Coronary artery spasm and acute myocardial infarction in naproxen-associated anaphylactic reaction.

We present the case of a 43-year-old man who suffered an acute myocardial infarction after oral administration of 250 mg of naproxen, prescribed as antiinflammatory-analgesic agent after tooth extraction. Both intradermal skin test and human basophil degranulation test were positive to naproxen. These findings suggest a naproxen-associated anaphylactic reaction with concomitant coronary artery spasm and posteroinferior infarction, a clinical event previously not reported with the use of this drug.


[The prevention of a pressor reaction to tracheal intubation in patients with aneurysms of the cerebral vessels. A comparative study of 7 methods].

A comparative study of seven techniques preventing pressor reactions to tracheal intubation (profound barbiturate anesthesia, conventional clinical doses of fentanyl, intravenous lidocaine, pentamine, glycerol trinitrate, sodium nitroprusside and magnesium sulfate) has been conducted in 75 patients with arterial aneurysms and arteriovenous malformations in brain vessels. The best preventive effect was observed with the use of glycerol trinitrate and conventional clinical doses of fentanyl. However, none of the above techniques could completely prevent pressor reactions to intubation.


[Oxygen transport in patients with ischemic heart disease operated on under a program to preserve the patient's blood].

The results of the studies performed in 112 patients operated on with preservation of the patient's blood are reviewed. This meant pre- and intraoperative blood taking, surgery under normovolemic hemodilution, blood taking and transfusion upon its neutralization with heparin, collection of the blood flowing from drainages. Acid-base balance, pO2, blood Hb level, the degree of Hb saturation with O2, free plasma Hb, platelet count, the level of 2,3-diphosphoglyceric acid have been determined and parameters of oxyhemoglobin dissociation curve have been calculated. Computer monitoring of O2 transport was performed before and after assisted circulation in 28 patients. During surgery it proved possible to collect and return to the patients 10% of the circulating blood. The blood collected during surgery had no negative effect on the hemostasis. The above technique makes it possible to reduce the amount of donor blood used during surgery and has no negative effect on O2 transport.


[Norfin in oncological practice].

A synthetic opiate agonist-antagonist norphin (buprenorphin) has been studied in 297 cancer patients as an analgetic component of general anesthesia, in postoperative analgesia and in the treatment of chronic pain syndrome. In modified neuroleptanalgesia based on norphin, diazepam, droperidol and N2O the patient is more adequately prevented from surgical trauma than in conventional neuroleptanalgesia based on fentanyl. This is confirmed by greater stability in circulation, metabolism and stress hormone parameters, however this anesthesia technique is less manageable and may be accompanied by prolonged postanesthesia depression of the central nervous system. Good results have been obtained when norphin pills were used sublingually for the treatment of long-lasting intensive chronic pain syndrome in incurable cancer patients. Norphin is no less effective than morphin, however, unlike morphin, it causes no severe adverse reactions.


[The comparative characteristics of anesthesia methods in operations for tumors located on the extremities].

Seventy patients operated on for malignant tumors located in the extremities have been examined, 30 of them were operated on under conduction anesthesia. The adequacy of anesthesia was assessed using clinical metabolic and electrophysiological techniques. Evident advantages of conduction anesthesia over general anesthesia during short-term interventions have been substantiated. Anesthesia with bupivacaine proved most effective.


[The protein components of the acid-soluble fraction of normal human blood plasma and in peritonitis patients].

Samples of acid-soluble blood plasma fractions from 10 healthy donors and 12 patients with peritonitis have been fractionated, using the techniques of vertical electrophoresis in polyacrylamide gel and high pressure liquid chromatography. Three basic protein-containing components with the molecular mass 43, 30 and 14 kD have been identified in samples of donor blood plasma. In peritonitis there is an increase in the level of some fractions present in acid-soluble fractions of donor blood plasma and the generation of new protein-containing acid-soluble components. A band corresponding to a component with a molecular mass 64 kD and a wide band in the range of 9-14 kD have been registered. The treatment of donor blood with trypsin generates some components characteristic of acid-soluble blood plasma fraction of patients with peritonitis. The authors believe that increased proteolytic activity is one of the factors responsible for qualitative and quantitative changes in acid-soluble blood plasma fraction in peritonitis.


[The validation of the use of Moradol for anesthesia in spontaneous labor].

Pharmacodynamic and pharmacokinetic peculiarities of moradol have been studied during natural delivery. It has been shown that moradol injected both intramuscularly and intravenously in the first period of labour did not inhibit the circulation in the women in labour, had no impact on the course of labour and had no negative effect on the newborn. The use of moradol is recommended for analgesia of natural delivery. A correlation has been established between blood drug concentration and its pharmacodynamic indexes in women.


[Intrapulmonary blood shunting during surgical interventions in children].

It has been observed that controlled lung ventilation during surgery in children is accompanied by an increase in intrapulmonary blood shunting, which averages 7.3% in urological surgery, 12% in abdominal surgery and 16.8% in thoracic surgery. The shunting is caused by ventilation-perfusion disturbances. The use of high-frequency jet ventilation, i.e. application of 16.7 Hertz oscillatory modulations together with conventional controlled lung ventilation enables one to decrease intrapulmonary shunting, reduce the signs of circulatory hyperdynamia and the load on the heart ventricles and leads to normalization of pulmonary flow in thoracic surgery.


[The use of T-activin in the intensive therapy of the postoperative period in gestosis patients].

Cellular immunity and blood serum levels of parathyroid hormone have been studied in patients with gestoses depending on the disease severity. Progressive immune depression accompanied by a parallel drop in parathyroid hormone level up to critical values has been demonstrated in patients with eclampsia. The patients with pre-eclampsia were treated postoperatively with t-activin. Cellular immunity was compared in patients on and off t-activin. A marked immunostimulating effect of the drug on T-lymphocytes and especially on theophylline-resistant T-lymphocyte subpopulations has been revealed. The effect of t-activin was most marked on the 3rd-5th day of the postoperative period.


[The prevention and treatment of suppurative-inflammatory complications in the bronchopulmonary system during prolonged artificial ventilation].

The use of physical methods, namely low frequency magnetic field in critically ill patients under respiratory therapy made it possible to prevent and in case of their development to effectively treat pyoinflammatory bronchopulmonary complications that accompany prolonged controlled lung ventilation. The results obtained were due to the elimination of an unfavourable effect of controlled lung ventilation on natural resistance and immune response of the respiratory tract because of normalization of physicochemical properties of the tracheobronchial tree secretion, enhanced functional capacities of phagocytes, repaired bonds between cellular and humoral local immunity in the lungs.


[The use of moderate neurovegetative adrenergic inhibition together with anticoagulants in patients with acute cholecystitis].

The studies have been performed in 178 patients during and after surgery on the biliary ducts. The patients developed marked hyper-reaction of the sympathoadrenal system, total and regional hemodynamic disturbances, hypoxia, disorders in redox processes and blood viscosity and hypercoagulation. To prevent and eliminate the disorders observed small doses of ganglioblockers, alpha- and beta-blockers in combination with heparin were used during surgery and in the earliest postoperative period. As a result hyper-reaction of the sympathoadrenal system was considerably reduced, total and regional hemodynamic parameters were improved, hypoxia was attenuated, redox processes were activated, hypercoagulation decreased and blood viscosity was improved. Lethality in this group decreased from 7.9% to 1.1%. The above technique of neurovegetative adrenergic inhibition and heparinization enhanced adaptation capacities of the body to surgical intervention and improved the results of surgical treatment of patients with acute cholecystitis.


[The gas-exchange properties of membrane blood oxygenators with immobilized heparin].

Gas-exchange properties of membrane oxygenators (MO) "MOST-122" with immobilized heparin have been studied during 18 open heart surgeries. It has been shown that heparin immobilization on MO surfaces that are in contact with blood is accompanied by enhanced MO ability to oxygenate blood and remove CO2.


[The effect of dalargin on the hemodynamics in acute myocardial infarct complicated by clinical death].

Cardiac output and myocardial contractility have been studied in dogs with experimental myocardial infarction complicated by 5 min clinical death. Control animals (16 dogs) were intravenously injected physiologic saline, while test animals (12 dogs) were administered leu-enkephalin analogue dalargin at a dose of 100 micrograms/kg, 20 min and 6-h after recovery. It has been established that dalargin improved basic hemodynamic parameters due to normalization of cardiac contractility, arrhythmia removal and reduction of the peripheral resistance. The data obtained make it possible to recommend dalargin for combined therapy of postresuscitation hemodynamic disturbances in acute myocardial infarction.


[The importance of the monitoring of free-radical processes in the diagnosis and treatment of septic shock in newborn infants].

The changes in free-radical processes have been studied using peroxide chemiluminescence of the blood sera in patients with meconial-aspiration syndrome on controlled lung ventilation and in the newborns with severe forms of sepsis. Monitoring of free-radical processes may be used for the diagnosis and prediction of septic shock and hemosorption prescription.


[A method for determining the body water compartments in patients with mechanical jaundice in the preoperative and postoperative periods].

Literature data concerning the techniques of body fluid determination in patients with mechanical jaundice in the pre- and postoperative periods have been briefly reviewed. A well-known technique of determining total, extra- and intracellular body fluid using urea, sodium rodonate and I13-albumin has been modified. The possibility of one-time determination of body fluids and the results of the author's studies are presented. It has been established that the preoperative period in patients with mechanical jaundice is characterized by considerable disturbances in fluid balance due mainly to total and extracellular body fluid; in the most severe cases there are changes in intracellular space volume. It has been established that upon correcting infusion therapy positive changes are observed on the second or third day of the postoperative period.


[Problems in improving anesthesiological and resuscitation care for children].

Some organizational problems of children's anesthesiological and intensive care service causing certain difficulties for practicing physicians have been analysed. The following problems are reviewed: consultations of specialists in intensive care units, transmission of patients, methods of infusion therapy, clinical diagnosis, duration of resuscitation, etc.


[Lipoprotein lipase deficiencies].

Lipoprotein lipase (LPL) is an enzyme which plays a major role in the metabolism of circulating triglyceride-rich lipoproteins. It hydrolyzes chylomicron and VLDL triglycerides, thereby delivering fatty acids to tissues for storage or oxidation. In order to gain insight into the molecular basis of LPL deficiency, the structure of the LPL gene (ten exons and nine introns spanning about 30 kb) is first set out in relation to the different domains of the LPL protein. There is a high sequence homology between the aminoacids of LPL and of other lipases, such as hepatic triglyceride lipase (HL) and pancreatic lipase (PL). The PL catalytic triad Ser132, Asp156, His241 is also present in LPL. Absence of LPL activity can result from absence of LPL protein synthesis (Brunzell class I), or from the synthesis of an LPL protein devoid of enzymatic activity consequently to a mutation (class II). LPL can also be unable to bind to endothelial cells--a defect combined with deficient enzymatic activity--(class III). Among the known mutations of the LPL gene (such as nonsense, frameshift, abnormality in intron-exon junction, deletion, duplication) resulting in pathological cases, the most frequent are punctual mutations located mainly in exons 4, 5 and 6, leading to the substitution of an aminoacid for another in essential domains of LPL. The combined deficiency LPL + HL has also been described. The study of the abnormalities of the LPL gene, known only since the years 1990-1991, allows not only to better understand the pathology of LPL deficiencies, but also to point out which aminoacids play a major role in LPL activity.


Detection of occult blood in stools: comparison of three gaiac tests and a latex agglutination test.

The detection of occult blood in the stools is the only simple screening method for colorectal cancer. The aim of this study was to compare the results obtained with the new Hemolex kit (Orion diagnostica, Fumouze France) with those given by three gaiac tests--Hemoccult (Smithkline diagnostics), Hemofec (Boehringer Mannheim) and Hemopreuve (Fumouze) of 165 stools from patients without special diet. Seventy-one patients with at least two positive gaiac tests or a positive Hemolex test underwent colonoscopy followed, if negative, by fibroscopy: 28 had lesions of the lower digestive tract and five of the upper digestive tract. Sensitivity, specificity and negative and positive predictive value were of 70, 98, 91 and 92% respectively for Hemolex; 82, 74, 94 and 44% for Hemoccult; 94, 67, 98 and 42% for Hemopreuve and 91, 73, 97 and 46% for Hemofec. The results obtained in this study confirm the value of the Hemolex test for the detection of human occult blood in the stools whereas the gaiac tests used are influenced by dietary components (unless restricted), explaining their poor positive predictive value. In conclusion, due to their good negative predictive values, the authors recommend that screening for colorectal tumours should be based on the use of two or three gaiac tests which should be confirmed, when positive, by an immunological test for human hemoglobin.


[Intensive therapy in high fever in young children at the prehospital stage].

It has been shown that in the most severe cases of high fever children with encephalopathy and epileptic syndrome should be treated with droperidol. The clinical signs of circulation centralization in such cases are as follows: marble skin, disturbed consciousness, elevated BP, increased difference between rectal and axillary temperature. High fever was more favourable in children without concomitant diseases and with moderately expressed signs of circulation centralization (pale skin and cool extremities).


Comparative value of polymerase chain reaction and conventional biological tests for the prenatal diagnosis of congenital toxoplasmosis.

When toxoplasmosis is acquired during pregnancy, there is a risk of severe congenital defect in the foetus. Maternal treatment with spiramycin limits the transplacental passage of the parasite to the foetus but does not prevent infection in all cases. Prenatal diagnosis should be based on specific and fast methods to prescribe the more potent combination of sulfadiazine and pyrimethamine. This study evaluates PCR in the prenatal diagnosis of toxoplasmosis; PCR was based on the detection of the gene coding for the P30 surface protein. Amniotic fluid from 44 women with suspected foetal infection was tested by PCR and results were compared to those of conventional diagnostic tests on foetal blood and amniotic fluid. PCR was positive in 7 out of 10 samples from proven congenital toxoplasmosis cases. Sensitivity of PCR was similar to cell culture and mouse inoculation of amniotic fluid but was superior to tests carried out on foetal blood (specific IgM, eosinophil and platelet counts, gamma glutamyl transferase, mouse inoculation). In two cases, PCR was positive with no detected infection of the foetus. In this study, the combination of fast detection methods, ie cell culture and PCR of amniotic fluid, eosinophil and platelet counts, GGT activity and specific IgM, enabled us to confirm 10/10 cases of congenital toxoplasmosis in less than a week. PCR therefore appears to be an additional test which improves early prenatal diagnosis of toxoplasmosis.


[The systems analysis of anesthesiological activities in a general hospital].

Using an information mathematical model of anesthesiological service suggested, the authors have performed system analysis of anesthesia management in a multi-profile hospital in Arkhangelsk. Changes in the scope and structure of anesthesia, indexes of anesthesiological activity, frequency of procedures, asepsis, incidence of complications have been analysed. The analysis performed demonstrates the possibility of the control and management of anesthesiological service and forms the necessary prerequisites for its further development on the basis of economic parameters and criteria.


Microdialysis and glucose biosensor for in vivo monitoring.

Microdialysis coupled to a glucose biosensor led to a continuous monitor system in vivo for glucose. Several microdialysis probes were used to stabilize the biosensor response. In vivo experiments, especially when the probe was placed subcutaneously, showed that the sensitivity of the biosensor decreased continuously; various kinds of fibers with a molecular weight cut-off (MWCO) ranging from 6,000 to 20,000 were compared. A wall-jet flow cell as detector for glucose showed less interference when compared to a thin layer cell. Glucoday, a new commercial instrument based on this principle, is presented.


[The effect of fentanyl on myocardial function].

The addition of fentanyl to the perfusate (up to the concentration of 1.84.10(-7) M) did not change the baseline levels of the parameters studied in the isolated hearts. By the end of the experiments stroke volume, heart rate, coronary flow, heart performance, rates of contractions and relaxations in the left ventricle remained at baseline level and were better than in the control group. The authors hold that reduced O2 demands are the reason for the stabilization of the myocardial function observed. The above peculiarities of fentanyl make it a drug of choice in cardiosurgical patients.


New generation RIBA hepatitis C strip immunoblot assays.

Second generation hepatitis C virus (HCV) Elisas are currently in use in Europe and have been submitted for approval in the United States. These new assays contain additional antigens from the putative nucleocapsid and NS-3 regions of the HCV genome in addition to the c100-3 antigen present in first generation Elisas. A supplementary test, the second generation RIBA (Chiron Co trademark) HCV strip immunoblot assay (2-RIBA HCV SIA) has also been developed. The strip immuno-blot assay uses four recombinant HCV antigens (5-1-1 [NS-4], c100-3 [NS-4], c33c [NS-3], and c22-3 [NS-3 [nucleocapsid]) slot blotted on nitrocellulose. Screening of random volunteer blood donors with the Ortho (Ortho Diagnostic Systems trademark) second generation HCV Elisa (2-Ortho HCV Elisa) indicates that a substantial change in the repeat reactive donor population is observed with the new test. Two notable features of this change are: i) a large number of samples reactive in the 2-RIBA HCV SIA for the second generation antigens, c33c and c22-3, are detected by the 2-Ortho HCV Elisa; ii) the percentage of 2-Ortho HCV Elisa reactive specimens found indeterminate (reactive for only one HCV antigen) by the 2-RIBA HCV SIA is higher than in first generation HCV Elisas (approximately 25 versus 5%). In addition, 2-ortho HCV Elisa repeat reactive, 2-RIBA HCV SIA indeterminate samples are dominated by reactivity to c22-3 instead of c100-3 which is the case for first generation HCV Elisa repeat reactive samples.(ABSTRACT TRUNCATED AT 250 WORDS)


Multianalyte microspot immunoassay. The microanalytical 'compact disk' of the future.

Throughout the 1970s, controversy centered both on immunoassay 'sensitivity' per se and on the relative sensitivities of labelled antibody and labelled analyte methods. Our own theoretical studies in this period revealed that radioimmunoassay (RIA) sensitivities could be surpassed only by the use of very high specific activity non-isotopic labels in 'non-competitive' designs, preferably based on the use of monoclonal antibodies. The time-resolved fluorescence methodology known as Delfia - developed in collaboration with the instrument manufacturer LKB/Wallac - represented the first commercial 'ultra-sensitive' non-isotopic technique based on these theoretical insights, the same concepts being subsequently adopted in comparable methodologies relying on the use of chemiluminescent and enzyme labels. However, a second advantage of high specific activity labels is that they permit the development of 'multi-analyte' immunoassay systems combining ultra-sensitivity with the simultaneous measurement of tens, hundreds or thousands of analytes in a small biological sample. This possibility relies on simple, albeit hitherto unexploited, physicochemical concepts. The first is that all immunoassays rely on measurement of Ab occupancy by analyte. The second is that, provided the Ab concentration used is 'vanishingly small', fractional Ab occupancy is independent of both Ab concentration and sample volume. This leads to the notion of 'ratiometric' immunoassay, involving measurement of the ratio of signals (eg fluorescent signals) emitted by two labelled Ab's, the first ('sensor' Ab) deposited as a microspot on a solid support, the second a 'developing' Ab directed against either occupied or unoccupied sensor Ab binding sites.(ABSTRACT TRUNCATED AT 250 WORDS)


The impact of mammography on breast biopsy.

To determine the efficacy of mammography in the detection of early breast carcinoma at an urban teaching hospital, the results of all breast biopsies performed between 1983 and 1987 that were preceded by mammographic examination were retrospectively reviewed. There were 503 women in this population. Malignancy was detected in 79 cases (15.7%); 21 were in situ and 58 were invasive. Among all nonpalpable malignancies, 53.0 per cent were in situ, while only 2.4 per cent of all palpable malignancies were in situ. An abnormality was found in 374 mammograms (74%), and 73 (19.5%) were malignant. The abnormality most likely to represent a malignancy (44% yield) was spiculated density, followed by clustered microcalcifications (25%), mass (22%), and asymmetric density (14%). Six malignancies were detected by biopsy for clinical indications, despite a negative mammogram (4.7% false- negative rate). The interpretation of mammograms by radiologists carried a 2.4 per cent false-negative rate. The mammographic features of mass, clustered microcalcifications, spiculations or asymmetric density should generally mandate breast biopsy, although the clinical examination should remain an important basis for management decisions. An aggressive approach toward screening mammography and breast biopsy based on mammographic criteria may enhance survival among women with breast carcinoma.


Laser thoracoscopy for pleural effusion.

A potential, new, therapeutic modality for the treatment of recurrent symptomatic pleural effusion in a patient with metastatic carcinoma is presented using "minimal access surgery." Diagnosis at the time of thoracoscopy, as well as treatment using free-beam and contact-tip modalities, is outlined in detail. Also, a complication of inter-costal artery bleeding is presented, as well as its solution using the end-firing endoclip applier. This is an effective and useful procedure that should be particularly of interest to surgeons already using various scope methods. Surgeons currently express strong interest in accomplishing diagnosis and treatment goals in a variety of clinical situations using "minimal access surgery," a phrase coined at the 1989 International Congress of the Society of American Gastrointestinal and Endoscopic Surgeons. Enthusiasm about this procedure is evident across the country by the number of laparoscopic courses offered at a variety of institutions. Similarly, the chest allows certain applications of minimal access surgery resulting in accurate diagnosis and possible definitive treatment by use of the thoracoscope.


Bronchial carcinoid tumor: experience over 20 years.

Nineteen cases of bronchial carcinoid tumor seen over 20 years in a 1,000-bed, tertiary medical center were retrospectively reviewed. They consisted of 0.4 per cent of all patients with lung tumors. Initial complaints were hemoptysis, persistent pulmonary infection, chest pain, and diarrhea. Two of the five patients with atypical carcinoid tumors came to the hospital with diarrhea as a result of their chemically active tumors. However, seven patients (36%) were asymptomatic and were diagnosed after an abnormal chest radiograph was noted incidentally. Of 13 patients receiving bronchoscopic examination, 9 (69%) had visible tumors. Bronchial biopsy was performed in 7 patients and led to a diagnosis in all seven. Significant bleeding was noted in 3 patients as a result of biopsy. Lobectomy was the most common surgical procedure in this series. Follow-up of these patients was from 6 months to 15 years. The general outcome for patients with typical carcinoid was good. However, all patients with atypical carcinoid died as a result of dissemination.


Management of barium enema-induced colorectal perforation.

Unless recognized and treated promptly, colorectal perforation induced by barium enema examination is a life-threatening complication. Between 1977 and 1986, 13,000 barium enemas were performed at the Mayo Medical Center. Colorectal perforation occurred in five patients (overall incidence: 0.04%). The two colonic perforations were managed by immediate celiotomy with resection in one and primary repair in the other. The three rectal perforations were managed conservatively in two patients and by proximal diversion in one. All patients recovered. Perforations were believed to be related to the tip of the enema catheter or presumably to excessive hydrostatic pressure. In contrast to other reports, barium enema-induced colorectal perforation is not always fatal when recognized early and treated aggressively. Localized, contained extraperitoneal rectal perforation may be managed conservatively in selected patients.


Small bowel metastases from primary lung carcinoma: a rarity waiting to be found?

Isolated, small bowel metastases from lung carcinoma are extremely rare; only 34 cases have been previously reported. Rarer still is the presentation of lung carcinoma with a lesion metastatic to the small bowel. These 34 cases and 3 recent ones from Easton Hospital (Easton, PA) were analyzed to clarify the clinical and pathologic features of the disease. The majority of patients had a history of abdominal pain (86%), melena (23%), or nausea and vomiting (26%). Few had weight loss (16%). Twenty-one patients (57%) came to the hospital with perforation and peritonitis, including 9 in whom lung carcinoma was undiagnosed before laparotomy. Thirteen patients (34%) underwent laparotomy because of small bowel obstruction, 2 (6%) for bleeding and 1 (3%) for a mass found during work-up. Squamous cell (49%) and large cell (22%) were the most common cell types, and the jejunum was the most common site of the metastases (79%). Survival time was dismal (mean 51 days) and was unaffected by therapy to the primary site of the cancer or its metastases. The authors conclude that small bowel metastases from lung carcinoma are not uncommon and may be seen more frequently as patients live longer after their diagnosis of cancer. Small bowel metastases must be considered in any patient with both lung carcinoma and abdominal pain, and should be expected in patients with both lung carcinoma and an acute abdomen.


Management of isolated splenic metastases from carcinoma of the lung: a case report and review of the literature.

Splenic metastases from bronchogenic carcinoma are considered very rare. In most cases, these represent diffuse disease and widespread hematologic dissemination. Reports of isolated splenic metastases are exceedingly rare and essentially unknown in the thoracic literature. A case report of isolated splenic metastases is detailed and a review of the literature provided.


Changing patterns in colorectal carcinoma: a 25-year experience.

The pattern of colorectal carcinoma, especially with respect to stage and tumor location, has changed noticeably over the past 25 years. During that time period, 1,959 patients came to Hahnemann University Hospital with colorectal cancer, 1,584 of whom were reviewed in this study. There was a significant relationship between extent of disease and date of diagnosis, with the trend being toward decreasing stage at the time of diagnosis. In addition, there has been a demonstrable "rightward shift" in tumor location, especially over the past 15 years. This has been accompanied by a slight increase in the detection of rectal lesions as well. The trend toward earlier and more proximal lesions is likely due in large part to the increasingly widespread use of surveillance colonoscopy and sigmoidoscopy.


Breast cancer in nonpalpable lesions: can mammographic parenchymal pattern improve the predictive value of biopsy?

The increasing number of women referred for surgical biopsy of nonpalpable breast lesions detected by screening mammography led to a retrospective review of all such cases from October 1, 1986 to September 30, 1990. There were 165 consecutive, wire-localized, excisional biopsies of radiographic lesions performed on 158 patients during this 4-year period. A positive (i.e., malignant) result was found in 16 patients (10%); all but one of these 16 patients had stage I disease at subsequent treatment. Examination of historical factors (age, family history, prior biopsy, breast symptoms) and mammographic factors (mass, microcalcification, irregular borders, new lesion, parenchymal pattern of increased fibroglandular density) revealed that no patient with a diffuse parenchymal pattern of increased fibroglandular density had a malignant diagnosis. This finding was statistically significant (P = 0.002) by chi-square analysis. This negative relationship of radiographic parenchymal pattern to early cancer in nonpalpable lesions is contrary to what one would expect, based on several reports in the radiology literature. Over one-third (36%) of the author's patients had the increased fibroglandular x-ray pattern, making this finding potentially important for surgeons evaluating the patient with a nonpalpable lesion detected by mammography.


Endarterectomy with arterial dilators: surgical technique.

A simplified technique of semi-closed endarterectomy with arterial dilators that insures complete removal of intimal fragments was used by the authors. Complications, such as arterial wall penetration and residual intimal fragments, are reduced. This technique has proven useful in aortoiliac and short-segment femoral artery endarterectomy. It is also helpful for proximal anastomosis of femoral/popliteal/tibial in situ bypass where termination of saphenous vein cannot reach femoral artery.


Inhibition of afferent vagus nerves decreases gastric stress lesions.

Capsaicin (Sigma Chemical Co.) is a unique chemical agent that causes degeneration of afferent nerve fibers. Previous conclusions about Capsaicin effects on the gastric mucosal response to stress have not precisely defined which afferent nerves were affected. Therefore, the aim of the first portion of this study was to define the origin of afferent vagus nerves to the anterior gastric wall after injections of fluorogold (which is an axonal tracer) into the stomach. The second part of this study was to compare the stress effects on the gastric mucosa in rats with impaired afferent nerve function after Capsaicin treatment.


Solcoderm as alternative conservative treatment for acute anal fissure: a controlled clinical study.

Acute anal fissure is a common malady that results in morbidity. If a patient is not responsive to conservative treatment, the current recommended treatments are either anal dilatation or lateral internal sphincterotomy. Both operations promise relatively good results, but the recurrence rates are about 16 per cent and 7 per cent, respectively. This fact, together with possible postoperative complications and costs, justifies trying conservative treatment before referring patients for surgery. The authors treated a study group of 25 patients with a topical application of Solcoderm. Another group of 25 patients concurrently treated with the usual conservative treatment served as the control group. Analysis of the early and late results proved Solcoderm to be simple to use, safe, without systemic side effects, cost-effective, and with statistically significant better outcome. Consequently, the authors believe that this method of treatment is justified in cases of acute and fissure and should be attempted before operation.


Treatment of Zenker's diverticula by cricopharyngeus myotomy under local anesthesia.

Optimum surgical management of the hypopharyngeal diverticulum is controversial. The authors discuss 48 consecutive patients (average age 72.1 years) with documented hypopharyngeal diverticula who were treated by cricopharyngeus myotomy, leaving the diverticula in situ. All came to the hospital with dysphagia; other symptoms included postdeglutitive cough, regurgitation, aspiration, and weight loss. Seven patients had had previous surgery for a Zenker's diverticulum with recurrence. Aspiration pneumonia was treated in 9 patients; 28 patients had concurrent chronic obstructive pulmonary disease or cardiovascular disease. Thirty-nine patients had cricopharyngeus myotomy under local anesthesia, 5 had cricopharyngeus myotomy under general endotracheal anesthesia, and 4 patients underwent myotomy with a cervical esophagostomy. There was one mortality (2.1%) and no incidence of postoperative bleeding, sepsis, or cranial nerve injury. Follow-up was done with 30 patients via telephone an average of 64 months after operation. Twenty-one of 30 patients reported excellent relief of symptoms, 5 reported improvement with occasional symptoms, and 4 patients described persistent dysphagia. Cricopharyngeus myotomy under local anesthetic is a safe and effective approach to the patient with a hypopharyngeal diverticulum. The awake patient can swallow on command, which enables the surgeon to identify the upper esophageal sphincter (UES) and to perform an accurate, complete myotomy. The absence of a pharyngeal suture line eliminates the risk of leakage and mediastinal sepsis, and allows early, postoperative feeding and discharge.


The reliability and stability of biomarkers of aging.

Different types of stability of a biomarker are important properties, influencing the degree of predictability across age (ordinal stability) and the interpretation of quantitative and qualitative change with age (structural stability). These properties may be expected to differ from biomarker to biomarker and may change with age. Any age-related process with individual differences in time of onset of change or in rate of change will necessarily display reduced ordinal stability. Another source of reduced correlation across occasions is the short-term fluctuance of individuals due to cyclic processes and to responsiveness to environmental displacements of biomarker values and recovery therefrom. Structural stability of composite variates may be quite high across relatively short intervals but sufficiently low across longer intervals as to suggest the inappropriateness of simple description of mean changes or differences across these longer time spans. The outcome with multivariate composites raises the issue that single biomarkers may have quite different meanings at different parts of the life span.


The response of human lymphocytes to phytohemagglutinin is impaired at different levels during aging.

Several parameters generally believed to be necessary for the activation and progression of proliferation of human lymphocytes have been investigated and compared with special reference to aging. The responding capacity of plasma membrane potential to depolarizing and also repolarizing conditions induced by exposure to mitogens like PHA was lower in lymphocytes from old donors as compared to those of young ones. This indicates a significant age-dependent difference in the readiness to respond to channel-activating perturbations. As an early signal of activation, after one hour PHA stimulation the merocyanine 540 uptake by the lipid regions was chosen, based on the property of this fluorescent probe to bind to loosely packed lipids of the plasma membrane. The proteins encoded by the c-myc and c-myb genes were chosen as markers of the G0/G1 and G1/S phased transition, respectively. The mean number of cells that increased the uptake of MC 540 following mitogenic stimulation did not differ in young vs. old individuals. However, 4 samples out of 10 from the old population showed lower MC 540 fluorescence than the lowest signal from the young population. The number of responding cells was decreased during aging when the presence of the c-myc protein was taken as its measure; and this decrease was further accentuated, determining the expression of the c-myb protein. This frequently encountered age-dependent pattern, however, was not followed by the lymphocytes of all old donors. One example is reported in which the MC 540 uptake, the c-myc and c-myb expression in the cells from one old subject fell in the range of the young subjects. However, even in this case, the response of the lymphocytes as measured by 3H-thymidine incorporation was only 64% of that of young subjects. For this sample, we found an impairment of the response at the mitochondrial level. In addition to these parameters, the amount of 3H-thymidine incorporated by the cells expressing the c-myb protein was calculated. The values in old individuals were lower than those in the young, suggesting that not all the cells expressing the c-myb protein were able to synthesize DNA in lymphocyte populations from the elderly. Our data support the view that the age-dependent decline of lymphocyte responsiveness to mitogens can be accounted for by impairments at different levels.(ABSTRACT TRUNCATED AT 400 WORDS)


Free radical injury in skin cultured fibroblasts from Alzheimer's disease patients.

Oxygen radical production is postulated to be a major cause of cell damage in aging. We have studied the response to toxic oxygen metabolites of fibroblast cell lines derived from skin biopsies of patients with familial and sporadic Alzheimer's disease compared with those derived from normal controls. Fibroblasts were damaged by the generation of oxygen metabolites during the enzymatic oxidation of acetaldehyde by 50 mU of xanthine-oxidase. To quantify cell damage we measured lactate dehydrogenase activity in the culture medium and cell viability in fibroblast cultures from four normal subjects, five FAD, and four AD patients after 2 hours of Xo incubation. We found a significant increase of LDH activity in FAD vs. controls and also in AD vs. controls, suggesting that AD cells are more susceptible to oxygen radical damage than are normal controls.


Transmembrane signaling changes with aging.

Altered immune response and transmembrane signaling with aging has previously been demonstrated. The aim of the present study was to characterize PMNLs and lymphocyte G proteins and to determine whether their relative amounts are altered with aging. First we studied the effects of FMLP on PMNLs IP3 formation. It was found that in any group of elderly the PMNLs IP3 formation was significantly decreased compared to that of young subjects. In FMLP receptor binding affinity no measurable difference exists in either low- or high-affinity FMLP receptors. The autoradiogram of 32P-ADP-ribosylated proteins by CT in lymphocytes of young individuals showed a major polypeptide of 40 kDa, and two much less prevalent components of 52 and 45 kDa. In contrast, in lymphocytes of elderly subjects the major polypeptide was 45 kDa, and the two others were very weakly labeled. In PMNLs, CT labeled the 45-kDa band quite strongly, mainly in the elderly, and the 52- and 40-kDa bands were very weakly labeled, mainly in young subjects. When PT was used, no age-related pattern changes could be demonstrated, while differences could be observed between the two types of cells.


Thymic involution in aging. Prospects for correction.

The thymus produces several putative thymic hormones: thymosin alpha 1, thymulin, and thymopoietin, which have been reported to circulate and to act on both prothymocytes and mature T cells in the periphery, thus maintaining their commitment to the T cell system. These endocrine influences decline with age and are associated with "thymic menopause" and cellular immune senescence, which contribute to the development of diseases in the aged. Thymus endocrinology is characterized by the action of many hormones and hormone-like substances on the cellular components of the thymus, including thymocytes, thymic epithelial cells, and thymic stromal cells. The intrathymic environment is characterized by a complex network of paracrine, autocrine, and endocrine signals involving both interleukins and thymic peptides, which can be envisioned to operate in a synergistic network to carry the evolving T cell through its stepwise development to a mature T cell. Extrathymic influences regulating the secretory function of thymic epithelial cells and the stepwise evolution of T cells can be ascribed to circulating interleukins, mainly IL1 and IL2, derived from activation and secretion of leukocytes in the periphery. These interleukins act in a synergistic fashion at all levels of T cell development by the induction of high-affinity IL2 receptors and the resultant IL2-dependent proliferative responses. To determine whether exogenous administration of interleukins would induce T lymphocyte development in aged mice, we chemically thymectomized aged mice with a steroid hormone and treated them with mixed interleukins or thymic hormones such as thymosin. We found that mixed interleukins, but not thymosin, restored thymic weight and cellularity and enhanced thymocyte responses to interleukins and mitogen. Thymosin potentiated the effect.


Aging in the T lymphocyte compartment. A developmental view.

A decline in the capacity of bone marrow cells to differentiate to T lymphocytes was found when cells from young and old donors were seeded onto an alymphoid fetal thymus. A step-by-step analysis of cell-cell interactions of the lymphohemopoietic cells and the thymic stroma indicated an effect of age on a variety of cell differentiation parameters. These included a decrease in the affinity of bone marrow cells to the stroma, and in their capacity to compete with the thymic lymphoid resident cells on colonization of the thymus. There was a significant decrease in the ability of cells of old donors to replicate sequentially within the thymic microenvironment. There was a reduced capacity of bone marrow cells from aging mice to express a developmental preference after seeding onto a syngeneic fetal thymus in a mixture with cells from allogeneic donors. We addressed the question whether the aging thymus contains increased levels of immature cells that fail to differentiate in the involuted thymic microenvironment by seeding thymocytes from young and old donors onto the fetal thymic stroma. The values of T cells that developed from the old donor inoculum were lower under these conditions. Our studies suggest that at least some of the manifestations of aging in the T cell compartment are related to developmentally programmed events in the lymphohemopoietic cell compartment.


Age-related white matter atrophy in the human brain.

Aging of the brain involves not only appreciable shrinkage of the cortex and other gray matter structures but above all loss of white matter. This could be due to a decline in the number of myelinated fibers or to a loss of water. To assess the role played by each of these factors we studied brains from 33 neurologically intact subjects at autopsy representing three different age groups: 15-50, 51-70, and 71-93 years. The precentral gyrus, gyrus rectus, and corpus callosum were selected for investigation, with staining for alkaline phosphatase on native cryostat sections to visualize the capillary network, and staining for myelin on semithin sections for nerve fiber visualization. Atrophy was objectified by measuring the number of capillaries, the intercapillary distance, and capillary length, since the capillary network remains constant throughout normal life. A mean difference of 16-20% was found, representing white matter atrophy, between the oldest and youngest age-groups. The cortex of the corresponding gyri, on the other hand, showed a difference of less than 6%. Morphometric investigation of sections stained for myelin showed that the brains with a mean age of 78.7 +/- 6.6 years had 10-15% fewer myelinated fibers. This was only partly offset by an increase in the volume of extracellular space. Our findings show that the age-related decline in brain volume is much more a question of white matter atrophy than of brain cortex atrophy. White matter atrophy could be an indirect indicator of nerve cell loss, since the volume of a nerve cell is much smaller than its myelinated fiber.


Arteriosclerosis. Impairment of cellular interactions in the arterial wall.

Our understanding of the cellular interactions in the arterial wall has increased considerably during the last 15 years. It has become clear that arteriosclerosis is a multifaceted disease, in which the accumulation of monocyte-derived macrophages, smooth muscle cells, T-lymphocytes, and lipid deposits contributes to the progressive thickening of the arterial intima. Many different types of stress, including cholesterol-rich lipoproteins, smoking, hypertension, hyperfibrinogenemia, endothelial damage, and inflammatory activation, contribute to this derailed "repair" response in the arterial intima. They are recognized as risk factors for cardiovascular disease. As a consequence of the progressive thickening of the arterial intima, the arterial lumen narrows, the barrier, vasoregulatory, and anticoagulant properties of the endothelium become impaired, and the arterial wall becomes prone to rupture and thrombosis. The advanced lesions can cause serious complications: myocardial infarction, stroke, claudication, and angina pectoris. As the extent of arteriosclerosis increases with age--a process that is accelerated by risk factors--it has a particular impact on the mortality and the quality of life of elderly people.


New in vitro findings on the "free" form of apolipoprotein A-1.

Clinical and experimental gerontologists are extremely interested in lipoproteins as well as in new methods for investigating and probing the apolipoprotein pattern. Using immunofixation electrophoresis, we separated free apolipoprotein A-1 from the apo A-1 associated with high-density lipoproteins. Free apolipoprotein A-1 is a low-molecular-mass form of apo A-1 that seems to contain an extremely low quantity of lipids. The use of IFE as a tool for probing free apo A-1 has revealed new and interesting findings, such as its "artificial" increase during serum conservation at temperatures between 0-4 degrees C. From the clinical point of view, we demonstrated a decrease to the point of disappearance of free apo A-1 in some patients with liver cirrhosis. Moreover, one of the main findings here reported is the failure of anti-human apo A-1 murine monoclonal antibody and monoclonal antibody mixture to precipitate free apo A-1 in agarose systems. This discovery has important implications both for basic knowledge on apolipoproteins and for practical reasons concerning variability in those immunoassays (radial immunodiffusion) utilizing monoclonal antibody mixtures.


Dietary restriction in nonhuman primates: progress report on the NIA study.

Rhesus and squirrel monkeys have been fed a semisynthetic diet at approximately ad libitum or 30% reduced levels for 3.5 (rhesus group 2) to 4.5 (rhesus group 1 and squirrel) years. Animals have maintained excellent health status as determined by physical examinations, hematology, and blood chemistry. While relative rates of body weight gain in restricted group 1 rhesus and squirrel monkeys have been markedly reduced, DR effects on crown-rump length (body height) have been variable. In addition, numerous physiological and biochemical parameters have been measured, and several exhibit significant cross-sectional age effects. Interestingly, several of these also exhibit possible species and genotype (group 1 and 2 rhesus) differences. A number of physiological parameters are emerging that might be altered by DR; however, further explanation of these effects awaits more extensive and detailed analyses.


Mitochondrial DNA mutation associated with aging and degenerative disease.

Previous theories of aging based on somatic mutation neglected mtDNA, which has a high propensity for mutational error. Knowledge of yeast mtDNA mutations and their functional effects, and of human mtDNA mutations identified in the mitochondrial cytopathies, provides for a concept of aging based on the cumulative effect of mutations affecting human mtDNA. An essential feature of this concept is heteroplasmy, representing mixtures of normal and mutant mtDNA at the cellular and mitochondrial level, resulting in a "tissue mosaic" of focal bioenergetic deficits. Direct evidence for the concept is provided by (i) focal loss of staining for mitochondrially encoded enzymes, such as cytochrome c oxidase, in tissues of aged individuals (humans and rats) and (ii) an age-related increase in deletional mutations in mtDNA demonstrable by application of the polymerase chain reaction to DNA templates from individuals of different ages.


Cause and treatment of presbyopia with a method for increasing the amplitude of accommodation.

To understand the mechanism and cause of accommodation and presbyopia, the sclera in the region of the ciliary body of presbyopic patients was expanded. The amplitude of accommodation was increased in all presbyopic patients. A unique hypothesis of accommodation based on increased zonular tension is presented, which when applied clinically, results in a treatment for presbyopia.


Hyperbaric oxygen therapy in the treatment of secondary keratoendotheliosis.

We evaluated the effectiveness of hyperbaric oxygen therapy in the treatment of keratoendotheliosis secondary to surgical treatment. A total of 33 patients were randomized to two arms of this study. The first arm consisted of 12 patients treated with pharmacologic therapy and hyperbaric oxygen daily for ten days. The second arm consisted of 21 patients treated with pharmacologic therapy alone (control group). Our evaluation of the results was based on testing visual acuity, grading of corneal alterations, and pachymetry findings. Hyperbaric oxygen treatment was effective in reducing corneal edema, particularly when administered early. Corneal neovascularization did not occur in any patient treated with hyperbaric oxygen.


Our experience in intraocular foreign-body removal.

Foreign bodies embedded in the retina and choroid that cannot be extracted by a magnet and require vitreous surgery for their removal comprise a separate group. A retrospective review of 40 consecutive cases (between 1977-1990) showed that this type of trauma frequently accompanied extensive ocular damage, including corneal and or scleral perforation, disruption of the lens, significant vitreous hemorrhage, retinal and choroid hemorrhage, and retinal detachment. Intraoperative and late complications occurred frequently, making the visual and structural outcomes of such eyes uncertain; therefore, another alternative must be sought that might improve the prognosis of these eyes. In this review, we emphasize (1) the time elapsed between the accident and the removal of the foreign body and (2) the final visual acuity and the time before the surgery.


Inorganic element concentrations in cataractous human lenses.

We evaluated the presence of calcium, potassium, zinc, copper, and selenium in human lenses (53 cataractous and 10 clear lenses). The determinations of these elements were done using atomic absorption spectrometry techniques, namely flame and flameless methods, after acidic digestion of the samples. Compared with the results obtained from samples of normal lenses (zinc, 16.5 +/- 2.5 mg/kg dry weight; copper, 0.53 +/- 0.08 mg/kg dry weight; selenium, 0.83 +/- 0.18mg/kg dry weight; potassium, 10,306 +/- 1232mg/kg dry weight, and calcium, 9.9 +/- 2.7mg/kg dry weight), the mean concentration values of the cataractous lenses showed some significant changes. Increases were found for zinc, copper, and calcium; the potassium concentration decreased. No significant changes occurred in selenium values. A positive correlation was found between zinc and copper concentrations (y = 0.030x + 0.007, r = .79). An inverse correlation was evident between calcium and potassium values (y = -0.097x + 1141, r = -.65).


Ocular and visual side effects of systemic cyclosporine.

In this study, we investigated the ocular and visual side effects of systemic cyclosporine used as an immunosuppressant in 51 renal transplant recipients during the postoperative period. Three different treatment schemes were used. The patients in the first group received cyclosporine and a corticosteroid. The second group was given azathioprine and a corticosteroid. Those in the third group were treated with azathioprine, a corticosteroid, and cyclosporine. Cotton-wool exudates, retinal hemorrhages, and retinal artery branch occlusion were observed only in one patient each in the second group, and these patients were excluded from the statistical evaluation. Macular hyperpigmentation was observed as a new finding in each group, but there was no statistical difference between the groups. The same results were found for cataract; this probably was related to the use of steroids. Trichomegaly, visual hallucinations, and cerebral blindness were not observed by contrast with previous studies. We suggest that systemic cyclosporine does not have significant ocular and visual side effects.


Corneal epithelial basement membrane dystrophy: an overlooked cause of painless visual disturbances.

Although decreased vision from corneal epithelial basement membrane dystrophy (CEBMD) usually is associated with pain from corneal epithelial erosion, it may be an overlooked cause of painless, sometimes sudden, visual disturbance. We report a series of eight patients referred to our department with visual deficits for whom various diagnoses had been made. A total of 15 neurologic and ophthalmologic tests had been ordered before their referral. All patients had CEBMD as a cause for their visual deficit. Retroillumination through a dilated pupil and examination of the fluorescein tear film were the best methods to demonstrate the CEBMD. Six of the eight patients underwent epithelial debridement with complete resolution of their symptoms. We recommend that all patients with unexplained visual disturbances be examined closely for CEBMD.


[Neonatal laryngeal paralysis. Apropos of 116 cases].

The following study is based on a retrospective survey of 116 cases of neonatal vocal cord paralysis referred to out department over a period of 5 years. The purpose of this study is to better define the etiology, the evolution, and the prognosis of this affection in the newborn. The principal prognostic factors are: 1) unilateral versus bilateral involvement, 2) the etiological factors associated with the paralysis. Among 21 newborns with unilateral paralysis occurring after an abnormal or difficult delivery, 90% recovered spontaneously. In this form of vocal cord paralysis and in brachial plexus or facial nerve paralysis of obstetrical origin, the etiopathogenesis and prognosis are comparable. Unilateral vocal cord paralysis as the result of other etiological factors and bilateral paralysis as a group have a worse prognosis (76% and 74% spontaneous recoveries, respectively).


[Sudden deafness. Analysis of a series of 117 cases].

A retrospective study have been conducted in 117 cases of sudden sensori-neural hearing loss, between 1988 and 1991, int he department of Head and Neck Surgery (Strasbourg). After a brief review of actually treatments, they show, in a statistic and comparative analysis, that efficacy of therapeutics are never significant. This results are compared with international bibliography, and show that treatments of sudden loss remains doubtful.


[Multiple localization and lymphatic involvement of papillary micro-carcinoma of the thyroid. Results of total thyroidectomy with bilateral lymph node excision. Apropos of 38 patients].

This study involved 38 patients with occult papillary carcinoma of the thyroid gland treated by total thyroidectomy and bilateral prophylactic neck dissection. The histological results show the glandular multicentricity on either side, both in single nodule (65%) and in multinodular goiter (73.3%). High risk of cervical spreading clearly appears in papillary carcinoma (18.4% of the patients) even in these small foci (lower than 10 mm). Topography of involvement brings into prominence two main territories: paratracheal, mid and lower jugularly nodes (involved in 92.8% of the positive dissections).


[A multiparameter method of computer-assisted objective vocal evaluation].

The aim of this study is to validate an aid for the evaluation of dysphonia with objective measurements. We recorded exhaled airflow, fundamental frequency and sound level pressure, for a sustained vowel "a", with 51 dysphonic subjects and 15 normal subjects. The following measurements are made on these three parameters: mean value, standard deviation and coefficient of variation. The exhaled airflow volume was also computed for a duration of 2 seconds. A principal components analysis of the measurements indicated that it is possible to recognise the classes of vocal evaluation and vocal pathology. These findings reinforce on objective aid for the vocal evaluation of dysphonia.


[Polyposis of the nasal sinuses. Epidemiology and clinical aspects of 350 cases. Treatment and results with a follow-up over 5 years on 93 cases].

The authors report a series of 350 patients referred for clinical investigation of nasal polyps between 1980 and 1990. 93 patients were followed for more than 5 years. Allergy to inhalants was rarely found (2.8%). Detailed study of past rhinosinusal and bronchial symptoms often revealed a history of vasomotor rhinitis (nasal hyperreactivity HRN) preceding the nasal polyposis by a mean interval of 8 years. The ratio non-allergic vasomotor rhinitis/nasal polyps was 4.31 in women (41.4% of the patients) and 1.74 in men (58.6% of the patients). Treatment is usually based on the use of local corticosteroids. However, because of the variable clinical pattern of nasal polyposis treatment may be medical alone or both medical and surgical, and always requires a long clinical follow-up. Intolerance to aspirin is a factor of poor prognosis. A 15% failure rate was noted among patients intolerant to aspirin.


[Cervicofacial metastasis of cutaneous neuroendocrine carcinoma (Merkel cell tumor). Apropos of a case. Review of the literature].

The authors report the case of an 81 year old woman with a Merkel cell tumor (trabecular carcinoma, cutaneous neuroendocrine carcinoma). A review of the literature is used to recall the principal clinical and pathological characteristics of this rare tumor and to define treatment modalities.


[Evaluation and treatment of chronic pain after cervicofacial cancer surgery].

When lasting pain occurs after surgery of head and neck cancer, tumoral recurrence should be considered. In addition to curative treatment, relief of pain is often provided by opioid analgesics. Doses vary according to tolerance and patient. Other than digestive routes of administration may be required. Here are two clinical reports: the first case with cervical epidural analgesia by ambulatory autoadministration device (Patient control analgesia), the other one with intrathecal in C7-T1 catheter with port access in which morphine was injected every 24 hours resulting in efficient analgesia, in metastatic Pancoast's syndrome. Surgical or radiotherapy sequelae sometimes bring about pain; bilateral cervicalgy described as burns associated with pain-related depression, 18 months after glotto-subglottic partial laryngectomy, requires psychological support and carbamazepine for desafferation pain removed within 6 months. When the only treatment left appears to be analgesia after surgery of head and neck cancer, follow-up in a multidisciplinary pain treatment centre allows a therapeutical management with optimum tolerance and efficiency.


[Contribution of therapeutic angiography in the management of tumors of the base of the skull].

Embolization of tumors of the skull base plays an important role in the treatment of these often complex lesions. Endovascular techniques provide important information concerning the circle of willis and facilitate surgery by reducing blood loss. The coordination of the different steps of embolization and neurosurgical treatment necessitate a preliminary multidisciplinary discussion of each case. Different procedures are possible: Arterial embolization of the branches of the internal and external carotid arteries, definitive or temporary champing of the internal carotid, and, most recently, embolization by direct injection.


[Intramuscular hemangioma of the sternocleidomastoid muscle. Apropos of a case. Review of the literature].

One patient presenting this vascular abnormality in this unusual site was treated surgically. The literature pertaining to this rare etiology for a neck mass is reviewed.


[Deep lupus erythematosus in children].

Deep cutaneous lesions are seldom encountered in lupus erythematosus. The disease described in the literature as lupus erythematosus profundus or lupus erythematosus panniculitis usually occurs in middle-aged women. The authors report a case of deep lupus erythematosus which was exceptional in that it occurred in an 11-year old girl. The lesions were situated on the face and consisted of solid subcutaneous nodules and clear-cut ulcerations leaving atrophic pigmented scars. The histological image of a nodule was one of lobular lymphocytic panniculitis with homogeneous hyalinization of adipose nodules, to which must be added periadnexal and perivascular dermo-epidermal lymphocytic infiltrates. Granular IgM deposits arranged along the dermo-epidermal junction were observed at direct cutaneous immunofluorescence. Laboratory examinations showed leucopenia (3,300/mm3) with neutropenia (1,100/mm3) and the presence of antinuclear antibodies at 1/100 speckled fluorescence, as well as antibodies directed against native DNA. Studies of renal function and for complement gave normal results. The other causes of lobular panniculitis were excluded. The lesions regressed within 3 weeks under hydroxychloroquine; this drug was also successful in arresting a relapse consecutive to withdrawal of treatment. The authors have analysed the 17 paediatric cases of deep lupus erythematosus and were able to determine their main characteristics: 1. The lesions occur mostly in girls (70 p. 100). They are located electively on the face and the lateral aspect of the shoulders. They consist of well-limited, solid or hard subcutaneous nodule which may congregate to form plaques. The epidermis may be normal or pathological, poikilodermic, looking like a discoid or ulcerated lupus erythematosus. The lesions regress, leaving a characteristic atrophic scar.(ABSTRACT TRUNCATED AT 250 WORDS)


[Facial hemiatrophy, homolateral cervical linear scleroderma and thyroid disease].

A case of facial hemiatrophy and homolateral cervical band of scleroderma, complicated by hypothyroidism is reported. This case raises two problems: one is the problem of distinction between Romberg's disease and facial hemiatrophy due to a genuine localized scleroderma; the other concerns the relationship between localized scleroderma and dysthyroidism. The generalized scleroderma-dysthyroidism association has now been recognized, but the coexistence of thyroid disease and localized scleroderma has not yet been reported. Several pathogenetic hypotheses on this association are discussed.


[Dermal myxoma of nerve sheats (neurothecoma)].

The histological study of a painful cutaneous nodule located in the interscapular region, which had been present for 20 years in a 59-year old male patient has show typical features of dermal myxoma of the nerve sheaths. This was a lobulated myxomatous tumour with fusiform and dendritic cells plus a few epithelioid and multinucleate cells. Immunostaining was positive for the S100 protein and negative for factor XIIIa and EMA. These data suggest that this tumour was of schwannian origin.


[Squamous cell carcinoma and recessive dystrophic epidermolysis bullosa].

We report a case of spindle cell carcinoma developed in a patient with recessive dystrophic epidermolysis bullosa. This association is classical but rare since only 46 cases have been found in the literature. The various possible treatments are discussed.


[Histology and physiology of black skin].

The aim of this article is to review the experimental knowledge concerning black skin. We point out its histological and physiological features without discussing here the specific pathology of black patients. Under the microscope skin structure is roughly the same in all races, but morphological differences exist, particularly within the epidermis, with potential practical consequences. In comparison with white skin, the black skin stratum corneum is equal in thickness but more compact: about twenty cell layers are observed in blacks versus sixteen layers in whites. The lipid content of black epidermis is also somewhat higher, and this perhaps explains the greater cellular cohesion, hence the difficulty in stripping off the black horny layer. These findings could also explain a slightly inferior permeability of black skin to certain chemicals. The hair of blacks in naturally more brittle and more susceptible to breakage and spontaneous knotting than that of whites. The kinky or wooly form of black hair, the weak intercellular cohesion between cortical cells and the specific hair grooming practices among black people account for these effects. The higher electrical resistance of black skin suggests that the black epidermis would be less hydrated than white epidermis. Anatomically, the amount of sweat glands in black and white skins is identical and varies with climatic changes but not with racial factors. Likewise, sweating is thought to be similar in both races, taking into account the contradictory results from studies, but black subjects withstand humid heat better while whites cope better with dry heat.(ABSTRACT TRUNCATED AT 250 WORDS)


[Lipomas of the mesentery in young children].

Lipomas of the small bowel and mesentery are exceedingly rare in young pediatric patients. This article reports a case which underlines the difficulty of establishing this diagnosis before exploratory laparotomy.


[Multicenter study of sodium alginate in the treatment of regurgitation in infants].

An open multicenter study was performed to assess the efficacy and safety of alginic acid in two different dosages in 76 pediatric patients with gastroesophageal reflux confirmed by pH monitoring. Among the 69 patients in whom endoscopy was carried out before treatment, 18 had erythematous esophagitis and 5 had erosive esophagitis. Irrespective of the dosage used, the frequency of regurgitation and vomiting decreased significantly (p < 0.00001 and p = 0.01, respectively). Clinical and biochemical tolerance were outstanding and no adverse effects were recorded. On the basis of these data, the recommended dosage is 1 to 2 ml/kg/day in divided doses after meals.


Laparoscopic cholecystectomy. Experience of the first 150 patients.

Between April 1991 and May 1992, 150 patients were treated by laparoscopic cholecystectomy. Eleven patients (7.3%) required conversion to open laparotomy and five (3.3%) patients were operated on for postoperative complications. There were two (1.3%) patients with a hepatic duct lesion, one of which was treated with a T-tube alone but the other required a bilioenteral reconstruction. The average operation time was 72 minutes (range 30-240 minutes). The mean hospital stay of all patients was 2.1 days (range 1-28 days) and the mean time to return to work was 11.5 days (range 6-60 days).


Laparoscopic cholecystectomy for symptomatic gallstone disease. Experience of the first 200 cases.

Laparoscopic cholecystectomy was carried out in 200 patients between January 1991 and September 1992 at the Second Department of Surgery, Helsinki University Central Hospital. Mortality was nil. The overall major complication rate was 4% (n = 8). The incidence of common bile duct lesions was 0.5% (n = 1). In seven (3.5%) patients the procedure had to be converted into open cholecystectomy. Repeat surgery was needed in two patients. The average hospital stay was 3.0 +/- 1.5 days and the average sick leave 14 +/- 4 days. Obese and high-risk patients tolerated the procedure well without significant increase in complication rate or hospital stay. Laparoscopic cholecystectomy may be regarded as the treatment of choice for symptomatic gallstone disease.


Bile acid malabsorption in patients with post-vagotomy diarrhoea.

75SeHCAT scanning was evaluated as a means of detecting bile acid malabsorption in patients with postvagotomy diarrhoea. Seven day 75SeHCAT retention ratios were measured in five patients with unequivocal post-vagotomy diarrhoea. The results were compared with an age matched group of asymptomatic control patients (n = 4) each of whom had previously undergone truncal vagotomy and drainage and a further group of normal volunteers (n = 6). The median 75SeHCAT retention ratios in patients with post-vagotomy diarrhoea was 2% (range 0-9%). In contrast, the median 75SeHCAT retention ratios in asymptomatic controls was 29% (range 26-61%) and 28% (range 19-70%) in normal volunteers. These results demonstrate that there is gross bile salt malabsorption in patients with post-vagotomy diarrhoea and that 75SeHCAT scanning is an effective screening test in these patients.


Cholecystoenteral anastomosis with the biofragmentable ring and manual suture--a prospective, randomized study.

20 patients treated by cholecystojejunostomy for obstructive icterus were randomized to be treated either with a biofragmentable intraluminal ring (Valtrac) (10 patients) or suture of the cholecystointestinal anastomosis (10 patients). Postoperatively one patient in each group died of advanced malignancy. There were no surgical complications in either group. The relief of icterus, recovery of the gastrointestinal tract and the mean hospital stay were similar in both groups. The biofragmentable anastomosis ring (BAR) is a safe method for cholecystoenteral anastomoses.


Injection sclerotherapy for esophageal varices.

Thirty-five consecutive patients with bleeding esophageal varices were treated by repeated endoscopic injection sclerotherapy. During each session the varices were injected with 14 +/- 4.2 ml (mean +/- SD) of 5% ethanolamine oleate submucosally or intravariceally. The varices were obliterated in 31 (89%) patients. On average 3.3 +/- 2.4 sclerotherapy sessions were required for eradication of the varices. Mild fever was noticed almost in every patient after sclerotherapy. Mediastinitis was a complication in one (2.8%) patient. Esophageal stricture ensued in two (5.7%) patients which did not require treatment. The cumulative survival rates at 1, 2, 3, 4 and 5 years were 83%; 65%; 52%; 52% and 47% respectively. The corresponding 95% confidence intervals were (0.7, 0.96); (0.48, 0.8); (0.34, 0.7); (0.3, 0.74) and (0.22, 0.7). Sclerotherapy is an effective and safe method to treat bleeding esophageal varices.


Aesthetic repair of submeatal strictures with transverse ventral skin flap.

Reconstruction of fossa navicularis strictures by a modified plastry is presented. The method relies on the use of a pediculated skin flap taken ventrally. To achieve a good cosmetic result, the skin between the glandular edges is left untouched. The functional results have been excellent.


Femoral shaft fractures in the elderly treated with Grosse-Kempf slotted locked intramedullary nail.

Thirty-one femoral shaft fractures in patients over 60 years of age were treated with the Grosse-Kempf slotted, locked intramedullary nail and followed for a median of 24 months. The patients tolerated the operation reasonably well and the mortality was not higher than the mortality connected with femoral neck fractures. Three reoperations were performed due to intra- and postoperative complications. The main reason for the less satisfactory result was shortening > 2 cm after unstable dynamical locking. This occurred in 8 of 15 dynamically nailed fractures with locking screw(s) in one end of the nail only. A 9 cm shortening among these was the reason for one of the two poor results in the series. The other poor result was a malalignment of the distal fragment in a statically locked fracture. We conclude that locked intramedullary nailing is a good way to treat femoral shaft fractures in the elderly, the high subtrochanteric, midshaft and infraisthmic fractures.


Hip fractures in two health care regions in Finland in 1989: an analysis of treatment.

We studied prospectively the demographic data, fracture types and modes of treatment in 390 patients with acute traumatic hip fractures in two health care regions in Finland, the Middle Finland region and the Kymenlaakso region in 1989. In Middle Finland population (251,203 inhabitants) 199 patients with a hip fracture were admitted to two acute care hospitals, while 191 patients were admitted in Kymenlaakso (population 189,726) to four acute hospitals. There were no significant differences in the sex- and age-specific incidences between the two regions. In Middle Finland, 70% of the fractures were of the femoral neck, 28% were trochanteric and 2% subtrochanteric. The corresponding figures in Kymenlaakso were 57%, 38% and 5% (P < 0.05). In Middle Finland, 73% of the femoral neck fractures were treated primarily with a hemiendoprosthesis, 2% with primary total hip replacement and 25% by osteosynthesis. The corresponding figures in Kymenlaakso were 81%, 7% and 12% (P < 0.001). The mean duration of hospital stay was 14 days in Middle Finland and 21 days in Kymenlaakso (P < 0.01).


Holding power of metallic screws in cancellous bone and metallic plates in cortical bone. An experimental study on rabbits using polymethylmethacrylate and bone graft as supporting material.

The holding power of metallic screws in cancellous bone and metallic plates in cortical bone was tested in sixty rabbits (n = 60). These metallic devices were fixed either without support or with the support of plastic material or autogenous bone graft. The fixation firmness was studied radiographically and by a test of the bonding strength. After six weeks, the mean value of the holding power of screws in cancellous bone without support was 440 N, and that of screws supported by polymethylmethacrylate 674 N and by bone graft 540 N. Corresponding values after twelve weeks were 436 N, 664 N, and 616 N. Fixation with polymethylmethacrylate was better than either fixation without support (P < 0.001, t-test) or fixation with bone graft (P < 0.01), whereas fixation with bone graft was better than fixation without support (P < 0.07). The best fixation was achieved by polymethylmethacrylate according to group mean values. Our investigation of the holding power of plates in cortical bone did not reveal any statistically significant differences between the methods used.


[Influence of the maternal pineal gland on the testicular function in rats].

Female rats were exposed to a short (6L:18D) photoperiod from 21 days of age. On day 2 of gestation, animals were pinealectomized or sham-operated. Lighting regimens were not changed during the course of the study. Male offspring of the 2 groups of rats were sacrificed on days 21 after birth. Pinealectomy of the mother induced the following modifications: a decrease in prostate and seminal vesicle weights, a decrease in testicular testosterone and androstenedione content and in plasma dihydrotestosterone levels. We conclude that when rats are maintained on a 6L:18D cycle the maternal pineal gland stimulates the testicular function in 21-day-old offspring.


[Urologic cancer mortality in France].

In 1989, 14,150 men died from urological cancer in France: 64% of these deaths were due to prostatic cancer, which represents the second highest cause of male cancer mortality in France. Deaths from urological cancer are mainly observed after 50 years of age, with a frequency which increases very rapidly with age, except for testicular cancer for which one out of every two deaths occurs between 20 and 45 years of age. Between 1968 and 1989, increased mortality was observed in males due to prostate cancer and kidney cancers, whereas a decreased mortality was observed for testicular cancer, especially in males between 20 and 45 years of age. Mortality was stable for bladder cancer and cancer of the penis. In females during the same period, mortality was stable for cancer of the kidney and bladder. During the period 1979 to 1984, a significant increase in mortality due to bladder cancer was observed in certain Northern departments and those surrounding the Mediterranean basin, although the mortality for other cancer sites is generally lower in this latter region. A significant increase in mortality was also observed for cancer of the kidney in Auvergne and in Alsace-Lorraine. Regarding prostatic cancer, geographical variations are minor and no particular region with an increased or decreased mortality could be identified.


[Epidemiology of kidney cancers].

Renal carcinomas represent 2% of all tumors. More than 90% of these cancers occur in adults with the frequency in adult males being twice as high as that in adult females. The frequency of renal carcinomas is relatively high in France especially in males. Renal carcinomas mortality has been increasing in France over the last 40 years by more than 2% per year and suggests that tobacco is involved in this increase. Obesity, especially in women, and chronic renal failure are two other frequent associations found with renal carcinomas. The prognosis for this cancer is not clear-cut as the relative 5-year survival rate for all adult tumors ranges from 36 to 54%.


[Epidemiology of bladder cancer].

The urinary bladder cancer mortality varies in different countries. The highest rates are noted in Denmark, UK, Belgium and Italy, the lowest rates in Japan, Singapore and Venezuela. The mortality rates are increasing for both males and females. In France, the highest rates are observed in the South of France contrary to other cancer sites. The highest incidence rates are observed in Europe, in USA and in some countries of Africa. In these same areas, the rates are higher for males and are increasing with time. The mortality is high in the first years after diagnosis. The five-year relative survival rates are 41%, for males and 35% for females. Tobacco, and especially cigarettes, is a well known risk factor. A dose effect relation appears to exist. The occupational risk factors are potentiated by tobacco and modifications are noted and are in relation with new factors. Ground coffee is associated with urinary bladder cancer and appears to be a co-carcinogenic factor with tobacco. Some drugs, such as antimitotics, phenacetin, radiation and urinary bilharziosis, are etiological factors of this cancer. The role of artificial sweeteners, alcohol and nutrition is less well documented.


[Epidemiology of prostate cancer].

Prostatic cancer is frequent in elderly men. The incidence of "clinical" cancer varies greatly in different regions of the world. The highest incidences have been reported in black populations in North America and the lowest incidences are observed in Asian populations. "Subclinical" cancer is much more frequent than "clinical" cancer. Among the subclinical forms, the prevalence of carcinoma in situ varies only slightly from one region to another and is constant beyond the age of 40 years. Different aetiological factors are therefore probably involved in these two forms of prostatic cancer. The corrected 5-year survival for all patients with prostatic cancer in France is 41 to 47%. These poor results can probably be attributed to the very advanced stage of the disease at the time of diagnosis. Dietary, toxic, infectious, hormonal and genetic factors have been suggested in the aetiology of prostatic cancer, but the results of the various studies conducted are sometimes contradictory. In the absence of any known risk factors, primary prevention cannot be envisaged. Secondary prevention by means of screening raises certain problems due to the poor understanding of the natural history of the disease.


[Epidemiology of testicular cancer].

Testicular carcinoma is a rare disease, with an incidence ranging from 0.2 (Blacks in Connecticut) to 7.8 (Denmark) in the World, and ranging from 2.5 to 4.3 in French Cancer Registries. An increase among young men has recently been described in Denmark and in England (Mortality Data between 1936 and 1976). Survival is 75% after five years, all histological types combined. No role as a risk factor "per se" has been confirmed for Genetics alone (Twins study in Finland), but a familial RR of 6 has been observed among first degree relatives of testicular carcinoma cases. Most interesting is a study by A.R. Moss, showing a RR of 4.4 among cases whose mother on had a breast cancer, as it emphasizes a possible role or hormones for non seminomatous testicular cancer.


["Surveillance" of non-seminomatous testicular tumors. A prospective study of 100 patients in the first stage of illness].

In a prospective study, 100 patients with clinical stage I nonseminomatous testicular tumours were investigated by a surveillance policy, which consisted of regular follow-up after orchiectomy alone until disease progression was confirmed. Follow-up revealed that 65 of the 100 patients were free of disease at 25 to 90 months after orchiectomy. Disease progression was detected in 35 patients at 3 to 27 months following orchiectomy. Patients with progression were treated by PVB chemotherapy. Patients with non-seminomatous testicular tumours in clinical stage I represent a group which is not homogeneous and can therefore not be treated by means of a single modality. It is necessary to individually define optimal treatment based on prognostic factors. The surveillance policy is available in patients without risk factors and regular follow-up is mandatory. Multidisciplinary collaboration and cooperation with patients are essential.


[Epithelial tumors of the urinary tract in children].

Through 1987 the authors observed and treated ten children with malignant urothelial cancers of the urinary tract: three malignant papillary cancers, six cancers of the bladder and one papilloma of the pyeloureteral segment. All were transitional cell cancers. The methods of diagnosis and treatment are described. The early results were good and the late results did not reveal any recurrence. All children are alive, except for one case with cancer of the bladder. Death in this case was due to lung cancer eighteen months after cystectomy. The authors analyse the aetiological factors involved in these tumours for the year 1987, taking into account the ecological-radioactive contamination of our country, after the accident of Chernobyl in 1986.


[Staghorn calculi in children. 32 cases].

The authors report thirty-two cases of children with staghorn calculi treated in the department of urology H. Bourguiba, Hospital of Sfax. Such calculi are frequently seen in young boys over the age of 6 years. Urinary tract infection by Proteus is the main etiologic factor of lithogenesis. Surgical treatment, still the most advocated, is laborious; it must ensure complete stone removal, while protecting renal function.


Role of exposure databases in risk assessment.

Risk assessments have assumed an increasingly important role in the management of risks in this country. The determination of which pollutants or public health issues are to be regulated, the degree and extent of regulation, and the priority assigned to particular problems are all areas of risk assessment that influence the country's $100 billion annual investment in environmental protection. Recent trends in public policy have brought the practice of risk assessment under greater scrutiny. As policy makers increasingly insist that specific numerical risk levels (so-called bright lines) be incorporated into regulatory decisions, the stakes for good risk assessment practice, already high, are raised even further. Enhancing the scientific basis of risk assessments was a major goal of the Workshop on Exposure Databases. In this article, we present the Risk Assessment Work Group's evaluation of the use of exposurerelated databases in risk assessment and the group's recommendations for improvement. The work group's discussion focused on the availability, suitability, and quality of data that underly exposure assessments, a critical component of risk assessment. The work group established a framework for evaluation, based on exposure scenarios typically used in regulatory decisions. The scenarios included examples from Superfund, the Clean Air Act, the Toxic Substances Control Act, and other regulatory programs. These scenarios were used to illustrate current use of exposure data, to highlight gaps in existing data sources, and to discuss how improved exposure information can improve risk assessments. The work group concluded that many of the databases available are designed for purposes that do not meet exposure and risk assessment needs. Substantial gaps exist in measurements of actual human exposure and in the data necessary to model exposures, to characterize distributions of exposure, to identify high-risk groups, and to identify possible environmental inequities in exposure. The work group, on the basis of its findings, made both short-term and longer-term recommendations for improving the collection of exposure data in the future.


Estimating human exposures to environmental pollutants: availability and utility of existing databases.

Information about human exposures to environmental agents is a crucial component of informed decisions about protection of public health. Results from an inventory of exposure-related databases are used to examine the value of exposure information for risk assessment, risk management, surveillance of status and trends, and epidemiologic studies. Findings indicate that current and future exposure-related databases should include (1) standardized procedures for the collection, storage, analysis, and reporting of data; (2) an enhanced ability to compare data over time, i.e., conduct comparison studies of "old" and "new" methods; (3) mechanisms for coordination and cooperation among public and private-sector organizations with respect to the design, maintenance, exchange, and review of information systems; (4) measurements of actual exposures and dose for relevant human populations; and (5) data collection, storage, and retrieval methods that permit easy manipulation of information for both model building and testing.


Role of exposure databases in risk management.

Despite the development of numerous national exposure-related databases, exposure assessment remains a weak link in the chain of risk assessment and risk-management activities. Most databases include measures of environmental releases or concentrations of pollutants in specific media, but do not include actual measures of exposure. If accurate estimates of exposure experienced by populations or individuals are absent, it is impossible to judge the effectiveness of risk-management strategies. The Risk Management Work Group evaluation identified the following needs: refinement of measurements of total exposure experienced by individuals, improved characterization of the distribution of exposures in the population, longitudinal monitoring of exposure trends, and improved information about the public health implications of exposure. Recommendations are presented with the hope that the utility of existing databases will be improved and that future initiatives will be developed that meet the needs of risk management.


Systemic and mucosal antibodies to Klebsiella in patients with ankylosing spondylitis and Crohn's disease.

Whole gut lavage fluid is a useful source of material for the study of intestinal immunity and inflammation in humans. Systemic and mucosal antibodies to Klebsiella pneumoniae were measured by enzyme linked immunosorbent assay (ELISA) in serum samples and whole gut lavage fluid from 14 patients with ankylosing spondylitis, 14 with Crohn's disease, and 16 immunologically normal controls. As the concentration of IgG in whole gut lavage fluid reflects disease activity in Crohn's disease, this approach was used to detect intestinal inflammation in patients with ankylosing spondylitis who also had disease activity and use of non-steroidal anti-inflammatory drugs (NSAIDs) recorded. Small intestinal permeability to cellobiose and mannitol was also studied. In serum samples, levels of IgA antibody to klebsiella were high in patients with Crohn's disease and in patients with active ankylosing spondylitis, and were significantly correlated with the erythrocyte sedimentation rate in patients with ankylosing spondylitis. Levels of IgG antibody to klebsiella were also high in patients with Crohn's disease. Studies of whole gut lavage fluid showed similar levels of IgA antibody to klebsiella in the three study groups, but levels of whole gut lavage fluid IgM and IgG antibodies to klebsiella were high in patients with Crohn's disease. Levels of IgG in whole gut lavage fluid were high in patients with Crohn's disease but in only one patient with ankylosing spondylitis, though the cellobiose/mannitol permeability ratio was abnormal in eight of 13 patients with ankylosing spondylitis. It is concluded that high levels of serum IgA antibody to klebsiella are not specific to ankylosing spondylitis, and that there is no evidence of an abnormal intestinal IgA antibody response to klebsiella in patients with ankylosing spondylitis.


Role of exposure databases in epidemiology.

At present, exposure databases record data primarily for regulatory purposes; they have not focused on serving the needs of epidemiologists or public health. However, the modification of exposure databases could facilitate their use in epidemiology. Characteristics necessary to enhance the use of all databases include easy access by users; documentation of methods, sampling bias, error, and inconsistences; widespread coverage in time and space; and methods and measures for estimating exposure of individuals as well as populations. Also needed are exposure scenarios and models to estimate exposures for geographic areas and time intervals not currently sampled. Multidisciplinary teams are needed to examine current databases, to review strategies for improving data collection, and to suggest and help implement appropriate changes. A long-term goal is to develop and validate data from exposure scenarios and models using data on the relationship of exposure to doses measured in humans.


Autoantibodies in chronic arthritis of childhood: relations with each other and with histocompatibility antigens.

Studies have shown the presence of either antibodies to histone or anticardiolipin antibodies in some forms of childhood chronic arthritis. The relation between these autoantibodies has not been previously reported, however, and the immunogenetics of their association with childhood arthritis has not been studied. The interrelation of fluorescent antinuclear antibodies, antibodies to histone, and anticardiolipin antibodies and their associations with histocompatibility antigens (HLA) were studied in 114 children with chronic arthritis (45 children with pauciarticular onset juvenile chronic arthritis (JCA), 22 with polyarticular onset JCA, 13 with systemic onset JCA, and 34 with juvenile psoriatic arthritis (JPsA). Antibodies to histone and anticardiolipin antibodies were determined in 108 children. HLA antigens (A, B, C, and DR) were studied in the 83 white children. Antibodies to histone occurred in 0% (systemic onset JCA) to 42% (uveitis negative, pauciarticular onset JCA), and anticardiolipin antibodies in 26% (JPsA) to 55% (polyarticular onset JCA) of patients. Only 12 patients (11%) had both antibodies to histone and anticardiolipin antibodies. Neither antibodies to histone nor anticardiolipin antibodies associated with the type of arthritis. Neither of these antibodies alone associated with uveitis. Antibodies to histone were associated with HLA-A2, probably reflecting the known association of HLA-A2 with pauciarticular onset JCA. There was no other HLA association. Fluorescent antinuclear antibodies occurred most often in patients with uveitis; however, the occurrence of fluorescent antinuclear antibodies in patients with pauciarticular onset JCA (the group most at risk for uveitis) was not significantly greater in children with uveitis than in those without uveitis (100 and 88% respectively). Although antibodies to histone and anticardiolipin antibodies often occur in serum samples from patients with JCA and JPsA, they rarely occur together. Their presence does not associate with uveitis. This study did not show any strong evidence that production of either antibodies to histone or anticardiolipin antibodies in patients with JCA or JPsA is under the control of the histocompatibility locus.


IgG and IgM anti-snRNP reactivity in sequentially obtained serum samples from patients with connective tissue diseases.

Sequentially obtained serum samples from 30 patients with connective tissue disease positive for antibody to ribonucleoprotein (RNP) were examined to determine the specificities of IgG and IgM antibodies to snRNP during the disease course using immunoblotting of nuclear extracts. The antibody patterns were correlated with disease activity. The patterns of antibody to snRNP of individual patients were mainly stable during the study but changes in levels of antibody to snRNP were seen corresponding to changes in clinical activity. These results indicate that increased reactivity of serum IgM antibodies against the B/B' proteins seems to precede a clinically evident exacerbation of disease whereas IgG antibody reactivity to the 70 K protein peaks at the time of a disease flare.


Use of exposure databases for status and trends analysis.

Exposure databases are useful for monitoring status and trends in environmental health. However, other supporting data are usually needed to infer human exposure or internal dose. Program planning and evaluation, environmental health surveillance, epidemiologic research, and contributions to international efforts are four major purposes for monitoring environmental exposure status and trends. Although databases play an important role in monitoring human exposure, certain methodological problems need to be overcome. The work group developed six criteria for meeting information needs for human exposure assessment. Areas that need attention are (1) specification of location, (2) specification of facility and chemical identifiers, (3) documentation of special populations at risk, (4) provision of early warning of new problems, (5) monitoring changes over time, and (6) enhancement of documentation. We tested these criteria by examining six available databases that might be used for monitoring exposure to contaminants in drinking water. Available data fell short of information needs. We drew four conclusions and offered several recommendations for each. First, available data systems lack adequate measures of human exposure. Second, data for monitoring exposures for many important population subgroups and environmental settings are inadequate. Third, an "early warning" system that monitors human exposures is needed. Fourth, designers of data-collection systems should consider the needs of users who monitor status and trends of human exposure.


Clinical associations of IgG antibodies to the ribonucleoprotein p67 polypeptide in patients with systemic lupus erythematosus.

The ribonucleoprotein (RNP) p67 antigen was purified from rabbit thymus and used in an enzyme linked immunosorbent assay (ELISA) with low interassay variability to detect IgG antibodies to p67 in patients with autoimmune connective tissue diseases. These antibodies were found in eight (80%) patients with a clinical diagnosis of mixed connective tissue disease (MCTD) but also in 27 (40%) patients with systemic lupus erythematosus (SLE). Sixty six per cent of the 12 patients with SLE with high levels of antibodies to p67 (> 50 U) had three or more features of MCTD, including myositis, fibrosing alveolitis, Raynaud's phenomenon, and sclerodactyly. Antibodies to the p67 RNP were not associated with the presence or absence of renal disease in the patients with SLE. This study suggests that antibodies against the p67 RNP are markers for clinical features of MCTD even in the context of SLE.