[Malignancy of uterine sarcoma in comparison with suspect leiomyoma. An anatomo-clinical study of 16 cases].

Sarcoma of the uterus accounts for less than 1 per cent of uterine neoplasms but is responsible for more than 15 per cent of deaths. However, histological or clinical malignancy features are poorly understood, in particular those which differentiate sarcomas from leiomyomas. This study involved 16 cases, seen during 8 years in two gynecology clinics in Iasi (Rumania) and chosen according to histological diagnosis. Ten leiomyomas were also chosen for comparison of symptomatology. The malignancy criteria studied--vascular invasion, cellular density, number of mitoses and histological type (most often leiomyosarcoma: 8 out of 16)--were used to compare sarcomas with suspect leiomyomas. The mean age was 50, 7 cases being diagnosed after the menopause. The commonest symptom was metromenorrhagia (11 cases out of 16), but pain was more frequent in leiomyomas (9 out of 10). Treatment was above all surgical, total hysterectomy having the best prognosis (3 deaths out of 8 patients operated upon). Other methods (in particular radiotherapy) not being used immediately after surgery, they could not be studied. In terms of its difficult diagnosis and its high degree of malignancy (9 deaths out of 16), sarcoma must remain an argument in favour of total hysterectomy.


[Value of clinical gynecological examination in understanding sexual problems. Apropos of 40 case reports].

The author reports, in the context of gynecological practice, 40 sexology cases involving a superimposition of Oedipus complex and castration complex. A complex is a mismatch between reality and actions: the Oedipus complex involves an adult (reality) with the affect of a child (actions); the castration complex involves normal genital anatomy, the urethro-clitoro-vulval entity (reality), and abnormal sexuality (actions). The usefulness of clinical examination with palpation of the urethral sphincter (G point), which should be routine (notably for seeking the existence of chronic chlamydia urethritis), is to enable: better resolution of the two complexes, by superimposition of anatomical findings on psychological findings; distinction between subcortical castration complex (known sensitivity) and sub-limbic castration complex (previously unrecognised desirable vaginal sensitivity); identification of certain organic disorders of the urethral sphincter with urinary and sexual manifestations (notably post-partum).


[Cordocentesis and evaluation of fetal wellbeing in a very high-risk population (a very reliable index)].

In a population of 57 very high-risk pregnant women (severe clinical history and/or compromised fetus). A total of 240 tests for antepartum fetal evaluation were performed: baseline cardiotocography (CTG), biophysical profile scoring (BPS), doppler-velocimetry of umbilical artery and determination of blood gas analysis in venous umbilical cord blood obtained by cordocentesis. The results of the CTG, BPS, and umbilical artery doppler velocimetry showed a significant relation with those of pH and pO2. The sensitivity, specificity, false-abnormal value, and false-normal value of the CTG, PBS, and doppler velocimetry, used for the diagnosis of fetal acidosis, hypoxia, and asphyxia were comparable. The rate of fetal (asphyxia) was high if present severe/terminal CTG (85.0%), abnormal (4) BPS (82.0%), or absent-end diastole in umbilical artery doppler velocimetry (74.0%). The immediate complication rate due to cordocentesis procedure was minimal.


[Outcome of pregnancies obtained by fertilization in vitro. Experience at the V. Olivier Ward (department of Professor Monnier, Lille University Hospital Center) and review of the literature].

The outcome of 87 pregnancies obtained by fertilisation in vitro and progressing beyond 20 weeks of amenorrhea monitored in the Victor-Olivier Ward (Prof. Monnier, Lille Teaching Hospital Group) was analysed. Results were compared with those in the literature. The group was characterised by three features: age, the number of primipara and above all the multiple pregnancy rate. One quarter of FIV pregnancies are multiple pregnancies and almost two newborn out of live are the result of multiple pregnancies. Almost 70 per cent of clinical pregnancies progressed beyond six months. Pregnancy pathology was represented by a marked worsening of the prematurity rate and by a slightly increased risk of fetal under-development. The cesarean section rate was very markedly increased. Sex ratio, and perinatal mortality, malformation and chromosomal aberration rates were similar to those for spontaneous pregnancies. Results are reassuring overall, the pathology being encountered in pregnancies of this type being only partially explained by age, the number of primipara and the multiple pregnancy rate. This pathology could possibly be explained by the underlying situation in which sterility occurred.


[Hydrometra. Apropos of 6 cases].

Six cases of hydrometra are reported. The diagnosis could be confirmed only by ultrasonography. Histology revealed two cases of hyperplasia and three of endometrial atrophy. Culture of curettage material remained negative. Blood count was normal.


[Chickenpox and pregnancy].

The authors report a case of chickenpox exposure during the first three months of pregnancy. Ultrasonographic monitoring of the fetus revealed signs of fetal infection starting from 32 weeks of amenorrhea (hepatomegaly, ascites, pleural effusion) but clinical examination of the child at birth showed nothing abnormal. The diagnosis was confirmed by the development of herpes zoster in the child after birth. The difficulty of determining a fetal prognosis during pregnancy is emphasised.


[Gynecology and obstetrics in Ancient Rome].

Gods and Goddesses were invoked by the Romans for the termination of a good delivery. Diana, Juno, Lucina and Cybele were the preferred ones. Sterility was sometimes treated by the whip of the Lupercali of ministers of Pan. The first doctors in Rome were coming from Greece. Celsus, Pliny the Elder were encyclopedists, Rufus an anatomist, Dioscorides a pharmacologist. Archigenes, Aretaeus and Antyllus surgeons. Soranus from Ephesus, was the first to recommend podalic version. His works was a long time buried in a profound oblivion and discovered by scholars during the nineteenth century. Galen was looked as the most famous medical man after Hippocrates. During the Roman Empire of Occident (Byzantine Empire), Oribasius, Aurelianus Caelius, Moschion and above all Aetius and Paul of Aegina wrote many works which were many times plagiarized. Roman laws concerning public health were severe. Midwives took an important action in the care of pregnant women. Roman poets as Plautus, Terence, Lucilius, Catullus, Virgil, Tibullus, Ovid and Martial were many times concerned in their writings with gynecologic or obstetric subjects. Children were easily forsaken. Three Emperors, Trajan, Marcus-Aurelius and Alexander Severius, a writer, Aulu-Gelles, and a rhetor, Quintilian, took protection of them.


[A randomized prospective study comparing supplementation of the luteal phase and early pregnancy by natural progesterone administered by intramuscular or vaginal route].

Deficiency in the luteal phase has been shown during stimulated cycles using a protocol involving a GnRH agonist. The authors undertook a randomised prospective trial of supplementation by progesterone of the luteal phase and of early pregnancy in two hundred and seventy two patients requiring fertilisation in vitro (FIV), gamete inter-fallopian transfer (GIFT) or zygote inter-fallopian transfer (ZIFT). Either progesterone in solution in oil (50 mg/day) administered by intramuscular injection or micronized progesterone administered intra-vaginally (600 mg/d) were used as support for the luteal phase. Administration of progesterone in association with estradiol valerate was started on the day prior to oocyte puncture and was continued until the 12th week of pregnancy. The implantation rate was very close to the threshold of significance (P = 0.07) in favour of the patients given vaginal progesterone. There was a higher rate of clinical pregnancies (33.6 versus 26.7 p. cent) in the latter group, though this was not significant. While plasma progesterone (Pg) levels were lower in patients using vaginal progesterone, the abortion rate during the first three months was lower in this group (P < 0.05). Micronized progesterone administered vaginally was well tolerated by all patients. During stimulated cycles, notably by GnRHa, it thus proved to be more effective than Pg administered by intramuscular injection with regard to implantation and abortion rates.


The nasal response to exercise in patients with cystic fibrosis.

This study has evaluated the nasal response to exercise in patients with cystic fibrosis (CF), a genetic disease in which factors such as chronic lung disease and/or nasal polyposis might be anticipated to modify nasal function responses. Measurements of nasal resistance (NAR) by posterior rhinomanometry and specific airway resistance (sRAW) were made before and 1, 5, 10, and 30 min after a 4-min period of exhausting legwork exercise (50% predicted maximal) in 19 CF patients (aged 11-29 years) and 10 healthy subjects (aged 11-31 years). One minute after exercise, healthy subjects showed a 54 +/- 5% (mean +/- SEM; standard error of the mean) relative fall from baseline in NAR and CF patients showed a 31 +/- 8% relative fall from baseline (p < 0.05). There were no significant differences in the magnitude or pattern of recovery in NAR after exercise (1 to 30 min) between the groups, largely because of the variability in NAR responses in CF patients. Exercise did not result in significant changes in sRAW in either group. We also found that a history or presence of nasal polyposis does not significantly affect functional nasal responses to exercise. Our conclusion is that the CF genotype and its airway sequelae do not substantively affect the control of the nasal response to exercise.


Incidence of medico-surgical treatment for nasal polyps on the development of associated asthma.

The surgical treatment of nasal polyps (in asthmatic patients) is still controversial today because of the contradictory, inconsistent, and unforeseen results reported in the literature. The 50 patients included in this study (mean age 49 years, range 25-67 years) came for a check-up on an average of 18 months (lower limit 12 months, upper limit 40 months) after a radical endoscopic intranasal ethmoidectomy. Thirty patients suffered from polyps and bronchial hyperreactivity; 12 patients in this group also suffered from aspirin intolerance. Twenty patients suffered from nasal polyps alone, and served as a control series. The following parameters were methodically noted relative to the date of ethmoidectomy: 1) the frequency of attacks and possible intervals of respiratory difficulty, pre- and postoperatively; 2) the basic treatment for the asthma, and the difference in size of the therapeutic doses necessary and/or the elimination of one or more therapeutic classes; 3) bronchospasticity, evaluated pre- and postoperatively by auscultation for wheezing and peak flow measurements. A bronchial challenge with carbamyl choline and a four-doses aspirin challenge over two days (10 mg, 50 mg, 100 mg, 400 mg) were carried out pre-and postoperatively in the absence of contra-indications. Ninety-one per cent of the patients have improved and now live in less discomfort. The factors studied show a lower frequency of attacks, a distinct decrease of respiratory difficulty, less need for anti-asthmatic medication and especially less oral corticoids, and a marked improvement in functional respiratory test. The carbamyl choline test confirms these data and even shows the totally reversible nature of nonspecific bronchial hyperreactivity in 30% of these patients. This series is too limited for us to say that intolerance to aspirin is reversible; perhaps only the reactivity threshold changes. In the 20 subjects with nasal polyps alone, no case of asthma have been recorded since the operation. Improvement of the asthmatic condition may be partly dependent upon a global diagnosis and treatment of the patient by the pneumo-immunoallergologist and the ENT-specialist. However, the nature of the surgical act seems to be of prime importance, and we must insist on the need for a radical marsupialization of the paranasal sinuses.


Relationships between vital capacity, height and nasal airway resistance in asymptomatic volunteers.

Nasal airway resistance (NAR), vital capacity and height were measured in 76 asymptomatic volunteers aged between 18 and 71, mean age 28 +/- 1.4 years. Total NAR ranged from 0.15-0.39 Pa/cm3/s, with a mean total NAR of 0.23 +/- 0.006 Pa/cm3/s. Despite a good correlation between vital capacity and height in these subjects (r = 0.76) no relationships were found between either total NAR and vital capacity or total NAR and height. Physiological NAR is not related to vital capacity or height in normal healthy individuals.


Allergic rhinoconjunctivitis: diagnostic and clinical assessment.

In allergic rhinoconjunctivitis not only the nasal mucosa but also the conjunctiva and, in severe cases, the cornea are affected by reactive phenomena. This pathological process is often encountered in clinical practice, its incidence ranging from 10% to 30% of the whole population, as reported by many authors. Up to now, the pathogenetic mechanisms of allergic reactivity are not completely understood. In our opinion this is due to insufficient standardization of the diagnostic procedures; even the clinical picture of such a pathological process seems to be insufficient, especially with regard to the analogies between the nasal and conjunctival pathologies. To a great extent this depends on the different clinical pictures both in otorhinolaryngology and ophthalmology. Our study has been carried out on 98 patients suffering from rhinoconjunctivitis, and presents an accurate documentation with regard to the existence of analogies in reactivity at the immunoallergic level, in both the nose and conjunctiva. These are evident when we refer not only to specific routine allergological tests but, mainly, to local examinations. The evaluation of the selected data enables us to formulate a single classification of allergic rhinoconjunctivitis, taking into account the common reactive phenomena.


Clinical evaluation of the nasal dilator Nozovent. The effect on snoring and dryness of the mouth.

When the lateral walls of the nostrils are dilated with Nozovent, inhalation requires less force, thus reducing the risk of vibrations of the soft palate creating the snoring sound. There is also less need for mouth-breathing. When 17 patients were tested during 10 nights, every second night using Nozovent, the sleeping partners noted significantly less snoring these nights than during the nights without Nozovent. The patients themselves also noted significantly less dryness of the mouth when they dilated the nostrils with Nozovent, being able to avoid mouth-breathing.


A comparative study of detection methods for evaluation of microfilaremia in lymphatic filariasis control programmes.

The evaluation of microfilaremia (mf) was performed in 96% of the population aged 15 years or more in a village of Moorea, one of the Society Islands in French Polynesia. Finger-prick and venous blood samples were collected simultaneously from 782 individuals in order to compare the results obtained by the standard blood film method and the membrane filtration technique. Of the 782 blood-sampled inhabitants 69 (8.8%) were found mf positive. 39 (5%) were mf positive by both methods and 30 were mf positive by the membrane filtration technique only. In these latter 30 carriers the geometric mean mf count was 19.7 mf/ml, significantly lower than that of 651.1 mf/ml in the 39 carriers positive by both techniques. Using the membrane filtration technique, the mf carrier prevalence rate increased from 1.9% in the youngest age group (15-19 years) to 16.9% in the oldest (< or = 60 years) while using the blood film method, it increased from 1.3% to 12.7%. Roughly, when using the membrane filtration technique, the mf carrier prevalence rate was 1.77 higher than that found using the blood film method, considering either the whole population or successive age-groups. Moreover, when using the blood film method in the 40 years and more age group, the mf carrier prevalence rate was 10%, a proportion similar to the 8.8% prevalence rate determined by the membrane filtration technique in the whole population. Further studies are planned to assess whether the last finding may be confirmed in other Polynesian populations.(ABSTRACT TRUNCATED AT 250 WORDS)


Repeatability and reproducibility of egg counts of Schistosoma haematobium in urine.

Egg output in urinary schistosomiasis can be influenced by several factors, such as time of collection of urine, day to day variations, seasonal variations and environmental conditions. Additionally there are unavoidable random errors inherent in every test procedure. To assess the precision of Schistosoma haematobium egg counts, carried out after paper filtration, two measures are determined, namely repeatability (r) and reproducibility (R). 10 aliquots of 10 urine samples are examined by 5 microscopists and values for r and R are calculated following the methods of the British Standards Institution (BSI, 1987). Results show unexpectedly high values for the 2 measures in relation to the overall means in all 10 urine samples, and analyses of variance confirm that there are large variations between aliquots of equal volume drawn from the same urine specimen, highly significant in all 10 urine specimens; variations between microscopists are considerably lower and only highly significant in one urine specimen. The Poisson heterogeneity test for all urine samples refutes in 9 out of 10 cases the hypothesis that aliquots of equal volume taken from a well mixed urine sample could reasonably be drawn from a Poisson distribution. It is therefore concluded that egg counts are very valuable for community studies and should always be performed, but results must be interpreted with more caution than before and great care taken in analyzing counts (especially in longitudinal studies), in classifying them and in relating them to morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of Schistosoma haematobium infection on mental test scores of Kenyan school children.

Adverse effects of Schistosoma haematobium infection on mental activities were studied at a primary school in rural Kenya, where the intensity of infection was light (the average egg count: < 50/10 ml of urine). The school children received three kinds of mental tests, which examine attentiveness and concentration, before and a month after treatment with a single dose of praziquantel. A pretreatment analysis showed that test scores became worse as egg counts of children increased. The praziquantel treatment improved the scores of all three tests among children who got high scores in the first tests. The study showed that even the light infection caused adverse effects on mental activities, which were detectable using simple mental tests.


Identification of Schistosoma mansoni, S. rodhaini, S. bovis, S. haematobium, and S. intercalatum cercariae using segmentation analysis.

Cercariae of five species of schistosomes identified with certainty were fixed in boiled alcohol and mounted in glycerol-alcohol mixture. The cercarian body (Cbl) and tail-furcae lengths (Ctl) were measured, the values of which were treated using a computer. Even mean values allowed partly identification of the present species, the segmentation analysis gave better informations for separating any cercaria taken at random, with a given probability (p). Thus, five classes (A, B, C, D, E) have been established: class A: Cbl > 139 microns and Ctl, > 236 microns, p = 0.59 to be considered as S. bovis; class B: Cbl > 139 and Ctl < 236, p = 0.86 to be considered as S. haematobium; class C; Cbl < 114 microns, p = 0.75 to be considered as S. intercalatum; class D: 114 < Cbl < 125 microns, p = 0.57 to be considered as S. mansoni; class E: 125 < Cbl < 139 microns, p = 0.57 to be considered as S. rodhaini. Two groups of schistosome have been established on basis of cercarian morphometry with S. intercalatum, S. mansoni and S. rodhaini from one side, S. haematobium and S. bovis to the other side.


Schistosoma mansoni in Pachwach, Nebbi District, Uganda, 40 years after Nelson.

Human- and snail-related aspects of the transmission of schistosomiasis mansoni was studied in the Amor Parish community located at the western bank of the River Nile in the Nebbi District, north-western Uganda. A cross sectional survey involving 642 people revealed an overall prevalence of infection among males and females of 81.6% and 81.3%, respectively. The prevalence of infection peaked in the 10-14 years age group, being 93.2% and 93.6% in males and females, respectively, but the prevalence remained high also in older age groups. Intensity of infection peaked in the 10-14 years age group in males and in the 15-19 years age group in females, reaching 768 and 482 eggs/g faeces, respectively. Intensity of infection diminished only to a moderate extent with increasing age with the infection intensity in the 40+ years age group being 270 and 241 eggs/g faeces in males and females, respectively. Observations on the human water contact pattern revealed a community having a very intensive water contact persisting into old age. Interviews revealed a high level of awareness of the disease schistosomiasis, and 87.2% had a history of passing blood in stool. The total set of observations point to intestinal schistosomiasis being of public health importance in Amor Parish. Studies on snail-related aspects of transmission revealed that Biomphalaria stanleyi was by far the most important snail host in the area. A tendency was seen for B. stanleyi snail numbers to be reduced during the rainy season.


Persistence of IgG, IgM, and IgE antibodies in human trichinosis.

An enzyme-linked immunosorbent assay (ELISA) was used to detect serum IgG, IgM, and IgE antibodies against Trichinella spirals s. str. following an outbreak of human trichinosis in 1989 in Chiang Rai Province, Thailand, for two years and seven months in order to observe diagnostic sensitivity of ELISA as well as the persistence of antibodies. It was found that the sensitivity of IgG-ELISA, as determined from biopsy-positive cases, reached 100% on the 50th day of infection. For IgM-ELISA, peak sensitivity was 93.33% at the 57th and IgE-ELISA 100% at the 85th day of infection. Two years and seven months after infection, the diagnostic sensitivity of IgG-ELISA was 88.24%, and that of IgE-ELISA was 47.06%, while the sensitivity of IgM-ELISA was only 11.76%. It was suggested from the data that IgM-ELISA is a helpful indicator of infection within three years. Other two groups of trichinosis cases, i.e., high-titer and seroconversion cases, were also studied. Antibody response curves were constructed from mean ELISA values from each group. It was revealed that all curves were similar in shape, independent of the group studied. The only exception was IgG-antibody response in the high-titer group, which showed the highest antibody level at the first collection of blood samples, i.e., 23 days after infection.


Trypanosomal antigen and antibody levels in field camels following treatment with two trypanocidal drugs.

The efficacy of treatment in 61 naturally trypanosome-infected camels was evaluated by antigen and antibody detection. Following treatment of 14 infected field camels with an arsenical drug (RM110) no trypanosomal antigens could be detected in the animals which were treated with 0.6 mg/kg body weight and 1.2 mg/kg body weight, 90 days thereafter. In two out of three camels treated with 0.4 mg/kg body weight no trypanosomal antigens could be detected by day 90 post-treatment. However, there was evidence of trypanosomal antigens in camels treated with 0.2 mg/kg body weight and untreated positive controls. Antibody levels were still high in all the 14 camels, 90 days post-treatment. In another group of 55 field camels, of which 47 camels were parasite-positive and eight parasite-negative, trypanosomal antigens could not be detected in 42 camels, 28 and 48 days post-treatment with Quinapyramine Prosalt. However, antigen levels were still high in five parasite-positive camels, 48 days post-treatment. In all the parasite-positive camels, antibody levels were still high 48 days after treatment. In the eight parasite-negative camels, antigens were detected in four camels before treatment. By day 48 post-treatment, all the four camels were antigen-negative. However, four of the eight parasite-negative camels were still antibody-positive by day 48 post-treatment. These observations indicated that antigen-detection could be used to evaluate the success of therapeutic trials where trypanosome detection tests may fail to pick low patent infections.


Child morbidity and mortality due to cerebral malaria in Brazzaville, Congo. A retrospective and prospective hospital-based study 1983-1989.

This study was conducted in all four hospitals of Brazzaville, the capital of the Congo in order to assess the trend in malaria morbidity, the frequency of cerebral malaria and the related mortality between 1983 and 1989 in Brazzaville children. For the period 1983 to 1987 the study was retrospective, based on records. For the period 1988 and 1989 a prospective study was carried out in the two main hospitals in which a system for reporting cases of cerebral malaria was set up. This was completed by a retrospective analysis of data similar to that carried for the previous years. The population of Brazzaville children aged between 0 and 14 years and the distribution by district were estimated from the 1984 official census taking the annual demographic growth to be 5%. The results show a marked increase in hospitalizations for malaria, noticeable since 1985, and which now account for about 50% of the overall non-surgical hospitalizations. The number of cases of cerebral malaria and related deaths have probably increased. However, these severe forms of malaria were relatively rare. Indeed, in 1988 and 1989, for the 0-4, 5-9 and 10-14 year age groups, the annual incidence rates of cerebral malaria were estimated at respectively 240, 61 and 13 per 100,000 and the related mortality rates at respectively 58, 5 and 1 per 100,000. No obvious relationship was found between the intensity of malaria transmission, which varied considerably according to the district, and the level of mortality from cerebral malaria.


Infant and child mortality and malaria in the Congo. The trend in the suburbs of Brazzaville between 1981 and 1988.

This survey was carried out on a cohort of children born between 1st January 1981 and 30th June 1987 in the maternity department of the hospital in Linzolo, a village situated 25 km south-west of Brazzaville, the capital of the Congo. The mothers of the children resided in the suburbs of Brazzaville at the time of delivery. In this region, the rate of transmission of Plasmodium falciparum malaria is high without marked seasonable variations. The mothers and children were traced in the second quarter of 1989 in order to assess the rates and, where possible, the causes of mortality. Information on 75% of the recorded births (2424 children) was obtained directly by interviewing the mothers in the home. Between 1981 and 1988, the infant mortality rate varied overall between 33 and 52 per thousand, and in the 1-2 year age group, between 7 and 25 per thousand (1981 to 1987). The number of deaths attributable to malaria was relatively low although resistance to amino-4-quinolone is well established since 1985. During this period, no particular trend was observed in the mortality at 0-2 years, or at 0-5 years.


Plasmodium vivax and P. falciparum epidemiology in Gambella, south-west Ethiopia.

Plasmodium vivax and P. falciparum epidemiology were studied for parasitological and entomological samples collected during the period 1989 and 1990, respectively, from Gambella, South West Ethiopia. Of the total population examined (n = 1091), 147 (13.5%) were found to be positive for malaria parasites. Prevalence rates among males and females were 13.8% and 13.1%, respectively. Differences in the prevalence rates of malaria in the eleven villages were observed, the highest (33.3%) being in Ukuna 2 and the lowest (3.9%) in Ukuna 22. The dominant species of malaria found were both P. falciparum and P. vivax. 88.9% and 11.1% of the malaria cases of the general population were due to these parasites, respectively. It was also recognized that P. falciparum and P. vivax were prevalent in 81.6% and 18.4% of the Anuak population, respectively. The mosquito species responsible for malaria transmission were the indoor-resting A. gambiae s. l. and A. pharoensis. The parasite infection rates of these species were 0.76% and 0.46% and they were found to be the exclusive vectors of P. falciparum and P. vivax, respectively. The present findings are not in accord with the study results previously reported twenty years ago by Armstrong (1972) and Krafsur (1971). The most probable contributing factors for such switch of malaria transmission patterns were, the rehabilitation and resettlement programmes and agricultural activities undertaken in Gambella for the past 10 years that may have brought changes of the socio-economic situation and environmental factors.


Detection of Bartonella bacilliformis in cultures, blood, and formalin preserved skin biopsies by use of the polymerase chain reaction.

A polymerase chain reaction (PCR) is described for the detection of Bartonella bacilliformis, the etiologic agent of bartonellosis, which cannot be identified biochemically. Amplification of a genomic 231 bp Bartonella DNA sequence permitted specific identification of 12 Bartonella isolates from Peruvian bartonellosis patients as well as detection of Bartonella DNA in blood samples and formaldehyde preserved skin biopsies. Specificity of amplification products was confirmed by restriction fragment analysis. No positive results were obtained with Brucella abortus, phylogenetically closely related to B. bacilliformis, and several other bacterial, fungal, and protozoal species. PCR appears as a promising technique for specific identification of B. bacilliformis in cultures and in clinical materials with further applications in taxonomic studies and in the investigation of Bartonella-like isolates obtained outside South America.


A bioassay for derivatives of qinghaosu (artemisinin).

A sensitive bioassay was developed for measuring the serum antimalarial activity for qinghaosu (artemisinin) derivatives. This should assist in the formulation of optimum regimens for the treatment of P. falciparum malaria.


Susceptibility of African isolates of Plasmodium falciparum to artemisinin (qinghaosu).

We studied in vitro susceptibility of 79 African strains of Plasmodium falciparum to artemisinin, chloroquine, quinine, mefloquine and halofantrine and the potential cross-resistance among the drugs. Most strains presented an 50% inhibitory concentration (IC50) of artemisinin below 26 nmol/liter. A positive correlation between IC50S of artemisinin and those of quinine, mefloquine and halofantrine was observed. Cross resistance between artemisinin and other antimalarials may limit its use as a replacement drug.


Is the prevalence of HTLV-1 infection higher in Strongyloides carriers than in non-carriers?

To assess the concomitance of strongyloidiasis and HTLV-1 infection, an epidemiological survey was conducted in Okinawa, Japan, using the agar-plate culture, a highly sensitive method for detection of Strongyloides stercoralis. No significant difference in the positive rate of anti-HTLV-1 antibody was found between Strongyloides carriers and non-carriers. This result suggests that these two infections occur independently.


Isolation of an immunodiagnostic Taenia solium coproantigen.

Antigens of Taenia solium can be demonstrated by ELISA technique in stool samples of tapeworm carriers. In order to isolate these immunodiagnostic components from stool, fecal samples of known T. solium carriers were subject to chromatographic purification procedures: immunoaffinity chromatography and a subsequent two-step high performance liquid chromatography yielded a 60-kDa protein that was shown to react in a Western blot with polyclonal anti-T. solium IgG. The protein isolated appeared to be the major antigenic component excreted with the feces of parasite hosts.


[Development of reference standards for preferential evaluation of odors].

The easy to handle and usefull portable standard for hedonic judgement of odors should consist of 5-6 microencapsulated various odorants to comparisons with evaluated odor in practice. In present study the 14 odorants were investigated on purpose to select the 6 ones. The group of judges was engaged and each odorant several times was classified as more or less unpleasant then one from 13 others. The set of individual preference relations was analyzed by two ways. First, the best acceptable sequence of all 14 considering odorants was computed and divided into 6 clusters. The single optional representative of each cluster was included in designed standard. The alternative approach bases on the best acceptable sequences of only 6 odorants from 14 considering ones. Thus, circa 50 primary solutions were obtained. Then the elimination from practical and medical points of view were executed and finally two follow standards are recommended: 1) anethole, 2) n-butyl alcohol, 3) acetone, 4) tetralin or indole, 5) isobutyric acid, 6) 2-mercaptoethanol.


[Comparison of results for evaluating calcium and phosphorus content in children's daily diets obtained by analytical methods and calculations].

The results of two methods for the estimation of calcium and phosphorus in daily rations of children aged up to 1 year were compared by simple statistical tests. Ca and P contents were determined by the analytical method; moreover, the theoretical Ca and P contents were calculated from the bills of fare menus and food composition tables. The analytical procedure was accepted as reference method. Ca and P contents determined by the analytical method accounted, on the average, for ca. 90% of those obtained by the calculation method. The coefficients of correlation between the results obtained by both methods (x and y) amounted to: rCa = 0.456 and rP = 0.786. There were significant differences between Ca and P contents obtained by both methods at significance level alpha = 0.05.


[Nutritive value of daily food rations reproduced in several regions of Poland. Part VII. Evaluation of cobalt, chromium, nickel and selenium intakes].

On the basis of the data of the Chief Census Bureau, concerning the consumption of more than 80 food products, we reproduced in years 1987 and 1988 in Lublin, Olsztyn, Poznań, Warszawa and Wrocław the food rations characteristic of manual workers' families and of other families with medium incomes. In samples of these diets, chromium, cobalt and nickel were determined by the ASA method, and selenium-spectrophotometrically. Daily intakes were: for cobalt 15-32 micrograms, chromium 65-187 micrograms, nickel 138-316 micrograms and selenium 93-233 micrograms. It was found that the investigated food rations cover the requirements of these elements, and create no risk of their excess in food. The present results indicate that the levels of the investigated elements are mainly related to the kind of food products and to their composition, whereas they depend to a lesser extent on the region in which the food ration has been reproduced.


[Studies about the values of polycyclic aromatic hydrocarbons in oils used in production of plant protective agents].

Determination of polycyclic aromatic hydrocarbons (PAH) contents in oils used in agriculture and forestry as additives to plant protection agents was made. PAH were isolated from oil samples by column chromatography, and TLC was applied for their identification and determination. PAH (fluoranthene, perylene, phenanthrene) were present in three oil samples, whereas they were not detected in three subsequent samples. The sensitivity of the method is +/- 0.1 ppm.


[The effect of selected xenobiotics and low protein diet on reproduction and offspring of rats. Part I. The course and condition of rat exposure to tobacco smoke].

The effect of tobacco smoke and low-protein diet on rat reproducibility and offspring was investigated in six litters of white rats. Smoke concentration was controlled by determining the air carbon oxide content which averaged 1000 mg/m3. During the experiments blood carboxyhemoglobin level was measured; by the end of exposure, each generation displayed closely similar concentrations amounting to 23.9-26.6%. There were no diet-related differences in blood carboxyhemoglobin concentrations.


[The effect of carbaryl poisoning on noradrenaline (NA) levels in rat brain].

The influence of acute (50% and 20% LD50), subacute (10% LB50) and 12-week (5% LD50) intoxication with carbaryl on NA level in rat brain was investigated. The level of NA was decreased by about 40% of the control level (p > 0.001) after acute and subacute intoxication. In the subchronic study (5% LD50 for 12 weeks) carbaryl significantly decreased the NA level (p < 0.001), but after 2-week intoxication only. During the next weeks NA content remained on control level (p > 0.05). These results indicate that carbaryl causes noradrenergic alterations in rat brain, which may lead to neurotoxic action.


[Combined effect of administering amberlite 252 together with hydrocortisone or diuretics on elimination of radiocesium from the rat].

It was shown that diuretics: diuramid and furosemide enhance elimination of radiocesium by organic ion exchanger Amberlite 252 from the rat. Administration of Amberline 252 together with hydrocortisone is more effective in radiocesium elimination than administration Amberline only. Using mentioned-above agents 2 hours after administration of radiocesium and even 9 days after contamination cause significant reduction of radioisotope retention period in rat organism.


[Attempts at measuring low radioactivity using a Tristan-1024 spectrometer].

A method for measurement of cesium and potassium-40 in environmental samples with the use of a gamma Tristan-1024 spectrometer was presented. The method involves taking into account the influence of the Compton effect on the shape of the observed spectrum, and then counting of the impulses in appropriate energetic intervals. The results showed that it is possible to rapidly measure K-40 activities exceeding 30 Bq/kg as well as the activities of Cs-137 and Cs-134 isotopes of an order of several Bq/kg in so-called "fresh" sample, with no need for applying expensive preparative treatment. The low cost of measurements, as compared with radiochemical methods, is an advantage of the presented method.


[Determination of raffinose type sugars in seeds of leguminous plants by high pressure liquid chromatography (HPLC)].

A method was developed for the determination of galacto-sugars: raffinose, stachiose and verbascose, in bean and broad bean seeds by high-pressure liquid chromatography. The effect of various concentrations of the ethanolic extraction solvent and of other solutions (methanol and acetonitrile) on the effectiveness of sugar extraction from bean was investigated. The optimal composition of the mobile phase was established. It was found that the effectiveness of raffinose and stachiose extraction from bean seeds was highest when 40-60% ethanol was the extraction solvent, and when the proportion of bean to the extraction solvent by weight was 2:25. The presented HPLC technique, as compared with gas chromatography, allows for threefold shortening of the duration of one chromatographic analysis.


[Determination of histamine content in canned fish products determined by the colorimetry method of Hardy and Smith].

The content of histamine in 79 samples of imported canned fish products (sardines, mackerel) was determined. Histamine was assayed by colorimetric method of Hardy and Smith. In 18% of tested products (sardines) levels of histamine were exceeded 20 mg/100 of product. Usefulness of this method in routine quantitative determination of histamine content in canned fish products was documented.


[Evaluation of school noise by teachers and assessment of its effect on health and general feeling].

Internal noise related mainly to the activities and overcrowding of schools is the main source of teachers' discomfort. It causes negative feelings and generates various hindrances at work in 80.2% of women and 67% of men. for a substantial part of the teachers' milieu (42.1% of women and 32.3% of men), noise is the dominant element among the whole complex of adverse professional factors. In schools with a higher noise level, the number of teachers assessing negatively the acoustic climate of schools increases, and the intensity of discomfort is enhanced. This is associated with awareness of excessive vocal effort, as well as with intensification of discomfort symptoms and of negative emotions. The group of teachers working under more adverse acoustic conditions is characterized by higher incidence of irritation states, deconcentration of attention, sleepiness, tiredness, depression and headaches. Moreover, there are symptoms on the part of the cardio-vascular, upper respiratory and digestive system, as well as signs of neurosis. Some of these health problems are intensified in smokers.


[Hygienic and health conditions at scout camps].

In 1990, 230 scout camps organized throughout the whole of Poland (except for the Legnica and Lódź voivodeships) were inspected. In co-operation with the staff of the children's and youth hygiene departments of the provincial sanitary-and-epidemiological stations, the data concerning the hygienic and health conditions at scout camps collected. Moreover, information on medical care, health state and nutrition at these camps was obtained. The data showed that in the period under survey, despite some exceptions, the hygienic and health conditions at scout camps could be regarded as satisfactory, when making allowances for the current limited organizing, financial and staff-related possibilities of scouting. In the present difficult economic situation of Poland, when the standard of living of many families is low, special attention has to be given to balanced nutrition of children, which is decisive of their normal psychophysical development.


Endothelin reduces blood flow in experimental skin flaps.

An island buttock flap based on the deep circumflex iliac artery and vein was raised in four pigs. Cutaneous laser Doppler blood flow (LDF) and total venous outflow (VO) from the flaps were measured. Intra-arterial infusion of endothelin-1 (0.3-2.5 nmol) through a branch of the deep circumflex iliac artery induced a pronounced and long lasting decrease in both LDF and VO. The maximal mean reductions being 95.3% and 73%, respectively, were seen within 5 minutes of the infusion. Intra-arterial infusions of endothelin in the circumflex iliac artery on the contralateral side caused a considerable reduction in intact skin LDF. Endothelin has potent vasoconstricting properties and its possible release and effect must be considered in reconstructive surgery.


Dependence of traumatic vasospasm on blood flow in the central artery of the ear in rabbits.

The effect of total obstruction of blood flow on traumatically induced vasospasm was studied in the central arteries of rabbits' ears. All side branches were ligated along a 7 cm segment of the artery. Obstruction of blood flow was achieved by ligation of the central artery distal to this segment. The inner diameter of the artery was measured microscopically after transillumination. A standardised injury was induced with a clip applying forceps. The duration, intensity (reduction of diameter) and severity (integrated change in diameter over time) of the resulting spasm were assessed. Spasm induced after cessation of blood flow lasted significantly less time (mean (SEM), 6.0 (2.0) minutes compared with 18.1 (2.5) min) and was less severe than spasm induced when the blood flow was intact (1.6 (0.6) mm/min compared with 6.2 (0.6) mm/min). The results may be explained by local accumulation of vasodilating substances in the injured segment of the vessel in the absence of blood flow.


Reduction of capsular formation around silicone breast implants by D-penicillamine in rats.

In a controlled study in 109 female rats we evaluated the effect of soluble D-Penicillamine in doses of 10 mg/ml or 100 mg/ml on capsular formation around semipermeable 2 cm3 mini-prostheses. This was compared with methylprednisolone 1 mg/ml or 10 mg/ml, and a group given saline served as controls. The drugs were injected into the lumen. Capsular wet weight and capsular tensile strength were measured after a period of 40 days. Rats given D-Penicillamine showed a significant, dose-dependent, reduction in wet weight and tensile strength compared with the saline group. There was no significant difference between the groups given D-Penicillamine and those given steroids. Topical treatment with diffused D-Penicillamine can significantly reduce the amount of capsular formation around silicone implants. This drug, which is highly specific for the systemic treatment of fibrotic diseases, should be evaluated further to use in reducing capsular formation.


Intercalary flexor tendon grafts. A morphological study of intrasynovial and extrasynovial donor tendons.

Intercalary intrasynovial and extrasynovial flexor tendon graft donors were placed within the synovial sheaths of the medial and lateral forepaw digits of 22 dogs and treated with early controlled passive mobilization. Specimens were studied by light and transmission electron microscopy at 10 and 21 days. Early repair in the extrasynovial tendons occurred by an ingrowth of connective tissue from the digital sheath. Adhesions obliterated the gliding surface and occupied the space between the tendon's gliding surface and surrounding tissues. There was no epitenon response noted in the extrasynovial tendon grafts. While there was considerable new collagen fibril formation within the repair site at the ultrastructural level, there was a lack of longitudinal remodeling. In contrast, the intrasynovial tendon grafts showed early healing, with minimal adhesion formation, by a proliferation and migration of cells from the epitenon. These cells showed greater cellular activity and collagen production at 10 and 21 days compared to cells in extrasynovial tendons at the same intervals. The findings of this study suggest that the use of intrasynovial autogenous tendon graft donors, coupled with early controlled motion, stimulates an intrinsic repair process in both the tendon stump and autogeneous tendon graft. These findings differ significantly from the experimental findings in which extrasynovial, paratenon-covered grafts are used.


Reinnervation of muscles in rats after repair of transsected sciatic nerves with Y-shaped and X-shaped silicone tubes. Muscle reinnervation after nerve repair.

Reinnervation of the gastrocnemius and anterior tibial muscles was assessed by measurements of tetanic force after repair of sciatic nerves with Y-shaped or X-shaped silicone tubes in rats. The transsected proximal stump of either the tibial or the peroneal fascicle was introduced into the opening of a Y-shaped silicone tube, or both fascicles were introduced into an X-shaped tube. The distal tibial and peroneal fascicles were inserted into the distal outlets of the tubes leaving a gap of 4 mm between proximal and distal stumps. In the X-shaped tubes the proximal inserts were placed opposite or adjacent to their respective distal parts. Sixteen weeks later reinnervation was evaluated by measurements of tetanic force of the gastrocnemius and anterior tibial muscles after electrical stimulation of the fascicles. There was preferential reinnervation in both types of tubes. In Y-shaped tubes about 90% of the tetanic force could be recorded from both muscles after stimulation of the peroneal and tibial fascicles, respectively. Recovery was lower in the X-shaped tubes, amounting to about 75%. Contractions evoked by misrouted fibres were similar (roughly 40%) in both models. We conclude that motor axons preferentially, but not exclusively, selected a path to reinnervate their original target muscle.


Pain drawing as an investigative tool in hand surgery.

Fifty consecutive patients referred to the departments of hand surgery in Malmö and Lund were asked to chart their pain on a diagram of the body before their first visit to the clinic. Three patients never answered the questionnaire and were excluded. The drawings were evaluated separately by a senior hand surgeon without access to the case records. In 19 of 47 cases (40%) the evaluation of the pain drawings agreed with the clinical diagnosis. In another 17% (8 of 47), in which the pain drawings had indicated a condition not related to hand surgery, clinical examination failed to establish a diagnosis. The evaluation of the drawings had a false negative rate of 4% (2 of 47). In the remaining 18 cases pain drawings did not give enough information for diagnosis because of the variety of symptoms. Pain drawing seems to be valuable in the evaluation of patients with chronic pain in the upper extremity.


Dimensions of capsular collagen fibrils: image analysis of rapid compared with slow tissue expansion for breast reconstruction.

Thirty women who were to undergo breast reconstruction by tissue expansion were randomly divided into two groups. Those in the first group were to undergo expansion once a day (rapid expansion) and the second group once a week (slow expansion). When the expanders were replaced by permanent prostheses, biopsy specimens were taken from the capsules around the expanders, and were examined by transmission electron microscopy at a magnification x 22,000. The diameters of the collagen fibrils in the capsules were analysed by an interactive image analysis system and measured. An analysis of variance was performed on a test series to optimize the sample. Ninety fibrils from each patient (two patients were excluded), were analysed and there were no significant differences in collagen fibrillar diameters (about 50 nm) between those who had undergone rapid or slow expansion, or between patients who had also undergone radiotherapy to the chest wall and those who had not. These results indicate that the collagen fibrils may still be in a transitional stage, and that further longer term studies are desirable. It is difficult, however, to see how they could be justified ethically in patients who are otherwise well.


Melanoma of palms, soles, and nail-beds.

The clinical and histological characteristics of palmar, plantar, and subungual melanomas treated in the division of plastic surgery of Helsinki University Hospital between 1970 and 1984 were analysed. The peak incidence was during the seventh decade of life, and the mean delay between the onset of symptoms and the diagnosis was one year. The delay was as much the fault of the physician as of the patient. The observed and relative five-year-survival rates for all 31 patients were 60% and 67%, and the 10-year-survival rates 39% and 49%, respectively. There were 15 cases of the acral lentiginous subtype, and the observed and relative five-year-survival rates were 65% and 71%, and the 10-year-survival rates 48% and 64%, respectively. For the nodular melanomas (n = 11) the survival rates were 53% and 60%, and 39% and 53%, respectively. For the three superficial spreading melanomas they were 50% and 52%, and 25% and 28%, respectively. Microstaging criteria (Breslow and Clark) were both good prognostic indicators. The series was too small for multivariate analysis.


Magnetic resonance imaging in the assessment of craniosynostosis.

Modern interest in craniosynostosis began when clinicians, regardless of their individual specialty but united in their interest in the problems raised by patients with this condition, first realised that if treatment was confined simply to opening up the fused sutures of the skull vault, success in terms of both function and the restoration of a more normal appearance was likely to be limited. Indeed, the grouping together of such specialists into formal craniofacial units was tacit recognition of this, as was the acceptance that many affected children had evidence of clinical problems that could not be explained on simple mechanical grounds alone. It is not surprising, therefore, that the advent of any new method of investigation has been welcomed by craniofacial surgeons eager to learn anything that might lead to an improvement in management, particularly of the more complex syndromes.


Nasalance scores in patients with a modified Honig velopharyngeal flap before and after operation.

Nasalance scores were measured with a model 6200 Nasometer in 28 patients with cleft palates and 8 patients with signs of velopharyngeal insufficiency but no cleft palate, both before and after a modified Honig velopharyngeal flap operation. The nasalance measurements were compared with subjective speech assessments. Patients were assessed as normal or borderline if their scores were < 30, and as having hypernasal speech if the score was > 29. The overall scores were improved by operation from a mean (SD) of 47 (13) to 26 (12). It was concluded that a modified Honig velopharyngeal flap is effective in eliminating hypernasality as defined by the nasalance scores.


Tongue posture in cleft palate patients with a pharyngeal flap.

Position of the tongue was studied in lateral cineradiographic pictures of 15 patients with cleft palate and velopharyngeal incompetence, and from ten unaffected reference subjects. The patients were examined before and after pharyngoplasty. Before operation there was no difference in the degree of tongue/velum contact between the patients and the reference subjects, but after the operation, contact was lost in 13 of the 15 patients because the tongue was lowered and the velum raised by the pharyngeal flap. This contradicts the previous theory that the position of the tongue should be expected to be higher to maintain the posterior oral seal. The tongue was in a more posterior position in the patients than in the reference subjects both before and after operation. After operation the tip of the tongue retracted into the anterior oral cavity. The posterior and downward change in position of the tongue may account for part of the posterior and downward growth pattern of the lower third of the face which occurs in children after pharyngoplasty. A loss of tongue-lip balance around the premaxilla may be one of the factors that causes the maxillary retrusion that has been reported after pharyngoplasty in patients with cleft palates.


Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to three different regimes. Assessment of nasolabial appearance.

From extraoral photographs taken from the front and in profile of 61 16-year old children with unilateral cleft lip, alveolus, and palate (UCLAP) who had been treated by three different treatment regimes, the nasolabial appearances were assessed by a panel. The photographs were masked, leaving only the mid face including the nose and lips. The following features were assessed using a five point scale: nasal form, symmetry of the nose, vermilion of the upper lip, shape of the vermilion border, total symmetry of upper lip, and nasal profile including the upper lip. The number and type of secondary operations required were recorded. Intraobserver reliability was good but interobserver agreement was poor, some observers systematically scoring more severely than others. A panel of six was therefore set up to establish an acceptable mean assessment. The treatment regime that included secondary bone grafting, and the one that included primary bone grafting and presurgical orthopaedic-T-traction, scored better on all features assessed compared with the group that underwent primary bone grafting but no T-traction. The latter group required fewer secondary revisionary procedures, however, which could explain these results.


Clinical results in 87 patients treated for asymmetrical breasts. A follow-up study.

A retrospective study was made of 87 patients operated on between 1984 and 1990 for asymmetrical breasts. Thirty-two patients had 36 implants (13 also had breast reduction or mastopexy of the contralateral breast). Capsular contraction, Baker grade II-IV, was found in a third of the implants. The remaining 54 patients underwent reduction mammaplasty or mastopexy alone. 90% of the patients were satisfied with the result. There was no significant difference in the overall satisfaction between the patients who did or did not have implants. We nevertheless think that mammary implants should be avoided whenever possible in the correction of breast asymmetry. Even though there is no difference in patients' satisfaction, it is our experience that those with implants have more frequent follow-up consultations and are subject to more postoperative procedures than those corrected without implants.


Vulvar reconstruction with an abdominal flap.

There are many procedures for vulvar reconstruction after excision for cancer. The aim of which is to provide cosmetic and functional results with minimal secondary deformity. A patient presented with gross fibrous contracture and vaginal ectropion after radical vulvectomy and groin dissection for cancer. We used the pendulous lower abdominal tissue to reconstruct the vulva and mons pubis. There was no secondary deformity.


An unusual cause of carpal tunnel syndrome. Case report.

A 38 year old woman with carpal tunnel syndrome of the right hand was treated with operative decompression, initially successfully. Subsequently, she developed a compartment syndrome after an injury. On re-exploration, an accessory palmaris longus muscle was encasing the median nerve at the distal forearm and passing through the flexor sheath, underneath the flexor retinaculum, inserted into the deep palmar fascia.


Application of BANA during experimental gingivitis. Application of N-alpha-benzoyl-DL-arginine 2 naphtilamide (BANA) hydrolysis to identify periodontopathic environments during experimental gingivitis in man.

This study evaluates the accuracy of the PerioScan reagent card kit which uses BANA hydrolization to detect the presence of P. gingivalis, T. denticola, and B. forsythus in dental plaque during an experimental gingivitis in man. 32 healthy subjects underwent a phase of optimal oral hygiene before they abolished all oral hygiene practices for 21 days, but rinsed twice daily with a slurry of three different toothpastes. On days 0, 7, 14, and 21, full mouth Plaque and Gingival Index scores were assessed and, in addition, on days 0 and 21, sulcular plaque samples were obtained from the mesiobuccal aspects of the second premolars. The samples were placed on BANA reagent cards (PerioScan), and the result of the trypsin-like activity read after 15 minutes. Subsequently, the samples were processed for the detection of P. gingivalis, T. denticola and B. forsythus using ELISA. The Gingival Indices on day 21 indicated a development towards gingival inflammation. The frequencies of detection of the three periodontopathogens revealed by ELISA showed increased presence of P. gingivalis, B. forsythus and T. denticola on day 21. Changes in the composition of the microbiota were also indicated by the higher rate of positive BANA results at the end of the experimental gingivitis. Without considering further clinical diagnostic tests such as "bleeding on probing", this clinically simple test does not provide a prognostic indicator for the eventual onset of disease in cases with gingival inflammation. However, specificity was only 61% and the sensitivity was 41.7%.


[The microbial colonization of implant elements made of plastics and titanium].

12 edentate subjects wearing lower complete dentures stabilized by an IMZ-implant-supported Dolder bar took part in the experiment. Elastic (POM) and titanium connection parts were alternatingly inserted. After the removal of 24 POM and titanium elements from each of the patients, a qualitative analysis of the microbial flora was performed. Except for actinomycetes, aerobic as well as anaerobic microorganisms were found less frequently with titanium than with POM elements.


[The therapy of the postextraction syndrome with Taurolin. A controlled clinical study].

In a controlled clinical study with a total of 200 patients the broad spectrum agent and antitoxin taurolidine (Taurolin) was clearly superior to conventional medication with the broad spectrum antibiotic chlortetracycline (Aureomycin) when applied topically to treat the postextraction syndrome. Thus, the mean duration of therapy (primary target criterion) with Taurolin (group A) was 5.6 days compared to 8.2 days with the standard therapy (group B). In statistical terms this difference was highly significant (p < 0.0001). Compared with the conventionally treated patient group, the clinical control parameters such as pain, swelling, secretion, tenderness to pressure and remission (secondary target criteria) in the Taurolin group exhibited not only a markedly more rapid normalisation of the score-data during the initial phase, but also an appreciably shorter interval until the patients were symptom-free. Age, gender, localisation of the lesion or facultative systemic antibiotic or analgetic administration had no demonstrable effect on the course of the treatment, although the patients in the reference group required concomitant medication with antibiotics (p = 0.007) and analgetics (p = 0.01) considerably more often than those in the Taurolin group.


[Caries intensity in Turkish children in Germany and in Turkey].

This study compares oral hygiene, dental care, dietary habits and caries prevalence among German and Turkish children in Germany with the Turkish children in Turkey. Although German children have better oral hygiene and dental care habits than the Turkish children, the caries prevalence of the Turkish children in Turkey is significantly lower because of their dietary habits.


[Acute lead poisoning in calves: clinical, pathological and toxicological findings].

We present a case of acute lead poisoning in 10 calves. All calves died with few or no clinical signs prior to death. The clinical signs included neurologic and gastrointestinal symptoms but were of an unspecific nature. Several painted iron girders, stored on a field close to the farm, were determined as the source of the poisoning. Postmortem findings were minimal. Some animals presented acid-fast, intranuclear inclusion bodies in the renal tubules. A chemical analysis of some frozen parts of the liver and kidney revealed levels of lead as high as 12 ppm in the liver and 63 ppm in the kidney on a wet-weight basis. This article discusses the etiology, clinical signs, postmortem findings and diagnosis of lead poisoning in calves with special emphasis on the chemical analysis.


[Clinico-chemical blood parameters in foals in the first two months of life].

Eighteen healthy foals were studied from birth until 2 months of age. Blood samples were obtained at the following times: presuckle, 30 hours, 1, 3, 5, 7 and 9 weeks of age. Changes in serum P, Mg, Ca, Na, K, Cl, iron, AP, ASAT, ALAT, GGT, GLDH, CK, lipase, urea, creatinine, cholesterol, triglyceride, uric acid, protein and fibrinogen and in plasma total solids were examined and the values compared to reference values of adult horses. There were characteristic age related changes in several parameters. Single measurements should be interpreted cautiously to allow for individual variations.


[An outbreak of infectious chicken anemia in fattening chickens in Switzerland].

An outbreak of infectious anaemia in 46 broiler flocks due to chicken anaemia agent (CAA) is described. The vertically acquired infection led to increased mortality (3.6-19.8%) in 16 to 24 day-old broiler chickens. At necropsy severe atrophy of thymus and anaemia with pale bone marrow was observed. The histologic findings were depletion of cortical thymocytes and of hematopoietic cells in the bone marrow. The CAA was isolated from 15 of 35 examined broiler flocks.


Selection of a ribozyme that functions as a superior template in a self-copying reaction.

The sunY ribozyme is derived from a self-splicing RNA group I intron. This ribozyme was chosen as a starting point for the design of a self-replicating RNA because of its small size. As a means of facilitating the self-replication process, the size of this ribozyme was decreased by the deletion of nonconserved structural domains; however, when such deletions were made, there were severe losses of enzymatic activity. In vitro genetic selection was used to identify mutations that reactivate a virtually inactive sunY deletion mutant. A selected mutant with five substitution mutations scattered throughout the primary sequence showed greater catalytic activity than the original ribozyme under the selection conditions. The sunY ribozyme and its small selected variant can both catalyze template-directed oligonucleotide assembly. The small size and reduced secondary structure of the selected variant results in an enhancement, relative to that of the original ribozyme, of its rate of self-copying. This engineered ribozyme is able to function effectively both as a catalyst and as a template in self-copying reactions.


Components of sterol biosynthesis assembled on the oxygen-avid hemoglobin of Ascaris.

The parasitic nematode Ascaris infests a billion people worldwide. Much of its proliferative success is due to prodigious egg production, up to 10(6) sterol-replete eggs per day. Sterol synthesis requires molecular oxygen for squalene epoxidation, yet oxygen is scarce in the intestinal folds the worms inhabit. Ascaris has an oxygen-avid hemoglobin in the perienteric fluid that bathes its reproductive organs. Purified hemoglobin contained tightly bound squalene and functioned as an NADPH-dependent, ferrihemoprotein reductase. All components of the squalene epoxidation reaction--squalene, oxygen, NADPH, and NADPH-dependent reductase--are assembled on the hemoglobin. This molecule may thus function in sterol biosynthesis.


Cryobiological preservation of Drosophila embryos.

The inability to cryobiologically preserve the fruit fly Drosophila melanogaster has required that fly stocks be maintained by frequent transfer of adults. This method is costly in terms of time and can lead to loss of stocks. Traditional slow freezing methods do not succeed because the embryos are highly sensitive to chilling. With the procedures described here, 68 percent of precisely staged 15-hour Oregon R (wild-type) embryos hatch after vitrification at -205 degrees C, and 40 percent of the resulting larvae develop into normal adult flies. These embryos are among the most complex organisms successfully preserved by cryobiology.


Cellular proteins bound to immunodeficiency viruses: implications for pathogenesis and vaccines.

Cellular proteins associated with immunodeficiency viruses were identified by determination of the amino acid sequence of the proteins and peptides present in sucrose density gradient-purified human immunodeficiency virus (HIV)-1, HIV-2, and simian immunodeficiency virus (SIV). beta 2 microglobulin (beta 2m) and the alpha and beta chains of human lymphocyte antigen (HLA) DR were present in virus preparations at one-fifth the concentration of Gag on a molar basis. Antisera to HLA DR, beta 2 m, as well as HLA class I precipitated intact viral particles, suggesting that these cellular proteins were physically associated with the surface of the virus. Antisera to class I, beta 2m, and HLA DR also inhibited infection of cultured cells by both HIV-1 and SIV. The specific, selective association of these cellular proteins in a physiologically relevant manner has major implications for our understanding of the infection process and the pathogenesis of immunodeficiency viruses and should be considered in the design of vaccines.


Protective effects of a live attenuated SIV vaccine with a deletion in the nef gene.

Vaccine protection against the human immunodeficiency virus (HIV) and the related simian immunodeficiency virus (SIV) in animal models is proving to be a difficult task. The difficulty is due in large part to the persistent, unrelenting nature of HIV and SIV infection once infection is initiated. SIV with a constructed deletion in the auxiliary gene nef replicates poorly in rhesus monkeys and appears to be nonpathogenic in this normally susceptible host. Rhesus monkeys vaccinated with live SIV deleted in nef were completely protected against challenge by intravenous inoculation of live, pathogenic SIV. Deletion of nef or of multiple genetic elements from HIV may provide the means for creating a safe, effective, live attenuated vaccine to protect against acquired immunodeficiency syndrome (AIDS).


Targeted degradation of c-Fos, but not v-Fos, by a phosphorylation-dependent signal on c-Jun.

The proto-oncogene products c-Fos and c-Jun heterodimerize through their leucine zippers to form the AP-1 transcription factor. The transcriptional activity of the heterodimer is regulated by signal-dependent phosphorylation and dephosphorylation events. The stability of c-Fos was found to also be controlled by intracellular signal transduction. In transient expression and in vitro degradation experiments, the stability of c-Fos was decreased when the protein was dimerized with phosphorylated c-Jun. c-Jun protein isolated from phorbol ester-induced cells did not target c-Fos for degradation, which suggests that c-Fos is transiently stabilized after stimulation of cell growth. v-Fos protein, the retroviral counterpart of c-Fos, was not susceptible to degradation targeted by c-Jun.


Isolation and structure of a brain constituent that binds to the cannabinoid receptor.

Arachidonylethanolamide, an arachidonic acid derivative in porcine brain, was identified in a screen for endogenous ligands for the cannabinoid receptor. The structure of this compound, which has been named "anandamide," was determined by mass spectrometry and nuclear magnetic resonance spectroscopy and was confirmed by synthesis. Anandamide inhibited the specific binding of a radiolabeled cannabinoid probe to synaptosomal membranes in a manner typical of competitive ligands and produced a concentration-dependent inhibition of the electrically evoked twitch response to the mouse vas deferens, a characteristic effect of psychotropic cannabinoids. These properties suggest that anandamide may function as a natural ligand for the cannabinoid receptor.


Direct visualization of the dendritic and receptive fields of directionally selective retinal ganglion cells.

Optical methods were used to locate the cell bodies of directionally selective ganglion cells in isolated rabbit retinas. These neurons detect the direction in which images move across the retinal surface and transmit that information to the brain. The receptive field of each identified cell was determined, after which the cell was injected with Lucifer yellow. An image of the receptive field border was then projected onto the fluorescent image of the dendrites, allowing precise comparison between them. The size of the receptive field matched closely the size of the dendritic arbor of that cell. This result restricts the types of convergence that can be postulated in modeling the mechanism of retinal directional selectivity.


Prevention of programmed cell death in Caenorhabditis elegans by human bcl-2.

Programmed cell death is a physiological process that eliminates unwanted cells. The bcl-2 gene regulates programmed cell death in mammalian cells, but the way it functions is not known. Expression of the human bcl-2 gene in the nematode Caenorhabditis elegans reduced the number of programmed cell deaths, suggesting that the mechanism of programmed cell death controlled by bcl-2 in humans is the same as that in nematodes.


Neutrophil recruitment by tumor necrosis factor from mast cells in immune complex peritonitis.

During generalized immune complex-induced inflammation of the peritoneal cavity, two peaks of tumor necrosis factor (TNF) were observed in the peritoneal exudate of normal mice. In mast cell-deficient mice, the first peak was undetected, and the second peak of TNF and neutrophil influx were significantly reduced. Antibody to TNF significantly inhibited neutrophil infiltration in normal but not in mast cell-deficient mice. Mast cell repletion of the latter normalized TNF, neutrophil mobilization, and the effect of the antibody to TNF. Thus, in vivo, mast cells produce the TNF that augments neutrophil emigration.


Coagulation abnormalities in malignancy: a review.

As outlined in this review, patients with cancer may harbor many alterations of hemostasis. These are multifaceted and must be taken into account when trying to control hemorrhage or thrombosis in cancer patients. Often, hemorrhage or thrombosis is the final fatal event in many patients with metastatic solid tumor or hematologic malignancies. Patients with malignancy present a major clinical challenge in this new era of oncologic awareness and more aggressive care, which has led to prolonged survival for patients and a longer time frame during which these complications may develop. Therefore, these complications are occurring more commonly. It is important to realize that these alterations of hemostasis exist and must be approached in a sequential and logical manner with respect to diagnosis; only in this way can responsible, efficacious, and rational therapy be delivered to patients. By far the most common alteration of hemostasis in malignancy is that of hemorrhage associated with thrombocytopenia, either drug-induced, radiation-induced, or from bone marrow invasion. However, hemorrhage resulting from DIC is also quite common and may present as hemorrhage, thrombosis, thromboembolus, or any combination thereof. Many antineoplastic drugs and radiation therapy may lead to or significantly enhance hemorrhage in patients with malignancy. Thrombosis, also commonly seen in patients with malignancy, is often a manifestation of low-grade DIC, conspicuous as an intravascular thrombotic or thromboembolic event instead of an intravascular proteolytic (hemorrhagic) event. When suspecting this, confirmatory laboratory evidence must be sought and the patient treated appropriately. When approaching the patient with malignancy and either hemorrhage or thrombosis, all the potential defects in hemostasis must be taken into account, defined from the laboratory standpoint, and treated in as precise and logical manner as possible.


Use of platelets and other transfusion products in patients with malignancy.

The need for blood components for oncology patients is small compared with the need for patients with hematologic malignancies. Appropriate use of blood components is necessary, not only medically, but also because of limited supply and availability. Agreement on when to use components is extremely important. In fact, at the time of this writing, the Transfusion Practices Committee of the AABB is conducting an extensive survey on the use of platelets in the oncology and hematology cancer patients (Questionnaire on Institutional Policy on Platelet Transfusion Practice for Hematology/Oncology Patients). The results will, it is hoped, provide a consensus on the proper times and counts that require prophylactic use of components for these patients. Since these patients use the vast majority of components (see Table 15), their proper use is imperative to maintaining an adequate platelet and frozen plasma supply. Transfusion support in cancer patients is vital for their survival. Platelets, in particular, are necessary to prevent serious bleeding. However, refractoriness to platelet transfusions can develop. It must be appreciated that refractoriness is not a general problem and need not require the expensiveness of a universal decision for handling all platelet transfusions in the same manner. Total refractoriness probably occurs in 15 to 20% of patients frequently transfused. In patients in whom frequent platelet transfusion is anticipated, that is, bone marrow transplantation, the development of platelet refractoriness may be reduced by using SDPC and administering them through leukocyte filters. Patients who become refractory to either random or SDPC can either be cross-matched for single-donor platelets that are compatible or can be given HLA-A,B matched platelets. Certainly, the success of platelet transfusion in leukemic patients cannot be denied, since only a small number of these patients now die because of bleeding due to platelet refractoriness. Most of the serious bleeding still seen is associated with sepsis. The risks from transfusion must always be considered. Fortunately, with increased monitoring of the blood supply, they have been reduced. As with any therapeutic regimen, these risks must be weighed against the benefit the patient may gain. Transfusion should always be used prudently.


Platelets and cancer metastasis: more than an epiphenomenon.

In this review we have presented overwhelming evidence that platelets play an important enhancing role in tumor cell-vasculature interactions and cancer metastasis. Tumor cells employ a host of mechanisms to induce platelet aggregation; vice versa, platelets make use of a spectrum of mechanisms to modulate tumor cell-EC and tumor cell-ECM interactions. Various COX and LOX metabolites are closely involved in this bidirectional modulation, thus providing us with a very promising therapeutic avenue by modifying the actions of these metabolites. On the other hand, adhesion molecules are mediators of tumor cell-platelet-EC interactions; therefore interference with these adhesion molecules and various adhesive processes either by soluble peptides, nonpeptidic analogues, or specific antibodies holds great investigational and clinical appeal.


Marry in haste, repent at leisure: women, bureaucracy and the post office, 1870-1920.

Between these two extremes [of caring for children and manual labour] there lies what may be called a neutral or debatable ground of labour requiring the exercise of qualities which are the exclusive property of neither sex. It is in this neutral field ... [that] the activities of women are confined to those departments of the labour market into which men do not care, or actively object, to enter. Thus, if there were no question of economic competition, it seems to me that the invasion by woman of these departments ... formerly monopolized by men would be bound to awaken a certain amount of opposition; since her consequent desertion of the dull, unpleasant, and monotonous tasks assigned to her, might mean that these tasks would have to be performed by those who had hitherto escaped the necessity by shifting it on to her shoulders. Hence a natural and comprehensible resentment.


Disseminated histoplasmosis in patients with AIDS.

Disseminated histoplasmosis (DH) is recognized as an opportunistic infection in patients with the human immunodeficiency virus (HIV), especially in regions where histoplasmosis is endemic. At the Kansas University Medical Center 148 patients were hospitalized with the diagnosis of AIDS from December 1983 to March 1991; 23 of these patients (16%) had disseminated histoplasmosis. The charts of these 23 patients were reviewed. Clinical signs and symptoms included fever (91%), cough (65%), and weight loss (48%). Splenomegaly, hepatomegaly, or lymphadenopathy was present in 52% of all patients. Anemia (39%), leukopenia (65%), and thrombocytopenia (52%) were common, and 22% had pancytopenia. Diagnosis was made by peripheral smear examinations (organisms visualized on 7 of 22 smears [32%]), blood cultures (positive for H capsulatum in 16 of 20 patients, [80%]), bone marrow cultures (positive in 14 of 15 patients, [93%]), and bone marrow aspirate and biopsy examinations (organisms seen on 18 of 21 stains, [86%]). The combination of these four tests revealed the diagnosis of DH in 23 of 23 patients (100%). Induction and maintenance amphotericin B therapy was given to all but 2 patients, and currently 8 of the 23 are alive. DH is a common opportunistic infection in AIDS patients from regions endemic for histoplasmosis. When DH is suspected, a peripheral smear examination, blood cultures, bone marrow cultures and bone marrow aspirate and biopsy should be done to make the diagnosis, since suppression of the disease is possible with appropriate therapy.


Pleural effusions in right-sided endocarditis: characteristics and pathophysiology.

The incidence, characteristics, and pathogenesis of pleural effusions in patients with right-sided endocarditis (RSE) are poorly defined. We have recently observed four patients with a history of intravenous drug abuse and bacteremia due to Staphylococcus aureus who had pleural effusions during an episode of RSE. We report the pleural fluid characteristics of five effusions in these four patients and attempt to define the pathogenesis of each. We found that (1) an exudative, sterile, serosanguineous, or bloody effusion is common in RSE, (2) empyema occurred in only one patient, and (3) transudative effusions due to CHF were not observed. Possible mechanisms of pleural fluid formation in RSE include parapneumonic effusion, septic pulmonary emboli with or without infarction, and empyema. Congestive heart failure does not appear to be a common cause of pleural effusion in pure right-sided endocarditis.


Unrecognized association of sleep disorders and depression with chronic pelvic pain.

Assessment of cases of chronic pelvic pain presents a challenging problem, and many physicians overlook the association of sleep disorders and depression with such pain. We examined these linkages in our chronic pelvic pain clinic, using a questionnaire that assists in diagnosis and management of these cases. To date, the cases of 72 patients (both physician- and self-referred) with pelvic pain have been evaluated. Of these patients, 51 of 71 (72%) reported sleep disorders, and 37 of 72 (51%) had clinical depression, as determined by the Beck Depression Inventory. After adjustment for a sleep-related item on the Beck scale, these two measures showed a positive correlation of .355 (P < .01). The scores of pain patients differed significantly from those of a control group of asymptomatic patients on the depression and sleep disorder measures. By being aware and using a simple questionnaire, the clinician may readily identify overlooked factors, such as sleep disorders and depression, when assessing cases of chronic pelvic pain.


Swing bed program in a small rural hospital: discharge outcome.

Swing beds contribute significantly to inpatient rehabilitation and skilled nursing care of the rural elderly, but little information is available in the general clinical literature regarding the types and outcomes of patients admitted to these programs. All swing bed admissions to a small rural hospital for the 1989 fiscal year were identified and the records were reviewed. The mean age of the patients was 81 years, and the average length of stay was 13 days. Most patients were admitted because of acute problems necessitating short-term rehabilitation or because no bed was available in an appropriate skilled-care nursing home. At discharge, 40% of patients were able to return home. Information regarding the availability and appropriate use of swing beds needs to be disseminated to physicians who care for the elderly. More study is needed to determine optimal use of and requirements for swing beds on a national level.


Is the pediatric preoperative hematocrit determination necessary?

The usefulness of the preoperative hematocrit determination as a screening test before outpatient pediatric surgical procedures has been questioned. It has been suggested that a careful history and physical examination are of greater importance than routine laboratory tests in determining a child's fitness for surgery. We evaluated the utility of preoperative measurement of hematocrit as a screening test for surgical fitness in healthy children having a variety of elective outpatient surgical procedures.


Vascular surgery: possible adverse effect on extent of subsequent lower limb amputation.

The influence of previous vascular surgery on the level of amputation was examined retrospectively in 345 amputations (66 bilateral) in 279 patients with peripheral vascular disease. Seventy-two patients (38% diabetic) had previous vascular surgery on 74 limbs and 207 (65% diabetic) had no history of vascular surgery on 271 limbs. In patients with previous vascular surgery, above-knee amputation was done on 55% of limbs versus 71% of limbs in patients with no previous vascular surgery (P < .05), despite a lower incidence of diabetes in the former group. We conclude that although reconstructive vascular surgery is an effective treatment for vascular insufficiency, occasionally it not only fails, but is associated with an increased incidence of above-knee amputation.


Zygomatic fractures: reduction with the T-bar screw.

The prominent zygomatic bone is one of the most commonly fractured. Fracture with displacement of the bone results in a cosmetic and functional deformity. The fractured zygomatic bone is usually dislocated in an inferomedial and posterior direction, which results in a cosmetic deformity with loss of ipsilateral malar prominence, possible depression of the zygomatic arch, asymmetry of the bony orbital circumference, and possible enophthalmos. Fracture of the zygomatic bone may result in ocular, maxillary antral, and mandibular dysfunction; diplopia, restricted extraocular muscle movement, or intraocular injuries; infection or obstruction of the maxillary antrum; and restricted mandibular function and malocclusion. Various surgical methods have been used to reduce the displaced fractured zygomatic bone. Our preferred method for reduction is the T-bar (Carroll-Girard) screw. This clinical study reviews 30 cases of zygomatic complex fractures, outlines the surgical technique used, illustrates the proper use of the T-bar screw with anatomic schematics and clinical cases, and presents illustrative case summaries.


Thallium poisoning: an outbreak in Florida, 1988.

In October 1988, five of seven members of a Florida family were poisoned with thallium, constituting the largest outbreak of acute thallium poisoning in the United States since thallium was banned as a rodenticide in 1972. Three patients had an acute severe neuropathy with respiratory depression; one died. The other two had no symptoms. No cases were identified among nonhousehold relatives or friends, or in the community. Of the more than 100 environmental specimens collected at the family household and tested by atomic spectroscopy, three empty and four unopened glass soft drink bottles of the same lot number yielded thallium in a concentration fatal to humans. All family members who consumed the soft drink were poisoned (5/5) as compared with none of those who did not (0/2). Because poisoning was clustered to the family and police investigators provided evidence that the poisoning was deliberately targeted to the family, it was assumed that no other soft drink bottles contained thallium, and it was decided not to recall all soft drink bottles with the same lot number. A year later a neighbor of the family was arrested and convicted of the murder.


Pharmacologic considerations in the treatment of substance abuse.

Drug and alcohol abuse continue to be commonly encountered problems in most patient populations. To deal effectively with these problems, the primary care physician must have a thorough knowledge of the pharmacology of commonly abused drugs and the adjunctive agents used in treatment. Management of alcoholism may involve a range of medical interventions, including the treatment of alcohol intoxication, the use of benzodiazepines for alcohol withdrawal, and possibly the short-term administration of disulfiram to maintain sobriety. Successful management of cocaine or amphetamine abuse requires an understanding of the powerful reinforcing properties of these drugs and the unique problems that arise in the recovery period. Barbiturate intoxication and withdrawal are potentially life-threatening events requiring skilled in-patient treatment. Prolonged use of benzodiazepines can lead to drug dependence; successful withdrawal involves gradual dosage reduction. Acute intoxication from marijuana or hallucinogenic drugs may occasionally result in adverse reactions requiring medical intervention, but significant withdrawal reactions are rare. Management of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid overdose, whether illicit or iatrogenic, requires the prompt and skillful use of opioid antagonists. Promising new pharmacologic approaches are now being successfully applied to the management of opioid dependence. An acceptance of nicotine as the addictive component of tobacco smoke has led to the development of nicotine gum as substitution therapy for cigarette smoking. Successful pharmacologic management of overdose or withdrawal is often the prerequisite for effective long-term treatment and recovery.


Postsplenectomy infections.

Serious postsplenectomy infection is a significant threat to patients. Although the incidence of such infection is low, the resultant mortality is extremely high. This susceptibility to infection and ensuing mortality results from multiple immunologic changes that occur after splenectomy. These changes include alteration in immunoglobulin levels, loss of serum opsonizing proteins, and alterations in antigen clearance and cellular immunity.


Charles Drew: dispelling the myth.

The name Charles Drew is synonymous with blood transfusions, but his life encompassed many other areas of work. A native of Washington, DC, Drew attended Dunbar High School and Amherst College, and went to medical school at McGill University in Montreal. All during his schooling he was a highly regarded athlete (track and football). Drew spent 2 years in postdoctoral training in Montreal and 3 years in Washington, DC, followed by 2 years in New York City, working on a doctorate in medicine in blood banking. He was instrumental in the Blood for Britain program in 1940 and helped establish the future Red Cross blood bank in the United States. Finally, at Howard University, where he taught from 1941 to 1950, he trained a generation of black surgeons. He died, at age 45, of injuries received in a car accident in 1950 in North Carolina. Controversy surrounding his death, involving numerous erroneous claims, has served unfortunately to detract from the significance of his achievements.


Heterotopic ossification and deep venous thrombosis: concurrence (?), bleeding complications, and caval interruption.

Diagnosis and treatment of apparent deep venous thrombosis in a patient with spinal cord injury can be difficult. Heterotopic ossification in the paralyzed limbs of such patients can mimic deep venous thrombosis and can even produce false-positive findings on venograms. Anticoagulation, in turn, can be associated with soft tissue hemorrhage that may resemble thrombophlebitis and further confound interpretation of venograms. We have presented a case in which all these phenomena were present and in which a remaining risk of embolism was successfully managed through placement of a Greenfield filter.


Trichosporon beigelii: a potential cause of sepsis in premature infants.

Trichosporon beigelii is an emerging pathogen, often resistant to amphotericin B, that causes disseminated infection in immunocompromised patients. Early identification of this organism and knowledge of sensitivity patterns to antifungal agents may decrease the high mortality rate for immunocompromised patients with disseminated trichosporosis. I have reported a case of septicemia associated with T beigelii in a premature twin infant who had been granulocytopenic since birth.


Primary cerebral lymphoma manifested by dementia.

Primary cerebral lymphoma (PCL) accounts for less than 1% of intracranial neoplasms. In immunocompromised patients, multicentric lymphoma of the brain is typically manifested by focal neurologic deficits. In the immunocompetent individual, PCL involves leptomeninges and presents meningeal signs. Leptomeningeal lymphoma manifested by dementia has not been previously reported and should be included in the differential diagnosis of patients with Alzheimer's disease.


Disappearing breast calcifications: mammographic-pathologic discrepancy due to calcium oxalate.

We have reported a case in which breast biopsy was done to study suggestive microcalcifications that were confirmed by specimen radiography but were not evident with standard light microscopy. Examination of the specimen under polarized light revealed calcium oxalate crystals. Awareness of this potential pitfall should minimize the number of radiologic-pathologic discrepancies.


Gastrografin-induced aspiration pneumonia: a lethal complication of computed tomography.

A 43-year-old man with dysphagia and a tendency to aspirate was found to have squamous cell carcinoma of the esophagus. Curative surgery was planned and preoperative computed tomography of the chest and abdomen was ordered. A ward nurse administered Gastrografin according to a "standing" order, 4 hours before the CT was to be done. The patient aspirated about 50 mL of Gastrografin, and went into cardiorespiratory arrest caused by pulmonary edema. He sustained severe brain damage and died. This is a first report of lethal aspiration of Gastrografin, given in preparation for CT. We advise alerting nurses who administer Gastrografin, especially to patients with dysphagia or impaired consciousness about the grave consequences that can result if the contrast agent is aspirated by the patient. We further advise that responsibility for using contrast agents in radiologic procedures be assumed by the radiologist and not by medical house staff.


Pancoast tumor: use of MRI for tumor staging.

Pancoast tumors (superior sulcus tumors) are apical lung cancers that may cause any or all of the symptoms originally described in 1932 as Pancoast's syndrome. We have presented a case report and a review of pertinent literature on the treatment of this tumor. Our patient was treated with preoperative radiation and en bloc tumor resection, the current standard of care for cure of Pancoast tumor. We support an aggressive approach in the treatment of this tumor, as radiation followed by radical tumor resection offers good palliation and the best chance for cure. Magnetic resonance imaging has emerged as the procedure of choice to assess the local extent of tumor, and in our patient, MRI accurately predicted that the tumor was resectable.


[Several results of the experiment on improving public health management in a city].

The experimental approbation of new conditions of economic activities revealed a discrepancy between the development of health service network and manpower potential and needs of population in medical care, the possibility of priority development of primary health care, promotion in the development of "semi-hospital" forms of medical care organization, the excessive level of hospital care, the interest among workers in increasing the volume of work and increase of effectiveness in the utilization of resources under normalization of economic relations in public health.


[Main goals of the activities of family physicians and general practitioners].

The activity of a new category of general practitioners and their role in the delivery of medical care for the population are analysed. The functional structure of the computer system for information supply of family doctor is considered. The flow chart of a unified primary information document of the given automated system is presented.


[Ways of improving health care of industrial workers of Kazakhstan].

The health of industrial workers should be considered from the point of view of broad social positions and primarily from the working and living conditions and the state of health services. Environmental factors should also be taken into consideration. Periodic medical check-ups of industrial workers indicate that their health is improving. Despite the success achieved, this problem in Kazakhstan is not being adequately solved, there are only 61 health units. Hospital beds in these institutions do not have necessary specialization corresponding to the profile of industrial enterprises. Numerous industrial enterprises, oil-and-gas extracting works pollute the environment, which has been confirmed by respective examples. The authors provide evidence for the necessity of economic education for the population. Preliminary results of experimental introduction of a new economic mechanism and medical insurance in Kazakhstan are being considered as factors contributing to the improvement of public health financing resources.


[Characteristics of home injuries in Kursk].

Today home injuries, as evidenced by a current survey, constitute 21.53 +/- 0.58% in the pattern of all referrals to traumatological care units. New and objective data have been obtained by age and sex, place of accident, circumstances and mechanisms of occurrence of home injuries, which present a certain interest for working out preventive measures and medical care organization. The materials are submitted for consideration to the city health department.


[Work of a district pediatric service for young children: analysis, problems, solutions].

The study data are provided on the volume of curative and preventive care for 1740 infants at the outpatient department and at home, an analysis is made of the working time spent by a district pediatrician in two polyclinics of Nizhniy Novgorod. It has been shown that most of his time is devoted to sick children. Practically no time is spent on follow-up group of children pertaining to the populations "at risk". To improve preventive work among children of the first three years of life it is proposed to establish departments for young children in the territorial children's polyclinics. The organization of these departments makes it possible to improve the main qualitative indicators of child health.