Landis test, contrary to what happens in glomerulonephrosis with minimal changes which features increased systematic capillary permeation with hypovolemia. The look of the oedema, together with the hypervolemia, led to the suspicion that the nephritic oedema was a sign of mainly intracellular oedema. In the opinion of the Authors these nephritic forms would seem to show systemic cellular respiratory suffering sensitive to the action of chlorpromazine, which has also dealt swiftly and cleanly with the oligoanuresis. The Authors consider 52 cases of Schöenlein-Henoch vasculitis which showed very rapid detumescence of periarticular swelling and those on the back of the hands and feet, as well as the disappearance of skin petechias and melena following treatment with chlorpromazine. They also mention two cases of Kawasaki's disease which seemed to react favorably to the combination of the action of chlorprmazine with acetylsalicylic acid. The effects obtained with chlorpromazine in 27 cases of epidemic parotitis with periscialoadenitis elastic tumescence are reported, with the focus on the reduction of the perisalivary tumescence. It is important to point out the very rapid disappearance of epigastrial pain, probably pancreatic in origin.(ABSTRACT TRUNCATED AT 250 WORDS)


[Evaluation of blood sugar self-monitoring of diabetic children and its educational applications].

In diabetics children's education is important to "make" information, but it's important also to verify whether informations are given correctly. By use of computerized system it's possible to control the quality of self-management (number of glycemias, change in doses of insulin, values of HbA1c) and to determine the "know" and the "know how".


[Comparison of plasma concentrations of amoxicillin administered by oral and venous routes in neonatal bacterial colonizations].

The amoxicillin is a drug that for the incomplete capacity of intestinal absorption in newborn is give for intravenous way. The use of this way and the duration of treatment impose the separation of the newborn from mother and a proportionate preparation of the nurses for the execution of this therapy. We have compared, in newborn infants, with clinical and laboratory diagnosis of neonatal infection, the amoxicillin's plasmatic concentration after intravenous giving and oral giving, in relation to minimum inhibiting concentration the bacteria cause of neonatal infections. In our study (duration 10 months) the newborn infants were perfectly comparable for gestational age, Apgar's score, birthweight, breastfeeding. The newborn infants, at random, were divided in two groups; the first group (18 newborns) received drug for oral way, the second group (14 newborns) for intravenous way. The dosage was 40 mg/Kg/dose of amoxicillin. The duration of treatment was 4 days. Remarkable was the great individual variability of plasmatic concentration of amoxicillin independently from way of giving. The plasmatic concentrations were nearly similar except for the first half hour (plasmatic concentrations after oral giving was lower). The use of oral way is, therefore, favourable for the facility of giving and effective as the intravenous way in the control of neonatal infections.


[Hypertrophic pyloric stenosis in infants. A retrospective study of cases observed in the years 1970-1990].

Although the definitive cause of infantile hypertrophic pyloric stenosis is unknown, it's probable that several predisposing risk factors would be associated with the condition. We analysed some perinatal factors in relation to the incidence of infantile hypertrophic pyloric stenosis among children observed during the period 1970-90. We examined 61 infants with surgically confirmed hypertrophic pyloric stenosis and, as controls, 61 healty children comparable for age. In every child we studied: sex, birth rank, pregnancy and delivery, birthweight, parental age, type of feeding, familial history of hypertrophic pyloric stenosis and of atopy, seasonal variation in incidence, AB0 and Rh blood phenotypes. In the 61 infants with hypertrophic pyloric stenosis, the incidence of three factors (male sex, primogeniture and feeding with artificial milk) was significantly higher than that in the controls. We conclude that infantile hypertrophic pyloric stenosis probably has a particular genetic basis, but perinatal factors are responsible for the rising of the condition. However the true aetiology remains to be elucidated.


[A comparative study of 3 different types of trivalent measles-mumps-rubella vaccine].

The results of a randomized double blind comparative clinical trial are described. 201 children, 101 males and 100 females, average age 3.11 +/- 1.1 (range 15 months to 14 years) received 3 different types of triple vaccine against measles, mumps and rubella. The vaccine containing the strains Edmonston-Zagreb, Rubini and Wistar Ra 27/3 was well tolerated both for the number of side-effects and for the number and the level of the fever attacks, that resulted the most frequent symptom, especially in the children from 2 to 5 years. The differences between side effects were highly significant. In accordance with the obtained results and considering the data of other studies, the Authors conclude that the principal reason of this tolerance is due to more attenuated strain against measles.


The epidemiology and clinical features of obsessive compulsive disorder.

During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.


The genetics of obsessive compulsive disorder and Gilles de la Tourette's syndrome.

This article reviews the evidence that obsessive compulsive disorder (OCD) and Gilles de la Tourette's syndrome (GTS) are both familial and genetic. Studies are summarized that suggest that (1) some forms of OCD are related to GTS, (2) some forms of OCD are familial and may not be related to GTS, and (3) the patterns of inheritance of GTS and OCD within the same families are consistent with the transmission of an autosomal dominant genetic locus.


Childhood-onset obsessive compulsive disorder.

The clinical presentation of OCD in children and adolescents is quite similar to that in adults, with overlapping obsessional content and compulsive ritualistic patterns. In addition, both age groups provide essentially identical descriptions of the anxiety accompanying their compulsions and invoke similar mechanisms to resist acting out the ritualistic behavior. Responses to behavioral treatment and pharmacotherapy are similar across ages, and the disorder appears to be chronic and unremitting in the studied populations whether its onset is in childhood or adulthood. Conversely, the strong familial influence, male predominance, neuroendocrine abnormalities, presence of tics and other neurologic abnormalities, and possible impact on personality development suggest that pediatric OCD has important differences from its adult counterpart. Further investigations of these unique features of childhood-onset OCD are warranted and may provide etiologic clues to the disorder.


[Long-term asymptomatic incubation in vertical HIV infection. Description of a case and review of the literature].

The natural history of HIV infection in perinatally-infected children is still poorly defined; more information about disease progression is needed for the design of clinical and therapeutic trials. According to the most recent reports, vertically-acquired infection seems to follow two different modes of progression, with the majority of patients expressing early signs of severe disease, whereas a subgroup of mildly affected infants has a longer survival, comparable to that previously reported for adults: the long term prognosis of this last patient group remains unknown. Current estimates of incubation periods in children are based on limited data, largely drawn from ill patients: hence subjects with a short incubation time are more likely to be observed. A case is described of a child born in 1982 to an asymptomatic intravenous drug abuser mother. HIV infection was detected in both mother and son only in 1984, but other risk factors for HIV infection of the infant (i.e. blood transfusions, sexual abuse) were excluded. The child had an uneventful neonatal period and childhood, with normal growth and development; up to now, at the age of 9 years 6 months, no clinical signs and symptoms possibly related to HIV infection became evident. Laboratory examinations showed only slight immunologic abnormalities (class P-1 B, CDC), such as increased serum immunoglobulin levels, reduction of CD4+/CD8+ ratio with no relevant decrease of absolute CD4+ lymphocyte count (1100/mm3); HIV-p24Ag and virus isolation were always negative.(ABSTRACT TRUNCATED AT 250 WORDS)


Trichotillomania. An obsessive compulsive spectrum disorder?

Trichotillomania is a neglected neuropsychiatric disorder that only recently has received research attention. Based on clinical data, it appears far more common than previously believed. Like OCD, the behavior is recognized as senseless and undesirable, but is chronic and difficult to treat. The comorbidity, drug response data, familiality, and phenomenology of the disorder extend the concept of OCD to a spectrum of inappropriately released, excessive grooming behaviors. Although the discovery of clomipramine's effectiveness has provided relief to some trichotillomanics, further work is indicated to find regimens that provide long-term suppression of symptoms. Ongoing investigations of early-onset trichotillomania may reveal etiologic triggers, whereas studies that examine the similarities and differences between trichotillomania and OCD may help define the neurobiology of OCD, and possibly of other atypical impulse control disorders.


[A case of diaphragmatic eventration associated with Wolff-Parkinson-White syndrome].

The Authors report a case of diaphragmatic eventration associated with Wolff-Parkinson-White's syndrome. It's difficult to explain this unusual association. It's possible that the presence of cardiac accessory pathways in this particular patient is due to the alteration of the normal anatomical relationship resulting from the diaphragmatic eventration.


Hypochondriasis and obsessive compulsive disorder.

Hypochondriasis and OCD differ conceptually in the degree to which the patient's disease concerns are experienced as an intrusive mental event or a reasonable psychological response to a realistic health threat, in the degree to which the ideation is resisted, and in the presence of somatic sensations and medical help-seeking. There are, however, some similarities between the conditions, including the development of excessive, stereotyped, repetitive behaviors in an attempt to allay their anxiety. Empirical data on the degree of overlap between the conditions are too limited to permit definitive conclusions. The little that we do know, however, suggests that (1) the prevalence of OCD in hypochondriasis is probably elevated, but not extraordinarily so; (2) the prevalence of hypochondriasis in OCD is unknown; (3) fears about disease, illness, and injury are one of the more common forms of obsessions seen in OCD; and (4) there are several ill-defined and largely unexplored conditions, such as disease phobias, which appear to be very similar to both OCD and hypochondriasis. Clinical experience suggests that there may be a subgroup of hypochondriacal patients who are closer to the anxiety disorders in general and to OCD in particular. This subgroup might respond to the newer, antiobsessional, serotonin reuptake blocking agents.


[Neuroblastoma with muscular localization: description of a case].

An unusual case of abdominal neuroblastoma, whose extension involved the psoas muscle, leading to an ultrasonographic and Magnetic Resonance imaging simulating an haematoma, is described. Histology disclosed the malignant nature of the muscle mass. The Authors discuss the value of the new imaging techniques and in particular of Magnetic Resonance in the diagnostic work-up of paediatric malignancies.


Personality disorders in obsessive compulsive disorder.

Standardized structured interview personality scales are now available that provide better reliability than clinician interview, but are still imperfect. These scales diagnose DSM III-R personality disorders, which are more illness-oriented than Freudian notions. Use of these scales has found that the majority of patients with OCD have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD, and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. The prevalence of this personality disorder as modified in DSM-III-R (making it easier for a patient to qualify for this personality disorder diagnosis) appears to be higher, although still present in a minority of patients with OCD. Obsessive compulsive personality disorder (along with the other cluster B and C personality disorders) has not been reported to have a consistent relation to treatment outcome. There is evidence that in some cases, obsessive compulsive personality disorder may be secondary to OCD. Swedo et al hypothesized that some children may develop compulsive personality traits as an adaptive mechanism to deal with OCD. This hypothesis is in accord with our finding that OCD often predates compulsive personality disorder and that mixed personality disorder may develop over time, possibly secondary to OCD. We found in our sample of 96 adult patients with OCD that the presence of mixed personality disorder was more likely with longer duration of OCD, suggesting that patients who do not have premorbid personality disorders may develop significant personality traits (especially avoidant, compulsive, and dependent), which may be related to behavioral and life-style changes that are secondary to OCD. This hypothesis is strengthened by our finding that patients with one of these personality disorders at baseline tended to no longer meet criteria for them following successful treatment of their OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia (e.g., in three male identical twin pairs concordant for OCD but discordant for schizophrenia or schizoaffective disorder, the nonpsychotic co-twins all had schizotypal personality disorder), is the only consistent personality disorder predictor of poorer outcome in OCD. These traits may help explain other proposed poor predictors of treatment outcome such as overvalued beliefs, poor compliance, and chaotic family situations.(ABSTRACT TRUNCATED AT 400 WORDS)


Neurobiology of obsessive compulsive disorder.

In this brief review of two of the neurobiologic aspects of OCD, two simplistic models have been suggested. Although these models reflect different perspectives, they may not be independent. For instance, the striatum, which is a focus for the neuroanatomic model, receives a dense serotonergic projection from the dorsal raphé. Similarly, as mentioned previously, combining PET studies and drug treatment demonstrates that the increased metabolic activity seen in the orbital cortex appears to normalize with serotonin uptake inhibitor treatment. Insights into the neurobiology of this syndrome will require combining perspectives as well as developing additional approaches. In addition, the search for neurobiologic abnormalities must be guided by a continuing regard for phenomenology. There is no reason, a priori, to assume that this syndrome subsumes only one disorder. The careful dissection of subgroups--whether based on symptom type, character style, or comorbid diagnoses--will be increasingly vital for understanding the results of neuropharmacologic and functional imaging studies.


Normal and abnormal information processing. A neuropsychological perspective on obsessive compulsive disorder.

This article presents a neuropsychological perspective on obsessive compulsive disorder (OCD) and describes some of the cognitive strengths and weaknesses that characterize the disorder. Neuroanatomic findings and theories of the neurologic basis of OCD are reviewed as are studies that use neuropsychological assessments. Findings of frontal lobe and/or basal ganglia dysfunction as well as memory deficits are emphasized. This information is then discussed in the context of cognitive-behavioral and information processing perspectives that emphasize normal patterns in anxiety and worry. The goal is to provide an integrated conceptual model of OCD, identifying the normal and abnormal information processing patterns that characterize the disorder.


[Spondylo-costal dysostosis: presentation of a new case with autosomal dominant heredity and discussion of problems in genetic counseling].

The Authors report a new family with spondylo-costal dysplasia in which three members in three generation are affected. The genetic heterogeneity of the condition and its implication in genetic counseling is discussed.


Tourette's syndrome and obsessive compulsive disorder. Clinical aspects.

Tourette's syndrome (TS) is a disorder that typically has its onset in childhood or early adulthood and is characterized by the presence of both motor and vocal tics. Obsessive compulsive symptoms (OCS) frequently occur in patients with tic disorders. The earliest descriptions of TS included obsessive thinking as a part of the symptom complex. Recent studies suggest that obsessive compulsive disorder (OCD) may occur in as many as 7% of patients with TS, and that both of these disorders share a similar clinical phenomenology and familial patterns of transmission. This article explores similarities and differences between these two disorders.


Assessment of severity and change in obsessive compulsive disorder.

Useful clinician-rated measures of OCD are now available. The Y-BOCS and NIMH Global OC both seem suitable for monitoring outcome in drug trials of OCD. These two scales seem relatively specific for symptoms of OCD and are sensitive to drug-induced changes in symptoms. Neither the Y-BOCS nor the NIMH Global OC confuse trait with state. There are ample data suggesting that the Y-BOCS is reliable and valid scale. Unlike some of the symptom inventories, such as the LOI and MOCI, final scores on the NIMH Global OC and Y-BOCS are not influenced directly by the type or number of obsessions and compulsions present. A computer-administered version of the Y-BOCS has been developed. Currently available patient-rated instruments suffer from serious shortcomings, including insensitivity to change and poor representation of patients with mono-symptomatic clinical pictures (e.g., hoarding alone). Some rating scales have been adapted for use in children with OCD. Several groups, including our own, have elected to use change scores on the 10-item Y-BOCS and a global measure of OCD, such as the NIMH Global OC or modified OGI, as the principal outcome variables in drug trials in patients with OCD. Several studies have selected a 35% decrease in Y-BOCS scores from baseline as indicative of clinically significant improvement. A limitation of all single-item global measures is that they cannot be resolved into smaller components. The more fine-grained analysis that is possible with the multi-item Y-BOCS makes it more desirable as a primary outcome measure, with a global scale as a secondary outcome measure.


Neuroimaging studies of obsessive compulsive disorder.

In the last 5 years, there has been an explosion of neuroimaging studies of obsessive compulsive disorder. This work is now beginning to suggest dysfunctional brain regions and circuits that may mediate some of the symptoms of this classic neuropsychiatric illness.


Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.


Pharmacologic treatment of obsessive compulsive disorders.

Medications are currently available that have been well studied in adequately designed controlled trials that predictably help the majority of obsessive compulsive disorder (OCD) patients. This article reviews the considerable data on the use of these agents in patients with OCD. In addition, an approach to patients with resistant symptoms is presented.


Neurosurgical treatment of malignant obsessive compulsive disorder.

Although the majority of patients with obsessive compulsive disorder (OCD) respond well to behavioral techniques, pharmacotherapy, or combinations of these two approaches, a small percentage of patients remain refractory and are severely disabled by their symptoms. Such patients may well be helped by neurosurgical interventions. This article reviews the selection guidelines, indications and contraindications, available procedures, probable outcome, hazards involved, preoperative work-up, and the rationale behind neurosurgery in OCD.


Radiation sensitization by estramustine studies on cultured human prostatic cancer cells.

In low-stage prostatic carcinoma, local cure can be obtained with radiation therapy alone, while in locally advanced disease the chances for cure are less. In this study, we have addressed the question of whether estramustine (EM), the main cytostatic metabolite of estramustine phosphate (Estracyt), may act as a radiosensitizing agent. This drug accumulates in prostatic cancer and has also been shown to arrest cancer cells at metaphase both in vitro and in vivo. The human prostatic cancer cell line DU 145 was grown as cultures monolayer and incubated with EM in concentrations varying from 1 to 20 micrograms/ml. External beam irradiation was performed with doses ranging from 0 to 8 Gy using gamma rays from a 60Co source. Clonogenic cell survival (CS) was used to analyse the radiation sensitizing effect of EM. The radiation dose modifying factor (DMF) at the survival level 0.1 was found to be 0.77 in the presence of EM (5 micrograms/ml), i.e., 23% sensitization was obtained. When irradiating cells at the standard fraction dose of 2 Gy in the absence of EM, 22% of the cells lost their clonogenic ability. In presence of EM (5 micrograms/ml), 2 Gy caused 40% of the cells to lose their clonogenic ability. Thus a radiation sensitizing effect of EM was established in the CS assay. It was also of interest to determine if the radiosensitizing effect of EM could be confirmed in a rapid assay. The rapid fluorescence assay was used to observe early damage of the cells. Results showed that by 2 days after exposure to irradiation a weak tendency towards sensitization was seen, while a clear sensitization was obtained after 4 days. This indicates that the rapid assay might be developed to a predictive assay for detection of the response of primary prostate tumor cells to the radiation sensitizing effect of EM.


Distal femoral osteotomy for valgus deformity of the knee.

Distal femoral varus osteotomy and blade-plate fixation for valgus deformity of the knee proved effective in restoring axial alignment in 18 of 36 knees (34 patients). Patients were followed for an average of 5.4 years (range: 2 to 19 years). The osteotomies were performed on 14 men and 22 women (average age: 44 years; range: 14 to 77). The patients' average preoperative valgus deformity of the anatomical axis was 19.4 degrees (range: 8 degrees to 33 degrees). The surgical procedures performed were a medial closing wedge osteotomy (14 knees) and a lateral opening wedge osteotomy with bone grafting (22 knees). Postoperative correction of the anatomical axis averaged 3.8 degrees valgus (range: 8 degrees varus to 20 degrees valgus). Maximum improvement was reached within 6.3 months by patients who were less than 60 years old and within 5.1 months by patients who were more than 60 years old. Pain decreased or resolved in 21 of 35 knees (60%); activity level improved in 24 of 35 knees (69%). One patient was unavailable for follow up evaluation. Varus osteotomy in the distal femur was concluded to be an acceptable form of treatment in the valgus knee alone or associated with traumatic or osteoarthritis of the lateral compartment.


Tinel's sign and Phalen's test in carpal tunnel syndrome.

Tinel's sign and Phalen's test are two provocative tests used in the diagnosis of carpal tunnel syndrome. A review of the literature reveals a wide range of sensitivity for these tests. Analyzing the historical data and comparing these to the Tinel's sign and Phalen's test results of 100 individuals without carpal tunnel syndrome (200 wrists), we conclude that the Tinel's sign is not useful in the evaluation of patients with carpal tunnel syndrome, whereas Phalen's test, which has a greater sensitivity and specificity, can be of use.


A new scale for the clinical assessment of spinal cord function.

The systems currently used for grading the severity of neurologic injuries have serious limitations. The authors have developed a neurologic grading system to assess spinal cord function. This is a new, functionally oriented scale which can be used at the bedside and requires no special tests other than those done in a routine clinical neurological examination. This scale includes assessment of motor and sensory function, rectal tone, and bladder control. A major advantage of this scale is that motor function is assessed on a functional rating system. To evaluate the usefulness of this scheme, patients who have been previously entered into a prospective study on the surgical treatment of burst fractures were re-evaluated. A significant number of patients under our new reclassification system were noted to have had significant improvement which had been overlooked using the Frankel Grade system. The authors conclude that their new spinal cord assessment technique has many advantages and suggest that it be used by spinal cord injury centers.


Concomitant injuries of the hip joint and abdomen resulting from gunshot wounds.

Septic arthritis is a devastating complication of transabdominal gunshot wounds to the hip. Five patients sustained gunshot wounds to the hip which violated the alimentary tract. Diagnosis was established with plain radiographs in three patients, arthrogram in one patient, and a gastrointestinal series in one patient. Three patients had an exploratory laparotomy with diverting colostomy followed by immediate hip arthrotomy within 24 hours and no joint infections occurred. In the other two patients, hip involvement was identified late after septic arthritis occurred. Early diagnosis, diverting colostomy, and immediate arthrotomy are recommended for gunshot wounds to the hip which involve the alimentary tract.


The use of postoperative suction drainage in total hip arthroplasty.

Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the non-drained group (P < .025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.


Lyme disease: an orthopedic perspective.

The incidence of Lyme disease is increasing. This spirochetal infection may frequently manifest itself with joint involvement without characteristic dermatologic signs or history of tick bite. Serologic testing remains unreliable. Oral or parenteral antibiotics remain the mainstay of treatment. Chronic arthritis develops in approximately 10% of patients with Stage III disease. Lyme arthritis must be considered in the differential diagnosis of patients with mono- or oligoarticular joint involvement, especially in children and young adults with possible tick exposure. Further advances in antimicrobial therapy and serologic testing are anticipated.


Subtrochanteric fractures following osteosynthesis of femoral neck fractures with the VLC-femoral system.

Twenty-two patients with femoral neck fracture were treated with the VLC (Variable Length Cannulated)-femoral screw system. In four patients, the osteosynthesis had complications with ipsilateral subtrochanteric femoral fractures in relation to the screw holes in the lateral cortex. The problem seemed to be excessive stress on the lateral cortex during insertion of the screws. The method has been abandoned in our department.


Oxygen saturation during reaming and intramedullary nailing of the femur.

Oxygen saturation was monitored during the reaming and intramedullary nailing of 15 femoral fractures (three impending) to assess the relationship between intramedullary reaming and nailing and the production of hypoxemia. There were no statistically significant drops in oxygen saturation during this procedure in either the fractured or intact (impending fractures) femora.


Long-term treatment with 1 alpha-hydroxyvitamin D3 with calcium supplement in spinal osteoporotic patients.

The long-term effect of 1 alpha-hydroxyvitamin D3 and calcium lactate in osteoporotic patients was evaluated by the bone mineral density (BMD) measured at the distal one third and one sixth of the radius and by the vertebral fracture rate. Forty-five osteoporotic patients medicated for 1 to 13 years (treated group) and 11 osteoporotic patients with no medication for 1 to 3 years (control group) were compared. The BMD of the treated group remained unchanged for the first 4 (one-third site) and 6 years (one-sixth site), followed by significant decreases, whereas that of the control group decreased significantly at the second and third year. The effect on BMD was more prominent in the patients with lower initial BMD. The vertebral fracture rate of the treated group was significantly less than that in the control group at the third year. No serious side effects were recognized. Overall, we believe 1 alpha-hydroxyvitamin D3 with calcium supplement can be considered a safe and effective agent for long-term use in osteoporotic patients.


Treatment of multiple pterygium syndrome.

Multiple pterygium syndrome is a rare, inherited disorder manifested by growth retardation, facial or genital anomalies, and widespread musculoskeletal deformities. Pterygia are the predominant hallmark of the syndrome. Five children with multiple pterygium syndrome were treated from 1978 to 1987. Treatment involved both upper and lower pterygia and contractures. The results of treatment and modalities used are discussed and a protocol suggested.


Photoelastic analysis of stress distribution on the tibiofemoral joint after meniscectomy.

Three-dimensional photoelasticity models of the knee joints were made of epoxy to observe the change in the status of stresses according to the size of defect in the meniscus. Three kinds of meniscus models were made of rubber. Through axial application of a vertical compressive load of 8 kg, equivalent to the joint reaction of 3000 N in the human knee joint, the patterns of the isochromatic fringes were observed and stresses around the knee joint were analyzed according to the size of the defect in the medial meniscus. Stress was increased in magnitude according to the size of the defect of the meniscus, and was focalized after meniscectomy. In the partial meniscectomy model, the maximum stress concentration point of the removed side migrated to the margin of the same side of the joint. But, in the total meniscectomy model, stresses were markedly increased in magnitude on both sides of joints, and maximum stress concentration points were more centralized. This centralization effect would contribute to the degenerative process of the knee joint after meniscectomy.


[Tutoplast-Dura and Zenoderm-Corium implant--materials for tissue replacement. Experimental studies].

The results of experimental studies with the use of two biostatic materials: solvent-preserved human dura mater (Tutoplast-Dura--Pfrimmer-Vigo) and lyophilized porcine dermis (Zenoderm-Corium implant--Ethicon) as prosthesis of deficient, abdominal wall tissue are submitted. The studies were performed on an animal model and consisted on the evaluation of mechanical and biological qualities of the investigated materials as well as their surgical handiness and tissue tolerability. The application of knitted polyester net as a reinforcing agent for both materials was also estimated. Process of incorporation of the prosthetic material was investigated macroscopical at 3, 6 and 12 weeks after the implantation. The experimental trials revealed the usefulness of Tutoplast-Dura and Zenoderm-Corium implant in reconstructive surgery in account of their good biocompatibility and adequate, mechanical properties. It was stated that Tutoplast-Dura was characterized by remarkably better surgical handiness in comparison to Zenoderm-Corium implant. Additional mechanical reinforcement with polyester net was not necessary.


[Correlations between the properties and effects of clinical therapy using textile material with antipsoriatic action].

The aim of the study was to design a textile material as a carrier for dermatological drugs. Cotton fabric was chosen for experimentation to be a fibrous support for the system. Additional components were a drug carrier in form of synthetic hydrogel impregnation (partially crosslinked poly(acrylic acid) and a bioactive agent dithranol) dispersed within the gel. The rate of release of the drug from the fibrous system was measured in aqueous media and depended on the concentration of dithranol. The structure and physical properties of the material were designed and controlled in order to ensure the optimal contact with the skin. Clinical studies were carried out with psoriatic patients. The results of the treatment with the textile material containing dithranol were presented using a computer optimalization method. In conclusion it was asserted that this type of textile-based medical device is effective and in many respects more convenient and less troublesome alternative in the treatment of psoriasis as compared to conventional treatments with dithranol suspended in ointments and creams.


[Absorption of chitosan applied to polyester discs in rats after implantation].

Experiments have been made on white rats implanting polyester blocks covered with chitosan into the peritoneal cavity and to the abdominal wall skin. Before implantation the material was sterilized with ethylene oxide or radiation. The animals were subjected to autopsy 3, 7, 14, 21, 25, 30, 35, 40, 45, 50, 55 and 60 days after implantation with macroscopic and microscopic evaluation. On the basis of the carried out experiments it was stated that the disintegration of chitosan proceeded not uniformly. The resorption time of chitosan oscillated in the range of 45-60 days and it was accompanied by rather strong specific inflammation process. It was characterized with fibrin effusion and with appearance of multi-flapped neutrocytes. Essential distinctions in the resorption process of depending on the sterilization mean of the blocks as well as on the place of implantation were not stated.


A new procedure in the surgical treatment of large incisional ventral hernias with the use of Dexon Mesh.

A new procedure in the surgical treatment of large incisional ventral hernias is described. It is based on the use of enlarged relaxation incisions of the abdominal fascia on both sides of the hernia to perform a direct suture of the posterior and superficial fascial layer of the hernia defect without tension. Extensive fascial defects after enlarged side relaxation incisions should be reinforced to prevent a weakness of the ventral abdominal wall. The best material may be a resorbable knitted mesh.


Activity of glucose-6-phosphate-dehydrogenase enzyme studies in calves with long--survivals with total artificial heart.

The research aimed at studying metabolic changes of erythrocytes in the calves surviving for a long period with total artificial heart of BRNO VII type. The authors studied partly the count of erythrocytes, the plasma levels of free hemoglobin and activity of glucose-6-phosphate-dehydrogenase enzyme. The changes found were compared with the levels measured in a group of 10 healthy calves. Constant decrease of erythrocyte count, slightly increased concentration of free hemoglobin in plasma and repeatedly decreased activity of the enzyme studied were found in the group of 4 experimental calves, from the 5th to 17th weeks of surviving. These changes can be explained by a long-term action of mechanical stress on the erythrocytes that pass through the pump of the total artificial heart. The cells damaged mechanically have the decreased energetic metabolism and, consequently, shortened viability. As young healthy animals with normal erythropoiesis which is stimulated by the application of drugs during the experiment are used, compensated anaemia develops, but it is not a limiting factor for the surviving of the calves with total artificial heart.


[Effect of re-utilization of cuprophan capillary dialysers with different liquids on their biocompatibility and effectiveness of elimination].

In 22 patients cuprophane capillary dialyzers reutilized in turn with four sets of liquids were used four times (Andante type in 13 and TAF-12 in 9 patients). The degree of biocompatibility and efficiency of elimination of small molecules was evaluated. During four-time reuse of dialyzers reutilized with sodium hypochlorite and with formaldehyde a reduction of intra-dialysis leukopenia, granulocytopenia and thrombocytopenia was not stated in blood of the patients. Activation of the complement system measured with the quantity of decrease of C3c fraction of the complement in the patients blood after 20 minutes of dialysis reduced essentially only at the fourth reuse of dialyzers (p < 0.01). Creatinine clearance measured always one hour after starting of the dialysis, did not change in succeeding reuse of dialyzers. Reutilization of dialyzers with hydrogen peroxide solution and formaldehyde caused essential reduction of ++intra-dialysis leukopenia and neutropenia (p < 0.001). There was lack of changes in ++intra-dialysis thrombocytopenia. Activation of the complement system was reduced essentially only after the fourth reuse of dialyzers (p < 0.001), but was also essentially lower (p < 0.05) than with dialyzers reutilized with sodium hypochlorite and with formaldehyde. Creatinine clearance practically did not change and at the fourth reuse of dialyzers it decreased on the average by 1.8%. Reutilization with acetic acid already at the second reuse of dialyzers essential (p < 0.001) and deepened decrease of intradialytic leukopenia and neutropenia and the activation of the complement system in course of succeeding reuses. Intradialytic thrombocytopenia was subjected to vestigal, not essential decrease. Creatinine clearance lowered a little but not essentially. At the fourth reuse of dialyzers it was lower on the average by 3.6% than the initial one. Reutilization with Dialina (stabilized blend of peracetic, acetic acid and hydrogen peroxide solution) caused essential (p < 0.001) and, in course of further reuses, deepening of lowering of intradialytic leukopenia and neutropenia as well as the activation of the complement system already at the second reuse. At the same time at the second and fourth reuse of dialyzers reutilized with Dialina the activation of the complement system was essentially lower than reutilized with the other liquids (p < 0.02). At the fourth reuse intradialytic thrombocytopenia also lowered essentially (p < 0.01). Creatinine clearance lowered a little more than with other liquids and at the second reuse of dialyzers was lower on the average by 5.6%, and at the fourth reuse--by 6.7% in relation to the new dialyzers.(ABSTRACT TRUNCATED AT 400 WORDS)


Leg ulceration in venous disease.

We have given a brief summary of the scale of the problem caused by venous ulceration in the UK, and have then reviewed the various theories of causation, including a historical survey, and presented the evidence for and against the two main current theories of fibrin cuffs and white cell trapping. We also outline previous hypotheses of the aetiology of venous ulceration, including arteriovenous microanastomoses, stasis and oedema. The contribution of superficial venous incompetence in the pathogenesis of ulceration is also examined.


Intracerebral haemorrhage after thrombolytic therapy for acute myocardial infarction.

Seven cases of intracerebral haemorrhage were identified following the use of thrombolytic therapy in a total of 710 patients with acute myocardial infarction. Each case was reviewed in detail with particular attention to the presenting symptoms. A confusional state was the commonest initial feature. Increased age and male sex were associated with increased risk of cerebral bleed. The possible role of intravenous heparin in increasing risk and the management of affected cases is discussed. Early recognition and action is emphasized.


Severity of alcoholic liver disease and markers of thyroid and steroid status.

Alcoholic liver disease is associated with abnormalities in circulating levels of thyroid, adrenal and gonadal steroid hormones. The relative importance of ethanol consumption and severity of liver disease in the aetiology of these changes and their relationship to clinical abnormalities are unclear. We studied 31 subjects with alcohol-induced liver disease divided into three groups according to the severity of histological features: fatty change, hepatitis and cirrhosis. Circulating concentrations of thyroid, adrenal and gonadal steroid hormones, together with their major binding proteins, were measured in all subjects, and changes related to histology and tests of liver function, as well as clinical endocrine status. A reduction in circulating free tri-iodothyronine (fT3) was seen in subjects with alcoholic hepatitis and cirrhosis, in association with normal or reduced levels of thyrotrophin (TSH). The absence of abnormalities in subjects with fatty change despite similar ethanol intake to the other groups, and correlations between fT3 and liver function tests, suggest that changes in fT3 reflect the severity of underlying liver disease. Similarly, marked increases in circulating cortisol in the hepatitis and cirrhosis groups, and correlations between cortisol and liver function, suggest that changes largely reflect hepatic disease. The absence of clinical features of hypothyroidism or Cushing's syndrome in these groups, despite abnormalities of fT3 and cortisol, suggest an altered tissue sensitivity to hormone effects. In contrast, increases in circulating oestradiol and reductions in testosterone were found in all three groups in males. These findings suggest that both direct effects of ethanol and hepatic dysfunction determine changes in gonadal steroids in males.


A randomized trial of one versus three doses of Augmentin as wound prophylaxis in at-risk abdominal surgery.

In a randomized prospective trial of prophylactic antibiotics in at-risk abdominal surgery, one dose of intravenous Augmentin (amoxycillin 250 mg and clavulanic acid 125 mg) on induction has been compared with three 8 hourly doses in 900 patients. Wound infection rates which included minor and delayed infections were very similar in those given one dose: 48/449 (10.7%) compared with those given three doses: 49/451 (10.9%) 95% confidence limits - 4.25% + 3.9%. There were more septic and sepsis-related deaths in those patients given one dose (14 deaths) than in those given three doses (7 deaths) P > 0.1 95% CL - 0.4% + 3.0%. However, there were more very elderly patients in the one dose group: 64% of the deaths were aged over 80 and all but one had an emergency operation. There was no difference in the other outcome measures studied which included non-fatal deep sepsis, length of postoperative hospital stay, duration of postoperative fever or the use of antibiotics for postoperative infection. One dose of a suitable intravenous antibiotic gives prophylaxis against wound infection in at-risk abdominal surgery which is at least as effective as multiple doses. However, there may be a risk of overwhelming systemic sepsis in very elderly patients having emergency surgery.


Patient recovery following cholecystectomy through a 6 cm or 15 cm transverse subcostal incision: a prospective randomized clinical trial.

The effect of incision length on patient recovery following cholecystectomy has not been investigated previously. In this study, 30 patients with symptomatic gallstones were randomized to cholecystectomy through a 6 cm or 15 cm transverse subcostal incision. Postoperative hospital stay was significantly shorter in the 6 cm incision group (median 3 days vs 5 days; P = 0.0069 Mann-Whitney U-test). In the 6 cm group analgesic requirements were reduced (median 2.5 vs 4.5 intramuscular opiate injections per patient) and recovery of depressed postoperative pulmonary function (FVC and FEV1) was faster (3% difference between groups on day 1 and 7% on day 3), although these differences did not achieve statistical significance. These results suggest that the length of incision may influence patient recovery following elective cholecystectomy. This has important implications as surgery carried out through shorter and less traumatic incisions may offer a cost-effective alternative to laparoscopic cholecystectomy. Moreover, some surgeons may find mini-laparotomy cholecystectomy easier to adopt than laparoscopic techniques.


Neuromuscular disease, respiratory failure and cor pulmonale.

Respiratory muscle weakness is an uncommon cause of chronic respiratory failure and a rare cause of cor pulmonale. The problem may not be apparent unless specific physical signs are sought or appropriate investigations performed. We present three patients who presented diagnostic difficulty for prolonged periods until the presence of respiratory muscle weakness was considered. Once the diagnosis was established treatment with nocturnal nasal intermittent positive pressure ventilation produced a dramatic improvement in symptoms and allowed a return to a near normal lifestyle.


Safety of anticoagulation in the elderly: reasons for discontinuing therapy.

We have conducted a retrospective study on the reasons for discontinuing anticoagulants in 50 patients over the age of 75 years compared with 198 adults under 75 years to determine the safety of therapy in the elderly. Venous thromboembolism and arterial embolization were the most common indications for therapy in the elderly and the median duration of therapy in all patients was 7 months (9 days-22 years). There were no deaths attributable to anticoagulants. There was no significant difference in the proportion of elderly patients who stopped treatment because of bleeding compared with 198 patients under 75 years (5/50 (10%) vs 12/198 (6.1%), P = 0.26), nor in the rate of bleeding between the two groups (5/52.5 (9.5%) treatment-years vs 12/249 (4.8%) treatment-years, P = 0.15). This complication rate does not suggest that age per se is a risk factor in the use of oral anticoagulants.


Craniospinal intradural arachnoid cyst.

A patient with an uncommonly situated congenital intradural arachnoid cyst is reported. The cyst extended from the cervical spinal canal into the posterior cranial fossa and was posterolateral to the spinal cord. The patient's initial complaint was urinary hesitancy. The location of the cyst is unique and the presenting complaint rare.


Idiopathic hypereosinophilic syndrome presenting as childhood hemiplegia.

A case of childhood hemiplegia due to idiopathic hypereosinophilic syndrome is reported. There was no cardiac lesion. The neurological complications associated with hypereosinophilic syndrome and the pathophysiological mechanism of neurotoxicity of human eosinophils are discussed. It is likely that the neurological deficit was due to eosinophilic neurotoxicity.


Brucellosis with nephrotic syndrome, nephritis and IgA nephropathy.

A patient with systemic brucellosis due to Brucella melitensis had severe renal involvement. Clinical features included hypertension, macroscopic haematuria, massive proteinuria of 10 g per 24 hours and azotaemia. Following treatment with antibiotics, the azotaemia resolved and proteinuria decreased to less than 0.5 g per 24 hours, but microscopic haematuria and hypertension persisted. Renal biopsy during recovery revealed IgA nephropathy with minimal mesangial changes, suggesting a causal relation between brucellosis and IgA nephropathy with a reversible nephrotic syndrome.


Biliary peritonitis secondary to perforation of common bile duct: an unusual presentation of chronic calcific pancreatitis.

Common bile duct perforation causing biliary peritonitis is an unusual entity and a pancreatic calculus causing this perforation is all the more rare, and to our knowledge has not been reported previously. Such an unusual presentation of chronic calcific pancreatitis is herein reported.


Why test antiplatelet therapy in acute ischaemic stroke and how can this be done?

Stroke is a major public health problem, yet there is no treatment of proven value for widespread use in the acute phase of the illness. This paper outlines the rationale for using antiplatelet therapy in acute ischaemic stroke and why it appears to be one of the most promising agents for testing in very large scale clinical trials.


Optimization of the blood for oxygen transport and tissue perfusion in critical care.

In present practice, patients in intensive care are managed with subnormal haematocrit values and oligovolaemia. Optimization of the blood for oxygen transport in preterm infants in intensive care yields major benefits in their prognosis. A rational basis is described for this optimization in terms of the circulating blood volume and haematocrit, represented by circulating red cell volume (mass). Extrapolation of these lessons in haematological management is proposed for adult patients in critical care, so as to reduce dependence on respiratory support and minimize clinical complications and costs.


The use of dobutamine stress thallium scintigraphy in the diagnosis of syndrome X.

Dobutamine stress thallium scintigraphy is a non-exercise stress technique used in the assessment of myocardial ischaemia. Non-exercise techniques are independent of the patient's exercise capacity or the subjective development of limiting symptoms. Preliminary data are presented regarding the effects of graded infusions of dobutamine (maximum 20 micrograms/kg/min) in seven consecutive patients with syndrome X. The dobutamine stress test caused significant increases in mean heart rate (rest 65.4 beats/min, peak dobutamine infusion 112.4 beats/min, P < 0.001) and systolic blood pressure (rest 138.6 mmHg, peak dobutamine infusion 166.7 mmHg, P = 0.002) and provoked typical symptoms in all the patients. Single photon emission computerized tomography was performed and the mean number of reversible defects was 1.86 per patient (range 1-3). One patient developed transient atrial fibrillation during the dobutamine infusion but there were no complications in the remainder of the study group. It is concluded that dobutamine-thallium scintigraphy in patients with syndrome X is safe, reproduces patients symptoms' reliably and presents a controllable degree of stress to the cardiovascular system. The consistent demonstration of a reversible perfusion defect in patients with syndrome X is evidence of abnormal myocardial physiology. This criterion could be added to those currently used to define syndrome X in order to improve objectively the identification of this patient group.


Mercury in silastic strain gauge plethysmography for the clinical assessment of the microcirculation.

We have used the mercury in silastic strain gauge plethysmography (MSG) system, which is wholly non-invasive, to obtain values (mean +/- s.e.m.) for the following parameters in the legs of supine control subjects: venous pressure (Pv) 9.89 +/- 0.88 mmHg, vascular compliance (Comp) 3.50 +/- 0.29 ml 100 g-1 mmHg-1 x 10(-2), microvascular hydraulic conductivity (Kf) 4.10 +/- 0.16 ml min-1 100 g-1 mmHg-1 x 10(-3) and isovolumetric venous pressure (Pvi) 22.12 +/- 0.82 mmHg. On passive foot-down tilting of control subjects through about 45 degrees, both Pv and Pvi rose to 28.00 +/- 2.33 and 36.58 +/- 2.29 mmHg respectively. The increases in both parameters were highly significant, P < 0.0001. We found that the time course of the vascular compliance component was short if small pressure steps were used. The value increased markedly if large steps were used. We also observed that none of the microvascular parameters studied in the arms differed from those in the legs of the same subjects. We observed that the mean value Kf in the arms of 12 young, non-neuropathic diabetics (9.08 +/- 6.12 x 10(-3)) was significantly greater than that of age and sex-matched controls (P < 0.001). Studies on 14 venous ulceration patients indicated that the values for Kf and Pv were unchanged, whilst those of vascular compliance (5.60 +/- 0.58 x 10(-2) ml 100 g-1 mmHg-1) and Pvi (37.30 +/- 2.25 mmHg) were significantly greater than those found in age-matched controls (P < 0.002 and 0.001, respectively). We feel that Pvi is a useful index of microvascular perfusion. We attribute the pressure-dependent difference, in the time course of the vascular compliance response, to the veni-arteriolar reflex. We feel that the pressure dependency of this response might form the basis for the assessment of peripheral autonomic neuropathy. We believe that the MSG system offers a means of monitoring the development of pathologies resulting from microvascular under-perfusion and, of course, the improvement in response to therapeutic interventions.


The relationship between cardiac reserve and survival in critically ill patients receiving treatment aimed at achieving supranormal oxygen delivery and consumption.

The relationship between survival and cardiac responsiveness to therapy aimed at achieving supranormal values for cardiac index, oxygen delivery and oxygen consumption (cardiac index (CI) > 4.5 l/min/m2, oxygen delivery (DO2) > 600 ml/min/m2, and oxygen consumption (VO2) > 170 ml/min/m2), has been investigated in a heterogeneous group of critically ill patients. Thirty-two patients were prospectively studied and divided into survivors and non-survivors. Cardiac reserve was assessed by determining changes in CI, left ventricular stroke work index (LVSWI) and cardiac power output (CPO) in response to optimal fluid administration and inotropic stimulation with dobutamine. On admission LVSWI and CPO were significantly higher in survivors (P < 0.05), despite no significant differences in pulmonary artery occlusion pressure (PAOP). In response to fluid CI, CPO and LVSWI increased significantly in survivors (P < 0.01), but not in non-survivors. Following optimal fluid administration, survivors achieved significantly higher values for CI, LVSWI (P < 0.01), and CPO (P < 0.001) than non-survivors. At maximum resuscitation all three variables were significantly higher in survivors than in non-survivors (P < 0.001). The dose of dobutamine administered to non-survivors (median (range) 100 (5-200)) was significantly greater (P < 0.001) than that given to the survivors (median (range) 10 (0-25)). The dose of dobutamine was limited by complications in 12 of the non-survivors. These observations suggest that cardiac reserve is an important determinant of outcome following critical illness. In unresponsive patients attempts to achieve supranormal oxygen delivery and consumption with massive inotropic support may not only be ineffective but frequently precipitates tachydysrhythmias and myocardial ischaemia.


The renal effects of dopamine and dobutamine in stable chronic heart failure.

Although an extensive literature exists on factors controlling sodium excretion in animal experimental models of heart failure, the relevance of these to the human condition remains largely unexplored. Increased renal sympathetic stimulation is considered responsible for heightened urinary sodium retention. Stimulation of dopamine receptors is believed to cause a diuresis. Accordingly, we sought to explore the influence of dobutamine (a beta-1 receptor agonist) and dopamine in high and low doses on a frusemide-induced diuresis in patients with chronic stable heart failure. Preliminary results indicate that low doses of dobutamine and dopamine do not increase a moderate, frusemide-induced diuresis. With higher doses dobutamine, but not dopamine, increased urine volume and sodium excretion. These results suggest that direct stimulation of beta-1 receptors increases urinary sodium excretion, either by a direct effect on the kidney or by altering systemic and renal haemodynamics.


[The epidemiological situation and the efficacy of antituberculosis measures in children in West Siberia].

Stabilization of tuberculosis morbidity among the children and adolescents in West Siberia was found against the background of its reduction in adults. The main causes of the unfavourable situation for tuberculosis in children of West Siberia include the presence of numerous infectious foci unknown to the antituberculosis center; incomplete examination of subjects who take care of the newborn; drawbacks in the organization and early detection and vaccination of the newborn and in the follow-up of children of groups IV and VI of dispensary record.


[Epidemiology and clinical picture of tuberculosis in children in an ecologically unfavorable coastal zone near the Aral Sea].

Tuberculosis epidemiology was studied in children living in the Ara Sea costal region, in particular in the Karakalpakia, where tuberculosis incidence is twice as high as in the whole region on the average. In conditions of mass dispensarization of the population the rate of tuberculosis detection in children who undergo fluorographic examination from the age of 7 years was 0.06%. In 35% of tuberculosis children the disease took an aggravated course, 68% had intoxication symptoms, 84.6% polylymphadenitis, 23% anemia and 76% presented inhibition of immune reactivity in the form of a decreased number of T-lymphocytes and suppression of their functional activity.


[Extrapulmonary tuberculosis in children].

Extrapulmonary tuberculosis morbidity in children of the Novosibirsk region for the period of 10 years was analysed on the basis of the materials presented by the regional antituberculosis center. It was found that 44 children has extrapulmonary tuberculosis which accounted for 17.9% of the total number of sick children and 5.7% of all extrapulmonary tuberculosis patients. Tuberculous lymphadenitis was diagnosed in 50% and bone-and-joint tuberculosis in 27.3% of cases; nephrotuberculosis occupied the third and ocular tuberculosis the fourth place; 20% of sick children were detected after their examination and 80% after surgery for other general diseases. Complications of the main process at the moment of application for help had 18.2% of children. The basic causes of later extrapulmonary tuberculosis diagnosis in children is the absence of awareness for tuberculosis in the general practitioners and inadequate work carried out in tuberculosis infection foci.


[Outpatient observation and treatment of patients with tuberculosis and massive bacterial excretion aggravated by negative social factors].

Social and epidemiologic features were studied in 1145 newly diagnosed tuberculosis patients in Yakutia who were on the dispensary record in the period between 1981 and 1990. Among the negative social and hygienic factors which aggravated the course of tuberculosis were unsatisfactory living and domestic conditions, failure in family life, unskilled hard labour, idle life, stay in the penitentiary-labour establishments and chronic alcoholism. To improve the effectiveness of dispensary follow-up and treatment of this category of patients measures should be taken aimed at the centralized epidemiologic control. They include, registration of copious bacilli excretors as a special contingent of antituberculosis dispensaries, active measures directed against drug addiction and removal of the unfavourable psychologic factors as well as obligatory hospitalization of patients into specialized tuberculosis centres.


[The use of the biochemical and cytochemical indices of the bronchoalveolar lavage fluid for the diagnosis of the activity of pulmonary tuberculosis].

On the basis of guinea pig experiments and clinical findings related to 103 patients of whom 51 were operated on, the authors propose a diagnostic set which allows determination of pulmonary tuberculosis phase. The set informative value is 93.5%.


[The potentialities and results of the etiologic diagnosis of acute pneumonias].

The paper deals with the results of the joint Soviet-Hungarian study for the determination of etiology of acute pneumonias. Study included 617 patients. The bacteriologic and serologic methods were used to reveal the causative agent of the disease. Prevalence of Streptococcus pneumoniae (33-49%) in the etiologic structure of acute pneumonias was established both in the USSR and Hungary. In many cases pneumonia is also caused by Haemophilus influenzae (21-22%). In 15-31% of the cases the causative agent of pneumonia is gram-negative microorganisms. A protracted course of acute pneumonia is due to the complex associations of microorganisms including S. pneumoniae. A conclusion has been drawn to the effect that the initial antibacterial therapy should be started with administration of antibiotics that act effectively on S. pneumoniae.


[The significance of haptoglobin in the differential diagnosis of tuberculosis of the female genital organs].

Study included 115 women with suspicion of genital tuberculosis. Combined clinical, X-ray and laboratory examination made it possible to classify patients into 3 groups: group 1 included 44 patients with active genital tuberculosis, group 2 32 women with clinically cured tuberculosis of internal genitalia and group 3 39 women with nonspecific genital diseases. The haptoglobin-tuberculin test was given to all patients. High haptoglobin parameters before or 72 h after tuberculin administration were found only in the group of patients with active genital tuberculosis. In groups 2 and 3 the haptoglobin level did not exceed normal values both before and after tuberculin administration in a dose of 50 TU. The informative value of serum haptoglobin parameters in patients with active tuberculosis of internal genitalia constituted 88.6%.


[The use of intrapulmonary needle-jet injections of chemical preparations in the preoperative management of patients with pulmonary tuberculosis].

Among the various methods of antibacterial preparation injection for the management of pulmonary tuberculosis the intrapulmonary injection techniques with the help of a needle-stream injector (NSI-1) still remain little studied. The experience of using these techniques for treating more than 200 patients, among whom 23 patients were later operated on, showed that the early use of the method (immediately after the diagnosis was established) helped to stabilize the process in 1-1.5 months. This made it possible to perform operations within 3 months after the diagnosis was made. The method proved effective also in patients who did not present favourable dynamics during 3-6 months of the use of the traditional therapeutic methods. The results obtained allow for the use on a wide scale of needle-stream injections in the preoperative management of destructive tuberculosis patients.


[The efficacy of the use of different types of lasers in the operative treatment of patients with tuberculosis of the lungs].

The efficiency of various types of lasers used in the surgical treatment of patients with tuberculosis and other diseases of the lungs and pleura was evaluated. Surgical (CO2 and YAG) and therapeutic lasers (helium-neon, ultra-violet and semiconductive) were used. The findings demonstrated that use of various lasers in lung surgery enables one to improve preoperative management, reduce the volume and traumatism of surgical interventions, decrease the number of postoperative complications and increase the effectiveness of surgical treatment of patients with tuberculosis and other diseases of the lungs and pleura.


[A system of methods of tuberculosis immunodiagnosis based on the use of antigenic preparations isolated from BCG mycobacteria].

The antigenic composition, immunochemical properties and immunogenicity of the antigenic complexes isolated from BCG mycobacteria were studied. A system of sensitive and specific measures of tuberculosis immunodiagnosis has been developed on the basis of specific antigens and antibodies. The informative value of these methods considerably exceeded the previously used test-systems based on the commercial tuberculin.


[Lymphocyte enzymes, activity of lipid peroxidation processes and the antioxidant protection of patients with tuberculosis of the lungs].

Activity of succinate dehydrogenase, alpha-glycerophosphate dehydrogenase, NAD2- and NADP2-diaphorases and acid phosphatase in lymphocytes of the peripheral blood as well as malonic dialdehyde and alpha-tocopherol, as parameters of lipid peroxidation defense, were studied in 49 patients with different forms of pulmonary tuberculosis and in 17 practically and clinically healthy subjects. Patients with focal pulmonary tuberculosis presented drop of succinate dehydrogenase and NAD2-diaphorase activity and rise of alpha-glycerophosphate dehydrogenase and NADP2-diaphorase activity in lymphocytes. Parameters of malonic dialdehyde and alpha-tocopherol in patients and healthy subjects had no difference. Patients with infiltrative and fibrocavernous pulmonary tuberculosis had drastic suppression of energy enzymes and sharp rise of acid phosphatase activity in lymphocytes, which correlated with a significant rise of malonic dialdehyde level and decrease of blood serum alpha-tocopherol. There was a tendency to an increase in energy enzymes activity and decrease of acid phosphatase activity 3-4 months after chemotherapy, which was followed by the clinical improvement of patients' condition. Direct dependence was found between the normalization of enzyme activity of lymphocytes and diminution of lipid peroxidation processes.


[Results of carrying out a planned program "Acceleration of the tempo of lowering the tuberculosis morbidity in the RSFSR, 1983-1990"].

Analysis of the results of a planned program "Acceleration of the tempo of tuberculosis morbidity reduction in the RSFSR for the period of 1983-1999" has shown that formally it was fulfilled in 60 of the 73 administrative territories. The tempo of morbidity reduction during 1986-1990 was 24.2% in relation to 1985. This high tempo was associated with reduction of the volume of prophylactic screening examinations from 75% in 1985 to 52% in 1990. Hence, acceleration of the tempo of tuberculosis morbidity reduction is not genuine. Changes in socioeconomic conditions in the region should be taken into consideration in compiling planned programs. The basic aim of the program is to preserve a positive dynamics of the main epidemiologic indices for tuberculosis by finding the optimal model for the transition of the phthisiatric service to a new mechanism of economy.


[Pneumotropic microorganisms in chronic diseases of the respiratory organs and tuberculosis of the lungs].

Species composition and the etiologic role of S. pneumoniae and of bacteria of Haemophilus genus in origination and maintenance of diverse lung pathology were specified and the problem of their carriage in pulmonary tuberculosis patients in the absence of nonspecific infection was investigated. The results of study have confirmed that S. pneumoniae was and still remains one of the most common pathogens of chronic respiratory diseases (55.8% of bacteria was found in sputum and 64.7% in bronchoalveolar lavage and exudate). Serological verification of microorganisms isolated from the sputum by the indirect immunofluorescence method was obtained in 77.4% of the studies. Bacteria of Haemophilus genus were more often isolated together with pneumococcus (15.4%) and were verified serologically in only 31.8% of the cases. Transitory (asymptomatic) carriage was found in 412 pulmonary tuberculosis patients. S. pneumoniae accounted for 62% and Haemophilus for 20%.


[Serological studies of synanthropic birds for infection by M. avium].

Examination for M. avium contamination covered 702 specimens of the synanthropic birds of 6 species (hooded crows, daws, rooks, magpies, sparrows, starlings) which was carried out in 13 landscape-epizootic areas of the northern zone of the Low Volga region. Contamination was studied by a serological test (AIT) using the M. avium extract and dry avian tuberculin as an antigen in the parallel tests. It was found that 96 (23%) of the 416 specimens from the right bank of the Volga and 65 (22.72%) of the 286 birds from the left bank were AIT-seropositive. The paper presents methods of study and contamination parameters of birds; the character of distribution of the infected birds by the region of the examination zone is discussed.


[Tuberculosis in the Ural and Volgo-Vyatka regions and means for optimizing antituberculosis activity].

Analysis of certain parameters has demonstrated that situation for tuberculosis in the Ural and Volgo-Vyatsky region for the period of 1986-1990 remains unsteady. The epidemiologic and economic conditions of today dictate the necessity to improve the effectiveness of tuberculosis control by strictly differentiating the available antituberculosis measures, their volume and frequency of use, depending on the risk of disease contraction in each particular territory in the whole population and in separate groups taking technical, material and personnel potentialities into consideration.


[Tuberculosis morbidity among the population of a large industrial center].

Tuberculosis morbidity in children, adolescents, young people and adults for the period of 1986-1990 has been analysed. Parameters of morbidity were compared with general morbidity of the population of Chelyabinsk. It was found that at the present stage of tuberculosis control parameters of general morbidity remained unchanged. Morbidity in adolescents and young people aged 18-19 years markedly decreased, while a tendency to its slow growth was revealed in children and in subjects aged 24-29 years. In contrast to other groups, parameters of morbidity in adults are the highest (32.7-37.4 per 1,000,000) and steady owing to which measures aimed at tuberculosis control should be improved.