Twinning and the r/K reproductive strategy: a critique of Rushton's theory.

The theory of r selection, favoring population growth, as opposed to K selection, favoring more efficient utilization of resources, has in recent years been applied by Rushton to contrast human ethnic groups in terms of their r/K reproductive strategies, suggesting the existence of a continuum from r groups, producing many offspring but providing little parental care, to K groups, producing few offspring but providing much parental care. Rushton's theory, which is largely based on ethnic differences in twinning rates, is here critically examined. It is pointed out that twinning rate differences are not necessarily genetic in origin since various environmental factors clearly play a role, and also that twinning, as a mode of reproduction, is not necessarily an r strategy, considering the high prenatal and perinatal selection to which it has been, and still is, associated. Moreover, Rushton misinterprets a number of relevant aspects related to the biology of twinning. The claim that ethnic differences in twinning rates provide evidence for an r/K typology in human populations with respect to reproductive strategies does not appear to be warranted.


[Cytochemical properties of peripheral blood neutrophils in patients with hyperthyroidism].

In the cytoenzymatic investigations of peripheral blood neutrophils in patients with hyperthyroidism there was found the increase of acid phosphatase activity, beta-glucuronidase, leucine aminopeptidase, and catalase moreover there was found the decrease of the activity of alkaline phosphatase. After a two-week treatment with thiamazole (methimazole++) 50 mg in 24-hour dose there was observed the decrease of acid phosphatase activity in neutrophils. During incubation of plasma containing leucocytes, from healthy persons, with L-thyroxine there was observed the increase of the activity for acid phosphatase and beta-glucuronidase. In patients with hyperthyroidism there appear many changes of enzymic equipment of neutrophils which are concerned with lysosomal and connected with cell membrane enzymes. The results of cytochemical investigations after application of thiamazole and no difference, with exception of catalase, between patients with Graves-Basedow disease and with toxic goitre and the results of investigations in vitro with L-thyroxin point out, that there is the possibility of connection between the observed changes in the range of enzymic equipment of neutrophils and the hormonal state of the investigated group of patients.


[Clinical trial of mannose treatment of hemolytic anemia caused by congenital deficiency of erythrocyte glucosephosphate isomerase].

A therapeutic trial with mannose given intravenously as a 5% solution during 7 consecutive days (daily doses 12.5 g, 25 g and 50 g) was performed in a GPI deficient girl with nonspherocytic hemolytic anemia. The aim of the trial was to substitute glucose--the main red cells metabolic substrate--with mannose, since the glucose metabolism, due to the GPI deficiency, was significantly decreased. An initial good effect of treatment was disturbed with viral infection. No complications due to treatment with mannose were observed.


[Cardiotoxicity of antineoplastic drugs].

Anticancer drugs, especially anthracyclines, may induce adverse cardiac effects which can be life-threatening in some patients. In this article we discuss the mechanisms and the types of cardiotoxicity and its prevention, with special attention paid to the role of monitoring of the cardiovascular system during chemotherapy.


[Comparison of clinical usefulness of immunophenotyping of leukemia using the immunofluorescence and immunoenzyme APAAP methods].

The clinical utility of the indirect immunofluorescence (IF) and the alkaline phosphatase-anti-alkaline phosphatase (APAAP) techniques was compared in 103 newly diagnosed acute leukaemia patients immunophenotyped using a panel of 19 monoclonal antibodies (MoAb). In spite of slight variations in the percentages of cells reacting with particular MoAbs when comparing the two methods we found no discrepancies in the final classification of each case. In ANLL (n = 73) the best correlation between the two methods was found for CDw65 which is a good screening marker, and for CD15 having a prognostic significance. In ALL (n = 30) the best correlation was observed for CD19 and CD10, both of great diagnostic importance. The following antigens present both in membrane and in cytoplasm displayed higher positivity with the APAAP than in IF HLA-Dr, CD71 and CD11b in ANLL, CD22 and HLA-Dr in nonT-ALL and CD3 in T-ALL. The important advantages of the APAAP technique are: 1) its use with routinely performed bone marrow or peripheral blood films, which can be stored before staining, 2) the possibility of correlating morphology with immunological characterization and documentation of the results.


[Anemia and recurrences in acute lymphoblastic leukemia in children after the treatment and the frequency of the erythroblasts with micronuclei].

A retrospective analysis of the relation of relapses and anaemias to the frequency of micronucleated erythroblasts in bone marrow smear in 140 children with acute lymphoblastic leukaemia after BFM and Memphis schemes of therapy was carried out. The anaemias correlated with the frequency of micronucleated erythroblasts in statistically significant manner. Correlation concerning relapses, was not shown. The frequency of micronucleated erythroblasts in children treated by BFM scheme is lower than by Memphis scheme. This suggests smaller genotoxicity of BFM scheme therapy.


[Molecular biology of chronic myeloid leukemia].

Chromosome Philadelphia (Ph) which originated from translocation 9;22 is an aberration connected with chronic myelogenous leukaemia (CML) and with part of the cases of acute lymphoblastic leukaemia (ALL). The analysis on the molecular level has shown that the rearrangement of ABL and BCR genes is the most important consequence of this translocation. The new hybrid gene translates the protein p210, which shows tyrosine phosphokinase activity. This protein could play an important role in the pathogenesis of CML. The investigations of BCR/ABL rearrangement on molecular level are an important tool for differential diagnosis of lymphoblastic crisis of CML and ALL and also are very valuable in detection of residual Ph positive cells in cytogenetic conversion of CML.


[Treatment of blast crisis of chronic myeloid leukemia].

Up-date of chemotherapy in the accelerated and blastic phases of CGL has been done. Cytostatic therapy, even very intensive, remains ineffective in the eradication of pathological cellular clones as well as interferons therapy. The unique chance of being cured for a small cohort of patients with accelerated or blastic disease is allogeneic bone marrow transplantation. An effective treatment of these phases of CGL remains to be solved in the future.


[Use of interferon in the treatment of chronic myeloproliferative disorders].

Clinical trials have shown that interferon (IFN) have myelosuppressive effects that can help reduce the uncontrolled clonal growth of hematopoietic cells in myeloproliferative disease. There are at least four diseases that are considered to be myeloproliferative disorders: chronic myelogenous leukemia, myelofibrosis polycythemia vera and idiopathic thrombocythemia. Recombinant IFN alpha has shown promise in inducing haematological and cytogenetic remission in some patients with chronic myelogenous leukemia. The exact role of IFN in prolonging the life of CML patients, however, remains to be determined in larger studies of longer duration. Preliminary evidence suggests that in myelofibrosis it may be more efficacious in the cellular than in fibrotic or osteosclerotic phase. IFN alpha has been reported to be of value in controlling excess platelet production in chronic myelogenous leukemia and idiopathic thrombocythemia as well as in reducing of red cell mas in polycythemia vera.


[Bone marrow transplantation in chronic myeloid leukemia].

Bone marrow transplantation (BMT) is at present the only curative therapy for chronic myelogenous leukemia (CML). The outcome of this therapy is much better if marrow transplantation from HLA-matched siblings is performed within 1 year of diagnosis, in young patients and in the chronic phase of the disease. BMT from HLA-matched unrelated donors expands the application of this therapy among CML patients with no available identical siblings. Autologous bone marrow transplantation is presently considered in patients unresponsive to interferon therapy or with high risk of blastic transformation.


[Allogeneic bone marrow transplantation in myeloid leukemia: chemical conditioning, clinical course and results].

10 patients between the ages of 5 and 40 yrs with myeloid leukemia (4 acute, 6 chronic) in early (5 cases) or intermediate stage of the disease were given Cyclophosphamide and Busulfan (6 cases) or Cyclophosphamide, Busulfan and VP-16 (4 cases with CML) and bone marrow transplants from HLA-matched donors (in 9 cases from siblings and in one case from HLA phenotypically matched father). There was one transplant related death and 3 relapses in CML cases. In cases which relapsed GvHD was not observed. Altogether acute GvH and chronic GvHD was seen in 2 and 4 cases, respectively. All grafted cases with AML survive in continuous remission lasting more than 2 years (median 30.5 month).


[Chromosome aberrations in chronic myeloid leukemia].

Chromosome Philadelphia is a cytogenetic marker of chronic myeloid leukemia. It results from a translocation t(9;22) or other, more complex, translocations. Before the onset of blastic crisis, secondary aberrations occur, the most often--trisomy 8, isochromosome 17q and extra Ph chromosome. Their presence has a prognostic significance. Particular aberrations may occur in association with determined haematological and clinical features.


Oscillatory potentials, retinopathy, and long-term glucose control in insulin-dependent diabetes.

The main objective of the study was to assess effects of long-term lowering of glucosylated hemoglobin (HbA1%) on neurosensory function in insulin-dependent diabetes. Individual (OP-1, OP-2, OP-3) and summed (OP-sum) amplitudes of oscillatory potentials (OPs) of electroretinography were recorded at study start and 7-years later in 45 patients (the Oslo study). As an overall 7-year change, amplitudes of OP-2, OP-3 and OP-sum were reduced (p < 0.0001-0.01), retinopathy worsened (p = 0.005), intraocular pressure decreased (p < 0.001), systolic blood pressure increased (p < 0.0002), and glycemic control improved from HbA1 of 11.2 +/- 2.2% at study start to a 7-year cumulative mean of 9.5 +/- 1.5% (p < 0.0001). Multiple regression analysis did not identify any independent relations between change in OP-1, OP-2, OP-3, OP-sum and change in glycemic control or background variables, including change in age and duration of diabetes. However, cross-sectional observations at 7 years showed negative correlations between all OPs and age (p < 0.0001-0.003), and between OP-3 and duration (p = 0.003) and counts of microaneurysms (p = 0.02). The data suggest that various clinical background variables may influence individual and summed amplitudes of OPs differently. Reduced neurosensory retinal function (OPs) seemed to appear after 7-years, independently of vascular defects of retinopathy and long-term improvement in glucose control.


A new hereditary syndrome with a bleeding tendency, extreme miosis, spasms, dyslexia, thrombocytopathia etc. Pupillometric, evaporimetric, and ophthalmological observations.

A recently described familiar syndrome consists of the following components: A bleeding tendency with thrombocytopathia, miosis, muscular weakness and spasms, ichthyosis, asplenia, dyslexia, and headache. Four definite and 2 probable patients have been identified in 4 generations. In the present study, the pupillary behaviour was scrutinized in two 'definite' cases with the infrared, binocular pupillometer. The forehead sweating pattern was also investigated with an Evaporimeter. The basal pupillary widths were: 1.25-1.75 mm. Only minor responses were noted upon topical stimulation with an indirectly acting pupillodilating agent (OH-amphetamine). A directly acting sympathicomimetic drug (phenylephrine) exerted a more marked influence on the pupil, indicating a relative supersensitivity. The evaporimetric pattern in the forehead seemed to be within reference limits, at variance with what is the case in Horner's syndrome. Further findings were: the orbit seemed to be smaller than normal; a bilateral VI. cranial nerve palsy was identified, and a marked upward gaze palsy coexisted with pupils with Argyll Robertson's traits. There is no readily acceptable explanation for the ocular abnormalities. The disorder underlying the pupillary abnormality may possibly be located in the upper mesencephalon.


Neurological problems presenting to an ophthalmic casualty department.

All patients presenting with neurological problems to an eye hospital casualty department over one year were prospectively studied. A total of 119 patients were identified. The most frequent diagnoses were retrobulbar neuritis (34; 28.5%), sixth cranial nerve palsy (22; 18.5%), third cranial nerve palsy (15; 12.6%) and Adie's tonic pupil (11; 9%). Cranial nerve palsies were most commonly due to diabetes or hypertension (16; 43.2%). Only one intracranial aneurysm was found. Symptoms included blurred vision (52; 43.7%), binocular diplopia (51; 42.8%), and eye pain (27; 22.7%). Fifty patients (42.0%) were referred by a general medical practitioner. Twenty-two (18.5%) were admitted to hospital. Forty-nine skull X-rays were requested and all were normal. Twenty-nine chest X-rays were requested. One (3.4%) showed an abnormality (carcinoma of the bronchus). Neurological patients present to ophthalmic casualty departments because of ophthalmic symptoms. Ophthalmic casualty officers are able to make working diagnoses and to direct patients appropriately. The use of investigations in the casualty department, however, is unlikely to be productive.


An aetiological profile of optic atrophy.

484 cases of optic atrophy were studied for the distribution pattern and significance of various etiological factors in different age groups of both sexes. Bilateral optic atrophy was found to be two and a half times as common as unilateral optic atrophy. Intracranial neoplasm (29.5%) was the most frequent known cause of bilateral optic atrophy in either sex and the most common tumor was chromophobe adenoma (48% of intracranial tumors) with highest incidence over 20 years of age. Craniopharyngioma was the most frequent tumor responsible for bilateral optic atrophy before 20 years of age. Intracranial glioma also emerged as an important cause of bilateral optic atrophy. Head injury due to road accidents and periocular trauma were the most common causes of unilateral optic atrophy in males, whereas no definite factor could be elucidated in unilateral optic atrophy in females. Vascular factors were the usual cause of optic atrophy after 40 years of age, highlighting the significance of thorough systemic evaluation.


Epikeratophakia for keratoconus in mentally retarded patients. The use of fresh, free-hand made lamellar grafts.

Epikeratophakia for keratoconus was done in 11 mentally retarded patients, using fresh, free-hand made lamellar grafts. The mean follow-up period was 31.5 months. The grafts remained clear and well adapted in 7 cases (63.6%). Necrosis of the lower part of the graft occurred in 3 eyes (27.3%), and was probably caused by persisting epithelial defects. Only one of these grafts had to be removed. Despite concurrent eye diseases, such as cataract and possible amblyopia, an improved overall visual function was reported in 5 of the 11 patients (45.5%). No vision-threatening complications related to the epikeratophakia surgery was found.


Visual results after RK.

The series of radial keratotomy (RK) in 79 myope eyes in 60 patients was studied to evaluate improvement of uncorrected visual acuity. The main aim with radial keratotomy was to help patients see better without glasses or contact lenses. Myopia ranged from -1.0 D to -9.0 D. Forty-two eyes (53%) achieved uncorrected visual acuity (VA) of 1.0 or better and 73 eyes (92%) better than 0.5. The follow-up period ranged from 3 months to 3.5 years. Postoperatively the most common complication was undercorrection. The risk for progressive myopia made surgeons cautious not to overcorrect patients and to leave them slightly myopic.


Short-term effects of proparacaine on human corneal thickness.

.5% proparacaine HCl is commonly used for topical anaesthesia in ultrasound pachometry prior to refractive surgery. This drug is known to alter corneal epithelial adhesion. Does 0.5% proparacaine result in an alteration in corneal thickness due to changes in the corneal epithelium? Corneal thickness was measured by optical pachometry at 30 sec intervals for 15 min under 3 experimental conditions; 1) 2 drops of artificial tears, 2) 1 drop of 0.5% proparacaine, 3) 2 drops of 0.5% proparacaine. Baseline measurements were recorded before each trial. No significant differences were found between the mean corneal thicknesses measured in the baseline, 2 drops of artificial tears and 1 drop of 0.5% proparacaine conditions. The mean corneal thickness in the 2 drops of 0.5% proparacaine condition was significantly greater than those measured in the other conditions. In particular the measured corneal thickness was significantly different from the baseline measurements 1 to 2 min after instillation of the 2 drops of 0.5% proparacaine. Exponential modelling of the corneal edema recovery function demonstrated that recovery to baseline corneal thickness occurred 7 to 8 min following the instillation of 2 drops of 0.5% proparacaine. The data of this study suggest that only 1 drop of 0.5% proparacaine should be used for topical anaesthesia prior to ultrasound pachometry. This recommendation may minimize the possibility of measuring artifactually large corneal thickness estimates, and thus reduce the possibility of corneal microperforation during refractive surgery.


Acquired dacryocystitis: microbiology and conservative therapy.

The dacryocystitis in adults is mainly caused by postsaccal stenosis of the lacrimal ducts. The banking up of the lacrimal fluid leads to an accumulation of germs and following infection. This report describes the clinical and microbiological findings in a large consecutive series of patients that presented at the outpatient clinic of the 2nd Department of Ophthalmology of the University of Vienna with the signs of acute, chronic recurrent or chronic infections of the lacrimal system between 1983 and the end of 1990. Within the bacterial genus Staphylococci (S. aureus, S. epidermidis and S. saprophyticus) were the most frequently isolated organisms (74 cultures = 50% out of samples with positive cultures). It was quite interesting that a significant number of gram-negative rods (37 = 25.5%) could be isolated. Of these microorganisms Escherichia coli was most frequently growing on special media (17 cases = 11.7%) when cultures were obtained from acute inflamed lacrimal sacs of patients who suffered from chronic recurrent infections. Conservative therapy of purulent dacryocystitis constitutes the last possible preparation for a necessary surgical intervention and therefore the authors want to point out the importance of microbiological examinations so as to optimize antibiotic therapy.


Gentamicin, norfloxacin and lysozyme concentration in human tears: in vivo and in vitro study.

Hen's egg lysozyme (HEL) activity was measured in vitro with gentamicin and norfloxacin by a turbidimetric technique. Gentamicin at the concentration of 10(-3) M inhibited HEL activity by 39%, while 10(-3) M norfloxacin did not affect HEL activity. However, an in vivo study in healthy persons did not show any significant statistical difference in tear lysozyme activity when 0.3% gentamicin or 0.3% norfloxacin were topically applied.


Sampling methods for tear stix tests.

Four different methods for transferring conjunctival fluid to stix test pads were studied. One hundred and twenty eyes from 120 cataract-extracted patients (35 in the operated eye 0-5 days post-operatively and 85 in the contralateral eye) were included in the study. Transfer of fluid by a glass rod from the lateral part of the inferior fornix was demonstrated to be the most suitable method, showing the highest sensitivity to leucocyte-esterase (83%, N = 120, p < 0.05) and with a specificity equal to that of the other methods tested (cotton, spongostan, Schirmer paper strip). The glass rod method is suitable for detecting blood, nitrite, albumin, pH, and glucose, and is a both quick and unintrusive procedure. All four transferring methods may, however, cause an increased desquamation of epithelial cells and an increased amount of mucus.


The effect of varying wavelength on subconjunctival scleral laser suture lysis in rabbits.

We studied laser suture lysis of subconjunctival scleral sutures in a rabbit eye using selected wavelengths from a dye and diode laser to determine which wavelength caused the least conjunctival damage. We found an oval shaped area of coagulation necrosis surrounding the suture track in the conjunctival substantia propria measuring in depth 61.0 mu for 488 + 514 nm (blue-green), 105.7 mu for 514 nm (green), 148.3 mu for 630 nm (red), and 29.0 mu with 780 + 830 nm (infrared) wavelengths. No observable damage was noted with 585 nm (yellow) or 610 nm (orange) wavelengths. The energy intensity required for suture lysis was similar across each wavelength studied. No damage was observed in the sclera or conjunctival epithelium. These findings suggest that using the yellow or orange wavelength, when performing laser suture lysis clinically, potentially may limit conjunctival damage.


Dependence of ocular protrusion, asymmetry of protrusion and lateral interobital width on age.

Ocular protrusion and lateral interorbital width were measured in 462 patients; 187 females and 275 males ranging in age from 9 to 92 years. The object of this study was to determine if ocular protrusion, asymmetry of protrusion and lateral interorbital width was dependent upon age. There was a significant reduction in ocular protrusion and lateral interorbital width with increasing age in both females and males. There was a strong correlation between ocular protrusion and lateral interorbital width. Asymmetry of ocular protrusion did not develop with age. These findings may help in the longitudinal assessment of patients.


Long-term results of anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas.

We performed the anterior chamber tube shunt to an encircling band procedure in 34 patients (36 eyes) with refractory glaucoma, and evaluated the long-term outcome. The preoperative mean intraocular pressure (IOP) was 36.8 +/- 9.6 mmHg, the postoperative mean IOP was 21.6 +/- 13.6 mmHg, a statistically significant (p < 0.01) reduction of IOP following this procedure. The final postoperative IOP was under 21 mmHg in 23 (63.9%) of the 36 eyes. The success rate of IOP control 36 months after the operation without any elevation of post-operative IOP was 30.3% (life-table method). Complications of this procedure included flattening of the anterior chamber (61.1%), damage to the corneal endothelium (25%), hyphema (25%), and a transient IOP elevation (25%). As filtering surgery with 5-fluorouracil is more effective and simple to perform, we conclude that the anterior chamber tube shunt to an encircling band procedure should be reserved for those with refractory glaucoma who have had multiple surgical interventions.


Radiotherapy of malignant melanoma of the uvea with I-125 seeds.

Nineteen patients with malignant uveal melanomas were treated with I-125 applicators. There were 10 males and 9 females with a median age of 61 years (range 42-76). The tumour was located in the choroid in 12 eyes and in the choroid and ciliary body in 7 eyes. The size of the tumours was 7-18 mm in maximal basal diameter (median 12), 5-16 mm in minimal basal diameter (median 10), and 5.5-15 mm in thickness (median 8.5). The volume of the tumours was 123-1890 mm3 (median 540). All tumours were classified as large (T3). For the irradiation, a computer program, which calculates three-dimensional dose distribution of I-125 seeds in gold plaques, was developed. By modifying the seed positions, activity and the orientation, patients can be treated individually. Iodine-125 emits low energy photons, ideal for intraocular tumour therapy and tissue. Extra-ocular tissue located behind the applicator can be completely shielded by a 0.5 mm gold layer. The dose at the apex of the tumour ranged from 30 to 120 Gy (median 93). The treatment time ranged from 44 to 600 h (median 235). Preliminary results are good. After a median follow-up of 6 months, the tumour growth has been arrested in all eyes and in 10 eyes the tumour has decreased in size.


The association between HLA B5 and ocular involvement in Behçet's disease in southern Turkey.

HLA B5 plays an important role in the aetiology of Behçet's disease. The frequency of HLA B5 differs between racial groups and geographical regions. Ocular involvement, which could lead to serious complications, is a very important feature of Behçet's disease. Various racial groups having different genetic properties live in the Cukurova region, located in southern Turkey. To investigate the role of HLA B5 in Behçet's disease in Cukurova region, HLA B5 antigens were investigated by lymphocytotoxicity assay in 65 patients and 200 healthy controls. A significantly higher frequency was found in the patient group. Neither ocular involvement, nor the type of uveitis showed any correlation with HLA B5, but it was found that patients presenting with frequent ocular attacks had significantly higher HLA B5 positivity than the patients with rare attacks. This observation suggests that HLA B5 would be a negative factor in visual prognosis in Behçet's disease.


A comparative study of total protein, total and lipid associated serum sialic acid levels in patients with Behçet's disease and control groups.

The current investigation was designed to determine the total serum sialic acid (TSA), lipid associated sialic acid (LASA), total protein (TP), and TSA/TP values for 16 patients with active form of Behçet's disease, 12 patients with other uveitis types (pathologic controls) and 22 normal individuals. Data analysis indicated significant differences in mean TSA, LASA and TSA/TP values in patients with Behçet's disease (95.6 +/- 15.3 mg/dl, 29.8 +/- 7.4 mg/dl and 12.9 +/- 2.1 mg/g, respectively) and in pathologic controls (75.8 +/- 8.1 mg/dl, 26.6 +/- 0.3 mg/dl and 10.0 +/- 0.9 mg/g, respectively) when compared to normal controls (59.5 +/- 7.5 mg/dl, 19.2 +/- 3.2 mg/dl and 8.2 +/- 0.9 mg/g, respectively) (p < 0.01). No significant difference was observed in mean LASA values in patients with Behçet's disease when compared to pathologic controls (p > 0.05). No significant difference was observed in mean TP values in patients with Behçet's disease (7.4 +/- 0.7 g/dl), normal controls (7.3 +/- 0.4 g/dl) and pathologic controls (7.5 +/- 0.6 g/dl) (p > 0.05). A statistically significant difference was observed between the patients with Behçet's disease and pathologic controls with respect to TSA, TSA/TP values (p < 0.01). The results indicated that TSA and TSA/TP is most useful for differentiating Behçet's disease from other forms of uveitis.


Aggressive toxoplasma retinitis.

Toxoplasma infection is a common cause of infectious uveitis. It usually produces a characteristic fundal appearance, with evidence of previous inflammation. However, it may occur in an atypical and aggressive form. Steroids administered to salvage vision may then worsen the clinical course. Retinal biopsy may be diagnostic in cases where doubt exists. We illustrate these points with two cases.


Giant cell arteritis and visual loss. A 3-year retrospective hospital investigation in a Danish county.

An ophthalmic status is given for 95 consecutive patients referred from other departments of the Central County Hospital 1986-88 due to suspected giant cell arteritis. Eventually, the diagnosis was confirmed in 51/95 (18 had positive biopsy of the temporal artery; in 33 it was on clinical grounds). Nine of the 51 had significant visual loss, in one even as bilateral blindness. Generalized malignancies were found in 2 of the 44 with diagnosis other than giant cell arteritis. Retrospectively, in the same 3-year period a total of 263 cases of giant cell arteritis were registered in the somatic hospitals of the county (population 340,000). One further case with visual loss became known from requests to the primary health sector ophthalmologists. Between 3-4% were thus known to have significant visual loss, a result mainly in keeping with other Nordic clinical studies. Probably, the low figures of visual impairment are related to high diagnostic rates of giant cell arteritis, and to early treatment. Our hospital-based data of giant cell arteritis gave a calculated annual incidence of 1 per 1000 of those older than 50 years in the county, or 27/100,000 including all ages. The true county incidence would be even higher had it been possible to find and include the additional cases of giant cell arteritis who were diagnosed and treated in the primary health sector only.


Fibrillopathy in a pseudophakic eye. Production of fibrils by remnants of the lens capsule.

The ultrastructure of the lens capsule remnants in an eye with known fibrillopathy (pseudoexfoliation/exfoliation syndrome) subjected to an extracapsular cataract extraction (ECCE) and lens implantation 11 months earlier was examined. Lens epithelial changes typical in lenses with fibrillopathy were observed. The well-known fibrils radiated from pits in the lens epithelial cells, forming a deep layer in the lens capsule and the Busacca bushes on the capsule surface. It thus appears that the production of fibrillar material from lens epithelium may continue after ECCE and implantation of an intraocular lens. A possible connection between intracellular and extracellular fibrils was noticed.


Changes in the soluble protein of the human vitreous in vitreoretinal disease.

Samples of the vitreous were analysed in order to identify changes of soluble proteins in vitreo-retinal disease. The soluble proteins of the vitreous were separated on an anion exchange column (Mono-Q). The degree of neutral proteolytic activity in vitreous body was also measured. The vitreous from cataract cases without vitreoretinal disease was characterized by its low content of soluble proteins equivalent to about 1% of that of serum. Albumin and transferrin were the major identified components and their concentrations were approximately 0.85 and 0.03 g/l, respectively. In cases with vitreoretinal disease the vitreous showed changes of total soluble protein and the appearance of additional protein peaks. In patients with PVR the albumin concentration in the vitreous was found to be three times higher as compared to the control group consisting of patients with cataract. Neutral proteolytic activity in the vitreous was relatively low in both normal and pathological vitreous.


Is retinopathy in pancreatitis caused by leukocyte emboli?

The theory of granulocyte embolization in the retinal arterioles in acute pancreatitis cannot account for several aspects of the ophthalmic complication. Therefore we studied retinal circulation by fluorescein angiography, light and transmission electron microscopy following the first six hours of acute experimental necrotizing pancreatitis. The studied period was characterized by high serum lipase and amylase concentrations, hypocalcemia, necrosis of the pancreatic tissue and preceded the development of hypovolemic shock. Ophthalmoscopy and fluorescein angiography revealed no pathologic alterations and no granulocyte aggregation was found. Our results suggest that granulocyte aggregation induced by pancreatic enzymes is not the reason for the ophthalmic circulatory disturbances in acute pancreatitis.


Quantification of the ocular response to treatment in posterior uveitis.

Twenty patients with posterior uveitis were studied by anterior segment fluorophotometry to determine whether there was a relationship between the degree of breakdown of the blood-aqueous barrier and the clinical recovery of posterior uveitis. In individual eyes the degree of breakdown and recovery of the blood-aqueous barrier (as measured by changes in the anterior chamber fluorescein concentration) followed the resolution and relapse of disease making it possible to quantify the ocular response to treatment.


Retinal involvement in Wucheria bancrofti filariasis.

We report the first case of inflammation of the retinal pigment epithelium and retinal vasculities presumably caused by microfilaria of Wucheria bancrofti and discuss its possible pathogenesis. Therapy with diethyl carbamazine citrate resulted in rapid resolution of the inflammation.


The incidence of complications associated with retrobulbar injection of anaesthetic for ophthalmic surgery.

A retrospective study of the incidence of complications associated with the use of retrobulbar injections was carried out on a sample of 1083 consecutive patients. The overall incidence of retrobulbar haemorrhage (1.3%) compared favourably with previous reports, but was found to be related to the experience of the surgeon. None of the more serious ocular complications of retrobulbar injection occurred in this sample. The relative safety of this technique is discussed.


Role of trace elements in senile cataract.

The contents of copper, zinc and protein were determined in cortex and nucleus sections of cortical and nuclear cataracts. The results show that copper and zinc content increased in both types of cataracts, although more in the cortex than nucleus sections of the cataractous lenses.


Enterococcal endophthalmitis following cataract extraction, treated with ampicillin intravitreally.

A case of Enterococcal endophthalmitis developed following an extracapsular cataract extraction. The infection was successfully treated with intravenous and intravitreal ampicillin, but a secondary glaucoma led to a later enucleation. We report a case of postoperative endophthalmitis with an unusual etiology, which did not respond to common treatment.


Traumatic globe luxation.

A case of globe luxation which followed a relatively slight trauma is presented. The luxation was accompanied by laceration of the conjunctiva in this case. After achieving reposition in the emergency room, the patient underwent a surgical exploration of extraocular muscles and conjunctival fornices where many eyelashes were removed. The clinical features and management of globe luxation is discussed, importance of surgical exploration is emphasized.


Multicentre evaluation of the temporal bones obtained from a patient with suspected Menière's disease.

A multicentre study of the inner ears of an 88-year-old patient with vertiginous spells and severe hearing loss in the left ear was performed, employing regular and block surface preparations, light and electron microscopy with qualitative and quantitative evaluation of the cochlear and vestibular nerves. There was severe hydrops of the left cochlea and saccule. Reissner's membrane extended into the vestibule and herniated into the perilymphatic space of the non-ampullated end of the horizontal canal. Furthermore, the short canal connecting the posterior ampulla with the utricle had a small, exceedingly thin balloon-like expansion. Only slight hydrops limited to the cochlea was found in the right ear. Sensorineural degeneration was much more pronounced in the left cochlea than in the right. The number of cochlear and vestibular nerve fibres was greatly reduced in the left ear where more fibres with degenerative changes were present. In both specimens the number of myelinated nerve fibres in osseous spiral lamina was smaller than that in the cochlear nerve in the internal auditory canal. Changes occurred in the endolymphatic sacs but were considered non-specific. In this case severe, apparently progressive hydrops and sensorineural degeneration, characteristic of Menière's disease, were associated with atypical onset of clinical symptoms at a late age.


[A drug ahead of its time: the success story of selegiline].

The racemic form of Selegiline was investigated in clinics a short time after its discovery in the sixties. However its fate seemed to be sealed by the so-called "cheese effect" associated with the applications of other MAO inhibitors. In the seventies the (-) enantiomer, called Selegiline was investigated again in European Clinics, and was finally introduced into therapy as an adjuvant of L-Dopa treatment for Parkinsonism. In the eighties its launch to the market of the USA was influenced by events known as the "MPTP Story" and the "Orphan Drug Act". Further clinical investigations of Selegiline are expected to clarify the real therapeutic value of Selegiline.


[Synthesis of selegiline, its potential impurities and metabolites].

Selegiline is prepared in a three-step synthesis starting from phenylacetone and methylamine. Its possible impurities may be the (+)-isomer and compounds formed in side reactions. The syntheses of selegiline's metabolites are also described.


[Survey of the analysis of selegiline].

The characteristics of the selegiline active substance, identification tests, purity tests and the determinations of the active substance content are summarized in the paper. Fast, simple, selective reverse phase HPLC method is used for purity tests and active substance determinations. The validation of the determination of the active substance and the purity test is presented. The solvent residues were determined in vapour phase by the headspace method. A potentiometric acidi-alkalimetric titration, carried out in nonaqueous solution with the application of a titriprocessor is applied as an assay. A thermoanalytical method developed for the purity determinations is also published in this issue by Ladányi et al.


[NMR spectroscopy of selegiline and related compounds].

In the course of the 1H NMR investigation of Selegiline and compounds related to it, the 3J coupling constants of the protons of the alpha and the beta carbon of the beta-phenyl-ethylamine moiety were determined. The rotameric population around the single bond of the alpha and beta carbons were calculated from these values. It is discussed how substituents at the alpha-carbon atom, at the nitrogen atom and on the phenyl ring as well as the solvent influence the conformational equilibria. The optical purity of the samples were determined using chiral europium shift reagents, however different reagents have to be used for primary, secondary and tertiary amine derivatives. The coordination process between p-F-amphetamine and Eu(tcf)3 was studied in detail, the formation constant of the complex and the bound shifts were determined.


[Study of selegiline and related compounds with x-ray diffraction].

Selegiline and its parent compounds were studied by X-ray diffraction. It was established that the racemates of primary and secondary amines (p-fluoro-amphetamine, methamphetamine, p-fluoro-methamphetamine) hydrochloride do not form racemic compounds but crystalline as conglomerates, at the same time tertiary amines like selegiline and p-fluoro-selegiline hydrochlorides do. The crystalline structure of five enantiomeric hydrochlorides were determined, the CPhe-C-C-N torsion angle is anti-periplanar in all cases but in p-fluoro-amphetamine where it is gauche.


[Thermoanalytic determination of the enantiomeric purity of selegiline].

The thermal behaviour of Selegiline (a chiral, non racemic pharmaceutical used in the therapy of Parkinson disease) was studied by differential scanning calorimetry (DSC) for determining the enantiomeric purity (e.p.) of the bulk substance. It has been found, that (i) the binary phase diagram (melting point phase diagram) of the R/S enantiomer mixtures is characteristic to that of the true racemic compounds; (ii) the melting behaviour of the R/S binary mixtures follows the thermodynamic laws (i.e. the Schröder-Van Laar and the Prigogine-Defay equations); (iii) the e.p. of the highly purified bulk substance can be expressed as "DSC purity" (this latter is obtained from the Van't Hoff equation) and the microcalorimetric method as above gives good reproducibility; (iv) due to the minor impurities (other than the S(-) enantiomer) the obtained e.p. (expressed as DSC purity) can be higher but not lower than the actual e.p. of the investigated substance.


[Pharmacology of selegiline (recent considerations)].

The nigrostriatal system, where dopaminergic neuron activity dominates, plays and important role in control of motoric and psychic functions. Selegiline with its neurochemical activity ie. MAO-B enzyme and dopamine uptake inhibition is able to restore or improve the deteriorated function of that system. Selegiline can hinder the uptake of tyramine into the peripheral sympathetic nerve endings, so cheese effect, which is a characteristic and dangerous side effect induced by MAO-A inhibitors, does not occur. Selegiline can potentiate the learning activity of PEA in rats, these effect may be connected with increased dopamine turnover in the striatum. In pathological conditions dopamine can be replaced by L-dopa, so it has a fundamental role in the improvement of dopaminergic functions. According to neurochemical activity selegiline takes a prominent role in the extension and improvement of L-dopa therapy. The neuroprotective effect of selegiline is multiple, with the inhibition of MAO-B it can stop the production of neurotoxin MPP+ (arising from MPTP) and its uptake into the nerve endings respectively. In chronic treatment with Selegiline SOD activity increases in rats, as a consequence the level of free oxygen radicals and toxic metabolites can be diminished. Chronic treatment with selegiline does not influence the activity of young animals, but improves sexual activity and learning capacity and enlarges life expectancy of old rats. These experiments verified its positive activity on the nigrostriatal system and give a good chance for geriatric usage. In longtime treatments dependency was not stated.


[Pharmacokinetics and metabolism of selegiline].

As it has been shown is animal experiments, selegiline administered orally is absorbed rapidly. The compound penetrates the blood-brain barrier and the concentration of selegiline and/or its metabolites is high in the brain. Selegiline is eliminated primarily by renal excretion (73%) and 14% of the dose is eliminated with faeces. The main metabolic pathway is N-dealkylation. N-demethyl-selegiline, amphetamine and methamphetamine are the main metabolites. p-Hydroxylated derivatives of amphetamine and methamphetamine could also be identified in rat urine. (-)-Selegiline gives rise to (-) metabolites and does not undergo racemization. Selegiline is bound to macromolecules extensively. The metabolites have lower affinity to plasma proteins than the parent drug do. Selegiline and its metabolites do not accumulate in the organism not even during prolonged administration.


[Positron emission tomography of C-11-labelled selegiline].

The combination of C-11-labelled Selegiline with PET gives the possibility of a non-invasive method for the determination of the distribution, activity and turnover of MAO-B enzyme and all the enzyme-related changes in the brain as well as for the early detection of Parkinson's disease.


["Widening horizons" in the clinical application of selegiline].

The first paper on the beneficial effect of selegiline in the treatment of Parkinson's disease was published 17 years ago. In the first ten years several clinical studies were conducted world-wide to prove its efficacy as an adjuvant to the basic 1-dopa therapy. Although the design, duration and number of treated patients were different, the overall results were mainly uniform. The patients treated with 1-dopa selegiline combination showed marked improvement in disability, increasing duration of 1-dopa effect and marked lessening of dose-related fluctuations were seen, compared to those treated with 1-dopa alone. It became also generally evident that selegiline allows a 10-30% decrease in 1-dopa dose. The investigations in which selegiline has been used as monotherapy have been triggered by some purely clinical experience and by the discovery of pathobiochemical mechanisms of MPTP toxicity which causes fairly similar clinical picture to Parkinson's disease and can be successfully prevented by selegiline. The newly diagnosed parkinsonian patients treated with selegiline alone showed marked improvement in their clinical state. Beside the actual clinical effect on disability, selegiline slowed down the progression of Parkinson's disease. The latter fact has been proven in the largest clinical trial ever done with selegiline (DATATOP). Selegiline monotherapy can delay the need for 1-dopa substitution by around one year or longer. Based on the continuously growing clinical experiences it became widely accepted that selegiline is the drug of choice as initial treatment for newly diagnosed parkinsonian patients.(ABSTRACT TRUNCATED AT 250 WORDS)


[Radioreceptor assay for determination of the anti-progestogen, RU-486 and its active metabolites in the blood].

RU-486 is an antiprogesterone 19-norsteroid with high binding affinity for the progesterone receptor. It can be used with success for termination of early human pregnancy. Since the metabolites of RU-486 are often biologically active, their concentrations in blood can also have clinical significance. We have developed a rapid sensitive radio receptor assay for determination of RU-486 and its active metabolites. Human myometrium progesterone receptor was used as binding protein. The assay is based on the competitive replacement of 3H-ORG-2058 by the active molecular fraction of RU-486 present in the serum. The analytical parameters of this assay are the followings: intraassay percent of coefficient of variation (CV%) is ranged between 7.6 and 10.4%. The interassay CV% was from 7.1 to 16.3. The sensitivity of the receptor assay was 8.7 pmol/tube and the acceptable range was between 10 and 120 pmol/tube. The recovery ranged between 95 and 122% (r = 0.983). These parameters are suitable for the requirement of radioligand binding techniques based on the immunoassays.


[Evolution of the Hungarian oral contraceptives].

Author gives a review of the development of Hungarian oral contraceptives from the beginning to the present status. He describes the three main historical phases that means the high-dose combined pills, the low-dose compositions and the most modern two- and three-phasic preparations. Besides, he mentions the monohormonal mini-pills and the so-called postcoital pill, too. He refers to the fact that the Hungarian pharmaceutical research followed truly the international development in oral contraception, too.


[Comparative evaluation of the effect of mono-, bi- and three-phase oral contraceptive tablets on the endometrium].

It was established that the applied new pill has no atrophic effect onto the endometrium. Therefore it has better characteristics than other oral contraceptives (excepting Anteovin). Ovidon e.g. causes endometrial atrophy (concerning glands and stroma as well), when it is used for several years. We can expect the triphasis pill not to results any endometrial atrophy or hyperprolactinaemia not even in long term use. High progesterone levels detected in serum during pill administration refer to this fact.


[Formulation and in vitro investigation of antibacterial vaginal suppositories. Part 1. Considerations in selecting the vehicle. Methods and results of the physical examination].

Vaginal suppositories frequently used in gynaecological therapy were studied. Several antibacterial pharmacons are used for the topical treatment of vaginitis of various origins. However, the choice of the vaginal suppository base was often considered to be of minor importance for a long time. In view of the fact that the liberation of the given active substance and the subsequent therapeutic effect may be improved or inhibited by the vehicle, their aim was to find the optimal suppository base for vaginal suppositories containing sulphadimidine, chloramphenicol and gentamicin-sulphate by means of in vitro experiments. On the basis of breaking hardness, disintegration time and spreading properties the French Suppocire NA product, and compositions of macrogols with lower molecular weight proved to be the best lipophilic and hydrophilic bases respectively.


[Formulation and in vitro investigation of antibacterial vaginal suppositories. Part 2. In vitro membrane diffusion and microbiologic studies].

After the physical parameters had been determined, the in vitro drug liberation from vaginal suppositories containing 100 mg of antibacterial agent (sulphadimine, chloramphenicol, gentamicin-sulphate) was studied by membrane diffusion and microbiological methods. Among the vehicles available in Hungary the hydrophylic Massa macrogoli was found to be the best for this purpose. Among the lipophilic bases the in vitro drug liberation of the French Suppocire NA product was significantly better (p < 0.05) compared to the other lipophilic bases. This vehicle is recommended by the authors for the topical treatment of vaginitis, as these suppositories have the further advantage that they can easily be produced on a magistral, galenical or industrial scale as well. In the first part of the publication the formulation and some important physical parameters of lipophilic and hydrophilic antibacterial suppositories for vaginal use were described. In the present paper the drug liberation ability of the compositions with proper physical parameters was studied. The published results were obtained from measurements performed 1 week after formulation.


Kinetic methods for the determination of atenolol in pharmaceutical preparations.

The fixed concentration and the fixed time methods were used for quantitative determination of atenolol employing 0.0515 M ammonium meta vanadate as an oxidant in 2.5 M sulphuric acid at 84 degrees C. The two methods are based on reaction rate measurements following the absorbance of vanadium (IV) species produced, spectrophotometrically at 750 nm. The applicability of the methods was tested by assaying atenolol in drug formulations and comparing the results obtained statistically with the BP method.


[Cytochrome P-450: structure, function, induction and practical significance].

The liver contains a series of microsomal hemoproteins, called cytochromes P-450 which are mixed-function oxygenases involved in the metabolic oxygenation of diverse xenobiotic chemicals (drugs, pesticides, etc.). This enzyme system converts lipophilic foreign compounds into more water soluble products, thereby facilitating their elimination from the body. In general, cytochrome P-450-catalyzed oxidation results in detoxification, however the cytochromes P-450 can also convert certain xenobiotics to more toxic or carcinogenic products. Many of the individual isoenzyme forms of cytochrome P-450 are inducible by a wide variety of chemicals. After induction the concentration of total cytochrome P-450 in liver microsomes and the activity of different cytochrome P-450 forms increase. Elevated levels of cytochrome P-450 are the result of multiple mechanisms. Increased transcription of P-450 genes is a major mechanism of cytochrome P-450 induction. Higher levels of specific mRNAs are detectable soon after treatment with either "phenobarbital-like" or polycyclic aromatic compounds. Although increased transcription plays some role in the induction of cytochromes P-450 by other inducers like pregnenolone-16 alpha-carbonitrile (PCN)/glucocorticoids and "ethanol-type" compounds, post-transcriptional events are also very important. Cytochrome P-450 induction can be achieved by message stabilization and enhanced transport of mRNA from the nucleus to the cytoplasm that also increase the specific mRNA levels at the site of protein synthesis. Elevated cytochrome P-450 levels may also result from protein stabilization. Stabilization of cytochrome P-450 protein and/or mRNA are the main processes of induction by PCN/glucocorticoids and ethanol-type inducers. Although these mechanisms exist, they do not seem to be important in the induction by "phenobarbital-like" and "3-methylcholanthrene-like" inducers. The fact that induction is produced by a large variety of xenobiotics and is mediated by multiple mechanisms suggests that cytochrome P-450 system can provide increased protection for organisms in potentially hostile chemical environment. Since cytochrome P-450 induction is a characteristic response to chemicals for various living organisms ranging from microorganisms to man, it seems to be an adaptive mechanism for organisms to increase the chance for survival.


[Superficial carcinoma of the bladder. The pT1 G3 tumor: progression, recurrence, and survival. Treatment].

Surface vesical cancer continues to be a problem awaiting to be solved and with an alarmingly increasing incidence. The present report examines the inclusion criteria for the different categories as related to the accepted systems (NMT, Jwet-Marshall) and outlines the significance of the lamina propria invasion in the prognosis of patients with surface tumours. Also, it explores the various reported systems to define histological degree attending to morphological criteria. A review of prognostic factors with an emphasis on the relevance of the presence of in situ carcinoma associated to vesical tumour is included. There is an specific study of pT1 G3 tumours behaviour as related to progression, tendency to recurrence and survival; review of the different therapy approaches; and presentation of our personal experience based on the review of 448 tumours, which were compared to the results reported by the other national (Algaba, Vicente Rodríguez) and international (Heney, Soloway, Cooper, Kakizoe, etc.), authors.


[Scrotal suspension with hypogastric suture. Hemostatic technique in intrascrotal surgery].

Appearance of haemorrhages and bruises after surgery of scrotal bags contents is one of the most frequent complications in Urology. Presentation of results obtained in a prospective study carried out on 86 patients who had underwent surgery due to intrascrotal disease. In all of them and regardless of the approach used (inguinal or scrotal), suspension of bags to hypogastrium using suture traction was performed by Oesterling technique in combination to Joseph and O'Boyle's technique. Drainage was not used in any case. The article explains the characteristics of undergoing pathologies' surgical indications, describing both the technique used and the results obtained. It concludes by stating this is a useful method to prevent routine complications in scrotal surgery.


[Renal transplantation: results].

Between June 1986 and December 1991, 125 kidneys were transplanted in our hospital. Survival results of patients per annum was 94%, 90% of which represent grafts. Regarding the complications occurred in our series the most frequent ones were medical followed by surgical [urological (4%), vascular (2.4%) and others derived from the surgical procedure (20%)]. It was necessary to perform 5 transplantectomies.


[Prostatic melanosis].

Melanin presence in the prostate can be accurately localized in epithelial cells (nevus) or in the stroma (prostatic melanosis). This article describes a new case and compiles all recorded cases as well as the theories concerning their origin.


[Clinico-pathologic study of renal cell carcinoma].

Renal cell carcinoma (RCC) is an uncommon tumour with high mortality mainly due to late diagnosis. The various morphological variables and the clinico-pathological stage, however, induce highly different evolutions. Awareness of these characteristics would be a significant part of deciding the most appropriate therapy for each case. The pathological anatomy of 130 renal cell carcinomas obtained through nephrectomy was reviewed. A follow-up of at least 5 years was done in 121 patients. Also, a survival study related to the various clinical and pathological parameters was carried out. A significantly lower survival rate was observed for solid tumours with spindle or giant cells and nuclear degrees superior to 2, over 10 mitosis in 10 fields and staging higher than II. A significant correlation was also found between number of mitosis and staging, presence of metastatic disease, survival interval, degree of tumoral necrosis, histological type, cell type and nuclear grade. Our results indicate that staging, histological type, cell type, microscopic vascular infiltration, nuclear grade and number of mitosis can be highly predictive of the evolution and prognosis of RCC patients.


[The nuclear roundness factor as a parameter in the anatomoclinical correlation of prostatic carcinoma].

This paper correlates the nuclear roundness factor to clinical stage, patient's age and acid phosphatase level at the time of diagnosis in a group of 48 patients with prostate carcinoma and a minimal follow-up of 5 years. It has been demonstrated that, from an anatomo-clinical point of view, the nuclear roundness factor is a good indicator because it presents increasing values as the clinical stage of tumoral extension worsens, and in those stages where the number of patients was relatively high the average of deaths was always higher than that of survivors. On the other hand, a direct correlation to total acid phosphatase, and an inverse correlation to age at the time of diagnosis was shown in patients with changes in these values.


[Diagnostic and therapeutic aspects of vesico-colonic fistulae. Review of our experience].

Analysis of 10 fistulae in 9 patients, all male. The etiology was diverse although there was a predominance of colovesical diverticulitis. Mictional urinary symptomatology was most frequent. In one case symptoms had been first referred 10 months earlier, while the others ranged between 24 hours and 15 days. Cystography was the radiological procedure which diagnosed more cases whereas cystoscopy was the endoscopic procedure which provides more data. Seven fistulae were treated surgically, in 5 instances with curative and 2 with palliative purposes. Three cases were subsidiary to surgery. 44.4% of patients died within one month from diagnosis.


[Cystic cystitis in childhood].

Cystic cystitis is a benign entity highly uncommon throughout childhood and which, from a clinical and radiological point of view, can simulate an intravesical malignant neoplasia (rhabdomyosarcoma); thus an accurate differential diagnosis is required, a biopsy of the lesions being necessary to confirm their nature. The paper presents 2 patients with cystic cystitis discussing the condition's etiology, pathogenesis, signs and symptoms as well as its evolution.


[Retroperitoneal ganglioneuroma: an infrequent tumor].

Presentation of 2 cases of retroperitoneal ganglioneuroma (paravertebral and adrenal, respectively), accidentally diagnosed during ultrasound study. In none of these 2 cases diagnosis by thin-needle puncture-aspiration was possible, therefore, surgical exeresis of the lesion was performed. When diagnosis is made prior to surgery, management can be conservative with close follow-up, unless neuroblastoma is identified or there is other disease-derived pathologies present.


[Vesico-uterine fistula: report of 2 new cases].

Presentation of two new cases of vesico-uterine fistulae secondary to cesarean operation. In one case our route for surgical approach is explained as a novelty; also, the time-frame within which it was performed, one month, since it is usual to recommend a minimum of three months. In the second case an in-dwelling vesical catheter was sufficient to achieve closure. The article also reviews the existing literature on the different aspects: signs, symptoms and therapy, of this infrequent pathology.


[Nephrogenic adenoma of the bladder].

Presentation of one case of vesical nephrogenic adenoma diagnosed as an accidental histological finding following TUR of vesical tumour. This case if considered of interest due to the rarity of the lesion (some 300 cases reported) and the limited number of quotations in the Spanish literature.


Affective correlates of alcohol and cocaine use.

The affective correlates of alcohol and cocaine use were investigated in two studies. In the first, alcoholics (n = 50) and cocaine addicts (n = 40) were administered factor scales from the Inventory of Drinking Situations as well as the General Temperament Survey. Substance use in negative affect states was reported more often by alcoholics than by cocaine addicts, even when age and race differences were statistically controlled. Alcoholics also reported higher levels of negative temperament, and substance use in negative affect states was correlated with negative temperament across groups. In a study using subjects dependent on both drugs (n = 21), alcohol was more likely to be used in negative affect situations than was cocaine. Thus, the affective correlates of substance use are associated with both individual differences and drug-specific effects. Possible reasons for the differential association of alcohol with negative affect are proposed.


Alcohol, personality traits, and high risk driving: a comparison of young, drinking driver groups.

Four types of drinking driver groups were compared with each other and also with two nondrinking driver groups on sensation seeking, social responsibility, and hostility. Groups were also compared on traffic violations, accidents, alcohol consumption, frequency of driving after drinking, frequency of driving impaired, and perception of driving risk taking after drinking. Drivers under the influence apprehended in conjunction with an accident or moving violation had significantly greater alcohol consumption, frequency of driving after drinking, frequency of driving impaired, traffic violations, accidents, and self rating of risk taking after drinking in comparison with other groups.


Factors associated with nonparticipation among registrants for a self-help, community-based smoking cessation intervention.

Smokers (n = 96) who registered for but did not participate in a televised smoking cessation intervention based on the American Lung Association's self-help manual, Freedom From Smoking in 20 Days, were compared with participants (n = 1,035). Nonparticipants were more likely to be male, employed, and have a higher annual household income. At preintervention, nonparticipants expressed weaker desire to quit smoking, less confidence in their ability to quit, and less determination to quit. At post-program, 92% of nonparticipants smoked, but 93% planned to quit someday, with 82% planning to quit within the next 12 months. Additionally, nonparticipants were asked about their impressions of the manual, reasons for not reading the manual, and reasons for not watching the televised segments. Nonparticipants expressed positive initial impressions of the manual and mentioned time demands and conflicts with other commitments most often as reasons for not reading the manual and not watching the televised segments. Besides motivating smokers to try to quit, smoking cessation programs should help smokers to prepare to act. Also, nonparticipants are good candidates for recycling into subsequent programs.


Comparisons of retrospective and current reports of alcoholics and their spouses on drinking behavior.

This study examined the correspondence between reports of alcoholic husbands and their wives on multiple dimensions of alcohol consumption and drinking-related events. Retrospective reports as well as prospective diaries (90 day period) were obtained from both spouses on husbands' behaviors, and correspondence was assessed at group and individual levels. Although there was some variability in agreement between individual husband-wife pairs, overall results indicated that husband-wife correspondence was robust not only for global measures, but also for more specific dimensions of day-to-day consumption. Findings were discussed in terms of issues that affect the validity of alcoholics' reports.


Salmonella outbreak among railway and airline passengers.

A widespread outbreak by Salmonella infantis, infecting a total of 226 people, occurred in Finland at the beginning of August 1986. Of those infected, 107 were railway passengers, 91 were airline passengers and 28 were employed in a food processing establishment. The outbreak among the railway passengers was caused by egg sandwiches, the airline passengers were infected by a meal served on board and the catering employees by the breakfast served in the establishment. The outbreak was caused by food prepared in the establishment's kitchen. The employees' breakfasts had probably been contaminated by an employee who was a symptom-free Salmonella infantis carrier, and a number of the employees subsequently became infected, leading to widespread contamination of the food prepared in the establishment. The spread of the outbreak was further influenced by a heatwave at the time and by shortcomings in the cold storage facilities. The kitchen's hygiene supervision and the quality control of its output were reorganized after the outbreak.


Smokers' reactions to interpersonal interaction and presentation of smoking cues.

This study examined smokers' reactions to smoking cues and interpersonal interaction. Fifty-six smokers were assigned at random to the six cells of a factorial design which varied the level of interpersonal interaction (role play with a confederate vs. confederate absent) and the level of exposure to smoking cues (no cues vs. visual cues vs. visual plus olfactory cues). Measures of reactivity included changes from resting baseline on blood pressure, heart rate, self-reported smoking urge, and a measure of ad lib smoking behavior obtained after exposure to the experimental procedures. Results showed that blood pressure responses increased significantly from baseline only during the role play situation where the confederate manipulated an unlit cigarette or smoked a cigarette in view of the subjects. Although not significant, heart rate changes paralleled blood pressure changes, but urge ratings showed a different pattern of response to the manipulations. The latency to smoking a cigarette after the experimental manipulations was unaffected by the cues. The results suggest that modelling of smoking by others and exposure to some kinds of smoking cues may increase cardiovascular activation.


Effects of alcohol consumption on the prevention and alleviation of stress-reactions.

Alcohol's Stress-Response-Dampening (SRD) effect has been the subject of much research, but little has been done to examine the effects of drinking alcohol after experiencing a stressor (Stress-Response-Recovery; SRR). In this study, 65 male and 65 female moderate or heavy drinking undergraduates were randomly assigned (with equal numbers of each sex per group) to 1 of 13 groups. Six experimental conditions were used to compare alcohol's SRD and SRR effects with two doses (moderate: .75 ml/kg; low: .33 ml/kg) and a placebo, and seven control conditions were used to measure the effects of the stressor (uncontrollable aversive noise) and the alcohol doses alone on the dependent measures. The major dependent variable was escape learning in a human shuttle box. In the SRD conditions, subjects who drank a moderate dose of alcohol learned to escape faster than those drinking the low dose or placebo. However, in the SRR conditions, subjects in the placebo group did not show escape learning deficits, in contrast to the impaired performance of subjects in the two alcohol groups. These results suggest a complex alcohol-stress relationship in which timing, dose, and expectations about alcohol lead to differential SRD and SRR effects.


Hormonal interrelationships in postpartum suckled dairy cows.

Three cross-bred cows calved in March and April and were followed until day 62 after parturition. Each animal was suckled by 2 calves ad libitum. All calves were removed from the cows on day 55 after parturition. Blood was collected 3 times per day from the jugular vein by venipuncture. On 4 occasions after parturition--i.e. days 7-8, 21-22, 35-36 and 49-50, the cows were bled through a jugular venous catheter every 30 min during the 24 h. The plasma samples were analyzed for the content of 15-keto-13,14-dihydro-PGF2 alpha (main PGF2 alpha metabolite), LH, prolactin, cortisol and progesterone by radioimmunoassay methods. The concentration of PGF2 alpha increased from 280 to 730 pmol/l within the last 4 days before parturition. The highest geometric mean was 3106 pmol/l on the day of parturition. Thereafter a steady decrease of PGF2 alpha metabolite concentration was seen until day 21 when it reached plateau at 148 pmol/l. In all cows plasma LH concentrations increased significantly (P < 0.05) from about 1.6 micrograms/l on days 7-8 to 2.4 micrograms/l on days 21-22 post partum. The frequency of LH pulses showed no tendency to increase as the postpartum period progressed and averaged 6.5 pulses/24 h. Mean plasma LH concentrations increased from 2.1 micrograms/l 2 days before weaning to 3.2 micrograms/l 2 days after weaning (P < 0.05). LH peaks occurred less frequently in association with prolactin and cortisol peaks than in their absence. A partial positive correlation between PGF2 alpha metabolite and cortisol (r = 0.30) was found on days 7-8 post partum. Correlation between prolactin and cortisol on days 7-8 and 21-22 post partum was also positive (r = 0.20 and r = 0.27, respectively). There was a negative correlation between LH and cortisol on days 7-8 (r = -0.27) and days 49-50 (r = -0.21) post partum. The first and short progesterone increase observed after weaning was terminated in conjunction with PGF2 alpha metabolite peaks.


2.5 years follow-up of weight and Body Mass Index values in the Weight Control for Life! program: a descriptive analysis.

This descriptive study monitored weight, Body Mass Index, and percent excess weight changes in 60 clients, (44 women, 16 men) at about 1 year and 2.5 years following participation in the Weight Control for Life! program. The program integrates the habit reversal treatment model with contingency management and operant reinforcement principles; nutrition education; physical activity; stress management; cognitive-restructuring; relapse prevention; social support; intensive, on-going maintenance; self-monitoring; and the use of a medically supervised very-low-calorie diet or low-calorie-diet. Clients' pretreatment and posttreatment weights averaged 104.28 kg (229.42 lb) and 79.89 kg (175.76 lb), respectively, representing a 68% reduction in excess body weight at the end of the weight loss phase of the program. Mean weight loss at about 1 year and 2.5 years post weight loss was 19.28 kg (42.42 lb) and 13.09 kg (28.80 lb), indicating subjects maintained 75% and 52% of their weight losses at these two time periods. Men lost more weight and maintained better losses than women. Overall, there was a 41% reduction in excess body weight at the end of 2.5 years.


Germ cell weakness as a cause of testicular hypoplasia in bulls.

Sporadic cases of testicular hypoplasia were earlier found in bulls of the Swedish Red and White breed. An accumulation of cases have occurred since 1970 in sons of 2 outstanding progenytested bull sires, 2 F and 27 U, which had a common father, 545 B. The history and clinical examination of affected bulls varied. Some had azoospermia and very small testes at a young age, while others could be normal in all respect when they were young but had a short reproductive life and had to be culled at about 3 years of age. Most of the affected bulls were between these 2 extremes. The histologic examination showed principally different degrees of testicular degeneration. There were always some germ cells left in all affected seminiferous tubules indicating that there was not a lack of germ cells causing the hypoplasia. Germ cell weakness is obviously a hereditary condition. The sires 545 B, 2 F and 27 U had a relatively low fertility. In their pedigree were several bulls known to have had a low fertility. No sons of 2 F and only a few sons of 27 U were used for A.I. services and at present only few cases of testicular hypoplasia are seen.


A psychophysical task to quantify smoking cessation-induced irritability: the reactive irritability scale (RIS).

A psychophysical rating scale using magnitude estimation was developed as a tool to quantify irritability as one index of drug withdrawal. The scale measures reactive irritability by using environmental sounds as probes. Three studies are described in which target and reference stimuli are selected, tested for reliability, and presented to cigarette smokers abstaining from smoking, cigarette smokers who are not abstaining, and nonsmokers. This reactive irritability scale (RIS) was found to have test/re-test reliability and content validity. The RIS significantly differentiated abstaining smokers from nonsmokers and from smokers allowed to smoke, whereas the commonly used self-report measures of irritability failed to distinguish the two groups of smokers. By measuring irritability as a type of reactivity rather than as a static attribute, a different type of irritability is measured than that which is assessed by self-report questionnaires. The RIS should be used in the study of withdrawal from nicotine and other drugs of abuse.


Bulimia nervosa: occurrence with psychoactive substance use disorders.

The prevalence of bulimic symptomatology was determined in the female population of a state-funded chemical dependency treatment unit. Sixty women, 39 Caucasian and 21 Native American, all diagnosed with a psychoactive substance use disorder, were evaluated using both the Bulit-R and the eating disorder section of the Structured Clinical Interview for the DSM III-R to diagnose bulimia nervosa. The prevalence of bulimia was calculated to be 12% of the total subject group. Additionally, 3 anorectics were identified, resulting in a 17% rate of diagnosable eating disorders in the total group. Percentages of occurrence in the Caucasian group alone were 15% for bulimia and 23% for the combined eating disorders.


A study of the development of endotoxin-induced inflammation in the bovine teat.

Endotoxin-induced local inflammation was studied by frequent samplings in a bovine teat cistern model, which provides a unique possibility for in vivo studies of reactions in the teat without interference from the mammary gland. A rapid inflammatory response of rather short duration was elicited after endotoxin administration. An initial increase in the concentrations of bovine serum albumin and N-acetyl-beta-D-glucosaminidase, indicating a disturbance in the epithelial integrity, was observed between 1 and 1.5 h post infusion (p.i.). Approximately 0.5 h later, the first influx of leukocytes, mainly neutrophils, appeared. The neutrophils tended to enter the teat cistern in several peaks occurring between 2.5 and 5 h p.i. The sampling procedure decreased the accumulation of cells by approximately 40%, which was probably due to the removal of inflammatory mediators at an early stage. The parallel use of 2 teats instead of 1 had no major influence on the inflammatory process. This teat cistern model and the experimental procedure used should be suitable for further studies of the development of local inflammation.


Transfer of lactic acid bacterial strains from the feed to the sow, the environment, and the piglets.

The spread of lactic acid bacterial strains to the environment and to newborn piglets was investigated after feeding of such strains to sows. Rifampicin resistant bacterial strains were fed to sows, 10(10) c.f.u. per day, during the period from 1 week before expected farrowing until 1 week after farrowing. Fecal samples from the sows and samples of litter were collected for bacteriological examination together with swabs from the pens, the skin of the sows, and from the rectum of the piglets. The test strains were only excreted in relatively low amounts in the feces of the sows, approximately 10(3)-10(6) c.f.u. per gram. They were not able to displace the normal lactic acid bacterial flora in the sows nor were they transmitted to the intestinal tract of the piglets to any significant extent. After the last administration the test strains disappeared from both feces, skin, and environment, indicating that no permanent colonization had taken place, although considerable differences in duration of persistence were noticed between test strains.


Development of immunity to Ostertagia ostertagi (Trichostrongylidae: Nematoda) in pastured young cattle.

This experiment comprised 3 groups of calves, (+P2), (-P2) and (-P1), which all started their first grazing season as parasite-free calves. The (+P2)- and (-P2)-group grazed 2 seasons. In the first season the (-P2)-group of calves was grazing a pasture with no detectable trichostrongyles and treated with anthelmintics every second week. The untreated (+P2)-group grazed an Ostertagia ostertagi contaminated pasture. During the second grazing season these 2 original groups grazed together with a new group of first-year grazing calves (-P1) on paddocks infected with O. ostertagi. Parasitological analyses showed that (+P2)-group had negligible egg excretions in the second year in comparison with (-P2) and (-P1). This indicated, that the egg output may be regulated through acquired immunity. The difference in egg excretions was not reflected in the serum pepsinogen levels, which were only slightly elevated for all groups in the second year. Post mortem examination at the end of the experiment showed that only the (-P1)-group harboured relatively high numbers of worms in the abomasa at that time. Antibodies of 3 immunoglobulin classes were investigated: IgA, IgG1 and IgG2. The IgA and IgG1 responses correlated with the presence of developing and adult worms in the abomasa and they remained elevated in the (+P2)-group throughout the experiment, perhaps indicating an involvement of these antibodies in a protective immune response. In the (-P2)-group the IgA and IgG1 showed fast and sharp rises during the second season that most likely were age-related and as such a result of maturation of the immune system. The role of IgG2 is unclear as the IgG2 response was weak in all groups of calves and difficult to relate to the parasitological data.


A one-piece ocular drainage implant for glaucoma surgery: a preliminary report.

A one-piece silicone filtration implant for glaucoma surgery was evaluated in 18 normotensive rabbits. During the follow-up period of 60 days the function of the implant and the effect of the implant on intraocular pressure (IOP) and local reaction in operated eyes were examined. Mean IOP in operated eyes during the whole follow-up period stayed in a level that was statistically significantly (p < 0.001) lower than the preoperative starting value. Despite of a slight inflammatory reaction in the immediate postoperative period the implants were well tolerated. No marked foreign body reaction were noted around the implants in histological sections. In 3 eyes the implants had to be removed due to complications caused by surgical technique.


Oestrogens and milk fever--is there a link?

The trial involved 42 cows with clinical milk fever. Thirteen heifers and 32 cows without symptoms served as controls. Calcium, oestradiol and oestrone concentrations in serum were determined in blood samples taken within 6 h before or after parturition. Serum oestradiol and serum calcium concentrations correlated negatively. There was no association between oestrone and calcium concentrations. The results suggest that oestradiol plays a role in the aetiology of milk fever.


Impact of incubator type on the yield of in vitro produced bovine blastocysts.

Because of suboptimal in vitro production of bovine blastocysts a new incubator model (Mini) was tested against the traditional (Heraeus). The difference between their properties seemed only to be the volume of the incubator space. No difference was noted between the CO2 or the temperature, but the data clearly showed a highly significant increase of the blastocyst rates, 6% versus 51% in the Heraeus and the Mini incubator, respectively, calculated as blastocysts per cleaved embryos. It was concluded that the incubator type or model may be a very important part of the in vitro production of bovine embryos, although we were not able to pin point specific causes for this difference.


Oviduct epithelial cell co-culture of early porcine embryos.

One- to 16-cell porcine embryos were cultured in either Whittens medium supplemented with bovine serum albumin and fetal calf serum (WM) or in the same medium with porcine oviduct epithelial cell co-culture (WM-Poec). All stages of embryos cultured in WM-POEC had higher cell counts after 144-168 h of development than did embryos in WM. There was however, no significant difference in blastocyst formation rate of embryos cultured in WM-POEC over those cultured in WM. A high proportion of the embryos entering culture at the 1-2-cell were able to pass the 4-cell block stage in both WM and WM-POEC, 81% and 77%, respectively. In both media, most of the 1-2-cell embryos arrested their development at the compacted morula stage and failed to blastulate while embryos initiating culture at the 4- and 8-16-cell embryos formed blastocysts in culture at a rate of 80-90%.


The fox (Vulpes vulpes) as a reservoir for canine angiostrongylosis in Denmark. Field survey and experimental infections.

Until recently, Angiostrongylus vasorum was not considered to be an endogenous Danish parasite, since demonstration of this worm had been confined to necropsy findings in 2 dogs, both of which had visited France. During the last 2 years, however, clinical cases have been diagnosed among a considerable number of Danish dogs, none of which had ever been outside Denmark. All these cases have occurred north of Copenhagen, where an endemic focus seems to exist. In this field survey A. vasorum was found for the first time in wild Danish red foxes. Furthermore, experimental infections showed that the parasite can be transferred between foxes and dogs. Consequently, the wild fox population must be considered a potential reservoir for transfer of A. vasorum to domestic dogs.


Blastomere content of cultured/frozen bovine demiembryos.

The purpose of the study was to evaluate whether a period of co-culture with bovine oviduct epithelial cells (BOEC) could improve the tolerance of bisected bovine embryos to freezing and thawing. Day 6 embryos were bisected and the resulting demiembryos were stained with Hoechst 33342 and cell counts were made by counting intact blastomere nuclei. Of these, 11 were stained as freshly manufactured demiembryos, 25 after co-culture for 24 h with BOEC and 37 stained after 24 h co-culture and freezing and thawing. The staining revealed, that there was no significant difference in cell count of demiembryos that were stained immediately after bisection, compared to those, that were co-cultured for a 24 h period. Also, the co-cultured/frozen/thawed demiembryos had a significant decrease in cell numbers compared to the non-frozen demiembryos. We conclude, that a 24 h period of co-culture with BOEC does not result in appreciable cellular proliferation in demiembryos and therefore instead of improving the survival of frozen/thawed demiembryos by giving them opportunity to multiply their cell number and thus make them more resistant to cell damage, rather compromised the viability of cryopreserved demiembryos.


Factors affecting the incidence of necrotic enteritis, caecal carriage of Clostridium perfringens and bird performance in broiler chicks.

Two trials were conducted to study the effects of a competitive exclusion (CE) product BROILACT and the anticoccidial narasin on the incidence of necrotic enteritis (NE), the numbers of Clostridium perfringens (CP) in the caeca of broiler chicks and the performance of the birds. In trial 1 the effects of type of protein and partial replacement of a narasin containing diet with whole wheat were also studied. All groups of chicks were studied up to the point of slaughter at 43 days of age and after evisceration in a processing plant to determine slaughter yield. In trial 1, statistically significant results included the following: CE-treatment reduced total mortality, and incidence of NE, on diet containing animal but not vegetable protein. Caecal carriage of CP was also reduced, while slaughter yield increased. Narasin reduced caecal carriage of CP and increased both growth rate and slaughter yield in both trials. Whole wheat replacement improved feed conversion but reduced bird growth rate. In trial 2, both CE-treatment and narasin influenced feed intake, CE-treatment significantly only at days 22 and 44. Narasin improved feed conversion until 5 weeks of age and CE-treatment did so until 22 days of age. In both trials, there was also an interaction effect indicating that CE-treatment increased slaughter yield for birds that were not fed narasin.


Bovine uterine, cervical and ovarian androgen receptor concentrations. Correlation with estrogen and progesterone receptor concentrations.

Bovine cytosol androgen receptor (ARC) concentrations were examined simultaneously in various regions of the uterus and in ovarian tissues of cows, and were related to cytosol estrogen (ERC) and progesterone receptor (PRC) concentrations and circulating steroid levels. ERC concentrations were 3-7-fold and PRC concentrations 13-29-fold those of ARC in bovine endometrial and myometrial tissues. When serum progesterone levels were low, both endometrial and myometrial ARC, endometrial ERC, and endometrial and myometrial PRC concentrations were higher (p < 0.05) than those observed during higher progesterone concentrations. Because serum 5 alpha-dihydrotestosterone (5 alpha-DHT) concentrations were higher during the luteal phase, it is possible that ARC was down-regulated by this natural ligand at this phase of the cycle. There were no differences between uterine horns in endometrial or myometrial ARC concentrations. Bovine cervical and ovarian stromal tissue also contained ARC, and the concentrations were about the same as in the endometrium and the myometrium. The relative binding affinities (RBAs) of some steroid hormones towards ARC in vitro were: the synthetic compound R1881 (146%), 5 alpha-dihydrotestosterone (100%), testosterone (75%) while estradiol-17 beta, progesterone and dexamethasone had lower RBAs (2, < 1, < 1% respectively). Cytosol androgen receptor concentrations correlated significantly with cytosol progesterone (PRC) and estrogen receptor (ERC) concentrations, both in the endometrium and myometrium. These data show that androgens, such as 5 alpha-DHT, may participate the endocrine regulation of bovine reproductive tissues.


Skin color and mortality.

The relation of skin color and mortality from all causes, coronary heart disease, and all cardiovascular diseases was explored in 787 black men and women of the Charleston Heart Study Cohort. Associations were studied by examining rates of mortality during the period 1960-1990 by tertiles of skin color, as measured by reflectometer. Across the tertiles of reflectance there were no significant differences in mortality rates, except for sex differences. Proportional hazard regression analyses were used to investigate the relation between skin color, as a continuous variable, and time to death. Covariates for regression analyses were age, sex, skin color, the interaction of skin color and sex, education, blood pressure, serum total cholesterol, cigarette smoking, body mass index, and history of diabetes. Across the random sample of black men and women there was no significant relation between skin color and time to death, except for lighter skin color and all-cause mortality (p = 0.03). Our study results provided no evidence of a long-term effect of darker skin color, as measured by skin reflectance of light, on mortality from all types of cardiovascular disease, coronary disease, or all causes.


Trends in the incidence of and mortality from coronary heart disease in Finland, 1983-1988.

Trends in the incidence of and mortality from coronary heart disease during the period 1983-1988 were assessed in the population aged 35-64 years in three areas of Finland. The official mortality statistics and the FINMONICA (Finnish portion of the World Health Organization MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) project) Acute Myocardial Infarction Register were used as data sources. They both showed that coronary heart disease mortality declined steeply in Finnish men and women. This marked decline in coronary heart disease mortality was associated with a decline in the number of out-of-hospital coronary deaths. The changes in the incidence of acute myocardial infarction in men did not parallel the changes in mortality. No decline in incidence was seen in women in any of the study areas. These results suggest that the routine mortality statistics alone may give an overly favorable picture of coronary heart disease trends. Data on incidence are necessary to assess the need for the treatment and prevention of coronary heart disease.


The relation between multiple births and maternal risk of breast cancer.

Data from two case-control studies conducted in New York State during 1982-1986 were used to examine the relation between multiple births and the maternal risk of breast cancer. The cases were 2,561 women between 20 and 79 years of age with a diagnosis of primary breast cancer. Controls (n = 2,616) were selected from driver's license files and matched to cases by year of birth and county of residence. The odds ratio for any multiple birth was 0.94 (95% confidence interval (CI) 0.56-1.56) in women less than 55 years of age and 0.95 (95% CI 0.62-1.46) in women aged 55-79 years. A previous study had shown a multiple last birth to be protective against breast cancer in women less than 55 years of age (odds ratio (OR) = 0.60, 95% CI 0.43-0.85). A decreased risk of breast cancer was also observed for this age group in the present study, but the magnitude of the effect was not as strong and the confidence interval included unity (OR = 0.85, 95% CI 0.43-1.68). A logistic model that controlled for age at first pregnancy, number of live births, age, and county of residence increased the odds ratio to 0.97 for a multiple last birth. The current study does not support an association between multiple births and maternal risk of breast cancer.


Twin membership and breast cancer risk.

Pregnancy estrogens are substantially elevated in twin pregnancies and are likely to be more so in the case of dizygotic twins. If levels of pregnancy estrogens were positively related to breast cancer risk in the offspring, female twin members would be expected to be at slightly higher risk. Data from an international case-control study were utilized to assess this hypothesis. The analysis was based on 870 cases with breast cancer and 2,641 hospital controls from two sites: Glamorgan, Wales (1965-1967), and Boston, Massachusetts (1965-1966). Seventeen cases were members of twin pairs, and 8 of them had a twin brother; 33 controls were members of twin pairs and 14 had a twin brother. Among all women, the odds ratios for breast cancer were as follows: for twins with brothers, 1.54 (95% confidence interval (CI) 0.64-3.71); for twins with sisters, 1.30 (95% CI 0.58-2.92); and for all twins, 1.40 (95% CI 0.77-2.55). The odds ratios were higher among premenopausal women. These findings are not conclusive, but they are compatible with the hypothesis that pregnancy estrogens may affect the risk of breast cancer in the offspring.


Markers of health status in an HTLV-I-positive cohort.

The health effects of chronic human T-cell lymphotropic virus type I (HTLV-I) infection were examined in a cohort of Japanese men who had emigrated from Okinawa, Japan, and had been participants in a prospective study in Hawaii since 1965. In the present follow-up study carried out in 1987-1988, various health indicators were measured in the subjects, whose mean age was 72.5 years. Participation rates were lower in the HTLV-I seropositives than in the seronegatives (46.7% vs. 76.0%) in the > or = 75-year age group. Lack of participation was significantly correlated with a high HTLV-I antibody titer. Among the participants, seropositive subjects were significantly more likely than the seronegatives to have lymphocytopenia (32.7% vs. 17.7%) and mild anemia (25.5% vs. 14.1%) after adjustment for age and socioeconomic status. The seropositives also had a higher frequency of acupuncture therapy (age-adjusted odds ratios were 2.1 and 4.2 for 1-5 treatments and > or = 6 treatments, respectively). Proportions of subjects who had been hospitalized at least twice were higher among the seropositives in the oldest age groups, 70-74 years and > or = 75 years, but not in those aged 65-69 years. Although specific disease conditions were not identified in this study, hematologic data, treatment histories, and the correlation between participation status and HTLV-I antibody titers suggest that chronic HTLV-I infection may be associated with as yet undefined adverse health effects, particularly in older age groups.


Risk factors for Lyme disease in a small rural community in northern California.

A 1-year prospective study of risk factors for seropositivity to and contraction of Lyme disease among members of a small rural community (population, approximately 150) was conducted in northwestern California in 1988-1989. The initial rate of seropositivity for Borrelia burgdorferi for 119 current or former residents ranged from 15 to 20% among three laboratories, with statistically significant interlaboratory agreement. Questionnaires were completed by 93 current residents at entry and 80 residents a year later to evaluate the association of serologic status with 20 categorical and 47 continuous variables. Seropositive subjects had resided in the study area about 2 years longer, were bitten by unspecified biting flies more often, and were less likely to have engaged in hiking than seronegative subjects. One of 59 seronegative subjects seroconverted a year later (annual incidence = 1.7%). The cumulative frequency of seropositivity for Lyme disease in the study population was > or = 24%. Of 83 subjects examined physically, 13 were diagnosed as having definite and 18 as having probable Lyme disease. The seropositivity rate was significantly higher (38.7%) among individuals with definite/probable Lyme disease than in asymptomatic subjects (13.5%). Subjects who were seronegative or free of Lyme disease reported nearly as many tick bites as subjects who were seropositive or had a diagnosis of the disease. Age, time spent outdoors in the fall multiplied by a clothing index, and woodcutting were significantly associated with Lyme disease in logistic regression analyses.


Incubation period, severity of disease, and infecting dose: evidence from a Salmonella outbreak.

The associations between infecting dose, incubation period, and the severity of disease were examined in a large outbreak of Salmonella typhimurium which occurred at a medical conference in Wales in 1986. Persons who had eaten two or more pieces of the chicken vehicle had, on average, shorter geometric mean incubation periods than those who had only eaten one piece: 16.6 hours (95% confidence interval (CI) 13.5-20.5) compared with 20.7 hours (95% CI 19.0-22.6) (t = 1.97, p < 0.05). Incubation period was negatively correlated with the maximum frequency of diarrheal stools (r = -0.46, 95% CI -0.56 to -0.33), the maximum temperature reached (r = -0.34, 95% CI -0.50 to -0.16), the duration of symptoms (r = -0.41, 95% CI -0.53 to -0.26), and the amount of time taken off from work (r = -0.54, 95% CI -0.65 to -0.41). Those with shorter incubation periods were more likely to have been hospitalized. There was no association between chicken consumption and any of the measures of severity. The authors discuss the evidence that incubation period is inversely related to dose, the use of incubation period as a marker for dose, and the role that individual differences in susceptibility play in determining both the incubation period and the outcome.


Black-white differences in fracture rates.

To compare the incidence of all nonvertebral fractures between elderly blacks and whites, the authors conducted a retrospective cohort study among Tennessee Medicaid enrollees aged 65 years or more from 1987 through 1989. A previously validated computer algorithm identified 6,802 persons of black or white race with 7,645 new nonvertebral fractures. The incidence of all nonvertebral fractures in blacks was only half of that in whites. This finding persisted after the authors controlled for sex, age, and nursing home residence (relative risk = 0.4, 95% confidence interval 0.4-0.5). Rates were consistently lower among blacks within subgroups defined by these factors and for each of the 13 different fracture sites examined. The magnitude of the difference between blacks and whites in rates of all fractures combined and most site-specific fractures is similar to that previously reported for hip fractures. These consistent racial differences suggest a common underlying factor(s).