Social networks and support in long-term psychiatric patients.

This paper describes quantitative and qualitative aspects of social support in a sample of 40 long-term schizophrenic day patients attending a rehabilitation unit. The influence of symptomatology and experience of life stressors on network and support characteristics was also investigated. The primary networks of these patients were found to be small, comprising on average 7 members, of whom only 3 were seen regularly. Despite this, subjects rated their perceived support as adequate. The secondary networks were of the order of 32. It emerged that greater prevalence of negative symptoms was significantly associated with lower ideal levels of support and this group of patients was significantly less likely to seek support in the event of a life stressor. This may be a protective mechanism to insulate the person from the effects of stressful relationships but at the same time means that they are isolated from potential supports. The clinical implications are discussed in terms of offering optimum support for this marginalized group.


Can we measure need in the homeless mentally ill? Using the MRC Needs for Care Assessment in hostels for the homeless.

Hostels for the homeless contain many who are disabled by chronic mental illness but have little access to rehabilitation services. One approach to solving this problem might be to measure the needs of hostel residents in a standardized way and use this information as a basis for planning interventions. This study attempted to use the MRC Needs for Care Assessment Schedule to measure the needs of 46 mentally ill residents of Oxford hostels. It aimed to determine if a standardized assessment could be used in these difficult settings and if the needs it identified could form a useful basis for planning future interventions. Although it was possible to use the schedule, and although the pattern of need identified appeared broadly to reflect conditions in the hostels, it was not felt that the information produced was of sufficient quality to assist in planning services. The authors postulate that underlying this deficiency is the failure of the schedule to take sufficient account of the views of staff and residents.


A longitudinal psychopathological schedule.

A schedule is described for rating the symptoms of mental illness over a period of time which includes several episodes. The reliability was measured in a study involving six raters. The sources of information required were studied, in 20 patients, by comparing an interview with the patient, a similar interview with an informant and an analysis of the case records. A synopsis of interview and record data are necessary to obtain adequate information about longitudinal psychopathology and 'lifetime' diagnosis.


Depression and reduced natural killer cytotoxicity: a longitudinal study of depressed patients and control subjects.

Cross-sectional studies have demonstrated that natural killer (NK) cell activity is reduced in depression. To extend these observations and examine further the association between severity of depressive symptoms and values of NK activity, this study used a longitudinal case-control design and assessed NK cytotoxicity at intake and at follow-up 6 months after discharge from the hospital in depressed patients and control subjects. From acute hospitalization to follow-up, depression scores significantly (P < 0.01) decreased following treatment in the depressed patients but did not change in the control subjects. NK activity significantly (P < 0.05) increased from intake to follow-up in the depressives while lytic activity did not change in the controls. At intake NK activity was significantly (P < 0.01) reduced in the depressed patients as compared to values in the controls, while at follow-up cytotoxicity was similar between the two groups. These longitudinal data suggest that a reduction of NK cytotoxicity is temporally associated with the state of acute depression.


Neopterin measurement provides evidence of altered cell-mediated immunity in patients with depression, but not with schizophrenia.

Neopterin is a validated marker of the activation of cell-mediated immunity in a variety of disease states. We measured neopterin and creatinine concentrations in the plasma and urine of 22 schizophrenic and 26 depressed patients admitted acutely to hospital, and compared results with those in a large group of normal controls. Neopterin/creatinine ratios were normal in the schizophrenic patients, but significantly elevated in the plasma of depressed patients. In each diagnostic group, the use of psychotropic drugs before admission had no effect on the neopterin ratios observed. Our findings indicate altered cell-mediated immunity in depression.


Growth hormone response to clonidine in male patients with panic disorder untreated by antidepressants.

We report a non-significantly higher growth hormone (GH) response to intravenous clonidine administration (150 micrograms) in 10 male patients with panic disorder who had never received antidepressant therapy than in 10 matched controls. These results are consistent with data suggesting a normal or increased adrenergic receptor sensitivity in panic disorder patients.


A bulimic ruminator? The case of Dr Samuel Johnson.

Utilizing a wide range of eighteenth- and nineteenth-century biographical sources, the eating pathology of Dr Samuel Johnson is illustrated and examined. His presenting symptoms are considered in the light of modern criteria for eating disorders and current research on bulimia nervosa and rumination disorder.


Pterin metabolism in depression: an extension of the amine hypothesis and possible marker of response to ECT.

Urinary excretion of neopterins and biopterins was measured in 23 patients with severe depression before and after receiving electroconvulsive therapy (ECT) and 26 healthy control subjects. Patients with psychotic depression and those responding to ECT had neopterin:biopterin (N:B) ratio significantly higher than controls before commencing ECT and positive therapeutic response was associated with reduction of N:B ratio towards control values. As a raised N:B ratio implies failure to convert neopterin to biopterin it is possible that reduced availability of tetrahydrobiopterin, the essential cofactor for the formation of noradrenaline, serotonin and dopamine, may exert rate limiting control over the synthesis of monoamines implicated in the pathogenesis of depressive disorders. The N:B ratio may be a marker for certain depressive subtypes and response to ECT.


Clinical and neuropathological correlates of depression in Alzheimer's disease.

Depressive symptoms have been reported in patients with mild to moderate Alzheimer's disease (AD). Recent evidence suggests that a noradrenergic deficit originating from neuronal degeneration in brainstem nuclei may represent an organic correlate of these disturbances. We examined the neuropathological changes in the locus coeruleus (LC), substantia nigra (SN), basal nucleus of Meynert and cortex of 52 patients (12 male, 40 female, mean age 83.2 +/- 6.4 years) with pathologically verified AD. Fourteen patients (1 male, 13 female) showed signs of depression. The majority of these patients suffered from severe physical disability or sensory impairment and developed persistent delusions, but had less cognitive impairment. Neuronal counts in the LC were significantly lower than in the 38 patients without depression (36.9 +/- 14.0; 51.4 +/- 28.0 neuromelanin-pigmented cells per section per nucleus; F = 3.4, df = 1, 50, P = 0.04). Neuron counts were higher in the basal nucleus of Meynert in depressed AD patients and there were no differences of the neuron numbers in the SN. Depression (main effect; F = 4.5, P = 0.04) contributed significantly to the variance of neuronal counts in the LC, even when covarying for gender, age of onset, cognitive impairment and cortical Alzheimer pathology. The observed disproportionate loss of noradrenergic and cholinergic neurons in the LC and basal nucleus of Meynert may represent an important organic substrate of depression in AD.


A cancellation test: its reliability in assessing attentional deficits in Alzheimer's disease.

The aim of the study is to provide (i) a standardized procedure for a Cancellation Test of Digits, designed to assess in the visual modality selective attention deficits in patients with Alzheimer's disease, and (ii) a detailed analysis of how patients cope with it. Age-, education-, and sex-adjusted normative scores earned by 352 healthy controls are set forth, as well as data yielded by the Digit Cancellation Test in 74 Alzheimer patients, in 26 patients with a CT-assessed frontal lobe lesion and in a group of 24 healthy subjects urged to perform the task with a shortened time-constraint. Findings include discriminant power of Alzheimer patients versus healthy controls, sensitivity to cognitive evolution of the dementing process and analysis of errors. Attention data failed to supply psychometric support for the posterior-to-anterior algorithm of progressive cortical encroachment of Alzheimer's disease suggested by PET-findings. Emphasis is put on methodological aspects of neuropsychological research on Alzheimer patients and on the analysis of processing components of the tests employed. Results are discussed in the light of the relationships between psychometric assessments and related functions, and underlying neuronal degeneration.


Estimating pre-morbid intellectual ability in the Alcoholic Korsakoff syndrome.

The National Adult Reading Test (NART) is widely used in clinical and research settings to estimate pre-morbid intellectual levels. The validity of the NART in estimating premorbid ability in Alcoholic Korsakoff Syndrome (AKS) is examined in the present study. Twenty AKS subjects were compared with 40 healthy controls. The validity of the NART as a pre-morbid measure in AKS was examined using four methods. AKS subjects made more NART errors than controls, had lower NART predicted IQ than demographically predicted IQ, made more NART errors than predicted by demographic variables and demonstrated NART performance which correlated with degree of memory impairment. It is concluded that NART performance is detrimentally affected by the AKS and that estimating pre-morbid intellectual level in Korsakoff's psychosis using the NART may be invalid. Furthermore, it is postulated that the impaired ability to pronounce correctly irregular words in AKS may reflect a failure in cognitive 'error checking' which may represent a consequence of frontal lobe dysfunction.


Sub-syndromes of tardive dyskinesia and some clinical correlates.

Syndromes of dyskinetic movements in subjects (N = 70) with chronic schizophrenia were investigated, using principal components analysis of AIMS ratings. Consonant with previous research, three discrete groupings were found, namely dyskinetic movements of lips-jaw-tongue, limb-truncal and facial movements. These were then related to demographic, psychological and movement disorder variables. The limb-truncal, but neither the lips-jaw-tongue nor facial movements components, were associated with negative symptoms and cognitive impairment.


A population survey of ischaemic heart disease and minor psychiatric disorder in men.

Associations between ischaemic heart disease and psychiatric morbidity in hospital recruited samples may be confounded by differential referral of patients with co-morbidity. Associations of angina, past history of myocardial infarction, blood pressure, and electrocardiographic evidence of ischaemia with psychiatric disorder can best be examined in community samples as reported here in 2204 middle-aged men from the Caerphilly Collaborative Study. There was a strong association between past history of myocardial infarction, non-specific chest pain, Angina Grade II and psychiatric disorder measured by the 30-item General Health Questionnaire. Electrocardiographic evidence of ischaemia alone was not significantly associated with psychiatric disorder. It is suggested that non-specific chest pain is a symptom of psychiatric disorder; conversely in severe angina psychiatric disorder is secondary to the pain, restricted activity and threat to life which angina implies.


Bulimia nervosa: a 5-year follow-up study.

Fifty patients with bulimia nervosa were followed up for a minimum length of 5 years. Standardized interviews, observer-rated instruments and self-rated questionnaires were employed both at entry and at completion of the follow-up period. After tracing, the positive response rate was 72%; one patient had died. At the time of follow-up 31% of those traced had made a complete recovery and 25% still fulfilled diagnostic criteria for bulimia nervosa. Judged on behavioural symptoms 47.2% of responders had a 'good' outcome. Good outcome was associated with fewer social problems, higher social class, and a significant improvement in eating attitudes at follow-up. All outcome groups reported a reduction of interference by symptoms in other areas of life, and an improvement in mood state. No factors, including those described in previous studies, were identified which predicted outcome.


A quantitative study of body-related attitudes in patients with anorexia and bulimia nervosa.

The Ben-Tovim Walker Body Attitudes Questionnaire (BAQ) is a psychometrically sound self-report instrument for assessing women's attitudes towards their own bodies. The BAQ responses of a large sample of patients with eating disorders (ED) diagnosed in accordance with DSM-III-R criteria were compared with those from a normative population and from diverse groups of psychiatrically and physically ill patients. The ED group was distinct, and showed extreme responses in the area of weight and shape concerns. But a better discrimination between the ED and other populations was achieved using subscales that related to 'body disparagement' (an intense loathing of the body) and 'attractiveness', rather than to weight and shape concerns. ED patients may have a more pervasive disturbance in body-related attitudes than is currently widely accepted. Patients with anorexia and bulimia nervosa showed very similar attitudes despite the symptomatic differences between the groups.


The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.


The Gulf War and its impact on burnout and well-being of working civilians.

Burnout signifies the chronic depletion of coping resources following prolonged exposure to emotionally charged demands. It is manifested by symptoms of emotional, physical and cognitive exhaustion, and is usually studied in relation to occupational stressors. We hypothesized that the major life crisis engendered by missile attacks would give rise to burnout or exacerbate preexisting burnout symptoms. We also hypothesized that individuals suffering from prewar burnout would appraise the war as being more threatening and would be more vulnerable to upper respiratory infections (URI). Wartime and pre-war (baseline) levels of burnout and related symptomatology (cognitive weariness, listlessness, tension and somatic complaints) were compared among 162 Israeli civilians who carried on with their employment duties throughout the Gulf War. We found that the war impacted primarily on younger individuals (age < 45). All the pre-war levels of the above measures increased significantly (except for a marginal increase in tension). The impact of the war was mediated by threat appraisal, as indicated by worry and apprehension. Worry was positively associated with pre-war burnout, and negatively with age and education. Pre-war burnout was associated positively with wartime URIs. It was concluded that the war accelerated the depletion of coping resources and that burnout may be affected by factors other than occupational stress.


Mental health in the oil industry: a comparative study of onshore and offshore employees.

Few empirical studies have examined the mental health of workers on North Sea oil and gas installations, and it is unclear from the available literature whether offshore employees show impaired mental health relative to their onshore counterparts. The present study was intended to clarify this issue by direct comparison of the General Health Questionnaire (GHQ) scores of onshore and offshore personnel engaged in similar work. As compared with published data, only the onshore group showed low GHQ-12 scores, although both groups were low in neuroticism. Analysis of GHQ subscale scores demonstrated that anxiety was significantly higher among offshore workers than among those working onshore, but there were no significant differences in somatic symptoms or social dysfunction. Regression analyses showed that this result was not affected by control for age, job level, and neuroticism, although there was a significant interaction between job level and neuroticism in predicting anxiety. The nature of the offshore environment, and the factors which may play a causal role in elevated anxiety among offshore workers, are discussed.


Body image disorders.

The concepts of disorders of body image are reviewed from three aspects: sociocultural, neurological and psychiatric disorders. Particular attention is paid to the construct of body dysmorphic disorder as defined in the DSM III-R and the separation of this from somatic delusional disorder. The recognition of associated psychopathology will frequently lead to successful treatment before too much time is spent on fruitless attempts at treatment of the presenting complaint.


Psychodermatology: an overview.

As the skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli, dermatological practice involves a psychosomatic dimension. It is, however, the high visibility of dermatoses and their easy accessibility which make the skin a direct target for behavioural problems. Furthermore, self-destructive tendencies and hypochondriacal features often express themselves through dermatological symptoms: dermatitis artefacta and skin hypochondriasis are among the specific psychocutaneous disorders discussed here. In view of the clinical interface between dermatology and psychiatry, general guidelines are formulated and specific aspects of psychotherapy, behavioural treatment and psychotropic drug treatment are discussed.


Psychosomatic disorders related to gynecology.

In this paper current issues on four psychosomatic disorders related to gynecology will be reviewed. The history, nosological problems and psychoneuroendocrine correlates of psychogenic amenorrhea have been summarized taking into account the important role of psychological factors in inducing loss of menses. Definition and diagnostic problems in assessing menstrually related disorders (formerly premenstrual syndrome) have been reviewed, looking at this syndrome as a disorder of adaptation to the cyclical changes of neuroendocrine functions. The impact of stress on fertility and, on the other hand, the effects of infertility on psychological well-being have been pointed out trying to ascertain the pathways involved in these mutual relationships. Finally, the issue of mood changes at menopause and the effects of steroid replacement on affective state have been discussed. As a whole, these evidences indicate the importance of a close cooperation between gynecologist and psychiatrist in the management of gynecological disorders.


Physical illnesses underlying psychiatric symptoms.

The authors reviewed 21 studies dealing with the rate of diagnosed and undiagnosed physical illnesses in the psychiatric patient population. These studies performed by different authors in variable clinical settings with diverse methodology in different locations over a period of 45 years yielded a close concordance. Approximately half of the patients (50.1%) suffered from significant physical illnesses, of these 58.2% were previously undiagnosed. A substantial portion of the physical illnesses (27.1%) produced symptoms showing direct relation to the psychopathology of the patient. These numbers are quite close to those found by authors in earlier research.


Compliance.

Compliance is an ancient topic subjected to intense recent scrutiny as a result of scientific and social changes which focus on lifestyle adjustment to chronic illness and emphasize increasing patient involvement in self-care. Difficulties in definition, measurement and research design as well as the complexity of the problems contribute to conflicting findings and a lack of consensus about determinants of compliance. Five conceptual models have been studied but only a few positive and negative factors have been consistently identified, perhaps because outcome is often influenced by subtle attitudes, beliefs and quality of life considerations. Management involves both education and a variety of interventions that range from simple single strategies to complex multimodal approaches in which the patient's role may vary from being a passive participant of professional supervision to complete autonomy and self-care.


Review of the use of pattern analysis to differentiate true drug and placebo responses.

Placebo response in patients assigned active drug is a troubling source of variance in antidepressant studies. This paper summarizes a series of studies utilizing pattern analysis to distinguish between placebo and true drug responses. Analysis of the persistence, speed, and timing of onset of patients' improvement during antidepressant therapy reveals distinct patterns of response which are likely to be attributable to placebo and true drug effects. While true drug effects seem to be characterized by a 2-week delay in onset followed by persistent improvement, placebo effects seem to be characterized by abrupt, transient improvement. Gradual responses on placebo may be due to spontaneous remission. The heuristic and clinical implications of pattern analysis are discussed.


Factor structure of a Spanish version of the Toronto Alexithymia Scale.

A Spanish adaptation of the Toronto Alexithymia Scale (TAS) was factor-analyzed and its factor solution compared with the Canadian version of this test. A principal factor analysis was performed, revealing four factors of alexithymia. These factors are quite similar to those found through factor analysis of the TAS for the Canadian sample. A discussion of the factor structure is presented.


Denial and the discrepancy between heart rate and reported negative affect: a study of convergent and discriminant validity.

This study examined the convergent and divergent validity of heart-rate (HR)-based response discrepancy scores as measures of denial. After standardizing measures of stressor-related anxiety, hostility, and HR, response discrepancy scores were calculated by subtracting each measure of negative affect from the HR value. Analyses revealed the response discrepancy scores to correlate positively with measures of denial, negatively with a measure of trait anger, and to not correlate with measures of the nondefensive need for approval and the positive trait of curiosity. These findings support the construct validity of response discrepancy scores as markers of denial.


Measurement of psychological and heart rate reactivity to stress in the real world.

The purpose of the present investigation was to develop and test an innovative methodology to assess stress reactivity in the real world. A portable microcomputer was programmed to administer two questionnaires eight times per day for 3 days in the field. Heart rate was measured simultaneously using a reliable and valid ambulatory monitor (Sport Tester PE-3000). Data were analyzed in terms of stress versus no stress, based on subjects' perceptions of the 24 events. It was found that heart rate was significantly higher in the stress condition and that physical stressors contributed significantly to heart rate variability, as did cigarette smoking. Three emotional responses were evident when subjects were stressed: anxiety, hostility and depression; the former two emotions also contributed to heart rate variability. The heart rate data were compared to a number of other studies conducted in the field and found to be strikingly similar. It was concluded that the new technologies currently available allow for the measurement of stress reactivity in the field.


[Psychological and somatic factors in the disease course of Crohn disease].

Crohn's Disease is a severe chronic illness. It is only a little known about which factors determine its course. In this study we investigate 3 somatic (firstly diagnosed vs. repeated inflammation, Crohn's Disease Activity (CDAI), anatomic localization) and 6 psychic (coping-patterns) factors in relation to the duration of the acute inflammatory phase. The sample consists of 90 patients from internistic clinical departments. Under a nomothetic perspective we apply a survival analysis and supplement this by a comparison of two single cases. The results support the thesis, that the course of Crohn's Disease is multifactorially determined. The somatic as well as the psychic (coping) factors allow an at least modest prediction. But there is a marked tendency that an "active-problemorientated", a "not-trivializing" coping and a well established compliance are the more promising predictors.


[Psychological and psychotherapeutic aspects of grief].

Psychological theories on the significance and the process of mourning are discussed, and an approach to the psychotherapy of pathological grief is described. Bereavement behaviour refers to the total response pattern, psychological and physiological, displayed by an individual following the loss of a significant object, usually a loved person. Various theories on the nature and course of bereavement are reviewed. The following psychological aspects associated with bereavement are discussed in more detail: Shock, denial, searching, depression, guilt, aggression, anxiety, jealousy and reintegration. Specific conditions that might lead to pathological mourning are pointed out. At last, an implosive therapy approach to pathological mourning is described, which is based on the prolonged exposure to the painful stimuli until extinction of the severe emotional response occurs ("flooding"). The procedure is illustrated by examples from actual therapies.


[Grief, depression and anxiety after spontaneous abortion--a study of systematic evaluation and factors of influence].

Recent studies demonstrate profound and long-lasting adverse psychological and family sequelae of a spontaneous abortion. However, decisive issues of quality, course and determinants cannot be answered sufficiently due to shortcomings of research (e.g. lack of representative samples and adequate measures, reliance on cross-sectional study designs). Grief reactions and their determinants are differentiated in relation to depressiveness and anxiety in 86 patients from a longitudinal study, employing the Perinatal Grief Scale (Thoedter et al. 1988) and standardized symptom checklists. For the majority of the women, around the 10th week of gestation, the embryo is psychologically represented in fantasies, dreams and concrete arrangements in reality. Immediately after the abortion, these women react with painful feelings of "active grief" and "despair". Additional stresses in the pregnancy and lack of social support predict "self-reproachful coping". Women with recurrent abortions who have no children show depressive reactions. Retrospectively, these also present more anxiety and depressive moods during pregnancy. Results support reliability and validity of the grief scale. Implications for counselling and psychotherapy of women after a spontaneous abortion are discussed with respect to these risk constellations.


[Complementarity and Gestalt circle--Viktor von Weizsäcker and the importance of a general theory of illness].

Two developments have led to the elaboration of a complementarity theory in modern natural science--the Copenhagen interpretation of quantum mechanics and Viktor von Weizsäckers introduction of the subject into biology. The revolutionary implications of these developments are discernible in modern literature. The author seeks to show that a paradigm shift in positivistic clinical medicine is necessitated by the history and theory of science.


[History of psychosomatic medicine in Heidelberg. V. v. Weizsäcker and A. Mitscherlich as clinic founders].

The History of Psychosomatics in Heidelberg: The history of the Mitscherlich psychosomatic clinic and the older Weizsacker ward at the Krehl clinic has been retold with the help of new archive discoveries, it seems to be necessary and also possible to advance the deidealization of these Father figures which, in Mitscherlich's case, has hardly begun. The problem here is to avoid getting involved in the difference which the descendants of these founding fathers nurtured, to the disadvantage of all involved. Reconciliation of this matter includes both resolving the past and severing any identification with the alleged heroes. Even though now smaller, they appear even friendlier.


Histochemical and cytochemical localization of blood group antigens.

The oligosaccharide structures of blood group antigens are not the primary gene products; they are constructed in a stepwise manner by adding particular sugar to precursor oligosaccharides via several glycosyltransferases coded for by different blood group genes (Watkins 1966, 1978, 1980). Consequently, final profiles of antigens expressed in each cell type are influenced by many different factors such as the intrinsic composition of glycosyltransferase species which are defined by the genotype of the individuals, relative activity or amount of these enzymes (repression, derepression or induction of the enzymes), competition between enzymes with overlapping substrate specificity, the organization of the enzymes in membranes, utilizability of precursors and specific substrate sugars, and the activity level of degradating enzymes. Changes in the antigen profiles during maturation, differentiation and malignant transformation are thought to be intimately related to the variability of these factors. Although great importance attaches to histo- and cytochemical information on the distribution and levels of glycosyltransferases and messenger RNA corresponding to the relevant enzyme, detailed and precise localization of the blood group antigens and their variants is the base line for analyzing these complex factors. On the basis of individual genotype and histochemical findings about the antigen distribution and the interrelationship between cells and cellular components producing different antigenic structures (cellular and subcellular mosaicism), we can deduce precursor oligosaccharide levels as well as the status of gene activation and its primary product, glycosyltransferases. Thus, these findings are a prerequisite for further analysis at the molecular genetic level. As emphasized in this article, lectin staining or immunostaining methods with MAbs combined with glycosidase digestion procedures are powerful tools for in situ analysis of carbohydrate structures in histochemical systems. Although in some cases valuable results have been obtained by applying the technique, our knowledge concerning the distribution of complex carbohydrate structures is still far from satisfactory. Along with well defined MAbs and lectins, the key to developing our methods further is successful introduction of glycosidases, in particular, endoglycosidases since these reagents are indispensable for analyzing the inner core structures and glycoconjugate species of the blood group antigens. Application of these techniques at the ultrastructural level is an alluring possibility, even though many difficulties must be overcome. Although their functional roles have not yet been determined, a diverse array of macromolecules is known to be decorated with blood group-related antigens.(ABSTRACT TRUNCATED AT 400 WORDS)


[Domiciliary geriatric care: 20 months' experience].

Geriatric home care (GHC) can help elderly patients by providing comprehensive health care and avoiding prolonged hospital admissions. In this article we discuss our experience in this field. METHODS. From February 1990 to October 1991, 171 elderly patients have been followed periodically at their homes by our GHC team, formed by two geriatricians, a nurse, a social worker, an occupational therapist and a driver. RESULTS. Our patients were very old (81.3 +/- 77 years), had multiple medical problems and high levels of disability (48.6% had a katz ADL index worse than E). The frequency of hospital admissions was high (50% of the patients) but the total number of days in hospital was low (16.1 +/- 18.6 days for a 211.7 +/- 162.3 days of follow-up). Total mortality was 33.9%; 56.9% of them happened at home. CONCLUSIONS. Geriatric home care units can reduce long hospital stays of severely disabled or terminally ill elderly patients, and can provide adequate health care to this group at patients.


[Drug use pattern in an ambulatory geriatric population].

To provide an update of drug utilization patterns of 500 ambulatory subjects over 60 years of age. Subjects were asked about their prescribed and nonprescribed medications an a detailed questionnaire was fulfilled. The case records and prescription sheets, when available, were examined. Drug histories were obtained on 313 women and 187 men. the mean age was 71 years (range 60-96). Of these participants 1.8% were taking no medications. The average number of drugs used was 4.8 (range from 0-16) nevertheless, the mean number of pharmacological active ingredients was much higher (7.3). The mean number of nonprescribed medications was 0.11, the majority with only an active ingredient. 87% had been used for longer than three months, and were taken daily (84%). The most commonly prescribed medications in this population were paracetamol, digoxin, hydrochlorothiazide, amiloride, nifedipine and captopril. The elderly are, in fact, receiving an increasing number of medications with a narrow therapeutic index and chronically.


[Effect of acarbose on glycemia and pancreatic hormone secretion induced by usual meals in Spain].

Acarbose is a pseudotetrasaccharide of bacterial origin which, in a competitive and reversible way, inhibits intestinal alphaglycosidase. Following such mechanism of action, carbohydrates are not split to monosaccharides and, therefore, cannot be absorbed as easily as in normal conditions. Controlled clinical trials have shown the therapeutic usefulness of Acarbose in the treatment of mon-insulin dependent as well as insulin dependent Diabetes, specially in reducing postprandial hyperglycemia and glycosylated hemoglobin levels. The objective of this study was to evaluate the effect of Acarbose when it is used in a diet with a time-schedule and calorie distribution typical of a Spanish environment. A cross-over simple-blind study design was followed, in which 8 healthy volunteers, with ages between 23 and 29 years, took at 8:30 a.m. a 530 Kcal breakfast (18% of the daily total), at 13:30 p.m. a 1.400 Kcal lunch (40%), and at 21:00 p.m. a 1.070 Kcal dinner (36%). Before each of the meals 100 mg of Acarbose (or placebo, following a randomized distribution) were administered, and blood samples were drawn-10, 0, 30, 60, 90, 120, 150 and 180 minutes, in which glucose levels, insulin, pancreatic polypeptide and glucagon were determined. When Acarbose was administered statistically significant differences in glycemia and insulin postprandial figures were observed. It is concluded that when Acarbose is administered at a 100 mg dose (t.i.d.) together with a diet with a typically spanish calorie distribution and time-schedule, it produces a significant lowering in the postprandial glucose and insulin raises.(ABSTRACT TRUNCATED AT 250 WORDS)


[Hypersensitivity syndrome caused by allopurinol: report of 2 cases and review of the literature].

A severe adverse drug effect secondary to allopurinol ingestion has been described, characterized by fever, eosinophilia, cutaneous rash, hepatic lesion and renal failure, with a high mortality (21-26%) and unknown ethiopathogenicity. In many cases patients had a previous disorder on their renal function (53%) and more than half received allopurinol due to asymptomatic hyperuricemia. We present two new cases and review other 18 patients diagnosed in the last nine years, analyzing the ethiopathogenicity, epidemiological, clinical, therapeutical and preventive aspects.


[Werner's syndrome. Report of a new case].

Werner syndrome or adult progeria is a very rare disease transmitted in a recessive autosomic way. It is characterized by a pathologic and premature aging in all organs and systems, which begins generally between 1st and 3rd decades of life. We discuss a new case with a very visible expression both clinical as well as analytical, highlighting the characteristic chromosomic study.


[Nodular regenerative hepatic hyperplasia associated with primary biliary cirrhosis].

An Hepatic Regenerative Nodular Hyperplasia (RNH) linked to a stage I Primary Biliary Cirrhosis (PBC) is presented. The scientific literature backing such association in reviewed. The pathogenic relationship between the two lesions and the role of RNH in the onset of portal hypertension in the initial stages of PBC is discussed.


[Extraintestinal manifestations of chronic inflammatory intestinal disease].

Intestinal Inflammatory Chronic Disease includes a series of pathological entities of unknown etiology, basically characterized by inflammatory lesions in the digestive tube. Importance of this disease, which frequency has grown in the last few years, lies in the fact that not only affects the intestine but also other organs, originating systemic manifestations which, occasionally, modify the evolution and therapy of these patients. Because of this fact, we try, in this work, to provide a general overview of the extra-intestinal pathology associated with Crohn's disease and ulcerative colitis.


[Delay in childhood tuberculosis detection as a negative factor in the anti-tuberculosis struggle].

Childhood morbidity due to tuberculosis infection in Spain is not diminishing at the expected rate in relation with available knowledge and facilities. An important factor is the delay in diagnosis, which evaluation constitutes the objective of this publication. Said delay is due to several causes, patient does not consult on time (mean value between onset of symptoms and consult is 34.3 days), or physician does not think in tuberculosis as first diagnosis, which meant an added mean delay of 7.6 days more. These delays mean an important detriment for the patient, and one of the objectives in the anti-tuberculosis struggle is to shorten delays through information to the lay public and health professionals on the highly important current issue of tuberculosis.


[HIV antibodies in a hospital emergency unit. Detection through a system of pooled batches].

In order to determine the frequency of HIV seropositivity of sera from patients attending our hospital emergency department (ED) we used a HIV screening system based on the use of pooled sera. To determine the reliability of this marker we collect all ED serum samples during two different intervals of a week. From 577 sera analyzed by this method we detected 1.38% of HIV positive samples (95% confidence interval from 0.43% to 2.33%) with 74% benefit on reactives. We did not find significative differences between the rates of HIV seropositivity in the two period of analyzing (1.6% in October 1990 vs 1.2% in February 1991). The consistency of this method for anonymous HIV testing could be applied to a large number of samples from cohorts of expected low HIV prevalence rates and indirectly using this marker to control the spreading of HIV in a given population.


[Acute-phase reactants in sepsis].

In 71 patients with fever and bacteremia without complications, a prospective study of acute-phase reactants is done. Raises in haptoglobin, ceruloplasmin, alpha-1-antitrypsin, protein C, beta-2-microglobulin, IgA and ferritin serum levels, together with leucocytosis and GSR, were very significant when diagnosis was done. Fibronectin, sideremia and transferrin were lowered. After 3 and 6 days of treatment haptoglobins, alpha-1-antitrypsin, protein C, ferritin, leucocytosis and GSR are lowered, while immunoglobulins, sideremia, transferrin and fibronectin raised, the latter until normalization. Fibronectin as well as changes in iron metabolism were very reliable parameters of inflammation and favorable evolution.


[Meningeal infiltration in multiple myeloma. Study of a new case and literature review].

A patient with lambda light-chains Bence-Jones multiple myeloma (MM) showed a meningeal myelomatosis during a relapse of his illness. Meningeal infiltration was showed through the detection of plasmatic cells in cerebro spinal fluid, identified morphologic and immunophenotypically, together with hyperproteinemia constituted exclusively by lambda light-chains. Treatment was given, intrathecal (methotrexate and cytosine arabinoside) and systemic (vincristine, adriamycin and dexamethasone) chemotherapy, with disappearance of meningeal infiltration. However the patient died, after three months evolution of MM, tough. Literature on this topic is reviewed.


[Primary empty sella turcica: clinical, radiological and hormonal evaluation].

A retrospective study of 33 patients diagnosed of primary empty sella turcica has been done. Main clinical feature was cephalea, which was present in 51.1% of cases. Diagnosis was done based in Neuroradiologic studies (CAT, Cisternography, Pneumocisternography, Nuclear Magnetic Resonance) finding sellar size being significantly smaller in cases studied after 1980. After Hypophyseal function study, 19 patients did not show any endocrinological disorders, in the other 14 (42.4%), hyperprolactinemia was the most frequent finding (7 patients, 23.3%). 17.8% of cases showed a lowered response of Growth Hormone to insulinic Hypoglycemia. In two cases Panhypopituitarism was found and in case Insipidus diabetes was diagnosed.


[User's arguments in the use of a hospital emergency unit].

300 cases admitted in a hospital Emergency Unit are studied, corresponding to two weeks of June 1989, with the aim to know user's characteristics and pathology shown. Through a survey addressed to the patient, or person accompanying him/her, it is intended to know the reasons which motivated the election of this type of service. Predominant pathology is the one which groups lesions and adverse effects (52%) and are younger age groups the ones who consult more frequently. Most part of patient (80%) show up with no previous inform or document and 89% of admitted patients were sent to their homes. Geographical proximity explains in most cases the election of the Emergency Unit. Reasons vary according to age, diagnostic and different circumstances. For example during morning hours, and among patients who attend based on their initiative, "familiarity" is the most important reason to adopt the decision to attend Emergency Unit.


[The kidney in mechanical ventilation].

The negative effect of artificial ventilation with positive pressure on renal function, expresses itself as a decrease of water and sodium excretion, being directly related with the raise of intrathoracic pressure. Factors participating in this process are: lowering in cardiac output, arousal of sympathic nervous system, increase in vasopressin action, activation of renin-angiotensin-aldosterone system and decrease of atrial natriuretic peptide release. This disorder of hydromineral metabolism produces: Impairment of hemodynamic equilibrium, favors the increase of hypoxia and renal failure. The effects of mechanical ventilation on renal function can be attenuated with the adoption of the following measures: a) techniques (use of low levels of PEEP and early disconnection of respirator); b) therapeutic (dopamine 2-3 mcg/kg/min, rational use of diuretics and fluids); y c) monitoring of renal function and hydro-mineral equilibrium.


The level of supercoiling affects the regulation of DNA replication in Escherichia coli.

The chromosome of Escherichia coli is negatively supercoiled. This favours processes that unwind the two DNA strands, such as DNA replication. In this paper, we have investigated the effect of changed levels of overall chromosomal supercoiling on the initiation of DNA replication. Specifically, we have used flow cytometry to reveal effects on the synchrony of initiations of DNA replication in single cells. An increase in the level of supercoiling moderately reduced initiation synchrony. In contrast, decreased supercoiling led to pronounced asynchrony. We have excluded the possibility that this asynchrony is caused by changes in the level of the Dam methyltransferase or the DnaA protein. We suggest that the global level of supercoiling influences the topology of oriC and thereby the sequence of events leading to initiation of DNA replication in E. coli.


Functional analysis of the pertussis toxin promoter.

The expression of the pertussis toxin ptx operon is positively regulated in cis by a promoter region of about 170 base pairs and in trans by the bvg locus, which codes for the transcriptional activator protein BvgA. The promoter contains two direct repeats which are essential for its activity. When the position of these direct repeats relative to the transcription start point was changed, the activity of the promoter was strongly impaired. The repeated sequences therefore do not represent enhancer-like elements similar to those which have been identified in other positively regulated promoters; instead, the integrity of the whole promoter region seems to be an important feature of ptx regulation. A transcription interference assay was carried out to analyze in vivo binding of regulatory proteins to the ptx promoter. The results suggest that the direct repeats are the recognition sequence of a protein, which binds to them only under conditions in which the promoter is activated. In vitro DNA binding experiments with BvgA protein purified from an overproducing Escherichia coli strain were performed. However, no binding of BvgA to the ptx promoter was observed under conditions where binding of BvgA to the fha and bvg promoters occurred. This suggests that factors in addition to the bvg system are involved in the regulation of the Bordetella virulence regulon.


Further characterization of the histidine gene cluster of Streptomyces coelicolor A3(2): nucleotide sequence and transcriptional analysis of hisD.

We have further characterized the genomic region of Streptomyces coelicolor A3(2) that contains genes involved in the biosynthesis of histidine. A 2,357-base pair fragment contained in plasmid pSCH3328 that complemented hisD mutations has been sequenced. Computer analysis revealed an open reading frame that encodes a protein with significant homology to the Escherichia coli, Salmonella typhimurium and Mycobacterium smegmatis hisD product, Saccharomyces cerevisiae HIS4C, and Neurospora crassa his3 gene products. Two other contiguous open reading frames oriented divergently with respect to hisD did not show significant similarity with any of the his genes or to other sequences included in the gene bank. S1 nuclease mapping and primer extension experiments indicate that the transcription initiation site of the his-specific mRNA coincides with the GUG translation initiation codon of the hisD cistron.


Membrane phospholipid composition in Saccharomyces uvarum cells grown in the presence of subinhibitory doses of amphotericin B and desertomycin.

In Saccharomyces uvarum cultures, subinhibitory doses of amphotericin B and desertomycin induced alterations in the plasma membrane phospholipid composition. Amphotericin B increased the lipid content in the plasma membrane. It showed a pronounced effect on fatty acyl constituents by raising the amounts of mono- and polyunsaturated derivatives in phospholipids. On the other hand, desertomycin had no apparent effect on fatty acid synthesis but altered the relative composition of phospholipids in the membrane. Phosphatidyl choline and phosphatidyl ethanolamine contents decreased, while their precursors, phosphatidyl serine and phosphatidic acid, increased. On the other hand, the rates of phosphatidyl inositol were not significantly affected by the action of either antifungal agent.


Molecular typing of Salmonella enterica subsp. enterica serovar Wien by rRNA gene restriction patterns.

Analysis of digested DNA from 40 Salmonella enterica subsp. enterica serovar Wien isolates revealed five different rRNA gene restriction patterns for HindIII (H1 to H5) and five for PstI (P1 to P5). The isolates had been selected on the basis of the year of isolation, the geographic origin and the antibiotic resistance pattern and were distinguished as follows: a) 13 pre-epidemic isolates from different French towns in 1958-69 and from Senegal in 1968; b) 7 epidemic isolates from Algiers in 1969; c) 20 post-epidemic isolates from different French and Italian towns in 1970-90. Three different rRNA patterns (H1P1, H3P3 and H4P4) were observed among the pre-epidemic isolates. Conversely, the epidemic isolates, which were characterized by the previously described large antibiotic resistance patterns and by the presence of 1.3 and 80-109 MDa plasmids, belonged to the same H1P1 ribotype. All but two post-epidemic isolates were of the H1P1 ribotype. The determination of rRNA gene restriction patterns together with the plasmid content proved to be useful for a better characterization of the serovar Wien endemic and epidemic isolates.


The origin of His+ revertants of Salmonella typhimurium obtained on selective medium.

The spontaneous reversion to His+ of the Salmonella typhimurium alleles hisD3052 and hisG46 was investigated. In fluctuation tests, the expected "jackpot" distribution of His+ revertants was not observed. The experimental distributions were close to Poisson distribution. The redistribution test showed no significant differences in the His+ colony counts between spread and unspread plates. An attempt at indirect selection of His+ revertants in fluid medium failed. It was also shown that the mean number of His+ reversion events and the mean number of revertants per plate were similar. At the same time, kanamycin-resistant mutants had jackpot distribution. Selection for His+ revertants (histidine starvation) did not increase mutation to Kanr.


Isolation and characterization of isoniazid-resistant mutants of Mycobacterium smegmatis and M. aurum.

INH-resistant mutants of Mycobacterium aurum and M. smegmatis were isolated and characterized in an attempt to provide fresh insight into the activity of isoniazid (INH), a key antibiotic in the treatment of tuberculosis. In both cases, high levels of resistance were accompanied by slower growth rate, by loss of peroxidase and reduced catalase activities, although mycolic acid production was unaffected. A gene homologous to the katG gene of M. tuberculosis, encoding peroxidase-catalase, was detected in wild-type and INH-resistant strains and it appears that INH resistance may stem from the loss of its product.


An improved method for quantitative culture of Malassezia furfur.

Quantitative culture of Malassezia furfur from clinically healthy skin in 25 individuals was performed with two different methods using contact plates. The best results were obtained when a glucose peptone yeast extract medium, with the addition of milk, Tween-60, glycerol and glycerol monostearate was used. Different techniques for incubation and the reproducibility of this method were evaluated. Incubation can be done in a plastic bag at 32 or 37 degrees C. This new method is simple, the colonies are easy to identify and the counts are high and reliable.


Immunological and clinical effect of long-term oral treatment with RU 41740 in patients with chronic bronchitis: double-blind trial long-term versus standard dose regimen.

The immunological and clinical effects of two oral treatment schedules of RU 41740 (standard for 3 months vs. long-term for 6 months) were assessed in 40 patients with chronic bronchitis by a controlled, double-blind, randomized trial. Both treatments significantly improved phagocytosis index of both neutrophils and monocytes, and the phagocytosis frequency and the candidacidal activity of neutrophils, showing the maximum stimulation at the end of the third course of treatment. Both treatment schedules reduced the number and the duration of infectious exacerbations of chronic bronchitis with respect to those observed in the corresponding period of the previous year. However, no significant difference between standard and long-term treatment with RU 41740 was found with respect to the immunological and clinical effect and tolerability.


Respiratory impedance measurements in a dose-response study of isocapnic hyperventilation with cold air.

Spirometry and impedance of the respiratory system were compared after increasing rates of isocapnic cold air hyperventilation (IHCA) in 10 asthmatics and 11 healthy nonsmokers. In the control group IHCA at 60% of indirect maximum breathing capacity (IMBC) resulted in a significant, equal increase in resistance at lower and higher frequencies, suggesting central airway constriction. In the asthmatics negative frequency dependence of resistance and a significant increase in resonant frequency and decrease in the reactance at 8 Hz were found at 40 and 60% IMBC. These changes suggest an increase in the resistance of the peripheral airways. The frequency dependence of resistance and resonant frequency were found to be the most sensitive measures to differentiate between normals and asthmatics. It is concluded that impedance measurements provide a suited method to assess the response in cold air provocation tests.


Enhanced chemiluminescence with decreased antibody-dependent cellular cytotoxicity of human alveolar neutrophil in patients with adult respiratory distress syndrome.

In order to elucidate the intrinsic defects of inflammatory cells in adult respiratory distress syndrome (ARDS), 10 ARDS patients, 6 non-ARDS respiratory failure patients and 30 healthy controls were included in this study. The peripheral blood neutrophils (PBNs) were isolated from heparinized venous blood. Human alveolar neutrophils (HANs) were taken during bronchoalveolar lavage (BAL). Chemiluminescence was then measured with a luminometer (LKB Wallac) and antibody dependent cellular cytotoxicity (ADCC) was assayed using a Cr51 cytotoxic assay. The bacterial killing test utilized heparinized PBNs and Staphylococcus aureus. The results showed that the chemiluminescence of PBNs and HANs was higher in ARDS patients than in the normal control group (p < 0.05). However, ADCC levels in the PBNs and HANs of ARDS patients were much lower than in normal subjects (p < 0.01). The bacterial killing ability of PBNs was also impaired in ARDS patients, compared with either the normal control subjects or non-ARDS respiratory failure patients. In conclusion, chemiluminescence is increased in both PBNs and HANs of ARDS patients, which could partly explain the pathogenesis of acute lung injury. Furthermore, the suppression of ADCC in both PBNs and HANs as well as the impaired bacterial killing of PBNs may explain the impaired bacterial defenses and the consequent increase in pulmonary infection among ARDS patients.


Preventive effects of inhaled formoterol and salbutamol on histamine-induced bronchoconstriction--a placebo-controlled study.

The preventive effects of inhaled formoterol (a new beta 2-agonist) and salbutamol aerosols on histamine-induced bronchoconstriction were studied in 12 patients with mild or moderate asthma in a placebo-controlled, double-blind study. Three hours after the administration of 12 micrograms formoterol, 200 micrograms salbutamol (doses with equal bronchodilator effects) or placebo via aerosol, histamine challenge was undertaken, using a dosimetric jet nebulizer with controlled tidal breathing. The noncumulative dose of histamine diphosphate aerosol provoking a 15% fall in FEV1 (PD15) was calculated. The PD15 after inhalation of 12 micrograms formoterol was significantly higher than that after 200 micrograms salbutamol (median values 640 and 310 micrograms, respectively; p < 0.01). For both treatments, the PD15 was significantly higher than that after placebo (median 185 micrograms). The results indicate that the preventive effect against histamine-induced bronchoconstriction at 3 h after drug is significantly better with formoterol than with salbutamol when using inhaled doses with an equal acute bronchodilator effect.


Comparison of histamine and acetylcholine for use in bronchial challenge testing in atopic and nonatopic subjects with chronic airways obstruction: a review of 180 cases.

A retrospective study was performed to evaluate the diagnostic yield for bronchial hyperresponsiveness from histamine and acetylcholine challenge tests. The records of 180 cases from the last 10 years were analysed. They were selected because their hyperresponsiveness to inhaled histamine or acetylcholine was equal or less than 32 mg.ml-1. Increasing doses of histamine and acetylcholine were given up to a maximum of 32 mg.ml-1 according to the method of de Vries et al. [3]. The challenges were accomplished on two separate days. The provocative dose of agonist causing a 20% fall in FEV1 (PC20) was noted. The interrelationships between smoking history, objective markers of allergy, patient's complaints, histamine and acetylcholine responsiveness were examined. Separate statistical analyses are presented for atopic and nonatopic subjects with chronic airways obstruction. More subjects had a measurable PC20 with acetylcholine than with histamine (43 vs. 16 subjects, p < 0.0001). Using the chi 2 test, the relationship between PC20 histamine and PC20 acetylcholine was similar in smokers and nonsmokers, and in atopics and nonatopics. It is concluded that for an equal molar basis, acetylcholine evokes a higher frequency of bronchus obstruction than histamine in patients.


Effect of order on the performance of maximal inspiratory and expiratory pressures.

We studied the effect of order in the performance of maximal respiratory pressures (PImax and PEmax). For this purpose 20 healthy subjects (male/female: 1/1) were studied. PImax and PEmax were obtained on 2 different days at the same hours (9 and 12 a.m.). The test order was random. On the first day, the entire manoeuvre was performed twice, changing the order in the second determination. On the second day, we repeated the same exercises with reversed order. There were no differences between values for PImax and PEmax when we altered the order of manoeuvres on various days.


Treatment and developmental therapeutics in aspergillosis. 1. Amphotericin B and its derivatives.

In recent years, the frequency of infections caused by Aspergillus sp. has been on the rise. Immunocompromised patients are especially vulnerable to such infections. The polyene antibiotic amphotericin B is currently considered to be therapeutically the most effective drug against Aspergillus-induced infections. In the present review, the clinical efficacy of amphotericin B, its toxicities and various routes of applications, are discussed. Different combinations of amphotericin B with other drugs have also been reviewed, along with the anti-Aspergillus activity of various other antibiotics and some ester derivatives of amphotericin B.


Treatment and developmental therapeutics in aspergillosis. 2. Azoles and other antifungal drugs.

The present article surveys the anti-Aspergillus activity of various azole derivatives as well as a number of miscellaneous other antifungal agents. The drawbacks of sodium (potassium) iodide therapy in the management of pulmonary aspergilloma are discussed along with current efforts at treatment of allergic bronchopulmonary aspergillosis and Aspergillus-induced otomycosis.


Primary pulmonary Hodgkin's disease.

26 months after the onset of alcohol-induced pain, a diagnosis of primary pulmonary Hodgkin's (PPHD) disease could be made in a 34-year-old woman. Standard radiology of the thorax remains normal up to 18 months after the onset of symptoms. A short review of the literature concerning PPHD is given.


Effect of posture on arterial oxygenation in patients with chronic obstructive pulmonary disease.

We studied 117 patients with chronic obstructive pulmonary disease (COPD) to evaluate (1) the frequency and magnitude of postural changes in resting arterial oxygenation and (2) the relationship of these changes to other measures of pulmonary function and exercise arterial blood gases. Compared to the supine measurement, room air PaO2 measured while standing increased more than 3 mm Hg in 28 patients (group 1), did not change (+/- 3 mm Hg) in 57 patients (group 2), and decreased more than 3 mm Hg in 32 patients (group 3) (range = 31 mm Hg increase to 20 mm Hg decrease). Patients in group 1 had significantly less severe disease than patients in the other two groups. There were no significant pulmonary function differences between groups 2 and 3. Supine PaO2 was similar for all groups, suggesting that standing PaO2 accounted for the postural change in PaO2. Because of unpredictable postural changes in PaO2 in patients with COPD, we believe that body position should be noted for arterial blood gas measurements and should be kept constant for valid comparison of serial measurements. These findings may also be important for other diffuse lung diseases.


Therapeutic equivalence of a fenoterol/ipratropium bromide combination (Berodual) inhaled as a dry powder and by metered dose inhaler in chronic obstructive airway disease.

A randomized double-blind cross-over study was performed to compare the bronchodilator effects of a fenoterol/ipratropium bromide combination (Berodual) when inhaled as a dry powder and by metered dose inhaler (MDI) in an equal doses (fenoterol 100 micrograms + ipratropium bromide 40 micrograms). Thirty-eight patients (29 male, 9 female, mean age 53 years) with reversible chronic obstructive airway disease were studied on 2 separate days by employing the double-dummy technique. The effects of the two modes of administration of the fixed combination were followed by pulmonary function tests [forced expiratory volume (FEV1), forced vital capacity (FVC)] from 15 min up to 6 h after administration. In addition, the pulse rate was recorded just before each pulmonary function test. The FEV1 and FVC time-response curves showed that the dry powder had an overall efficacy profile similar to MDI. Both formulations produced clinically significant improvements in FEV1 in approximately 10 min. Peak effects occurred in 1 h while at 6 h after test drug inhalation there was still an increase in FEV1 of 14%. No safety problems were observed after the use of the test drugs and no clinically significant changes in pulse rate were found. It is concluded that the dry powder of the fenoterol/ipratropium bromide combination provided effective bronchodilation of similar degree and duration to that achieved with the MDI. It would appear, therefore, to be a valuable alternative to MDI.


Cardiorespiratory function in surgically treated thoracic scoliosis with respect to degree and apex of scoliotic curve.

We studied the relationship of deterioration of cardiorespiratory function with respect to degree and localisation of apex of spinal curvature. The study comprised 33 patients (27 females and 6 males) aged 15 (11-21) years, surgically treated for an average scoliotic angle of 72 degrees (55-129 degrees, after Cobb) which was postoperatively reduced to 32.6 degrees (13-74 degrees). The static and dynamic cardiorespiratory function parameters were tested (pre-operatively and 24 months after surgery) by spirometry and plethysmography, arterial blood gas analysis, and the exercise tolerance test. In terms of the site and apex of the thoracic curve as determined by spine X-ray, patients were divided into two groups: upper thoracic scoliosis with the apex between T5 and T8 and lower thoracic scoliosis with the apex between T9 and T11. Only upper thoracic scoliosis with Cobb angle of more than 70 degrees correlated (r = -1) with restrictive ventilation disorder (vital capacity 68%) and latent hypoxaemia (uptake O2 ml/kg/min 63%) demonstrated during the exercise tolerance test (p > 0.05). The results of the test have demonstrated that surgically obtained 54% correction of the scoliotic curve improves pulmonary function (p < 0.05). However, the improvement does not match the degree of achieved scoliotic curve correction, what means that even in surgically treated high-angled thoracic scoliosis exists an increased risk of morbidity and mortality.


Modification of histamine- and methacholine-induced bronchoconstriction by calcium antagonist gallopamil in asthmatics.

We studied the comparative modification of histamine- and methacholine-induced bronchoconstriction by a calcium antagonist, gallopamil, in 8 subjects with bronchial asthma. Dose-response curves to aerosolized methacholine or histamine were performed, without and following pretreatment with inhaled gallopamil (10 mg), on 6 different experiment days to determine the cumulative provocative dose (PD50) of each agonist in breath units which caused a 50% decrease in specific airway conductance (SGaw). Baseline values of SGaw were similar on different experiment days and gallopamil had no significant effect on SGaw. PD50 values for histamine on control and placebo days were 6.8 +/- 2.8 and 5.2 +/- 2.8 breath units (mean +/- SE), respectively. Pretreatment with gallopamil increased histamine PD50 to 19.8 +/- 7.5 breath units, which was significantly greater than on control and placebo days (p < 0.01). PD50 values for methacholine on control and placebo days were 9.5 +/- 5.6 and 8.8 +/- 5.8 breath units, respectively. Gallopamil pretreatment had no significant effect on methacholine-induced bronchoconstriction; methacholine PD50 increased to 13.4 +/- 5.5 breath units (p = NS). The mean dose ratio (ratio of PD50 for the agonist in the presence and absence of gallopamil) for histamine was 6.9, which was 3.7-fold higher than the dose ratio of 1.9 methacholine in the same subjects. These data suggest that gallopamil causes greater inhibition of histamine- versus methacholine-induced bronchoconstriction. This suggests that calcium influx in airway smooth muscle through voltage-dependent channels primarily occurs in response to histamine and not to methacholine.


Varicella pneumonia in adults. A review of pulmonary manifestations, risk factors and treatment.

Pneumonia is a rare but serious and occasionally fatal complication of varicella. Two cases of varicella pneumonia were successfully treated with acyclovir in our department. We reviewed the pulmonary manifestations of varicella, the risk factors and the effect of acyclovir on varicella pneumonia on immunocompetent adults. Early, aggressive therapy with acyclovir seems to abort the catastrophic consequences of varicella pneumonia, while oral acyclovir chemoprophylaxis is probably beneficial in high-risk populations with chickenpox.


Squamous cell carcinoma of unknown origin in middle mediastinum.

We report a rare case of squamous cell carcinoma located in the middle mediastinum as a solitary mass. Histologically, lymphatic tissues remained together with nests of squamous cell carcinoma which were occupying the greater part of the mass. Examinations of the whole body failed to detect a primary site of the squamous cell carcinoma. It is considered that the carcinoma cells reflect metastasis from a primary-unknown carcinoma (most likely TO lung squamous cell carcinoma) or that they originated from benign epithelial inclusions in a mediastinal lymph node.


Benign metastasizing leiomyoma. A case report and review of the literature.

This is a case report of an asymptomatic, 65-year-old white female who was evaluated for multiple pulmonary nodules. This patient's presentation, clinical course and pathologic specimens are consistent with benign metastasizing leiomyoma. A review of this rare disorder is included in this report with emphasis on past cases, clinical overview and treatment.


Gigant carcinosarcoma.

We present a case with gigantic carcinosarcoma (the largest described to date, diameter of 20.5 cm), located in the right upper lobe, in which the discordance between the brief clinical course with limited symptoms and its large size were remarkable. Preoperative diagnosis by bronchial biopsy, as used to be the case in this malignancy, was incorrect (epidermoid), and the define histological characterization was made by thoracotomy. The controversy about pathology, diagnosis and treatment of the carcinosarcoma is discussed.


[Genetic influence on energy requirements. I. Development of an experimental model].

In attempting to explore the mechanisms of interaction of genetic and environmental factors that affect the quantitative requirements of energy by man, the convenience of an animal model was considered and searched for. The idea was to start with male and female Wistar rats and through inbreeding segregate the highly effective users of energy from the poor users. The efficiency of dietary energy utilization was measured by the index of conversion (IC) defined as the dietary intake necessary to increase 1 g of body weight in a 32-day period, from day 21st to day 52nd of extrauterine life. The median value of the IC for all animals included in each experiment was the cut-off point to classify each individual as a good or a poor energy user. The first generation had three males and five females with a median IC = 2.90 and a range from 2.54 to 3.25. The proportion of males below the median was 3/3 while the proportion of females was 2/5. The difference in proportions was striking and led immediately to the consideration of a sex-link hypothesis, and to test it the, IC of 91 Wistar rats randomly selected at birth was obtained. The median value of the series was 2.99 with a range from 2.24 to 3.95. The proportion of male rats with values below the median was 33/38 while the corresponding proportion for females rats was 13/53. In other words, while nine of every ten male animals were good users of energy, only two out of ten females fell into this category.(ABSTRACT TRUNCATED AT 250 WORDS)


[Postprandial lipemia in subjects with primary hypoalphalipoproteinemia and hypoalphalipoproteinemia associated with diabetes].

The postprandial (PP) elevations in triglyceride rich lipoproteins (TRL) are potentially atherogenic. We compared PP lipemia in non insulin dependent diabetes mellitus (NIDDM) with hypoalphalipoproteinemia (HA) and patients with primary HA. Eight males in each group, mean age +/- SD 54 +/- 10 years, were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, triglycerides (TG) and cholesterol (C) in plasma and in the different lipoprotein fractions were measured. The PP triglyceridemia was significantly greater in NIDDM patients with HA and correlated with the fasting TG concentrations. The curve pattern of the lipemia (% delta) was otherwise similar in the patients with secondary or primary HA; only the triglyceridemia persisted for a longer period of time in the latter but was otherwise similar to that of the NIDDM patients with lower basal triglyceride values. Patients with primary HA may have a disturbed metabolism of triglyceride rich lipoproteins which have a delayed depuration during the postprandium. Basal HDL-C in patients with HA cannot predict the PP triglyceridemia.


[Prevalence of diabetes and glucose intolerance in a urban population at a low economic level].

In this report we present the results of an epidemiologic survey performed in a low income urban neighborhood. The study was designed to investigate the prevalence of type II diabetes mellitus (DM) and impaired glucose tolerance (IGT) in this socioeconomic stratum. The study was done using the standard procedure for the oral glucose tolerance test (OGT) and the recommended diagnostic criteria for defining DM and IGT according to the World Health Organization. A neighborhood corresponding to a census tract was selected and defined by a map. The 39 blocks encompassed in the neighborhood were identified and randomized using the statistical package Systat. According to the randomization, a complete household enumeration was performed. All the residents and the family relationships were identified. The individuals that were between 35-64 years of age and were not pregnant, were considered eligible and were interviewed at home and invited to have a physical examination with an OGT. The number of inhabitants in the study was 4411 of whom 931 were eligible: 452 (48.5%) men, 479 (51.5%) women. The response rate for the home interview was 91.7%; for the physical examination with the OGT it was 69.8%. The crude rate prevalence of DM for men was 10.6%, and for women it was 14.8%. The crude rate prevalence of IGT for men was 12.8% and 12.3% for women. These results show that susceptibility to DM and IGT is high in our population and are among the highest in the world.


Role of angiotensin II in the antinatriuresis that follows acute volume depletion.

The aim of this study was to examine the contribution of the renin angiotensin system to the antinatriuresis that follows acute volume depletion. Four groups of six dogs each were studied. The first group was exposed to saline expansion (8% body weight) (SE). The second group was exposed to acute volume depletion (2% body weight) followed in one hour by saline expansion (AVD). The third and fourth groups were similar but in dogs treated with high doses of captopril (SE + C and AVD + C). Dogs were anesthetized with phenobarbital. Control measurements were made for 30 minutes before and 60 minutes during saline expansion. Glomerular filtration rate (inulin), renal blood flow (para-aminohippuric acid) and mean arterial pressure were similar in the four groups during the experiment. The increase in fractional sodium excretion from the control period to the end of saline expansion was in the SE group from 0.6 +/- 0.2 to 6.4 +/- 1% and in the SE + C group from 1.1 +/- 0.3 to 8.5 +/- 1.3%. In contrast, in the AVD group it only rose from 0.8 +/- 0.2 to 3.5 +/- 0.7% and in the AVD + C group from 1.3 +/- 0.4 to 4.1 +/- 0.6%. Therefore, the increment in sodium excretion during saline expansion was significantly lower in dogs exposed to acute volume depletion, independent of the treatment with captopril. The blunted natriuresis cannot be explained by differences in GFR, RBF or MAP. These results suggest that renin angiotensin system is not the responsible agent of the sodium retention that follows acute volume depletion.


[9 cases of encephalitis in an epidemic outbreak of exanthematous diseases].

We report here nine cases of encephalitis secondary to exanthematous diseases diagnosed from March to June 1990 at the University Hospital in Monterrey, Mexico. Two of the cases were secondary to measles, three to rubella, and four to varicella. One patient with varicella died, and the histopathological study showed findings compatible with viral encephalitis. The sex distribution was four males and five females with ages ranging from two to fourteen years. The most common clinical manifestations were hemiparesia, intracranial hypertension, meningism and altered consciousness. The CSF examination showed lymphocytic pleocytosis (mean = 295 cells), increased protein levels (mean = 118 mg/dL) and a normal glucose value in eight cases. These findings and the presence of an exanthematous disease suggested viral invasion of the CNS. Magnetic resonance imaging showed high intensity signal areas mainly in the frontal and temporal lobes. In this paper we compare the relative incidence of encephalitis secondary to exanthematous diseases in our geographical area during the last four years.


[Diagnostic performance of immunologic tests in amebic liver abscess using receiver operating characteristic curves].

Objectives. 1) To identify the tests of immunological diagnosis with a high diagnostic efficiency in amebic liver abscess. 2) To determine the ideal cutoff point for such tests. 3) To identify the influence degree of the antigen used over the test efficiency. Design. Comparative survey. Study units. Analysis of 24 articles identified in the medical literature about tests of immunological diagnosis in amebic liver abscess. Measurements. Starting from the articles, operating characteristics curves (ROC) were established derived from the test application to patients with amebic liver abscess. Results. A great variability in the diagnostic efficiency was identified between the various tests, even when the analysis was focused on the investigations of a specific test. It was not possible to conclude which test had a major degree of efficiency due to such variability. The cutoff level considered as relevant was higher than the one traditionally used for indirect hemagglutination and it had concordance with the one presently accepted for the fluorescence antibodies test. By maintaining steady the spectrum of the study patients and the type of test, variability among the tests persisted. This was due to the use of different antigens. Conclusions. A great variation in the diagnostic efficiency of the analyzed tests was identified. The variation source was the type of test, the antigen used and probably the illness spectrum.


[Gasometric values reported in healthy subjects from the Mexican population: review and analysis].

We do not know the normal relationship between altitude and PaCO2 in Mexico. We collected and analyzed the reports of reference values for gasometry in Mexico City (2240 m above sea level and a mean barometric pressure of 585 Torr) and other places in the country. The reports include arterial, capillary and expired gases in children and adults, with measurements done in resting and exercising subjects, breathing room air and 100% oxygen. In Mexico City we found 18 studies in normal subjects reporting a mean PaCO2 ranging from 25.5 to 38.4 Torr. Averaging arterial studies from children and adults, adjusting for the number of subjects studied, and discarding data with mean pH below 7.37 or above 7.43 (suggesting non steady state), 10 studies with a total of 581 subjects have the following average values (Torr, means and SD): PaCO2 = 31.1 +/- 2.6, PaO2 = 67.7 +/- 2.6, calculated PAO2 and P(A-a)O2 73.6 +/- 3.3 y 6.1 +/- 3.7 respectively. The PaCO2 found was much lower than that reported for native Peruvians in the Andes who have a mean PaCO2 of 37.8 Torr at an altitude of 2390 m, and a mean PaCO2 of 33.0 Torr only at 4860 m above the sea level. On the other hand, the average values in Mexico are similar to those found in North Americans who have a mean PACO2 of 33.1 Torr at 2131 m of altitude, a mean PACO2 of 30.7 at 2371 m and a mean PaCO2 of 31 Torr at 2238 m. Normal values for gasometry in Mexico are scarce and some of the existing ones are erroneous probably due to lack of adequate calibrations and to poor quality control. Values of PaCO2 in Mexico are more similar to those found in the USA than to those found in Peruvian natives.


[Bone marrow transplantation in Mexico. Report of the 1st successful case in acute myeloblastic leukemia. Grupo de Trasplante Medular Oseo del INNSZ].

The first case of allogeneic bone marrow transplantation in acute myelogenous leukemia (AML) done in Mexico is reported. The patient was a 26 year old Mexican woman who in October 1987 was diagnosed of having AML of the M2 subtype. After three cycles of the TADOP regimen (6-thioguanine, cytosine-arabinoside, doxorubicin, vincristine & prednisone), the patient entered complete remission. Unfortunately, after a seven month period of remission she suffered a relapse which was refractory to a new chemotherapy cycle. On 9/14/88 an allogeneic BMT from her HLA identical brother was performed. The conditioning regimen consisted of busulfan and cyclophosphamide. Prophylaxis for GVHD consisted of cyclosporine and methylprednisolone. The posttransplantation course was satisfactory, reaching > 500 neutrophils x 10(9)/L on day 14 and > 50,000 platelets x 10(9)/L without support on day 23 posttransplant. The patient developed fever of unknown etiology, which was satisfactorily resolved with ceftazidime, vancomycin and metronidazole. She also presented a grade II oral and esophageal mucositis. As a late complication, on day 90 posttransplant, she developed a bilateral pneumonia which was resolved with sulfamethoxazole-trimethoprim administration. Up to the time of this report (40 months posttransplant) the patient is completely asymptomatic, is under no immunosuppression, and shows no evidence of graft versus host disease or recurrent leukemia.


Soluble elastins, their preparation and characterization.

We followed amino acid composition, sugar content, immunological reactivity and thermal coacervation of elastin-derived peptides in order to show whether the preparation procedure influenced the properties. Insoluble elastin was prepared by alkaline hydrolysis (N-elastin) or cyanogen bromide cleavage (C-elastin) of bovine ligamentum nuchae. The insoluble elastins were solubilized in oxalic acid, phosphoric acid or trifluoroacetic acid. The differences in properties were found in the case of trifluoroacetic hydrolysis only in comparison with soluble elastin-derived peptides prepared by oxalic or phosphoric acids hydrolysis. Trifluoroacetic acid probably breaks down the structure markedly including the antigenic determinants, which results in a low reactivity with antibodies. The ability of these peptides to form coacervates is also decreased.


Superoxide dismutase activity in radioresistant tissues of irradiated rabbits.

The activities of Cu, Zn-containing superoxide dismutase were studied in radioresistant tissues (liver, brain, erythrocytes) of whole-body irradiated rabbits with 6.0 Gy and 24.0 Gy with local shielding. No significant changes were observed after irradiation with 6.0 Gy. Both the changes in Cu, Zn-SOD activity and the protein concentrations were more pronounced after exposure to 24.0 Gy with local shielding of the head and abdominal region. The dose on the shielded regions was about 6.0 Gy. Local shielding of rabbits irradiated with a lethal dose 24.0 Gy influenced positively the survival of animals. However, the decrease in SOD activity on 60th day after irradiation seems to be unfavourable for further survival of rabbits, if we accept that SOD content in tissue is maintained at a rather constant level.


Activity of superoxide dismutase isoenzymes in the bone marrow of irradiated rabbits.

The activities of total, Cu,Zn- and Mn-containing superoxide dismutase were studied in the bone marrow of whole-body irradiated rabbits with 6.0 Gy or 24.0 Gy with local shielding. Irradiation with 6.0 Gy depressed the activities of total and Cu,Zn-SOD on the 8th and 15th days, whereas the activity of Mn-SOD did not change. The exposure to 24.0 Gy with local shielding of head and abdominal region decreased Cu,Zn-SOD activity on the 4th and 60th days after irradiation, Mn-SOD activity was lower nearly at all time intervals investigated. The exposure to 24.0 Gy with shielding of whole body without head region increased markedly Cu,Zn-SOD activity, whereas Mn-SOD activity was diminished on the 8th and 15th days after irradiation in comparison with control group. Mn-SOD activity (U per 10(6) of bone marrow cells) was increased at early time intervals, the changes were not so striking after irradiation of rabbits with 24.0 Gy with shielding of whole body without head region.


Changes of acetylcholinesterase activity in hepatectomized rats following soman poisoning.

Acetylcholinesterase activity in the blood, pontomedullar area, basal ganglia of the brain and diaphragm following sublethal soman poisoning (i. m., 31 micrograms/kg) was studied in four groups of rats (n = 6) pretreated as follows: intact, hepatectomized (65 % of resection), sham-operated and narcotized animals. Soman was administered 12 hours following hepatectomy, narcosis or sham-operation, respectively. Except hepatectomized rats, all animals in the groups survived: in hepatectomized rats, 2 animals died. Acetylcholinesterase activity was decreased in each group. The differences among enzyme activities in these groups were not statistically significant for the blood. The highest and significant (p < 0.01) decrease of this activity in the brain parts and diaphragm following hepatectomy was demonstrated. The results indicate that undiminished liver functional capacity is an important factor influencing soman toxicity.


Liver and brain DNA contents in acute soman intoxication.

Contents of DNA in the liver and brain parts (cerebellum, pons, hemispheres) of the rat following acute intoxication with soman (i. m., 32 micrograms/kg) were studied. Statistically significant increase of DNA concentrations in the liver and decrease in the hemispheres 1 and 3 hours after the intoxication was demonstrated; in other brain parts studied, no changes were detected. The blood acetylcholinesterase activity was diminished 1 hour after the injection of soman and it was statistically significant 3 days following poisoning. In rats pretreated with atropinee (i. m., 200 mg/kg) and intoxicated with higher dose of soman (i. m., 50 micrograms/kg), specific activity of incorporation of radiolabelled thymidine into DNA was significantly decreased in the liver only. The results suggested that soman except cholinergic effects also influenced metabolism of nucleic acids.


Enhancement of hypoxia radioprotection and decrease of hypoxia toxicity caused by adenosine monophosphate.

It was shown in experiments on mice that the radioprotective effects of adenosine monophosphate (AMP) or of a combination of Mg aspartate and AMP join with those induced by hypobaric hypoxia. The hypotensive effects of these drugs lead probably to hypoxia in radiosensitive tissues which acts additively with hypoxia elicited by way of respiration. Furthermore, Mg aspartate and AMP decrease the toxicity of high degrees of hypobaric hypoxia. These effects can be explained by the ability of adenosine liberated from AMP and of magnesium to increase brain and heart blood perfusion and/or to mitigate excessive sympathetic activity. The pharmacological effects of AMP and Mg aspartate are thus not only radioprotective but also energy preserving and protecting vitally important organs against hypoxia toxicity. These effects may be of favourable importance in hypoxic radiotherapy.


Urinary excretion of some metabolites of tryptophan in malignant diseases.

The urinary excretion of four tryptophan metabolites, namely indolylacryloylglycine, indolylacetic, 5-hydroxyindolylacetic and 3-hydroxyanthranilic acids, was studied in two control groups, in children suffering from acute leukemia, hepatic and brain tumours and in adults with bladder cancer. Compared with controls, a significantly lower excretion of IAcrGly was observed in all patient groups with the exception of that with hepatic tumours. Hematological malignancies were further accompanied by low excretion of indolylacetic acid, and bladder cancers by a lower 5-hydroxyindolylacetic acid level. We found no correlation of the metabolites tested in individuals of any patient group. In controls, however, indolylacryloylglycine and indolylacetic acid did correlate.


Comparing laboratory and portable tone-burst auditory brain-stem-response (ABR) systems for monitoring high-frequency (> or = 8 kHz) auditory function.

High-frequency (8-20 kHz) hearing sensitivity is of special interest because of its early warning potential for ototoxicity. Many ill patients, however, are unable to respond behaviorally to auditory test procedures. To objectively monitor high-frequency auditory function in these patients, laboratory instrumentation to evoke the auditory brain-stem response (ABR) with high-frequency (8-14 kHz) tone-burst stimuli was developed and documented. To provide evaluation at bedside, a portable high-frequency tone-burst generator was developed to elicit the ABR. Combined with a portable signal averager, this system was validated by comparison with the laboratory system. Thirty-five normal-hearing subjects were used to compare ABRs to high-frequency tone bursts from each system. Analysis of responses to tone bursts revealed no significant mean latency differences, and no significant intersession reliability differences between systems. These results confirm that the portable system is comparable to the laboratory system in obtaining reliable high-frequency tone-burst responses.


A new approach for recording distortion product oto-acoustic emissions.

A system for recording of distortion product oto-acoustic emissions (DPOEs) utilizing a linear time-averaging technique is described. The main advantage of the system is the ability to obtain a high signal-to-noise ratio of the recordings. DPOEs have proven to yield important frequency-specific information on the behaviour of the outer hair cells in the human inner ear. DPOEs at nine audiometric frequencies, elicited at a stimulus intensity of 75 dB SPL were recorded from a group of 14 normal-hearing subjects in an attempt to establish normative data. An example of the relationship between the configuration of the conventional audiogram and DPOEs for a patient with a noise-induced hearing loss is presented to demonstrate the diagnostic value of the method.


Defining the relationship between cochlear hearing loss and acoustic reflex thresholds.

In this study several methods of defining the relationship between the magnitude of cochlear hearing loss and the acoustic reflex threshold (ART) levels were examined, with a view to defining the appropriate upper limits of ART that would ease clinical applicability and reduce the false positive rate. The 90th percentile, two standard deviations (SD) from the mean, the regression method and an empirical method based on the scatter plots of the ART at each activator frequency were all applied to the results of 99 patients with cochlear and/or peripheral vestibular pathology. The upper limits of ART defined on the basis of the scatter plots provided the most appropriate upper limits for different ranges of hearing loss, with relatively few false positives. A clinical criterion based on the ART levels at adjacent frequencies is proposed, which further reduces the false positive rate and could also prove effective in the differential diagnosis of cochlear from retro-cochlear lesions.


Sound perception induced by extracranial magnetic stimulation in deaf patients.

Two profoundly hard-of-hearing and deaf patients were examined by non-invasive extracranial magnetic stimulation (EMS) in an effort to determine whether EMS could evoke auditory sensations. The patients were fitted with standard earplugs and were stimulated at the auricle, the mastoid and the temporal lobe area. The threshold of auditory sensation (TAS) was determined at each stimulus position and found to be approximately 20-40% of the maximum EMS level (2.0 Tesla). The TAS was generally lowest in mastoid stimulation, but was variable, and dependent on the angle and position of the stimulating coil relative to the skull. Middle-ear muscle reflex (MEMR) tests performed by EMS of the auricle, mastoid and temporal lobe area contralateral to the probe ear were negative. It was concluded that EMS of the auditory system, particularly the mastoid area, can evoke auditory sensations in cochlea-deaf ears, and that this technique deserves further study as a non-invasive procedure for evaluating potential cochlear implant patients in conjunction with electrostimulation.


Acupuncture for tinnitus management.

Fifty-six patients with continuous and severe tinnitus as their major complaint were treated with traditional Chinese acupuncture. After a pre-treatment period with baseline evaluation of tinnitus, 10 treatments were given during a period of 20 days, followed by a post-treatment period in order to obtain indications of prolonged treatment effects. Assessments were made using visual analogue scales (VAS) and a verbal retrospective rating scale. Three patients reported improvement which lasted for at least 10 days after the last treatment, indicating a possible long-term effect in some cases. Twenty-one percent of the patients reported transient intensity reductions lasting for hours/days. Estimated 'substantial' improvement rate by VAS, consistent for all three parameters involved (intensity, annoyance, awareness), was 20%, while the corresponding deterioration rate was 25%. Statistical analysis of the whole group did not show any significant general treatment effects. Interactions between treatment evaluations by verbal rating and VAS are discussed as well as interactions with psychological components.


Recognition of telegraphy signs at different listening levels and frequencies.

The recognition of telegraphy masked by noise at 40 and 80 signs/min telegraphy speed was studied in 10 normal-hearing subjects at different sound pressure levels (25-85 dB SPL in steps of 5 dB) as well as at different test frequencies (2000, 1000, 800, 630, 500 and 250 Hz). The ability to recognize the signs varied with varying SPL. Recognition for most of the subjects was best at an SPL close to 70 dB. All subjects improved their recognition as the frequency was lowered to 500 Hz, some even at 250 Hz. These facts should be taken into consideration when training telegraphy operators as well as in the construction of radio receivers to permit listening at low frequencies. Furthermore, the critical ratio was calculated at the different test frequencies.


Speech perception in noise with BICROS hearing aids.

The speech perception in noise abilities of 14 asymmetrically hearing-impaired subjects who had been fitted with Bilateral Contralateral routing of Signal (BICROS) hearing aids was evaluated. Speech tests were administered with subjects wearing both conventional monaural amplification and their own BICROS aids. Test procedures involved the use of sentence lists from the Speech Perception in Noise (SPIN) test and the Synthetic Sentence Identification (SSI) test, presented in a background of recorded four-talker babble. The performance of the subjects was found to be significantly better with the BICROS aids than with monaural amplification alone.


Psychoacoustical performance in children.

In order to contribute to knowledge of the elementary auditory functions in infancy, a group of normally hearing children below the age of four years was examined using advanced tests for cochlear (remote masking, brief-tone audiometry, critical ratio) and central auditory functions (masking-level difference). The results showed that both cochlear and central auditory functions were almost the same in three-year-olds as they were in adults, if not better. This behavior is similar to that recorded with electrophysiological methods and leads to the conclusion that at age three years the auditory system has completed its neurofunctional maturation and it is therefore completely efficient in its elementary psychosensorial functions.


Genetic influences on susceptibility of the auditory system to aging and environmental factors.

Auditory susceptibility to aging and environmental factors (noise and toluene) was investigated in two genotypes of mice, CBA/Ca (showing a moderate hearing loss with onset late in life) and C57BL/6J (undergoing spontaneous auditory degeneration with onset during young adulthood). Both strains of mice were often used together as a model of human age-related hearing loss, with a primary decline in auditory high-frequency sensitivity. Auditory function was analysed by recording auditory brainstem response (ABR). Morphological alterations of mouse cochleae were studied by light, transmission and scanning electron microscopy. The age-related elevation of ABR thresholds was more precipitous and the individual variability was larger in C57BL mice than that in CBA mice. Degeneration patterns of the organ of Corti were different between the two strains. In the old CBA-mouse cochlea, giant stereocilia on the inner hair cells (IHCs) and elevated pillar heads were evident. Some normal-looking outer hair cells (OHCs) still remained. In C57BL mice, however, early loss of OHCs and extensively damaged stereocilia constituted the primary lesions of the organ of Corti. After exposure to a 2-7 kHz steady noise of 120 dB SPL for 5 min at the age of 1, 2, 3, 6, or 12 (only for CBA) months, compound and permanent threshold shifts (CTS and PTS) at middle frequencies (8-12.5 kHz) reduced with age in CBA mice but remained in C57BL mice. C57BL mice were more severely affected by noise than the age-matched CBA mice. The amount of recovery from CTS to PTS was, however, independent of age and strain. Pathological changes of the organ of Corti were correlated with noise-induced PTS. Possibilities for prediction of susceptible individuals were tested. At 6 months of age, there was only 2% risk of classifying C57BL mice as CBA mice by pre-exposure thresholds at the high frequency (31.5 kHz), but about 40% risk by CTS at the middle frequency (12.5 kHz), or vice versa. With increasing age, the progress of the interaction between noise trauma and aging had two phases for both strains of mice. First an additivity and then, at total threshold shifts of 30-50 dB, a blocking-like interaction were observed. The rate of progression in post-noise hearing loss did not exceed the spontaneous rate of age-related degeneration. The difference between exposed and non-exposed groups decreased with advancing age for both strains of mice.(ABSTRACT TRUNCATED AT 400 WORDS)