[A comprehensive fact finding study of home care elderly for planning of the community based rehabilitation system in Koga City, Ibaraki Prefecture].

An interview survey was held with the purpose of grasping the problems faced by the home care elderly living in Koga city in Ibaraki prefecture. The subjects of the study were 100 cases who had been registered as elderly requiring home care in the municipality. The main results were as follows: (1) The most frequent underlying disorders that were considered as causes of disabilities in the home care elderly were cerebrovascular diseases, senile dementia and external injuries. In 67 percent of the subjects, one of these three disorders had caused the disabilities. (2) Disabilities in self care activities and in mobility were closely related to each other and the order of the difficulty in performing these activities was similar in many cases. A large number of the subjects sustaining severe disabilities expressed discontent with their daily life. (3) Forty two percent of the subjects were so-called bedridden elderly who got out of bed for less than 3 hours a day. The Barthel index score was 60 or less in all of the bedridden subjects. (4) For most of the bedridden elderly, bed rest was not required and probably exacerbated the disuse syndrome. In order to ameliorate their condition, adequate rehabilitation programs and assistance in their daily activities need to be offered. (5) Seventy eight percent of the care givers complained about the burden of care. Those who had no assistant care giver complained more frequently. Many of the care givers complaining about their burden had their own health problems. (6) The utilization of social welfare services were not always without any problems. The number of the experts who can deal with the psychosocial aspects in the elderly should be increased in order to improve the situation.


[Analysis of factors influencing the recent decline in birth rate in Tokyo].

This study was undertaken in an attempt to find factors which affected the recent declining birth rate in Tokyo. Vital statistics of the female population, age 20-39, for the period of 1970 through 1985 for Tokyo were compared to national averages. Indices examined were birth rate, percentage of married women, birth rate for married women, and birth rate for married women by live birth order. Results thus obtained were as follows: 1. Birth rates for females aged 20-24 and 25-29 were largely dependent on percentages of married women rather than birth rates for married women both in Tokyo and in the nation as a whole, while the birth rates for females aged 30-34 and 35-39 were more dependent on birth rates for married women. 2. Percentages of married women aged 20-24 and 25-29 decreased during the observation period both in Tokyo and in the nation as a whole. 3. Birth rates for married women aged 30-34 and 35-39 dropped in the first 5 or 10 years of observation in both groups as a result of the reduction in high order live births. Thereafter, the decline changed to an upturn trend. 4. Yearly changes of birth rate, percentage of married women, birth rate for married women, birth rate for married women by live birth order, and birth rate of first child for married women appeared to have the same timing both in Tokyo and in Japan as a whole in each age category.(ABSTRACT TRUNCATED AT 250 WORDS)


[Development of a method for estimation of physical fitness age for the evaluation of physical performance levels].

The aims of this study are to develop a method for estimation of physical fitness age for the evaluation of physical performance levels and to examine the efficacy and adaptability of the method. Physical fitness data collected on 15,845 subjects from 23 health promotion centers in Japan, during a 2-year period, 1985-1986, were analysed by correlation analysis to find factors which affect physical performance. From this analysis, stature and exercise habit were selected as factors to be considered in the computation of physical fitness age. For determination of physical fitness and its relation to chronological age, four tests, side step, sit-ups, vertical jump and wing lift were selected from results of correlation and multiple regression analysis and an estimation equation for physical fitness age was developed by stepwise multiple regression analysis, in which the subjective variable is physical fitness data and objective variables are chronological age and height, on 9,528 people without habitual physical activities. Physical fitness age for each fitness test was calculated from the equation and mean individual physical fitness age computed. The suitability of the developed method was tested on other groups with results showing that the developed method was generally applicable to the other group and was exact enough to evaluate the characteristics of the physical level of the group. Analysis of the relation between health indices and physical fitness age obtained by this new method, revealed that the group in which physical fitness age is inferior to chronological age contained relatively more hypertensive patients and obese people.


[Health conditions of caregivers of elderly living at home and the influence of factors present in the home care environment].

Health conditions of primary caregivers for elderly aged 65 and over living at home were surveyed. Subjects were 167 caregivers in Osaka prefecture. Results obtained were as follows. 1) The primary caregivers were largely associated with and varied with the sex of the cared elderly. The caregivers for the female elderly were almost daughters-in-law or daughters. The caregivers for the male elderly were mostly their elderly wives. 2) Seventy-five percent of the caregivers had health complaints, such as anxiety for health, physical fatigue, lower back pain, sleeplessness, or emotional fatigue. 3) Logistic regression analysis was used to statistically analyze factors in the home care environment. Health conditions of the caregivers showed significant correlation with age of caregivers, sex of the elderly, degree of dementia, and number of family members.


[An epidemiological evaluation of the efficacy of mass screening for uterine cancer in Japan. The relationship between coverage rate of mass screening and reduction in death rate from uterine cancer].

To evaluate the efficacy of mass screening for uterine cancer, the relationship between the coverage rate of mass screening and the reduction in mortality rate from uterine cancer was analyzed. The percent change in the AADR (Age-adjusted death rate) from 1979-1983 to 1984-1988 were compared between the high coverage rate areas and the control areas with relatively lower coverage rates, and among the high coverage rate areas with varied coverage rates. The main results were: (a) the decreases of AADR from uterine cancer were greater in three groups of high coverage rate areas than in control areas with low coverage rates. (b) Among three groups of high coverage rate areas with variation in coverage rates (> or = 20%, > or = 30%, > or = 40%), the higher the coverage rate was, the greater was the percent reduction (-45.9%, -52.3%, -63.5%) of AADR. These results suggest that systematic mass screening may be effective in reducing mortality from uterine cancer.


[Bacterial contamination of infant urine samples obtained from filter papers used in neuroblastoma-screening tests. (6) Protective effects of preaddition of chlorhexidine digluconate in filter papers or containers for urine on bacterial break-down of creatinine, vanillylmandelic acid and homovanillic acid].

The effects of chlorhexidine digluconate preadded to urine samples for a neuroblastoma-screening test in preventing the break-down of creatinine (Cre), vanillylmandelic acid (VMA), and homovanillic acid (HVA) by creatinine-cleaving bacteria and the influence of the added disinfectant on the HPLC determination of urinary Cre, VMA, vanillillactic acid (VLA) and HVA. Laboratory or field experiments showed that preadded disinfectant (0.02% volume) nearly completely inhibited the growth of the bacteria and satisfactorily protected urinary Cre, VMA, and HVA from bacterial decomposition. Chlorhexidine digluconate was comparable to benzalkonium chloride in its inhibitory effects on the growth and activities of creatinine-cleaving bacteria. Unlike benzalkonium chloride, chlorhexidine digluconate added to urine samples gave no troubles in subsequent analytical processes. Addition of the disinfectant (0.02% volume) to standard Cre, VMA, VLA, and HVA solution did not affect retention times and sensitivities in HPLC analyses. To estimate influences of the added disinfectant on the serial HPLC determinations of VMA, VLA, and HVA on a large number of urine samples (40, 80, 120, 160, 200, or 5, 500), HPLC analyses were performed on standard VMA, VLA, and HVA solution with repeated injection of the disinfectant in great amounts into a column. The results showed no appreciable changes in the retention times and sensitivities of VMA, VLA, and HVA, and almost complete elution of the disinfectant retained on the column were possible with water-methanol (1:1, 2:8) or methanol washing.(ABSTRACT TRUNCATED AT 250 WORDS)


[Traditional religion and terminal care in the Ryukyus, southern Japan].

The public health significance of traditional religions in terminal care was studied in the Ryukyu Archipelago. The traditional religious view of life, in which death at home is ideal, is still maintained: while inhabitants seek modern medical care in facilities outside of the island, they are transported back to die in their homes when their condition becomes critical. Most of the general hospitals, special nursing homes for the aged, and psychiatric hospitals of Okinawa allow bereaved families to perform "Nujifa", a traditional religious ritual for transferring soul of the dead from the death to their own home, that functions as a significant factor in relieving grief. In many of the special nursing homes for aged, not a few aged women practiced activities uniquely associated with traditional religion on strongly reflecting the fact that endemic religion is deeply embedded in their thinking. Although acculturation is in rapid progress in the Ryukyu Archipelago, such endemic religion still has a significant effect on the people. Therefore these religious factors should be considered in the terminal medical care of these people.


[Elimination of Japanese cedar (Cryptomeria japonica) aeropollen by rainfall].

The concentration of aeropollens of Japanese cedar decreases on rainy days, due to the rainfall removing pollens from the atmosphere. An analysis was performed of the concentration of pollen grains in rain water samples from Yokohama during the period February 10 to April 30, 1991. Sampling of rain water was performed using an automatic rain water collector, and an analysis performed on each mm of rainfall, from 1 mm to 5 mm. In this collector, 1 mm of rainfall corresponds to 100 ml of accumulated rain water. The pollens in rain water were concentrated by centrifugation to 1/200 volume, and pollen grain count was performed on a Fuchs. Rosenthal hemocytometer. Pollens of Japanese cedar were detected in the rain water during the period, 22 February to 19 April, and peaked on 22 March. The number of pollens at peak was 264,000 grains per 100 ml. The pollen count contained in the 2nd to 5th mm of rainfall compared to that in the first mm of rainwater was 19.4% in the 2nd mm of rainfall, 6.7% in the 3rd, 4.4% in the 4th and 2.3% in the 5th. From a log-log graph plot of this data, a regression line was obtained for a regression equation, y = 100.x-2.29. These data indicate that rainfall quickly clears pollens of Japanese cedar from the atmosphere. Examination of pollen obtained from the rain water, showed a few % of the pollen grains had ruptured, and on the surface of the cytoplasmic membrane of the ruptured pollen were attached suspended particulate matters from atmosphere.


C-terminal sequencing of peptides using electrospray ionization mass spectrometry.

A low-flow reactor is described for the on-line monitoring of peptides digested with carboxypeptidase P by electrospray ionization. Two peptides were analyzed using this technique: glucagon (average MW 3482.8 Da), and apomyoglobin (average MW 16,951.5). Both peptides gave interpretable results. The first 19 amino acids of glucagon were successfully sequenced. Apomyoglobin yielded sequence information to the 30th amino acid with some gaps. At 300 nL/min, 50% of the first 30 amino acids were sequenced and at 1 microL/min, 67% of the first 30 amino acids were observed.


An investigation of fragmentation mechanisms of doubly protonated tryptic peptides.

Peptides formed as reaction products, of specific hydrolysis of proteins by trypsin, are characterized by a basic residue (Arg or Lys) at the C-terminus, which facilitates formation of abundant [M + 2H]2+ ions under electrospray or ionspray conditions. These doubly charged ions readily dissociate upon collisional activation to y" and b fragment ions which are mass complements of one another. The suggestion that these fragments are formed by direct charge-separation dissociations must contend with the observation that the y" intensities are generally appreciably larger than those of their b counterparts. However, it is shown that this can be accounted for by a greater susceptibility of the b ions to undergo further dissociation to smaller fragments such as immonium ions. In addition no evidence could be found to support alternative mechanisms, including dissociative electron capture, for which equal intensities of the two fragment ion series are not obligatory. Initial protonation at the N-terminus was shown to be required for formation of these [M + 2H]2+ ions via its suppression by mono-acetylation at the N-terminus. These findings, and others concerning formation of [y"']2+ fragments, are consistent with extensions of published mechanisms for formation of b and of y" fragments from singly protonated peptides, via charge-site-induced cleavages and intramolecular proton transfers between nitrogen atoms, respectively.


Charge promotion of low-energy fragmentations of peptide ions.

We have examined the hypothesis that structural features which predispose to localization of charge at a strongly favored site are not conducive to the low-energy fragmentation of peptide ions via a multiplicity of pathways. Consistent with this proposal, it is demonstrated that the formation of N- or C-terminal pre-charged derivatives is detrimental to the formation of sequence-specific product ions following low-energy collisional activation. Protonation of pre-charged derivatives (yielding doubly charged ions) restores favorable fragmentation properties; the effect is attributed to the fragmentation-directing properties of the proton which may occupy one of several sites. Similarly, a doubly protonated peptide which incorporates a C-terminal arginine residue as a single strongly favored site of protonation exhibits favored low-energy fragmentations attributable to location of the second proton at one of several sites remote from the C-terminus.


Thermospray high-performance liquid chromatography/mass spectrometric determination of cyclosporins.

The cyclic undecapeptides cyclosporin (Csp) A, CspD and dihydro CspC (HCspC) were analyzed by high-performance liquid chromatography/thermospray-mass spectrometry (HPLC/TSP-MS) on line with a UV detector. Positive ion partial (1000-1300 u) mass spectra of these compounds could be obtained with 1-2 pmol injected on column. Mass spectra were characterized by signals corresponding to the [M+H] ions as well as fragment ions derived from the loss of 112 (CspA and CspD) or 44, 114 and 114 + 44 (HCspC) mass units from the parent ion. The same qualitative profile was observed for negative-ion acquisition where the ions were formed by proton abstraction. The application of the technique to the characterization of CspA and its major hydroxylated and dealkylated metabolites in human blood samples is presented.


Ion detection limitations to mass resolution in matrix-assisted laser desorption time-of-flight mass spectrometry.

The ion detection process in a discrete-dynode electron multiplier can result in significant mass resolution losses in time-of-flight mass spectrometry (TOF-MS) for higher mass-to-charge (m/z) ion species. This resolution loss is attributed to propagation time delays and signal broadening in the ion detector. This is presumed to be due to the generation of a distribution of secondary ion species produced initially upon impact of a primary ion with the first dynode surface of the ion detector. Comparisons are made between the signals produced by a standard discrete dynode ion detector (which amplifies the negatively charged species produced by impact of a primary ion) and a detector modified to respond to only the positively charged secondary ion species produced by a primary ion impact. Ion signals for higher m/z ions with the standard detector geometry are seen to be due to a narrow signal component, most likely due to the generation of secondary electrons and/or very low mass secondary ions (H-), and a broad signal component, apparently due to secondary ions which take significant amounts of time to traverse the low potential fields between the first and second detector dynode. This results in ion signal tailing for higher m/z ion species. Numerical subtraction of the ion signal obtained with the standard and modified detector geometries (singly protonated molecular ion species of equine myoglobin) results in an improvement in mass resolution, such that a new adduct ion species (from trifluoroacetic acid) can be resolved.


Sequence distribution of beta-hydroxyalkanoate units in bacterial copolyesters determined by desorption chemical ionization mass spectrometry.

The sequence distributions of poly(beta-hydroxyalkanoate) copolymers were determined by analyzing oligomers obtained by the pyrolysis direct-chemical-ionization (DCI) mass spectrometry technique. Oligomers up to nonamers were identified and the comparison between the experimental and calculated peak intensities makes it possible to calculate repeating unit compositions and sequence distributions. Comparisons with other earlier methods are given.


The changing architecture of the neonatal rat ovary during histogenesis.

The purpose of this study was to describe the changing histological organization of the rat ovary during postpartum days one through three (p1-p3). A PC-based image-combining microscope system was used to reconstruct the ovary in three dimensions. On p1, cyclindrical pocket-like structures radiated from the core of the ovary that were open toward the surface epithelium. The walls of the pockets contained connective tissue cells and capillaries (stroma). By p2, these pockets had completely closed; each pocket enclosed a small nest of oocytes and a few presumptive granulosa cells. By p3, the pocket-like organization had disappeared. On p1, only one or two primordial follicle-like structures were observed in the core and toward the periphery of the ovary; most oocytes were not enclosed in follicles. By p3, very few naked oocytes remained; primordial follicles predominated in all the regions of the ovary and some of the follicles had multiple layers of granulosa cells. There were changes in location, area, and volume of the rete tubules during these postnatal days. The extraovarian rete was visible on all 3 days but changed its orientation relative to the ovary. The connecting rete was found beneath the epithelial layer of the ovary on all 3 days and showed dramatic increase in area on p2. The wide lumen of the intraovarian rete was in direct contact with some of the oocytes near by on all 3 days, but these "communication points" were most abundant on p2. Based on our observations of different cell-cell associations during this time period, we hypothesize (1) that the mesenchymal-presumptive granulosa cell association is essential for the completion of folliculogenesis, and (2) the rete ovarii may have an inductive role in follicle assembly. These observations suggest that the first 3 days postpartum are critically important for studying the heterogeneous cell interactions that lead to the assembly of primordial follicles. The regional differences in tissue organization during this formative period may have significant implications on later aspects of follicular development.


Urokinase expression during the epithelial-mesenchymal transformation of the avian somite.

Early events in the morphogenesis of the axial skeleton involve an epithelial-mesenchymal transformation of the somites. Cells of the ventromedial wall of the somite (the sclerotome) migrate to regions surrounding the notochord and neural tube and condense to form the cartilage model of the vertebrae. Urokinase activity in the axial region of the quail embryo trunk was found to increase during these stages. In situ hybridization localized urokinase mRNA expression in this region and suggests an important role for this protease in the process of cell migration and matrix remodeling during development of the axial skeleton.


Insertional mutation of a gene involved in growth regulation of the early mouse embryo.

A transgenic mouse strain derived from embryonic stem (ES) cells infected with multiple copies of a retroviral vector carries a recessive insertional mutation resulting in prenatal lethality. A detailed histological analysis of developing embryos has shown that the mutation results in hyperplasia of both embryonic and extraembryonic ectoderm and failure of mesoderm formation in the egg cylinder stage embryo. The number of cells in each lineage of normal and mutant embryos was estimated using stereological analysis of serial sections taken from implantation sites. We observed a 2-fold increase in the number of embryonic ectoderm cells in mutant embryos at 7.5 days postcoitum (dpc). In addition, we found that mutant embryonic ectoderm cells are only 0.6 times as large as normal cells. The number of extraembryonic ectoderm cells in mutant embryos at 7.5 dpc is also increased, by almost 4-fold. Mutant extraembryonic ectoderm cells are also smaller than normal, being only two-thirds the size of wild-type cells. The mutant phenotype suggests that the gene identified by this insertional mutation plays an important role in the growth control of early embryonic lineages.


Neuroblastoma x spinal cord (NSC) hybrid cell lines resemble developing motor neurons.

We have developed a series of mouse-mouse neural hybrid cell lines by fusing the aminopterin-sensitive neuroblastoma N18TG2 with motor neuron-enriched embryonic day 12-14 spinal cord cells. Of 30 neuroblastoma-spinal cord (NSC) hybrids displaying a multipolar neuron-like phenotype, 10 express choline acetyltransferase, and 4 induce twitching in cocultured mouse myotubules. NSC-19, NSC-34, and their subclones express additional properties expected of motor neurons, including generation of action potentials, expression of neurofilament triplet proteins, and acetylcholine synthesis, storage, and release. In addition, NSC-34 cells induce acetylcholine receptor clusters on cocultured myotubes, and undergo a vimentin-neurofilament switch with maturation in culture, similar to that occurring in neuronal development. NSC cell lines appear to model selected aspects of motor neuron development in an immortalized clonal system.


Scanning electron microscopy of femoral ossification in the human foetus.

The ossification of human femoral bone was studied in 10 fetuses aged from 8 to 40 weeks, and in a 3 1/2 month-old child. After dissection and radiographic examination, each femur was sectioned in a sagittal plane. One part was processed for routine histology, the remaining one for scanning electron microscopy. By comparing the radiographic, light microscopic and scanning electron microscopic pictures, it is possible to precise the pattern of ossification and to define 3 main periods during human fetal development (pure cartilage, metaphyseal and diaphyseal ossification, constitution of a cortex and a medulla in the diaphysis).


Spleen's relative growth in human fetuses.

The growth of the spleen weight was studied by bivariate allometry. It was correlated to fetal parameters of development as gestational age (in weeks), crown-rump length (mm) and weight (gm). Thirty human fetuses ranging from 16 to 36 weeks were studied. These were analysed in second and third trimesters separately and together. The growth of the spleen weight presents statistically significant positive allometry relative to age, C-R length and fetal weight. In second trimester the allometric coefficient, analysing spleen's weight and fetus' weight, calculated by reduced major axis method (RMA) was 1.21. In the third one the RMA was 1.73. Considering fetuses together the RMA = 1.65. This study presents growth curves of the spleen weight useful in medical branches such as anatomy, forensic medicine, medical imagery, fetophatology, obstetrics and pediatrics.


[The carpal synovial sheaths and their vascularization].

The synovial sheaths of the flexor digitorum of 70 pieces of fresh cadavers have been studied on the whole of their length as far as the basis of the fingers: 20 have been injected with a latex or a physiologic solution, after the ablation of the palmar aponeurosis and of the superficial palmar arch. The arteries of the 50 other pieces have been injected with coloured latex solution from humeral artery. The proximal limit of the superficial sheaths is located 5 centimetres above the radiocarpal articular line and this of the deep sheaths 7 centimetres. In the metacarpal area, the superficialis central sheath presents peritendinous expansions, which realise an uninterrupted connection with each digital sheath. It is the aponeurotic and vascular extrinsic compressions, which simulate the interruption of these expansions. The proximal synovial arteries have a muscular origin. The antibrachial collateral arteries, 3 pairs in number, arise from the radial and the ulnar arteries. The distal synovial arteries come from the palmar arches and from their branches: superficial branches for the superficial sheaths and deep branches for the deep sheaths. There is many anastomoses between the different synovial arteries. Two are particularly developed and connect the proximal arteries to the palmar arches: the superficial longitudinal anastomotic artery; which runs close along the medial edge of the median nerve; the deep longitudinal anastomotic artery, which gives the nutritious branches for the tendons of the flexor digitorum. This disposition allows to create two synovial flaps of gliding and vascular help, centred on the anastomotic longitudinal arteries, pediculated on the volar archs and distal-ward rotated.(ABSTRACT TRUNCATED AT 250 WORDS)


[Finger extension. I. History. State of knowledge].

Recapitulation of the principal stages concerning the descriptive and the functional anatomy of the extensor apparatus of the ulnar digits. They can be written in the following frame: The Gálien's theories of the exclusive role of the extensor digitorum muscles prevail during more as a millenium. The indispensable conjoined action of the interosseus muscles through the collateral tendon is demonstrated by Duchene in 1867. The role of antagonistic muscles is clearly showed by Bouvier in 1851 on the level of the metacarpo-phalangeal joints and by Valentin and Tubiana in 1962 on the level of the proximal interphalangeal joints. The role of the oblique retinacular ligament on the extension of the third phalanx is specified in 1956 by Landsmeer.


[Finger extension. II. Materials and methods].

The study of the extensor apparatus through different methods concerns 200 fingers, the most of fresh cadavers. The dissection through direct observation or with surgical microscope of the dorsal aponeurosis of 30 fingers has been completed by an histological study of 10 fingers. The mechanic properties of each dorsal aponeurotic structure has been tested by extensometry on 12 fingers. The functional study of the role and of the transmission of the different motor components concerns 128 fingers. It has been completed by experimental sections of each aponeurotic structure concerning 20 fingers.


[Validity of the Pauwels theory: Focus on experimental methods for studying deformations of the hip joint during unilateral and bilateral weight-bearing].

A critical analysis is proposed between two experimental studies of the hip joint. Is it very important to respect the PAUWELS theory? The authors try to answer this question.


[Anomalies produced by cytochalasin B after 10.5 days of gestation: in vitro study].

124 rats embryos (Rattus Norvegicus sp.) have been cultured for 48 hours period (from 9.5 days to 11.5 days). 24 hours after the beginning of the culture, cytochalasin B (CB) dissolved in 1% dimethylsulphoxide (DMSO) was added to the culture medium in the experimental group (61 embryos), whereas only DMSO was added to the medium in the control group (63 embryos). Survival rate in the control group was 100% whereas in CB-treated embryos the higher the dose, the lesser the survival rate. Embryo growth and morphological score was reduced in CB-treated embryos. The most common gross malformations were delays in axial rotation as well as open neural tube defects.


[The segments of facial profiles: cutaneous and osseous. Sex differences using canonical correlations].

By calculation of new parameters named "canonicals", with matrix methodology, it is possible to calculate the relations between whole of cutaneous and bony profile elements and between there wholes and each facial original segment. The affinity between subjects are raised in evidence and drawn. Sexual differences are obvious in spite of 27% "bad classed" subjects.


[Pericardial fatty fringes: preoperative anatomo-radiographic value of their use in the protection of bronchial sutures].

Bronchial sutures grafts by epiplooplasty is a method used to allow a better vascularisation of the bronchial sutures. The authors purpose an other method using the pericardial fatty fringes (P.F.F.). The vascularisation of P.F.F. was studied on 30 fresh cadavers and 8 patients before surgery. Angiography of the internal thoracic artery was done in the first group and M.R.I. in the second group. M.R.I. is better than angiography because numerous parietal vessels project in the angiogram, and they overlap pericardial fat fringes vessels.


[The characteristic phenotype of the masseter muscle fibers is established after birth].

Muscle biopsies were taken from the superficial portion of the M. masseter in 10 foetuses (aged between 12 and 38 weeks), in a child of 18 months and in an adult without any neuromuscular disease. Serial frozen sections were processed for immunocytochemistry using antibodies specific for the embryonic, foetal, slow and fast myosin heavy chains (MHCs). Diameter of the different types of fibers were measured with a Leitz ASM 68 K; the results have been expressed as average diameters and histograms. During foetal development, the masseter is formed from two successive generations of muscle fibers in a manner very similar to that which has been previously described for other skeletal muscles. After birth, a particular phenotype appears. This phenotype is characterised by the persistence of embryonic and foetal MHCs and by the presence of two distinct populations of fibers: small diameter fibers which coexpress embryonic, foetal and fast myosin isoforms but never express the slow MHC; large diameter fibers which express slow myosin either exclusively or in variable associations with the other isoforms.


New management techniques in neurosurgery.

New management techniques continue to be explored by neurosurgeons in order to improve their subspecialty, as well as medicine in general. This year has seen advances in many aspects of cerebrovascular surgery, traumatic brain and spinal cord injury, and chemotherapy for neoplastic disease. Stereotaxis also continues to be a strong alternative for the guidance and treatment of various pathological entities. The basis for developing new management techniques in neurosurgery continues to be rooted in the results of stringent basic science research and well-designed clinical trials.


Biology and therapy of glial tumors.

Glial tumors remain challenging problems for the clinician and researcher. Despite more aggressive therapy, the majority of these tumors recur locally. This review will provide an update on the new strategies being developed to treat gliomas. Advances in our understanding of the biology of glial tumors will provide new targets at which to direct therapy.


Non-glial tumors of the brain: tumors of the cerebellopontine angle and meningiomas.

The principal non-glial tumors of the brain are meningiomas and acoustic schwannomas. Advances in the management of meningiomas have included endovascular techniques for embolization to reduce blood loss, radical surgical approaches, and the recognition of the high recurrence rate of these tumors. Advances in the management of acoustic tumors have been in preservation of VIIth nerve function, improved preservation of hearing, and the availability of stereotactic radiosurgical techniques as an alternative. There is still a substantial discussion concerning the route of surgery for acoustic tumors and not all agree that hearing preservation is a reasonable goal at present.


Intracranial pressure measurement/cranial vault mechanics: clinical and experimental observations.

The absolute value of intracranial pressure (ICP) should be considered in conjunction with evaluation of a patient's clinical condition. In addition, other aspects of cranial vault mechanics may be important in multiple disease states. Among the important physiological measures of cranial vault sufficiency are hydrodynamic interaction between brain tissue, blood and cerebrospinal fluid (CSF)--volume-pressure relation, CSF dynamics--CSF outflow resistance, CSF production rate, sagittal sinus pressure, and appearance of ICP waves. Clinical and experimental studies brought together in this review provide an insight into the dynamics of ICP and the cranial vault.


Early prediction of outcome from coma.

It is increasingly important to be able to predict early in the course of illness a patient's outcome from coma. Potential indicators include clinical scales, electrophysiologic responses, and cerebral blood flow and metabolism. Our current knowledge provides some understanding of the ultimate impact of the illness, but is of limited assistance in decisions regarding initiation or withdrawal of therapy.


Outcome evaluation in acute neurological injury.

To evaluate outcome one must define the outcome and those factors that contribute to it. Recent advances in measurement of brain injury by radiology, evoked potentials and electroencephalogram (EEG), cerebral blood flow (CBF) and cerebral metabolism have demonstrated differential prognosis. Outcome from coma has also been expanded to include cognitive and neurobehavioral measures as well as functional assessments.


Radiology of the developing central nervous system.

Functional and anatomical imaging of the developing central nervous system continue to engender considerable interest. Structural anomalies have been further defined and catalogued, aiding in the diagnosis and genetic counseling of children with developmental delay. Anomalous development of the brain has recently been linked to certain neuropsychiatric disorders. The natural course of many of the metabolic brain disorders has now been chronicled with imaging studies, rendering standards on which to evaluate efficacy of treatment.


Infections of the central nervous system.

Several discussions of the neuroimaging of inflammatory diseases with emphasis on computerized tomography (CT) and magnetic resonance imaging (MRI) findings and on rare diseases, such as sparganosis, neuroborreliosis and various types of encephalitis, have been published during the past year. Infectious processes in immunosuppressed patients have been described by many authors, especially in the field of acquired immune deficiency syndrome (AIDS). The importance of gadolinium-diethylenetriamine-penta-acetic acid (Gd-DTPA) in MRI for delineation, and differential diagnosis of the inflammatory processes has been considered. Newly introduced techniques such as technetium-99m hexamethylpropyleneamine oxime (99mTc-HMPAO) single photon emission CT (SPECT) and proton spectroscopy have made the early detection of diseases possible.


Technical advances in magnetic resonance imaging.

Magnetic resonance (MR) imaging continues to develop at a rapid rate. Major new innovations include functional neuroimaging, fast spin-echo, magnetization transfer, the fluid attenuated inversion recovery sequence, MR angiography and measurement of cerebrospinal fluid (CSF) flow. Further developments of functional imaging and interventional techniques are expected.


Recent advances in magnetic resonance angiography of the brain.

Newer techniques in magnetic resonance angiography (MRA) are faster, have higher resolution, and have greater vascular conspicuity than the early techniques introduced just a few years ago. Advances in 'black blood' and 'bright blood' (time-of-flight and phase-contrast) MRA are discussed with attention to saturation effects, use of gadolinium, and background suppression with magnetization transfer contrast.


The role of nuclear medicine in neurology and psychiatry.

Nuclear medicine has a place in the study of brain trauma, brain tumours, stroke, dementia epilepsy and depression. The development of new tracers labelled with widely available radionuclides, such as technetium-99m (99Tc) and iodine-123, has played a key role here. Practical methodology can now be implemented in the routine setting. Additional applications are reviewed in the context of brain death, encephalitis, post-viral fatigue syndrome, Parkinson's disease and schizophrenia.


Interventional neuroradiology.

Recent technical developments and improvements in angiographic equipment, variable stiffness microcatheters, embolic materials, and better training increased efficacy, safety, and growing acceptance of endovascular procedures by various specialties. Additional treatment options, frequently supplementary to neurosurgical procedures can be offered to patients with intracranial vascular lesions, using existing vascular pathways and avoiding the need for surgical exposure. For endovascular embolization of unclippable aneurysms coils which are soft, retrievable, and thrombogenic appear a better alternative than detachable balloons. New understanding and capabilities in brain arteriovenous malformations (AVMs) as an adjunct to microsurgical resection, or as the sole form of treatment may improve results and long-term outcome. Experience with intravascular thrombolysis and balloon angioplasty of extracranial and intracranial vessels will potentially improve neurological deficits in cerebrovascular or vasospastic occlusive disease. Safety, efficacy, and long-term follow up are needed to maintain and improve standards of practice and offer new therapeutic alternatives.


Cytoskeletal abnormalities in Alzheimer's disease.

A fundamental process in the pathogenesis of Alzheimer's disease (AD) is the breakdown of the cytoskeleton. The microscopic manifestation of this--neurofibrillary tangles--is described. Tangles are formed from paired helical filaments (PHF), in turn constructed from abnormally phosphorylated Tau proteins. Recent investigations on the process of Tau phosphorylation and possible links between amyloid deposition and tangle formation are reviewed.


Lewy body disease.

Subsumed under the rubric of Lewy body disease are idiopathic Parkinson's disease (PD), pure diffuse Lewy body disease (DLBD), and, most commonly, combined brainstem and neocortical Lewy bodies with Alzheimer's disease (AD) pathology in a relatively early developmental stage. Clinical correlates are dementia with psychiatric and subcortical features plus mild extrapyramidal signs (EPS).


Human prion diseases.

The past year has seen considerable advances in our understanding of the prion diseases, and there is increasing acceptance that the transmissible agent in these diseases may be an abnormal isoform of a normal host encoded protein. Molecular genetic studies have led to a new appreciation of the phenotypic spectrum of the prion diseases as the inherited forms of these conditions can now be diagnosed by a direct gene test. The conundrum of how a disease can be both inherited and transmissible is beginning to make sense.


Mitochondrial encephalomyopathies.

Molecular genetic studies are now bringing a new classification and new insights into already recognized mitochondrial encephalomyopathies. There are, however, numerous reports on an overlap pattern between mitochondriopathies. In addition, the link between the defect in oxidative phosphorylation (OXPHOS) in the brain and the specific neuropathological pattern is unclear. A better knowledge of nuclear mutations in mitochondriopathies and of the interactions between nuclear and mitochondrial genomes will probably allow new developments.


Cerebral pathology in AIDS: a new nomenclature and pathogenetic concepts.

Complementary to a clinical classification of human immunodeficiency virus (HIV)-associated nervous system syndromes, a neuropathology-based terminology defines entities at tissue level, including the new HIV-specific diseases, HIV encephalitis and HIV leukoencephalopathy. Poor clinico-neuropathological correlation may be explained by complex pathogenetic mechanisms in which several factors, including virus load, neurotoxicity, vascular changes, and metabolic abnormalities, may act together to damage both white and gray matter of the brain.


[Ataxia telangiectasia: what impact in clinical oncology?].

Ataxia telangiectasia (AT) is a hereditary disease transmitted in a recessive mode and characterized by chromosomal instability and radiosensitivity. AT patients have a 100-fold higher risk of cancer than the general population. Although AT is a rare disease of which the frequency has been estimated to be 1/40,000, the frequency of the heterozygosity status, when assessed with the Hardy-Weinberg equation is high (about 1.4%). Parents of AT children, thus obligate AT carriers, show chromosomal instability and radiosensitivity, but at a lower level than AT patients. Assuming that these AT characteristics deal with the cancer predisposition, it can be hypothesized that AT heterozygote individuals have a higher cancer susceptibility than the general population. To test this hypothesis, M Swift's group compared cancer incidence rates from adult blood relatives of AT patients with controls. The risk of cancer in AT heterozygotes could be increased by 3.5 and, for carrier women, the breast cancer risk could be increased by 5.1. Actually, the diagnosis of the AT heterozygote status is not possible. However, the near cloning of the gene (or genes) for the disease will permit to identify the AT carriers in a population of patients suffering from cancer and to assess precisely the impact of AT heterozygosity in the genetic predisposition to cancer.


[Prevention and treatment of postmenopausal osteoporosis in women treated for cancer].

Among 50-year-old women, about 30%, will suffer from osteoporosis resulting in vertebral compression, pain, and possible disablement; this represents a cost of over 4 billion French franco, and therefore necessitates a prevention policy. It has been established that estrogens applied in a dose-dependent manner have a preventive action against bone loss during the treatment period. The action of nor-steroid progestatives and anti-estrogens is likely, although this has not been fully demonstrated. Estrogens, when administered alone, increase the risk of endometrial cancer; however, this risk seems to be reduced by the addition of progestatives over a minimal period of time. Regarding breast cancer, it seems that substitutional hormone treatments for menopause only increase the risk of the above cancer after a prolonged period of over 10 years. The role of progestatives in breast-cancer risk remains uncertain, and is a subject of controversy. It therefore seems justified to prescribe substitutional hormone treatments combining estrogens and progestatives for young women in whom treatment for non hormone-dependent cancers of the cervix, ovary, etc has resulted in castration. For women who have been treated for breast or endometrial cancer, we are of the opinion that the treatment of choice should consist of non-hormonal treatments for prevention of osteoporosis.


[Primary neuroendocrine cutaneous carcinoma or Merkel cell carcinoma. Review of the literature].

The neuroendocrine carcinomas of the skin, also called Merkel cell carcinomas, are unusual malignancies mostly observed in the elderly. They are diagnosed by a pathologist: ultrastructural studies and immunohistochemistry support the diagnosis. The prognosis is poor. Lymph nodes and metastases quickly arise although sometimes, they are discovered immediately. A combination of surgery and radiotherapy is recommended. Metastases and unresectable tumors should be treated by chemotherapy.


[Evaluation of the consequences of signing a written consent on physician-patient relations. Apropos of Huriet's legislation].

Whenever an innovative treatment or a research protocol is proposed to a patient, the "loi Huriet" requires a written consent from the patient. This is an important change in the field of the interrelation between the doctor and his patient. To evaluate the impact of this written consent we asked 215 patients who have signed a consent form to answer a questionnaire at the end of their radiation treatment. The signature appears as an important event. The majority of the patients (70%) is not shocked by this procedure. In 97% of cases, in spite of this written relation, the patients keep intact their confidence in their doctor. Sometimes this consent form may improve the information given to the patient and it should not be seen as an obstacle for the development of research trials. There are still many problems to be solved as regards the information of the patient and the application of the "loi Huriet".


[Primary epidermoid carcinoma of the breast. Clinical, histopathologic and prognostic study of 14 patients].

We reviewed the charts of 14 patients with epidermoid breast carcinoma, whether pure or associated with a minor glandular component. These patients were treated between 1970 and 1989 at the Institut Curie and represented 0.06% of all breast cancer patients treated during the same period. No clinical or radiological criteria could help to discriminate these forms from other types of breast cancer. Four out of 13 patients with initial axillary node dissection had nodal involvement. Various combinations of surgery and radiotherapy were used to treat these patients. One out of 14 hormone receptor levels was positive. Median survival was 54 months (9 months-144 months). Two patients had a local recurrence and 7 had metastasis. No event occurred beyond 5 years of follow-up. This suggest that the outcome of epidermoid breast tumors is closer to that of other epidermoid tumors, rather than to other types of breast cancer.


[Breast cancer in men: incidence and types of associated previous synchronous and metachronous cancers].

Male breast cancer represents about only 1% of all breast cancers. We have analysed a retrospective, multicentric series of 404 patients, initially non-metastatic, with mean age of 63 years. The 5 and 10-year overall survival rates were 65 and 36% respectively. Sixty-eight patients developed secondary cancer. From ten patients who already presented with cancer (2.5%) 3 cases corresponded to prostatic cancer treated by estrogen. Four had synchronous cancer (1%). Three and eight patients respectively had a synchronous and metachronous contralateral breast cancer (2.7% of bilateral cancer). Forty-three other patients (10.6%) developed metachronous cancer. The main tumor types were: prostate (9), lung (6), colon and rectum (6), esophagus (4). Four patients developed various hematologic malignancies and 14 patients, various types of solid tumors. From these 43 patients, 27 died; 19 as a result of secondary cancer. This represents 9% of all deaths among the 404 patients. While the bilateral cancer rate is similar to women, the second cancer rate appears to be higher in men. From hematological malignancies, chemotherapy and radiotherapy do not seem to contribute to this high incidence of second cancer.


[Value of the combination of piperacillin and pefloxacin possibly followed by vancomycin in the treatment of febrile neutropenia in nephrotoxic chemotherapy].

We evaluated the efficacy and safety of piperacillin-pefloxacin potentially associated to vancomycin as a non nephrotoxic antimicrobial therapy in febrile neutropenic cancer patients, treated with nephrotoxic chemotherapy. Fifty-seven patients: 49 with solid tumors and 8 non-Hodgkin lymphomas, were treated during 85 episodes with: piperacillin 4 g IV every 8 h pefloxacin 400 mg IV every 12 h. If the patient remained febrile after 72 h, 1 g of vancomycin IV was added every 12 h. The mean duration of neutropenia was 7 days (3-14 days). In 44 episodes, the granulocyte nadir was < 100/mm3. Infection was microbiologically documented in 17 episodes (20%) with ten Gram-positive cocci and 11 Gram-negative bacilli. There were 64 apyrexia with piperacillin-pefloxacin (75%) and further 14 were resolved by the addition of vancomycin (total success = 92%); three early changes because of clinical deterioration (two episodes) or germ resistance (one episode); three protocol violations, and one apyrexia by addition of amphotericin. Neither septic death nor toxicity were observed. We conclude that this empirical treatment is active and safe and avoids nephrotoxicity in cancer patients heavily treated with nephrotoxic chemotherapy.


[Esophageal cancer: did combined treatments improve prognosis?].

Prognosis of esophageal cancer is very poor. Five-year survival does not exceed 20% after radical surgery, the best available treatment. Unfortunately, only 40% of the patients are amenable to surgery because of poor general status and/or locoregional extension. Adjuvant treatment did not yield survival improvement. Preoperative radiotherapy (three randomized trials) or postoperative radiotherapy (one randomized trial) showed only a decrease of regional relapses, perhaps only for the nodes negative patients. Neoadjuvant chemotherapy obtains some interesting response rate (20-60%), but there has been no evidence yet for survival improvement. Recently, promising results were presented after combination of radiotherapy and chemotherapy. In this paper, we review the present status of combined treatment for esophageal cancer. Our multicentric group (OSOF) is now completing a phase II trial, that should soon form the basis for a phase III prospective study.


[Reflections on the classification validation of the most common forms of osteosarcomas by functional isotopic methods].

After noting the limits of a purely morphological approach, either the descriptive methods for classifying certain osteosarcomas, or the techniques connected with these limitations such as particularly limited or non significant sampling, the authors consider the possible contribution of new methods such as immunohistochemistry or in vivo radioisotope tests to improve osseous tumor classification. The latter methods may be particularly useful in clarifying a significant number of difficult diagnoses or in providing information on tumor location, to be combined with morphological observations regarding osteosarcomas.


[Present and future of the practice of medical oncology and multidisciplinary cancerology].

The Assembly of French Professors in Cancerology, consisting of medical and surgical oncologists as well as radiotherapists, has introduced a new diploma for specialized studies in medical oncology. This diploma is entitled oncology, medical option; the pre-existing diploma for radiotherapy is entitled oncology, radiotherapeutic option. Both diplomas are awarded after a common training period followed by specific studies for each one. A third diploma requiring a shorter study period (2 years) has been in existence for a few years and is awarded after complementary pluridisciplinary studies in cancerology. It provides medical oncologists and radiotherapists, as well as surgical and medical specialists in organs with the possibility, if they wish, to acquire global knowledge in cancerology over and above that connected with their specific area of expertise. It familiarizes them with a pluridisciplinary cancerological approach to setting up diagnostic and treatment protocols with subsequent applications to clinical and therapeutic trials. The recent reforms in post-graduate studies have now made available teaching models and state diplomas for all areas of clinical cancerology including an optional pluridisciplinary course--and should constitute an invaluable contribution to both public and private practice. They should also facilitate the work of the state bodies and those in charge of health expenditure.


[Value of thymidine kinase in the prediction of response to treatment by chemotherapy or hormone therapy in breast cancer].

Thymidine kinase (TK) was assayed in the cytosol of 210 primary breast cancers to assess its predictive value for response to first line chemotherapy and hormonotherapy. We performed correlations between TK and the other prognosis factors of breast cancer. TK activity is correlated with SBR grading and estrogen receptors. It has a low predictive value for response to chemotherapy and is not useful for hormonotherapy.


[Treatment of metastatic malignant melanoma with interleukin-2].

Between April 1988 and December 1990, 37 patients with progressive histologically proven metastatic melanoma were treated with interleukin-2 according to three multicentric successive protocols. Eighteen males and 19 females entered the trial. Mean age was 44 years (range 20-66); none of the patients had severe visceral disease or brain metastasis. Superficial and visceral metastatic sites were equally distributed. Interleukin-2 was administered as a 3 to 5 day continuous intravenous infusion, at a dose varying from 16 to 24 million international units/m2/day, as previously described by West. The second course was given after a 9 to 16 day free interval and one to seven courses were administered (mean three courses). A total of 132 courses has been given to the 37 patients. All are evaluable for toxicity and efficacy. Toxicity was tolerable and not different from that presented in recent reports. Only four patients had to definitively stop therapy for toxicity, one of them for cardiotoxicity; a dose modification or a transient suspension of therapy occurred in 18% of treatment cycles. One hypothyroidism with anti-thyroglobulin and anti-microsome antibodies was observed. We observed eight major responses (21.6%), usually of short duration (2-6 months). Most responses occurred in superficial lesions. One patient remains in complete remission, as therapy is stopped for 40 months. Immunological parameters, although demonstrating induced immunostimulation, did not correlate with clinical outcome. With an overall response rate of 21.6%, we confirm the activity of interleukin-2 in melanoma, as previously reported by others.


Cancer mortality among Polish migrants to France.

Cancer risk in the Polish-born population of France has been compared to that in Poland and in native French subjects (born in France), using mortality data from the period 1979-1985. The Polish-born community in France is a long-established one--most migration occurred during the 1920s--so that for many cancer sites the cancer pattern is closer to that of French natives than that in Poland (eg oral cavity, oesophagus, large bowel, gall bladder, uterus, leukaemia). Polish migrants, however, retain their characteristically high rates of cancer of the stomach and lung (in men), and low rates of breast and prostate cancer. The Polish-born community has a characteristic pattern of residence (living mainly in the Nord and the Pas-de-Calais) and occupational status (a higher proportion of 'workers' than the French-born); these are important confounding factors which can mask the true differences in risk for several sites (larynx, oesophagus, large bowel) if no adjustment is made during analysis.


[To plead for the introduction of a new psycho-oncology in France].

Psycho-oncology is a new discipline which considers the problem of psychological distress of cancer patients in a different manner to that of classical psychoanalysis. It is symptomatic, practical, scientific, and widely used on an international scale. It provides fresh clarification and the latest practical techniques in many areas: treatment of side-effects subsequent to radio- or chemotherapy, problems connected with life "after", risk factors, psychosocial interventions for normal stress reactions, treatment of anxiety and depressive syndromes, etc. This approach has been adopted to only a limited extent in France and deserves wider diffusion.


Effect of post-delivery care on neonatal body temperature.

A prospective observational study of post-delivery care and neonatal body temperature, carried out at Kathmandu Maternity Hospital, was followed by a randomized controlled intervention study using three simple methods for maintaining body temperature. There were 500 infants in the initial observation study and 300 in the intervention study. In the observation study, 85% (420/495) of infants had temperatures < 36 degrees C at 2 h and nearly 50% (198/405) had temperatures < 36 degrees C at 24 h (14% were < 35 degrees C). Most of the infants who were cold at 24 h had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the "kangaroo" method, the traditional "oil massage" or a "plastic swaddler". All three were found to be equally effective. Overall, 38% (114/298) of the infants had temperatures < 36 degrees C at 2 h and 18% (41/231) at 24 h (when none was < 35 degrees C).


Macromolecular absorption in small-for-gestational-age infants.

Using human alpha-lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of alpha-lactalbumin was measured as concentration in serum after a human milk feed and expressed as micrograms alpha-lactalbumin/l serum/l human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of alpha-lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of alpha-lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.


Predictive inability of cord zinc, magnesium and copper levels on the development of benign hyperbilirubinemia in the newborn.

Cord serum concentrations of zinc, magnesium and copper were determined in 90 healthy term infants. The infants were divided by peak bilirubin values into an icteric group (peak bilirubin > 136 mumol/l) (n = 21) and a control group (peak bilirubin < or = 136 mumol/) (n = 69). Mean cord serum zinc, magnesium and copper concentrations in the icteric group did not differ from those of the control group. Furthermore, no significant correlation was found between peak serum bilirubin concentrations and cord serum concentrations of these three elements. We conclude that cord serum concentrations of zinc, magnesium or copper are not useful in predicting which neonates will develop hyperbilirubinemia.


Efficacy of "high-intensity" blue-light and "standard" daylight phototherapy for non-haemolytic hyperbilirubinaemia.

We report our clinical experience with phototherapy in 3802 infants; 3629 were exposed to "standard" daylight phototherapy and 173 to "high-intensity" blue-light phototherapy. High-intensity blue-light phototherapy was twice as effective as standard daylight phototherapy in decreasing bilirubin concentrations. No failures occurred with high-intensity phototherapy compared with an overall failure rate of 1.84/1000 with daylight lamps; these cases were transferred to high-intensity phototherapy with prompt response. Rebound after cessation of phototherapy was greater in those exposed to high-intensity blue light with a significantly greater number requiring a second exposure. However, the incidence was still low. No third exposure was required in any infant. Nursing of infants under high-intensity blue light was more difficult and inconvenient as was clinical monitoring. The light also caused more stress on the nursing and medical personnel. However, the infants tolerated both types of phototherapy equally well. High-intensity blue-light phototherapy would seem to be the treatment of choice for infants with rapidly increasing or very high bilirubin levels, as well as in those not responding adequately to daylight phototherapy.


Oxygen saturation and breathing patterns in preterm infants with cyanotic episodes.

The pathophysiology of cyanotic/apnoeic episodes in preterm infants was investigated using overnight tape recordings of beat-to-beat arterial oxygen saturation (SaO2), plethysmographic waveforms from the oximeter, breathing movements and nasal airflow. Recordings were made in 16 preterm infants with recurrent cyanotic episodes of unknown cause that had received stimulation or resuscitation, and 15 preterm controls, matched for birth weight, post-conceptional and postnatal age. The recordings were analysed for baseline SaO2, the number of hypoxaemic episodes (SaO2 < or = 80% for > or = 4 s) and the breathing patterns associated with each episode. There was a significant difference in the total number of hypoxaemic episodes between patients and controls (520 versus 100; p < 0.01), but no difference was found for mean baseline SaO2 (98.6 versus 99.0%; p > 0.05). The mean duration of each hypoxaemic episode in the patients was 9.5 s compared with 5.8 s in the controls (p < 0.01). Although most hypoxaemic episodes (62 and 76%) were associated with pauses in breathing movements, a proportion (8 and 18%, respectively) occurred despite continuous airflow and breathing movements in both patients (6 of 16) and preterm controls (2 of 15). The rate of decrease in SaO2 was significantly more rapid during these latter hypoxaemic episodes than during episodes associated with isolated apnoeic pauses (8.5 versus 3.2% per second, p = 0.02). Preterm infants with cyanotic episodes have increased numbers of clinically unapparent hypoxaemic episodes, some of which have continued ventilation and rapid desaturation. The pathogenesis of these episodes warrants further investigation.


Giardiasis causing chronic diarrhoea in suburban Copenhagen: incidence, physical growth, clinical symptoms and small intestinal abnormality.

During a six-year period, 29 children (aged 0.7-13.5 years, mean 3.3 years) suffering from chronic diarrhoea due to giardiasis were studied. The incidence of this illness was 81 per 1,000,000 children aged 0- < 7 years per year. According to growth charts, relative height and weight of the patients decreased significantly (approximately 0.5 SD) from before the onset of diarrhoea to the time of diagnosis and subsequently increased up to the end of catch-up growth. Small intestinal mucosal specimens were studied. Two patients had severe villous atrophy, 8 moderate abnormalities, 6 only light changes and 13 biopsies were normal. D-xylose or lactose malabsorption was detected in 25% of the patients. The lactose malabsorption was due to hereditary low lactase levels. None of the patients with a Danish ethnic background showed lactose malabsorption. D-xylose absorption and the relative weight loss of the patients correlated with the degree of mucosal damage. Patients with persistent diarrhoea (n = 19) were younger and had a shorter duration of diarrhoeal illness and a more significant weight reduction than those with intermittent diarrhoea (n = 10). However, the age at onset of symptoms was similar in the two groups (medians 1.3 years). Seven patients contracted the disease abroad. They all developed persistent diarrhoea and had a more severe course of the illness than those who acquired the disease in Denmark.


Effect of measles-mumps-rubella vaccination on polymorphonuclear neutrophil functions in children.

Adherence, metabolic burst and chemotaxis of polymorphonuclear neutrophils (PMNs) were examined in 15 children before and seven days after measles-mumps-rubella vaccine administration. In all children, PMN functions were significantly reduced on the seventh day. Adherence, metabolic burst and chemotaxis tested in three subjects one month after vaccination had returned to normal values. Only two children presented transient hyperpyrexia. We conclude that measles-mumps-rubella vaccine administration suppresses PMN functions without clinical consequences. This is probably because attenuated strains of vaccine viruses do not replicate in lymphoid tissues as extensively as do wild-type strains.


Skin test reactivity to atypical mycobacteria among healthy Finnish preschool children vaccinated with BCG vaccine at birth.

Skin test reactivity to three mycobacterial sensitins (M. avium, M. fortuitum and M. scrofulaceum) was studied in 353 healthy children vaccinated with the BCG vaccine at birth. A significant waning of reactivity to all of the three sensitins was found to occur with increasing age. Revaccination against measles, parotitis and rubella had been given to 31 (9%) of the children, all aged > 5.5 years. They had significantly larger reactions sizes, which was contrary to what was expected. Children with atopic dermatitis (n = 19) had significantly smaller reaction sizes to the M. fortuitum sensitin. Neither respiratory viral infections during the preceding six months nor contact with pets or farm animals had any influence on reaction sizes. The variation of sensitin reactions was large in preschool children vaccinated with the BCG vaccine at birth. The diagnostic value of sensitin reactions in preschool children needs to be elaborated in clinical studies in children with clinically demonstrable mycobacteriosis.


A double-blind, placebo-controlled study of the effect of intranasal budesonide in the treatment of children with seasonal rhinitis.

The effectiveness of the intranasal glucocorticosteroid budesonide was investigated in children with grass pollen-induced rhinitis during a pollen season. The trial was of a randomized, double-blind, placebo-controlled, parallel-group design with a one-week run-in period and a three-week treatment period. Twenty-four children received treatment with budesonide 200 micrograms bid and 27 children with placebo, administered by a nasal aerosol. Concomitant terfenadine, as required, was allowed in both groups. Recordings of nasal symptom severity, use of terfenadine and adverse effects were made in diaries. Nasal symptoms were significantly less severe in patients treated with budesonide as compared with placebo-treated patients. An overall assessment of treatment effect made by the children was significantly in favour of budesonide, and the consumption of terfenadine was significantly larger in the placebo than in the budesonide group. These results provide good evidence that intranasal budesonide is effective in seasonal rhinitis in children.


Implantable central venous catheter facilitates prophylactic treatment in children with haemophilia.

Twelve children with a severe form of haemophilia A received a totally implantable venous access system (Port-A-Cath) to facilitate regular prophylactic treatment with factor VIII. The indication for implantation was difficulty in obtaining regular access to a peripheral vein. Postoperative bleeding around the portal site occurred in two of 12 cases. After a median duration of follow-up of 26 months (range 5-79 months), none of the systems had needed replacement due to bleeding, septicaemia or thrombosis. One child, with an inhibitor against factor VIII, had an infection at the portal site and this system was removed. None of the other children had any serious side effects. Nine of the 12 children's parents learned how to use the Port-A-Cath system, thus enabling optimal prophylactic home treatment with factor VIII to be begun early in life.


Borrelia arthritis in Swedish children: clinical manifestations in 10 children.

Since 1986, serology against Borrelia burgdorferi has been performed on patients with arthritis admitted to the Division of Pediatric Rheumatology, S:t Göran's Hospital, Stockholm. We studied, retrospectively, the period 1986-88. Among 300 children with arthritis, 10 had positive titers against B. B. burgdorferi. Other causes of arthritis were excluded. The onset of Borrelia arthritis was throughout the year. Only 3 of the 10 children remembered an actual tick bite. No other manifestations of Lyme borreliosis were present simultaneously. The typical clinical picture was a relapsing unilateral arthritis of the knee.


The influence of scoliosis brace treatment on function in children with myelomeningocele.

The influence of Boston brace treatment on the functional and motor ability of children with scoliosis secondary to myelomeningocele was studied in a consecutive series of 20 children of 5-19 years of age. Motor activity, ADL function and ambulation ability were assessed before brace treatment and then annually during the treatment period, which lasted an average of 2.7 years (range 0.6-8.7 years). Thirteen children were followed-up one year after braces were removed. The effect of brace treatment on the scoliosis was favourable as is reported elsewhere. The children's motor activity and ADL function remained unchanged during brace treatment, but brace wearing was accompanied by a decreased ambulatory skill. This may partly be explained by a slight increase of flexion contractures of the hips during treatment. Patients with useful ambulation ability kept this ability up even during brace treatment. Considering the favourable effect of brace treatment on the scoliosis curve and the few complications encountered, we recommend brace treatment for scoliosis in patients with myelomeningocele.


Absences for sickness among children in day care.

The number of days of absence because of sickness, recorded for all children in one city in Finland, cared for in municipal day care over a period of 2.5 years, was collected from the monthly figures kept by the city council office for accounting purposes. The average number of days of absence per child was 24 per year at child-care centers and 9 in family care (p < 0.01) at age less than 3 years, 13 and 7, respectively (p < 0.05) at age 3-5 years, and 10 and 5, respectively (p < 0.05) among those aged 6 years. The average duration of absence in all age groups was 3.6 days in child-care centers and 2.5 days in family-care centers. The number of days absent at each child-care center in 1986 correlated significantly with that for 1987 (r = 0.58, p < 0.001), indicating consistency in the absence figures. A bivariate analysis showed the number of children in the child-care centers (r = 0.32, p < 0.05) to explain the number of absences for sickness, and after this factor had been controlled in a multivariate analysis, the number of nurses serving out food while looking after the children (r = 0.27, p < 0.01) and the number of families to whom the children belonged (r = 0.27, p < 0.01).


Chloramphenicol-resistant Haemophilus influenzae meningitis in young urban Nigerian children.

In a developing country like Nigeria, the unusual emergence of Haemophilus influenzae type b, resistant to cost-effective antimicrobials, is of serious concern. We report three cases of H. influenzae type b meningitis in young Nigerian children in whom clinical and bacteriological features of resistance to chloramphenicol were identified. One of the cases had concomitant resistance to ampicillin (multiple-drug resistance). Significant anaemia was an associated feature in two cases, one of whom had a recent measles infection. All three cases were malnourished. The possible mechanisms of antimicrobial resistance in H. influenzae infections are highlighted while the need for periodic surveillance of antibiotic resistance profiles in resource-poor countries is emphasized. The potential value of prophylactic measures like H. influenzae type b conjugate immunization is discussed.


Rupture of the trachea: an unusual complication of delivery.

We describe a neonate whose trachea ruptured during delivery. The baby developed respiratory symptoms shortly after delivery and became dramatically ill after 6 h. This particular birth trauma appears to be very unusual: there are few cases reported in the literature. Rupture of the trachea should be considered as a differential diagnosis in a neonate who develops pneumomediastinum after a complicated delivery.


Cardiac natriuretic peptide hormones during artificial cardiac pacemaker stimulation and left heart catheterization.

Brain natriuretic peptide (BNP) is synthesized and released predominantly in the ventricular myocardium whereas atrial natriuretic peptide (ANP) is produced mainly in the atria. This study evaluated whether artificial pacemaker stimulation or left heart catheterization results in specific changes in BNP and ANP plasma levels. Both BNP and ANP responded sensitively to changes in pacemaker stimulation (single-chamber pacemakers; pacing rates of 72 and 92/min) and during the left heart catheterization procedure. However, whereas higher pacing resulted in a more pronounced increase in plasma BNP levels, a stronger ANP release followed catheterization. This incongruous rise in ANP and BNP plasma concentrations points to at least partly independent mechanisms governing the release of BNP and ANP.


Peptic ulcer bleeding: medical and surgical point of view. Results of a prospective interdisciplinary multicenter observational study. DUSUK Study Group.

Various treatment policies and clinical disciplines compete for the treatment of bleeding peptic ulcer. In a prospective multicenter and interdisciplinary study performed during a 1-year period at ten hospitals in Düsseldorf, all patients admitted for peptic ulcer bleeding were recorded. The characteristics of patients admitted to surgical and to medical departments, the distribution of endoscopic treatment, indications for surgery, type of surgical procedures, and outcome were investigated. In the study period 387 bleeding peptic ulcers were recorded. Of these patients 82% were primarily admitted to medical and 18% to surgical departments. No differences in terms of severity of ulcer disease or bleeding activity were noted between the groups of medical and surgical patients. However, accompanying or underlying diseases were detected more often in patients admitted to medical departments. Endoscopy treatment was performed in the majority of patients with arterial spurting bleeding (88%) or a visible vessel (80%). Injection therapy with epinephrine or polidocanol was mainly used (78%). In 16% of cases the patients underwent operation; 44% of the patients primarily admitted to a surgical department were operated (medical departments, 10%). About half of the operated patients underwent emergency surgery; in the majority of cases resections were performed (gastric ulcer, 76%; duodenal ulcer, 56%). Overall mortality was 11%, with no difference between surgical and medical patients. A high mortality was observed in the subgroup of patients with late recurrent bleeding (27%). It is concluded that for optimal treatment of peptic ulcer bleeding intensive cooperation between physicians and surgeons is necessary, and that agreed and evaluated treatment policies are needed.


Endothelin-1 in patients with complicated and uncomplicated myocardial infarction.

Endothelin-1 concentrations were measured in peripheral venous blood samples from 42 patients with acute myocardial infarction. In patients with ischemic or hemodynamic complications (n = 11), endothelin-1 concentrations were significantly higher already on admission (P = 0.008) and remained significantly higher until day 6 after admission compared to patients with uncomplicated infarctions (n = 31; P = 0.035). There were no close correlations between peak concentrations of endothelin-1 and creatine kinase or creatine kinase isoenzyme MB mass in either group. Only in complicated patients did left ventricular ejection fraction correlate closely and inversely with peak endothelin-1 concentrations (r = -0.71; P = 0.03). Therefore, plasma endothelin-1 concentrations in patients with acute myocardial infarction patients may reflect states of markedly depressed cardiac performance and recurrent myocardial ischemia.


Erythema nodosum of dental origin.

The association of erythema nodosum and dental infectious foci has rarely been described in the literature. This report concerns four women who developed erythema nodosum either following dental treatment associated with gingival bleeding or due to infectious dental foci. In these cases, tooth extraction, removal of dental deposits, interrupted pulp treatment, apical periodontitis, or a relicted root were identified as causes of the development of erythema nodosum. Upon admission to the hospital, these patients also presented fever and and a maximally elevated erythrocyte sedimentation rate (ESR). In all instances, surgical treatment of the dental foci and/or administration of antibiotics rapidly led to the regression of the erythema nodosum, as well as to the normalization of body temperature and ESR. The cases described indicate that antecedent dental treatment and the possible presence of infectious dental foci should be considered in the differential diagnosis of erythema nodosum when taking the patient's medical history. This approach may avoid unnecessary, possibly invasive diagnostic procedures and can lead to rapid improvement in the patient's clinical status.


Disseminated toxoplasmosis with sepsis in AIDS.

A 24-year-old woman with acquired immunodeficiency syndrome was admitted with septic fever of unknown origin and a 2-week history of diarrhea. Clinical diagnostic procedures did not reveal the cause of sepsis. Broad-spectrum antibiotics and intensive symptomatic therapy could not prevent progressive deterioration. The patient developed septic shock and consumptive coagulopathy and died 6 days after admission. Autopsy revealed disseminated infection with toxoplasma gondii and multiple organ manifestations. We conclude that disseminated toxoplasmosis should be considered in AIDS patients with septic disease of unknown origin. Extremely elevated lactate dehydrogenase may suggest disseminated toxoplasma gondii infection. New procedures such as polymerase chain reaction for detection of toxoplasmosis may be helpful diagnostic tools.


Coincidence of primary myelodysplastic syndrome and non-Hodgkin lymphoma.

A 60-year-old patient is presented with primary myelodysplastic syndrome classified according to the criteria of the French-American-British classification as chronic myelomonocytic leukemia and with a hyperviscosity syndrome. We found a monoclonal gammopathy with a very high serum immunoglobulin M level. There is strong evidence for coincidence of myelodysplastic syndrome and Waldenström's macroglobulinemia in this patient.


Comparison of nitroglycerin with nifedipine in patients with hypertensive crisis or severe hypertension.

To determine whether nitroglycerin is as effective as nifedipine in lowering the blood pressure in severe hypertension and hypertensive crisis, two groups of 20 patients received in random sequence either 1.2 mg nitroglycerin sublingually or a 10-mg nifedipine capsule, which was chewed and swallowed. The blood pressure fell after 5 min in the nitroglycerin group from 211/122 mmHg to 171/95 mmHg and after nifedipine from 210/118 to 185/102 mmHg. The greater effect of nitroglycerin may result from faster absorption through the oral mucosa than through the small intestinal mucosa where nifedipine is primarily absorbed. After 15-20 min a satisfactory reduction in blood pressure was reached in both groups: 157/91 and 158/92 mmHg, respectively. After 30 min the heart rate in the nitroglycerin group had decreased from 83 to 80/min, but in the nifedipine group it had increased from 84 to 90/min. The reduction in blood pressure persisted up to 6 h. No significant differences in side effects were determined. Since a hypertensive crisis is usually accompanied by left ventricular failure, pulmonary edema, angina pectoris, or infarction, nitroglycerin has been definitively shown positively to influence these conditions, and preference should be given to nitroglycerin in the treatment of hypertensive crises.


Low incidence of Pneumocystis carinii pneumonia in HIV patients receiving 300 mg pentamidine aerosol every 2 weeks.

The optimal dosage of pentamidine for prophylaxis of Pneumocystis carinii pneumonia (PcP) is unknown. We assessed the effects of 300 mg pentamidine inhaled every 2 weeks. Salbutamol was added for prevention of bronchoconstriction. A total of 128 consecutive HIV patients were enrolled, 21 of whom were excluded within 8 weeks; the remaining 107 patients, 66 on primary and 41 on secondary prophylaxis, were treated for 39 weeks (median; range 8-133). Two patients developed PcP. Side effects occurred in only 14 of 5082 inhalations. Three patients developed hypoglycemia after inhalations. Blood glucose levels determined in 34 patients before and after inhalation revealed a decline from 89 +/- 23 mg/dl to 79 +/- 23 mg/dl (P < 0.005). A randomized prospective trial is necessary to evaluate the efficacy of 300 mg pentamidine inhaled every 4 or 2 weeks.


Living with altered body image: the cancer experience.

A wide range of cancer problems (e.g. tumour, treatment and treatment delivery systems) cause alterations in body image for patients. Individuals' sense of self-worth is bound up with appearance, function and control of their bodies. This value system is developed through the process of socialization and the advertising in the fashion industries. Nurses must consider the value system that patients employ and the way in which they value different aspects of their bodies. Nurses cannot make effective care contributions to the problems of altered body image during the immediate acute phase of illness. It is at a later stage, normally at discharge, that patients experience a reaction to their altered body image.


Nursing implications of increasing asthma prevalence.

There is evidence of a worldwide increase in the prevalence of, and mortality from, asthma. Suggested causes of these increases include environmental and medical factors. There are implications for nursing practice. The nurse has a role to play in health education and promotion for asthmatics. Research is being carried out but there is a need for further work.


Care of a patient with breathing difficulties.

Use of the Roper model of nursing care enabled the patient's physical, social and psychological needs to be met. Identification of actual and potential problems in each activity of daily living enabled goals to be set and care plans to be implemented to alleviate the problems. It is important that nursing care addresses not only the physical side of nursing, but also the psychological needs of the patient and the patient's family. By identifying the patient's fears in each activity of daily living, we could offer practical help and reassurance which greatly facilitated her return to independent living.


Smoking and the young.

Over one quarter of the risk of death due to the sudden infant death syndrome (cot death) is attributable to maternal smoking. Maternal smoking during pregnancy and infancy is one of the most important avoidable risk factors for infant death. Nicotine is a drug of addiction. Many young smokers are addicted to nicotine and develop withdrawal symptoms on stopping. Smoking is an important marker for other types of drug abuse, e.g. alcohol, cannabis and cocaine. The earlier children start smoking, the greater the risk of lung cancer and heart disease. Smoking affects immunity and has been associated with an increased risk of acquiring human immunodeficiency virus-1 infection.


Extended role of the nurse in ICU.

A popular definition of a nurse's extended role is a procedure that is not covered in basic training and for which further training is needed (Rowden, 1987). Nurses' past need for certification and the concept that certain procedures are part of an extended role negates nurses' professionalism. Many nurses fear that the UKCC's abolishment of certification for extended role procedures will open the floodgates for unsafe practice and strip the profession of its protection. This survey analysed what procedures intensive care nurses were performing, how responsibility was related to status, whether certain procedures were classified as extending their role and how staff related these procedures to patient care, staffing levels and professionalism.


Behaviour at the scene of an accident.

Remember that your behaviour at the scene of an accident will directly influence the actions of the other people present. Be aware of your own safety at all times. Double-check that vehicles, machinery and smokers involved in the accident pose no further threat. Be mindful of spinal injuries. Do not move injured patients unless their lives are in immediate danger. Never leave an unconscious patient's airway unsupervised. If a motor cyclist's helmet is removed, it must be done slowly and smoothly.


Career opportunities in oncology.

Oncology nursing offers nurses a wide range of opportunities. Nurses need a wide range of skills in order to care for patients who may have acute oncological illnesses or require palliative care. The nature of the nurse/patient relationship can be intense. Nurses generally find this enhances job satisfaction. The pressures exerted on nurses working in oncology can be immense. Oncology nursing is rewarding but very demanding and therefore the nurse has to be resourceful. Early career planning is advisable to take advantage of the opportunities that are currently available.


Two G-box-related sequences confer different expression patterns in transgenic tobacco.

We have analyzed the expression patterns conferred by two G-box-related motifs, a perfect palindromic sequence (PA, 5'-GCCACGTGGC-3') and motif I (Iwt, 5'-GTACGTGGCG-3'), in transgenic tobacco plants. A mutant version of motif I, Imu, was used as a negative control. PA is present in the promoters of several different genes, whereas Iwt is a conserved sequence found in abscisic acid-inducible promoters. Previously we have demonstrated that PA and Iwt, but not Imu, can bind to the tobacco transcription activator TAF-1 in vitro, with the PA sequence showing a 70-fold higher affinity as compared to Iwt. We found that tetramers of PA and Iwt, which differ by only 2 bp per 10-bp repeat, confer very different tissue-specific and expression patterns in transgenic tobacco plants. PA confers preferential expression in root tissues with a low level of activity in leaves, whereas Iwt directs developmentally regulated expression in seeds beginning 15 days after petals have fully expanded until seed maturation. Imu appears to be inactive because it gives the same expression pattern as the -90 cauliflower mosaic virus 35S promoter control. RNA gel blot analysis showed that the expression pattern of TAF-1 mRNA is similar to that directed by PA, suggesting that TAF-1 may be involved in the transcriptional regulation of PA.


Recent developments in the ENB framework and higher award.

The ENB Higher Award is designed to be flexible and clinically relevant, allowing practitioners to study to first degree and to masters if desired, or simply to follow individual units of learning in the programme to meet identified professional development needs. The structure of the ENB Higher Award is based on the 10 key characteristics of the ENB Framework; these encapsulate all the qualities that should make a good nurse and act as a reference point for practitioners. The aim of the Higher Award is to produce Quality Education for Quality Care, promoting higher standards of nursing care by the application of relevant skills and knowledge. The CAT (Credit Accumulation and Transfer) scheme has been introduced to give credit to existing qualifications and prevent replication of learning for all applicants. APEL (Assessment of Prior Experiential Learning) gives the practitioner the opportunity to claim further exemption from study based on relevant experience declared in a professional portfolio. Because this new scheme is deemed extremely cost-effective, no additional funds will be provided by regional health authorities or the ENB to fund this excellent continuing education initiative.


Developing standards in palliative care.

Palliative care is an area of nursing that demands special skills and deserves standards of excellence. Standards are vital for the monitoring of patient care. Standards ensure that all staff are aware of the level of care to be delivered. Palliative care should be given to all patients who are dying, not just those with cancer. Before standards can be created, a philosophy of care must be written. Time limits must be set and adhered to.


COP9: a new genetic locus involved in light-regulated development and gene expression in arabidopsis.

We report here the identification and characterization of a new Arabidopsis light-regulatory locus, COP9, mutation that leads to a constitutive photomorphogenic phenotype. Dark-grown cop9 seedlings exhibit many morphological characteristics of light-grown seedlings, including short hypocotyls and open and enlarged cotyledons with cell-type and chloroplast differentiation. Furthermore, the cop9 mutation leads to high-level expression of light-inducible genes in the absence of light, probably by altering the promoter activities of these genes. These properties imply that the mutation in the COP9 locus uncouples the light/dark signals from morphogenesis and light-regulated gene expression. In addition, light-grown cop9 mutants are severely dwarfed and are unable to reach maturation and flowering. This adult-lethal phenotype indicates that the COP9 locus also plays a critical role for normal development of the light-grown plant. Similar to cop1 mutants, but not det1, the cop9 mutants show (1) no effect on the phytochrome control of seed germination and (2) deficiency in the dark-adaptive change of expression of light-regulated genes. Our results suggest that the cop9 and cop1 mutations result in the same range of phenotypes and therefore COP9 and COP1 loci may encode closely related components in the same regulatory pathway.


Initial characterization of a pea mutant with light-independent photomorphogenesis.

We have identified a mutant of pea cultivar Alaska that has many of the characteristics normally associated with light-grown seedlings even when grown in complete darkness. We have designated this mutant lip1, for light independent photomorphogenesis. Etiolated wild-type pea seedlings are white to slightly yellow in color and have a distinct morphology characterized by elongated epicotyls and buds containing unexpanded leaves with small, undifferentiated cells. In contrast, mutant seedlings grown under the same conditions are yellow in color and have short epicotyls and expanded leaves showing clear cellular differentiation. Transmission electron microscopy revealed partially developed, agranal plastids in the dark-grown mutant, unlike wild-type seedlings that contain etioplasts with prolamellar bodies. The mutant also exhibits a much shorter lag period for chlorophyll accumulation when etiolated seedlings are transferred from darkness to white light. The dark-grown mutant has 10-fold less spectrally detectable phytochrome, which can be attributed to a 10-fold reduction in the level of the PHYA polypeptide. Cab, Fed1, and RbcS transcripts are present in dark-grown mutant seedlings at levels comparable to those produced in light-grown material. The levels of these transcripts show a normal decrease when green plants grown for 15 days in a light/dark cycle are transferred to continuous darkness. However, transcript levels remain high during dark treatment of seedlings grown for 9 days in continuous light, indicating that the dark adaptation response in this mutant is developmentally plastic. The lip1 mutant has several features in common with the deetiolated Arabidopsis mutants det1, det2, and cop1. However, there are also several important differences, including varying effects on phytochrome levels, organ-specific gene expression, plastid development, and response to dark adaptation.


Pumpkin phloem lectin genes are specifically expressed in companion cells.

Pumpkin phloem exudate contains two abundant phloem proteins: PP1 is a 96-kD protein that forms polymeric filaments in vivo, and PP2 is a 48-kD dimeric lectin. Polyclonal antibodies raised against pumpkin phloem exudate were used to isolate several cDNAs corresponding to PP1 and PP2. RNA gel blot analysis indicated that PP1 is encoded by an mRNA of approximately 2500 nucleotides, whereas PP2 subunits are encoded by an mRNA of 1000 nucleotides. Sequence analysis of PP2 cDNAs revealed a 654-bp open reading frame encoding a 218-amino acid polypeptide; this polypeptide had the carbohydrate binding characteristics of a PP2 subunit. The PP2 mRNA was localized within the phloem of pumpkin hypocotyl cross-sections based on in situ hybridization of a digoxigenin-labeled antisense probe. PP2 mRNA was found within the companion cells in both the bicollateral vascular bundles and the extrafascicular phloem network.


Spatial and temporal gene expression patterns occur during corm development.

We investigated gene expression patterns that occur during taro corm development. Two-dimensional gel electrophoresis identified several different prevalent proteins that accumulate during corm development. Microsequencing studies indicated that some of these proteins are related to taste-modifying proteins, such as curculin and miraculin, and proteins found in other storage organs, such as sporamin and the Kunitz trypsin inhibitor. A curculin-encoding cDNA clone, designated as TC1, was identified that corresponds to a highly prevalent 1-kb corm mRNA. The TC1 mRNA accumulates during corm development, is more prevalent in corm apical than basal regions, and is either absent, or present at low concentrations, in other vegetative organs such as the leaf and root. In situ hybridization experiments showed that the TC1 mRNA is highly concentrated in corm storage parenchyma cells and is absent, or present in reduced concentrations, in other corm cells and tissues. Our results show that corm development is associated with the differentiation of specialized cells and tissues, and that these differentiation events are coupled with the temporal and spatial expression of corm-specific genes.


A 62-kD sucrose binding protein is expressed and localized in tissues actively engaged in sucrose transport.

Sucrose transport from the apoplasm, across the plasma membrane, and into the symplast is critical for growth and development in most plant species. Phloem loading, the process of transporting sucrose against a concentration gradient into the phloem, is an essential first step in long-distance transport of sucrose and carbon partitioning. We report here that a soybean 62-kD sucrose binding protein is associated with the plasma membrane of several cell types engaged in sucrose transport, including the mesophyll cells of young sink leaves, the companion cells of mature phloem, and the cells of the developing cotyledons. Furthermore, the temporal expression of the gene and the accumulation pattern of the protein closely parallel the rate of sucrose uptake in the cotyledon. Molecular cloning and sequence analysis of a full-length cDNA for this 62-kD sucrose binding protein indicated that the protein is not an invertase, contains a 29-amino acid leader peptide that is absent from the mature protein, and is not an integral membrane protein. We conclude that the 62-kD sucrose binding protein is involved in sucrose transport, but is not performing this function independently.


[Results of the Strassmann operation at the Innsbruck University Gynecologic Clinic (1976-1991)].

Strassmann's operation in the presented manner has proven to be a valuable intervention in the case of infertility due to uterus bicornis or subseptus. The pregnancy rate observed after the operation was 92%, while the rate of abortion was 16%. Strassmann's operation requires smaller incisions compared with other metroplasties and was therefore continued. The establishment of the so-called 'abortus habitualis consulting hours' has led to a dramatic increase in the indication of a metroplasty. The proportion of patients with uterine malformations among those presenting with abortus habitualis amounts to 18%. Delivery by cesarean section 1-2 weeks before term should be taken into consideration from the obstetrical viewpoint. However, the decision for this treatment mode is also governed by the wish of the patient for minimal risk.


[Current therapeutic strategies in breast cancer].

In the last 20 years the general and operative treatment of breast cancer has changed to a large extent. The super-radical Rotter-Halstedt operation of breast cancer is past history, and also the modified radical mastectomy (Patey) is performed in fewer cases. The ablative operative therapy of breast cancer is replaced more and more by a breast-conserving operative treatment with the combination of an adjuvant local and general therapy. Adjuvant therapy is mainly understood as a hormonal treatment or polychemotherapy. A great number of randomized studies proves the efficiency of this therapeutic strategy.