Risk indicators of childhood undernutrition in Kingston, Jamaica.

In Jamaica, early childhood undernutrition remains a problem; however, the health of all children cannot be monitored due to limited resources. Therefore, there is a need for the early identification of children at risk of undernutrition. A simple screening instrument for use by paraprofessionals in the primary health care system was developed. We conducted a case-control study using 649 children, aged 6 to 48 months. The cases were undernourished (weight-for-age less than 80% of the reference) and identified from a survey. The children's guardians were given a questionnaire comprising 31 variables thought to be associated with undernutrition and which were present from 6 weeks of age. Nine variables were significantly associated with undernutrition. Multiple logistic regression analysis indicated that low birth weight, short birth spacing, being born at home, poor ante-natal and post-natal clinic attendance, overcrowding and a lack of house-hold possessions were independent predictors of undernutrition. Using these variables, a simple scoring system was developed to identify high risk children. It had a sensitivity and specificity of 56% and 76% respectively and a positive predictive values of 31%. This simple screening instrument should be easy to use in the primary health care system. However, its low sensitivity indicates that it is difficult to identify children who are at risk of undernutrition from 6 weeks of age. Subsequent high morbidity and poor child care which were not measured may account for some of the missed cases.


Molecular genetic analysis of Drosophila rDNA arrays.

Large repeated DNA arrays are a major component of the eukaryotic genome, but we know little about their internal organization. Understanding their architecture, however, is critical for describing genome structure and for inferring the mechanisms that shape it. One repeated family that is yielding a picture of how structure, function and recombination mechanisms come together is the ribosomal DNA (rDNA) of Drosophila melanogaster.


Insertional mutation of 'classical' and novel genes in transgenic mice.

Approximately 5% of established transgenic lines carry insertional mutations. The mutated genes may be directly isolated using the transgene DNA as a molecular probe. These mutants provide useful models of human inherited disorders and developmental abnormalities.


Embryonic lens induction: shedding light on vertebrate tissue determination.

The principle of embryonic induction was defined by early studies of lens determination, and because of the relative simplicity of the developing lens and its interaction with presumptive retinal tissue it has been a favored system for examining mechanisms of induction. Recent studies have led to substantial alterations of the classic model for this process, introducing several elements that significantly refine our view of vertebrate tissue determination.


[A stereoscopic analysis of the centrosome structure in tissue culture cells under the action of carbonyl cyanide p-trifluoromethoxyphenylhydrazone and ouabain].

The action of carbonyl cyanide p-trifluoromethoxyphenylhydrazone (FCCP) and ouabain results in significant increase of the quantity of microtubules with attached and free proximal end around the centrosome. The majority of free microtubules are oriented with their proximal ends towards the heads of pericentriolar satellites or towards the walls of centriolar cylinders. The increasing of total number of microtubules is the result of the increasing of microtubules attached to or oriented towards the pericentriolar satellites. Comparing the action of FCCP and ouabain from one side and taxol from the other side it is possible to conclude that FCCP and ouabain promote the initiation of microtubule growth in the centrosome of they have an influence on the frequency of separation of the microtubules from microtubule nucleating centers.


[Cytoskeletal changes in the endothelial cells of the rat aorta in the early periods of postnatal ontogeny].

The cytoskeleton of endothelial cells is a modulator of all the cell reactions. The formation of a definitive structure of the bearing-contracting apparatus of the rat aorta endothelium is finished in the postnatal development (up to the age about 3 months after birth), passing through some qualitative changes. Using the transmission and scanning electron microscopy of detergent extracting preparations, the structuring pattern (saturation) of the aorta endothelial cell cytoskeleton of newborn animals. From 10 days to 1 month after birth, the most important period takes place within peripheral dense microfilament bundles are formed responsible for the cell monolayer integrity for the contractility of cell boundaries (it is most important in recombination of endothelial monolayer in the processes of cell proliferation and vessel growth) and also for the integrity of longitudinal bundles of microfilaments, i.e. fibres of tightening. The increase in anisotropy of cytoskeleton frame during its maturation evidences on the establishment of orientation of microfibril bundles, whose main function being the opposition to haemodynamic loading.


[Nuclear differentiation and nuclear heteromorphism in the protozoa].

This is a review based upon a lecture given at the Developmental Biology School near Moscow in November 1991. Cases of successive and simultaneous nuclear differentiation are defined, and examples from various groups of protozoa are considered. Three cases of simultaneous nuclear differentiation, leading to the nuclear dualism phenomenon (heteromorphism) are analysed in detail. In heterokaryotic agamonts of some Foraminifera, nuclear differentiation occurs at the diploid level, proved to be irreversible and caused by either deletion or stable repression of some genes. In the Karyorelictid ciliates, the somatic nuclei (macronuclei) are paradiploid, metabolically active but unable to divide. They are irreversibly differentiated due to deletion of part of the initial (micronuclear) genome. Differentiation occurs in every cell cycle from the generative nuclei (micronuclei), which retain omnipotency and reproduce by mitosis. In most (higher) ciliates the differentiation of macronuclei occurs at an early stage of replication and involves a more or less drastic reorganization of the micronuclear genome, including both deletions and transpositions. Thereafter, the reorganized (and generally reduced) genome is strongly amplified to provide a high dose of active genes. The chromosomes of the majority of ciliates are fragmented in their macronuclei into either subchromosome-sized or gene-sized molecules, both being acentric. Systems regulating the differential replication of these molecules are likely to exist in macronuclei to keep the respective gene doses within certain limits.


[The detection of a cluster of beta-globin genes in the long arm of chromosome 2 in the domestic hen by using DNA-DNA in situ hybridization].

Using isotopic and nonisotopic methods of in situ hybridization, the localization the beta-like globin gene cluster was established. Molecular hybridization of DNA probes containing embryonic epsilon-globin and adult beta-globin genes revealed the localization of the cluster of the long arm on chromosome 2 (2q).


[The photometric characteristics of the nuclei of normal human and bovine lymphocytes and in pathology].

Chromatin structure has been studied with a method of optico-structural machine analysis for interphase nuclei of peripheral blood lymphocytes in healthy donors, a girl with the Shereshevskiĭ-Turner syndrome (45, XO) and her parents, and for peripheral blood lymphocytes of a cow, Bos taurus L., in the last trimester on the background of preeclamptic syndrome and with normal cow pregnancy of compared terms. A significant change was revealed both in human heteroploidy and in developing preeclamptic syndrome in animals as concerns such indexes as the nucleus area, integral optical density, the amount and area of condensed, decondensed chromatin. The profile of histograms, according to the given parameters, is distinctly changing. The analysis based on constructing a two-measured field in the given coordinate system showed changes in the lymphatic population structure with the increase in the rate of "heavy", enriched DNA cells.


[The effect of inhibitors of glucose utilization on the chemiluminescence and fluorescence of murine peritoneal macrophages].

Using the inhibitors of glucose utilization and mitochondrial oxidation we found that the blue autofluorescence (AF) of murine peritoneal macrophages (MP) originates predominantly from the cytosolic NAD(P)H. AF intensity correlates with the changes in glycolytic enzymes activity. The luminol-dependent chemiluminescence (CL) intensity which characterizes the amount of O2- generating by MP upon the addition of formyl-methionyl-leucyl-phenylalanine (FMLP) is inhibited in the case of maximum activity of glycolytic enzymes. Incubation of MP with non-convertible analog of glucose, such as 2-deoxyglucose increases the CL intensity under the influence of FMLP. A conclusion is drawn that amount of O2- generating by MP depends on the intracellular concentration of sugars.


[The effect of the lysosomotropic agent primaquine on the endocytosis of the epidermal growth factor receptors in A431 cells].

It has been shown elsewhere that the epidermal growth factor (EGF) in A431 cells can recycle in receptor-bound state (Teslenko et al., 1987; Sorkin et al., 1989, 1991). Present study deals with the action of primaquine, a lysosomotropic agent, on EGF-receptor complexes (EGF-RC). By the method of indirect immunofluorescence with anti-EGF-R monoclonal antibody it is found that following a 1 h incubation of cells at 37 degrees C in the presence of EGF a bright staining of endosomes appears in the intranuclear region, while after incubation of the cells at 4 degrees only margins of cells are stained. Such a pattern of fluorescence is peculiar of endocytosis in A431 cells. When the cells were incubated in the presence of a 0.3 mM primaquine for 1 h, the immunostaining is changed: bright compact spot in the para-Golgi region appeared. The effect of primaquine is reversible. When the cells after preincubation with EGF were incubated in the absence of EGF for 3 h at 37 degrees C, the staining of cell margins could be observed again, demonstrating the recycling of EGF-RC. Under similar conditions of cell incubation, but in the presence of primaquine, the staining of the para-Golgi region was not changed. In the experiments with 125I-EGF it was shown that intracellular accumulations of 125I-EGF were maintained when the cells were incubated in the presence of 0.3 mM primaquine. It is concluded that primaquine inhibits the recycling of EGF-R in A431 cells.


[The dependence of DNA repair induced by genetically hazardous exposures on the ionic strength of the medium containing the cells].

The dependence of UV-induced unscheduled DNA synthesis (UDS) in non-stimulated lymphocytes of human peripheral blood on the ionic strength (mu) of the culture medium has been shown. With the level of mu lower or higher than physiological (mu ph) the UDS significantly decreases. The effect of modification of mu due to changes in ionic strength is absent in the lymphocytes of patients with the classic form of xeroderma pigmentosum. This phenomenon may become useful for development of a new test revealing cells with genetically or physiologically changed system of UV-induced DNA repair. Mechanisms of investigated phenomenon, particularly their dependence on the chromatin structure, as well as the influence of ionic strength on binding the repair enzymes with DNA are discussed.


[The phenotypic characteristics of T-lymphocytes that interact with hematopoietic stem cells: the expression of the antigens Lyt-1, Lyt-2 and L3T4].

The role of T-lymphocytes, bearing antigens Lyt-1, Lyt-2 and L3T4, in regulation of the functional activity of blood-forming precursor cells of syngen and non-syngen origin was investigated. The treatment of cells of murine lymphatic nidi with monoclonal antibodies to the above antigens and with the complement did not abolish the capacity of T-lymphocytes of controlling proliferation and differentiation of syngen and allogen blood-forming precursor cells. The subpopulation characteristics of lymphocytes interacting with the stem cells is discussed.


[Changes in the frequency of cells with micronuclei in cell populations of rat transplantable rhabdomyosarcoma RA-2 as a result of selection for an increased and a decreased frequency of such cells].

Artificial selection for increasing and decreasing frequencies of cells with micronuclei (FCM) was conducted in populations of cell clones of the rat transplantable RA-2 rabdomyosarcoma. The selection was effective in both the opposite directions. The average FCM increased from 3.3 +/- 0.2 to 6.9 +/- 0.6% and decreased from 3.3 +/- 0.2 to 1.6 +/- 0.2%. Heritability coefficient, h2, varied from 0.2 to 0.4. In the cell population with increased FCM, 37% of anaphases and early telophases had lagged chromosomes and fragments. In contrast, in the cell population with decreased FCM, lagging were observed in 11% of cases. The DNA-content in G1 cell varied greatly in cell population with increased FCM (P < 0.01). The selection for increased FCM has led to a significant decrease in metastatic capacities of cells.


Microscopic structure of renal dysplasia in a man with ectopic ureter opening into the seminal tract.

Histologically, we examined a dysplastic kidney obtained from a patient with an ectopic ureter opening into the seminal tract. The dysplastic kidney did not have any normal renal tissue or typical primitive ducts but epididymis- and prostate-like ducts. The last ducts contained degenerating spermatozoa in the lumen. The presence of epididymis- and prostate-like ducts is considered to be characteristic of dysplastic kidneys in this anomaly.


A study on the viscoelastic properties of the urinary bladder in dogs.

This experimental study was designed and carried out in order to investigate the participation of the collagen and muscular tissues on the viscoelastic properties of the bladder wall. Sixty-five adult male mongrel dogs were utilized. These animals were divided into 5 groups: control group (n = 10); dogs (n = 10) receiving 2.5 mg/kg atropine (cholinergic antagonist); dogs (n = 10) receiving 0.7 mg/kg verapamil (calcium extracellular inflow blocker); dogs (n = 10) receiving 0.1 mg/kg/min nitroprusside (intracellular calcium blocker), and dogs (n = 25) receiving EGTA (a calcium-chelating agent) at increasing doses from 90 to 450 mg/kg. Based on a mathematical model, we have demonstrated that: (1) the collagen component is responsible for the elastic properties; (2) the muscle component is responsible for the viscoelastic properties; (3) the viscoelastic properties have an active element which is affected by calcium total depletion, and (4) such viscoelastic properties are not dependent on cholinergic stimulation.


Influence of papaverine on rat bladder contractions in vivo.

In an acute rat model (in vivo) spontaneous rhythmic bladder contractions were induced by ligation of the urethra. In addition single bladder contractions were recorded during neurostimulation of the pelvic nerve. Spontaneous and electrically induced bladder contractions were sensitive to papaverine and isoprenaline in vivo. The basal bladder pressure and bladder contraction parameters were reduced more potently by isoprenaline. Blood pressure decreased significantly after isoprenaline injection (0.5-50 micrograms/kg = 4.73 x 10(-6)-4.73 x 10(-4) mol/l) and high concentration of papaverine (5 mg/kg = 2.95 x 10(-2) mol/l). Compared to isoprenaline papaverine was less toxic. These results are different to previous in vitro investigations in rat bladder strips. In vivo papaverine seems to be less effective on nerve-mediated bladder contractions and decreases bladder pressure. Our results indicate that beta-adrenergic receptors play a potent role in the inhibition of spontaneous and pelvic nerve-induced bladder contraction.


Comparison of ultrasonography, computerized tomography and angiography in dialysis patients with renal cell carcinoma.

Seventeen dialysis patients with renal cell carcinoma were examined preoperatively by ultrasonography, computerized tomography (CT) and angiography. Ultrasonography, CT and angiography correctly predicted the diagnosis of renal cell carcinoma in 17 (100%) and 12 (71%) of 17, and 11 (69%) of 16 patients, respectively. All renal tumors of more than 3.0 cm in diameter were detected by the three diagnostic procedures. However, ultrasonography, CT and angiography detected renal tumors of less than 3.0 cm in 12 (100%) and 7 (58%) of 12 patients and 6 (55%) of 11 patients, respectively. Seven renal cell carcinomas were associated with acquired cystic disease of the kidney (ACDK). All renal tumors were found by ultrasonography. However, CT predicted the correct diagnosis in 3 (43%) of 7 patients with ACDK and in 9 (90%) of 10 patients without ACDK, and angiography was correct in 3 (50%) of 6 patients with ACDK and 8 (80%) of 10 patients without ACDK. Our results indicate that ultrasonography is an effective procedure to detect renal cell carcinomas in dialysis patients.


Gas formation after renal artery embolisation: genesis and clinical relevance.

Preoperative embolisation of renal carcinomas has several pros and cons for the patient. The negative aspects can be summarized as 'post-infarction' syndrome'. Radiologically, intrarenal gas formation is always evident. As sterile breakdown products of tumor cell necrosis these have to be interpreted as regular postinterventional findings and not as indicators for infection or even sepsis. Tumor embolisation as a means to reduce surgical difficulties in large hypervascularized renal carcinomas and also as a palliative measure in marked macrohematuria and/or tumor-induced flank pain is thus very conceivable. The best time for the tumor-nephrectomy is the day of embolisation or the first postinterventional day. This makes the nephrectomy easier and prevents the postinfarction syndrome for the patient.


Use of a prototype 3-Fr needle electrode with flexible ureteroscopy for antegrade management of stenosed ureteroileal anastomosis.

Stenosis at the site of ureterointestinal anastomosis requires a modified approach and surgical treatment. A 3-Fr needle electrode was used successfully with flexible ureteroscopy to manage complete ureteroileal anastomotic strictures.


Seminal transferrin levels in seminal plasma of fertile and infertile men.

Seminal plasma transferrin levels as well as serum FSH and LH levels were measured in fertile (normozoospermic) and infertile (oligozoospermic and azoospermic) men in an effort to find out whether transferrin levels correlated with sperm density and serum FSH and LH levels. Seminal plasma transferrin levels were found to be significantly lower (p < 0.0005) in the infertile group than the fertile group. Seminal plasma transferrin levels can be regarded as a functional parameter of Sertoli cell function in men.


Rhinosporidiosis mimicking penile malignancy.

Rhinosporidiosis is a chronic infection which is endemic in India and Sri Lanka. Penile involvement in rhinosporidiosis is rare and we report one such case. The pathology, treatment and possible etiology of the condition are reviewed.


High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence.

Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is 'high-flow'; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.


[Patient rehabilitation following cystectomy for cancer].

In 171 out of 251 cancer patients subjected to cystectomy, the bladder was replaced for isolated intestinal segment followed by recovery of transurethral urination. This recovery produced a favorable effect on physical, psychological and social, occupational status of the patients. Two-stage technique of establishing reservoir for the urine with renewal of transurethral urination is detailed. Normalization of the function of the kidneys and upper urinary tracts, prevention or early treatment of complications, natural transurethral urination should be considered criteria for rehabilitation of postcystectomy cancer patients.


[The intravesical chemotherapy of surface tumors of the bladder].

Intravesical chemotherapy (IVC) for bladder cancer was conducted in 83 patients who had been admitted to the Moscow Cancer Research Center in 1981-1988. Farmorubicin IVC produced a complete response (CR) in 3 (21.4%) and a partial one (PR) in 6 (42.9%) of the 14 patients treated. In mytomicin C administration CR was achieved in 4 (30.8%), PR in 2 (15.4%) of the cases. For adriamycin, spirobromin, thiotef (60 mg), thiotef (20 mg), CR was registered in 4 (30.8%), 5 (17.9%), 1 (11.1%), 2 (18.2%), 2 (25%) patients, PR in 2 (15.4%), 8 (28.6%), 1, 1 (9.1%), 1 (12.5%) patients out of 13, 28, 9, 11, 8 cases, respectively. Complications of the IVC in the form of drug cystitis occurred in 57.1%, 23.1%, 46.4%, 12.5-18.1% of those treated with farmorubicin, mytomicin C, adriamycin, thiotef, respectively. Spirobromin arose no complications.


[The correction of the humoral and hemodynamic disorders in patients with urolithiasis complicated by chronic kidney failure].

The paper presents the analysis of 52 cases of urolithiasis complicated by chronic renal failure in the intermittent stage. The patients were examined for renal blood flow, central hemodynamics, myocardial function, factors of humoral regulation of the circulation kallikrein-kinin, sympathoadrenal systems, renin activity, renal function. The test were performed preoperatively and 1, 3, 7, 14 days after surgery. The patients entered two groups. 24 patients of group I received routine symptomatic treatment, 28 patients of group II were treated with regard to the changes revealed and underwent preoperative enterosorption. Group I demonstrated severe shifts in renal and central hemodynamics, reduction of renal circulation, hypokinetic circulatory syndrome, phasic syndrome of myocardial hypodynamics, hypoactivity of kallikrein-kinin and sympathoadrenal systems, hyperactivity of renin. The disturbances aggravated postoperatively and disappeared only on day 14 since the operation. having been corrected by cardiac glycosides, desaggregants, hypotensive drugs diuretics. Group II patients developed increased renal circulation, weak activation of humoral blood regulation factors. Hemodynamic disorders showed no progression. As a results, renal postoperative function improved.


[The laser therapy of cystalgia].

The paper yields the results of treating patients with cystalgias. The conventional therapeutic techniques are low effective. The duration of out- and in-patient care is great, 24 days. Laser therapy was performed in 62 patients with cystalgias, including 30 who received a combined therapy due to concurrent diseases. An AFL-1 helium-neon optical maser generation radiation at a wave of 632.8 mM and at an output power of 18-20 mW has been employed in the treatment of cystalgias in the past 5 years. The biologically active points for urinary diseases were exposed to the laser therapy. With intercurrent diseases, the respective biologically active points or an inflammatory organ alone were additionally irradiated. No intra- and postoperative side effects were found. Laser therapy proved to be highly efficient in treating cystalgias, halving the average bed-days per patient.


[The selection of the treatment method in stenosis of the pelviureteral segment in nephrolithiasis].

Ureteropelvic stenoses in nephrolithiasis are suggested to be considered reversible and irreversible depending on the lesions of the upper urinary tracts and the adjacent fat. To ascertain reversibility of the stenosis, use was made of the progesterone test in view of progesterone ability to dilate the ureter. No retention changes in the upper urinary tract in the reversible stenosis can serve an indication to impulse lithotripsy. Large stones and all cases of irreversible stenosis indicate validity of open surgery the scope of which is decided intraoperatively after isolation of the ureteropelvic segment from the periureteral fat and upon the indigo carmine test. In the absence of dysfunctional zone in the segment the patients may be subjected to ureterolysis and pyelolithotomy. If such zone is detected it is possible to make pelvic and proximal ureteral resection, pyeloureterostomy. The technique of the latter surgery in the intrarenal pelvis is detailed.


[The surgical treatment of congenital hydronephrosis in children].

Available are the results of surgical treatment (Andersen-Hynes operation and its modifications) of 85 children with hydronephrosis bor the period 1981-1987. The patients' age ranged from 6 months to 14 years. Anastomotic stenosis occurred in 12% of the procedures as a result of: urethral or pelvic trauma when suturing, wound channels due to the needle perforating puncture, catgut unwanted properties, tissue strain at the anastomosis site, inadequate renal drain. This necessitates modification of the operative technique: surgical manipulations restricted to the operated on pelvic part and pelvic-urethral segment, optical amplification, microsurgical instruments, synthetic suture. An original pyelostoma made of silicon rubber was used in draining. Out of 34 surgical cases, good results were achieved in 31, satisfactory in 3. No complications were recorded.


[The phenotypes of blood haptoglobin in urolithiasis patients].

Haptoglobin Hp phenotypes were determined in 104 patients with uroliths of different chemical composition and in healthy controls. 98 patients showed one of the three main phenotypes Hp (1-1, 2-1, 2-2). Electrophoretic motilities of protein fractions Hp were found out for the main phenotypes. Hp was not registered or its fraction motility was distinct from the main phenotypes in 6 patients. Hp phenotypes distribution obtained for all the examinees was compared to that of the controls. For healthy and total group of urolithiasis patients, for healthy and having CaPi and HVr nephroliths, the difference was insignificant in contrast to CaOx stones the incidence of which grew in Hp 1-1 carriers (p < 0.05). In view of this, Hp 1-1 phenotype can indicate a risk of oxalate urolithiasis.


[Hyperbaric oxygenation in the combined treatment of acute kidney failure].

The paper presents the review of the treatment performed in 183 patients with acute renal failure caused by trauma, myorenal syndrome, surgical, obstetric and urological lesions. All the patients underwent hemodialysis. The majority of the patients manifested hypoxia due to pulmonary edema and abnormal central and visceral hemodynamics, anemia resultant from blood loss and suppression of hemopoiesis, impairment of tissue oxidation-reduction enzymes by uremic toxins. Hemodialysis aggravated hypoxia. A direct relationship existed between arterial hypoxemia and the degree of metabolic acidosis, electrolyte alterations and residual diuresis in oligoanuric stage of acute renal failure. The treatment of 48 relevant patients involved 5-10 sessions of hyperbaric oxygenation (1.5-2.2 atm for 60-90 min). The session usually followed hemodialysis. The response was achieved in arterial hypoxemia, central hemodynamics, peripheral blood, water-electrolyte balance, acid-base equilibrium, uremic intoxication. The frequency of hemodynamic reactions during hemodialysis and pyoseptic complications induced by uremia reduced as well as the need in urgent hemodialysis. The introduction of hyperbaric oxygenation diminished the lethality by 29%.


[Cancer of the kidney: nephrectomy or resection?].

Malignant tumors of renal parenchyma remain a problem for a clinician in view of the lacking distinctive algorithm and treatment policy based principally on the diagnosis terms. Optimal treatment, surgical, is represented by two kinds of operations: preserving and radical. Out of 292 patients admitted to the clinic from 1974 to 1990, 243 (83%) underwent surgery which was conservative in 37 (15.2%) cases. Five-year survival of surgical cases was 65.5%, in nonsurgical ones 7%. The stage of renal cancer was diagnosed as I. Renal resection was universal. There were 2 cases of heminephrectomy for cancer of the fused kidney. Histologically, the tumors appeared hypernephroid carcinoma. One patient was followed up for 10 years, 11 for 5 years. Recurrences occurred in 3 cases only, massive metastasizing in 5 years in 1 case. Dysfunctions of the kidney indicate inadequacy of the organ-preserving surgery while hypofunction of the contralateral kidney suggests possibility of the organ preservation. When it is feasible technically, the residual part of the parenchyma is functionally capable and the pelviureteral system is effective, resection of the kidney is recommended even in intact contralateral kidney. Such intervention is no less radical than nephrectomy.


[The functional properties of the erythrocyte membranes in patients with chronic glomerulonephritis].

Mg-, Ca-, Na-, K-ATPase, acetylcholine esterase and sulfhydryl groups of red blood cell membranes were evaluated in 40 patients with chronic glomerulonephritis in preazotemia stage versus 34 healthy controls. In chronic glomerulonephritis there was a significant fall in Ca-ATPase activity irrespective of the disease pattern. Na, K-ATPase tended tot a decrease contrary to sulfhydryl groups levels and acetylcholine esterase activity. In the nephrotic variant of the disease Na, K-ATPase, Ca-ATPase activity dropped and came to increase due to glucocorticosteroid treatment. The changes are attributed to modification of the lipid bilayer of the red blood cell membranes.


[The biochemical indices of the sperm in chronic inflammatory diseases of the accessory genital glands].

Male accessory gland inflammation may interfere with the reproductive potential and can result in the glands secretory dysfunction. Asymptomatic inflammations are difficult to diagnose. This study correlates the white blood cell count in semen to different biochemical markers of accessory gland function, e. g. zinc, citric acid, acid phosphatase, fructose, gamma-glutamyl, transferase to facilitate the diagnosis of asymptomatic inflammation. 230 patients were investigated using the WHO simplified protocol for the infertile couples (project N 84914). Basing on the semen leucocyte number, all the patients were divided into five groups. The semen and biochemical markers were analyzed according to the WHO guidelines including the regression analysis. The data obtained indicate that WBS in the semen correlates closely with reduced concentrations of seminal plasma citric acid and zinc.


[A testiculoepigastric venous anastomosis in varicocele].

Fifty-two patients with varicocele due to renal hypertension underwent surgery. In small diameter of the internal testicular vein, the authors employed microsurgical technique to establish proximal testiculoepigastric shunts to preserve compensatory renocaval shunt.


[Urologic diseases in boys and adolescents found during targeted prophylactic examinations].

One-year screening of urological diseases in preschool and schoolboys under 17 years of age identified relevant affections in 264 (10.13%) of the examinees. Phimosis and varicocele were the most frequent findings. Urological examinations of 3-, 7- and 14-year-old boys are suggested to be included into routine prophylactic check-ups.


[New strategies in treatment of severe hypercholesterolemia in coronary patients: HMG-CoA reductase inhibitors and H.E.L.P.-LDL apheresis].

LDL-cholesterol is the leading risk factor which influences the clinical outcome of patients with preexisting coronary heart disease. Clinical trials show that diet and medication, that lower plasma LDL-cholesterol below 100 mg/dl decrease the rate of recurrent myocardial infarction and can induce regression in patients with coronary heart disease. However, in most cases of severe hypercholesterolemia with plasma LDL-cholesterol concentrations above 220 mg/dl LDL cannot be sufficiently decreased by maximal dietary and pharmacological therapy alone. Today this group of high risk CHD patients can be treated in addition with an extracorporeal procedure to eliminate LDL from the plasma circulation, the H.E.L.P.-LDL-apheresis. This method for selective removal of LDL, lipoprotein(a) and fibrinogen from plasma has been shown to be a clinically safe and very efficient method for the treatment of patients with homozygous familial hypercholesterolemia or CHD patients with severe hypercholesterolemia. Treatments with one week H.E.L.P. intervals revealed a mean reduction of minus 51% for LDL, of minus 45% for Lp(a) and of minus 46% for apo B, while HDL was increased by +12%. Fibrinogen was decreased by minus 46%. Besides the marked reduction of LDL and fibrinogen plasma concentrations the H.E.L.P.-treatment significantly improves hemorheological parameters and increases the oxygen tension in the tissue. We have also investigated the efficiency of a combined therapy, using HMG-CoA reductase inhibitors together with the H.E.L.P.-apheresis. Under this combined treatment, a reduction of the interval LDL-cholesterol levels of 70-80% has been achieved, while Lp(a) and fibrinogen were not further affected.(ABSTRACT TRUNCATED AT 250 WORDS)


[Lowering increased cholesterol--prolonging life?].

Epidemiologic surveys reveal a positive correlation between serum cholesterol levels and the incidence of coronary artery disease. Intervention trials demonstrated that a reduction of serum cholesterol by 1% results in a decrease of coronary non-fatal events by 2%. Fatal coronary events remain almost uninfluenced. On the other side, several intervention trials showed an excess mortality from non-cardiac causes in the therapy groups (i.e. malignant tumors, suicides, accidents). Thus, until now no prolongation of life expectancy could be verified by cholesterol lowering measures.


[The treatment of stress urinary incontinence in women].

Fifty-six females with enuresis were observed in 1986-1990. Their x-ray examinations included urodynamic techniques: uroflowmetry, cystomanometry, test of the profile of the intraurethral pressure. Basing on the findings, 11 patients were excluded from the group to be operated on. Two kinds of surgery were employed: urethrovesicofixation according to Marshall-Marketti-Kranz, endoscopic submucous administration of teflon paste. The former method corrected the position of the bladder but is less effective in correction of the intraurethral pressure. The experience obtained by the authors permitted them to propose Marshall-Marketti-Kranz operation for apparent vesicoptosis whereas the teflon paste injection in enuresis without pronounced vesicoptosis. The methods can be used in combination: if, in spite of good anatomical results of the operation, enuresis persists, the paste administration is advocated to achieve better functional outcome.


[Assessment of risk factors and their modification in rehabilitation applicants].

Compared with the general population male workers applying for medical rehabilitation show a higher risk-load, especially regarding smoking and alcohol consumption. However, at present it can't be decided, if the risk-load within this group of applicants is even higher than among the non-applying workmen. Such a selection would be intended. Overweight is the main risk-factor among applicants for medical rehabilitation. It is present far more often than generally within the general population and even within the working class. Male workers with repeated courses of medical rehabilitation exhibit a significant lower risk-load than applicants for a first rehabilitative procedure. A causal relation might be suggested, but at present other explanations regarding the observed relationship have to be considered. A long-term Follow-up study is necessary.


[Is there a change in the trend of the risk factor profile in the adult population?].

In a comparative study of a total of 7169 unselected patients of both sexes, that has been admitted as inpatients for rehabilitation reasons concerning rheumatic diseases, has been examined which differences result between 1988 und 1990 with respect to the prevalence of overweight of more than 20% in relation to the individual ideal weight and to impairment of the carbohydrate metabolism. Age structure, professions and social levels were comparable in both populations. In comparison with the large upward trend of the risk factor profile between 1976 and 1988 there was a slight but significant increase of the prevalence of overweight between 1988 und 1990 only for males (53.9% vs. 57.7%), whereas among females the prevalence showed an insignificant downward trend (67.9% vs. 66.6%). At the same time the prevalence of an impaired carbohydrate metabolism did not differ significantly (10.5% vs. 9.5%). There is evidence for a small success of public and medical efforts to improve public health.


[The characteristics of the histocompatibility antigen associations in patients with sterility due to varicocele].

Associations between sterility in varicocele and HLA antigens have been studied. The results show increased incidence of antigens B13 and B22 in sterile males with varicocele. Specific distribution of HLA antigens, their relations with varicocele were characterized. The findings can be of use in identification of risk groups among varicocele patients.


[Value of laboratory diagnosis of liver function from the insurance medicine viewpoint].

After a brief passage on the reliability and special features of the most important liver values, this paper deals with the diseases of the liver most frequent in everyday rating practice from the angle of specific laboratory patterns and enzyme processes, putting emphasis on prognostic aspects. Special mention is made of the most recent diagnostic findings in the field of virus hepatitis. Furthermore, the influence of alcohol on the liver values is explained in detail. In a résumé, GPT, Gamma-GT and cholinesterase are regarded as sufficient for classifying almost 98% of all diseases of the liver, the limited significance of liver values as "functional parameters" being stressed, however.


[Kidney resection in cancer].

The authors analyze 5 cases of conservative surgery in renal cancer and formulate their point of view on indications for such interventions in patients with contralateral kidney. Relevant techniques and policy are specified.


[First indications of decrease in the incidence of hyperuricemia in North Germany].

For the first time after onset of the economic miracle since 1948/49 the continuous considerable upward trend of the prevalence of hyperuricemia among the adult population in northern Germany seems to be stopped. In a comparative study of a total of 7169 unselected patients of both sexes, that has been admitted as inpatients for rehabilitation reasons predominantly concerning rheumatic diseases, has been examined which differences result between 1988 and 1990 with respect to the prevalence of hyperuricemia in relation to overweight. Age structure, professions and social levels were comparable in both populations. In comparison with the large upward trend of the risk factor profile between 1976 and 1988 the prevalence of hyperuricemia in males decreased significantly from an average of 17.9 per cent to 15.2 per cent. For females only an insignificant trend to a decrease of the prevalence of hyperuricemia (4.5 per cent vs. 4.2 per cent) was noted. In hyperuricemic males the prevalence of overweight of more than 20 per cent in relation to the individual ideal weight was significantly more frequent than in the whole male population (70.1 per cent vs. 57.7 per cent). Just as for obesity and diabetes mellitus the prevalence of hyperuricemia among the adult population in northern Germany appears to have culminated or crossed its summit. There is further evidence for a small success of public and medical efforts to improve public health. Of a total of 3584 patients who were investigated in 1990 1977 males showed a mean serum uric acid level of 5.71 +/- 1.62 mg/dl whereas in females the corresponding mean value was highly significantly less (4.22 +/- 1.06 mg/dl).


[The organizational and methodological aspects of teaching student interns clinical nephrology].

The analysis is given to experience in teaching clinical nephrology to subinterns at a therapeutic chair. The initial knowledge in nephrology assessed in undergraduates proved unsatisfactory. Guidelines are presented for lecturers as well as results of questioning surveys of the students. The students answers showed that individual clinical tasks appeared most difficult for them. The mean score fr home tasks was 3.1, good marks being given in 21% only. Poor knowledge was reported in resolving diagnostic questions, treatment of renal failure, treatment of the kidneys in systemic disorders of the connective tissue. The post-study test control stated considerable gain of relevant knowledge.


[Measuring work capacity in rheumatic diseases: functional disability, pain, pain-related cognitions and affects].

Rheumatic diseases, particularly those affecting the back, cervical spine, and the joints, are widespread in the general population. The general costs, especially those associated with social medical services, show constant increases. Time and effectiveness lost from work due to back problems in the FRG accounted for most of the days off the job because of disability, time spent in the hospital or at a health spa facility. Therefore, the appropriate evaluation of the degree of disability plays an increasingly important role in the area of social benefits. Yet unambiguous and objective physical measurements of the disease and the degree of associated disability are lacking in most cases of rheumatic diseases. More attempts to address the subjective aspects of the disease should be included in such evaluations. For recent years, models of measurement have been developed and tested, which are suited to the multidimensional nature of rheumatic illnesses. It is recommended that these be introduced in routine use for physical evaluations.


Caesarean sections in cattle attended by a practice in Cheshire.

The results of 77 caesarean sections in cattle carried out in a seven-person practice over a period of 16 months are described and evaluated. The standardisation of the surgical technique, the speed of decision making in dealing with dystocia, and the education of the farmers contributed to the 84 per cent calf survival rate, and post surgical complications were few. There was only one fatality in a dam.


Some aspects of the epidemiology and control of Salmonella typhimurium infection in outwintered suckler cows.

Two outbreaks of Salmonella typhimurium infections affected outwintered, spring-calving suckler cows in late pregnancy. The infections spread rapidly both within and between groups of stock on the affected farms, with morbidity in the infected groups varying from 14.5 per cent to over 60 per cent, and mortality in adult cattle varying from 0 to 14.3 per cent. Prophylactic measures included the use of antibiotics and killed vaccines against Escherichia coli, Salmonella dublin, S typhimurium, and Pasteurella multocida. In one outbreak, use was also made of a polyvalent serovaccine and hyperimmune serum against E coli, S typhimurium, and S dublin. In both outbreaks no new cases were reported in the affected groups after the administration of the second dose of vaccine, and there was no resurgence of disease on the affected farms within 18 months of the primary outbreaks.


Risk factors for the reinfection of specific pathogen-free pig breeding herds with enzootic pneumonia.

A case control study was designed to determine the risk factors for the reinfection of Swiss specific pathogen-free (SPF) pig herds with enzootic pneumonia. Detailed housing, management and environmental data were collected from 42 case farms and 50 control farms by means of a questionnaire. Factors with a significantly asymmetrical frequency distribution among the two groups were considered to be possibly associated with reinfection; they included the distance to the nearest non-SPF pig herd, the size of that herd, the density of the pig population in the area, the distance to the next road regularly carrying pig transporters and differences in topography. The results tended to support the hypothesis of the airborne transmission of enzootic pneumonia. Using a formula considering the main risk factors, it was possible to classify farms as high or low risk with an 84 per cent specificity and 74 per cent sensitivity.


Oesophageal choke in an African elephant.

A young African elephant suffered a fatal obstruction of the caudal oesophagus caused by an ingested apple. This report describes the attempts made to relieve the obstruction and the subsequent post mortem findings.


Characterization of the third origin of DNA replication of the genome of insect iridescent virus type 6.

The structure of the third origin of DNA replication (CIV-ori-M) of the genome (209 kbp) of Chilo iridescent virus (CIV) was determined by DNA nucleotide sequence analysis. The CIV-ori-M is located within the DNA sequences of the EcoRI CIV DNA fragment M (7 kbp; 0.310-0.345 viral map units) between the genome coordinates 0.310 (EcoRI site) and 0.317 (NcoI site). The DNA nucleotide sequence of the EcoRI/NcoI CIV DNA fragment (1601 bp) was determined for identifying the DNA sequence of the corresponding origin of DNA replication. The analysis of the DNA sequences of this region revealed the presence of a 12-mer inverted repeat at nucleotide positions 485-496 and 503-513 (485-AGATATTTGACT-496-TATGT-503-AGTCAAATATCT-513) that are able to form a hairpin-loop structure. A double-stranded DNA fragment was synthesized that corresponds to the nucleotide positions 485-513 that were cloned into the phages M13mp18 and M13mp19, and were screened for their ability to be amplified in CF-124 cell cultures infected with CIV. The successful amplification of the DNA sequence of the CIV-ori-M is strong evidence that this particular region of the CIV genome indeed serves as the origin of DNA replication.


The presence of antibodies to purified p24gag protein of HTLV-I in sera of patients with systemic lupus erythematosus (SLE).

Sera of patients with systemic lupus erythematosus (SLE) were tested for their reactivity to HTLV-I by western blotting (WB). Seven (18%) of 40 SLE serum samples reacted to the p24gag protein of HTLV-I by WB using purified gag antigens. The specificity of anti-p24gag antibodies in the SLE sera was confirmed by competitive inhibition on WB. Two of the seven patients were shown to be HTLV-I carriers, because HTLV-I infected T cell lines were easily established from their peripheral blood mononuclear cells (PBMC). Except for these two carrier patients, the gag proteins were not detected in the lysates of PBMC by WB using anti-p24gag and anti-p19gag monoclonal antibodies. The gag and pX genes of HTLV-I were not detected by PCR in PBMC of the SLE patients, with the exception of the 2 HTLV-I carrier patients. These results show no direct involvement of HTLV-I in the etiology of SLE. However, the existence of a specific antibody to p24gag in the sera of some of the noncarrier SLE patients suggests a crossreactivity to either unknown viruses or some autoantigens.


Transient expression assay in a baculovirus system using firefly luciferase gene as a reporter.

Transient gene expression assays were developed to assess the function of the regulatory sequences of baculoviruses Bombyx mori nuclear polyhedrosis virus (BmNPV) and Autographa californica nuclear polyhedrosis virus (AcNPV) in insect cells of Bombyx mori and Spodoptera frugiperda, respectively. DNA sequences encoding luciferase (luc) of the firefly Photinus pyralis was successfully employed in the expression assay as a reporter gene. Recombinant plasmids were constructed containing the luc gene under control of baculovirus-specific or heterologous promoters. Cotransfection of Bombyx mori and Spodoptera frugiperda cells with recombinant plasmids carrying virus-specific promoter sequences and BmNPV and AcNPV DNA, respectively, gave rise to efficient synthesis of luciferase (Luc), while heterologous promoters induced a low level of luc expression. We found that flanking sequences of the AcNPV DNA in the transfer plasmid contained an unknown promoter conferring an efficient luc expression. The activity of this promoter was modulated by the polh promoter sequences. The assay allows one to conduct highly sensitive monitoring of the transient expression of foreign genes from the transfecting plasmids prior to construction of recombinant viruses.


[The criteria for the diagnosis of chronic overheating in miners in deep coal mines].

The author analyzes a complex of informative signs and symptoms characterizing the main forms of disorders in chronic overheating: vegeto-vascular dysfunction, astheno-neurotic syndrome, reduced heat resistance, seizure. An integral criterion of the presence of chronic overheating in miners with a large length of work in conditions of heat is the total threshold of diagnostic coefficients (-9.8 units) and its absence (+12.5 units). Precision of the method -80%.


[The dispensary observation of patients with chronic nonspecific lung diseases who work in a dust-producing industry with a high radionuclide level as a consequence of the accident at the Chernobyl Atomic Electric Power Station].

Patients working at a small mining institution and suffering of chronic unspecific pulmonary diseases due to high dust and radionuclide contamination levels were examined. Four groups of dispensarization were singled out with the purpose of differential treatment for each group. Such treatment including also antiaggregant agents, nitro-drugs resulted in a good medico-social effect within 2 years.


[The characteristics of the Holter monitoring data on patients with a vasospastic reaction during the performance of transesophageal electrocardiostimulation].

Along with organic involvement of the coronary arteries their spasm is one of the mechanisms of development of acute myocardial ischemia. Transesophageal electrocardiostimulation in 314 patients with non-stable stenocardia revealed in 32 (10.2%) increased vasospastic activity. Holter monitoring allowed to find essential differences in patients with vasospasm manifested in a significant increase of the frequency and duration of nonpainful myocardial ischemia in the absence of distinct changes in painful ischemia. Two-week treatment with calcium antagonists allowed to reduce the ischemia level in the group of patients with vasospasm tendencies.


[The clinical characteristics of patients with an acute myocardial infarct complicated by ventricular tachyarrhythmias].

Having studied 455 cases of documented ventricular fibrillations and ventricular tachycardias leading to circulatory arrest, the authors distinguished clinical factors of unfavourable prognosis of the disease at early and late ventricular tachyarrhythmias, their primary and secondary forms. The possible role is stressed of prolonged persistence of electrical instability of the myocardium in late primary tachyarrhythmias which also include arrhythmias of the 2nd myocardial infarction day. The necessity is substantiated of early electrophysiological examination in myocardial infarction complicated by circulatory arrest or during high risk of its development.


[An assessment of the efficacy of different physical rehabilitation regimens in the hospitalization period of acute myocardial infarct (based on bicycle ergometric test data)].

A study is presented of 135 patients with uncomplicated acute myocardial infarction (macrofocal--70, microfocal--65) using the bicycle ergometry [correction of veloergometry] test with determination of the hemodynamics by tetrapolar rheography after hospital rehabilitation treatment. It was shown that early physical rehabilitation effected favourably remaining working capacity and hemodynamics after physical loads.


[The characteristics of the clinical manifestations of chronic hepatitis and liver cirrhosis depending on the structure of the inflammatory infiltrate in the liver tissue].

A study is presented of 107 patients with chronic hepatitis and liver cirrhosis verified on the basis of morphological changes of the punctate obtained at echocontrol puncture liver biopsy. It was established that clinical manifestations of chronic hepatitis and liver cirrhosis are determined not only by their morphological forms, but also by the structure of the inflammatory infiltrate of the liver tissue. This is to be considered in evaluation of the severity of the disease course and differentiated treatment.


[The functional-morphological changes in the duodenum in chronic pancreatitis].

A study of the cavitary and membrane digestion of lipids, carbohydrates, proteins and data of the histological structure of the bioptate of the duodenal mucosa in 34 patients with chronic pancreatitis revealed the morphological picture of chronic duodenitis. This resulted in a reduction of the sorption properties of the intestinal epithelium that was manifested in a reduction of the rate of membranous digestion, mainly of lipids and lactose. Lesser degrees of protein, starch and saccharose hydrolysis were observed. Biopsy specimens of the duodenal mucosa showed a reduced activity of enterokinase and alkaline phosphatase. Antacids (almagel, phosphalugel), mineral waters ("Borzhomi", "Poliana Kvasova"), regeneration stimulators (Metacyl, retalil), agents stimulating the motor function (cerukal, reglan and oth.) are recommended for the complex treatment of concomitant duodenitis.


[The local treatment of patients with a duodenal ulcer with millimeter-range electromagnetic radiation].

A technique was designed for the treatment of duodenal ulcer patients by electromagnetic radiation of the millimeter range (ERMR); 30 patients were treated by this method, while 50 patients received traditional therapy; other patients were treated by lasers, cithemidin. Endoscopic ERMR treatment in combination with drugs was more effective than other methods.


[Plasminogen activators in assessing the reaction of patients with chronic obstructive bronchitis to physical loading].

Patients with chronic obstructive bronchitis showed an increased activity of the blood plasminogen activator in a group of patients under 40 years of age and absence of the dynamics of this index an older age group. The urokinase urinary activity did not change in the two groups. The blood activator activity increased in healthy young non-trained and trained young persons under the effect of loads. The urinary urokinase activity reduced only in trained persons.


[The characteristics of lysozyme and carbenicillin action on the clinico-immunological status of patients with chronic bronchitis].

Clinical, laboratory and immunological methods used to study 68 patients with chronic bronchitis revealed a normalizing effect of intratracheal administration of lyzozyme and its combinations with carbenicillin on the indices of cellular and humoral links of immunity. Treatment tactics is discussed.


[The morphofunctional characteristics of the adaptation of the erythron system in patients with iron-deficiency anemia].

The morphofunctional aspects of the erythron were studied in 168 pregnant with iron deficiency anemia and in 50 healthy pregnant women during the second half of pregnancy. Changes were found in the functional links of the structural-qualitative and oxygen-transport state of the erythrocytes depending on the severity of anemia up to development of the erythrocytopenia syndrome. Most effective was complex treatment including tocopherol acetate and unithiol.


[The characteristics of the lipid peroxidation processes in patients with glomerulonephritis and a hematuric component].

A study of 86 patients with glomerulonephritis, urinary syndrome, presence of the hematuric component is characterized by an activation of lipid peroxidation as a result of disbalance the antioxidant system, that causes corresponding changes in the lipid phase of the cell membranes, reduction of the phospholipid and cholesterol level in the membranes, increase of its deformability capacity that may be of significance for the development of the hematuric component in patients with glomerulonephritis. The data stimulate the necessity of searching treatment directed to reduction of lipid peroxidation activation, normalization of the antioxidant system, stabilization of renal cell membranes.


[A clinico-diagnostic evaluation of the sequelae of craniocerebral trauma by using computed tomography].

The authors analyzed sequelae of head injuries in persons of call-up age (16-23 years) using computer tomography. Neurological, psychopathological, clinico-laboratory methods, electroencephalography, rheoencephalography, echoencephalography and lumbar puncture were also carried out. The obtained data indicate that these subjects who sustained head injuries showed pronounced polymorphous posttraumatic disorders in the nervous system. These data should be considered in the examination of call-up age persons.


[The characteristics of population immunity to measles and diphtheria in adolescent collectives].

Population immunity to measles and diphtheria was evaluated among adolescents of a professional-technical school. Low indices of immunity were found. There was a clear difference in the number of girls and boys with antibody titers to measles virus and diphtheria anatoxin (dilution 1:40) as well as in the number of non-immune to diphtheria. A clear increase of the number of students with protective titers by the end of the school year evidences presence of latent epidemic process of measles and diphtheria.


[The characteristics of the psychoprophylaxis, treatment and rehabilitation of patients with alimentary obesity at an industrial enterprise].

The experience is described of a rehabilitation programs on reducing the body weight of a group of women working in a factory of food concentrates. changing the status food stereotype. Individual approaches are emphasized.


[Changes in the thrombocyte and procoagulant links in hemostasis in patients with arterial hypertension].

A study of 62 workers with arterial hypertension of the ore mining industry revealed significant and various changes of the thrombocytic and coagulation hemostasis in patients. Hyperfibrinemia, increase of adhesive-aggregation properties of cellular elements, depression of fibrinolysis creates a thrombogenic situation. For choice of treatment tactics in clinical conditions it is recommended to evaluate the thrombocytic and procoagulant links of hemostasis. Disorders in the system of primary hemostasis (increase of adhesive-aggregational properties of cellular elements) are an indication to the use of antiaggregants (tyclid, tyclopidin). In case of fibrinolysis depression, anticoagulants should be used in the therapy complex.


[Changes in the humoral systems in juvenile arterial hypertension and their correction by using nifedipine and anaprilin].

Examined were 140 adolescents with juvenile arterial hypertension (JAH) and 54 healthy adolescents (age: 15-19 years). Niphedipine was used in 36, anaprilin in 40; 60--did not receive these drugs (control group). The treatment lasted 6 months. It was found that before treatment adolescents with JAH showed a clear increase of the angiotensin, testosterone and plasma renin activity (PRA). Niphedipine treatment resulted in normalization of the angiotensin level, while anaprilin treatment resulted in normalization of PRA and testosterone. The two drugs reduced equally the level of arterial pressure.


[Neurogeriatrics--a new chapter in clinical neuropathology].

An analysis is presented of age-related changes of the nervous system in the course of aging and their role in the development and course of age-dependent diseases, primarily, atherosclerosis, arterial hypertension, parkinsonism, osteochondrosis etc. in the elderly and old. Practical physicians have to pay attention to the peculiarities of clinical symptomatology, diagnosis, treatment and secondary prophylaxis of nervous system diseases in the elderly and old.


[The use of the multivitamin preparation Supradin in treating patients with chronic gastritis and peptic ulcer].

The content of ascorbin acid and thiamin was assessed in the food ration of 36 patients with chronic gastritis and ulcer disease. By the end treatment including dietotherapy these vitamins showed a deficit. Correction of this deficit of the above mentioned vitamins with a polyvitamine drug "Supradin" allowed to improve significantly the biochemical indices and availability of ascorbic acid and thiamin in patients with chronic gastritis and ulcer disease. The treatment produced a favourable effect on the clinical course of the disease, reduction of the pain syndrome and earlier recovery.


[The diagnosis and treatment of osteoarthrosis deformans in subjects in contact with fluorine compounds].

A comparative study is presented of 378 workers with osteoarthrosis deformans (OD) contacting with fluorine compounds and in 106 patients with primary OD. The diagnostic criteria in these two categories of patients coincided. But the pain syndrome in the joints in professional fluorosis (PF) was associated with ossalgias (85%), tenderness of the bones (50.1%) and in 100% by symmetric hyperostosis. OD in PF was accompanied by a more pronounced density, was not accompanied by formation of nodes, and secondary synovitis was 4 times frequent. In OD plus PF males prevailed (96.7 e), and were averagely 10 years younger. In OD+PF treatment diet, calcium agents, glutamic acid should be used that bind and excrete fluorine from the body.


[The immunomodulating action of vilozen and splenin in angina patients against a background of chronic bronchitis].

Immunological indices were compared in 138 patients with angina and concomitant bronchitis; 86 of them received antibiotics, splenin and vylosen; 52 received routine treatment. It was established that use of a combination of splenin and vylosen produces a pronounced immunodulating effect in primary immunodeficiency states due to recurrences of angina and concomitant pathology of the bronchopulmonary in workers of a large industrial enterprise. Immunomodulators are indicated in the treatment of repeat and relapsing angina, especially in the presence of concomitant bronchitis.


[Enterosorption in the combined treatment of patients with salmonellosis].

Two groups of patients were estimated: one received routine treatment supplemented by microspheric carbonic sorbent per os. The sorbent-treated patients showed a more rapid disappearance of nausea, abdominal pain, fever, diarrhea. Enterosorption favoured normalization of the content of immunoglobulins, blood serum lyzozyme, reduction of the length of salmonellosis C-antigenemia.


[The prevention of skin diseases in workers in the manufacture of enzyme preparations].

Skin diseases, mainly, allergodermatoses, mycoses and pustular lesions are registered in most workers of the enzyme production. The authors recommend hygienic and therapeutic-prophylactic measures including complexes of antirecurrence therapy which allow to reduce the number of skin diseases in workers of the enzyme industry.


[The effect of nizoral on the function of the hypothalamo-hypophyseal-ovarian system in virilism].

A study is presented of the effect of nisoral on the hypothalamo-pituitary-ovarian system in 25 patients with hyperandrogenism (ovarian in 11, suprarenal in 14). It was established that most patients with oligomenorrhea and anovulation showed a restoration of the menstrual cycle after the 2-3 treatment courses and also absence of progression and reduction of the rate of pathological hair growth. After nisoral treatment the testosterone level decreased while estradiol and progesterone increased, gonadotropins remained unchanged, urinary excretion of 17-ketosteroids reduced.


[Experience in promoting the health of the children of a rural district at the physiotherapy clinic of a central district hospital].

Gastroenterological diseases were treated in children of a rural area using physiotherapy methods and non-traditional therapy. Treatment included mineral water ("Borzhomi", "Naftusia"). Favourable results are reported. The treatment is often carried out during school vacations.


The effect of human immunodeficiency virus infection on the distribution and outcome of pneumonia in intensive care units.

To determine the frequency and distribution of pneumonia in an intensive care unit (ICU), we retrospectively examined the records of 1,854 consecutive ICU admissions between January 1987 and April 1990. A total of 266 patients met criteria for pneumonia (unilateral or bilateral infiltrate by chest roentgenogram, plus 2 of the following: leukocyte count > 10 x 10(9) per liter, temperature > 38.5 degrees C, or culture of blood or sputum positive for pathogens). Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus was the most frequent cause (28%) precipitating an ICU admission in this series of patients. Streptococcus pneumoniae (13%), Staphylococcus aureus (8%), Haemophilus influenzae (4%), and viruses (4%) were also commonly observed. Overall mortality was 20%. An APACHE II score of greater than 24, the need for intubation, and the presence of P carinii were predictive of increased mortality. Age, sex, and length of stay did not predict final results. Patients with P carinii pneumonia who required intubation had an overall mortality of 54%, which was higher than patients without P carinii pneumonia who required intubation (P < .05). Our experience shows the changing spectrum of pneumonia in ICUs. In contrast to reports of a decade ago in which S pneumoniae and Pseudomonas aeruginosa are cited as most common, P carinii is now most prevalent in our ICU. Although our findings reflect the increasing incidence of human immunodeficiency virus infection in San Francisco, California, they may also be pertinent to other areas in the United States where the incidence of this infection continues to increase.


Submersion injuries in children younger than 5 years in urban Utah.

Submersion injuries of children younger than 5 years in 4 urban Utah counties from 1984 through 1988 were studied retrospectively to identify associated risk factors. Infants younger than 1 year had the highest rates of both submersion injuries and deaths. The incidence of bathtub drownings was 2 to 3 times higher than reported national rates. All bathtub drownings occurred while the victim was bathing with a young sibling (10 months to 7 years of age) without adult supervision. All drownings in pools and moving bodies of water (rivers, irrigation ditches) resulted from unintentional falls into the water rather than from swimming and wading activities. Drowning prevention strategies should focus on educating parents about the risk of young children bathing with siblings in the absence of adult supervision and fencing regulations for pools and open bodies of moving water.


Scombroid fish poisoning. Underreporting and prevention among noncommercial recreational fishers.

Food-borne diseases, including those caused by seafood products, are common and greatly underreported sources of morbidity. In this article we review the epidemiology of scombroid fish poisoning and its possible relationship to the noncommercial and recreational catch and sale of fish. More than 20% of all fish sold in the United States is caught by sport fishers, and outbreaks of scombroid fish poisoning have involved improperly handled fish from private catches. We report an outbreak of scombroid fish poisoning among recreational fishers in California. The unregulated sale of recreationally caught fish for consumption and the prevention of scombrotoxism are discussed from the perspectives of public health agencies, clinicians, and the fishing public. Scientific and policy issues that require further attention are high-lighted.


Seizures after eating a snack food contaminated with the pesticide endrin. The tale of the toxic taquitos.

In September 1988 we investigated reports of seizures in persons who had eaten taquitos, a commercially prepared snack food. We identified and interviewed 5 persons with new-onset seizures within 12 hours of eating taquitos, all purchased during a 1-week period from a single store. Leftover taquitos were found to contain endrin, a highly toxic chlorinated hydrocarbon pesticide. Although tissue confirmation of exposure to endrin was not possible and the level of contamination in the tested taquitos was below that previously thought to be capable of inducing seizures, the pattern of symptoms and the common time and place of purchase strongly suggested that the seizures were due to endrin-contaminated taquitos. The source of endrin contamination could not be determined. This episode is the first report of illness associated with endrin-contaminated food products in the United States.


Orthostatic hypotension. Causes, evaluation, and management.

Chronic orthostatic hypotension is caused by a variety of disorders. Frequently patients withdraw from social interactions, are prone to adverse drug reactions and inappropriate diagnoses, and are bed-bound by the time of diagnosis. Applying basic principles of cardiovascular physiology and pharmacology usually permits these patients to lead active lives and to live longer. Much of the management is based on common sense and knowledge of the basic pathophysiology of the disorder and depends on thorough patient education and close monitoring of blood pressure in many of the activities of daily living.


Eating disorders. A review and update.

Anorexia nervosa and bulimia nervosa are prevalent illnesses affecting between 1% and 10% of adolescent and college age women. Developmental, family dynamic, and biologic factors are all important in the cause of this disorder. Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea. A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication.


Late effects of poliomyelitis--an update on fatigue and weakness.

The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in physical medicine and rehabilitation. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, and scholars to stay abreast of these items of progress in physical medicine and rehabilitation that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Physical Medicine and Rehabilitation of the California Medical Association, and the summaries were prepared under its direction.


[Selective screening for amino and organic acid inborn errors].

Aminoacidopathies and organoacidopathies are the most common acute life-threatening inborn errors of metabolism in the neonatal period. In the Federal Republic of Germany approximately 1 out of 5000 newborns is currently diagnosed as having an aminoacidopathy and approximately 1 out of 9000 newborns an organoacidopathy. Especially in the case of organoacidopathies there is substantial evidence that this number represents an underestimation. Many cases of amino- and organoacidopathies are still likely to remain undiagnosed. The incidence figures would warrant neonatal population screening for these disorders; however, the complexity and expense of the current methods prohibit this approach. Instead specialized investigations are carried out in children who develop symptoms indicative of an inborn error of metabolism. This approach is called selective screening. Early diagnosis, therefore, rests on a high degree of suspicion. In this paper clinical and laboratory findings of amino- and organoacidopathies are summarized. They can be nonspecific and misinterpreted. In the neonate and infant the presentation is commonly that of an acute overwhelming disease, whereas in the older child unexplained mental and/or neurological problems are often the leading symptom. We present an algorithm for the quick and comprehensive diagnosis of acutely presenting inborn errors of metabolism using commonly available parameters. However, in many cases the definitive diagnosis is not reached by selective metabolic screening of a single urine specimen of a patient, but requires close cooperation between the referring physician and the metabolic specialist. Multiple analyses, sometimes of different physiological fluids, or even in vivo and in vitro loading tests may be necessary.(ABSTRACT TRUNCATED AT 250 WORDS)


[Strategies for the diagnosis of lysosomal storage diseases: symptoms, methods and samples].

Lysosomal diseases are a group of about 30 genetic defects with a total incidence of 3 to 4 cases/10,000 newborns. Their clinical appearance is very heterogeneous and comprises infantile, as well as juvenile or adult forms. Our concept for their diagnosis has now been in use for eight years and entails the following strategy: The three main symptom groups coarse facial features, visceromegaly and/or psychomotor retardation should be examined for their typical expression and for the occurrence of specific "key symptoms". Thereafter, biochemical analysis of urine for oligosaccharides, mucopolysaccharides and in some cases, of sphingolipids or direct enzyme assays in serum, peripheral leucocytes or skin fibroblasts are performed. The selection of appropriate methods is usually the domain of the biochemist and greatly depends on the available samples and the quality of clinical information. The diagnostic value and the limitations of methods and samples are discussed in detail. Finally, evidence of defects in the expression of relevant gene products, such as enzymes, activator proteins or transport proteins can be obtained and used for genetic counselling and/or for prenatal diagnosis in chorionic villi or cultured amniotic fluid cells. Our results confirm the data on the high incidence of mucopolysaccharidoses I and III A. In addition, a comparatively high number of otherwise rare diseases, such as fucosidosis or sialic acid storage disease was found. Among the group of sphingolipidoses, special attention should be paid to juvenile or adult forms.


[Importance of genetic counseling in inborn errors of metabolism].

In genetic counselling a detailed history including the family tree and the collection of old and new data lead to a comprehensive knowledge of the illness of the patient. Nevertheless it is important that the metabolic disease is defined as exactly as possible. Enzymatic examinations and genetic diagnosis at the molecular level should be performed for optimal counselling. In descendants of consanguinic pairs the incidence of inborn errors of metabolism is increased. Although in most cases autosomal recessive inheritance gives a clear picture of the well-known risks for the offspring, the individual possibility exists that different alleles could combine to different genotypes with variable phenotypic expression. Loading tests for detecting heterozygotes have become less important with the introduction of probes.


[Hemofiltration in acute neonatal metabolic crisis].

Continuous arteriovenous hemofiltration (CAVH) and venovenous hemofiltration (CVVH) were successfully used in the treatment of two neonates, one with maple syrup urine disease and the other with ornithine transcarbamylase deficiency. The plasma concentrations of branched-chain amino acids as well as of ammonium decreased to non-toxic values within a few hours and the clinical improvement in the encephalopathy was striking. Our results and a review of the literature show that hemofiltration is more effective than peritoneal dialysis in removing toxic metabolites. The best clearance rates are achieved by intermittent hemodialysis, but continuous hemofiltration is a simple, safe and effective alternative and is sometimes tolerated better by critically ill infants.


[Mucoviscidosis screening with immunoreactive trypsin].

Up to now 49,116 immunoreactive trypsin (IRT) measurements have been carried out in Austrian newborns in the first week of life. Related to provisionally chosen cut-off points, 301 newborns (0.61%) showed an elevated IRT value; 253 of them were successfully recalled. According to a direct strategy, sweat tests were done without a second IRT measurement in 101 infants; eleven of them were identified as cystic fibrosis (CF) patients. In accordance with a 2-step strategy, 152 infants were reinvestigated by a second IRT determination. Twenty-eight of them again showed an elevated IRT value, as based on provisional, age-dependent reference values; seven were subsequently identified as CF patients by sweat testing. So far two false-negative findings were obtained on IRT screening: one child was later identified as having CF on the basis of typical clinical symptoms and a positive sweat test, the other patient presenting with meconium ileus showed a normal IRT value after surgery, but was subjected to a sweat test in view of the underlying condition. These preliminary results suggest a CF incidence of 1 to 2460 newborns in Austria. Hence, IRT screening appears to be a reliable method for identifying CF patients in the newborn period, thereby facilitating early treatment and genetic counselling.


[Food service in Austrian hospitals: results of a survey].

130 medical and 130 administrative heads were asked to fill in a structured questionnaire to obtain an assessment of meals provided in Austrian hospitals. 62 questionnaires in each group were returned fully completed. Meals: öS 46,--are available per patient and day; whereby the costs of special diets are öS 11,--higher on average per day. Diets on offer: 96.8% of the questioned hospitals offered a diabetes diet; 95.2% a weight-reducing diet, 93.5% a light balanced diet and diet for patients with hyperlipidaemia and 90.3% a reduced salt diet (the worst accepted by the patients). 90.3% of these hospitals would consider dietary recommendations as a preventive measure. In fact, preventive dietary measure are implemented in 75.5% of the hospitals questioned. It was apparent that the staff in charge are aware of the influence of correct-nutrition in hospitals. It is recommended that nutritional advice should be offered more often in all wards (this is at present available in only 8.0% of the hospitals). It should be mentioned that financial resources concerning hospital meals should be increased for the more widespread establishment of "healthy food", too.


[An alternative to alcohol at the work site. General practice test of an electrolyte beverage in hot work environments].

A survey was performed in 1989 by the Institute of Social Medicine and the Austrian Workers Compensation Board(AUVA) to investigated the alcohol problem in 277 factories in which the workers were exposed to hot and dusty atmospheres. As a result of the findings, a further study was undertaken by the same research team to investigate one possible solution to the problem of alcohol consumption at work in a paper-producing factory, predominantly under hot and dusty conditions. The study was well prepared by many activities in the field of health promotion. In this trial, an electrolyte drink especially suited for heat-burdened work places, was introduced for three months as alternative drink to alcohol. Before and after this period the employees answered a questionnaire regarding their alcohol consumption and any changes in consumption habits. One of the main results of the study was the significant increase in electrolyte drink consumption and decrease in wine consumption although that of beer remained practically unchanged. The offered electrolyte drink was accepted as alternative drink by many workers and represents a practical example of health promotion at the place of work. This study should encourage other factories and businesses to experiment with electrolyte drinks especially suited to their particular conditions in an attempt to overcome the problem of alcohol consumption during working hours.


[Uteroplacental circulation in growth retardation--experiences with the clinical use of continuous-wave Doppler].

Doppler ultrasound measurement of blood flow velocity represents a non-invasive method of studying uteroplacental and feto-placental haemodynamics. Using a continuous-wave Doppler device, the blood flow velocity was examined in the uterine and arcuate arteries, as well as in the umbilical artery in 81 patients demonstrating fetal growth retardation. An increase in vessel resistance was found in the uterine and arcuate arteries in most of the patients. In addition, patients with fetal retardation showed a significantly higher rate of diastolic notching and incomplete registration of uterine and arcuate wave forms, especially in pregnancies complicated by hypertension. The implementation of the continuous-wave technique as a simple Doppler system allows differential evaluation of placental function and provides information on the nutritional supply to the fetus.


[Differential prognosis of patients with breast cancer with pleuritis carcinomatosa and with pulmonary lymphangiosis carcinomatosa].

The retrospective analysis of 672 consecutive patients with breast cancer revealed malignant pleural effusion and lymphangitic carcinomatosis of the lung to be the sites of first relapse of the disease in only 2% and 1%, respectively. In half of the 10 patients with malignant pleural effusions evaluable for survival, generalization of the disease was recorded at 51 months (range 0-197 months); the corresponding data for patients with lymphangitic carcinomatosis of the lung (n = 7) were 19 months (range 9-44 months). This difference was statistically significant (p < 0.05). The median survival of patients with pleural effusions and with lymphangitic carcinomatosis of the lung was 22 and 8 months, respectively (n.s.).


[Fetal cerebral and renal circulation--a longitudinal study in the 2d half of pregnancy].

In a prospective longitudinal study 34 women were subjected to the following investigations 4-weekly from the 23rd to the 41st week of pregnancy: Doppler sonography of the umbilical artery, arteria cerebri media (ACM) and arteria renalis (AR), fetal biometry, estimation of the amniotic fluid volume and cardiotocography (CTG). 30 pregnancies ended in the birth of normal weight babies with no perinatal problems and in 108 examinations blood flow velocity waveforms of high quality were recorded in each vessel. We calculated the pulsatility index (PI), which was always within the normal range for the umbilical artery. Regression analysis was used to derive the 90% confidence intervals for the PI of ACM and AR and the PI ratio AR/ACM. A linear relationship was found between the AR PI and gestational age, while the relationship between the ACM PI and gestational age is better described by a quadratic equation. In both vessels a fall in PI was observed with advancing gestation. In the renal artery waveforms with absence of end-diastolic flow velocities were recorded up to 34 weeks only. CTG was assessed by the Fischer score, which showed a highly significant, positive correlation with gestational age (r = 0.316), but no correlation with the PI of the middle cerebral artery. The amniotic fluid volume showed a negative correlation with gestational age (r = -0.19), but no correlation with the PI of the renal artery.


[Computer-assisted patient data management: from department-specific individual solutions to Vienna-wide network comprehensive solution].

Up to now the daily routine work and statistics have been facilitated by using some self-developed microcomputer based data collection systems. No network has been established. Currently we implemented in out hospital "Krankenanstalt Rudolfstitung" a country-wide patient oriented data collection net system. In future it will be possible to compare all patients datas, methods and success of treatment of all Viennese hospitals.


[Prevention of the recurrence of duodenal ulcer with famotidine. Report of experiences with long-term therapy in an open clinical study].

In this open trial, 25 patients with identified duodenal ulcers were given long-term therapy of a single evening dose of 20 mg famotidine. 18 patients completed the study, 7 were withdrawn because of compliance difficulties. The patients included in this study had a long history of ulcer disease; ulcers were identified by endoscopy and they were healed after 4 or 8 weeks of H2-blocker therapy. Under long-term therapy with famotidine (Ulcusan), ulcers recurred in 3 patients after 3 months, a further 3 recurred after 6 months, and another 2 after 12 months. The recurrence of ulcers occurred in many patients without symptoms. Tolerance of the drug was good in all patients. No change in biochemical parameters was observed. Undesired side effects were not seen. Low dose famotidine therapy (20 mg Ulcusan tablets) is suitable in long-term treatment of peptic ulcer disease; frequent endoscopy would be advisable to detect recurrency of asymptomatically ulcers.


[Therapy of peptic ulcers with famotidine. Report of experiences with an open clinical study].

In a two center open uncontrolled clinical trial, the efficacy of a single evening dose of 40 mg famotidine (Ulcusan) was studied in a total of 37 patients (20 with chronic duodenal ulcers, 9 with recurring and 8 with acute gastric ulcers). 35 patients completed the study. In all 35 cases, endoscopic examination confirmed that ulcers had healed. All but one gastric ulcer healed within 4 weeks (80%) or 8 weeks (94.3%) of therapy. The cumulative rate of recovery for gastric ulcers was 87.5% and for duodenal ulcers 100%. During the first 4 weeks of therapy, vanishing of symptoms occurred and additional intake of antacids diminished progressively. Day-time symptoms tended to disappear earlier than nocturnal symptoms during the course of treatment. No objective or subjective side-effects were reported. A temporary exanthema appeared in 1 case after 4 weeks of treatment but could not be identified as causally related to famotidine. In this study famotidine turned out to be very effective in ulcer healing and was free of side effects. Thus, this preparation may be recommended also for "low-dose long-term prophylaxis" of chronic peptic ulcers.


[Time of famotidine administration and healing of duodenal ulcer: is 18.00 o'clock of importance?].

In a double-blind, placebo-controlled two centre trial, the effect of a 40 mg oral dose of famotidine administered at 6 p.m. to the same dose given at 10:00 p.m. was studied in 38 patients with duodenal ulcers. After 2 weeks 61% of the ulcers had healed; this had risen to 89% by the end of week 4. The statistically non-significant trend to better results following administration later at night (which apparently contradicts other published results) may have been due to a delay in adsorption caused by food ingestion and the related nocturnal pH levels.


[Treatment of mild to moderate reflux esophagitis with the H2-blocker famotidine].

The efficacy of a single daily dose of 40 mg famotidine was compared with that of the same dose administered twice daily for 4 and 8 weeks respectively, in the treatment of reflux oesophagitis of varying severity (oesophagitis stage I to III). A total of 20 patients took part in the trial; the rate of total recovery was 50%. A significant improvement was recorded in a further 10% of the patients, and no change was observed in 30%. In 5% of cases, a deterioration was seen, that is to say that the treatment was discontinued for 1 patient due to adverse reactions. Following a 4 week course of treatment, the rate of recovery was markedly better in the patient group given 40 mg twice daily, compared to the group receiving 40 mg once daily. After 8 weeks, taking into account the fact that 5 patients were withdrawn from the study, there was no significant difference in the rate of recovery. H2-blocker therapy would thus seem to be, as published, a potentially conservative treatment of mild to moderate forms of reflux oesophagitis. Higher daily dosages initially give better results.


[Causality and disease].

The interpretation of the causal relations in the beginning of a disease offers a central problem in medicine. It obtains a special interest with the increasing significance of the chronic diseases. The handling of this problem cannot depend on the experience of the every day life. It must take in consideration the general aspects of the causality as they are the topic of modern physics and biology as well as of philosophy. In the principle acknowledgement of the principle of causality a change from a deterministic monocausal to a more complex thinking takes place considering a complex of conditions followed by a field of possibilities of effects. Special interest needs the differentiation between the description and the interpretation of causal relations that means between ontological and epistemological thinking. The causal relation in medicine depends on the same principles as in physics and in biology.


[The effect of war-induced stress in Croatia on the incidence and mortality of acute ischemic heart disease].

During war operations in Croatia and air alarms in Zagreb, a significantly higher incidence of patients with acute coronary artery disease was registered. Higher incidence of patients with acute myocardial infarction was present and the incidence of hospital mortality among patients with myocardial infarction was significantly higher than earlier. Significant difference was not found between various study periods neither for sex ratio, localization of myocardial infarction (anterior vs. inferior) nor in the ECG form of myocardial infarction (Q vs. Non-Q).


[20 years pentoxifylline: a part of recent angiology history].

Pentoxifylline was first registered (in Germany) 20 years ago. Then its main action seemed to be vasodilatation. Later hemorheological effect, in particular on red cell deformability, were found. Independent of its pharmacological effects, the clinical effectiveness in peripheral and cerebral arterial disease is well established. More recently its action on leucocytes has gained interest. Both rheological and biochemical changes have been reported. This new knowledge will create new indications for pentoxifylline within the near future which possibly will go beyond angiology.


[Chronified headache].

Paroxysmal headache of the migraine type as well as permanent undulating headache (which we call cephalea) can lead to chronification, both often mixes within the chronification. Existence of psychogenic factors (in the broader sense) favourises chronification of headache. A self supporting circulus vitiosus may arise, in combination with the cervical column, depressivity, whiplash-injury, chronical over-use of drugs (often not without an iatrogenic component), expertise situations. Therapeutically we emphasise a polypragmasy orientated on target-symptoms. Analgesics and tranquilizers want to be excluded as much as possible. Clearly indicated antidepressant are of great value, physiotherapy and psychotherapy as well. As ultima ratio we administer a neuroleptic sleeping cure.


Job stress, psychosocial strain, and physical health problems in women employed full-time outside the home and homemakers.

A pair of studies was conducted to investigate for both women employed full-time outside the home and homemakers: (a) relations between job-related stress and various indices of psychosocial strain and reported physical health problems; and (b) social support and number of children in the home in regard to direct relations with indices of psychosocial strain and physical health problems as well as moderating effects on relations between job stress and these indices. Self-report data were collected from 91 women employed outside the home and 95 homemakers. For both groups of women, more quantitative overload was associated with more tension and health problems. Greater quantitative overload was associated with more marital dissatisfaction for homemakers but not for women employed outside the home. Greater underutilization of skills for both groups of women was associated with more self-reported tension and poorer quality of marital relations but was not associated with health problems. Less reported tension was associated with greater overall social support for homemakers and greater social support from supervisors for women employed outside the home. Better quality of marital relationships was associated with greater overall social support for homemakers and greater social support from husbands and relatives/friends for women employed outside the home. For women employed outside the home, social support from supervisors and coworkers were found to moderate some of the relations between job stress and measures of psychosocial strain. Social support for homemakers, however, evidenced no moderating effects for relations involving job stress. Possibly because of low mean number and small variability in number of children in these samples, no direct relations or moderating effects were found for number of children for either group of women.


A prospective study of women's health: the effects of stress, hardiness, locus of control, Type A behavior, and physiological reactivity.

This study was a five-year follow-up of women who had participated in a previous experiment. At time one, we obtained measures of hardiness, Type A behavior, locus of control, stress, illness, and physiological reactivity. At time two, we obtained measures of illness for the past twelve months. Multiple regression analyses support the hypotheses that both hardiness and locus of control buffer the effects of stress on illness. Furthermore, Type A classification was associated with greater illness frequency and resting systolic blood pressure predicted future health status. An examination of all variables simultaneously revealed that future illness frequency is best predicted by locus of control x stress, high resting systolic blood pressure and low systolic reactivity. Future illness severity was best predicted by locus of control and resting systolic blood pressure. These results support the hypotheses that hardiness and locus of control buffer the effects of stress on health in women employed as clerical workers; however, the predictive power of hardiness in these women is largely accounted for by the contribution of locus of control.


Restructuring federalism: the effects of decentralized federal policy on states' responsiveness to family planning needs.

The Reagan Administration sought to decentralize many federal programs by (1) consolidating categorical grants into black grants; (2) reducing their funding; and (3) relying more upon state fiscal support. This study examines the effects of this decentralist policy upon the federal family planning program. Two periods are analyzed: (1) FY 1976-1981, the period immediately prior to the Reagan Administration and (2) FY 1982-1987, the period during the Reagan Administration. Findings show that a more decentralized program produced less responsiveness to individual state needs for family planning, and that these effects could have been predicted from the previous period.