Use of generic quality improvement chart review to recognize nosocomial infection.

Generic medical quality improvement concurrent chart review for adverse patient occurrences was introduced into our hospital. To determine whether this program could be used to augment the surveillance activities of the infection control program, an evaluation of this review was carried out and it was compared with existing surveillance methods. Analysts were provided with Centers for Disease Control definitions of site infections and were trained in identification. During a 6-month period (period 1) infections in this manner documented were reviewed by infection control program to confirm nosocomial infection as a measure of specificity. Data were also compared with infection control surveillance data when the two programs overlapped (nosocomial bloodstream infections and surgical wound infections) as a check on the sensitivity of the data generated in the medical quality improvement process. A second 6-month review of data (period 2), starting 3 months after completion of period 1, was carried out; this review was limited to areas of overlap and designed to determine whether changes in data occurred with experience. In period 1, 72% (109/152) of infections detected by chart review were confirmed by infection control methods, and 51% (26/51) of infections detected by the infection control program were also detected by chart review. During period 2 the values were 73% (52/71) for confirmed infections and 61% (43/70) for detected infections. There was no statistical difference between periods 1 and 2. In the two periods 25 bacteremic infections went undetected by chart surveyors. We conclude that this chart surveillance has only moderate sensitivity and specificity compared with our infection control surveillance methods. Improvements were not demonstrated with experience.


Chronology of a hospital-wide measles outbreak: lessons learned and shared from an extraordinary week in late March 1989.

In March 1989, Mount Sinai Hospital, a community hospital in Hartford, Connecticut, faced a potential hospital-wide outbreak of measles when eight cases of measles occurred among medical personnel during several days. This article describes the chronology of events, from the initial discovery of the outbreak to the evolution of the hospital-wide containment program designed to protect patients and staff members. Measles IgG immune status was determined for 1249 employees during a 9-day period. Measles vaccine and immune serum globulin were administered to patients and employees. We offer advice from our experience for infection control practitioners who may face outbreak situations in their institutions.


Measles: lessons from an outbreak.

Measles outbreaks continue to be a problem for infection control in hospitals--patients, personnel, and employee health service. Guidelines for measles outbreaks are not clear for medical personnel in the hospital. Outbreak investigation in a university-affiliated teaching hospital. Four primary cases resulted in 607 staff exposures and two secondary cases. Forty-seven medical personnel were furloughed and 88 were vaccinated for measles. Minimal serologic criteria for immunity were found to be inadequate in the outbreak setting. We found that serologic guidelines for assessing immunity to measles are inadequate. During the outbreak, we arbitrarily doubled the acceptable enzyme-linked immunosorbent assay titers that we would consider protective, > or = 2, to decrease the possibility of further secondary cases. Employees with enzyme-linked immunosorbent assay measles titers less than 2 and without a definite history of natural measles were revaccinated with a measles vaccine. This strategy takes advantage of the anamnestic response that revaccination would confer in persons with low antibody titer.


[Tracheostomy in a resuscitation unit (methodology, tactics of postoperative management, long-term results].

The experience of management of 123 patients after tracheostomy and the following prolonged controlled lung ventilation has been summarized. The techniques of tracheostomy and postoperative management that made it possible to decanulate 118 patients without additional surgical interventions have been described. The studies performed using radiopharmacological agents have revealed considerable disturbances of the pulmonary flow, foci of chronic inflammation in tracheal and bronchial cartilages, mediastinal lymph nodes and pulmonary tissue, reduction in pulmonary tissue elasticity and increase of the lung area.


Surveillance of infection in home care.

Home care accreditation standards from the Joint Commission on the Accreditation of Healthcare Organizations require a system for recording, reporting, and evaluating infections related to the services provided. We developed a surveillance system for home care related infections to meet these requirements. Our goal was to reduce the risk of infection and improve the quality of care. Definitions for home care-related infections were adapted from the Centers for Disease Control's 1988 definitions for nosocomial infections. The home health care staff assisted by reporting clients with possible infections. Surveillance was completed by the infection control coordinator. On the basis of our findings in the population, we concentrated our efforts on reducing the risk of catheter-related genitourinary infection in our home care patients.


[The prostacyclin-thromboxane system and platelet hemostasis following aortocoronary bypass with an uncomplicated postoperative course].

Prostacyclin-thromboxane system and platelet hemostasis have been studied in 56 patients upon aortocoronary bypass surgery with uncomplicated early postoperative period. It has been established that cardiopulmonary bypass surgery leads to a considerable increase in 6-keto-PGF1 alpha and TXB2 levels per platelet, as compared to preoperative values. By hour 18 postoperatively 6-keto-PGF1 alpha to platelet number ratio returns to baseline, while TXB2 to platelet number ratio remains higher than preoperative values, which determines a shift in 6-keto-PGF1 alpha to TXB2 ratio towards TXB2, thus ensuring, probably, enhanced platelet aggregation properties. Thrombocytopenia, a decrease in platelet aggregation properties and elevated blood plasma level of beta-thromboglobulin were observed upon aortocoronary bypass surgery. By hour 18 postoperatively the number of platelets increased significantly, their aggregation properties were enhanced, beta-thromboglobulin blood plasma level was reduced, however, the parameters under study did not reach normal values at that time. Increased levels of 6-keto-PGF1 alpha and TXB2 per platelet in the early postoperative period are considered an important component of compensatory-adaptive body reactions directed to normalization of the damaged body functions, namely hemostasis and microcirculation.


Bovine monoclonal alloantibodies to blood group antigens prepared by murine x bovine or (murine x bovine) x bovine interspecies fusions.

In order to obtain monoclonal alloantibodies against bovine blood group antigens, lymph node cells from calves immunized with bovine red blood cells (RBC) were fused with either murine NSO/1 myeloma cells or a HAT sensitive murine x bovine heterohybridoma cell line. Both fusion partners resulted in heterohybridoma cell lines, producing monoclonal alloantibodies against bovine red blood cell antigens. Several clones produced antibodies against identical antigens and some of these clones have been further analysed. The antibodies produced by these selected cell lines have been compared with conventional polyclonal antisera used in bovine blood typing service. Thus extensive tests--including the ISAG Comparison Tests 1989/90 and 1991/92--have proved that monoclonal alloantibodies specific for the internationally recognized bovine red cell antigens A2, I1, O1, Q, A', B', Q', C1, R1, X1, S and Z have been produced. The Q, A', B', and C1 antibodies react weakly with certain phenogroups, whereas the A2, I1, O1, Q', R1, X1, S and Z antibodies have proved to be excellent blood typing reagents and have now substituted the polyclonal antisera in routine bovine blood typing in our laboratory.


Canine blood groups: description of 20 specificities.

Twenty blood typing reagents, four agglutinins and 16 operable in the antiglobulin test, were prepared from 54 antisera which were produced in 24 dogs. Two of the reagents were identified as anti-B and Nf6. Two of the antigens were shown by absorption and family studies to be linear subtypes. In most cases, detailed family studies demonstrated a Mendelian dominant inheritance for the genes controlling the canine red cell antigens. Gene frequencies were determined in various breeds of dogs and in the dingo.


Absence of evidence for linkage between Booroola gene and genetic markers at 11 sheep blood polymorphic loci.

Genetic linkage between the Booroola locus (Fec) and 11 sheep blood polymorphic loci (i.e. Tf, Hb, CA, OLA, and A, B, C, D, M, R, F41 red cell blood groups) was investigated in six large sire families (163 informative female offspring). The six sires tested were heterozygous for the Booroola allele (FecB) and for several genetic markers. No evidence in favour of linkage was found. Moreover, depending on the marker locus considered, linkage closer than or as close as the recombination frequency of 10-30% was excluded.


Sheep gene mapping: synteny between COL2A1 and the LDHB-PEPB-TPI-GAPD-LALBA-IGF1 group.

DNA extracted from 21 hamster-sheep hybrid cell lines was subjected, after Southern blotting, to hybridization with a type-II alpha 1 collagen genomic probe (COL2A1). The corresponding locus was found to be syntenic with the LDHB-PEPB-TPI-GAPD-LALBA-IGF1 group in sheep.


A study on association between mastitis and serologically defined class I bovine lymphocyte antigens (BoLA-A) in Norwegian cows.

A total of 102 cows was tested for class I antigens of the bovine major histocompatibility complex. Half of the animals (51) had completed at least four lactations without any veterinary treatment for mastitis. The distribution of BoLA-A antigens among these relative mastitis-resistant cows was compared to that in the other half of the material (51), which comprised animals with at least one recorded treatment for mastitis. There were no statistically significant differences in BoLA-A antigen frequency between cows with mastitis and cows without mastitis. The two most common antigens were A2 and w16. The frequency of these two antigens deviated from earlier estimates within the Norwegian cattle (NRF) population, the difference for w16 being statistically significant.


Characterization of five new bovine dinucleotide repeats.

Five new bovine (TG)n microsatellite sequences were characterized. During the screening procedure, one-third of the clones had essentially the same flanking sequences. A fast technique was devised to eliminate these clones.


Identification of a conserved microsatellite site in the porcine and bovine insulin-like growth factor-I gene 5' flank.

Examination of published rat and human sequences for the insulin-like growth factor-I (IGF-I) gene indicated the presence of CA dinucleotide repeats in corresponding segments of each. Presence of similar microsatellite sequences in the porcine and bovine IGF-I genes was hypothesized. A 1200-bp segment upstream of the porcine and bovine IGF-I genes was amplified using the polymerase chain reaction (PCR) with primers developed from a consensus of human, rat and bovine sequences. Both porcine and bovine PCR products contained similar microsatellite sequences. Amplified pIGF-I DNA was cloned and sequenced, and an additional primer was developed specifically for microsatellite marker detection. Six allelic variants of 124, 130, 132, 134, 136 or 138 bp were observed in pigs with differing frequencies between breeds (P < 0.01). The same primers were used to amplify the corresponding bovine microsatellite. Three alleles of 126, 128 and 130 bp were observed in a genetically diverse cattle population with estimated frequencies of 0.06, 0.68 and 0.26, respectively. Results of this study indicate sequence information from the human and laboratory species can be used to facilitate genetic marker development in livestock species.


Genetic polymorphism of esterase in plasma of American mink (Mustela vison L.).

Plasma samples of 412 minks, including 20 families and representing 15 lines, have been investigated by isoelectric focusing for the enzyme esterase (ES). The observed variation of the enzyme may be explained as a result of one locus with at least seven codominant alleles. The segregation of six alleles assumed for the locus in 20 families supports this genetic model. Genetic divergence among the lines is observed and may be due to founder effect and/or selection.


New A system allele of red cell alloantigens in Paso Fino horses.

Family data from Paso Fino horses support the existence of a new allele (Aabdf) in the A system of red cell alloantigens. Considering breeds throughout the world, the A system now consists of 13 alleles defined by reagents which serologically detect seven factors.


Direct sequencing and bidirectional allele specific polymerase chain reaction of the bovine beta-casein B variant.

We have used the polymerase chain reaction (PCR) to amplify exon VII of the bovine beta-casein gene. The mutations responsible for the B variant were identified by direct sequencing of the amplification products. A bidirectional allele-specific PCR method (BAS-PCR) has been developed using oligonucleotides overlapping the mutation site at their 3' ends. This new procedure allows a rapid and reliable discrimination between the B and non-B alleles of beta-casein.


[Intracellular traffic of the progesterone receptor].

The nuclear localization of the progesterone receptor is mediated by two signal sequences: one is constitutive and lies in the hinge region (between the DNA and steroid binding domains), the other is hormone-dependent and is localized in the second zinc finger of the DNA binding domain. The use of various inhibitors of energy synthesis in cells expressing permanently or transiently the wild-type receptor or a receptor mutated within the nuclear localization signals, demonstrated that the nuclear residency of the receptor reflects a dynamic situation: the receptor diffusing into the cytoplasm and being constantly and actively transported back into the nucleus. The existence of this nucleo-cytoplasmic shuttle mechanism was confirmed by receptor transfer from one nucleus to the other in heterokaryons. Preliminary evidence was obtained, using oestrogen receptor, that this phenomenon may be of general significance for steroid receptors.


Identification and susceptibility testing for obligate anaerobic bacteria using a semi-automated API ATB plus system.

We evaluated the reliability of the API systems, Rapid ID 32 A and ATB ANA, for the identification and susceptibility testing of obligate anaerobic bacteria in a clinical laboratory that does not possess either an anaerobic chamber or a chromatograph. Tested were 105 clinical isolates. Identifications were compared with those obtained according to the criteria of the Virginia Polytechnic Institute Manual using the API 20 A system with incubation in an anaerobic chamber and gas chromatography. Identifications were concordant in 86.3% of cases. The Rapid ID 32 A system was inaccurate in distinguishing Bacteroides of the fragilis group. Susceptibility to 10 antibiotics of the ATB ANA system was compared to that obtained by MIC determination on Wilkins Chalgren agar. Overall, concordance was 78.2%. Disagreements were mostly minor (16.4%): resistant strains classified as intermediate or intermediate classified as susceptible. When the ATB ANA strip cannot be inoculated in an anaerobic chamber, it is possible that a denser inoculum would decrease the percentage of minor disagreements.


Decrease in zinc serum concentrations after surgical intervention. A study of 87 cases.

The post-surgery zinc depletion reported by Hallböök in 1977 and subsequently confirmed by many authors is now well known. Our study concerns a homogeneous group of 87 female patients undergoing the same surgical procedure: simple or enlarged hysterectomy. Results confirm a mean 35% drop in serum zinc after surgery compared to initial values. The drop is mainly during the operation. A parallel zinc and albumin depletion was noted in 36 patients between the beginning and end of intervention. More systematic zinc supplementation could be proposed before surgery in patients presenting chronic zinc depletion.


[The use of tapioca as coverage in viral titration].

Virus titration is an important step required on viral vaccines quality control. "Plaque assay", which employs several types of overlay media, is usually used on viral titrations. In this paper we describe the use of Tapioca as an overlay media. Firstly, the toxicity of Tapioca was tested on Vero cells inoculated or not with the Yellow Fever virus (YF) 17DD vaccine strain. Secondly, different batches of the 17DD virus using the Tapioca and Karaya gum as the overlay on Vero cells were tested when higher titres were obtained using Tapioca. Tapioca was also shown to be a suitable overlay to be used in thermostability and plaque reduction neutralization tests. Other systems could benefit from the use of Tapioca as an overlay, since it was possible to titer Measles virus in Vero cells. Tapioca is a cheap Brazilian product, is locally available, easy to use, and reliable. Its use is suggested.


[Demography and public health: the complexity of interventions in women].

Some considerations on age distribution of the Italian population, in particular women, are reported; after 40, they are the majority. Problems of ageing and their quality of life constitute a large interest of future research. Cardiovascular diseases are more frequent with ageing for both, males and females; the differences, found in middle age males and females, suggest the possible protective role of feminine sexual hormones. Trials, which include hormone replacement therapy in women after menopause, are conducted for the possible influence on cardiovascular diseases, on osteoporosis and on thrombogenic factors.


[Epidemiology and risk factors for cardiovascular diseases in women].

Some Italian data on frequencies of cardiovascular diseases in women are reported. Recent data, published by ISTAT (1987), record that diseases of the circulatory system represent 50% of all deaths and cardiovascular events happen over 75. Mortality rates for cardiovascular diseases, aged 0-74, are lower than in men of the same age group. Coronary and cerebrovascular events recorded by the MONICA register in the Area Latina are lower in women than in men with a ratio of 3:1 and 3:2 respectively. Fatality rate is higher in women than in men. Incidence rate of definite coronary events assessed by population samples is 2.2 per 1000 per year in women aged 40-69. On cardiovascular risk factors few Italian data are published. Some data from American studies reported for women the prediction of risk factors, such as serum cholesterol, blood pressure, and smoking habit; an independent role is played by diabetes and obesity.


[Sex hormones and ischemic cardiopathy in women].

Gender differences in coronary heart disease frequency is dramatic during the reproductive age of the woman. The main biological difference during this age depends on the endogenous sexual hormone pattern. This paper discusses the possible role of these hormones in determining the coronary risk and the coronary heart disease.


[Diet and cardiovascular risk among women in Italy].

Coronary Heart Disease (CHD) is less common in females compared to males and geographical differences are observed in both sexes; furthermore time trend mortality in women follows the same pattern as in men suggesting that the environmental factors have similar influence in both sexes. Nutrition is an environmental factor which plays an important role in the etiology and pathogenesis of CHD. The Italian Nine Communities Study on Atherosclerosis Risk Factors analyzes the relationships between consumption of food rich in saturated fatty acids and cholesterol and a number of CHD risk factors in a sample of Italian women aged 20-59 years. The dietary habits of the participants were ascertained by a food frequency questionnaire. Intake of atherogenic food was evaluated for each participants systolic blood pressure, serum glucose, serum cholesterol increased with increasing consumption of atherogenic food (i.e. butter). Conversely, consumption of olive oil and vegetable oil was inversely associated with serum cholesterol, serum glucose and systolic blood pressure. Furthermore, calcium rich food consumption was associated with lower blood pressure. These findings were independent from any possible confounding effect of age, adiposity, alcohol intake and cigarette smoking. Data from the Intersalt Study in Italy (400 women aged 20-59 years) have clearly shown lower blood pressure levels in participants with lower intake of sodium and alcohol and higher intake of potassium. Some clinical and experimental observations suggest a possible difference in response to dietary factors in women compared to men due to the intermediate effects of the sex hormone pattern.


[Blood cholesterol in women].

The distribution of blood lipids is described and their role as cardiovascular risk factors in women is discussed. The determinants of serum cholesterol levels are identified in genes, in particular in changes of codes for LDL and HDL; in habitual food intake as polyunsaturated and saturated fats. Obesity, jointed by atherogenic lipoproteins as total and LDL-cholesterol, is considered a risk factor independently on smoking habit or age. Finally the role of menopause in changing lipoprotein levels and in increasing cardiovascular risk is reported.


[Prospective studies based on biological specimen banks: a new epidemiological generation].

A new generation of studies is emerging from the recent technical development in the epidemiology of chronic diseases. Prospective investigations on large number of individuals using a biological specimen bank as a support have been designed recently in the major European and North-American research center in epidemiology. The efficiency of this design may guarantee sound information on a number of etiological questions regarding modifiable environmental factors (such as nutrition) and tumours and cardiovascular diseases. Studies on women appear the most efficient use of this design in cardiovascular epidemiology, especially for coronary heart disease. The design, the objectives and the rationale of a study on the etiology of cardiovascular disease in Italian women are described in the present paper. The Progetto ATENA and the women-dedicated section of the Progetto Controllo Comunitario Integrato nel Distretto Sanitario di Sezze are the two components of the investigation.


[The biological specimen bank: methodological and organizational problems].

Little experience is available to solve methodological and organizational problems when setting up a biological specimen bank as a support to prospective studies on chronic diseases. Sample aliquots preparation, processing procedures and storage system are discussed in the present paper. Problems related to the quality of biological material stored, as to the influence of the very low temperature freezing physico-chemical effects, are discussed also in the appendix.


[The quality of biological information: standardization and quality control].

Some procedures and methods for the measurement of cardiovascular risk factor are described; in particular of anthropometric measurements (weight, height, arm circumference, wrist circumference, hip circumference) of blood pressure, of electrocardiogram and of blood samples for the preservation of biological specimens. Some advice for the quality control during screening activities are reported.


[Computerization of data collection in epidemiological studies].

Data collected in epidemiological studies on large cohorts need to be evaluated through the organization of a specific computer laboratory in order to make all procedures simple and fast. This paper describes the basic elements composing a computer laboratory and discusses its implementation in epidemiological investigations.


[The finalization of the information output].

A biological specimen bank, as a support to prospective studies on etiology of chronic diseases can be considered the final product of our research and the central point of an information system in which many participants are involved. After a brief consideration of some problems related to the criteria and the methodologies evaluation of scientific results and about their transfer to the users, the afferent and efferent informative flows are analysed using the bank as a central processing unit. The aim is to realize an interactive bidirectional communication process involving both the observer and the observed.


[Food questionnaire for epidemiological studies on large cohorts for use in Italy].

Two Italian studies on dietary habits have been analyzed to prepare a list of 78 food items explaining 95% of nutrients variation. These food items can be reliability used in nutritional investigations carried out in Italy, provided the limiting due to study design.


[Nutritional research in studies of large numbers of people: the need for integrating accuracy and simplicity].

Epidemiological investigations on nutrition and chronic diseases require high reliability, accuracy, low cost and feasibility of the system through which dietary information is collected. Food frequency questionnaire are commonly used in large epidemiological investigations. However, repeated 24 hour recall should be considered to integrate this information. Multiple 24 h recalls in random samples of large cohorts appear to be convenient choice to improve data accuracy. This procedure also allow calibration of dietary information in case of pooling of data from different cohorts. Multiple 24 h recalls can be easily carried out through telephone interviews instead of multiple face-to-face. This reliable procedure, tested in a study reported in this paper, may improve compliance.


[Reliability and power of genetic studies].

During the last few years new powerful diagnostic methods have been developed in the field of molecular and cell biology. It is now possible to work out the molecular pathology of many genetic diseases and to institute new techniques for the detection of carriers and neonatal diagnosis. However, it is in the field of polygenic diseases such as degenerative vascular disease, diabetes, cancer and other chronic diseases that molecular biology will play its most important part and perhaps change in the long term our clinical approach. There is considerable debate among geneticists on the safest strategy for obtaining and long term storing sufficient DNA from an individual for projects requiring large but unknown amounts of DNA. As little as 0.5 ml whole, blood samples (or white cells) which have been frozen with 10% DMSO or anticoagulants will provide sufficient DNA by direct extraction methods and also permit to establish lymphoblastoid cell lines providing an infinite source of DNA.


[Community prevention: the role of women].

Socio-cultural, biological, psychological and environmental determinants of health develop within the community. Therefore, any intervention aimed at promoting health must derive from and evolve within the community itself, with the participation of all its members, each of whom charged with a specific and well-defined role to play. Deep changes have occurred in modern society, as a consequence of industrialization and urbanization. This notwithstanding, the biological and social role of women in family management has remained unchanged, even after the spreading of female work. The community-based control of chronic and degenerative diseases calls for the acquirement of a lifestyle more suitable to maintaining health. To this purpose, women can be charged with the responsibility of carrying our activities aimed at improving scientific knowledge to the benefit of the whole community.


The genes coding for phosphoenolpyruvate carboxykinase-1 (PCK1) and neuronal nicotinic acetylcholine receptor alpha 4 subunit (CHRNA4) map to human chromosome 20, extending the known region of homology with mouse chromosome 2.

The mouse genes for cytosolic phosphoenolpyruvate carboxykinase-1 (Pck-1) and neuronal nicotinic acetylcholine receptor alpha 4 subunit (Acra-4) both map to distal chromosome 2 (Siracusa et al. 1989; Bessis et al. 1990). We have utilized Southern blot analysis on human/rodent somatic cell hybrids to map the human homologues of both of these genes, PCK1 and CHRNA4, to human chromosome 20.


The AD1 locus in familial Alzheimer disease.

The AD1 locus on chromosome 21 (MIM 104300) maps to the beta-amyloid precursor locus (APP) at approximately 27.7 Mb from pter (10.9 cM in males and 33.9 cM in females), flanked proximally by D21S8 and distally by D21S111, with D21S124 and D21S210 close but of uncertain order. AD1 accounts for 63 +/- 11% of multiplex Alzheimer pedigrees for which lod scores have been reported. Since a much smaller proportion of pedigrees have mutations in the cDNA for beta-amyloid (APP exons 16 and 17), it is likely that the AD1 locus spans controlling elements near those exons. There is no evidence for a second locus on chromosome 21. The remaining pedigrees may include sporadic cases as well as mutations at an AD2 locus on another chromosome.


Disequilibrium of multiple DNA markers on the human Y chromosome.

We characterized four DNA polymorphisms on the Y chromosomes of 123 males from five Caucasian populations. Three markers on the male specific portion of the chromosome varied appreciably in frequency among the populations. When combined, these markers define a limited number of haplotypes compared with the maximum expected on the basis of random association. The associations found in the five groups are qualitatively similar and are thus considered to be relatively stable on an evolutionary time-scale and possibly to predate the divergence of Caucasian populations. However, the haplotype frequencies varied markedly among populations, even between weakly isolated areas such as northern vs. southern Sardinia. This may indicate rapid progression towards fixation of alternative types of Y chromosomes. We also report data suggesting that the same associations no longer hold when examining a marker as close as 275 bp from the boundary of the pseudoautosomal region on the Y chromosome.


Hazard and probabilities of unknown genotypes.

The likelihood of a genotype of an unsampled individual depends upon genetic data from relatives. When these relatives may be carriers of a mutation as in X-linked disease, the likelihood of a genotype is altered by the consequences of the possible genotypes on offspring. The probabilities of the possible genotypes are easily derived from the probabilities conditional on the genotype obtained from a computer program aimed at risk calculation. This procedure of genotype reconstruction brings to light a potential hazard in the interpretation of computer data: a compound risk may be better represented as the harmonic mean of a set of conditional probabilities than the simple average of these probabilities.


The power of the N-test of haplotype concordance.

The N-test of haplotype concordance among siblings affected by some disease under investigation is used to decide whether there is a disease susceptibility gene linked to a marker locus or chromosomal region. The use of this test and appropriate modifications of it is briefly reviewed. The power of the ordinary N-test is then derived as a function of several parameters. The sample size needed to attain a given power is then derived. Some of the parameters are specified and the required sample sizes are given in tables for different values of the main unknown parameters.


Calculation of genetic identity coefficients.

Genetic identity coefficients define the kind and amount of gene sharing between two relatives at a single locus. Non-recursive computation of these probabilities depends on cumbersome graph-tracing algorithms. Closely related to the identity coefficients are certain generalized kinship coefficients which can be computed recursively. The present paper clarifies some ideas of Karigl about how to relate identity coefficients to generalized kinship coefficients.


Hydroxymethylthiobutanoic acid spares methionine from catabolism in the chick.

Two groups of chicks were fed, until they were 3 weeks old, diets supplemented with either DL-methionine (MET) or DL-2-hydroxy-4-methylthiobutanoic acid (HMB). Oxidation to CO2 and uric catabolism of intraperitoneally injected L-[1-14C]MET and DL-[1-14C]HMB were studied comparatively for 8 h. HMB supplementation spares available MET from both oxidative and uric catabolism.


Skinfold thickness at ulnar, triceps, subscapular, and suprailiac regions in 1,656 Japanese children aged 3-11 years.

We measured body weight, height, and skinfold thickness (SFT) at ulnar, triceps, subscapular and suprailiac regions in 1,656 Japanese children aged 3-11 years. Means of SFT in boys and girls with normal weight exhibited similar changes with age to Caucasian children. However, nadirs of SFT were observed 1 year earlier and means at 11 years were slightly higher in Japanese. Correlation coefficients between SFT and excess weight (EW) were high in boys and girls when EW was more than 10%. Some children with EW of more than 10% had abnormal SFT. Skinfolds in all children with EW of 30% or more were beyond the normal limits. In this study, normal ranges of SFT in Japanese children are demonstrated and their racial characteristics are compared to Caucasians. It is suggested that children with EW of 10-30% are heterogenous and determination of fat volume is essential to confirm the diagnosis of obesity in these subjects.


Infant feeding practices among poor families of an urban squatter community.

We studied the types of food, time of introduction, frequency and nutrient intake among 133 infants during the 1st year of life. A 24-hour dietary recall indicated that 42 different types of food, including mothers' milk, were offered directly or in suitable preparations. Breast- and mixed-fed infants were likely to receive more milk feedings than non-breast-fed infants. Sugar and liquids such as tea, fruit juices and soft drinks were introduced at a very early age. The breast-fed babies were offered only teas before the 3rd month. Solid food was offered as early as at 4 months, regardless of breast or bottle feeding. Fe and vitamin A were estimated to be below the recommended dietary allowance in the group that was not receiving breast milk.


Aging, energy expenditure and nutritional status: evidence for denutrition-related hypermetabolism.

Resting energy expenditure (REE) and nutritional status have been evaluated in 39 elderly inpatients (mean age 84.0 +/- 6.9 years). The nutritional status declined with aging as shown by significant negative correlations between age and, respectively, weight (p < 0.001), fat free mass (FFM) (p < 0.01) and body mass index (BMI) (p < 0.01). The best prediction for REE when considering the whole population was given by FFM (p < 0.001). Increased REE was observed in patients after recent surgery, related to an inflammatory state, as shown by increased plasma levels of C-reactive protein and orosomucoid. Irrespectively of the inflammatory state, REE was also found to be related to the nutritional status: patients who showed a BMI < 20 had higher REE than patients with a BMI > 20 (28.4 +/- 1.3 vs. 22.1 +/- 0.7 kcal/kg of body weight; p < 0.001; 35.7 +/- 1.6 vs. 30.9 +/- 1.0 kcal/kg of FFM; p < 0.02). These results increasingly suggest that elderly patients may suffer from denutrition relevant to hypermetabolism.


Fatty acid composition of blood lipids in Chinese children consuming high erucic acid rapeseed oil.

The fatty acid patterns of oils, blood plasma and erythrocyte lipids from 28 children in the Shaanxi province of the People's Republic of China were determined by capillary gas liquid chromatography. The main source of fat in this region is rapeseed oil. The analysis of locally available rapeseed oil shows a high erucic acid content (mean 43.83%, range 33.91-50.48%). According to protocol data, about 3% of the daily nutrient energy is provided by erucic acid. Despite a low fat intake in Chinese children, the composition of the fatty acids of the fractions analyzed showed normal patterns. However, erucic acid was found in all fractions analyzed. Data on erucic acid in human tissue are scarce. Although there are no indications of erucic acid toxicity in man, it is known to cause cardiac lipidosis and necrosis in rats. The question remains open if erucic acid aggravates selenium deficiency symptoms which are known to be associated with Keshan disease, an endemic cardiomyopathy.


Influence of milk factors on riboflavin uptake by rat intestinal everted sac.

The uptake of riboflavin was measured in Krebs' medium and a system consisting of riboflavin-free dialyzed milk (providing milk factors) equalized to Krebs' medium with respect to different salt concentration and pH. The final riboflavin concentration in the medium ranged between 0.1 and 0.5 microM. Total riboflavin incorporation was greater in the milk system and the increase ranged between 120 and 134% in comparison with Krebs' medium (100%). The Michaelis-Menten constant (Km) and Vmax for labelled riboflavin uptake were calculated by Lineweaver-Burk plotting of data. Km value decreased from 1.23 microM for Krebs' medium to 0.75 microM in the presence of milk factor(s). Vmax values were 62 and 60 pmol/100 mg tissue/min for Krebs' and milk systems, respectively. It was concluded that milk factor(s) enhanced intestinal uptake of riboflavin.


n-3 polyunsaturated fatty acid supplementation (Pikasol) in men with moderate and severe hypertriglyceridaemia: a dose-response study.

The effect of n-3 fatty acids in 11 men with hypertriglyceridaemia was investigated. The subjects were given daily supplements with three different doses of n-3 fatty acids for 8-week periods. The supplements given were 2, 4 and 9 g of n-3 fatty acids/day, respectively. Total cholesterol, triglycerides and the ratio of total cholesterol to HDL-cholesterol significantly decreased with all three doses in a dose-dependent way. HDL-cholesterol increased in a dose-dependent fashion, while apolipoproteins A1 and B were unaltered by the supplements apart from a small increase in apolipoprotein A1 after the lowest dose of n-3 fatty acids. The greatest effect was observed after 2 g of n-3 fatty acids/day.


Intestinal epithelial cell surface glycosylation in mice. I. Effect of high-protein diet.

The effects of variation in dietary protein content have been investigated on brush border glycosylation and enzyme activities in mice small intestine. The comparison of different parameters was made between the mice fed 30% (high protein, HP) and 18% protein (pair-fed, PF, and ad libitum-fed) for 21 days. The activities of brush border sucrase, lactase, p-nitrophenyl (PNP)-beta-D-glucosidase and PNP-beta-D-galactosidase were reduced in the HP diet-fed mice compared to PF and ad libitum-fed controls. Alkaline phosphatase and leucine amino-peptidase activities were significantly enhanced while gamma-glutamyl transpeptidase activity was unaltered under these conditions. Total hexoses and sialic acid content in the brush borders were reduced significantly in the test group compared to the controls while hexosamine and fucose contents remained essentially similar in different groups. The results on the binding of wheat germ agglutinin and Ulex europaeus agglutininI to microvillus membranes corroborated the chemical analysis data on sialic acid and fucose contents of the membranes. Peanut agglutinin binding was enhanced in mice from the HP group. Incorporation of (14C)-mannose into membranes was significantly less in HP diet-fed mice. These results indicate that the feeding of HP diet to mice brings about marked alterations in small intestinal epithelial cell surface glycosylation and enzyme functions.


Tracer study of metabolism and tissue distribution of sebacic acid in rats.

The present study investigates the metabolic disposition of sebacic acid in rats. Three groups of experimental animals received different doses of disodium sebacate with 25 microCi of 14C-labeled molecule by intravenous injection. In the first group radioactivity plasma elimination curves were examined for two administered doses (80 and 160 mg). In the second group, expired 14CO2, urine tracer and feces tracer were counted after intravenous administration of 160 mg of sebacate. The animals of the third group were sacrificed at different times after intravenous administration of 160 mg of sebacate, and tracer elimination curves were obtained for several organs. The plasma half-life of sebacate is 38.71 min; about 35% of the administered tracer was excreted in the urine as unchanged sebacate; about 25% was eliminated as 14CO2 in expired air. Disposition of sebacate was complete within 4 h of administration. The sebacate half-life is longest in adipose tissue (135 min) and in liver (74 min), sites of likely transformation. In all other organs examined, the sebacate half-life is similar to that in plasma.


Increase of long chain omega-3 fatty acids in the major serum lipid classes of patients with cystic fibrosis.

We studied the effects of supplementing patients with cystic fibrosis for 1 month with 3 g/day of a dietary supplement, containing 911 mg omega 3 fatty acids, on the fatty acid composition of serum cholesterol esters, free fatty acids, phospholipids and triglycerides. At the end of the supplementation period, the content of total omega 3 fatty acids was increased significantly in all lipid classes. The effect on individual omega 3 fatty acids depended on the fatty acid and lipid class studied, increased with the dose fed and decreased with the weight of the patient. One month after the end of the supplementation period, fatty acid levels had returned to pretreatment values. These results demonstrate that enrichment of serum lipid classes with omega 3 fatty acids is feasible in CF patients by dietary supplementation.


Effect of pyridoxine on mice gastric ulcers and brain catecholamines after an immobilization stress.

Fifty adult female Swiss albino mice were injected with either 1.11 mg/kg body weight pyridoxine or saline, subsequently they were all submitted to an immobilization stress with a complete fast for 17 h. At the end of this period, the animals were sacrificed, the gastric mucosa was dissected for ulcer count, and brain noradrenaline, dopamine and serotonin were determined by liquid chromatography. In addition, 26 nonstressed mice were used as controls, 16 of them being fed at libitum and 10 submitted to the same fasting period as the first two groups. In the stressed animals, the average number of gastric ulcers per mouse was twice as large in the saline-treated group than in the pyridoxine-treated group (p < 0.05). With a single exception, no ulcer was found in the non stressed controls. Brain norepinephrine content was almost identical in fasting controls and in stressed mice treated with pyridoxine; in the stressed animals treated with saline, the average norepinephrine content was higher by 15% and in the fed controls lower by 11% than in the two preceding groups. Pyridoxine treatment entailed a very significant reduction (p < 0.002) of norepinephrine variability, mainly due to the absence of high values (> or = 750 ng/g of fresh brain) which occurred only in the saline-treated group. Similar results were yielded for brain dopamine. No variations were observed for brain serotonin. These results suggest the antistress effect of pyridoxine.


Appropriate days for measuring intake of dietary fat and cholesterol.

Seven consecutive day food records were assessed in 224 free-living adult volunteers to (1) identify the smallest number of days, and which days of the week, would provide most of the information about dietary fat and cholesterol intake (assessed by B score) and (2) whether a complex mathematical formula for weighting certain days was required to achieve reasonable validity. A factor analytic approach was used to identify 3- and 4-day sets. The correlations with the 7-day average B score ranged from 0.95 for the best 4-day (Saturday through Tuesday) average B score to 0.91  for the best 3-day (Sunday through Tuesday) average B score. Simple averaging (no weighting) was found to be adequate to achieve this level of validity.


Changes in serum and urinary amino acids after the administration of a mixed beta-adrenergic agonist.

The administration of the repartitioning agent metaproterenol, with affinity for beta 1- and beta 2-receptors, induced marked increases in gastrocnemius muscle and heart weights. The renal loss of essential amino acids was reduced in animals treated with beta-adrenergic agonists and a significant reduction in total serum amino acids was found as well. The assessment of urinary 3-methylhistidine suggests, that those changes were accompanied by a lower myofibrillar protein breakdown, while hydroxyproline output was increased as an indirect index of collagen turnover.


Effects of weight loss on the fatty acid composition of serum lipids in obese women.

The effect of a weight reduction regimen, consisting of a protein-sparing modified fast and an exercise program, on the fatty acid composition of serum phospholipids and cholesterol esters of obese women, is described. In phospholipids, this treatment did not induce any significant change of the different fatty acid families (total saturated, monounsaturated, omega 9, omega 7, omega 6 and trans-fatty acids), except for total omega 3 fatty acids which increased. Within families, individual fatty acids change however. The changes are compatible with increased delta 5 and delta 6 desaturase activity. In cholesteryl esters, significant changes occurred which are suggestive of an increase in serum of the fraction of cholesteryl esters of intracellular origin. The changes in fatty acid compositions may not be beneficial with respect to atherosclerosis.


[Historic evolution of the use of the intestine in urology].

Knowing the history of Urology has allowed urologists to recover techniques which had been abandoned for different reasons, yet when modified or utilized with current technological advancements, have proved to be very useful. A brief review of the history of urinary diversion clearly shows that it has evolved in parallel with the important diseases; i.e., vesical exstrophy, urinary tuberculosis and bladder cancer. Time tests all new, and thus controversial, concepts or procedures. They become either well established or are condemned to oblivion. All the experience, both successes and failures, that make up the history of Urology undoubtedly contribute towards finding new therapeutic alternatives.


[The future of total substitution ileoplasty].

Up to now radical cystectomy with or without ancillary methods (radiotherapy, chemotherapy) has been usually considered as the most efficient treatment for invasive bladder cancer. Bladder replacement, which maintains body image, made this mutilation more acceptable for the patient and more easily offered for early stages T1b, T2. According to the progresses of oncologic knowledge, chemotherapy, immunotherapy, it seems reasonable to think that within less than 10 years, conservative treatments for bladder cancer will probably make obsolete radical cystectomy and, of course, associated bladder replacement. Nevertheless, bladder substitution must remain available as a second treatment of choice for some cases and also for bladder deteriorations secondary to trauma, neurologic or benign diseases.


[Evolution of urinary bladder substitution].

The historical background to the currently used methods for continent bladder substitution is shortly outlined. The significance for the patient's quality of life of various methods for bladder reconstruction or urinary diversion is briefly discussed. The importance of reservoir configuration for achieving a high compliant urinary receptacle is pointed out. Factors affecting reabsorption of urinary constituents are stressed and the significance of an antireflux mechanism is discussed. Currently the majority of patients undergoing cystectomy for cancer or for other reasons can be offered bladder substitutes providing continence and easy emptying; that is, complete control over voiding. This can be achieved by orthotopic bladder reconstruction or by diverting the urine to the augmented and valved rectum or to the skin via a continent intestinal reservoir.


[Ileal neobladder].

Since April 1986, 227 patients received an ileal neobladder at our institution. Of these patients 206 underwent simultaneous radical cystectomy for bladder cancer, and 21 received a bladder augmentation. The mean postoperative follow-up ranges from 3-71 months. Perioperative mortality was 2.55 percent, 15 percent of the patients died later than 2 months postoperatively, 13.4 percent due to tumor progression, 1.5 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexia. Day and night continence was preserved in 77 percent of the patients with a follow-up of more than 2 years; severe stress incontinence was found in 2 patients, and night time incontinence needing some external device in 4.6 percent. 11.5 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for re-operation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.


[The "Mainz pouch" technique (bladder augmentation with ileum and cecum) for bladder augmentation, bladder substitution, and continent urinary diversion].

Back in 1983 we created a continent urinary reservoir, called the MAINZ pouch, using 10 to 15 cm. of cecum as well as two terminal ileal segments of equal length. Following detubularization, the posterior wall of the pouch is established by anastomosis of the ascending colon with the terminal ileal loop starting at the inferior aspect. The latter is then anastomosed with the next proximal ileal segment. The ureters are implanted in an antirefluxive manner in the open end technique through a submucosal tunnel of 4 to 5 cm length. For bladder augmentation the pouch is anastomosed to the bladder remnant. For bladder substitution a buttonhole incision at the most inferior aspect of the cecal pole is placed or the appendix is used for end-to-end anastomosis to the membranous urethra. For continent diversion an additional 7 to 12 cm of ileum are isolated in order to create an ileal intussuscepted valve. Alternatively the appendix can be used. Continence is achieved by submucosal embedding of the appendix into the cecal pole. A total of 346 patients underwent the MAINZ pouch procedure in Mainz and Wuppertal; 56 for bladder augmentation, 49 for bladder substitution and 241 for continent urinary diversion. We encountered early complications in 29 of the 346 patients (8.38%). Late complications were observed in 72 patients (20.8%). The major complications we encountered were stone formation inside the pouch in 19 patients and stomal stenosis in 21. 54 of the 56 patients with a bladder augmentation are completely continent (mean follow-up: 50 months, range: 10 to 83 months). All of the 49 patients who received a bladder substitution after radical cystectomy are continent during daytime. Three of these patients who do not empty their bladder at regular four hour intervals have leakage during the night (follow-up: 23 to 69 months). The revision rate due to nipple gliding and subsequent incontinence could be greatly reduced by the use of staples for fixation of the ileal nipple and the use of the appendix. For correction of the most frequently occurring complications standardized techniques have been developed.


[Ileal cystoplasty in bladder cancer].

We present our experience with bladder substitution in radical surgery for bladder cancer. Ileocapsuloplasty was performed in 40 patients. There were 2 postoperative deaths and 11 patients died from tumor recurrence or progression 2 to 10 years later. Two patients had urothelial tumor recurrence in the capsuloplasty. Day continence was good in 89.5% of the cases and 10.5% were partially continent. Night continence was good in 23.5%, partial in 23.5% and poor in the remaining 53% of the patients. Detubularized ileal cystoplasty was performed in 9 patients. Two patients have died; one early postoperatively and the other from tumor progression. Day continence was good in all of the patients and night continence was good in four of the seven patients that were evaluated.


[Functional rectosigmoid neobladder: a new continent urinary diversion].

From 1988 to 1992, six patients underwent surgery to create a functional rectosigmoid neobladder following the technique initially described by Kock and Ghoneim. Four also had a total cystectomy (3 females were submitted to cystourecterectomy). This new continent urinary diversion procedure was performed at the time of reoperation in two previously cystectomized patients with complicated ileal conduits due to ureteroileal stenosis. There were no postoperative deaths. Two cases presented minor complications postoperatively (prolonged paralytic ileus and wall abscess). The follow up period ranged from 3 months to 4 years. All patients were continent during the day and voided every 4 to 6 hours. They were continent during the night and voided once or twice. Preservation of renal function was demonstrable analytically and urographically. The proctogram and proctography disclosed a rectosigmoid neobladder with a big capacity, low pressures and good adaptability to filling. Ureteral reflux was not observed and colosigmoid reflux was minimum, although they did not have the second valve (colosigmoid) of the original technique. Because the procedure is acceptable for the patients and achieves good results, this new alternative continent urinary diversion procedure should be considered for those patients who refuse cutaneous urinary diversion and for those in whom construction of an ileoureteral reservoir is not possible.


[Urodynamic basis and findings in detubularised intestine neobladders: bladder substitutions and continent urinary reservoirs].

Construction of a neobladder utilizing intestine is currently considered to be the ideal option for the cystectomized patient. We reviewed the history as well as the physical and urodynamic principles of the substitution neobladders and continent reservoirs. In our series of patients who underwent cystectomy from January 1988 to December 1991, we have performed bladder substitution using detubularized ileum in 37 patients (18 Camey II and 16 Hautmann) and 13 patients had a continent reservoir (Mainz pouch). Patient ages ranged from 33 to 72 years (mean 60.4). The functional behaviour of the intestinal neobladders was analyzed clinically, radiologically and urodynamically. Eleven of the 18 patients with a Camey II (61.8%) and 3 of the 16 with a Hautmann (18.7%) neobladder were incontinent during the night, the difference being statistically significant (p < 0.05). Incontinence correlated manometrically with high pressure peaks in the Camey II neobladders and waves with a lower intensity were recorded in the Hautmann neobladders. Flowmetry revealed a normal peak flow in all but one Camey II that required internal urethrotomy due to urethroileal stenosis. The maximum capacity was 215-500 cc for the Camey II (mean 340 cc), 310-850 cc for the Hautmann (mean 590 cc) and 350-925 cc (mean 675) for the Mainz pouch. Intermittent catheterization was required in 3 of the Camey II and 1 of the Hautmann neobladder with important postmicturition residual urine. The patients who received the Mainz pouch had good continence, with pressure recordings less than 55 cm H2O), which is lower than the continent closing pressure. Only one case was incontinent due to failure of the intussusception mechanism. The good functional results achieved with the Hautmann procedure are underscored. The pressure recordings and the incidence of night incontinence for the foregoing procedure were lower than the Camey II. For the unviable urethra, the Mainz pouch achieves moderate pressures and is socially acceptable.


[Why is intussusception an antireflux mechanism?].

One of the aims of bladder substitution or augmentation using the intestine is to preserve renal function. If reflux impairs renal function, an antireflux mechanism should be attempted. Direct ureteroileal reimplantation with spatulation of the ureter is safer and carries a lower risk of stenosis. The antireflux mechanism is created by ileoileal or ileocecal intussusception without involvement of the ureter. Thus we can diminish the risk of stenosis and reflux at the same time.


[Antireflux ureteroileal implantation in mucosal groove].

The technique of the mucosal groove antireflux uretero-ileal implantation is described. The clinical results based on 300 implanted ureters are analysed: No leakage or fistula; Late stenosis in 3 to 5% of implantations. The antireflux efficacy is 85 to 83%. The use of this technique can be recommended in any case of ureteroileal implantation.


[Ileal ureteroplasties].

When the ureter is extensively compromised, preservation of the kidney without recurring to external diversion may be attempted by a psoas bladder procedure, transureteroureterostomy, renal autotransplantation or ureteral substitution using the intestine. The first two are not always possible and transplantation is perhaps extremely disproportionate. We therefore recur to ureteral substitution using the intestine. Ureteral substitution may be partial or total, although it is recommended to preserve the upper segment of the lumbar ureter whenever possible. The procedure can be performed using the entire ileal segment with or without modelling to the appropriate thickness. Reducing the diameter of the ileal graft will enhance urine propulsion, reduce mucus secretion and improve antireflux dynamics. Nine cases of ureteral substitution are described herein. Treatment depended on the underlying pathology, extent of ureteral compromise and location. The techniques employed were ureteral substitution with or without modelling and ureteral substitution combined with a bladder repair procedure.


[De-diversions. Indications, techniques, and complications].

Today it is possible to restore the continuity of the urinary tract and to correct the underlying condition that had prompted the diversion procedure. Patients with a Bricker cutaneous ureteroileostomy will essentially benefit from this possibility. However, they must be carefully evaluated and meet the following criteria: patients with upper urinary tract disorders and/or symptoms arising from a malfunctioning urinary diversion, those who refuse a stoma for social or personal reasons, those requiring renal transplantation and those who had undergone urinary diversion for pathologies that can be resolved otherwise today. Undiversion, however, is not free from complications, which may present early (wound infection, suprapubic or intestinal fistula, irritation syndromes, mucus secretion) or late (diminished renal function, incontinence or urinary obstruction, electrolyte imbalance or problems arising from the artificial sphincter. In carefully selected patients, therefore, undiversion permits amending a surgical indication which, in the light of current knowledge and possibilities, can be resolved otherwise.


[Surgical staplers. Urologic surgery with intestines].

Since the late 1980s, different reservoirs and bladder substitution techniques have been added to the urological surgical armamentarium. The necessary use of an intestinal segment--generally detubularized--make these surgical procedures complicated and time-consuming. Furthermore, problems are encountered postoperatively due to the important morbidity arising from these procedures. The present article describes our experience with mechanical sutures and resorbable material. Although the results have not been analyzed, our initial experience at the Miguel Servet Hospital has shown that these devices significantly facilitate the operative procedure, thereby reducing the incidence of urinary and intestinal fistulas. Although there is an evident risk of calculi formation, complicated solutions are not required and the biological tolerance to the metal sutures is excellent.


[Ag-NOR in meningiomas. Clinical and morphologic study of 14 cases].

A total of 14 meningiomas were studied in this report, grouped in different subtypes. The number of NORAg of each was analyzed and quantified. This study analyzes the results obtained as opposed to different subtypes and with clinic and biologic characteristics of patients. Similarly, technical characteristics of silver impregnation method to determine nucleolar organizer regions (NORAg) and its application as a routine method were analyzed. We propose this as a fast and reliable method to analyze of neoplastic proliferative activity.


[Validation of the S-IQCODE: the Spanish version of the informant questionnaire on cognitive decline in the elderly].

Although in the last decade the screening test of dementia have improved, is still being of interest the study of simple methods with a most sensitivity and specificity in the detection of the cognitive decline. Jorm et al have used recently a questionnaire (IQCODE) by which a subject's relative informs of the decline suffered by this in his cognitive capacity. In this work is showed a spanish adaptation of this test, the spanish-IQCODE, analysing it's usefulness for the detection of mild dementia. The S-IQCODE shows a diagnostic validity (sensitivity of 86%, specificity of 92%, positive predictive value of 54% and negative predictive value of 98%) greater than Mini-Mental State Examination (MMSE); it also shows a correlation with the diagnostic of dementia greater (r = 0.70 vs r = 0.37); and, different from MMSE, it doesn't show significative correlations with the age, the schooling and the premorbid intelligence. The results in this study show the S-IQCODE as a good test for the detection of the mild dementia, of greater diagnostic power than the MMSE and less contaminated than this by strange variables to the cognitive decline.


[Meningiomas: morphologic and ultrastructural characteristics of psammoma bodies].

In this study we analyzed the morphologic and ultrastructural characteristics of the psammoma bodies in ten meningiomas of different histologic subtypes, characterizing the components of the psammoma body and the elements of the tumor, such as the capillaries and degenerative cells that have been classically considered as initiators of the formation of these calcareous is structures. The discussion considers the diagnostic interest of psammoma bodies in central nervous system tumors, as well as its histogenesis. The different points of view explaining biological mineralization in other territories of the organism are analyzed, as well as the formation of psammoma bodies, comparing the morphologic data obtained in this study. It is concluded that the mineralization of the psammoma bodies is induced principally by the collagen fibers synthesized by the meningocytes and that the form of mineralization is spherical and growth is radial, controlled by the tumoral cells.


[Multifocal neurologic syndrome and Fanconi disease].

A patient suffering from Faconi's anemia presented multifocal neurologic complications, initially with an exacerbating-remitting clinical presentation, next followed by chronic progressive course. Both as a nosologic association or as neurologic complication of Fanconi's anemia, this case is un unpublished observation, to our knowledge.


[An enzyme-linked immunosorbent assay for the quantitation of the major allergen from Japanese cedar (Cryptomeria japonica) pollen, Cry j I, using monoclonal antibodies].

We have developed an enzyme-linked immunosorbent assay (ELISA) using two anti-Cry j I monoclonal antibodies (KW-S10 and KW-S131) for the quantitation of the major allergen from Japanese cedar (Cryptomeria Japonica) pollen, Cry j I. Polystyrene microplates coated with KW-S131 were incubated with pollen allergen extracts. Cry j I, which bound to the antibody, was detected with alkaline phosphatase-conjugated KW-S10 using chromogenic enzyme substrate. Cry j I could be measured in concentration of between 0.16 and 2.5 ng/ml by this assay. Intra- and inter-assay coefficients of variation were 1.1-3.5% and 0.9-4.6%, respectively. This assay was considered that it was specific for Cry j I of Japanese cedar pollen because it didn't react with allergens of hinoki (Chamaecypairs obtusa) pollen which have antigenicity in common to Japanese cedar pollen. This assay would be useful for the standardization of Japanese cedar pollen allergen extracts.


[Environmental and immunological survey of sensitization with Japanese cedar (Cryotomeria japonica) pollen in children. Part 2. The clinical significance of Japanese cedar (Cryptomeria japonica) pollen specific IgE antibody and IgG4 antibody].

The clinical manifestations and Japanese cedar (sugi in Japanese) pollen specific antibodies were studied in 340 children who had not received specific hyposensitization. Specific IgE antibodies were measured by radioallergosorbent test (RAST) and IgG4 antibody by enzyme linked immunosorbent assay (ELISA). There were 52 children (15%) with RAST scores of over 2, and 44 children (13%) with ELISA of over 101 mu/ml. The specific IgG4 level was significantly higher in the RAST positive group than in the negative group. The incidence of pollinosis among children with RAST negative and IgG4 below 100 mu/ml was 13.3%, while combinations of RAST negative and higher ELISA, RAST positive and low ELISA, and RAST positive and higher ELISA were 50.0+-62.5%. There were 5 children with RAST scores of 4, and 6 children with ELISA of over 201 mu/ml. Symptoms of pollinosis manifested in all of them. Since the children with low IgE and high IgG4 antibodies had comparatively more symptoms, the IgG4 antibodies might be reaginic. It was concluded that measurement of sugi specific IgG4 antibodies as well as IgE antibodies could provide useful data on pollinosis in children.


[Atypical neuroradiologic manifestation of systemic lupus erythematosus].

The most frequent neurological lesions found on Cranial Computerized Tomography (CT scan) in patients with Systemic Lupus Erythematosus (SLE) are cortical atrophy (psychosis, although in general atrophy is not associated with a particular clinical presentation), infarcts and haemorraghes (strokes). We describe a patient diagnosed of SLE who developed a psychotic clinical picture followed by generalized epileptic seizures within a context of diffuse lupus encephalopathy. On the neurological examination, she presented cortical blindness, generalized piramidalism and extrapiramidal rigidity. Various electroencephalographic recordings showed signs of diffuse cerebral involvement predominantly in posterior regions. Cerebrospinal fluid analysis showed a slight increase of IgG without oligoclonal bands and a positive anti-DNA antibody with an homogeneous pattern. Sequential CT images were carried out demonstrating hypodense areas initially in the occipital regions that extended progressively to the temporal, parietal and finally to the frontal lobes, with a moderate mass effect on the lateral ventricles and with no contrast enhancement. The images of the lesions on the CT disappeared completely with the adequate treatment as the symptomatology resolved. A MRI and cerebral angiography were performed when the patient recovered. Both MRI and angiography showed no alterations. We consider that this neuroradiological finding is exceptional, because of its total resolution. Nevertheless, more observations will be necessary to determine the exact meaning of these abnormalities.


[Moyamoya syndrome. Diagnosis with angio-MRI].

We present a case of Moya-Moya syndrome in a 28-year-old female patient with an unusual debut in the form of mirror-image writing. The patient was studied by CAT, conventional cerebral angiography, MRI and angio-MRI. The results obtained show a very good correlation between the images of conventional angiography and those obtained by angio-MRI. Angio-MRI requires no contrast, is noninvasive and rapid, promising to be a first class alternative in the diagnosis and follow-up of Moya-Moya syndrome.


Eosinophil infiltration and enhancement of airway reactivity by leukocyte chemotactic factor, formyl-methionyl-leucyl-phenylalanine (fMLP), in guinea pigs.

N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP) is a bacterial-derived chemotactic factor for eosinophils and neutrophils. This study is aimed to examine whether or not eosinophil infiltration induced by intra-airway administration of fMLP causes the damage of the bronchial epithelium and results in airway hyperresponsiveness in normal non-sensitized guinea pigs. In normal guinea pigs fMLP administered by aerosol inhalation or intratracheal injection caused significant infiltration of eosinophils in the tracheal mucosa and enhanced bronchial reactivity to inhaled histamine 6 and 24 hours after exposure. Electron microscopic examination showed damage of the alignment of the epithelial cells in the bronchial mucosa in fMLP-treated guinea pigs. PAF antagonists CV3988 and WEB2086 and a 5-lipoxygenase inhibitor (AA-861) did not prevent fMLP induced eosinophil infiltration, which suggests that fMLP caused eosinophil infiltration mainly by its chemotactic activity, not by the release of platelet activating factor (PAF) or leukotrienes in this experimental condition. These results showed that in normal guinea pigs a bacteria-derived chemoattractant of fMLP could reproduce a sequence of eosinophil infiltration and airway hyperresponsiveness, similar to the inflammatory pathophysiology after antigen challenge in sensitized animals. We concluded that eosinophil infiltration induced by either immunological or non-immunological mechanisms can cause airway damage and airway hyperresponsiveness.


[The relationship between reactivity and asthmatic attacks before and after acetylcholine inhalation test].

Sixty two asthmatic children participated in this study to clarify the relationship between the number of the days of asthmatic attack and the respiratory threshold of acetylcholine (RT-Ach) and % fall of FEV1.0 at the RT-Ach. In the age group 5 to 11, there was a statistically significant correlation between the RT-Ach and % fall of FEV1.0 at RT-Ach. However there was no such relationship in the age group 12 to 15. In the age group 5 to 11, there was a statistically significant correlation between the % fall of FEV1.0 and the number of the days of asthmatic attack during 10 days and one month before the inhalation test. However there was no such relationship in the age group 12 to 15. There was a statistically significant correlation between the % fall and the number of the days of asthmatic attack over 12 months following the inhalation test in the age group 12 to 15. There was no such relationship in the age group 5 to 11.


[Complement system in status asthmatics--analysis of anti-complementary effects induced by methylprendisolone].

Complement system was investigated in 7 patients with status asthmatics treated with large doses of methylprednisolone (MPS). Complement hemolytic activities, complement protein profile, complement fragments and circulating immune complexes were measured before, 3 and 8 hours after and 14 days after MPS administration. MPS normalized C4 and C1INH activities 6 hours after administration. MPS also decreased ACH50 6 hours after administration and D activity 3 and 6 hours after, but these activities recovered to their previous normal range within 14 days. P and H were decreased at each measurement time, and C1s was transiently decreased 6 hours after MPS administration. Complement fragment iC3b was increased at each measurement time, but fragment Bb tended to be decreased 14 days after MPS administration. The increment of anaphylatoxin C3a recovered to normal 14 days after MPS administration. In vitro experiments, MPS inhibited D and C1s activation directly, and decreased the decay of B and C4. Inhibition of C1s might also increase C1INH activity clinically. These results clarified that the alternative complement pathway was activated, and suggested that the C1 bypass pathway might be also activated in status asthmatics. It was further considered that these anti-complementary effects induced by MPS, brought about an improvement in asthmatic symptoms. Studies to identify the complement activators continued, and circulating immune complexes may possibly be one of those agents activating complement cascade.


[Clinical epidemiology of bronchial asthma in children report. No. III. Comparison of prevalence of asthma with 1982 and 1990 and environmental factors].

In 1982, our group carried out a survey by the questionnaires and on the site medical check-ups to observe and occurrence of asthma and other allergic symptoms in elementary and junior high school children in Izu Ohshima island. Same procedure was repeated in 1990 for 1145 children of the same age group to see any data fluctuation. The occurrence of allergic symptoms with relation to living conditions was also researched. 114 students (11.0%) had either suffered from asthma in the past, or were still currently exhibiting symptoms, this marked a 7.5% rise (108 students) over the 1982 research data. However, patients in need of current treatment numbered 48 (4.5%), which was similar to the 1982 data of 82 (4.3%). For other allergic symptoms, rhinitis showed a marked increase over the 1982 data. The relation between living conditions and asthma was analyzed by Multiple Factor Analysis Quantification Theory. 1) Family history of allergy, 2) Selection of food products upon starting solids during infancy, 3) Infection of lower bronchus during infancy all seemed to have had much influence on the occurrence of asthma.


[Efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children].

The aim of this study was to evaluate the efficacy of continuous isoproterenol inhalation therapy for severe asthma attacks in younger children, compared with its efficacy in older children. We used l-body isoproterenol (Proternol L) in 31 children with 42 episodes of severe attacks. They were divided into two group according to age: 20 cases under 6 years old (Group A), and 22 cases over 7 years old (Group B). All of the patients except for one in Group B, eventually improved with this therapy. Wood's clinical scores for Group A were significantly higher than those for group B (p < 0.01). In 22 cases whose scores were 5-6, their SpO2 values at the onset of this therapy were 90.8 +/- 3.17 in group A and 92.4 +/- 3.82% in group B. The improvement time of group A (13.6 +/- 16.2 hours) was significantly longer than that of group B (2.5 +/- 5.66, p < 0.01). The nebulized isoproternol doses for group A were 0.47 +/- 0.168 and for group B 0.26 +/- 0.096 mg/kg/saline 500 ml. The dose for group A was significantly higher than that for group B (p < 0.01). We concluded that continuous isoproterenol inhalation therapy was effective even in younger children. But the degree of efficacy was slightly lower in younger children, although they inhaled higher doses of isoproterenal than older children.


[Prognosis of intractable asthma].

Forty-nine intractable asthma patients from January 1981 were divided into three groups. Group I consisted of patients still alive after ten years (January 1991) who were receiving decreased doses of steroids or no steroids at all. Group II patients were also alive, but the doses of steroids they were receiving were unchanged. Group III consisted of patients who had died during the ten years. Of the 49 patients, nine were in Group I, 13 in Group II and 17 in Group III. The condition of the other 10 patients was unknown. The mortality rate of the known 39 patients over 10 years was 43.6%, a very high rate. The groups of living patients (I + II) were younger than the patients in the dead group (III) and the latter patients had more obstructive ventilatory dysfunction in the stable state (FEV1.0/FVC%, and %FEV1.0 were 56.1% and 52.8%) in 1980. In the therapy carried out over the 10 years, antiallergic drugs and inhaled steroids were administered in order to decrease oral steroids in both Group I, II and III. In Group I, however, more patients had received immunotherapy (hyposensitization) or gold therapy than in Group II and III. There were more complications due to steroids during the ten years in Group II and III than in Group I. Aging and obstructive ventilatory dysfunction may be factors which worsen the prognosis of intractable asthma, and decreasing of the doses of oral steroids may be important to prevent complications.


[A case of asthma relieved by aspirin--the first case in Japan and investigation of its mechanism].

We report a case of asthma that was relieved by aspirin and other cyclooxygenase inhibitors. The patient, a 51-year-old man, was admitted to our hospital because of an asthmatic attack. Onset of asthma had occurred at the age of 40 years, after a flu-like infection, and was preceded for several years by perennial rhinitis and loss of the sense of smell. The course was perennial, and unrelated to the seasons. These clinical features resembled those of aspirin-induced asthma (AIA). Therefore, suspecting AIA, we performed a aspirin-DL-lysine iv challenge test. After aspirin-DL-lysine injection, FEV1 was increased by about 30% and nasal obstruction was improved. Other cyclooxygenase inhibitors (indomethacin, mefenamic acid, ketoprofen) also improved FEV1 by more than 30%. Hydrocortisone sodium succinate (HCs) improved FEV1 about 20%. Lipoxygenase inhibitor (AA861) produced an evident attack, but continued administration did not result in complete tolerance. On the other hand, seven other AIA patients showed no reaction to AA861. DSCG had an acute bronchodilative effect similar to that of AIA. Paraben and chloramphenicol sodium succinate (CMs) produced an asthmatic attack. The present patient showed a marked improvement in response to cyclooxygenase inhibitors and HCs, in contrast to the situation in AIA, and developed an evident asthmatic attack in response to lipoxygenase inhibitor. He showed marked improvement in the response to DSCG and developed an asthmatic attack in response to paraben and CMs, as in AIA. Our results suggest an abnormality of Arachidonic acid metabolism not only in AIA but also in asthma relieved by aspirin.(ABSTRACT TRUNCATED AT 250 WORDS)


[A case of chronic fatigue syndrome who showed a beneficial effect by intravenous administration of magnesium sulphate].

We have treated a case of chronic fatigue syndrome with atopic diathesis was had suffered general malaise, low grade fever, swelling of the lymph nodes, myalgias and arthralgias for a long time. A 29-year-old female, who had been treated for atopic dermatitis for 5 years, complained of general malaise in May 1990. She was admitted to the nearest hospital in December 1990 because of low grade fever, swelling of the lymph nodes and an elevation of antinuclear antibody (2520x). She was transferred to our hospital in May 1991. A diagnosis of collagen disease was not compatible with her condition. In addition to general malaise, fever and lymph node swelling, headache, myalgias, muscle weakness, arthralgias and insomnia were observed, and a diagnosis of chronic fatigue syndrome was made based on the working case definition proposed by Holmes et al. Although eosinophilia, a high serum level of IgE, and elevation of RAST scores, low NK and ADCC activity, and a reduced level of NK cells in the peripheral blood were detected, serum antibodies to a number of viruses were in the normal range. Treatments with non-steroid anti-inflammatory drugs, minor tranquilizers and antidepressant drugs were not effective at all. An administration of magnesium sulphate was intravenously performed once a week in order to improve her condition, especially severe general malaise. After about 6-week's administration of magnesium sulphate, she noticed reduced easy fatigability and an improvement in her impaired daily activities. Finally she was able to leave the hospital in January 1992.(ABSTRACT TRUNCATED AT 250 WORDS)


[Brief counting method of airborne Cryptomeria japonica pollen by a combination of fluorescence antibody staining and flow cytometry].

Airborne pollens collected in a pollen collector (Virtual Impactor) was treated with a fluorescein isothiocyanate-labeled monoclonal antibody (KW-S10) which was strictly specific to Japanese cedar pollen antigen (Cry j I). Flow cytometric analysis revealed that the intensity of fluorescence of the pollen samples treated with the antibody was greater than that of non-treated reference pollen or the antibody treated Hinoki-cypress pollen. By use of this method, it may be possible to display the airborne pollen concentration within 20 min after sampling.


[Effect of acute ethanol administration on lipid composition of rat liver plasma membrane and serum--with two different doses of ethanol].

This investigation was performed to determine whether acute ethanol administration (5 g and 3 g/kg body wt.) alters the lipid composition both of liver plasma membrane (LPM) and serum in rat or not. The changes of lipid composition of LPM and serum were observed during peak values which blood ethanol concentration was achieved, after both 5 g and 3 g/kg body wt. ethanol administration; LPM cholesterol (CH) content was significantly decreased, but LPM phospholipids (PL) content was not changed statistically. Serum CH and PL contents were significantly increased. However, CH/PL molar ratio showed significant decreases in both LPM and serum. SPM/PC in LPM was also decreased significantly. These changes of lipid composition in LPM were associated with the increase of the fluidity as demonstrated in our previous reports. These lipid values in ethanol treated animals expressed as a ratio of those from corresponding control animals, taken as 1, consisted with 0.7-0.8, that is very interesting from viewpoint of "homeoviscous adaptation", and in addition, suggesting the possibility that serum CH/PL molar ratio may be useful for the estimation of the changes of lipid composition concerned with LPM fluidity.


[Platelet adenylate cyclase activity in alcoholics].

Platelet adenylate cyclase (AC) activity in the long-term abstinent alcoholics, who maintained abstinence from alcohol for at least one year was examined. Guanine nucleotide [Gpp(NH)p] stimulated AC activity was not changed in platelet membrane from long-term abstinent alcoholics. However, the extent of AC activity induced by 250 mM ethanol in vitro, in the presence of 1 microM Gpp(NH)p, was significantly reduced in platelet membrane from long-term abstinent alcoholics. These results suggest that platelet AC activity may be a biological marker for alcoholics.


[ALDH phenotype in eating disorders with and without alcoholism].

Individuals who have inactive low Km aldehyde dehydrogenase (ALDH2) are much less likely to develop alcoholism than those who have active ALDH2. On the other hand, frequent alcoholism has been reported in eating disorder patients. Whether inactive ALDH2 works as an inhibitory factor for alcoholism in these patients is not known. We compared the ALDH2 phenotype in eating disorder patients with and without alcoholism. Among the 25 subjects (4 with anorexia nervosa, 6 with anorexia nervosa and bulimia nervosa, 13 with bulimia nervosa and 2 with eating disorder not otherwise specified according to the DSM-III-R), 13 were alcoholics and 12 were non-alcoholics. Isoelectric focusing of hair roots samples demonstrated that 8% of the alcoholic subjects had the inactive ALDH2, while 58% of the non-alcoholic subjects had this variant form of the isozyme (p < 0.01). The results suggest inactive ALDH2 has a similar inhibitory effect for alcoholism as in eating disorder patients as has been reported in normal populations.


[Effects of ethanol intake by the mother rat on learning ability and behavior of offspring rats].

The effects of ethanol intake by the mother rat were studied in five groups of Fischer strain rats; we observed learning ability and behavior of offspring rats using a maze with eight radial arms. I The ethanol free-intake groups (F-) were given a 10% aqueous solution of ethanol, classified by length of ethanol exposure. The mother rats were exposed to ethanol from a young age. The offspring were classified as follows: A. to the delivery (F-DEL), B. to the lactation period (F-NURS), C. to the lactation period, and after weaning, the offspring was continuously exposed to the maze experiment (F-CON). II The ethanol compulsory-intake group (P-DEL) was given a 20% aqueous solution of ethanol, 2 ml/100 g b.w., for the first time on the first day of pregnancy. The solution was given orally once a day through gestation. III The control group was not exposed to ethanol. Radial arm maze observations were made on offspring rats during a total of 30 trials, and we made the following findings: 1) The number of trials required for fulfilling learning criterion was significantly large in F-DEL and F-NURS male rats groups relative to the controls; that is, F-DEL and F-NURS were slow in learning. The number of rats which did not fulfill the learning criterion was significantly large in F-DEL and F-NURS male rats groups, relative to the controls. 2) In all groups running time was shortened with training time, it was result of acclimation to the device and of practice to catch and eating feed. In female rats of the F-DEL and F-NURS groups, running time was not shortened with the training, relative to the control. 3) The behavior of the rats in the F-CON group differed from those in the other groups: The number of well-performed trials was significantly large in F-CON rats group relative to control. They seemed to lack carefulness, and the number of times they failed to eat the feeds even though they succeeded in selecting the correct arm, was significantly large in F-CON female rats group, relative to the controls, in the final 10 trials. Their motion was abrupt and they ran at extraordinarily high speeds. 4) The number of trials required for fulfilling learning criterion was significantly large in the P-DEL rats relative to the controls.(ABSTRACT TRUNCATED AT 400 WORDS)


Acute effects of tobacco smoking on the autonomic nervous system in comparison with alcohol drinking.

A total of 21 male university students were used to investigate the acute physical effects on the autonomic nervous system of two adult daily habits; smoking and drinking. A tobacco loading trial and an alcohol loading trial were conducted, keeping the conditions as uniform as possible. The nine subjects were instructed to smoke two cigarettes in 10 minutes, and their blood pressure, heart rate, and pupil diameter were measured. In addition, blood samples were taken 30 minutes after initiation of the trial, and the level of nicotine in the samples was measured (Trial 1). The twelve subjects were instructed to drink one large bottle of beer in 10 minutes, and the same parameters were measured. (Trial 2: trial for comparison). The pupil diameter decreased significantly 30 minutes after the subjects started smoking. Also, the heart rate increased suddenly as soon as the subjects started smoking, and the increase in the heart rate was pronounced for the 10 minutes that they were smoking. The maximal and minimal blood pressures generally did not fluctuate greatly. On the other hand, the pupil diameter tended to decrease slightly as soon as the subjects began drinking, and no significant difference in this value was noted. Also, even though the heart rate tended to increase slightly, no significant difference was noted in this value. In contrast, the maximal blood pressure increased significantly when the subjects started drinking, and tended to decrease gradually after they finished drinking.(ABSTRACT TRUNCATED AT 250 WORDS)


Outcome of 143 pregnancies conceived by assisted reproductive techniques.

One hundred and forty-three pregnancies conceived by assisted reproductive techniques (ART) from October 1985 to June 1989 in the National University Hospital, Singapore, resulted in 66 deliveries and 89 babies. There were 27 (18.7%) biochemical pregnancies, 44 (30.7%) clinical miscarriages and 6 (4.2%) ectopic pregnancies when total pregnancies were considered. Of those who continued pregnancy to second trimester multiple births occurred in 20 (13.3%) patients. A high incidence of vaginal bleeding and hypertension in pregnancy was noted in 32 (48.5%) patients and 18 (27.3%) patients, respectively. Caesarean section was the method of delivery in 48.5% of patients. Twenty-six (29.2%) babies required admission to the neonatal intensive care unit. All babies except one set of twins delivered at 24 weeks of amenorrhoea survived. Fetal abnormality was noted in 2 cases.


Analysis and outcome of 502 cases of laser excision cone (LEC) at the Samaritan Hospital for Women, London.

When performed based on cytology, histological accuracy of the laser cone specimen improved with the more severe cytology. The incidence of adenocarcinoma in situ is 1.0%. With and without residual disease, the rate of abnormal cytology after laser excision cone are 0.6% and 1.6% respectively. There is good correlation between colposcopic biopsy and cone specimen in the more severe lesions. Out of 139 cases of incomplete excision, only 3 cases had abnormal cytology at follow-up. The complication rates are very low.


A case report: vesico-rectal fistula with ano-urethral atresia.

Vesico-rectal fistula is a rare congenital abnormality causing severe early second trimester oligohydramnios. Prenatal diagnosis of such a case is reported here. Ultrasound diagnosis could be aided by transabdominal amnio-infusion and, if necessary, fetal intraperitoneal saline installation. In a karyotypically normal fetus with normal somatic growth, demonstration of normal fetal kidneys together with a functioning urinary bladder, in presence of severe oligohydramnios, is very suggestive of the diagnosis. Since pulmonary hypoplasia is the major cause of neonatal mortality in these cases, restoration of normal amniotic fluid volume by serial amnio-infusion was attempted. Although amnio-infusion is an important diagnostic aid in the evaluation of severe midtrimester oligohydramnios, the role of multiple therapeutic amnio-infusion in improving lung growth remains to be evaluated.


Ultrasonography and Doppler studies in twin-to-twin transfusion syndrome.

In 40 twin pregnancies, the evaluation of hemodynamics by ultrasound was performed during the period January 1986 through September 1991. The blood flow velocities' waveforms in the umbilical artery, umbilical vein and tricuspid valve, and the total cardiac dimension, were obtained by ultrasonography in conjunction with 3.5 MHz pulsed Doppler ultrasound. Six patients with twin pregnancies were identified as having twin-to-twin transfusion syndrome (TTS), on the basis of like-sex twins with monochorionic diamniotic placentation, vascular anastomosis in the placenta, and umbilical cord venous blood hemoglobin difference exceeding 5 g/dl at delivery. No distinctive findings for TTS were revealed by the measurement of umbilical artery blood flow velocity waveforms. However, cardiomegaly in 5 recipient fetuses and tricuspid regurgitation and biphasic umbilical vein waveforms in 3 recipient fetuses constituted characteristic features of TTS. Ultrasonography and a Doppler study might be beneficial in diagnosing TTS and evaluating the hemodynamics in a recipient fetus.


Acute abdomen due to adenomyosis of the uterus: a case report.

A Japanese woman with severe abdominal pain underwent an emergent exploratory laparotomy. Intraperitoneal bleeding from the uterine serosal surface was observed, and a pathologic examination showed that the bleeding was caused by an exudative hemorrhage from the endometrial tissues in the myometrium close to the uterine serosal surface.


Effect of menstruation on serum CA125 levels.

CA125 levels were measured in the sera of 54 women with normal menstrual cycle and without infectious, benign and malignant gynecologic disorders. In 54 subjects studied, 13 (24%) had no significant variations in serum CA125 levels throughout the menstrual cycle. In contrast, there 41 (76%) had significant variations in serum CA125 with peak levels (51.8 +/- 6.5 U/ml, mean +/- SEM) during menstruation. The concentration reached a normal value (17.7 +/- 1.6 U/ml, mean +/- SEM) at proliferative phase, and remained low throughout the rest phases of the cycle. The mean peak level was significantly higher than that at proliferative phase (P < 0.001), where as no significant difference in mean concentration was detected between sequential phases from proliferative phase to premenstrual phase (P > 0.1). Among 41 with variable CA125 levels in the menstrual cycle, more than half of them, namely 39% of the total (21/54), had the levels of the upper limit or normal values.


Measurement of serum rubella antibody titers in Korean children, female adolescents, and pregnant women.

IgG antibody titers to rubella virus in serum of 322 nuchal cord blood, 1,473 children, and 1,103 reproductive and pregnant women were detected in Soonchunhyang University Hospital in Korea. Positive rate of IgG antibody to rubella virus was 86.3% (278/322) in nuchal cord blood, 68.0% (991/1,458) in children. The IgG antibody from the mother disappeared between the 7th to 11th month after birth, and then the positive rate increased as age increased. In the reproductive age group including pregnant women, positive rate of IgG antibody was 81.8% (894/1,103). Therefore, it was known that there was a possibility that 18.9% of this group would be attacked with rubella in Korea.


Origin of macrophage colony-stimulating factor (M-CSF) and granulocyte colony-stimulating factor (G-CSF) in amniotic fluid.

A large amount of M-CSF and G-CSF exists in human amniotic fluid and both are considered to have some physiological affect on maintaining pregnancy. We therefore examined the source of M-CSF and G-CSF found in the amniotic fluid. The average level of M-CSF in the amniotic fluid of patients without complications was 17.3 +/- 8.5 ng/ml and that of G-CSF 1.85 +/- 1.72 ng/ml, both being high values. In neonatal urine, the average level of M-CSF was also very high, 144.3 +/- 97.0 ng/ml, but that of G-CSF was below the determination limit of 60 pg/ml. Immunohistochemical staining indicated that production of M-CSF and G-CSF was localized in the epithelial cells of fetal membrane. On the basis of the above observations, M-CSF was found to derive from neonatal urine and the epithelial cells of fetal membrane, and G-CSF from the epithelial cells of fetal membrane.


The effects of glucose concentration on early embryogenesis using the whole embryo culture system on rats.

In order to investigate the effect of hyperglycemia on fetal teratogenesis, rat embryo culture was performed according to the method of New et al. The effect of hyperglycemia was then studied at glucose concentrations of 300, 600, 900 and 1,200 mg/dl in the medium. The embryos from the high glucose medium (600 mg/dl) had significantly shorter CRLs and fewer somites. Major anomalies characterized by neural lesions and minor anomalies characterized by extraneural lesions increased as the glucose concentration increased. However, fetal growth was promoted with statistical significance in the medium with 300 mg/dl of glucose, where the incidence of malformations remained unchanged as compared to the control group. The findings indicate that the glucose is one of the substantial compounds which influences embryo growth, development and abnormalities, but glucose alone appears to have no major effect on early embryogenesis in diabetic pregnancy.


Thymidylate synthase activity in normal and malignant gynecologic tissues.

We assayed thymidylate synthase (TS) activity in normal and malignant gynecologic tissues. TS activity in the normal cervix, secretory endometrium, and ovaries from a total of 61 patients was 1.00 +/- 0.52 pmol/g tissue (mean +/- SD). Thus the upper limit (mean + 2SD) of TS activity in normal gynecologic tissue was 2.00 pmol/g tissue. TS activity was generally higher in malignant tissue than in normal tissue, and particularly high activity was detected in cervical cancer. TS activity in endometrial cancer was relatively low, but activity in poorly and moderately differentiated tumors was significantly elevated compared to well differentiated tumors. These findings suggest that cervical cancer is a highly proliferative tumor and that in endometrial cancer, cell proliferation is more rapid in poorly differentiated tumors than in well differentiated ones.


Study of the relationship between abnormalities in nuclear DNA and drug sensitivity of human gynecological cancer transplanted into nude mice.

The relationship between abnormalities in nuclear DNA and anticancer-drug sensitivity of human gynecological cancer transplanted into nude mice is reported. Nuclear DNA content was expressed in terms of the DNA index (DI) and heterogeneity index score (HIS) using flow cytometry (FCM). Southern blot analysis was used to examine changes in DNA and in observed abnormal-size DNA fragments. Drug sensitivity was carried out according to a procedure described by Battelle Columbus Laboratories. The results were as follows: (1) Tumors with a high degree of DNA content were more sensitive to anticancer drugs than tumors with less DNA damage. (2) Severe heterogeneity of nuclear DNA caused drug resistance.