[Comparative clinical study of a new imidazole molecule (fluconazole) and ketaconazole in the treatment of Candida albicans vulvovaginitis].

A multicentre trial was carried out in Italy with the aim of comparing the efficacy, safety and tolerability of the oral administration of fluconazole with the oral administration of ketoconazole in the treatment of patients affected by Candida vulvovaginitis. A total of 174 patients with symptomatic Candida vulvovaginitis were identified both by objective examination and cell culture tests: of these 87 were treated using a single oral administration of fluconazole (150 mg) whereas the other 87 received 2 200 mg capsules of ketoconazole daily for 5 days. Tests to assess the efficacy, safety and tolerability of both treatments were carried out approximately 7 days and 5-6 weeks from the start of therapy. The results obtained showed a success rate of 92% for fluconazole-treated patients and 83% for those treated with ketoconazole. In addition to the rapid and safe efficacy of treatment, the most important findings which emerged from this study were the extreme simplicity of use, excellent patient compliance and the complete absence of collateral effects of variations in the hematochemical and urine parameters taken into consideration caused by fluconazole.


[Preventive and therapeutic use of cefriaxon in gynecologic surgery].

The Authors have been investigating the behaviour of ceftriaxone in gynecological surgery employing 1 g of the drug through intravenous injection an hour before the operation, after executing a cutaneous pomphus the night before. They obtained satisfactory results since out of 25 cases analyzed nowhere had they to intervene with other antibiotics. The drug, despite the 15 cases of infectious pathology observed, has been showing great tolerance and an utmost ease and usefulness of usage.


[Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case].

The incidence of splenic metastasis, revealed during autopsy, from solid tumours varies from 1.6% to 30% with a mean of 7%. The clinical observation of splenic metastasis in patients with carcinoma of the exocervix is only occasionally reported. In the majority of cases metastasis appears 4 or 5 years after the onset of disease. The case reported here is the only example we have found in the literature relating to an adenocarcinoma of the uterine cervix which led to an isolated splenic metastasis. A 47-years-old patient underwent radical hysterectomy according to Meigs due to a stage 1B N0 G2 endocervical adenocarcinoma. The patient was subsequently reoperated due to pelvic recurrence and received radiotherapy. Almost five years after the first operation CT showed a suspected isolate splenic recidivation following pain in the left side. Hepatosplenic scintigraphy confirmed the presence of a large central cold area, with blurred edges, suggesting metastasis. The patient again underwent laparotomy: the volume of the spleen was found to be increased with the splenic hilum covered with neoplastic tissue. Splenectomy was performed. Abdomino-pelvic and retroperitoneal inspection showed no further signs of metastasis. Histological tests confirmed the massive metastasis of the adenocarcinoma in splenic parenchymal tissue which was relatively differentiated with a clear cell appearance. Seven months later the patient was again operated following intestinal occlusion due to numerous entero-enteric adhesions. During the course of surgery a micronodule was removed from the cholecystic serosa, apparently composed of fibrin; histological analysis proved that this micronodule was the site of glandular micrometastasis. The patient then began three cycles of chemotherapy with Adriamycin (60 mg/m2).(ABSTRACT TRUNCATED AT 250 WORDS)


Post cardiac arrest hyperoxic resuscitation enhances neuronal vulnerability of the respiratory rhythm generator and some brainstem and spinal cord neuronal pools in the dog.

Selective neuronal vulnerability of the motor cortex, basal ganglia, brainstem, medulla, cerebellum, C6 and L6 segments of the spinal cord were studied after 15 min of cardiac arrest followed by 1 h of normoxic or hyperoxic resuscitation using the suppressive Nauta method in dogs. Hyperoxic resuscitation causes characteristic somatodendritic argyrophilia of the interneuronal pool in the spinal cord and lower medulla. Cuneate, lateral reticular, supraspinal, and caudal trigeminal nuclei as well as the dorsal and ventral respiratory neuronal groups were heavily involved. Similarly, the Purkinje cells, neurons in the middle and deep portions of the mesencephalic tectum, perirubral, pretectal, posterior commissure, middle-sized striatal and giant pyramidal (Betz's) neurons in the motor cortex became argyrophilic. Hyperoxic resuscitation versus normoxic resuscitation causes statistically significant somatodendritic argyrophilia of the dorsal respiratory group, cuneate, dorsal lateral geniculate and thalamic reticular nuclei.


Regional accumulation of amyloid beta/A4 protein precursor in the gerbil brain following transient cerebral ischemia.

Alterations of beta/A4 amyloid protein precursor (APP) were investigated immunohistochemically in the gerbil brain after transient global ischemia and subsequent reperfusion. Marked accumulation of this protein peaking at 24 h occurred in the neurons of the CA3 and paramedian region of the hippocampus as well as layers III, V and VI of the cerebral cortex. On the contrary, the accumulation was not observed in the neurons of the CA1 region. These results indicate that distribution of APP is altered depending on tissue viabilities after cerebral ischemia.


NG-nitro-L-arginine enhances neuronal death following transient forebrain ischemia in gerbils.

Experiments were performed with Mongolian gerbils to study the effect of the specific nitric oxide (NO) synthase inhibitor NG-nitro-L-arginine (L-NNA) on ischemic brain damage induced by 5 min bilateral carotid occlusion. A single i.p. injection of L-NNA did not result in any neuronal loss in the central nervous system. In animals undergoing ischemia, a selective destruction of hippocampal CA1 cells was observed whereas pretreatment with 50 mg/kg L-NNA 4 h before administration of ischemia produced significantly more extensive cell damage in the hippocampus and other brain regions. These findings demonstrate that in this model inhibition of nitric oxide generation augments ischemia-induced neuronal cell injury in the brain.


Antinociception from the administration of beta-endorphin into the periaqueductal gray of rat is enhanced while that of morphine is inhibited by barbiturate anesthesia.

Pentobarbital anesthesia causes about a 10-fold increase in the antinociceptive potency of beta-endorphin microinjected into the periaqueductal gray (PAG) region of the rat brain. The antinociceptive response to PAG morphine was markedly attenuated during anesthesia, but returned as the rats regained consciousness. As they recovered from anesthesia, muscular rigidity and body stiffness (catalepsy) also occurred in the pentobarbital treated animals receiving morphine. These results are consistent with the activation of separate and distinct descending pain inhibitory neuronal systems by these two opioid agonists, and the differential modulation of the systems by pentobarbital. They also suggest that the mechanism underlying muscular responses to morphine is sensitive to pentobarbital, and is not shared by beta-endorphin.


Thrombin accumulation in brains of patients with Alzheimer's disease.

Thrombin was detected immunohistochemically in brain tissue of Alzheimer's disease (AD) patients and age-matched controls. Positive staining was restricted to vessels and residual plasma in controls but was also present in senile plaques, some diffuse amyloid deposits and neurofibrillary tangles in AD. Positive staining was abolished by absorption of antibody with purified human thrombin but not by absorption with prothrombin. The data suggest that thrombin formation from prothrombin probably takes place in AD brain.


Circadian variation of [3H]dopamine handling in adrenal chromaffin cells of mice.

Circadian variation of exogenous [3H]dopamine handling by adrenal chromaffin cells was examined using mice habituated to 08.00-20.00 h light cycle. Experiments were carried out at 00.00, 06.00, 12.00 and 18.00 h. [3H]Dopamine-derived radioactivity reached a peak at 2 min then decreased rapidly except at 18.00 h, when no particular peak was observed at 2 min but at 30 min in both intact and denervated adrenals. In intact adrenals, the 2-min peak at 06.00 h was suppressed by corticosterone while in denervated adrenals the 2-min peak remained. The present result indicates that quick turnover of [3H]dopamine was suppressed by a steroid surge at about 2 h before light to dark alteration. Normal innervation is necessary for corticosterone-induced suppression.


Calretinin-immunoreactivity in the oro-facial and pharyngeal regions of the rat.

Calretinin-immunoreactivity (CR-ir) was examined in the rat oro-facial and pharyngeal tissues using an immunofluorescence method. CR-ir was distributed in the entire size range of trigeminal ganglion neurons. CR-ir was also observed in nerve fibers surrounding neuronal cell bodies in autonomic ganglia, and in nerve endings in the lip, tongue, incisal papilla, soft palate, pharynx and epiglottis. CR-immunoreactive nerve endings were all in close proximity to the epithelium, and classified into 2 types; simple (free nerve ending) and taste-bud-related types. In the salivary gland, positive nerve fibers were seen around large excretory ducts. The present study indicates that viscerosensory (probably including gustatory) nerve fibers innervating the oral and pharyngeal tissues contain CR, while somotosensory nerve fibers innervating the facial skin are devoid of CR.


Testosterone: a role in the development of brain asymmetry in the chick.

The visual projections from the thalamus to the Wulst of the chick forebrain are asymmetrically organized. The development of this asymmetry is dependent on light stimulation just prior to hatching, and it is present to a greater extent in males than in females. We have shown that administration of testosterone to the developing embryo alters the development of the asymmetry of the projections in both sexes. Following testosterone treatment, the asymmetry normally present in male chicks after hatching was marginally reversed in direction, and that normally present in females was no longer present. Thus the development of these visual projections depends on the interaction of light stimulation and the level of circulating testosterone.


Regional response differences within the human auditory cortex when listening to words.

The relationship between activity within the human auditory cortices and the presentation rate of heard words was investigated by measuring changes in regional cerebral blood flow with positron emission tomography. We demonstrate that in the primary auditory cortices and middle regions of the superior temporal gyri there is a linear relationship between the rate of presentation of heard words and blood flow response. In contrast, the blood flow response in an area of the left posterior superior temporal gyrus (Wernicke's area) is primarily dependent on the occurrence of words irrespective of their rate of presentation. The primary auditory cortices are associated with the early processing of complex acoustic signals whereas Wernicke's area is associated with the comprehension of heard words. This study demonstrates for the first time that time dependent sensory signals (heard words) detected in the primary auditory cortices are transformed into a time invariant output which is channelled to a functionally specialised region--Wernicke's area. Wernicke's area is therefore distinguished from other areas of the auditory cortex by direct observation of signal transformation rather than by association with a specific behavioural task.


Event-related potentials reveal how non-attended complex sound patterns are represented by the human brain.

Event-related potentials (ERPs) to complex auditory sound patterns consisting of eight 50-ms segments differing in frequency were recorded from the human scalp while the subject was performing a visual search task. Randomly occurring frequency changes of single segments elicited a 'mismatch negativity' although the subjects were not attending to the auditory stimuli. This negative deflection in the ERP waveform elicited by the changed pattern compared with the ERP waveform elicited by the standard pattern is consistent with the hypothesis that the spectro-temporal features of complex sound patterns are automatically and precisely represented in passive auditory sensory memory. The finding that an easily discriminable change, that is, a change with a high discrimination performance measured in a separate condition, elicited a larger mismatch negativity than a poorly discriminable change suggests that discrimination is based on these representations.


Potentiation of quinolinate-induced hippocampal lesions by inhibition of NO synthesis.

Low doses of quinolinic acid (QUIN) administered intracerebroventricularly (ICV) to rats produced either no damage or mild to moderate damage in the pyramidal cell layer of the hippocampus and resulted in mild, limbic seizures in the majority of animals treated. The same dose of QUIN following ICV pretreatment with the nitric oxide synthase inhibitor N-nitro-L-arginine (NARG), produced extensive hippocampal lesions with complete loss of the pyramidal layer in 50% of the animals, and moderate damage with total neuronal loss in areas CA1 and CA3 in the remainder of the group. Animals treated with both NARG and QUIN also exhibited a greater incidence of severe convulsive behavior (9/11) and 3 deaths. Pretreatment with the nitric oxide-generating drug molsidomine attenuated the enhanced toxicity observed with combined NARG-QUIN treatment, resulting primarily in no detectable hippocampal damages and mild seizures resembling those produced by QUIN alone. Administration of NARG alone produced neither seizure activity nor histological evidence of neurotoxicity. We conclude that inhibition of nitric oxide production with NARG potentiates the neurotoxicity of quinolinic acid in the rat hippocampus.


Localisation of aromatase activity in androgen target areas of the mouse brain.

Oestrogens are formed from androgens in the mouse brain, but the localization of aromatase activity is unresolved. Immunocytochemistry has not detected aromatase in expected key androgen target areas such as the medial preoptic area. Using a micropunch method and a sensitive in vitro 3H2O product detection assay, we report significant aromatase activity in adult male preoptic area (POA) and amygdala with [1 beta-3H]testosterone as substrate (Vmax < or = 1,200 fmol 3H2O formed/mg protein/h), in contrast to cerebrum (Vmax < 18 Units), from two strains of albino mice (BALB/c, Swiss NIHS) and the wild-type, Mus musculus. Aromatase activity was significantly higher in the amygdala than in the POA, particularly in the Swiss NIHS (4.6 x higher). Neonatal preoptic aromatase activity is 4 times higher than in the adult, but the Kms (both approximately 30 nM) suggest that the enzyme does not change during development. Similar inhibition potencies using Fadrozole HCl (IC50 approximately 0.5 nM) also suggest a common form of the enzyme in adult and developing brain. Adult mouse ovarian aromatase activity is higher (Vmax > 3,000 Units), but has a substrate binding constant similar to that of the POA.


Comparison of contraction times of a muscle and its motor units.

The twitch contraction time (CT) for each of 13 soleus (SOL) and 13 medial gastrocnemius (MG) muscles was compared with the mean CT from a sample of its motor units (MUs; 356 total) to see if the CT of a whole muscle when tested at its optimal length (Lo) differed systematically from that of its MUs tested at their individual Lo's. The CTs of the whole muscle were significantly longer in the ratio of 1.13. This is consistent with a hypothesis that electrical-field effects result in a more protracted contraction of the individual muscle fiber.


Analog of neuropeptide FF attenuates morphine tolerance.

Previous studies suggest that neuropeptide FF (NPFF) plays a role in opiate dependence and subsequent abstinence syndrome. Endogenous NPFF also appears to play a role in opiate tolerance since third ventricle injection of IgG from NPFF antiserum selectively restores morphine sensitivity in morphine-tolerant rats. The NPFF analog, desamino YFLFQPQRamide (daY8Ra) has previously antagonized behavioral effects of NPFF and has attenuated morphine dependence. The present study assessed whether daY8Ra could similarly attenuate morphine tolerance. Third ventricle (i.c.v.) injection of daY8Ra restored the analgesic response to i.c.v. morphine in morphine-tolerant rats (radiant heat tail flick test). Saline injection failed to produce this effect. In opiate-naive rats, however, the same treatment with daY8Ra did not affect the analgesic response to i.c.v. morphine. Thus, daY8Ra appears to selectively restore morphine sensitivity in opiate-tolerant animals. These results further support the hypothesis that endogenous NPFF contributes to opiate tolerance.


Dopamine regulation of gonadotropin-releasing hormone (GnRH) gene expression in the female rat brain.

The effects of the dopaminergic antagonist haloperidol (HAL) as well as the D2 dopamine receptor agonist bromocriptine (BRO) on gonadotropin-releasing hormone (GnRH) mRNA levels in intact and hypophysectomized rats were investigated by quantitative in situ hybridization. In situ hybridization was performed using a 35S-labelled 48-base oligodeoxynucleotide complementary to the GnRH coding region of the GnRH DNA. In intact animals, a 14-day treatment with BRO increased by 70% the number of silver grains per neuron while HAL decreased by 20% the value of this parameter. Hypophysectomy which induced a 32% decrease in the hybridization signal could not prevent the effects of BRO or HAL. The present data clearly demonstrate that GnRH mRNA levels are positively regulated by dopamine and that the effects of BRO and HAL on GnRH mRNA are not mediated by variations in pituitary hormone secretion.


Effects of high pressure on striatal dopamine release in freely moving rats: a microdialysis study.

When human divers and experimental animals are exposed to high pressure of helium-oxygen mixture, they develop the high pressure neurological syndrome, characterized by nausea, vertigo, tremor, myoclonus, EEG modifications and convulsions. Free-moving rats were stereotaxically implanted in the anterior caudate nucleus with a microdialysis probe to measure dopamine, dihydroxyphenylacetic acid and homovanillic acid levels during different phases of a simulated dive up to 5.1 MPa. Compression was found to cause an increase in extracellular dopamine and dihydroxyphenylacetic acid concentrations, but not in homovanillic acid. This represents a specific effect of high pressure on the dopaminergic pathway. Recent findings on D2 autoreceptors, showing a decrease in receptor affinity under pressure, allow us to conclude that pressure increases dopamine synthesis through a direct action on D2 autoreceptors.


D-cycloserine, a modulator of the N-methyl-D-aspartate receptor, improves spatial learning in rats treated with muscarinic antagonist.

The results of the present study indicate that D-cycloserine, a partial agonist at the glycine binding site, which is a positive modulation site of the N-methyl-D-aspartate receptor, could improve dose dependently the acquisition of a water maze task in rats treated with scopolamine, a muscarinic antagonist. The low to moderate doses of D-cycloserine which improved learning did not affect swimming speed in scopolamine-treated rats. The higher dose did not improve learning, but it increased swimming speed in scopolamine-treated rats. These results show a dissociation between impaired acquisition and abnormal behavioral activity in scopolamine-treated rats in the water maze task. Furthermore, the present results suggest that D-cycloserine can act as a cognitive enhancer at the appropriate doses.


Intrathecally administered N-methyl-D-aspartate increases persistent hindlimb flexion in rat.

Persistent hindlimb flexion was induced in pentobarbital anesthetized rats using a prolonged, electrical stimulus. Intrathecal (i.t.) N-methyl-D-aspartate NMDA) (1 mM, 5 microliters) applied prior to stimulation increased flexion relative to stimulated controls subsequent to stimulation (156%); 3 days later (109%) and after spinalization at 3 days (91%). Pretreatment with MK-801 (3 mg/kg, i.p.) prevented the enhancement of flexion. Withdrawal latencies to a thermal stimulus also were measured. I.t. NMDA plus stimulation reduced mean latency relative to controls only subsequent to stimulation. Latencies were increased by MK-801 post-injection, post-stimulation and at 3 days. The results suggest that the induction of persistent hindlimb flexion depends upon spinal NMDA receptors.


A new technique for fractal analysis applied to human, intracerebrally recorded, ictal electroencephalographic signals.

Application of a new method of fractal analysis to human, intracerebrally recorded, ictal electroencephalographic (EEG) signals is reported. 'Frameshift-Richardson' (FR) analysis involves estimation of fractal dimension (1 < FD < 2) of consecutive, overlapping 10-s epochs of digitised EEG data; it is suggested that this technique offers significant operational advantages over use of algorithms for FD estimation requiring preliminary reconstruction of EEG data in phase space. FR analysis was found to reduce substantially the volume of EEG data, without loss of diagnostically important information concerning onset, propagation and evolution of ictal EEG discharges. Arrhythmic EEG events were correlated with relatively increased FD; rhythmic EEG events with relatively decreased FD. It is proposed that development of this method may lead to: (i) enhanced definition and localisation of initial ictal changes in the EEG presumed due to multi-unit activity; and (ii) synoptic visualisation of long periods of EEG data.


Ultrastructural study of skein-like inclusions in anterior horn neurons of patients with motor neuron disease.

We investigated the ultrastructure of skein-like inclusions (SI) in 11 patients with motor neuron disease. SI mainly consisted of bundles of filaments. Each filament was approximately 15-25 nm in diameter and had a tubular profile on transverse sections. SI occasionally appeared to contain electron-dense material similar to Bunina bodies (BB), and in clusters of SI, electron-dense material closely resembling BB with vesicles were scattered among the bundles of filaments or were directly attached to the filaments, suggesting a close relationship between SI and BB. We also infer that SI might be the precursor of Lewy body-like hyaline inclusions (LBHI), on the basis of the frequent presence of in-between structures, the coexistence of SI and LBHI, the detection of tubular profiles (component of SI) in LBHI, the far greater frequency with which SI were observed compared with LBHI, and the occasional connection between ubiquitin-positive SI and LBHI observed in preceding immunocytochemical studies.


Cytochalasin inhibits light-dependent synaptic plasticity of horizontal cells in teleost retina.

Previous studies have shown that the horizontal cell-->cone photoreceptor negative feedback synapse in teleost fish retinae is 'plastic', being suppressed in the dark and potentiated by light adaptation. The possible involvement of filamentous actin in ultrastructural and electrophysiological aspects of this plasticity has been investigated using cytochalasins, which inhibit actin turnover, in the cyprinid fish (roach) retinae. Cytochalasin B or D (40 microM) inhibited both the light-dependent formation and maintenance of spinules, and enhancement of the feedback interaction involved in generation of biphasic spectral responses in horizontal cells. The results suggest that actin turnover is essential for both ultrastructural and electrophysiological plasticity of horizontal cell feedback and that spinules could mediate this dynamic interaction.


Sensitivity of Fischer 344 x brown Norway hybrid rats to exogenous NGF: weight loss correlates with stimulation of striatal choline acetyltransferase.

Nerve growth factor (NGF) infusion into normal Fischer 344 x Brown Norway (F344/BN) hybrid male rats for 2 weeks resulted in a dose-dependent stimulation of choline acetyltransferase (ChAT) enzyme activity to 70% above control values in both the basal forebrain and striatum, and a statistically significant 10% loss in animal weight. There was a significant correlation between weight gain and stimulation of striatal ChAT activity, but not with stimulation of basal forebrain ChAT. Thus, unlike some other rat strains, the normal F344/BN rat is sensitive to exogenous NGF, and can be used to study the efficacy of NGF on normal central cholinergic neurons. The NGF effect on weight gain may be mediated by cholinergic stimulation of the nucleus accumbens.


Photoconverted carbocyanine DiI allows direct visualization of transplanted glial cells at the ultrastructural level.

We have used the carbocyanine fluorochrome, DiI, to trace living glial cells (astrocytes, oligodendrocytes and immortalized Schwann cells) after their transplantation into the newborn shiverer and normal mouse brain. DiI fluorescence first detected on vibratome sections, was photoconverted into a stable, non-diffusible and electron-dense diaminobenzidine product. Both fluorescence and precipitate were found in the same cells and were detectable until 60 days after transplantation. At the ultrastructural level, DiI precipitate was contained within cytoplasmic vesicles scattered in the transplanted cell bodies and processes. Photoconversion did not interfere with the cell fine structure or predicted post-transplantation behavior. DiI is thus a suitable marker to trace, at the ultrastructural level, living cells after their transplantation.


Blockade of nitric oxide formation by N omega-nitro-L-arginine mitigates ischemic brain edema and subsequent cerebral infarction in rats.

In order to investigate whether or not nitric oxide (NO) formation underlies the cellular mechanisms of ischemic brain damage, we examined the effects of N omega-nitro-L-arginine (L-NNA), a NO synthase inhibitor, on ischemic brain edema and subsequent infarction in rats with middle cerebral artery occlusion (MCAo). For this purpose, administrations of L-NNA (1 mg/kg, i.p.) to each animal were done at the time of 5 min, 3, 6 and 24 h after MCAo, respectively. It was shown from this study that L-NNA significantly mitigated ischemic cerebral edema, and histological examinations revealed that this compound markedly reduced infarction size that occurred following MCAo. These results strongly suggest that NO formation is at least partly involved in the pathogenetic mechanisms of ischemic brain edema and subsequent cerebral infarction.


Actions of vasoactive intestinal polypeptide (VIP) on neocortical neurons of the rat in vitro.

The action of vasoactive intestinal polypeptide (VIP) was studied using intracellular recording techniques in neocortical neurons of the rat in vitro. When added to the perfusion medium, VIP enhanced direct excitability and increased the amplitude of the excitatory postsynaptic potential (EPSP). Effects of VIP were long-lasting and in most cases not fully reversible within the observation period. The present results suggest a role for VIP in long-lasting peptidergic modulation of excitatory synaptic components as well as direct excitability of neocortical pyramidal neurons of the adult rat.


Inflammatory stimuli induce a new K+ outward current in cultured rat microglia.

Membrane currents of cultured rat microglia were recorded with the whole-cell patch clamp technique. Undifferentiated microglia express only inwardly rectifying K+ channels. However, treatment of the cells with bacterial lipopolysaccharide, interferon-gamma, or their incubation in hydrophobic teflon bags, procedures that promote microglial differentiation, induced the expression of an additional outward current. Cycloheximide prevented the development of this conductance indicating the synthesis of a new channel protein. The reversal potential of the outward current was near to the K+ equilibrium potential; the current was abolished by intracellular Cs+ or extracellular 4-aminopyridine, and was depressed by extracellular tetraethylammonium. Hence, the channels involved appear to be highly selective for K+; their possible function is a rapid termination of depolarizing shifts of the membrane potential.


Neuronal and glial plasma membrane carrier-mediated uptake of L-homocysteate is not selectively blocked by beta-p-chlorophenylglutamate.

The proposed action of beta-p-chlorophenylglutamate (chlorpheg) as a selective blocker of L-homocysteate uptake was studied in primary cultures of mouse brain neurons and astrocytes and in rat brain synaptosomes. The preparations were incubated with 1 microM to 10 mM L-homocysteate and D-aspartate in the absence and presence of 7.5 mM chlorpheg. In each preparation uptake of the two amino acids comprised a saturable uptake and a non-saturable (passive diffusion) component. L-Homocysteate was of at least 100-fold lower affinity than D-aspartate as a substrate for the amino acid transporter. Chlorpheg was shown to be essentially equieffective as a weak competitive inhibitor of only the saturable uptake of L-homocysteate and D-aspartate. It is concluded that chlorpheg is not a selective blocker of L-homocysteate uptake.


Age-related loss of cannabinoid receptor binding sites and mRNA in the rat striatum.

Differences in the distribution of cannabinoid receptor (studied by receptor binding radioautography using the synthetic psychoactive cannabinoid ligand [3H]CP55,940) and its mRNA (studied by in situ hybridization histochemistry using oligonucleotide probes complementary to rat cannabinoid receptor cDNA) have been investigated in the rat striatum during ageing. The striata of old rats (24 months) show a 50% reduction in expression of cannabinoid receptors and mRNA levels when compared with young (3 months) equivalents. Thus, changes in cannabinoid receptor gene expression appear to be partially responsible for age-related loss of these receptors.


The dopamine D1 receptor antagonist SCH-23390 decreases the mRNA levels of the transcription factor zif268 (krox-24) in adult rat intact striatum--an in situ hybridization study.

By in situ hybridization with an oligonucleotide probe, we have studied the cellular distribution of the messenger RNA encoding the transcription factor zif268 (krox-24) in the adult intact rat striatum and regulation of its synthesis by acute treatment with the dopamine D1 receptor antagonist SCH-23390. Zif268 mRNA was found in the striatal medium-sized neurons and not in the large cells. Its levels were decreased by SCH-23390, suggesting activation of this immediate early gene in the striatum through dopamine D1 receptor stimulation.


Intracellular EGTA alters phasic firing of neurons in the rat supraoptic nucleus in vitro.

To determine the function of intracellular free Ca2+ which is important in generating the phasic firing pattern characteristic of vasopressin neurons in the supraoptic nucleus (SON), we injected the highly specific Ca(2+)-chelating agent ethyleneglycol-bis-(beta-aminoethyl ether) N,N-tetraacetic acid (EGTA) into SON cells in the rat hypothalamic slice preparation. Intracellular recordings from 29 SON neurons which showed phasic firing were analyzed. Of the 29 SON neurons, 21 were recorded with microelectrodes filled with 3 M potassium acetate and 20 of the 21 neurons retained the phasic pattern more than 1 h after penetration by the electrode. Only one neuron lost phasic firing and fired randomly. By contrast, in all 8 neurons which were recorded with microelectrodes filled with 100 mM EGTA/2 M potassium acetate, phasic firing disappeared 10-80 min after penetration of the recording electrode although the neurons still showed spontaneous activity. These neurons also lost the after hyperpolarization and plateau potentials which followed bursting discharges. Our results suggest that intracellular free Ca2+ may play an important role in generating phasic firing.


Effect of local cyanide perfusion on rat striatal extracellular dopamine and its metabolites as studied by in vivo brain microdialysis.

To investigate in vivo effects of energy failure on functions of dopaminergic neurons, we administered 0 (control), 0.2, 1 or 2 mM sodium cyanide (NaCN) dissolved in Ringer's solution for 60 min into the rat striatum through a brain microdialysis membrane. During NaCN perfusion, a transient and concentration-dependent increase in dopamine (DA) levels in the dialysate was observed. The maximum DA level during 2 mM NaCN perfusion was found to be 63-fold higher than the control levels. Leves of 3,4-dihydroxyphenylacetic acid and homovanillic acid were continuously lowered during and after NaCN perfusion. These data suggest that suppression of ATP production by NaCN induces an abrupt and remarkable increase in dopamine release from the nerve terminal in the striatum.


Light suppression of nocturnal pineal and plasma melatonin in rats depends on wavelength and time of day.

Effects of light on the pineal and plasma melatonin were examined in Wistar and Long-Evans rats at two different times in the dark phase (light off from 18.00 h to 06.00 h) using lights of two different monochromatic wavelengths but with the same irradiance. The green light pulse (520 nm) given at 24.00 h suppressed the pineal and plasma melatonin to the day-time level for at least 2 h, while the red light (660 nm) pulse given at the same time of the day suppressed pineal melatonin only transiently and did not suppress the plasma melatonin at all. Both green and red lights given at 4.00 h suppressed the pineal and plasma melatonin to a similar extent. The results demonstrated that the suppression of melatonin by light depends on the wavelength of light and the circadian phase.


Effect of two different routes of administration of R-PIA on glutamate release during ischemia.

Considering that adenosine decreases glutamate release from brain slices by stimulating presynaptic A1 receptors, we have attempted to modulate glutamate release in vivo during global ischemia with an agonist (R-phenylisopropyladenosine, R-PIA) of A1 receptors. Extracellular hippocampal glutamate was sampled by microdialysis and measured by HPLC. Conscious rats were submitted to transient global ischemia for 20 min. Ischemia induced a significant increase (10 fold) in extracellular glutamate. R-PIA (20 micrograms/kg) administered i.p. 30 min before ischemia significantly reduced (-64%) glutamate release. Conversely, R-PIA (100 microM) continuously infused through the hippocampal dialysis probe did not significantly modify glutamate efflux. The efficiency of infused R-PIA was evidenced by the decrease (-47%) of glutamate release induced by veratridine depolarization. These results indicate that the depressive action of R-PIA during ischemia results from various effects which are not restricted to a local action on the hippocampus.


A simple method for measuring ventriculomegaly in neonates.

The author presents a simple, easy-to-use, noninvasive, and easily reproducible method for measuring ventriculomegaly in the premature neonate. Neonatologists, as well as neurologists and neurosurgeons, have come to rely upon this method of measuring the ventricles in neonates.


Inpatient triage for out-of-hospital disasters.

Due to Operation Desert Storm, St. Francis Medical Center established an inhouse triage system to make bed space rapidly available during out-of-hospital disasters. The authors discuss the use of physician bed monitors and discharge criteria and suggest the importance of hospital readiness.


Childhood and young adult cancer in New Jersey.

Cancer incidence rates for 0 to 24 years of age were examined for New Jersey for 1979-1985. New Jersey rates generally were higher than the comparison states. They were most like those of Connecticut, the state most similar in demographics, geography, and degree of urbanization.


Radiology rounds: MRI of rotator cuff arthropathy.

Magnetic resonance imaging (MRI) has proved to be an excellent diagnostic tool in evaluating the musculoskeletal system. This article illustrates one particular facet of musculoskeletal MRI: investigation of the rotator cuff tendon complex.


LPN to ADN: a new model for educational mobility.

There is growing interest among nurse educators in methodologies to promote upward mobility between the levels of nursing education. The author describes an innovative model for facilitating mobility from licensed practical nurse level to registered nurse practice at the associate degree level.


The intimate dialogue: journal writing by students.

Nurse educators have long used logs and diaries with students in clinical settings. However, the literature is not specific about the development or implementation of journal writing in nursing classrooms. To guide nurse educators interested in integrating journal writing into their repertoire of teaching strategies, the author reviews relevant literature and describes a triangulation model for journal writing assignments tailored for nursing classrooms.


Dual assignment: an alternative clinical teaching strategy.

Meeting students' learning needs in acute care settings is challenging. The authors discuss dual assignment in the pediatric setting with beginning nursing students.


The acquisition of delegation skills: collaboration between education and service.

Many new patient care delivery models are being developed and evaluated. One of the most important skills needed by registered nurses (RNs) to function within these new models is delegation. For many reasons, RNs find it difficult to develop and implement this skill. The authors outline a program that can be used to assist students in the acquisition of delegation behaviors. As a result, students were able to explore and discover their delegation ability while gaining self-confidence in implementing the RN role.


Caring among nursing students.

Nursing students need to have a sense of being cared for in order to nurture their own ability to care for others. This phenomenologic study explored the meaning of caring among nursing students. Fifty-three nursing students were asked to describe a situation in which they had experienced caring from another nursing student. Their written descriptions were analyzed using Van Kaam's phenomenologic method. Four necessary constituents of a caring experience among nursing students emerged: Authentic presencing, selfless sharing, fortifying support, and enriching effects. The enriching effects of caring experiences among nursing students that were revealed support the author's stance that, along with faculty, nursing students can also be role models for caring.


A collaborative health promotion effort: nursing students and Wendy's Team Up.

Community health nursing students, faculty, and Wendy's fast food restaurant conducted a 2-day health fair that provided health screening, counseling, and educational opportunities for the community, an exciting learning experience for the students, funds for the school of nursing, and good public relations for Wendy's. The authors describe the planning, implementation, and evaluation of this health fair as a student learning activity.


Radioleucoscintigraphy in osteoarthritis. Is there an inflammatory component?

The possible contribution of an inflammatory component in osteoarthritis was investigated. There was no correlation between the percentage uptakes of 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells and 99Tcm-methylene diphosphonate (MDP) and between the former and pain scores. A significant correlation was found between the percentage uptake of 99Tcm-MDP and pain scores (0.002 > P > 0.01). In osteoarthritis, 99Tcm-HMPAO-labelled white cell imaging may or may not show a positive localization in the synovial membrane. Positive white cell localization appears to be limited to the area that corresponds to the radiological evidence of the condition and the positive uptake of the skeletal imaging agent.


The culturally diverse student: a model for empowerment.

The student who is at a disadvantage due to race, educational background, or cultural background is often unsuccessful in higher education. Specific programs designed to assist the culturally diverse student can make a significant difference in the successful completion of a program of nursing and passing of the National Council Licensure Examination (NCLEX). The authors discuss a model that assists culturally diverse students' success in a program of nursing.


A radiopharmaceutical for imaging areas of lymphocytic infiltration: 123I-interleukin-2. Labelling procedure and animal studies.

The labelling of interleukin-2 (IL-2) with 123I and its in vivo application for imaging chronic pathological lymphocytic infiltrations are described. The lactoperoxidase/glucoseoxidase technique was the labelling method of choice leading to immunoreactive IL-2 with high specific activity. Labelled IL-2 was injected in diabetes-prone non-obese diabetic (NOD) mice with pancreatic lymphocytic infiltration. As control animals, Balb/c mice were used. As specificity control, monoclonal antibodies AMT13 and UCHT1, bovine serum albumin and alpha-lactalbumin were radioiodinated and injected in mice. Eighteen NOD mice and four control Balb/c mice were used for gamma camera imaging experiments. Fifty-four NOD and 20 Balb/c mice were used for time course single organ counting and autoradiography. Gamma camera images showed that radioactivity accumulated in the pancreatic region from the 10th minute onwards in NOD mice injected with 123I-IL-2 but not in Balb/c mice, or in NOD mice injected with control radiopharmaceuticals. These findings were confirmed by counting the radioactivity present in single organs. Autoradiography of NOD pancreas, after injection of labelled IL-2, showed that radioactivity was specifically associated with infiltrating lymphocytes. In conclusion, this technique is highly specific and easy to perform and we suggest its application in humans for in vivo detection of areas of lymphocytic infiltration.


Anti D dimer monoclonal antibodies: a possible scintigraphic agent for immunodetection of thrombi.

The aim of this work was to produce a MoAb able to react with clots but not with fibrinogen. Monoclonal antibodies directed towards DD dimers, against specific products of plasmic digestion of cross-linked fibrin, were obtained. One of these antibodies, F 60/43/8, showed a 1.79 x 10(9) l mol-1 binding constant in spite of the presence of fibrinogen at a 4000 times greater concentration than the cross-linked fibrin. In vitro studies with 125I-F(ab')2 of F 60/43/8 showed that 34-80% of the radioactivity can be found in human clots, in the presence of physiologic concentrations of fibrinogen, and that 96-h washing does not remove the labelled F(ab')2 from the clot. 131I-F(ab')2 was injected into rabbits in which a clot had formed in an artery (six rabbits) or in a vein (six rabbits) of the left ear. Scintigraphic images of the clot were always obtained. In conclusion, the results of this work suggest that F 60/43/8 may be used as a specific antibody for the radioimmunodetection of thrombi.


Bringing electrolytes to life: an imagery game.

Stimulating the interest of nursing students in impersonal physiological processes, such as fluid and electrolyte exchanges, is a challenge for nurse educators. Facilitating the students' understanding beyond a superficial level may be a greater challenge. The author developed an imagery game that will bring electrolytes to life for nursing students. Imagery gaming, a new concept, could be used to teach many applied physiological processes.


Estimation of right ventricular ejection fraction by means of 99Tcm-macroaggregates.

A method is described for assessing right ventricular ejection fraction (RVEF) by means of 99Tcm-macroaggregates (MAA). The method consists of performing, in right anterior oblique (RAO) projection, a direct ECG-gated data acquisition over 120 s, as soon as the intravenous administration of the tracer is started. The activity returning to the left heart being negligible, background is limited to the lung activity overlapping the right ventricle. The distribution of lung activity in the gated frames is, however, exactly the same as that in the lung perfusion image, it can therefore be subtracted using static lung scintigraphy acquired directly after the gated study. Considering the count density distributions in the corrected end-diastolic (ED) and end-systolic (ES) frames and the first harmonic phase and amplitude images, ED and ES RV regions of interest (ROIs) are delineated for the calculation of RVEF. It has been shown that using 5 mCi 99Tcm-MAA, the ED count obtained is similar to that usually observed during a 20 mCi 99Tcm first-pass study. Intraobserver variation is acceptable and there is a good correlation between the RVEF calculated by this method and that obtained by means of a steady-state ECG-gated 81Krm technique. As the method presents similar advantages to those offered by 81Krm while using 99Tcm, it constitutes, in our opinion, a good approach for estimating RVEF in routine clinical practice.


Does gallium uptake in the pulmonary hila predict involvement by non-Hodgkin's lymphoma?

67Ga imaging of non-Hodgkin's lymphoma is useful for evaluating the presence of viable tumour in a residual mass after treatment. However, we have frequently seen gallium uptake in the pulmonary hila without other evidence of lymphoma. To study the significance of this finding, 79 patients with intermediate grade non-Hodgkin's lymphoma were reviewed. Thirty-seven (47%) had abnormal hilar gallium uptake. Twenty-three of these could be fully evaluated, and only five (22%) had hilar lymphoma. A pattern of bilateral, symmetric hilar uptake was seen in 19 patients, but only one had evidence of lymphoma. In 15 cases, this pattern was seen only on single photon emission computed tomography (SPECT). The aetiology of this uptake remains unknown. It is not treatment related, as 12 patients had hilar gallium uptake prior to chemotherapy. Unless confirmed by other methods, hilar gallium uptake should not be attributed to lymphoma, and should not influence patient management.


Cognition and 99Tcm-HMPAO SPECT in Parkinson's disease.

99Tcm-hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) of brain was performed in 43 unselected patients with Parkinson's disease to evaluate whether low cerebral perfusion on SPECT correlated with cognitive impairment in the patients. All patients received neurological, Mini-Mental State Examination and a neuropsychological assessment. Eighteen (41.9%) of the 43 patients were demented. Thirty patients (69.8%) had abnormal SPECT: 17 had perfusion defects in cortical regions, eight in basal ganglia and five in both regions. Of the 22 patients with abnormal cortical perfusion, 15 (68.2%) were demented; only three (14.3%) of the 21 patients without cortical defect were demented (P < 0.01). Twelve of the 15 demented patients had low perfusion in the parietal region alone or in parietal and occipital regions. The cortical perfusion defects, present in 22 (51.2%) Parkinson's patients, are highly correlated with cognitive impairment. The pattern of SPECT abnormality in most demented patients with Parkinson's disease is similar to that seen in Alzheimer's disease, suggesting that the underlying pathophysiology for dementia in patients with Parkinson's disease may be similar to that in Alzheimer's disease.


Changes in septal regional ejection fraction early and late following coronary artery bypass grafting in patients without postoperative myocardial infarction.

Changes in regional ejection fraction (rEF) of the interventricular septum following coronary artery bypass graft (CABG) surgery were examined using first-pass radionuclide ventriculography (RNVG) in patients without objective evidence of postoperative myocardial infarction (MI). One hundred and one patients had pre- (mean 6.3 days) and early postoperative (mean 8.7 days) RNVGs, and 60 of these patients had follow-up studies at 14-39 months (mean 27 months) postsurgery. Early post-CABG, mean rEF in the proximal septum was unchanged from the preoperative value (35.3%), with almost equal numbers of patients showing increased (n = 36), unchanged (n = 33) or decreased (n = 32) rEFs. In the distal septum, mean rEF increased from 47.1 to 50.7%, with more than twice as many patients having increased (n = 44) as decreased (n = 20) rEF. At late follow-up, proximal septum rEF in individual patients tended to revert to the presurgery baseline, with 72% (13/18) of regions with early decrease improved and 61% (14/23) of those with early improvement decreased. In the distal septum, rEF was less than early post-CABG in 76% (19/25) of patients with early improvement, while being improved in 27% (3/11) of those with early decrease in rEF. In the absence of MI, changes in rEF in the proximal septum early post-CABG tend to resolve over time. While global changes in cardiac systolic motion are the probable cause of many new post-CABG septal abnormalities, persistent septal dysfunction probably reflects effects of permanent damage as a result of the operative procedure.


SPECT versus planar scintigraphy for quantification of splenic sequestration of 111In-labelled platelets.

The splenic uptake of thrombocytes and spleen size were studied in 25 patients with idiopathic thrombocytopenic purpura (ITP) using two methods: anterior/posterior scintigraphy and single photon emission computed tomography (SPECT). Various factors (acquisition and reconstruction protocols) influencing the quality of 111In SPECT were studied. The splenic uptake, measured by SPECT, was found to be significantly higher in patients with a high level of autoantibodies in the blood than in patients without such antibodies (37 +/- 6%, n = 8 vs 22 +/- 3%, n = 11, P = 0.04, t-test). The correlation between the spleen SPECT volume and the geometric mean size in anterior and posterior images was 0.80 (P < 0.001). However, the spleen size calculated as geometric mean of anterior and posterior images differed by more than 50% from the SPECT volume in some patients. Based on these observations and on the results of phantom studies it is concluded that a reasonable estimate of the spleen:liver uptake ratio may be obtained using planar imaging, but to estimate the spleen volume and the absolute splenic uptake of platelets SPECT imaging is needed, in spite of the present technical limitations of SPECT.


The effects of hyperthyroidism on oesophageal motility.

This study, evaluating the effects of hyperthyroidism (HT) in oesophageal motility, depended on an oesophageal radionuclide transit test. A modified standard method was used to calculate: (a) total mean transit time (MTT), (b) residual fraction (RF) and (c) retrograde index (RI) in a supine position. Eighteen untreated patients with HT and 25 normal volunteers (NV) with a similar age distribution were included in this study. The results showed that oesophageal motility in patients with HT was worse than in the normal controls (P < 0.05 by Student's t-test). The correlation of MTT, RF and RI with size and function of thyroid glands in the patients with HT were calculated to explain the effects of HT in oesophageal motility. The results showed that neither the size nor the function of the thyroid glands in HT affected oesophageal motility.


Assessment of regional cerebral perfusion by 99Tcm-HMPAO SPECT in chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a severely disabling illness of uncertain aetiology. It is characterized by a chronic, sustained or fluctuating sense of debilitating fatigue without any other known underlying medical conditions. It is also associated with both somatic and neuropsychological symptoms. Both physical and laboratory findings are usually unremarkable. Regional cerebral blood flow (rCBF) was assessed in 60 clinically defined CFS patients and 14 normal control (NC) subjects using 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) single photon emission computed tomography (SPECT). Compared with the NC group, the CFS group showed significantly lower cortical/cerebellar rCBF ratios, throughout multiple brain regions (P < 0.05). Forty-eight CFS subjects (80%) showed at least one or more rCBF ratios significantly less than normal values. The major cerebral regions involved were frontal (38 cases, 63%), temporal (21 cases, 35%), parietal (32 cases, 53%) and occipital lobes (23 cases, 38%). The rCBF ratios of basal ganglia (24 cases, 40%) were also reduced. 99Tcm-HMPAO brain SPECT provided objective evidence for functional impairment of the brain in the majority of the CFS subjects. The findings may not be diagnostic of CFS but 99Tcm-HMPAO SPECT may play an important role in clarifying the pathoaetiology of CFS. Further studies are warranted.


Bone mineral density in children with Down's syndrome detected by dual photon absorptiometry.

Bone mineral density (BMD) in ten children with Down's syndrome (seven boys, three girls; aged 10-16 years) was measured by dual photon absorptiometry (DPA) using an M&SE OsteoTech 300 scanner. The BMD of the 2nd to 4th lumbar vertebrae was measured and the mean density presented as g cm-2. The BMD of Down's syndrome was compared with the BMD of normal Chinese children of the same age group. The results showed that the BMD in Down's syndrome was significantly lower compared to that found in normal children (P < 0.01). The percentage of decreased BMD is 8.47 +/- 2.69% (mean +/- 1 S.E.M.) in Down's syndrome compared to normal children of the same age group. The distribution curve of BMD against ages in Down's syndrome has a delay of 2.3 +/- 0.5 (mean +/- 1 S.E.M.) years compared to normal children. In our conclusion, the children with Down's syndrome have lower BMD than the normal children of the same age group. The causes of this abnormality may require further study in the future.


Clinical evaluation of 99Tcm-MIBI SPECT in the assessment of coronary artery disease.

To evaluate the clinical efficacy of 99Tcm-MIBI myocardial tomography for detecting coronary artery disease (CAD) 115 consecutive patients who underwent both 99Tcm-MIBI single photon emission computed tomography (SPECT) and coronary arteriography were studied. Thirty-three patients without and 82 with significant coronary artery disease were documented by coronary arteriography. The overall sensitivity and specificity of 99Tcm-MIBI SPECT for detecting coronary artery disease were 96 and 87.9%, respectively. The sensitivity for identifying patients with CAD without myocardial infarction was 88%. The sensitivity of 99Tcm-MIBI SPECT for detecting individual coronary artery lesions was 86% for left anterior descending artery (LAD), 69% for left circumflex artery (Lcx) and 86% for right coronary artery (RCA), lesions respectively. In conclusion, 99Tcm-MIBI SPECT provides a reliable method for detecting CAD.


The Pain Beliefs Questionnaire: an investigation of beliefs in the causes and consequences of pain.

This paper reports the development and validation of the Pain Beliefs Questionnaire (PBQ). This is a 20-item questionnaire covering beliefs about the cause and treatment of pain. It was administered to 294 subjects, comprising 100 chronic pain patients and 194 controls. An exploratory factor analysis revealed 2 factors accounting for 68.15% of the variance. From the final solution 2 scales were derived: the first called Organic Beliefs and the second Psychological Beliefs scale, comprising 8 and 4 items, respectively. The construct validity of the questionnaire was assessed in 2 ways. First, the responses of chronic pain patients and non-patient controls were compared: a significant difference (F(1,236) = 53.04, P < 0.0001) between these 2 groups emerged such that chronic pain patients were more likely to endorse the Organic Beliefs scale items, whereas non-patients were more likely to endorse the Psychological Beliefs scale items. Secondly, as predicted significant associations were observed between scores on the Organic Beliefs scale and scores on the Chance and Powerful Others scales of the Multidimensional Health Locus of Control (MHLC), and also between the Psychological Beliefs and Internal scales of the MHLC. No relationship, however, emerged between these scales and measures of pain intensity. The implications of these findings for the assessment and management of chronic pain patients, and in the understanding of the development of chronic pain, are discussed.


Chronic pain coping measures: individual vs. composite scores.

Differences in the use of coping strategies have been hypothesized to explain some of the variation in adaptation among chronic pain patients. Investigators often assess coping using composite indices of different coping strategies. Although the use of composite measures has advantages, it may obscure the importance of specific coping strategies as they relate to functioning. This study compared composite with individual coping scale scores in the prediction of adjustment among chronic pain patients. One hundred and forty-one patients completed the Coping Strategies Questionnaire (CSQ) and 2 measures of adjustment (Sickness Impact Profile (SIP) and the Beck Depression Inventory (BDI)). The scales and ratings of the CSQ were factor analyzed to create composite measures, and the ability of the composite scores and individual scales to predict adjustment was compared. The results indicated that the individual scales provided more information than the composite measures regarding the relationship between coping and adjustment to chronic pain. The results also suggested that individual scale scores may be more useful than composite scores in identifying the conditions under which coping efforts have their greatest effects on adjustment.


Relations between experimentally induced tooth pain threshold changes, psychometrics and clinical pain relief following TENS. A retrospective study in patients with long-lasting pain.

The present study investigates the relationships between clinical pain relief, physiological and psychological parameters. Out of 50 patients with long-lasting musculoskeletal neck- and shoulder-pain treated with transcutaneous electrical nerve stimulation (TENS), 21 were selected and classified as responders (n = 13) or non-responders (n = 8). Tooth pain thresholds (PT) were measured before and after an experimental TENS treatment and the relative change in PT following the stimulation was calculated. Three psychometric self-inventories were administered: Zung Depression Scale, Spielberger's Trait Anxiety Scale and the Multidimensional Health Locus of Control Scale. Responders (R) and non-responders (NR) differed significantly from each other in the PT measurements as well as on the psychometric scales. NR exhibited higher levels of anxiety and depression, a more pronounced powerful other orientation and no change or a decrease in PT following TENS compared to R. These findings indicate relationships and interactions between physiological and psychological factors in patients with long-lasting pain.


Effect of temporomandibular disorder pain duration on facial expressions and verbal report of pain.

This study investigated how specific expressive behaviors (verbal report of pain level and the frequency of emitting specific non-verbal facial expressions of pain) may change over the course of a chronic pain condition. Based on the concept of chronic pain behaviors, we hypothesized that both verbal and non-verbal behavior would increase with duration of pain. Thirty-six women with chronic temporomandibular disorder (TMD) pain (duration over 6 months) were compared with 35 recent onset cases (first episode, duration < or = 2 months). Subjects completed questionnaires assessing depression, anxiety, somatization, daily hassles and pain coping strategies. They were videotaped during a resting baseline and 2 painful conditions: experimental cold pressor pain and the clinically relevant pain of palpation of the masticatory muscles and temporomandibular joint; tapes were coded for facial expression using the Facial Action Coding System. Visual analog scale (VAS) ratings of the aversiveness and intensity of ongoing TMD pain were collected at baseline, and similar ratings of cold pressor and clinical examination pain were gathered after the painful stimulus. Recent onset and chronic cases did not differ on self-report measures of anxiety, depression, somatization or daily stress. Coping strategies were also similar, although chronic cases showed a greater tendency to catastrophize. Self-report measures of ambient facial pain, as well as the pain of clinical examination and cold pressor stimulation, revealed no significant differences between the 2 groups. In contrast, rates of pain facial expression were significantly higher for chronic cases under all conditions of the experiment, including baseline.(ABSTRACT TRUNCATED AT 250 WORDS)


The consistency of facial expressions of pain: a comparison across modalities.

A number of facial actions have been found to be associated with pain. However, the consistency with which these actions occur during pain of different types has not been examined. This paper focuses on the consistency of facial expressions during pain induced by several modalities of nociceptive stimulation. Forty-one subjects were exposed to pain induced by electric shock, cold, pressure and ischemia. Facial actions during painful and pain-free periods were measured with the Facial Action Coding System. Four actions showed evidence of a consistent association with pain, increasing in likelihood, intensity or duration across all modalities: brow lowering, tightening and closing of the eye lids and nose wrinkling/upper lip raising. Factor analyses suggested that the facial actions reflected a general factor with a reasonably consistent pattern across modalities which could be combined into a sensitive single measure of pain expression. The findings suggest that the 4 actions identified carry the bulk of facial information about pain. They also provide evidence for the existence of a universal facial expression of pain. Implications of the findings for the measurement of pain expression are discussed.


Reflex sympathetic dystrophy in brain-injured patients.

One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.


Effects of age and size on development of allodynia in a chronic pain model produced by sciatic nerve ligation in rats.

Sciatic nerve constriction injury in rats has been used by various investigators as a model of chronic pain exhibiting allodynia and hyperalgesia. Although rats ranging between 200 and 350 g (40-70 days old) at the time of operation have been used by various investigators, the effect of rat age and weight on the model has not been previously studied. We noted that a group of older rats failed to develop all the characteristics of the model and designed the present study to determine the effect of age and weight on the development of allodynia and hyperalgesia. Three groups of rats varying in age (54, 71, and 107 days) and weight (220-250 g, 270-350 g, and 370-470 g) with the experimental lesion were tested for hyperalgesia, cold allodynia, and tactile allodynia. We found that although the degree of hyperalgesia of all groups was the same, the oldest group had significantly longer response latencies to allodynia tests than the younger 2 groups. Responses to the cold test were no different than control in the oldest group. The results of the present study demonstrate that larger, older rats fail to develop allodynia after sciatic nerve ligation.


Sympathectomy does not abolish bradykinin-induced cutaneous hyperalgesia in man.

Bradykinin is an endogenous peptide that is thought to be a chemical mediator of the hyperalgesia following inflammation. In rat, bradykinin has been postulated to cause hyperalgesia to mechanical stimuli by releasing prostaglandin from sympathetic post-ganglionic terminals. The aim of this study was to determine whether bradykinin-induced cutaneous hyperalgesia in humans requires post-ganglionic sympathetic terminals. In humans, intradermal injection of bradykinin produces dramatic hyperalgesia to heat but not mechanical stimuli. Therefore, we measured the magnitude and duration of pain and hyperalgesia to heat stimuli following intradermal injection of bradykinin into the leg of a woman before and 6 months after an ipsilateral, surgical, lumbar sympathectomy. The pain and hyperalgesia to heat following bradykinin was found to be unaffected by the sympathectomy. These results suggest that the algesic effects of cutaneous bradykinin in human are independent of the sympathetic nervous system.


Selective changes of receptive field properties of spinal nociceptive neurones induced by noxious visceral stimulation in the cat.

This study was designed to examine the central changes in the receptive field properties of dorsal horn neurones induced by a period of visceral noxious stimulation. The aim of this investigation was to establish whether noxious stimulation of the visceral input to the spinal cord could influence transmission of cutaneous information through dorsal horn neurones. Single-unit electrical activity was recorded in the lower thoracic spinal cord of anaesthetized cats from dorsal horn neurones with a somatic receptive field in the ipsilateral flank. Changes in the properties of these receptive fields induced by reversible spinalization (by means of a cold block 4 or 5 segments rostral to the recording electrodes) and by a conditioning noxious stimulation of the biliary system (3 successive distensions of the gall bladder for 30 sec at 65-80 mm Hg at 1-min intervals) were analysed. Nineteen neurones have been studied, 10 of which could be driven by stimulation of the gall bladder. All of these 10 cells showed increases in the size of their cutaneous receptive fields following conditioning noxious stimulation of the biliary system. The increases were large and lasted for at least 20 min. None of the 9 spinal cord neurones without an input from the gall bladder were affected by the conditioning visceral stimulus even though 7 showed changes in receptive field size when the animals were spinalised. These results show that noxious stimulation of viscera can evoke increases in the somatic receptive fields of spinal cord neurones but only of those neurones which are also driven by the visceral stimulus.


Electrical stimulation of the subdiaphragmatic vagus in rats: inhibition of heat-evoked responses of spinal dorsal horn neurons and central substrates mediating inhibition of the nociceptive tail flick reflex.

Electrical stimulation of the subdiaphragmatic branch of the vagus nerve (SDVAS) inhibits the nociceptive tail flick (TF) reflex. The present experiments examined (1) the central substrates mediating SDVAS-produced inhibition of the TF reflex and (2) the effects of SDVAS on either background or noxious heat-evoked responses of spinal dorsal horn neurons. Microinjections of ibotenic acid in the ipsilateral nucleus tractus solitarius (NTS), nucleus raphe magnus (NRM), or bilateral locus coeruleus/subcoeruleus (LC/SC) significantly increased the intensity of SDVAS required to inhibit the TF reflex in lightly anesthetized rats. In studies of class-2 spinal dorsal horn neurons, SDVAS produced significant intensity-dependent inhibition of noxious heat-evoked responses of 17/25 (68%) units, facilitation of 4/25 (16%) units, and no effect on 4/25 (16%) units. In studies of class-3 spinal dorsal horn neurons, SDVAS produced significant intensity-dependent inhibition of noxious heat-evoked responses of 8/9 (89%) units. Noxious heat-evoked responses of 1/9 (11%) unit were facilitated by SDVAS. In general, the background activity of either class-2 or class-3 units was not significantly affected by SDVAS. SDVAS produced a significant rightward, parallel shift in the stimulus response function (SRF) of class-2 neurons to noxious, graded heat stimuli ranging from 40 to 52 degrees C, while SDVAS produced a significant increase in the threshold and a significant reduction in the slope of the SRF of class-3 neurons. These data indicate that SDVAS generally inhibits noxious heat-evoked responses of lumbosacral spinal dorsal horn neurons in the rat, but does not significantly affect background activity of the same neurons. Furthermore, the inhibition of the TF reflex produced by SDVAS depends on central relays in the ipsilateral NTS, NRM, and bilateral LC/SC.


Acute tolerance to nitrous oxide in humans.

The goal of this research was to determine whether the level of analgesia produced by nitrous oxide remains constant for the duration of a typical dental procedure or whether acute tolerance reduces the drug's efficacy. A computer-controlled stimulator delivered brief (approx. 1 msec) electrical pulses to a vital maxillary incisor which had been found to have normal sensitivity in a preliminary session. Subjects were trained to indicate the occurrence of a barely perceptible sensation (i.e., detection threshold) as well as a minimally painful sensation (i.e., pain threshold). On the experimental day, all subjects breathed a non-odorized placebo gas mixture during a 10-min baseline condition, and were then randomly assigned to receive either an odorized placebo gas mixture or an odorized 35-40% nitrous oxide/oxygen gas mixture for 46 min. Detection and pain thresholds were assessed repeatedly during the baseline and gas exposure conditions. Placebo control subjects had little change of either sensory threshold. Subjects breathing nitrous oxide significantly increased both detection and pain thresholds within 2-8 min following the onset of the drug. However, maintenance of the drug's effect was not consistent between subjects, despite continuous administration of a constant concentration of nitrous oxide. Some subjects had a relatively constant elevation of sensory thresholds throughout the nitrous oxide administration period, and others returned to baseline sensitivity values and therefore were acutely tolerant.


The postmastectomy pain syndrome and topical capsaicin: a randomized trial.

This paper describes a randomized parallel trial of topical 0.075% capsaicin versus vehicle (placebo) in the postmastectomy pain syndrome (PMPS). The study was double-blind in design; however, this was compromised by the burning sensation induced by capsaicin. We could not demonstrate a significant difference in the visual analogue scale (VAS) for steady pain although a trend was present. A significant difference was found, however, in the VAS for jabbing pain, in category pain severity scales, and in overall pain relief scales in favour of capsaicin. Five of 13 patients on capsaicin were categorized as good-to-excellent responses with 8 (62%) having 50% or greater improvement. Only 1 of 10 cases had a good response to vehicle with 3 rated as 50% or better.


Non-invasive ultrasonic biopsy in the classification of early arterial lesions and in the evaluation of the rate of progression of arteriosclerosis.

The evaluation of early arterial lesions and the follow-up of the progression of arteriosclerotic wall changes is possible with high resolution ultrasound. While dynamic (duplex scanning) data are suitable for the follow-up of advanced stenosis and plaques, the morphological evaluation performed using the technique of non-invasive ultrasonic biopsy may be used to follow-up early lesions and their progression. The data obtained by ultrasonic biopsy are related to the incidence of occult coronary ischemia and to the occurrence of cardiovascular events in 4 years. The rate of progression (ROP) to the next, more advanced UB class can be also evaluated by ultrasonic biopsy. It has been shown that in diabetic and hyperlipidemic subjects the ROP is higher. Also in interventional studies using lipid lowering agents (with a four-year follow-up) a reduction in ROP in treated asymptomatic hyperlipidemic subjects in comparison with controls has been documented. The combination of dynamic data and morphological data gives us a complete evaluation of the vascular system both for the assessment of single individuals and for large population studies.


Persistence of human growth hormone circadian rhythm in patients with homozygous beta-thalassemia.

Plasma levels of human growth hormone (hGH) were measured for an entire day every two hours, starting from midnight, in 6 healthy male subjects and in 6 male patients with homozygous beta-thalassemia, without evidence of any endocrine disease. The data were analyzed by the "cosinor" method, and the results show the presence of a significant (p < 0.05) circadian rhythm for hGH in both groups. Whereas no differences were found in mesors and acrophases between the two studied groups (p > 0.05), a statistically-significant (p < 0.05) difference was observed regarding amplitudes, being higher in the controls. These data suggest that in patients with beta-thalassemia major without evidence of any endocrine abnormality, the circadian secretory pattern of hGH is preserved, even if the rhythm amplitude is reduced: this could be a compensatory mechanism in order to stimulate growth.


Dubowitz' syndrome with special characteristics.

The Authors describe the main characteristics of Dubowitz' syndrome: retarded growth, microcephaly, cranio-facial deformations and dysmorphia of the extremities, psycho-motor development varying between normal and retarded, thin hair, cryptorchism, hyperactivity and others. They report a case which was brought to their attention in which, in addition to numerous anomalies and dysmorphia which justify its inclusion in Dubowitz' syndrome, there was marked bilateral metacarpal hypoplasia with strongly and permanently adducted thumbs. The aim of this report was to add to the mosaic of data relating to this highly polymorphous syndrome.


Skin blood flux and the venoarteriolar response in the perimalleolar area in patients with venous hypertension.

In patients with venous hypertension due to postphlebitic syndrome or varicose veins skin changes, liposclerosis and ulcerations are associated with increased skin blood flux at rest, a decreased venoarteriolar response and increased capillary filtration. Using laser-Doppler flowmetry we studied skin flux and the venoarteriolar response in the perimalleolar region in 100 normal limbs, 100 limb with varicose veins and 100 postphlebitic limbs with edema, skin changes and liposclerosis. The venoarteriolar response was studied with the leg on dependency, the foot being 50 cm below heart level. Flux at rest and on dependency were increased and the venoarteriolar response decreased in both groups of patients at a significantly greater extent in postphlebitic limbs. In conclusion laser-Doppler flowmetry measurements differentiate between normal limbs and those with venous hypertension and between postphlebitic limbs and limbs with venous hypertension due to varicose veins. The increase in skin flux and decrease in venoarteriolar response may be useful to define and quantify the degree of microangiopathy and the effects of treatments in venous hypertension.


Seminom cicatrice. About a case of spontaneous testicular regression.

This is a case of spontaneous regression of a tumour. Only the French Authors speak about this type of seminoma called them "seminome cicatrice". Probably the immunological defences are fundamental for the complete or partial spontaneous resolution of this type of tumour. Here we describe our clinical and surgical approach. The last control was normal with a relapse-free patient.


A theoretical look at gravity in the human cell: its role in normal cell division as well as neoplasia.

Explaining the ultimate expression of life with fundamental physical law is the proposition dealt with in this paper. Normal cell division, as well as cancer, are analyzed and scrutinized in terms of Jacobson resonance, cyclotron resonance, the quantum Hall effect and the piezoelectric effect. The underpinning concept is based in the unification and connection of gravity to biological systems.


The treadmill test in the assessment of peripheral arterial occlusive disease.

Results of a study using the treadmill test on 32 patients with peripheral Fontaine's stage II arterial disease are described. The aim of the study was to evaluate the utility of the test in assessing useful information concerning the site of the lesion. Patients were divided in three classes depending on the arterial segment involved (iliac-femoral, femoro-popliteal, associated lesions) as resulted from the velocimetric and angiographic evaluation. Ankle pressure and WI, at rest and after stress test, PFWD and RT were evaluated. The authors conclude that data achieved with the dynamic test are related to the arterial involvement, allowing to differentiate obstructive and stenotic lesions, but do not give information concerning the site of the lesion. Nevertheless it is a valuable means of highlighting arterial lesions well compensated at rest and with normal pressure values.


Systemic lupus erythematosus: medical and nursing treatments.

Systemic lupus erythematosus is a multisystem autoimmune disease that may affect skin, joints, mucous membranes, heart, lungs, kidneys, nervous system and all the blood cell lines. Although its cause is unknown, abnormal immune function results in the formation of antibodies directed against various components of the human body (autoantibodies). Treatment depends of the severity of the illness and may include nonsteroidal antiinflammatory agents for arthritis; antimalarial therapy for skin disease and other mild lupus manifestations; and corticosteroids and immunosuppressive agents including azathioprine, cyclophosphamide, and methotrexate for more severe lupus manifestations. Persons affected by lupus and their families need help in understanding the condition and require support as they deal with fear, depression, and possible disability. Implications for nursing are varied and include patient/family education about medication, joint protection principles, energy conservation, pain and stress management, and coping techniques.


Steroid management in orthopaedic patients.

Corticosteroids are encountered on a regular basis in the treatment of orthopaedic problems. Foreseeing potential dangers and complications and taking appropriate actions, the nurse helps to minimize the negative effects steroids may produce. This article discusses the physiologic production of corticosteroids and their effects. Potential risks associated with larger doses are described along with nursing interventions directed at assessing, avoiding, and managing steroid-related problems.


Surgical applications of the greater omentum. A critical review of the literature.

The paper presents and discusses a review of the literature on the use of the greater omentum, focusing in particular on chest surgery. Following an introduction on the anatomy and surgical techniques of mobilisation based on the vascular anatomy of the organ, the author examines the applications of the greater omentum in general surgery. Among these, it is particularly interesting to note the possibility of covering anastomoses, above all extraperitoneal; the interposition of the omentum in the prevention of endoabdominal adhesive syndromes, the covering of pathological perforations of hollow viscera. Lastly, the Author illustrates the applications of the omentum in chest surgery, both preventive and due to endothoracic pathological processes. The Author mentions the covering of bronchial and tracheal anastomoses following resection or lung transplant; the covering of defects in the thoracic wall in patients with osteoradionecrosis or previous irradiation; its therapeutic use in broncho-pleural fistulae and in post-sternotomy mediastinitis.


Practical tips on preparing for a JCAHO survey.

This article focuses on the role of the Nurse Manager and Staff Nurse in the Joint Commission for Accreditation of Healthcare Organizations survey process. We present practical tips to make the unit visits, interviews, and closed chart reviews easier and more meaningful. Emphasis is on meeting those standards that address use and documentation of the nursing process.


Compounded problem: chronic low back pain and overweight in adult females.

Overweight adult females may have negative self-concepts and body images compounded by chronic low back pain and obesity. This subgroup of clients need special attention and nursing interventions to adjust to chronic low back pain and to achieve permanent weight control. Interventions designed to improve female clients' self-concepts and body images also support their efforts toward weight control, and, in turn, improve their negative perceptions of chronic pain. Orthopaedic nurses are in an excellent position to explore the relationships among body image, overweight, and chronic low back pain.


Fundamentals of hyperbaric oxygen therapy.

Hyperbaric oxygen therapy (HBO) is an adjunctive treatment used for wound healing. HBO treatments are given by increasing the atmospheric pressure in a chamber while the patient is breathing 100% oxygen. Many orthopaedic disease entities can benefit from HBO therapy. For the orthopaedic nurse to recognize potential HBO patients, a basic understanding of HBO therapy is necessary. Knowledge of diseases that can be treated with HBO, the side effects of HBO, and educating a patient for HBO therapy are all important aspects of hyperbaric therapy.


Update in orthopaedic oncology.

Orthopaedic oncology is a growing field with unanswered questions. Improvements in imaging have led to increases in limb salvage surgery. Chemotherapy is indicated in most bone sarcomas but varied agents are used. Newer surgical procedures such as an internal hemipelvectomy and resection using an expandable prothesis are currently being evaluated. Further research in all areas is indicated.


[Optical and ultrastructural morphology in hyperparathyroidism during dialysis].

Twenty-six cases of surgically removed parathyroid glands in patients under chronic dialytic treatment were studied. In 19 cases a total parathyroidectomy was performed while in the remaining 7 cases only a subtotal parathyroidectomy was possible. All parathyroid glands (98) showed chief cells hyperplasia, with nodular pattern in 24 patients and diffuse pattern in two cases. A solid pattern was observed in 79 parathyroid glands, a trabecular in 49 and a follicular one in 33. Ultrastructural study was performed on 75 parathyroid glands. Electron microscopy has been useful in the evaluation of functional status of the single cell and in the detection of some morphological features (i.e., presence of intermediate filaments in the cytoplasms, mitochondrial abnormalities, multinucleation), rarely observed in hyperplasia and more frequent in adenoma. No morphologic differences have been found between hyperplastic glands and adenomatous glands. In the 27.2 per cent (out of 44 cases) flow-cytometric DNA analysis showed an aneuploid DNA content.


[The use of flow cytometry in the study of parathyroid hyperplasia and adenomas].

To discriminate benign from malignant parathyroid glands lesions is often difficult, because the morphologic features lack absolute diagnostic value. The differential diagnosis between chief cell hyperplasia and parathyroid adenoma is frequently based on physical features such as increased gland weight and number of enlarged glands. A carcinoma is identified by the evidence of local invasion, metastases or recurrence. Nevertheless the lesions classified as benign for lack of histologic features of aggressiveness can show nuclear atypia, increased mitotic figures and broad fibrous bands. Since DNA aneuploidy is present in a great number of human neoplasms and DNA aneuploidy has been suggest to be a marker of malignancy, flow cytometric assessment of ploidy appeared a possible method for rapid and objective distinction between benign and malignant lesions. Flow cytometric DNA content was evaluated on 113 parathyroid glands: the parathyroids were resected from 26 patients with hyperparathyroidism and from 17 patients with adenoma. The analysis was performed on paraffin-embedded specimens according to Hedley with minor modifications. Interpretable histograms were obtained for 103 parathyroids gland (mean CV = 5.3). Aneuploidy was detected in 22.5% of glands; in 12 instances of parathyroid hyperplasia the glands of the same patient showed different DNA Indexes. Cytometric results and morphological features do not correlate as far as aneuploidy and cellular atypia are involved. Although our results fail to show any correlation between morphology of parathyroid cells and DNA content, and abnormal DNA content suggests a careful follow up of these patients.


[Changes in the cardiovascular chemo-baroreceptors as a possible basis for sudden infant death (SIDS)].

A male sixty days old infant, dying suddenly, has been diagnosed as sudden infant death syndrome (SIDS). Autopsy visualized plurifocal haematic suffusions, typical for an asphyxial status. Abnormalities were not found in the conduction system, but aorticopulmonary paraganglia hyperplasia with mild inflammatory characters has been noted. The role of aorticopulmonary paraganglia, as baro-chemoreceptors, in the cardiovascular regulation, has been anatomical substrate for explaining a sudden infant death, according to a multifactorial theory of SIDS.


[Anatomopathological findings correlated with high-dose recombinant interleukin-2. Review of the literature and description of 2 autopsy cases].

After review of the pertinent literature on pathologic findings associated with Interleukin-2 (IL-2) therapy for metastatic malignancies (melanomas, renal cell carcinomas), two autoptic cases are described with particular emphasis on the cardiovascular and pulmonary changes. The authors report on the occurrence of massive transmural acute myocardial infarct in a patient with metastatic cutaneous melanoma, treated with recombinant IL-2, who did not show atherosclerotic lesions of the coronary arteries. Conversely, myocardial lesions were not found in the other patient with metastatic renal cell carcinoma, treated with recombinant IL-2; he had severe generalized atherosclerosis and died of pulmonary causes. It is suggested that myocardial direct toxic effects of IL-2 associated with capillary leak syndrome may determine a myocardial infarct. It is concluded that IL-2 therapy is not contra-indicated in oncologic patients with atherosclerosis of the coronaries if they are carefully monitored.


[Pharyngo-esophageal motility disorders in Steinert's myotonic dystrophy. Description of a case presenting with dysphagia].

In Myotonic Dystrophy symptoms of gastrointestinal dysfunction may dominate the clinical picture or they may be manifested long before the musculoskeletal disturbances become apparent. A case of Myotonic Dystrophy in a 26-year-old woman with dysphagia as the symptom of clinical presentation is reported. Manometric investigations demonstrated motor dysfunctions in pharynx and in proximal, middle and distal portions of the esophageal body, indicating both striated and smooth muscle involvement. The pathophysiology of the esophageal motility disorders in Myotonic Dystrophy and the related therapeutic problems are briefly discussed.


Physicochemical characterization of the inorganic phases in the aortic wall of young individuals.

The autopsy samples of human aortic wall were investigated to determine the structure of the inorganic deposits formed at the onset of the mineralization process. The studies were concentrated on the material for which histochemical staining of randomly selected sections did not reveal the presence of minerals. The highly mineralized human media samples as well as broad spectrum of model compounds were investigated for comparative purposes. It was found that the inorganic phase at the onset of tunica media mineralization is composed of a few compounds including octacalcium phosphate as the predominant Ca-P compound, and a Mg-compound, probably magnesium carbonate or double/triple salts containing magnesium carbonate.


[Morphological and biochemical study of the lipid components of the fetal aorta].

We made a biochemical and histochemical study of the lipidic component of intima of fetal aortas on 8 autopsy cases (7 +/- 2 months aged) arrived at our observation in the Pathology's Institute of II Faculty of Naples. We made a study with freeze-sections stained with Oil-Red 0 and after dissociation of the intima by the adventitia, it is valued biochemically the lipidic peroxidation studying the levels of malonyldialdehyde (MDA) like indirect marker of peroxidation. It is known that is present a lipidic component in the intima of fetal aorta whether intracellular or extracellular (Fig. 1, 2). Sometimes this component can accumulate until to determinate true lipidic striae. The aim of this study is a detection of MDA in lipids extracted from human fetal aortas. MDA levels was measured by Thiobarbituric method (TBA): lipids were extracted both intima and adventitia by Chloroform/methanol method, after surgery immediately. The results are expressed in nMoles/mg of lipids +/- Standard Deviation. Controls of spontaneous lipid peroxidation was take at a different times. It is known that in vitro incubation of LDL with cultured endothelial cells, smooth muscle cells or macrophages leads to peroxidation of LDL phospholipids and oxidatively modified LDL become atherogenic via foam cells production. In addition lipid peroxidation was formed by the direct peroxidation of unsaturated fatty acids and their esters are capable of further lipoperoxide production by oxygen free radical; chain reactions. In this context lipid peroxidation could be an important factor in the first stage of human pathophysiological development and this phenomenon may be related by an early free radical production.


Growth retardation due to idiopathic growth hormone deficiencies: MR findings in 24 patients.

In this study we evaluated the pituitary-hypothalamic abnormalities of "idiopathic growth hormone (GH) deficiency" as demonstrated by MR imaging. Twenty-four patients were examined with a 1.5-T unit using spin echo T-1 weighted images. The patients were divided into two groups according to MR findings: those with ectopic posterior pituitary glands (12 patients), and those with normal posterior pituitary glands (12 patients). Ten patients in the former group and four in the latter group had small anterior pituitary glands. All patients in the former group but only four in the latter group had severe GH deficiencies. Multiple hormone deficiencies were found in eight patients in the former group, but in only two in the latter group. Among the 12 patients with posterior pituitary ectopia, 11 were males, 10 had been born by breech delivery, and four had a history of asphyxia. It is speculated that perinatal abnormalities can cause posterior pituitary ectopia and that there is a close correlation between breech delivery and the male disadvantage of posterior pituitary ectopia. Half of our patients with "idiopathic GH deficiency" had ectopic posterior pituitaries. GH deficiency with posterior pituitary ectopia should no longer be considered idiopathic because organic lesions can now be identified during life.


Blue nevus of the lymph node capsule. Report of a case.

A case of blue nevus in the lymph node capsule is described. It's not a common pathology and only few cases have been reported so far. Nevus-cell aggregates in the same location are more frequent and difference between the two entities is described. So for histogenesis of these lesions, a melanocyte migration arrest is favoured rather than the hypothesis of a 'benign metastasis' from a cutaneous primitive site.


[A case of focal necrotizing granulomatous hepatitis in childhood].

Granulomatous hepatitis make up a group of conditions of various aetiologies. The diagnosis of granulomatous hepatitis is histologic, since the aspect of the granulomatous lesion is not always indicative of a specific disease. It is important to take into consideration for the aetiologic diagnosis a good response to a specific therapy or the execution of complementary examinations. The 25% of granulomatous hepatitis remain undiagnosed.


MR imaging of the pituitary gland in central precocious puberty.

Cranial magnetic resonance imaging was performed in 17 children with central precocious puberty (CPP) and 19 aged-matched controls to compare the appearance of the pituitary gland. Gland size was measured on T1-weighted sagittal and coronal images. The gland was graded according to the concavity or convexity of the upper surface, and the signal intensity of the gland was assessed visually. The mean pituitary volume in 13 CPP children without hypothalamic tumor (292.6 mm3) was significantly greater than that in normal controls (181.35 mm3). The mean volume for the four CPP children with hypothalamic tumor was smaller (145.0 mm3). Compared to controls, the upper pituitary surface in CPP patients appeared convex in a higher proportion. The anterior pituitary was isointense to pons in all patients and controls. Although the posterior pituitary bright spot was present in 14 controls and 11 CPP patients, none with hypothalamic tumor showed it.


Aberrant thymus--MR assessment.

Aberrant thymic tissue, particularly when it is located posteriorly, can present a diagnostic dilemma. Once a mediastinal "lesion" is defined on the plain film, MR is the most efficient and best diagnostic test for defining the nature of the mass and showing its relationship to other mediastinal structures. Two cases of aberrant thymic tissue, one on the right side and one on the left, are presented to elucidate the unique role of MRI.


[Rhodococcus equi infections in AIDS: personal cases].

We report on the occurrence of an uncommon pathogen, Rhodococcus equi (R.e.) in HIV infection. In the period february 1990-July 1991 we performed the diagnosis of R.e. infection (lung, lung-central nervous system) in two infected patients, aged 27 and 31 years, both males, drug addicts, classified as CDC IV. In the first of them an cavitating right bronchopneumonia (bpm) was diagnosed as of tuberculous origin, on the ground of the microscopic demonstration of an acid-fast, gram-positive strain in b.a.l.. A standard antituberculous regimen was uneffective and R.e. was eventually isolated in three blood culture taken shortly before the exitus and at post-mortem examination of the lungs. In the second patient a subclavian right bpm developed without microbiological evidence of any common pathogen. A third-generation cephalosporin course was only partially successful (clinical amelioration, incomplete clearing of radiological findings). After 3 months the patient relapsed and an aseptic meningitis developed. Cultures of blood and csf yielded a R.e. strain; post-mortem examination revealed a diffuse, cavitating bpm. Our personal experience underlines the difficulty in recognizing R.e. infections in compromised host, because of similarity to other entities (i.e. tuberculosis) and the absence of pathognomonic hints.


Neuroimaging in tuberous sclerosis: a clinicoradiological evaluation in pediatric patients.

CT, MRI and neurological features of 27 children with tuberous sclerosis were prospectively compared. Imaging studies were positive in 92.5% of cases. CT was more useful in detecting subependymal nodules, while MRI showed the number and location of cerebral cortical and subcortical lesions more accurately. Cortical lesions in the cerebellar hemispheres were present in 26% of patients. Gadolinium-DTPA used in 10 patients showed slight enhancement of the subependymal lesions in 80% of cases, probably representing active lesions with alteration of the blood-brain barrier. None of the cortical and subcortical lesions enhanced. Giant-cell astrocytomas were detected in 5 patients, the postcontrast CT and MRI studies improving their assessment. Unlike subependymal nodules, all tumors showed marked enhancement regardless of their size. Seizures were present in 96% of patients, mostly beginning before 1 year of age. There was no clear relationship between the radiological features and the neurological evolution of these patients. Therefore, it is not possible to establish a clinical prognosis based on the radiological findings. MRI is the procedure of choice in the diagnosis of tuberous sclerosis. When pre and postcontrast MRI are negative, CT is used to exclude small calcified subependymal nodules. MRI follow-up is required only when tumoral development is clinically suspected.