Low susceptibility of nude mice to induction of invasive urinary bladder cancers by N-ethyl-N-(4-hydroxybutyl)nitrosamine.

A time- and dose-dependent study of N-ethyl-N-(4-hydroxybutyl)nitrosamine (EHBN) bladder carcinogenesis was performed in nude mice maintained on tap water containing 0.025% EHBN for 4, 12, and 20 weeks ad libitum. A total of 13 invasive tumors, comprising 11 transitional cell carcinomas (TCCs) (84.6%) and 2 squamous cell carcinomas (SCCs) (15.4%), were found. Compared with previous results for B6C3F1 mice exposed to the same EHBN insult, the numbers of invasive carcinomas induced in nude mice, and especially of SCCs, were low. In order to ascertain whether this difference in cancer incidence between nude and B6C3F1 mice was due to variation in urinary excretion, the metabolism of EHBN was also investigated and compared with that of N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN). Respective total urinary excretions over 48 hr of N-ethyl-N-(3-carboxypropyl)nitrosamine (ECPN) or N-butyl-N-(3-carboxypropyl)nitrosamine (BCPN), the ultimate carcinogenic species of EHBN or BBN, were 822.4 +/- 41.4 micrograms and 530.4 +/- 81.0 micrograms, respectively, in nude mice, and 800.6 +/- 83.7 micrograms and 407.8 +/- 69.7 micrograms, respectively, in B6C3F1 mice. In conclusion, although it is apparent that nude mice have a low susceptibility to EHBN induction of urinary bladder cancer, this does not appear to be dependent on reduced metabolism to the active form.


Neoplasms and related proliferative lesions in control Sprague-Dawley rats from carcinogenicity studies. Historical data and diagnostic considerations.

Historical data are presented for neoplasms and related proliferative lesions from 1,170 Sprague-Dawley rats that served as controls in 9 carcinogenicity (2 year) studies conducted in the Safety Evaluation Facility of Ciba-Geigy Corporation, Summit, New Jersey. The most common neoplasm was pituitary adenoma, which occurred in 62.2% of the male and 84.7% of the female rats. Incidences of other neoplasms that occurred in more than 6.0% of the rats were, for males, benign pheochromocytoma (19.0%), cutaneous keratoacanthoma (7.9%), pancreatic islet cell adenoma (7.5%), benign testicular interstitial cell tumor (6.5%), and thyroid C-cell adenoma (6.5%). For females these incidences were mammary fibroadenoma (31.3%), mammary adenocarcinoma (16.8%), and mammary adenoma (6.5%). Focal cortical hypertrophy/cystic degeneration of the adrenal, a focal nonneoplastic lesion of zona fasciculata cells that often degenerate into large cysts, was present in 23.4% of all male and 82.7% of all female rats. Criteria for the differential diagnoses of selected neoplasms and related lesions are presented.


Tumor-promoting effects of both iodine deficiency and iodine excess in the rat thyroid.

Thyroid tumor-promoting effects of iodine deficiency and iodine excess were investigated in a rodent 2-stage model to estimate an optimal iodine intake range that would not effectively promote development of thyroid neoplasia. Six-week-old male F344 rats were given a single subcutaneous injection of 2,800 mg/kg body weight N-bis(2-hydroxypropyl)-nitrosamine (DHPN) or saline vehicle, maintained on Remington's iodine-deficient diet (21 +/- 2 ng/g iodide), and supplemented with various amounts of potassium iodide up to 260 mg/liter in drinking water to generate conditions ranging from severe iodine deficiency to severe iodine excess. In DHPN-treated rats, both conditions significantly increased thyroid follicular tumorigenesis. In DHPN-untreated rats, iodine deficiency produced diffuse thyroid hyperplasia, characterized by small follicles with tall epithelium and reduced colloid, together with a decrease in thyroxine (T4) and an increase in thyroid-stimulating hormone (TSH). On the other hand, iodine excess produced colloid goiter, characterized by large follicles with flat epithelium and abundant colloid admixed with normal or small-sized follicles lined by epithelium of normal height, together with normal serum T4 and slightly decreased TSH. These effects were directly proportional to the severity of iodine deficiency or extent of iodine excess and suggest that each condition has a different thyroid tumor promotion mechanism. Iodine intakes that showed the least tumor promotion were 2.6 and 9.7 micrograms/rat/day in this study. Promoting mechanisms and the problem of statistically estimating recommended daily iodine intake range are briefly discussed.


Renal lesions induced by ochratoxin A exposure in the F344 rat.

Groups of 80 male and female F344 rats were exposed by gavage to ochratoxin A, a naturally occurring mycotoxin, at levels of 21, 70, and 210 micrograms/kg body weight for up to 2 years. Ochratoxin A induced non-neoplastic renal tubular epithelial changes consisting of cytoplasmic alteration, karyomegaly, degeneration, and cysts. Exposure-related renal tubular proliferative lesions included focal hyperplasia, tubular cell adenoma, and tubular cell carcinoma. Renal tubular cell adenoma occurred as early as 9 months in 1 high-dose male rat, and both adenomas and carcinomas were seen in males by 15 months. At the terminal sacrifice, renal tubular cell tumors were found in both male and female rats, but the response was more pronounced in the males. The incidence of renal tumors in the high-dose rats was the highest of any National Toxicology Program (NTP) study completed to date. In the high-dose males approximately one-third of the renal carcinomas developed metastases. This study demonstrates that ochratoxin A is a potent renal carcinogen in the F344 rat and suggests that contamination of feedstuff by this mycotoxin may pose a potential hazard to domestic animals and man.


Morphologic and biochemical changes in articular cartilages of immature beagle dogs dosed with difloxacin.

Quinolones are efficacious antibacterial compounds, but they have been associated with arthralgia in human patients; experimentally, they have caused lesions in articular cartilages of immature animals. The earliest morphologic and biochemical changes induced in articular-epiphyseal cartilage complexes by difloxacin, a fluoroquinolone, were investigated in 27 3-month-old Beagle dogs that were dosed orally with the drug at 300 mg/kg body weight per day. Paraffin-embedded sections of humeral and femoral heads that were stained with either hematoxylin and eosin or toluidine blue and fast green were evaluated histologically, and lesions were scored according to established criteria. Although morphologic changes were not observed in cartilages of the control dogs or of the treated dogs in the 24-hr group, the severity of lesions, as represented by mean scores for lesions, increased during the 36-48 hr after dosing. The initial morphologic change, observed in cartilages from the treated dogs of the 36- and the 48-hr groups, was necrosis of chondrocytes that was rapidly followed by disruption of extracellular matrix and formation of fissures. Although glycosaminoglycan was aggregated along the margins of fissures, its concentration was not reduced in cartilages of any group of treated dogs. Collagen, however, was depleted from the cartilages of the dogs that were euthanized 36 or 48 hr after the first dose of difloxacin. Because degenerative changes were observed ultrastructurally in chondrocytes by 24 hr in a previous study, it was concluded that collagen was lost from affected cartilages as an early sequel to the degeneration of chondrocytes.


Naturally occurring intestinal epithelial neoplasms in aged Crl:CD BR rats.

Spontaneous primary epithelial neoplasms of the intestinal tract occurred in 6/682 (0.9%) male and 1/694 (0.1%) female Sprague-Dawley rats. Six of 7 neoplasms were adenocarcinomas, and 1 of 7 was an adenoma. Metastasis to the liver or lung occurred in 3 of the rats with adenocarcinoma. These findings are consistent with those reported for female Sprague-Dawley rats and for males and females of other strains over the past 25 years. The intestinal neoplasm incidence in males exceeded that reported for other Sprague-Dawley males with one exception, reported 30 years ago.


Histiocytic sarcoma in an aging gerbil.

A histiocytic sarcoma in an aging female gerbil is described. The neoplasm primarily involved the spleen and liver, and these organs were considered the primary sites of neoplastic origin. No neoplastic infiltration was noted in the uterus or ovaries as is commonly seen in the female mouse. This is the first report of histiocytic sarcoma in gerbils.


Osteochondroma in laboratory rats: a report of 3 cases in a Fischer-344, a Sprague-Dawley, and a Wistar rat.

Three cases of osteochondroma in a male Sprague-Dawley (SD) rat, a female Fischer (F344) rat, and a male Wistar rat are described. The rats were aged between 26 and 30 months. All osteochondromas were considered to be of spontaneous origin. The Wistar rat had multiple osteochondromas on both hind legs, the skull base, and a lumbar vertebra, whereas each of the F344 and SD rats was affected by a solitary osteochondroma, also on a lumbar vertebra. The lumbar osteochondromas were similar in appearance in all rats and consisted of a central core of trabecular bone, interspersed with fatty marrow and covered by a cap of hyaline cartilage. The additional tumors in the Wistar rat represented different developmental stages of osteochondroma with or without endochondral activity. The osteochondromas in the rats were morphologically similar to those described in humans and some domestic animal species.


Mesenteric lymph node hemangiomas of Wistar rats.

Vascular tumors in rodent mesenteric lymph nodes are uncommon. Fifty-seven of these neoplasms were identified in control and treated Wistar rats from 6 tumor bioassays. Tumor incidence ranged from 0.75% to 5.50% and was higher in males than females (2:1). Lesions, noted as incidental necropsy findings or in routine histologic sections, were typically solitary and restricted to nodal and perinodal tissue. Additional solitary vascular tumors were identified in skin of 3 rats and pararenal lymph node of 1 rat. Distinct metastases were not evident. When apparent grossly, affected nodes were red to purple, hemorrhagic, and/or enlarged. Histologically, all tumors were composed of variably sized, endothelial-cell-lined, blood-filled spaces separated by variable amounts of poorly cellular stroma. Nodal effacement was common in larger tumors. Approximately half of the tumors had features of typical cavernous hemangiomas. The remaining tumors had slightly more aggressive features consisting of single or multiple foci of lymph node capsule invasion, presence of tumor cells in muscular blood vessels, or cellular atypia with variable mitotic activity. Death due to tumor rupture and consequent hemoperitoneum occurred in 1 rat only.


The pathology of chronic bovine fluorosis: a review.

Clinical, pathologic, and analytical records from 200 cattle were reviewed to determine if long-term exposures to elevated fluorides resulted in previously unrecognized or unreported pathologic changes, especially skeletal neoplasia. Animals were part of comprehensive field and laboratory investigations of bovine fluorosis conducted by the Utah State University Agricultural Experiment Station over a 25-year period. Records indicated that over 170 cattle included in this review were exposed to dietary fluorides levels in excess of 25 ppm (dry wt), for most of their life span, and these animals exhibited bone fluoride concentrations ranging between 2,000 and 12,500 ppm (dry wt). Although dental and/or skeletal changes were present in most animals, significant soft tissue damage or neoplasia was not observed in any organ system. Renal degeneration and mineralization were slightly more prevalent in range cattle ingesting high fluoride levels, but these changes were not recognized in animals that received high experimental fluoride doses. The absence of significant soft tissue damage or neoplasia in these cattle combined with results of an extensive literature review suggests that environmental fluorides are not significant factors in mammalian carcinogenesis.


Environmental tobacco smoke: current assessment and future directions.

Scientific information on environmental tobacco smoke (ETS) is critically reviewed. Key areas addressed are: differences in chemical composition between mainstream smoke, sidestream smoke, and ETS; techniques for measurement of ETS; epidemiology; in vitro and in vivo toxicology; and chamber and field studies of perceptual or physiological effects. Questions concerning estimation of ETS exposure, suitability of various biomarkers, calculation of lifetime dose, control of confounding variables, use of meta-analysis, and the relationship between ETS concentrations and human responses all emphasize the need for additional research in order to assess potential effects of ETS on health or comfort.


Conventional spectral Doppler and color Doppler ultrasound imaging. Principles, limitations, artifacts and clinical indications in hepatology.

The physical principles, limitations, errors and indications of conventional Doppler and color encoded Doppler sonography are reviewed and their applications in the investigation of liver, spleen, portal and suprahepatic portal venous circulation are analysed. The actual possibilities and advantages of Doppler imaging, both in normal conditions and in pathologic ones, such as portal hypertension, portal venous thrombosis or cavernous transformation, liver cirrhosis, hepatoma and liver transplantation are discussed.


Liver disease in systemic lupus erythematosus.

The incidence of hepatic involvement was followed up in a retrospective study carried out in a group of 177 patients with SLE. The liver damage was estimated by clinical examination, the titer of hepatocytic enzymes and, in some cases by hepatic biopsy. The proportion of liver involvement was found reduced but that did not exclude severe hepatic inflammation in certain cases. A high incidence of hepatomegaly was noted in spite of the fact that the histopathologic examination often showed normal values. The entity "lupoid hepatitis" is discussed as well as its real relationship with SLE.


Effects of a multifactorial prevention trial of coronary heart disease on the seasonal variation of the incidence of major cardiovascular events.

Under the influence of a primary prevention trial of coronary heart disease carried out for 10 years (1971-1982) in male subjects aged 40 to 60 years at entry, the curves of the seasonal variation of the incidence of myocardial infarction, sudden death and stroke were changed. The most important reductions of the incidence of these events were registered in spring and in September. In the rest of the year the effect of the action becomes variable according to the month and to the particular major events. These observations are discussed as related to their possible cause and to the necessity of a change of action methodology according to the period of investigation.


New data in the management of digestive steroses.

The report is a review of the perendoscopic methods of treatment of stenoses at the level of the digestive tract and of the excretion canals of the annex glands. After a short description of the methods as well as of the necessary equipment, the authors discuss the indications according to the etiology of stenoses. The indications and contraindications are enumerated and an estimation is made of the therapeutic efficiency of the endoscopic methods as compared with the classical surgical methods. Emphasis is laid on the therapeutic advantages of the endoscopic palliative methods as an alternative to the surgical methods.


Evaluation of the electrocardiographic signs of left ventricular hypertrophy, using the echocardiography in patients with hypertensive cardiopathy.

The electrocardiography (ECG) contribution in the diagnosis of left ventricular hypertrophy (LVH) associated to arterial hypertension was evaluated in 54 hypertensive patients, 39 men and 15 women, with a mean age of 51.6 years, mean systolic and diastolic pressure 186 +/- 46 and 111 +/- 46 mmHg, respectively. The investigations included routine clinical and biologic tests as well as standard ECG in 12 derivations, Frank vectorial ECG and mono and bidimensional echocardiography (ECOCG). A correlative study of the ECG parameters demonstrated that the left ventricular mass index evaluated by ECOCG correlates best with Romhilt ECG index and with an LVH index elaborated by the authors of the present study, based on the Frank vectorial recordings (R wave amplitude in X and Z derivations; QRS duration in Z). These data were used in drawing linear regression equations for evaluation of the left ventricular mass, starting from the above-mentioned parameters. The results are discussed in comparison with those of other authors and their practical value is demonstrated.


Study of serum ceruloplasmin and of the copper/zinc ratio in cardiovascular diseases.

The serum copper and zinc concentration, the Cu/Zn ratio and ceruloplasmin activity have been studied in 400 subjects divided into 4 groups of study: 50 normal subjects (controls), 100 patients with ischemic heart disease, 100 subjects with myocardial infarction in the past history and 150 patients with acute myocardial infarction. It was observed that in normal subjects the Cu/Zn ratio is about 1, in acute myocardial infarction it reaches 2.5 but it returns to normal during convalescence. In the patients with ischemic heart disease the ratio decreases to 0.8 and in the subjects with infarction in the past history it is about 1.6 (almost normal). The variation of these ratio is due to the serum zinc concentration which in ischemic heart disease presents values over the upper normal limit and in acute myocardial infarction below the lower normal limit. In the subjects with acute infarction ceruloplasmin (copper depending enzyme) the activity was observed to be inversely proportional to the Cu/Zn ratio in the first 4 days after the onset of the disease. The quick normalization of one or of both parameters is a sign of positive evolution of the disease.


[The value of 3-dimensional plates in maxillofacial surgery].

Plate osteosynthesis for bone fragment stabilisation in maxillo-facial surgery is a universal method whose advantages and drawbacks are now well documented. A new system of plates made out of titanium (3-D plates) is presented. The geometry of the plate assures a good stability in the three dimensions of the space. Easy use, good resistance against torque forces, compact form of the plate are some of the advantages. Various clinical cases are presented.


Therapeutic effect of intralesional interferon (Roferon) in squamous cell carcinoma.

Recombinant alpha-2 interferon (IFN)--Roferon--100,000 IU/ml was intralesionally administered in 8 cases of squamous cell carcinoma (SCC) three times a week during 4-6 weeks in inoculations of 1 ml each. The therapeutic effect was scored as major--more than 60% reduction of the tumor size, moderate--30-60% reduction of the tumor mass and, nonreactive--less than 30% reduction of the tumor size. Three cases showed a major reduction, three showed a moderate reduction and two patients showed no reduction of the tumor volume. Histopathological examination of the surgically removed tumors after completion of the Roferon administration confirmed the clinical diagnosis of squamous cell carcinoma and revealed that an intense leukocyte, mainly lymphocytes, infiltration can be observed along with necrotic centers, progressively surrounding and reducing in size the tumor islets, thus proving an intense activation of the immune effector reactions against tumor cells.


[Mandibular fractures. Our patient enrollment during the past 2 years].

The method of patient referral; the patient's physical predisposition, the localization and the treatment undertaken for the different mandibular fractures seen by SOS Face over the past two years were analyzed. The 312 mandibular fractures were used to reevaluate the commonly accepted statistics concerning these parameters.


Variations of peroxides and total antioxidants from the plasma of normal blood donors, as a function of sex, age and blood group.

The level of peroxides and total antioxidants in normal individuals varies with sex, age and the type of blood group. The most significant differences were noticed in peroxide between young and aged subjects (over 60) of both sexes. For the free SH groups, significant differences were found, only in women, in whom it decreased with age. Similar changes were observed in men for the total antioxidants. High peroxide values were observed in donors with blood group 0-I and the lowest levels appeared in subjects with blood groups A and B, in parallel with increased values of total antioxidants. The latter results might be correlated with recent data on favourable prognosis in cancer related to the expression of group A antigens, as well as with the involvement of the glycoproteins in the characterization of blood groups (AB0 system). Our data could also be correlated with the preventive role of antioxidants in the etiology of cancer.


Zinc supplementation of chelation therapy in saturnism. Preliminary study.

The effect of zinc supplementation of chelation therapy in saturnism was studied in 20 patients hospitalized in the Clinic of Occupational Diseases of the Colentina Hospital. In 10 patients 400 mg/day zinc sulphate in two uptakes was administered concomitantly with the chelation therapy. The other 10 patients received only chelation therapy. The period necessary for the correction of the anemic syndrome was estimated comparatively by studying the evolution of the following parameters: hemoglobin, reticulocytes, red blood cells with basophilic granulations. Zinc supplementation of the chelation therapy had a favourable effect by reducing the necessary period for the correction of anemic syndrome.


[Isolated sub-orbital plexiform neurofibroma].

An unexpected finding on histology in a 73 years old patient was an isolated suborbital plexiform neurofibroma. Since this tumor is specific for von Recklinghausen's disease, the diagnosis was that of a minor form of the disease. The different cephalic manifestations of von Recklinghausen's disease are reviewed.


[Apparently primary malignant cervical adenopathy].

Despite a thorough examination it is not always possible to detect the primary cancer responsible for malignant cervical adenopathy. In the vast majority of cases the metastases arise from an epidermoid carcinoma of the upper respiratory or digestive tract. A possible diagnostic, but also therapeutic procedure is exploratory cervicotomy with extemporaneous examination. The prognosis is poor, both locally (glandular involvement) and generally (metastatic spread).


Two cases of unusual rupture of aortic aneurysm.

Two cases of unusual rupture of aortic aneurysm with extravasation in the bronchus and duodenum are described. The clinical evolution of such aneurysm ruptures is associated with considerable diagnostic difficulties due to the absence of pathognomonic typical features and the short survival time after onset of pain symptoms.


[Primary malignant lymphoma of the mandible. A study of 3 cases and a review of the literature].

Three cases of non-Hodgkin malignant lymphoma (LMNH in text) of the mandible are described, and findings compared with those reported in the literature. The mean age of patients was 46 years, without any significant male preponderance (sex ratio: 1.19), the preferential localization being the horizontal branch. Detection of the lesion was, by decreasing order of frequency, based on: mandibular tumefaction, pain, local neurologic disorders and dental mobility. Diagnosis was confirmed by histology of a deep biopsy specimen, facilitated by immunohistochemical techniques: the most frequently encountered histologic type was the diffuse large cell type (group G of the international clinical classification). Diagnosis was difficult because of the similarity of the presentation with other dental diseases and the difficulty of histologic interpretation. The principal differential diagnoses are osteomyelitis, sarcoma and carcinoma, the first one raising the risk of a long delay in diagnosis, the others of unnecessary mutilating surgery. The lesion was localized in more than half the cases, without accompanying enlarged cervical glands or metastatic visceral invasion. Treatment was by radiotherapy, usually in association with multiple chemotherapy because of the high incidence of intermediate or elevated histologic malignancy. Global prognosis was good (5 year total clinical remission rate of more than 60%), the poorest prognostic factor being metastatic spread.


[Solitary plasmacytoma. Apropos of a case of craniofacial involvement].

The authors report the case of a 24 years-old man who had a first tumor in the right maxilla diagnosed as Ewing's sarcoma and treated by chemotherapy and radiotherapy. A second tumor appeared in the skull vault twenty seven months later. The histological diagnosis after removal of the lesion was IgG Lambda plasmacytoma. The revision of the histological cut of the maxillary tumor retained the same diagnosis. The patient is without evidence of local recurrence and systemic diffusion of the disease two years after treatment. The authors insist on the necessity of immunochemistry to establish the diagnosis.


Enteral nutrition in maxillo-facial surgery.

Authors report their experience in enteral nutrition (E.N.) on maxillo-facial surgery. From 1987 to 1989, 24 patients were subjected to enteral alimentation in the Department of Maxillo-Facial Surgery of the 2nd School of Medicine of "Federico II" University of Naples (Italy). 50% of patients suffered from head and neck tumours, and 50% suffered from traumatic lesions. Before treatment, patients' nutritional conditions were evaluated by anamnesis, azotic balance, hydroelectrolytic balance, anthropometric, bioumoral, and immunologic parameters. Basal energy expenditure was calculated through Harris-Benedict formula. Patients were checked every week, and E.N. allowed a rapid and adequate caloric increase.


[The premaxilla and facial growth 68 years later].

The thesis of Dr Etienne Cadenat on the embryology of cleft-lip dates from 1924. From this epoch onwards it was demonstrated that the human premaxilla had a specific development not corresponding to that of other mammals, in whom the suture between the pre- and post- maxilla is active and participates in the sagittal, transversal and vertical growth of the maxilla. Numerous studies have been undertaken to verify that the human premaxilla does in fact exist, and several have gone as far as to conclude in its non-existence. The author restudied the question from the histologic angle, and showed that the zone of union between premaxilla and maxilla did not contain any histologic elements that could identify a growth suture. Indeed, the spatial orientation of this suture would not allow anteroposterior growth. It can be concluded that the human premaxilla does exist but its specificity has again been demonstrated.


[Lefort 1 osteotomy. The proposal of an outline modification].

A modified outline of Lefort 1 osteotomy using an "inverse step" design is proposed which ensures simple and effective down-fracture and pterygo-maxillary separation. Osteosynthesis of the mobilized fragment is facilitated due to the improved contact of bone surfaces, particularly laterally. Combined rigid and supple osteosyntheses allow some degree of post-operative adjustment.


[The dental system and facial growth].

1. As they grow, the dental germs build their chamber, exerting tensions on a fibrillar structure facing their occlusal side or incisive edge. This structure now stretches the circular margin of the alveolus, made of chondroïd tissue. 2. The maxillary bases, of negligible volume during foetal formation and prime infancy, have to be considered as adaptive structures among genetically determined growth factors: brain, basicranium and a number of dental germs. Those factors are the real agents forming the face. 3. In case of malformation due to a lack of space, the wording "cranio-dental dysharmony" seems to be more adequate than "dento-maxillary dysharmony".


[Temporomandibular joint pain-dysfunction syndrome after whiplash injury. Medico-legal problems in common law].

In four cases, the authors analyse the medical and legal factors which lead the expert to his conclusions in french law, concerning temporo-mandibular joint dysfunction after whiplash injury indemnification. An uncertain direct link between the injury and the damage together with the patient's dental prior state to the accident, lead to retain an incomplete legal imputability. The compensation awarded to the victim will consist of an overvalued extra-patrimonial damage which will eventually be able to balance a low physiological deficit price.


Is there a place for antacids in the treatment of Helicobacter pylori infection?

Two pilot studies were performed to determine whether aluminium-containing antacids may have a place in the treatment of Helicobacter pylori infection. The urease activity of H. pylori is cytopathic to gastric epithelium, and inhibition of this enzyme may have therapeutic potential. In the first study 24 subjects, 12 of which were infected with H. pylori, were given 1 tablet of chewable aluminium hydroxide-containing antacids 10 min before a 14C-urea breath test. Gastric urease activity was suppressed by 33.3% (p = 0.02) in the H. pylori-positive subjects (none became negative) within 40 min after administration of the tablet. Gastric H. pylori infection can be effectively eradicated by triple regimens containing bismuth salts, tetracycline, and metronidazole. Owing to adverse effects of this treatment and concern for possible neurotoxicity of bismuth, a bismuth substitute is warranted. Hence, in the second study, 20 subjects infected with H. pylori were treated with 1 antacid tablet 4 times daily between meals, plus 500 mg oxytetracycline and 200 mg metronidazole 4 times daily with meals for 2 weeks. Individual H. pylori status was assessed by the 14C-urea breath test. Four weeks after cessation of treatment, H. pylori was eradicated in 45% (9 of 20) of the subjects (95% confidence interval, 23.1-68.5%). Thirty per cent (6 of 20) observed one or more adverse effect regarded as moderate or severe, of which loose stools and headache were the most common.(ABSTRACT TRUNCATED AT 250 WORDS)


Eosinophil cationic protein and phospholipase A2 activity in human gastric juice. With emphasis on Helicobacter pylori status and effects of antacids.

To elucidate possible new effects of antacids, gastric juice from 15 volunteers with known Helicobacter pylori status were analysed for eosinophil cationic protein (ECP), phospholipase A2 (PLA2) activity, phosphatidylcholine (PC), and bile acids (BA) before and after administration of one tablet of antacid or placebo in a double blind cross-over design. Geometric mean ECP concentrations were more than 13 times higher in gastric juice from H. pylori-positive (12.9 micrograms/l) than from H. pylori-negative (0.97 micrograms/l) subjects (p = 0.0032). Geometric mean PLA2 activity was 1.31 U/l for the negative subjects and 4.02 U/l for the positive subjects (p = 0.13). There were no differences between positive and negative subjects with regard to either PC or BA concentration. Regardless of H. pylori status, mean PC concentration increased significantly after antacids as compared with placebo (p = 0.024). The effect of antacids did not differ significantly from placebo for ECP, PLA2 activity, or BA concentration. Hence, antacids may not act by binding 'toxic' H. pylori-associated gastric juice components like ECP or PLA2. Increased concentration of PC may indicate an increased protective capacity induced by antacids.


Omeprazole therapy for Helicobacter pylori infection.

To determine whether omeprazole eradicates Helicobacter pylori infection of the gastric antrum, six adolescents and one adult with H. pylori colonization of the antrum were entered into a clinical, open trial of medical therapy. Histologic evidence of antral gastritis and three complementary methods to document H. pylori colonization of the stomach (silver stain, urease testing, and culture of antrum) were obtained before and after an 8-week course of omeprazole. In vitro susceptibility to omeprazole and restriction endonuclease analysis were performed on H. pylori isolates obtained from patients before and after omeprazole therapy. Each of the seven patients treated with omeprazole had continued active inflammation in the antrum and one or more features indicative of persisting H. pylori colonization. Minimum inhibitory concentrations and DNA fingerprints of H. pylori isolated after therapy were identical to those of the pre-treatment bacterial isolates in each of the four subjects examined. We conclude that omeprazole therapy alone did not eradicate H. pylori infection of the human antrum. Continued bacterial colonization was not related to either acquired bacterial resistance to the drug or reinfection of the stomach with a different H. pylori strain.


Absorption of a nutrient solution in chronic alcoholics without nutrient deficiencies and liver cirrhosis.

Duodenal and jejunal absorption of a nutrient solution at two different caloric loads (1.32 and 3.96 kcal/min = 5.6 and 16.8 kJ/min) was compared in chronic alcoholics without malnutrition, liver cirrhosis, obvious small-bowel dysfunction, and exocrine pancreatic insufficiency and in an age-matched control group, by means of the intestinal perfusion technique. In chronic alcoholics duodenal net absorption of water (p < 0.025), sodium (p < 0.02), potassium (p < 0.005), total nitrogen (p < 0.02), carbohydrates (p < 0.05), and lipids (p < 0.05) was lower than in controls when both caloric loads were administered, but jejunal absorption rates were not decreased. Biliopancreatic secretion did not differ between alcoholics and controls. Higher serum protein leakage in alcoholics was indicated by an increased (p < 0.01) duodenal alpha 1-antitrypsin clearance under low caloric load infusion. It is concluded that the absorptive function of the duodenum is impaired in alcoholics, whereas the upper jejunum is not affected.


Do technetium-99m hexamethylpropylene amine oxime-labeled leukocytes truly reflect the mucosal inflammation in patients with ulcerative colitis?

Twenty-five patients with ulcerative colitis and nine controls with macroscopically non-inflamed colon were investigated with technetium-99m hexamethylpropylene amine oxime-labeled leukocyte scintigraphy and colonoscopy with biopsies. The interval between leukocyte scintigraphy and colonoscopy was < or = 14 days in all patients with ulcerative colitis and < or = 30 days in eight of nine controls. Scintigrams were obtained at approximately 45 min and 4 h after injection of labeled leukocytes. One nuclear physician, one internist, and one pathologist graded blindly and independently of each other the degree of active inflammation in seven different colonic segments for each patient, using 4-grade scales for scans and macroscopically and histologically viewed inflammation, respectively. A positive correlation between endoscopic and histologic grading of all colonic segments and scan gradings for all subjects and for ulcerative colitis patients separately was found (all, p < 0.001). By means of kappa statistics, the inter-observer agreement between scintigraphic grading at 45 min and endoscopy was, for all subjects, 0.32 (95% confidence interval (CI), 0.20-0.44; p < 0.001) and, for patients with ulcerative colitis, 0.19 (CI, 0.07-0.31; p < 0.001). When 17 patients who had complete colonoscopies were divided into those with total, extensive, or distal colitis, leukocyte scintigraphy underestimated the extension of active inflammation. A simple scintigraphic scoring system reflects the colonic inflammation viewed endoscopically and histologically in patients with ulcerative colitis but underestimates the presence of active inflammation in individual colonic segments.


Biologic and immunologic gastrin activity in serum of patients with gastrinoma. Bioassay of gastrin activity in serum.

The biologic gastrin activity in serum from 14 patients with the Zollinger-Ellison syndrome was assessed by the stimulation of histamine release and acid secretion from the isolated vascularly perfused rat stomach and compared with the immunologic activity as determined by radioimmunoassay using an antibody directed towards the active site of the gastrin molecule. Biologic gastrin activity assessed by the stimulation of histamine release was more closely correlated to immunologic gastrin activity than biologic activity assessed by the stimulation of gastrin acid secretion. This study does not contradict the concept that gastrin stimulates acid secretion at least partly by releasing histamine and also shows that the immunologic gastrin activity determined with the help of an antibody directed towards the active site reflects biologic activity.


Comparison between ranitidine and omeprazole for protection against gastroduodenal damage caused by naproxen.

Acute gastroduodenal injury is commonly associated with the use of nonsteroidal anti-inflammatory drugs. The mechanism of injury is not well understood. The objectives of this study were to evaluate the protective effect of two drugs that give different degrees of acid inhibition against naproxen-induced gastroduodenal injury. Fifteen volunteers aged 22-28 years underwent pre- and post-treatment gastroduodenoscopies during three treatment periods (that is, six examinations), and mucosal injury was graded on a Lanza scale ranging from 0 to 4. The subjects received placebo, 150 mg rantidine twice daily, or 40 mg omeprazole in a double-blind, random-order design for 7 days. Plain naproxen, 500 mg twice daily, was given on days 3-7. The mean injury score for the stomach during placebo treatment was 1.53, and ranitidine gave 44% and omeprazole 40% reduction compared with placebo, which did not reach statistical significance. About 70% of the stomach injury was located in the antrum. The mean injury score during placebo for the duodenum was 1.93, and ranitidine gave 80% and omeprazole 90% reduction (p = 0.004). In conclusion, a correlation between different degrees of acid suppression and a protective effect on the gastroduodenal mucosa could not be shown. The study suggests that acid plays a major role in acute naproxen-induced injury to the duodenal mucosa, and a moderate acid reduction is adequate for protection. In the stomach acid seems to play a minor role in the mucosal injury, but physiochemical contact with naproxen in the antrum and a cyclooxygenase inhibition are of greater importance.


Gastroduodenal lesions associated with two different piroxicam formulations. An endoscopic comparison.

This endoscopic study was performed to compare the gastroduodenal endoscopic findings after short-term treatment with plain and enteric-coated piroxicam tablets. Sixteen healthy male volunteers (mean age, 22 years; range, 19-27 years) were included in a double-blind, randomized study in which 20 mg piroxicam was given once daily for 2 weeks as plain tablets or enteric-coated tablets in a crossover fashion. The washout period was 5 weeks, and endoscopy was performed before each treatment period to ensure base-line conditions. Endoscopic evaluation of the stomach and duodenum was performed, with separate registration of the duodenum distally to the duodenal bulb. Visual analogue scales of 150 mm were used for grading the mucosal lesions, with separate registration of mucosal injection and erosive and haemorrhagic lesions. A 5-point scale (Lanza scale) was also used, to compare the two scoring systems. A significantly lower lesion score was found with the enteric-coated formulation for all endoscopic variables in both scoring regions. The sum of visual analogue scale scores in the stomach/duodenal bulb after treatment was 121 mm and 74 mm, respectively (p < 0.01), and in the middle and distal duodenum the corresponding figures were 54 mm and 23 mm (p < 0.01). The fixed-point scoring gave identical conclusions, as did the separate scoring by a different investigator evaluating the same endoscopies. Subjective symptoms were similar for the two formulations, and no carryover effects were detected. We conclude that enteric coating of piroxicam tablets may offer a means of protecting the gastroduodenal mucosa in short-term treatment of healthy subjects.


Longitudinal study of cortical bone loss in patients with inflammatory bowel disease.

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.


Serum carcinoembryonic antigen in relation to survival, DNA ploidy pattern, and recurrent disease in 406 colorectal carcinoma patients.

Serum carcinoembryonic antigen (CEA) levels in relation to survival, flow cytometric DNA ploidy pattern, Dukes stage, and recurrent disease was prospectively evaluated in 406 patients with colorectal carcinoma. In 246 patients (61%) the carcinomas were DNA aneuploid. Increased preoperative CEA levels (> 5 micrograms/l) were found in 151 of 363 evaluable patients (42%). Dukes stage-B patients with preoperative CEA elevation showed significantly poorer prognosis than those with normal CEA values (p = 0.001). A weak but significant correlation was found between preoperative CEA level and Dukes stage (Kendall's tau = 0.25, p < 0.01). Of 50 evaluable patients with clinical recurrence and postoperative normal or normalized CEA levels, 28 (56%) had a rise in CEA before or at the time of clinical recurrence. The sensitivity of the CEA test for primary and for recurrent disease was not significantly different in the DNA aneuploid and the DNA near-diploid groups.


Changes in endogenous lipid excretion in rats fed diets containing non-heated and thermally oxidized olive oils.

The objective of this study was to determine the effects of diets containing non-heated and thermally oxidized olive oils on fecal endogenous lipids. Male Wistar rats were fed fat-free diets and diets supplemented with 12% non-heated, heated, and a 1:1 mixture of non-heated/heated olive oils. After a 15-day experimental period two groups of fecal lipids from major endogenous sources were quantitated: neutral sterols and fatty acids associated with intestinal microflora action. Fecal endogenous sterols, particularly cholesterol, were significantly higher when diets contained oil, and excretion increased as the dietary oil alteration increased. Similar results were obtained for endogenous fatty acids. Increments of fecal sterols, dependent on oil alteration, could be explained by impairments in triglyceride hydrolysis and subsequent effect on cholesterol micellar solubilization. Moreover, high concentrations of poorly digestible lipids may have led to intestinal microbial modifications.


The effect of somatostatin analogue SMS 201-995 on serotonin levels in the medium of primary carcinoid cell cultures.

Carcinoid cell cultures were established from primary tumours and liver and mesenteric metastases. The cells continued to produce serotonin for up to 6 months. Cells from different tumours showed different properties. In most wells carcinoid cells grew on a layer of fibroblasts. The tendency to co-culture seemed to be less marked in cells from liver biopsy specimens. The amount of serotonin decreased to 63% 300 min after addition of the somatostatin analogue SMS 201-995 (SMS) to the culture, compared with controls (p < 0.05; n = 10). This decrease was observed up until 12 days, when SMS was added at each change of medium (p < 0.005; n = 8). In the first 10 min, however, SMS induced an increase in serotonin concentration (p < 0.005; n = 11). This effect may be related to other, immediate stimulatory effects of SMS seen in other cell lines originating from neural ridge-derived tissue. We believe it is important to elucidate the properties of individual tumours, as choice of therapy may vary between patients with the same diagnosis. We have described a method to obtain such information within a couple of days, before a definite treatment is selected.


Alkaline oesophageal reflux--an artefact due to oxygen corrosion of antimony pH electrodes.

Antimony electrodes are widely used for gastro-oesophageal pH monitoring. They are also sensitive to oxygen, however, especially at low PO2 levels, which are known to shift recorded values in the alkaline direction. This study, which compares antimony and glass electrodes for oesophageal pH monitoring in six adults, shows that values recorded by antimony electrodes are 2.1 +/- 0.8 pH units (mean +/- SD) higher than by glass electrodes (p < 0.001; n = 7642). A further 52 patients with suspected gastro-oesophageal reflux were investigated by 24-h pH monitoring by means of antimony electrodes. In these patients the oesophageal pH was higher than 8.0 for 7% of the time (range, 0-60%). The alkaline periods recorded with antimony electrodes were all protracted in time, smoothly increasing from a neutral pH, and did not correspond to a sudden increase in pH, which would be expected if alkaline reflux had occurred. It is concluded that high pH values obtained by antimony electrodes are due to the oxygen sensitivity of the electrodes. The diagnosis of alkaline reflux seems to be valid only when pH monitoring is performed with glass electrodes or when values obtained with antimony electrodes are adjusted for the influence of the oxygen tension in the oesophagus.


Normal inflammatory bowel disease mucosa conceals alterations in natural killer cell activity.

Non-major histocompatibility complex-restricted cytotoxicity or natural killer (NK) activity could be detected in all intestinal lamina propria mononuclear cell preparations of histologically normal mucosa from 57 patients with gastrointestinal disease. Similar levels of NK activity were detected among the different disease groups. Within the inflammatory bowel disease patient group, however, Crohn's disease patients showed a threefold higher level of NK activity than detected in ulcerative colitis patients. Cytotoxicity levels in Crohn's disease patients were also higher than in the control carcinoma patients, whereas ulcerative colitis patients had considerably lower cytotoxicity levels than the carcinoma patients. Thus, unaffected normal inflammatory bowel disease mucosa conceals alterations in NK activity which might occur before the inflammation. The colon adenocarcinoma cell line Caco-2 was found to be a representative target for detecting individual differences in NK activity of lamina propria mononuclear cells compared with standard K-562 targets. The latter can be of relevance when studying mucosal immunoregulatory mechanisms in intestinal disease.


Disease modification in rheumatoid arthritis with special reference to cyclosporin A.

Disease modifying antirheumatic drugs improve clinical markers of synovial inflammation as well as acute phase reactants and functional status in patients with rheumatoid arthritis. Some of the disease modifying antirheumatic drugs probably also retard radiographic progression. Data from prospective observational studies and epidemiological studies indicate a modest and temporary effect. New treatment modalities are needed, including both new strategies and new drugs. Cyclosporin A improves clinical markers of synovial inflammation and is useful for individual patients with rheumatoid arthritis. However, further studies are required to investigate the long term efficacy and tolerance of cyclosporin in rheumatoid arthritis.


Efficacy of cyclosporin A in rheumatoid arthritis: long-term follow-up data and the effect on quality of life.

Cyclosporin A is a potent immunomodulator which was used initially in organ transplantation. It has subsequently been used in the management of various autoimmune conditions. This paper is concerned with experience to date with cyclosporin A in the treatment of rheumatoid arthritis. It considers the major clinical trials, long-term experience, and the impact of cyclosporin A on quality of life.


Long-term outcome of rheumatoid arthritis.

Although developments in surgical and medical treatment methods have improved the average long-term outcome of rheumatoid arthritis (RA), it still is a severe disease. An 8-year follow-up study of patients with seropositive RA showed a large variation in the outcome. Only 24 percent of patients had no progression in the radiological destruction of the joints of hands and feet. Premature mortality seems to accumulate in patients with a poor outcome. Study of prognostic markers for RA would be of great importance.


Safety aspects of the long term cyclosporin A therapy.

The long term safety issues of cyclosporin A therapy of rheumatoid arthritis can be classified into two categories: side effects typical for the cyclosporin group of drugs and side effects due to the immunosuppression. A decrease in the renal function and elevation of the blood pressure are the main cyclosporin-related side effects. Blood pressure can be controlled in most cases by dose reduction or by antihypertensive therapy. With the current low dose strategy, a mild decrease of renal function is common but the incidence of permanent renal damage is low and the prognosis is good. Immunosuppression as such may predispose for malignancies and infections. Cyclosporin A is not mutagenic. However, it may impair the immunosurveillance for transformed cells. Data from organ transplantation suggest that immunosuppressive regimens including cyclosporin A increase the incidence of lymphoproliferative disorders and skin cancers. It is not clear whether cyclosporin A can increase the incidence of these tumors in patients with rheumatoid arthritis due to a relatively small number of patients studied thus far. Monitoring of cyclosporin A therapy of rheumatoid arthritis is simple but mandatory.


Cyclosporin A. Mode of action and effects on bone and joint tissues.

Cyclosporin A is an established immunomodulatory agent with an increasing number of clinical applications. Although its precise mechanisms of action remain elusive, one of the most important known properties of CyA is its ability to inhibit the production of cytokines involved in the regulation of T-cell activation. In particular, CyA inhibits de novo synthesis of interleukin 2(IL-2), the major cytokine involved in T-cell proliferation, as well as other cytokines, probably at the level of gene transcription, as shown by the suppression of mRNA levels in activated T-cells. Although the major actions of CyA are on T-cells, there is some evidence for possible direct effects on other cell types e.g. B-cells, macrophages and, from our own work, on bone and cartilage cells. Cyclosporin A is thought to enter cells and to bind to cyclophilins, which are members of a family of high-affinity cyclosporin A-binding proteins, now known as immunophilins. The binding of cyclosporins to such proteins appears to be closely linked to the immunosuppressive action of cyclosporins. The immunophilins possess enzyme activity, ie. peptidyl-prolyl cis-trans isomerase, also known as rotamase, which can regulate protein folding, and may therefore alter the functional state of many cell proteins. Cyclosporin A blocks peptidyl-prolyl cis-trans isomerase activity but it is not clear whether this plays a part in its selective inhibition of cytokine-gene transcription. Moreover, the ubiquitous presence of cyclophilins and immunophilins raises the question of why cyclosporin A has its apparent major effects only on T-cells. Recent proposals regarding the intracellular mode of action of CyA suggest that it interacts with cyclophilin and other regulatory proteins including calmodulin and calcineurin, which is a serine/threonine phosphatase, and thereby affects the functional state of key regulators of gene transcription in its target cells. The effects of CyA on T-cells and directly or indirectly on connective tissue cells, including bone, cartilage and synovial cells, which all can produce a range of cytokines, are of interest in relation to the tissue changes that occur in inflammatory diseases, such as rheumatoid arthritis. Thus, for example, cyclosporin A inhibits in vitro the bone resorbing activity of interleukin 1, 1,25-dihydroxy-vitamin D3, parathyroid hormone and prostaglandin E2 by apparently non-T-cell effects, while in vivo protects against bone and cartilage loss in adjuvant arthritis. More needs to be known about the direct and indirect modulation of cytokine production by cyclosporin A in connective tissues, in order to understand its potential value in clinical disorders.


Salmonella-triggered reactive arthritis.

Clinical significance of Salmonella-triggered reactive arthritis is rising, because the frequency of Salmonella infections is increasing all over the world. In this study reports on Salmonella-triggered reactive arthritis have been reviewed. A summary of clinical, epidemiological and laboratory data, as well as triggering serotypes, is presented. Diagnostic and therapeutic aspects are also discussed.


Longitudinal survey of anticardiolipin antibodies in systemic lupus erythematosus. Relationships with clinical manifestations and disease activity in an Italian series.

One hundred and two patients suffering from systemic lupus erythematosus were observed over 5-140 months. IgG and IgM anticardiolipin antibodies (aCL) were searched for by ELISA in 448 serum samples, and were found in 88 (86.3%) patients on at least one occasion. Changes of aCL levels and isotypes were recorded in most patients. In patients with medium (20-80 U. GPL and/or MPL) and high (> 80 U. GPL and/or MPL) aCL levels associations with thrombosis, neurological manifestations, cerebrovascular disease, prolonged aPTT, and thrombocytopenia were found. A highly significant statistical association was found between IgG aCL and the occurrence of active disease (p < 0.0001).


Uric acid and chronic musculoskeletal complaints.

The relation between chronic musculoskeletal complaints and serum uric acid was examined in 737 men and 771 women (40-42 years old). The study is cross-sectional and part of the National Health Screening Service county studies in Norway. Both men and women with chronic musculoskeletal complaints had significantly higher s-urate means than persons without such complaints. Moreover, the prevalence of chronic musculoskeletal complaints (gout excluded) changed significantly across increasing s-urate levels also within the normal distribution of s-urate. Multivariate logistic regression analysis showed that the s-urate odds ratio for chronic complaints rose in a linear manner across these s-urate levels (adjusted for 12 other independent variables that may interfere with uric acid). Such a relation has not to our knowledge been previously described.


Synovial fluid leukocytosis in bacterial arthritis vs. reactive arthritis and rheumatoid arthritis in the adult knee.

In this comparative analysis of laboratory data, we examined the characteristics of synovial fluid leukocytosis in eighty adult patients with bacterial arthritis, reactive arthritis or rheumatoid arthritis of the knee joint. Synovial fluid leukocyte count and the percentage of polymorphonuclear cells seemed to perform well as a discriminator between bacterial infection and acute flare of the underlying disease in patients with rheumatoid arthritis. In contrast, there were no definite difference in the intensity of synovial fluid leukocytosis between patients with bacterial arthritis caused by living bacteria and patients with reactive arthritis probably caused by bacterial antigens.


Pattern of SLE in Hong Kong Chinese: a cohort study.

One hundred and fifty six Chinese patients with Systemic Lupus Erythematosus (SLE) were studied prospectively over 50 months. The patients in the retrospective group (Group I) were diagnosed before and in the prospective group (Group II), at the time of entry into the study. The overall female to male ratio was 25:1 with mean age at onset (+/- SD) of 26 +/- 9.9 years. Neurological manifestation as the presenting feature was rare (3%), and none of the untreated patients presented with infection. Anti-nuclear antibody (ANA) was positive in 94% and anti double stranded-DNA antibody (anti DNA) 65%. New manifestations developed in 34 patients (26%) and 218 episodes of relapses occurred in 100 patients with a rate of 0.042 relapse per patient month. Five patients died during the study period with a 5 year survival of 97% and 10 year survival of 94% in the cohort. There was no significant difference in survival between Group I and Group II patients at 50 months (p = 0.72).


Postural control, muscle function and psychological factors in rheumatoid arthritis. Are there any relations?

The aim of the present study was to relate postural control, as measured on a quantitative test battery as standing balance on an AMTI force platform, to results of muscle function of the lower extremities, aerobic capacity, disease characteristics, attitudes revealing anxiety, and demographic variables in patients with rheumatoid arthritis (RA). A group of 61 patients with RA was investigated. Multiple regression analyses, using both the stepwise and the backward elimination method, were employed for length of sway path in two-leg standing looking straight ahead and blindfolded as dependent variables. The results revealed postural control in two-leg standing looking straight ahead to be highly related to age and sex but also to isokinetic endurance and to anxiety. In the model, 55% of the variance was explained by these variables at a significance level of p = 0.05. Characteristics of the RA disease, such as c-reactive protein and joint-mobility did not play any major role in explaining postural control.


Coronary risk factors in middle-aged men as related to smoking, coffee intake and physical activity.

The relationship between lifestyle and coronary risk factors in blood was investigated in 165 middle-aged men. Plasma fibrinogen, serum triacylglycerols (TG), and apolipoprotein B (apo B) were higher, and high density lipoprotein cholesterol (HDLc) lower in smokers (n = 69) than in non-smokers (n = 96). By linear regression analysis there was a significant positive association between degree of smoking and either total cholesterol (TC), apo B, or plasma fibrinogen, whereas smoking was inversely related to HDLc. Smoking and coffee intake were positively correlated with an atherogenic index, reflecting the balance between low and high density lipoproteins. Sedentary men (n = 59) had higher mean TC, apo B, and atherogenic index than physically active men (n = 104). Smokers used salt more often than non-smokers. Physically active men used vegetables more often than sedentary men. Combining several habits into a "bad habit" score gave a high level of significance for its association with TC, apo B, and the atherogenic index. The results indicate that lifestyle may influence several blood factors involved in atherosclerosis development.


Milk--a better drink? Relationships with total serum cholesterol in a cross-sectional survey. The Nordland Health Study.

Cross-sectional studies have not consistently shown a positive association between milk drinking and serum cholesterol. We studied this relationship in a cohort of 7506 men and women aged 40-42 years in the county of Nordland in northern Norway (72% of all subjects in the age-bracket living in the county). We found a positive relationship between the percentage of fat in the milk and total serum cholesterol, but no positive relationship between whole fat milk consumption (number of glasses per day) and serum cholesterol. The findings were, however, to some extent influenced by effects of present atherosclerotic disease, or perceived threat of this.


Hysterectomy among Finnish women: prevalence and women's own opinions.

This article describes the prevalence of hysterectomy, women's own opinions of it, and socioeconomic characteristics of hysterectomized women compared to non-hysterectomized ones. The questionnaire was sent in spring 1989 to 2000 45 to 64-year-old Finnish women picked randomly from the Population Census. After two reminders, 1713 (86%) had responded. One fifth of the women had had a hysterectomy and 5% had also had both ovaries removed. Among the highest educated there were less hysterectomized women than among the less educated. The largest differences in the prevalence of hysterectomy were between counties, not between socioeconomic groups. Fourty-one percent of the hysterectomized women had themselves wished hysterectomy, 25% did not have any specific opinion about the operation. Results raise further questions about clinical decision making and regional variation of hysterectomy.


Patients comment on video-recorded consultations--the "good" GP and the "bad".

The aim of this study was to describe and understand patients' positive and negative experiences of General Practitioners (GPs). Forty-six consultations were videotaped in four primary health care centres in Sweden. Afterwards the patients commented on the recorded consultations. The comments were categorized and analyzed using an exploratory qualitative approach. An image of the "good" GP emerged that had two major characteristics: that of being a caring human; an individual who listens, understands, and is concerned. At the same time, the good GP acts like an ordinary person and treats the patient as an equal. The personal relationship with the GP also influenced the choice and course of medical interventions. For the patient, the manner in which an intervention is seen is linked to whether the GPs treats the patient with respect or not. A typical experience of a "bad" GP was that the GP appeared unreachable as a person. An example is when the patient feels that the GP was not taking his or her symptoms seriously. Another characteristic of the bad GP is failure to communicate to the patient his or her standpoint on issues raised during consultations.


Ethical and professional aspects of the practice of alternative medicine.

The question of who should provide alternative medical treatment raises a number of different problems of both an ethical and a professional nature. Providing medical treatment, including alternative medical treatment, presupposes that the physician in question possesses diagnostic competence. It is in the best interests of society that medical care is safe, and therefore society must monitor the medical profession, e.g. in order to assure itself that the treatment provided is in agreement with the tenet of science and proven experience. The democratization of the patient-doctor relationship and the liberalization of the availability of medical and alternative medical treatments means that society also has an interest in ensuring that physicians offer alternative medical treatments or cooperate with practitioners of alternative medicine. A question is whether this is also of interest to the physicians? Another question touching on professional ethics is whether the doctor has the same responsibility to respect the desire of a patient to receive alternative medical treatment as he would have to respect the patient's right to forego ordinary medical treatment. These questions are analysed here against the background of the perspective of the relevant interest groups and are graded with regard to the disease and treatment concerned, how far the disease has advanced, the age of the patient, and whether or not the patient is competent to make his own decisions. These considerations are relevant in a discussion of who is qualified to provide or prescribe alternative medical treatment. This study points out that the individual physician should have the possibility to compromise and improvise from case to case.(ABSTRACT TRUNCATED AT 250 WORDS)


Extremely low birth weight infants less than 901 g. Impact on the family during the first year.

In a longterm prospective study 20 extremely low birth weight (ELBW) infants with birth weight between 500 and 900 g (mean 755 +/- 109 g) and gestational age between 24 and 30 weeks (mean 26.2 +/- 1.8 w) were compared with 20 fullterm infants. This part of the study focuses on the impact on the family. Structured parental interviews were conducted in the postnatal period and at the end of the first year concerning the pregnancy, the delivery and the infant's health and behaviour during the first year of life. Questions about the parents' and siblings' reactions, physical symptoms and the strains on the husband-wife relationship were also asked. It was found that the mothers of the ELBW infants had more fertility problems, more physical symptoms during the pregnancy and the infant's first year of life. The birth of an ELBW infant caused crisis reactions in 85% of the mothers and 65% of the fathers. Fifty-eight per cent of the ELBW parents and 21% of the parents in the control group reported that the stress during the infant's first year had led to strains on the husband-wife relationship. It is evident that the birth of an ELBW infant had an impact on the whole family. However, we found no relationship between permanent neurological injuries in the infant and strong reactions in the family members. On the other hand, the parental relationship in the perinatal period seems to be of significance, as does the length of time the infant was hospitalized during its first year of life.


The epidemiology of sick leave in an urban population in Malmö, Sweden.

The epidemiology of sick leave was studied in the city of Malmö, Sweden, (230,000 inhabitants). Every current and completed sick-leave episode during the year of 1985 was collected for 124,411 persons aged 16 to 65, who were registered with the National Health insurance scheme in 1985. Absence rate, absence incidence, absence prevalence and absence duration were analyzed in relation to age, sex, marital status, nationality, income and place of residence. Absence rate (mean value) in the total population was 25.5 days with a median of three days. The absence rate increased by age. High absence rates were seen for females, single people and some immigrant groups. This was even true for residential areas characterized by a higher proportion of single-person households and households on social welfare, of unemployed and people with a low income and a foreign background. The absence rate gives limited information as to the epidemiology of sick leave. Through adding absence incidence, absence prevalence and absence duration it was possible to get a more comprehensive picture of the phenomenon. Sex-differences in absence rate for instance were mainly explained by differences in absence incidence and prevalence, while differences in absence rate regarding nationality were explained by differences in absence duration. This is an important step towards a better understanding of the factors behind sick leave.


Creating partnership with the food industry in the Stockholm cancer prevention program.

To facilitate the supply of healthful foods in institutional kitchens and restaurants, the Stockholm Cancer Prevention Program (SCPP) produced a cookbook in collaboration with the food industry and the SCPP. Fifty different organizations participated in this work. The development of the cookbook was made in several steps and started with a recipe contest to engage chefs and employees in restaurants and institutional kitchens. Criteria for the recipes were that they should present low-fat/high-fiber meals. Complementary recipes were received from the food industry. All recipes were tested in 20 restaurants and institutional kitchens and 11,000 lunch guests assessed the palatability of the dishes. The cookbook was presented in conjunction with a food fair in 1989 and has until now been sold in about 4,000 copies. Production of a cookbook can thus be a focal point for involving food industry, restaurants and institutional kitchens in a community intervention program aiming at a change of dietary habits.


Aspects of comfort and safety of condom. A study of two thousand intercourses among volunteer couples.

In nearly 2,000 intercourses 14 different types of condoms were tested by 80 heterosexual and seven homosexual volunteer couples. The test couples were generally quite experienced in the use of condoms. It appears that the condoms rarely (1.3%) ruptured or slipped off during the actual intercourse. This means that emphasis must be put on consistency and skill in the use of condoms rather on technical improvements in the promotion of condoms as a means of preventing the spread of sexually transmitted infections like HIV. Lubricated condoms and condoms that were not too small were preferred by both users and their partners. Other condom properties were significant but of minor concern for the participants of the study.


Cancer mortality of Swiss men by occupation, 1979-1982.

Results of a study of male cancer mortality are presented by occupation. The data base consisted of the 1979-1982 mortality register and 1980 census data from Switzerland. In a novel approach, a linked subset of death certificates and census records was used to correct the numerator-denominator bias of standardized mortality ratios and their confidence intervals. Agricultural occupations exhibited low cancer mortality (exception: stomach cancer). Electricians suffered excess mortality from cancer of several sites. Foundry and chemical workers had elevated mortality risks for digestive tract cancers. Other metal workers suffered from high mortality from cancers of the respiratory organs. Construction workers were subject to high mortality from cancers of the upper digestive tract and lungs. Innkeepers, cooks, and owners or managers of guest houses had high rates of cancers of the digestive system. Occupations using combustion-powered equipment suffered from excess lung cancer mortality. In general the results of the study agree with those of several other studies.


[Internal medicine today--and tomorrow?].

Internal medicine has recently undergone major changes, which have created--among others--4 feelings of alienation among physicians: first, the internist--initially an observer of clinical signs, and later laboratory-assisted--has now become operator-assisted with modern technology in imaging and other technologies assisting him by giving him not the essence, but the interpretation of the gathered information; second, the dialogue between basic biomedical research and the bedside clinician has been interrupted by the creation of a new language in molecular genetics, to which he has no access any more; third, modern biotechnology is rapidly creating an unlimited number of new biological therapeutic modalities, giving the internist too many therapeutic options which he can no longer master. Fourth, the formerly direct, bipolar relationship between patient and physician has been extended to a triangular relationship between patient, physician and an institution (hospital administration, public health authority, health insurance). In order to solve these problems, internal medicine has several options. First, maintaining the dialogue in research across subspecialties by creating a group of full time clinical investigators, with training in basic molecular and cellular biology, who can be the interface between modern molecular genetics and clinical internal medicine; and second, developing new clinical investigators to evaluate our diagnostic and therapeutic strategies with a logical and scientific methodology: patient care analysis, health care research, medical outcome evaluation and quality assessment are all disciplines which will link the various fields of internal medicine into a tight network. To do this, the Swiss Society of Internal Medicine has to modify its structures, to become a scientific and a professional organization, cognizant of the evolution of medicine within the European scene.


[Does routine ultrasonography of the abdominal organs affect the subsequent management of the patient?].

When abdominal ultrasound is performed it is general practice to examine not only the organs needed to answer the clinician's question but also the remaining abdominal and pelvic organs for which there is no clinical indication (= routine examinations). We investigated the effect of these routine examinations on the further management in 533 medical outpatients (222 women; 311 men; age 45 +/- 16 years). Of 7684 organs examined, 6194 (81%) were routine examinations, 469 of which revealed unexpected abnormalities. Only 19 of these were considered clinically relevant enough to warrant further work-up, and long-term follow-up was regarded as necessary in 6 patients only. However, an abnormal finding on routine examination had no eventual therapeutic implications in any patient. We conclude that in middle-aged medical outpatients it is sufficient to perform sonography on those abdominal and pelvic organs which need to be examined to answer the clinician's questions. Failure to routinely examine the remaining organs does not lead to a relevant loss of information, but may save time and money on fruitless work-up of unexpected findings.


[Use of conventional and complementary medical care in patients with chronic non-cancerous pain].

The use of medical care was surveyed among 157 chronic pain patients. Half of them had consulted more than 6 and up to 17 specialists in "conventional" medicine for their pain problem. Moreover, 46% had used "complementary" medicine. They had tried many different "alternative" therapies in 40% of the cases. The users of "complementary" medicine, mostly females, also sought care from a significantly higher number of "conventional" therapists, had more physiotherapy, took drugs more frequently and had tried a larger number of different medications, even though their pain characteristics were similar to those of the other patients studied. Interestingly, they remained significantly more active professionally than patients who had never used "complementary" medicine. These characteristics could be attributed to a more active manner of coping with chronic pain.


[How does oligo- en asymptomatic non-tropical sprue present itself?].

According to the computerized ICD registration, 20 new cases of non-tropical sprue were detected in our outpatient clinic between 1979 and 1990. 8 of these patients had an oligo- or asymptomatic form of this disease (40%). The clinical presentation and spectrum of abnormal laboratory findings in these 8 cases are described in detail. It is concluded that laboratory parameters indicating malabsorption, especially hematologic changes, are helpful for the detection of the oligo- and asymptomatic form of non-tropical sprue, and that, in cases with undetermined anemia, this form of sprue must be considered in etiologic differential diagnosis. Finally, it seems advisable to perform a biopsy as a routine procedure during endoscopy in cases with unclear anemia.


[Blood pressure measurement during tachyarhythmia: validation of a graduated measuring technique with an intra-arterial technique].

Use of the usual technique to measure blood pressure is known to be unsatisfactory in tachyarrhythmia. An easy and non-invasive technique, called the stage by stage method, has therefore been proposed. The aim of the present study is to verify the precision of this method by comparison with intraarterial measurements. The study was performed in 9 tachyarrhythmic patients with heart rate over 90/min and wide systolic pulse amplitude variations. For systolic pressure, the results show an excellent correlation between the blood pressure values obtained by the stage by stage method and those obtained by intraarterial measurements (r = 0.99; p > 0.01). For diastolic pressure, the best practical approximation is the value of the last stage before all sounds have disappeared plus 5 mm Hg. We conclude that the bedside stage by method is worth performing in patients presenting with tachyarrhythmia and wide systolic pressure variations from one systole to the other.


[Evaluation of TSH suppression using a 3d-generation TSH assay: diagnostic and therapeutic consequences].

We measured basal and TRH-stimulated TSH values with a 3rd generation assay in patients under suppressive thyroxine (T4) therapy for thyroid carcinoma or goiter and in patients with overt hyperthyroidism. All hyperthyroid patients had undetectable basal TSH levels (< 0.01 mU/l). In patients on suppressive T4 treatment basal TSH values were undetectable in 37.5% (= group A) and measurable in the intermediate range of 0.01-0.05 mU/l in 62.5% (= group B). After TRH administration there was no TSH increase in the hyperthyroid patients (< 0.01 mU/l in 100%). T4-treated patients of group A showed no relevant TSH stimulation in 58% (peak < or = 0.05 mU/l = total TSH suppression). An increase of > 0.05 mU/l could be measured in 42% of group A and 100% of group B (= subtotal TSH suppression). Many of these TSH values measured by a 3rd generation assay are in the undetectable range for most of the commercially available 2nd generation assays (< 0.10 mU/l). TSH assay of the 3rd generation decisively improves the diagnosis of hyperthyroidism and probably also borderline hyperthyroidism. Against the background of increased risk of osteoporosis and cardiac function disorders as a result of suppressive T4 treatment, our results suggest the following practical therapeutic guidelines: total TSH suppression with the risk of iatrogenic hyperthyroidism should be confined to high risk patients (eg with metastatic thyroid cancer). Where the risk is low, however (thyroid cancer with favourable prognosis, goiter, goiter prophylaxis), only subtotal TSH suppression is indicated.


[Acquired factor V inhibitor treated with intravenous immunoglobulins].

We report the appearance of a factor V inhibitor in an 82-year-old female patient following abdominal surgery. This anomaly was totally corrected following 9-day treatment with i.v. immunoglobulins (0.4 g/kg/day), which allowed a needed further surgical intervention to be performed without hemorrhagic diathesis. The activity of this inhibitor was partly reversed by the in vitro addition of immunoglobulins, suggesting a concentration-effect relationship. This finding supports the hypothesis that anti-idiotypic antibodies could play a role in the therapeutic effect of immunoglobulins in such situations.


[The value of anticardiolipin antibody assessment].

Anticardiolipin antibodies (ACL) are associated with the presence of several clinical conditions. To determine the clinical interest of their evaluation, we reviewed all the results of ACL determinations performed in our laboratory during 1990 and 1991. 266 analyses (232 patients) were carried out. Determinations of IgG and IgM type ACL were performed by ELISA. ACL values were positive or slightly positive in 40% of the analyzed samples. Diagnosis was mentioned as the grounds for 212 requests (186 patients). ACL were positive (> m + 3SD) in about 40% of patients with autoimmune disease or with at least two of the following pathologies: autoimmune disease, venous or arterial thromboembolism, recurrent abortion.


[Stress-induced bundle-branch block].

We present two patients with exercise-induced bundle branch block (BBB), in which coronary heart disease could not be diagnosed by noninvasive techniques. Exercise-induced BBB (right BBB more than left BBB) is strongly associated with and requires intensive search for coronary heart disease.


[Diagnostic value of autoantibodies against microsomal thyroid peroxidase (anti-TPO)].

With the identification of thyroid peroxidase (TPO) as the main antigen of the thyroid microsomal fraction, the development of a sensitive and specific assay for detection of these antibodies became possible. The diagnostic value of the anti-TPO assay was evaluated in patients with different types of thyroid disease and in controls. 65% of patients with thyroiditis had elevated anti-TPO values. The frequency of elevated anti-TPO levels in patients with active autoimmune thyroiditis was 90% (clinical diagnosis Hashimoto thyroiditis) compared to 64% in patients with overt hyperthyroidism (clinical diagnosis Graves' disease). None of the controls or the patient with non-thyroidal illness showed elevated anti-TPO levels.


[Dry chemistry in the clinical laboratory: how reliable is it?].

The performance of dry chemistry analysis systems was evaluated using the results obtained from proficiency testing 1991 of practitioner's laboratories. 59% of the participants use dry chemistry (Ektachem DT 60 Kodak, Reflotron Boehringer, Cobas Ready Roche). The evaluation reveals the following: The declared values of the control sera for the dry chemistry systems agree well with those of the conventional wet chemistry, excepting enzyme assays. The precision of the dry chemistry parameters is substantially higher than that of the wet chemistry. The overall performance of the dry chemistry analysis systems was found to be superior as compared to the wet chemistry performance. A prerequisite for dry chemistry proficiency testing are control sera of human origin.


Influence of a new experimental bonding agent on marginal seal of Class V restorations: an in-vitro study.

The performance of a new experimental dentin bonding agent (A.R.T. Bond) was evaluated in vitro. Its influence on the marginal seal of mixed class V restorations made on freshly extracted third molars, using 7 different restoration techniques was studied. When using the new dentin bonding agent, the results of the dye penetration test revealed the least dentinal leakage with the direct inlay technique. Dye penetration scores of bulk and incrementally placed restorations were higher, but not significantly different from the direct inlay. The absence of the dentin bonding agent in incrementally placed restorations resulted in significantly higher leakage values.


[The modification of the polymerization of composite materials by eugenol-containing temporary fillings].

The objective of this study was to evaluate the influence of eugenol-containing temporary fillings on the polymerisation of composite materials. Cavities of 2 mm in diameter and 2 mm in depth were prepared in enamel as well as in dentine. Immediately after preparation the cavities of the control group were filled with a light curing composite, a chemical curing composite, or a light and chemical curing composite. The cavities of the experimental group were filled with Nobetec (temporary filling material containing zinc-oxide-eugenol). After six weeks, the Nobetec fillings were removed by means of an excavator, the cavities were cleaned with water and filled with one of the above six composites. The specimens were embedded in Epofix and afterwards cut through the center of the filling. The cut surfaces were polished to 3 microns and afterwards (> 4 days) the hardness was measured with a Knoop hardness testing machine at different distances from the cavity wall. The results of the control group and of the experimental group were compared statistically. The polymerisation of five of the six materials was not inhibited by a temporary filling material containing zinc-oxide-eugenol. The difference in hardness for Brilliant Lux (light curing) was fer-highly significant (p < 0.001) between 0 micron and 100 microns from the cavity margin, if the cavity was first filled with a temporary filling material, containing zinc-oxide-eugenol. The results show that there exist certain composite filling materials that are inhibited in their polymerisation by the tested eugenol containing temporary filling material.


[The abrasion resistance of plastic teeth--an in-vitro study].

Resistance against abrasion of premolar plastic teeth on their chewing surfaces was determined using an in vitro test method which approximately simulated oral conditions, as well as contact between antagonists, chewing pressure, biting pressure and chewing motion. The humpy surface of commercially manufactured teeth was levelled by grinding, using the abrasion test machine itself, which resulted in two little plain surfaces. After measuring the size of these surfaces, wear due to abrasion was determined by loss of weight. The commercial products showed different resistances against abrasion, the teeth of Dens-Nobilis and Vitapan, which contain amorphous silica, appeared to be more resistant against abrasion than IPN (Artiplus) and PMMA (Keracryl-7, Planustar, SR-Orthotyp-PE) teeth. Unexpectedly, IPN teeth did not show a higher resistance against abrasion than the PMMA teeth, which were tested in this investigation. Only SR-Orthotyp-PE were significantly worse. Under the prevailing test conditions SR-Orthosit-PE teeth are very little resistant against abrasion, although they contain amorphous silica. Investigations with a raster electron microscope revealed that they are too brittle.


[The effect of the motivation of a tracing device in the hygiene phase of PA treatment].

In a clinical comparative study the effectiveness of an oral hygiene motivation tool (Parograph) was evaluated. 100 patients with periodontal diseases got oral hygiene instructions with the classic clinical methods (brush-techniques) and the motivation tool. As a result, only the patients with higher plaque index showed a faster significant reduction of plaque index when motivation tool was used. The comparison between other indices used were statistically not significant.


[The effect of beverage composition and gastrointestinal function on fluid and nutrient availability during physical exertion: e review].

Intensive exercise affects digestion and absorption. Nevertheless, athletes involved in intensive endurance exercise are advised to ingest fluid and energy supplying nutrients, to compensate for the losses and to delay fatigue. The present review describes the effects of exercise on the gastrointestinal tract and the aspects which determine optimal fluid and nutrient delivery during exercise in different climatological and exercise conditions.


[Anterior cruciate lesions and the protective components of ski bindings].

Serious internal injuries of the knee make up today for the main share of alpine skiing casualties. As well the frequency of such mishaps, as the type of injury and the analysis of how the events happen to unfold, make obvious the requirement for a better protection of the knee joint, and more specifically, of the anterior cruciate ligament. The main role in this regard falls to the ski binding systems. To this end, adding a back fall release trigger, in introducing a vertical elasticity component, may be adequate to avoid the peak strength impulse which acts on the anterior cruciate ligament during an unprotected fall backwards.


[Requirements and risk profile of soccer-playing children. Orthopedic aspects].

Although the rate of injuries in soccer is high, this sport puts children only at moderate risk of getting injured. In younger children this risk is very low but the number and severity of injuries increases with puberty. The most common cause for injuries is a collision with another player, the most common injury is distortion of the talocrural joint. Playing soccer indoors is more dangerous than playing outdoors. The danger of accidents and injuries can be reduced by preventive measures, such as weight categories in children leagues.


[Study of the type of physical effort exerted by competition in Supercross].

The authors draw up a tentative account of the physiological load a pilot bears during a Supercross event. Examination of heart frequency and blood lactate concentration curves during a series of races shows that this sport is not only highly stressful, but demands by the same token a muscular effort which has to be taken into account. Muscular work is of the mixed type, both aerobic and anaerobic, the share of the latter being of moderate importance, as it depends mainly on the technical proficiency of the driver.


Chrysaora hysoscella in the Gulf of Trieste: presence, evolution and cutaneous toxicity in man.

In the past few years important changes in the occurrence of scyphomedusae have been observed in the North Adriatic Sea and in particular in the Gulf of Trieste, often reaching alarming proportions. Spring coastal blooms of C. hysoscella were observed in 1989. Until 1989, this jellyfish was considered to be innocuous but the data presented show its cutaneous toxicity in man.


Eutrophication, marine biotoxins, human health.

Eutrophication phenomena in marine coastal waters can today be explained on the basis of natural or anthropogenic causes. Undesirable effects and also sanitary problems in both types of eutrophication are often produced, but they may differ greatly in frequency and significance. Some algal biotoxins can affect both marine animals and man, whilst others affect man alone. From data currently available it appears that the sanitary state of man can be affected through the digestive, respiratory and cutaneous apparatus. Four main dinoflagellate biointoxications are now recognized: paralytic shellfish poisoning (PSP), neurotoxic shellfish poisoning (NSP), diarrhoetic shellfish poisoning (DSP), and venerupin poisoning. Other biointoxications are due to a diatom bloom responsible for amnesic shellfish poisoning (ASP) and to blue algae blooms which have effects on the skin and the respiratory tract. All these marine toxins are considered and particular attention is paid to: producing organisms, chemistry of the components, compromised sea foods, methods of analysis, occurrence worldwide, human intoxications, toxicology and mechanism of action on a molecular level, therapeutical notes, tolerance levels and remarks on safety. Attention is also paid to the relationship between the anthropogenic eutrophication and PSP and DSP since these are the most widespread biointoxications from toxic marine dinoflagellates in the world today and for which the European Economic Community (EEC) is proposing health legislation such as tolerance limits and methods for official analysis. In view of the harmful potential of coastal anthropogenic eutrophication, the main current committment of various countries concerns control. Finally, it is important to develop a suitable monitor research system using all the specific standards of allowed toxic substances, and also research on effective antiodotes against all biotoxins.


[Home accidents in children less than 10 years of age: causes and consequences].

A case-control study was carried out, aimed at identifying and defining the individual, family, household and childcare social support network characteristics, more likely to be associated with the occurrence of accidental home injuries in 0-9 year-old children. This study was carried out in the emergency units of three pediatric hospitals in the Federal District. In this article we report the results of the descriptive analysis only of the cases. The results were as follows: male children (62%) and the one and two year-old children group (37%) were the most affected. Contusions, head injuries and fractures occupied the first three places, the main three causes being falls from one level to another (mainly in stairways and off the bed) falls on the same level (sliding, tripping or stumbling) and burns with boiling liquids (most frequently boiling water for bathing). A history of injuries was documented in only 15% of cases. Thirty nine percent of cases requested medical attention after one hour of the accident; 51% of these were hospitalized. In 25% of cases, the mother worked outside the home, being absent from 6 to 12 hours. Risk factors occurring most frequently were: unprotected electricity inlets (40%); products within reach of children: cleaning products (38%), makeup products (34%), plastic bags (30%) and tools (30%); lack of protection rails for cradles (30%) and for staircases (48%), and free access to roofs (44%). In 62 percent of cases some care was provided in the house of the injured child; twenty six percent counted on a support network, and 3 percent were by themselves. We present some proposals for epidemiologic and health services research, and stress the necessity to implement health education, social security and health services policies to favorably influence the solution of these problems.


[Equality in medical education policy in Mexico].

We compared the results of the educational policies of public versus private medical schools and traditional versus module-based medical programs. The comparison centers on the political value of equality. The hypotheses are the following: a) Public and module-based schools offer more equality of opportunities for enrollment, permanence and graduation of students than private and traditional schools; b) medical schools maintain their educational policies over time. The value of equality was operationalized with the Equality Index (EI). To test the proposed hypotheses we used Wilcoxon's rank sum test and Mann-Whitney "U" test. We studied an intentional sample of 21 medical school in Mexico. The median of the EI for public schools between 1980 to 1989 was 4; 2 for private schools, 2 for traditional schools, and 3 for module-based schools. The only significant difference found was that between public and private schools (p < 0.05). We conclude that in public schools there is more equality of opportunities than in private ones. The results are consistent during the decade of the 80's.


Cockayne's syndrome fibroblasts are characterized by hypersensitivity to deoxyguanosine and abnormal DNA precursor pool metabolism in response to deoxyguanosine or ultraviolet light.

New cellular traits of Cockayne's syndrome (CS) associated with DNA precursor metabolism have been identified, namely, hypersensitivity to the toxicity of low concentrations of deoxyguanosine (dG) and abnormal changes in deoxyribonucleotide (dNTP) pools in response to dG or UV. dG treatment results in similar ribonucleotide pool changes in wild-type and CS cells, i.e., GTP levels increase at least twofold. However, the changes in the pool size of the purine deoxyribonucleotides are significantly different; in wild-type cells dATP and dGTP pools increase threefold, but remain unchanged in CS. The mechanism by which dG kills CS cells is not clear, but unlike the inherited purine nucleoside phosphorylase deficiency disease, the toxicity of dG is not due to the accumulation of dGTP and the consequent feedback inhibition of ribonucleotide reductase. UV induces different dNTP pool changes in CS and wild-type cells. In wild-type cells dTTP, dCTP, and dATP pools increase three- to fivefold within 4 h of irradiation, while the dGTP pool contracts. In CS cells, only the dGTP pool expands (four- to sixfold), while the other three contract. Each of these new phenotypic traits, together with UV sensitivity, is coordinately corrected in the complementing proliferating CSA x CSB hybrid cells.


[Organization and functioning of health services of the IMSS-Solidaridad program].

In this report the organization and performance of the IMSS-Solidaridad Program of Mexico is described. This program is managed by the Mexican Institute for Social Security, which services 10.5 million inhabitants of the rural underserved areas, with federal government resources in 18 states. This study compares the structure and functioning of the IMSS-Solidaridad Program with Local Health Systems, as they have been proposed by the Panamerican Health Organization for country members and by the Ministry of Health of Mexico, particularly in relation to the decision-making process at local level. Some assets and limitations of the IMSS-Solidaridad Program are analyzed and, finally, concrete procedures to improve coordination between the IMSS-Solidaridad Program and other health services for similar populations (populations without social security protection) in Mexico are suggested, with the purpose of using resources more adequately and succeed in the national goal to achieve equity in health.


[Infant nutrition in Mexico and its relationship with the utilization of maternal health services].

In addition to describing recent infant feeding patterns in Mexico, this paper attempts to answer the following questions: what are the mechanisms through which the socioeconomic level affects both infant feeding and the utilization of maternal and child health care practices? b) what is the effect of the socioeconomic level on the relationship between utilization of services and infant feeding practices? The research is based on bivariate and stratified analyses of the ENFES (1987) information. The data obtained prove that: a) even when there is a relationship between socioeconomic factors and, the utilization of services and feeding practices, the social dimension affects differently each of the two variables; b) there is a relationship between the utilization of services and infant feeding; and c) this relationship is explained, in part, by the association of both variables with socioeconomic factors. Operative strategies are proposed for the health services, as well as technical guidelines for future research in this field.