A pathogenesis study of highly pathogenic avian influenza virus H5N2 in chickens, using immunohistochemistry.

Eighteen specific pathogen-free chickens (nine hens older than 1 year and nine 15-week-old males) were inoculated with highly pathogenic avian influenza virus A/Chicken/Pennsylvania/1370/1983 (H5N2). Birds were serially killed and tissues collected for histological and immunohistochemical evaluation. In the group of older hens, disease was acute or peracute. By immunohistochemistry, antigen was abundant in capillary endothelium in multiple organs, and staining for antigen in parenchymal cells was marked in brain and heart. In the group of younger male birds, disease was subacute. Immunohistochemical staining of capillary endothelium was less pronounced and viral antigen staining was evident in the parenchymal cells of the heart, brain and kidney.


Demodicidosis in a child with leukemia.

A 2-year-old girl developed acute lymphoblastic leukemia at the age of 9 months. She was treated successfully with chemotherapy but developed a pruritic, papulopustular facial eruption that was caused by Demodex folliculorum. The eruption cleared after treatment with one overnight application of 5% permethrin cream. Demodicidosis should be included in the differential diagnosis of facial eruptions in children who undergo chemotherapy and in those with congenital or acquired immunodeficiency.


Minocycline-induced Sweet's syndrome.

This is the second reported case of minocycline-induced Sweet's syndrome (and the first such case to appear in the American literature). The syndrome developed in a 32-year-old man 10 days after minocycline therapy for acne was begun and resolved rapidly after discontinuation of the medication and start of oral prednisone therapy.


Pyoderma gangrenosum, polycythemia rubra vera, and the development of leukemia.

A patient with long-standing, well-controlled polycythemia rubra vera developed recurrent episodes of bullous pyoderma gangrenosum followed by the transformation of his hematologic disease into a rapidly progressive acute myeloid leukemia. This case, together with previously described patients, indicates that the appearance of bullous pyoderma gangrenosum in a patient with polycythemia rubra vera is often of ominous prognostic significance.


Q-switched ruby laser treatment of labial lentigos.

The Q-switched ruby laser causes selective damage to pigmented cells in the skin. This laser, which has a wavelength of 694 nm and a pulse duration of 40 nsec, has shown very promising results in the treatment of both amateur and professional tattoos. Less data are available on its ability to treat benign pigmented lesions of the skin. Three patients who had labial lentigos were treated with the Q-switched ruby laser, and dramatic clearing occurred after one or two treatments with a fluence of 10 J/cm2.


Hyperkeratosis lenticularis perstans (Flegel's disease). Ultrastructural study of lesional and perilesional skin and therapeutic trial of topical tretinoin versus 5-fluorouracil.

Lesional and perilesional skin samples from a 57-year-old man who had hyperkeratosis lenticularis perstans (HLP) (Flegel's disease) were studied by light and electron microscopic examination. Keratohyalin granules were diminished at the center of a fully-developed lesion. In contrast, keratohyalin appeared normal and membrane-coating granules were found in reduced numbers at the edges of the HLP lesion and were easily detected in normal numbers in clinically normal, perilesional skin. The inflammatory infiltrate in the HLP lesion was composed of small lymphocytes, which often displayed nuclei with deep infoldings resembling Sézary cells, and larger histiocytic cells, many of which were in close contact with the lymphocytes. Peripheral blood mononuclear cells did not show an abnormal ultrastructural appearance. Treatment with topical 5-fluorouracil cream led to the disappearance of the HLP lesions, whereas topical tretinoin was ineffective.


Congenital neonatal herpes simplex virus infection.

Intrauterine-acquired neonatal herpes simplex virus infection is a severe, often life-threatening infection that has a wide spectrum of clinical presentations. We describe a 31-week-gestation male who had a rarely reported epidermolysis bullosa-like clinical presentation. He acquired herpes simplex virus type II in utero secondary to a primary maternal infection that occurred on the knee. A review of the infection, the need for early therapy, and the prognosis are presented.


Churg-Strauss syndrome.

A 62-year-old woman who had a history of asthma and allergic rhinitis developed bilateral pulmonary infiltrates and marked eosinophilia. A transbronchial biopsy specimen did not help clarify the diagnosis. She later developed erythematous nodules on her feet; results of a biopsy specimen revealed necrotizing extravascular granulomas and marked infiltration of the dermis with eosinophils consistent with a diagnosis of Churg-Strauss syndrome. Skin manifestations are often nonspecific in this syndrome and occur in approximately two thirds of cases.


Failure of reticular erythematous mucinosis to respond to cyclosporine.

We describe a 48-year-old woman who had worsening psoriasis, photosensitive reticular erythematous mucinosis (REM), and acne rosacea. The psoriasis was unresponsive to etretinate, and the REM was unsuccessfully treated with hydroxychloroquine. Cyclosporine (6 mg/kg/day) successfully cleared the psoriasis in 8 weeks but did not improve the REM and acne rosacea. Possible causes for the lack of response of the REM to cyclosporine are discussed.


Autoerythrocyte sensitization syndrome (psychogenic purpura).

A case of autoerythrocyte sensitization syndrome is reported. This syndrome most often appears in young women who have an underlying emotional disorder; features include bizarre, tender ecchymotic lesions, which are most commonly located on the arms and legs. Systemic symptoms often accompany the onset of these lesions. A diagnosis of autoerythrocyte sensitization syndrome may be made in a patient who has the typical history and clinical picture of the syndrome and in whom a skin test with use of the patient's blood reveals a positive reaction.


Features of an autoimmune process in mid-dermal elastolysis.

Mid-dermal elastolysis is a rare disorder that is manifested clinically by wrinkling and histologically by the selective absence of elastic fibers in the mid dermis. We describe a young woman who developed abnormal wrinkling after augmentation mammoplasty with silicone implants. Histologic examination confirmed the diagnosis of mid-dermal elastolysis. In addition, a positive antinuclear antibody titer and a false-positive Lyme titer were subsequently detected. In a previously reported case a patient who had mid-dermal elastolysis also had an unusual false-positive pattern for Lyme disease. Silicone mammoplasty has been associated with connective tissue diseases. This report adds mid-dermal elastolysis to the list of diseases associated with augmentation mammoplasty and, along with the presence of autoantibodies, supports autoimmune involvement in mid-dermal elastolysis.


Petechial glove and sock syndrome caused by parvovirus B19.

The petechial glove and sock syndrome is a recently described febrile dermatosis characterized by acral pruritus, edema, pain, petechiae, and an enanthem of petechiae and erosions; these features suggest a viral origin. We report a typical case in a 36-year-old woman. IgM antibodies to human parvovirus B19 (PVB19) were present, and acute and convalescent IgG antibodies demonstrated seroconversion, which suggested recent infection with PVB19. Results of tests for other viral and bacterial agents were negative. These results strongly implicate PVB19 as an etiologic agent in the petechial glove and sock syndrome.


Successful treatment of musk ketone-induced chronic actinic dermatitis with cyclosporine and PUVA.

We describe a patient with chronic actinic dermatitis whose photopatch tests revealed reactions to musk ketone and musk ambrette, both of which were found in his aftershave lotion. Minimal erythema doses of UVA and UVB were decreased. After initial unsuccessful treatment with PUVA therapy the patient was successfully treated with a combination of cyclosporine and PUVA.


Long-term management of basal cell nevus syndrome with topical tretinoin and 5-fluorouracil.

The case of a child with basal cell nevus syndrome whose condition was successfully managed for 10 years with a combination of topical 5-fluorouracil and tretinoin is reported. The concurrent use of these two agents prevented the development of new tumors, inhibited the growth of existing tumors, and caused the regression of superficially invasive basal cell carcinomas.


Adult T-cell leukemia with regression of erythroderma and simultaneous emergence of leukemia.

A patient with smoldering adult T-cell leukemia had refractory erythroderma. Concomitant with the development of acute leukemia, the cutaneous lesions disappeared spontaneously. This suggests an extensive release of tumor cells from the skin to the blood.


Dermatomyositis pemphigoides: a case with coexistent dermatomyositis and bullous pemphigoid.

We describe a patient with coexistent dermatomyositis and bullous pemphigoid; both appeared within a few weeks. Protein blotting showed binding of the patient's serum to the classic 220 kd bullous pemphigoid antigen. Because of the close temporal association of the two disorders, we believe that they are almost certainly etiologically linked. One possibility is that exposure of basement membrane antigens by dermatomyositis led to exposure of bullous pemphigoid antigen and subsequent antibody formation.


Linear arrangement of multiple congenital melanocytic nevi.

A 28-year-old man had numerous slightly papillomatous melanocytic nevi that were arranged in a linear pattern on his right arm. Their distribution was reminiscent of the lines of Blaschko. The nevi had been present since birth and were in part covered with terminal hair. Histopathologic examination showed typical features of congenital melanocytic compound nevi. In addition, the blue-eyed patient showed an iris bicolor in the form of a sectorial brown pigmentation of his right iris. This unusual case may provide a clue to the genetic basis of pigmented nevi.


Hairy leukoplakia with involvement of the buccal mucosa.

Oral hairy leukoplakia occurs mainly on the tongue of human immunodeficiency virus (HIV)-infected persons. An HIV-infected patient with hairy leukoplakia involving the tongue and buccal mucosa was studied by light and electron microscopic methods, in situ hybridization, and polymerase chain reaction. Our findings indicate that hairy leukoplakia may involve the buccal mucosa and should be considered in the differential diagnosis of white oral lesions in HIV-positive patients. Epstein-Barr virus particles were found in the epithelial cells of both buccal and tongue mucosa.


Epidermolysis bullosa acquisita in a 3 1/2-year-old girl.

A 3 1/2-year-old girl had a subepidermal bullous eruption with immunopathologic features that were consistent with epidermolysis bullosa acquisita or bullous systemic lupus erythematosus. This report highlights the difficulty encountered in distinguishing between epidermolysis bullosa acquisita and other bullous disorders that involve the dermoepidermal junction and the need for modern immunologic investigations in the diagnosis of bullous diseases in children.


Localized pretibial pemphigoid and pemphigoid nodularis.

We describe a 75-year-old woman with a chronic, blistering eruption on the left leg whose clinical and immunopathologic features were consistent with a diagnosis of localized pretibial pemphigoid. After a disease-free interval of 5 years she developed a generalized prurigo nodularis-like eruption. Immunofluorescence studies revealed deposition of IgG and C3 along the dermoepidermal junction, and circulating autoantibodies against the dermoepidermal junction were demonstrated. Indirect immunoelectron microscopic examination of saponin-treated skin samples showed deposits of immunoreactants over the intracellular part of the hemidesmosomes. By Western immunoblotting the 230 kd bullous pemphigoid antigen was recognized by circulating autoantibodies. Thus our patient had two unusual clinical variants of bullous pemphigoid: localized pretibial pemphigoid and pemphigoid nodularis.


Pyoderma gangrenosum-like ulcer in a patient with large granular lymphocytic leukemia.

Large granular lymphocytic leukemia refers to a clonal expansion of lymphocytes that have abundant cytoplasm and azurophilic granules. The disease is characterized clinically by chronic neutropenia and it may be associated with recurrent pyogenic infections. Except for these infections, cutaneous manifestations of this disease have not been well characterized. We describe a patient with large granular lymphocytic leukemia, which was confirmed by molecular genetics studies, who had a pyoderma gangrenosum-like ulcer on his leg. Results of an evaluation of the histologic characteristics and the leukocytic immunophenotype of a skin biopsy specimen from the ulcer demonstrated large granular lymphocytes within the blood vessels. Cutaneous ulceration may be a manifestation of large granular lymphocytic leukemia, and this disease should be considered when diagnosing patients with otherwise unexplained pyoderma gangrenosum-like ulcers of the skin.


Lymphomatoid granulomatosis.

Lymphomatoid granulomatosis or angiocentric T-cell lymphoma is a systemic disease that affects multiple organs. The histopathologic findings include a characteristic infiltrate that is both angiocentric and angiodestructive. The prognosis is poor but may be improved by early recognition and aggressive chemotherapy. We report a case of cutaneous lymphomatoid granulomatosis and emphasize that dermatologists play an important role in the early diagnosis of this disease.


Noninflammatory bullae associated with epsilon-aminocaproic acid infusion.

Three patients who had cardiac surgery developed a transient, noninflammatory subepidermal bullous eruption on the legs after epsilon-aminocaproic acid infusion. Fibrin thrombi were demonstrated in papillary dermal vessels. The use of epsilon-aminocaproic acid as an antifibrinolytic agent may predispose patients to cutaneous vascular thromboses.


Aneurysm in the skin: arterial fibromuscular dysplasia.

We describe a pulsatile aneurysm in the skin of 16-year-old boy that was found to be a sign of a systemic vascular disease, that is, arterial fibromuscular dysplasia. The patient had aneurysms in the renal, cerebral, coronary, and other arteries; he developed renovascular hypertension and had a cerebrovascular accident and acute myocardial infarction at 17 years of age. This disease has not been previously reported in the dermatologic literature.


Necrobiotic xanthogranuloma in a human T-lymphotropic virus type 1 carrier.

A 67-year-old man who had necrobiotic xanthogranuloma associated with paraproteinemia is described. He was a human T-lymphotropic virus type 1 (HTLV-1) carrier who had a high titer of circulating anti-HTLV-1 antibodies and neurologic abnormalities that suggested HTLV-1-associated myelopathy. The patient's necrobiotic xanthogranuloma and neurologic symptoms improved after he received four 5-day courses of melphalan, 2 mg/day, and prednisolone, 20 mg/day, at 4-week intervals.


Oral and cutaneous lichen planus pemphigoides.

Lichen planus pemphigoides is a rare bullous disorder characterized by tense bullae on lichen planus lesions and on clinically uninvolved skin. A diagnosis of lichen planus pemphigoides is made on the basis of clinical, histologic, and immunopathologic evaluation. We describe a patient who had lichen planus pemphigoides of the skin and oral mucosa and briefly review the literature on this uncommon entity.


Crohn's disease presenting as unilateral labial hypertrophy.

We describe a child who had unilateral hypertrophy of the vulva, a rare extraintestinal manifestation of Crohn's disease. A biopsy specimen revealed a noncaseating granuloma. Flexible sigmoidoscopic examination revealed punctate 1 mm lesions with surrounding erythema in the rectum and sigmoid colon. Response to treatment with sulfasalazine was excellent. Gastrointestinal symptoms developed 1 year later when sulfasalazine was discontinued.


Effects of fasting and food restriction on sympathetic activity in brown adipose tissue in mice.

The activity of the sympathetic nervous system in mice that were either fed ad libitum, food restricted or fasted was estimated by measuring the accumulation of dopamine following the inhibition of dopamine beta-hydroxylase activity. Mice in each group were injected with the dopamine beta-hydroxylase inhibitor 1-cyclohexyl-2-mercaptoimidazole and were exposed to either 30 degrees C (warm) or 4 degrees C (cold). Mice were killed 1 h after the injection. Both heart and brown adipose tissue were then quickly removed and homogenized in ice-cold perchloric acid. Dopamine and noradrenaline were determined using high performance liquid chromatography. Regardless of whether mice were warm or cold exposed, both content and concentration of brown adipose tissue and dopamine were predictably higher in 1-cyclohexyl-2-mercaptoimidazole-injected mice than in non-injected animals. In mice fed ad libitum, post-injection content and concentration of dopamine in both brown adipose tissue and heart were higher in cold-exposed mice than in warm-exposed animals. In food-restricted and fasted mice, post-injection concentrations of dopamine in brown adipose tissue were higher in cold-exposed mice than in warm-exposed animals. In food-restricted and fasted mice there was no difference between warm- and cold-exposed animals with respect to post-injection contents and concentrations of dopamine in heart tissue. In fasted mice there was no difference between warm- and cold-exposed animals in post-injection content of dopamine in brown adipose tissue. This study provides further evidence that fasting, in contrast to food restriction, may blunt the tissue sympathetic nervous system response in brown adipose tissue of cold-exposed mice.


Dependence of oxygen uptake on ambient PO2 in isolated perfused frog skin.

Rates of O2 uptake across isolated perfused skin of bullfrogs (Rana catesbeiana) were measured in relation to blood flow at three levels of ambient O2 tension: normoxia (O2 tension = 152 torr), hypoxia (12% O2, 87 torr) and hyperoxia (42% O2, 306 torr). At bulk perfusion rates ranging from 3.4 to 10.1 microliters.cm-2 x min-1, O2 uptake was positively correlated with hemoglobin delivery rate in both normoxia and hyperoxia, but was independent of delivery rate in hypoxia. Mean O2 uptake in normoxia was 3.8 nmol O2 x cm-2 x min-1 at a delivery rate of 9.8 nmol.cm-2 x min-1 and 6.5 nmol O2 x cm-2 x min-1 at a delivery rate of 28.3 nmol.cm-2 x min-1. At any given bulk perfusion rate, oxygen uptake averaged about 49% lower in hypoxia than in normoxia, decreasing in proportion to the reduction of O2 tension difference between medium and blood. In hyperoxia, O2 uptake did not increase proportionally with the difference in O2 tension between blood and medium, averaging only 50% higher at a 2.4-fold greater O2 tension difference. Cutaneous diffusing capacity for O2 averaged 0.041 nmol O2 x cm-2 x torr-1 x min-1 during the first hour of perfusion in normoxia, and was not affected by reduction of ambient O2 tension. The results indicate that cutaneous O2 uptake in hypoxia is highly diffusion limited, and consequently, increases in cutaneous perfusion can not effectively compensate for reduction of ambient O2 tension. In hyperoxia, O2 uptake may be substantially perfusion limited because of reduced blood O2 capacitance at high O2 saturations.


Assessment of changes in body water by bioimpedance in acutely ill surgical patients.

To evaluate the relationship between changes in body bioelectrical impedance (BI) at 0.5, 50 and kHz and the changes in body weight, as an index of total body water changes, in acutely ill surgical patients during the rapid infusion of isotonic saline solution. Prospective clinical study. Multidisciplinary surgical ICU in a university hospital. Twelve male patients treated for acute surgical illness (multiple trauma n = 5, major surgery n = 7). stable cardiovascular parameters, normal cardiac function, signs of hypovolemia (CVP < or = 5 mmHg, urine output < 1 ml/kg x h). After baseline measurements, a 60 min fluid challenge test was performed with normal saline solution, 0.25 ml/kg/min [corrected]. Body weight (platform digital scale), total body impedance (four-surface electrode technique; measurements at 0.5, 50 and 100 kHz) and urine output. Fluid retention induced a progressive decrease in BI at 0.5, 50 and 100 kHz, but the changes were significant for BI 0.5 and BI 100 only, from 40 min after the beginning of the fluid therapy onwards. There was a significant negative correlation between changes in water retention and BI 0.5, with individual correlation coefficients ranging from -0.72 to 0.95 (p < 0.01-0.0001). The slopes of the regression lines indicated that for each kg of water change, there was a mean decrease in BI of 18 ohm, but a substantial inter-individual variability was noted. BI measured at low frequency can represent a valuable index of acute changes in body water in a group of surgical patients but not in a given individual.


Evaluation of indexes predicting the outcome of ventilator weaning and value of adding supplemental inspiratory load.

To assess the diagnostic accuracy of several measured and calculated indexes for early prediction of weaning outcome, and to study the value of supplemental inspiratory load in improving the accurate prediction of successful weaning. Prospective study. ICU of a University Hospital. Thirty consecutive patients under prolonged mechanical ventilation and without chronic obstructive pulmonary disease (COPD). Forty weaning trials were performed. Data were recorded at 15, 30 (adding inspiratory flow resistance), 60 and 120 min. The threshold values and the accuracy of three indexes were determined: Inspiratory airway occlusion pressure at 0.1 sec. (P01) to maximum inspiratory pressure ratio (P01/MIP), inspiratory effort quotient (IEQ), and the ratio of respiratory frequency to tidal volume (F/Vt). All three were useful predictors for weaning success with a diagnostic accuracy between 82%-87%. At 15 min of spontaneous breathing, a P01/MIP ratio < 0.14 predicts weaning success with a sensitivity of 82% and specificity of 83%. In our group of patients no reintubation was necessary. The application of mechanical inspiratory load significantly increased P01 values (3.16 +/- 1.22 to 3.60 +/- 1.19, p < 0.001). The degree of the P01 increase did not provide prediction of weaning outcome. a) P01/MIP, IEQ and F/Vt ratio were accurate, early predictors of weaning outcome. b) The addition of a moderate mechanical inspiratory load did not enhance the diagnostic accuracy of P01 measurements. c) In our patients, a period of two hours seemed to be sufficient for development and detection of weaning failure.


Continuous arteriovenous haemofiltration and respiratory function in multiple organ systems failure.

To determine what change in respiratory function occurred following prolonged and efficient continuous arteriovenous haemofiltration (CAVH) in a group of patients with multiple organ systems failure (MOSF). A retrospective assessment using patient notes and ICU charts. The Intensive Care Unit of a large University Teaching Hospital. All ICU patients satisfying the following criteria: (i) Failure of more than one organ system; (ii) Treatment with CAVH; (iii) Removal of more than 10 l of ultrafiltrate per day; (iv) Continuous haemofiltration for at least 5 days. Thirteen patients satisfied these criteria and 14 episodes of CAVH were analyzed. All data were recorded from the patient notes and ICU charts apart from the A-aDO2 and PaO2/FiO2 (PF) ratio which were calculated from available values. A mean of 3.5 different organ systems failed during the period of stay. The mean daily ultrafiltrate volume obtained was 23.7 (SD 0.95) l and the mean duration of treatment 9.6 (SD 4.3) days. Significant improvements occurred in the values for the PF ratio and ventilatory modality (p < 0.05), and the FiO2 and A-aDO2 (p = 0.001). The mean PEEP value remained unchanged at 4.8 cmH2O. Ten of the 13 patients subsequently died (77% mortality). A significant improvement in respiratory function occurred in patients with MOSF who had undergone a prolonged period of intensive CAVH. Haemofiltration may therefore be a useful treatment for respiratory failure in this patient group. Unfortunately the overall mortality of the group remained high.


An experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress.

To characterize different modes of pressure- or volume-controlled mechanical ventilation with respect to their short-term effects on oxygen delivery (DO2). Furthermore to investigate whether such differences are caused by differences in pulmonary gas exchange or by airway-pressure-mediated effects on the central hemodynamics. After inducing severe respiratory distress in piglets by removing surfactant, 5 ventilatory modes were randomly and sequentially applied to each animal. Experimental laboratory of a university department of Anesthesiology and Intensive Care. 15 piglets after repeated bronchoalveolar lavage. Volume-controlled intermittent positive-pressure ventilation (IPPV) with either 8 or 15 cmH2O PEEP; pressure-controlled inverse ratio ventilation (IRV); pressure-controlled high-frequency positive-pressure ventilation (HFPPV) and pressure-controlled high frequency ventilation with inspiratory pulses superimposed (combined high frequency ventilation, CHFV). The prefix (L) indicates that lavage has been performed. Measurements of gas exchange, airway pressures, hemodynamics, functional residual capacity (using the SF6 method), intrathoracic fluid volumes (using a double-indicator dilution technique) and metabolism were performed during ventilatory and hemodynamic steady state. The peak inspiratory pressures (PIP) were significantly higher in the volume-controlled low frequency modes (43 cmH2O for L-IPPV-8 and L-IPPV-15) than in the pressure-controlled modes (39 cmH2O for L-IRV, 35 cmH2O for L-HFPPV and 33 cmH2O for L-CHFV, with PIP in the high-frequency modes being significantly lower than in inverse ratio ventilation). The mean airway pressure (MPAW) after lavage was highest with L-IRV (26 cmH2O). In the ventilatory modes with a PEEP > 8 cmH2O PaO2 did not differ significantly and beyond this "opening threshold" MPAW did not further improve PaO2. Central hemodynamics were depressed by increasing airway pressures. This is especially true for L-IRV in which we found the highest MPAW and at the same time the lowest stroke index (74% of IPPV). In this model, as far as oxygenation is concerned, it does not matter in which specific way the airway pressures are produced. As far as oxygen transport is concerned, i.e. aiming at increasing DO2, we conclude that optimizing the circulatory status must take into account the circulatory influence of different modes of positive pressure ventilation.


Haemodynamic effects of selective positive end-expiratory pressure after unilateral pulmonary hydrochloric acid-aspiration in dogs.

We investigated 1) the effects of HCl-mediated acute left lung injury on regional juxtacardiac pressures and 2) the haemodynamic effects of different modes of ventilation before and after induction of left lung injury. The study was done in 7 mechanically ventilated, anaesthetized dogs. Juxtacardiac pressures and haemodynamic variables were recorded during 1) differential ventilation (DV) with zero positive end-expiratory pressure (PEEP = 0) and 2) DV with general (G) PEEP and selective right (R) and left (L) lung PEEP. Left lung injury increased left, but not right pleural pressure of pericardial pressure. Pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) were increased moderately. Cardiac output (CO) did not change. GPEEP reduced LV filling and cardiac output markedly and by approximately the same degree before and after lung injury. The haemodynamic effects of LPEEP were minor before as well as after the induction of lung injury. RPEEP, which had only moderate haemodynamic effects during control, caused a marked reduction in cardiac function after the induction of left lung injury. The transmission of airway pressure to the pleura was reduced in the diseased lung. These results suggest that serious haemodynamic side effects may be avoided by applying PEEP selectively to the diseased lung.


Reversal of neurological deficit with naloxone: an additional report.

We report the repeated improvement in neurological function following naloxone administration in a patient who developed acute hemiplegia after an intracranial neurological procedure. The mechanisms responsible for the neurological deficit and for its reversal by naloxone are discussed. A review of the literature suggests that the beneficial effect of naloxone can result from an improvement in haemodynamic status or from metabolic effects that could be favorable during cerebral ischaemia.


An uncommon cause of acute right ventricular failure and high mixed venous oxygen saturation.

Ruptured sinus of Valsalva aneurysms are rare. We report a case in which the usual clinical manifestations were not present and the patient was initially treated as an acute pulmonary embolus. Despite three negative echocardiograms an intra-cardiac shunt was suspected because of a persistently elevated mixed venous oxygen saturation. Cardiac catheterisation confirmed the diagnosis. Surgical repair was performed and post operative recovery was uneventful.


The utility of MRI in acute stage of carbon monoxide poisoning.

Intracranial abnormalities by magnetic resonance imaging (MRI) in acute carbon monoxide (CO) poisoning have been described in two cases. Edematous bilateral lesions have been demonstrated in the globus pallidus. Findings correspond with the pathological changes described in literature. In our experience MIR is a more sensitive examination compared to serial computed tomography (CT) in acute CO poisoning.


Treatment of neonatal hyperbilirubinaemia by plasmapheresis.

A term baby developed severe hyperbilirubinaemia in association with group-B streptococcal sepsis. Haemodynamic instability deterred us from performing exchange transfusion, and so plasmapheresis was used to lower the bilirubin level. The procedure was very effective and well tolerated.


Successful treatment of fungal right atrial thrombosis complicating central venous catheterization in a critically ill child.

A 9-year-old boy was admitted to our pediatric intensive care unit after multiple trauma. On the 17th day post trauma, he developed catheter-related sepsis with candidemia. After removal of the catheter and 6 days of unsuccessful intravenous antifungal therapy, conventional and transesophageal two-dimensional echocardiography was performed revealing a large right atrial thrombus. Surgical thrombectomy under cardiopulmonary bypass was performed and the patient recovered within a few days. Fungal right atrial thrombus is a rare, life-threatening complication of central venous catheterization. Two-dimensional echocardiography is a simple and effective diagnostic technique that should be performed when candidemia is detected. The proper therapeutic response depends on the findings of this examination. For a symptomatic patient with a large, mobile thrombus, we strongly recommend thrombectomy. Surgery not only allows removal of the mass and thus elimination of the mechanical complication but is also a key to management of infection.


Intravenous xylene poisoning.

A 30-year-old man injected intravenously 8 ml of xylene in a suicidal attempt. After 10 min he developed acute pulmonary failure requiring intubation, controlled ventilation with PEEP and high FiO2. Combined hemoperfusion and hemodialysis were carried out for 4 h. By 8 days later the patient was weaned from the ventilator and after 14 days transferred to the Department of Psychiatry with normal blood gases. Pulmonary failure threatened the patient's life, therefore treatment of this was dominant in the therapy.


Methanol poisoning.

Methanol ingestion is an uncommon form of poisoning that can cause severe metabolic disturbances, blindness, permanent neurologic dysfunction and death. While methanol itself may be harmless, it is converted in vivo to the highly toxic formic acid. The diagnosis is sometimes elusive and requires a high index of suspicion. Because antidotal treatment is available it is important to recognize methanol poisoning promptly. The presence of metabolic acidosis associated with an increased anion gap and increased osmol gap are important laboratory findings. Specific therapeutic measures include correction of the metabolic acidosis with sodium bicarbonate and administration of enteral or parenteral ethanol to competitively inhibit the metabolic breakdown of methanol to formic acid. Hemodialysis accelerates the elimination of both methanol and formic acid and also assists in correction of the metabolic acidosis. Experimental data suggests that administration of folic acid may be of benefit by hastening the metabolism of formic acid to carbon dioxide. Prompt institution of specific therapy can probably decrease the morbidity and mortality associated with this form of poisoning.


Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study.

To evaluate the effect of a method of Selective Decontamination of the Digestive Tract (SDD) on colonization, nosocomial infection (NI), bacterial resistance, mortality and economic costs. Randomized, double blind, placebo controlled study. Polyvalent intensive care unit (ICU) of a tertiary care hospital with 27 beds. 101 patients with > 3 days of mechanical ventilation and > 5 days of stay, without infection at the start of the study. 47 belonged to the Treated Group (TG) and 54 to the Placebo Group (PG). The TG was given Cefotaxime i.v. (6 g/day) for the first four days and an association of Polymyxin E, Tobramycin and Amphotericin B at the oropharyngeal and gastrointestinal level throughout the whole stay. In the TG, colonization by gram-negative agents at oropharyngeal, tracheal and gastrointestinal level fell significantly. There was a significant drop in the overall, respiratory and urinary NI (26% vs 63%, p < 0.001; 15% vs 46%, p < 0.001; 9% vs 31%, p < 0.01). The overall mortality and NI related mortality was less in the TG (21% vs 44%, p < 0.05; 2% vs 20%, p < 0.01). The economic costs, mechanical ventilation time and length of stay were similar. The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG (38% vs 15% and 38% vs 9%, p < 0.001). colonization by gram-negative bacilli, NI and the mortality related to it can be modified by SDD. Continuous bacteriological surveillance is necessary.


A fibre optics system for the evaluation of airway pressure in mechanically ventilated patients.

The present study was intended to evaluate the "in vivo" endotracheal (ET) tube resistance and respiratory mechanics in mechanically ventilated patients with respiratory failure by using fiber optic catheters. Two fiber optic catheters, consisting of a thin probe with a pressure transducer on the tip, were used. The first was placed at the proximal side of the ET tube and the second was positioned distally beyond the end. A low compliant air-filled catheter connected to a traditional pressure transducer was placed close to the proximal fiber optic device to compare the pressure values obtained with both systems. The study was performed in the General Intensive Care Unit of Rome "La Sapienza", University Hospital. Seven patients admitted for the management of acute respiratory failure of different etiologies were included in the protocol. All the patients were intubated and mechanically ventilated for at least 48 h prior to the investigation. The endotracheal tube resistance was obtained both by the end-inspiratory occlusion method and measuring pressure proximally and distally to the ET tube. The measurement of respiratory mechanics was obtained proximally and distally to the ET tube. Different flows and tidal volume changes were performed. The results showed that the fiber optic device gives an adequate evaluation of airway pressure and the possibility for an easy detection of obstructions and/or deformations of the ET tube. The area described by inspiratory and expiratory pressure recorded at both sides of the ET tube showed a positive relationship between the surface and flows while no surface changes were shown when the tidal volumes were modified. Thoraco-pulmonary compliance measured proximally and distally to the ET tube gave rise to a small and statistically insignificant difference. This study confirms that 48 h after the positioning of ET tubes the airflow resistance is significantly higher than might be expected from the "in vitro" data. The presence of the endotracheal tube can interfere with the evaluation of thoraco-pulmonary mechanics, particularly in dynamic conditions. The fiber optic system represents an interesting and simple tool for the evaluation of ET tube resistance and pulmonary mechanics in patients undergoing mechanical ventilation.


Diagnostic value of the blind brush in mechanically ventilated patients with nosocomial pneumonia.

To check on the accuracy of a new protected blind brush (BB) inserted through an endotracheal tube to collect respiratory secretions to be used in the diagnosis of nosocomial pneumonia (NP) in ventilated patients. Prospective study of patients who had undergone both BB and plugged telescoping catheter via fiberoptic bronchoscopy (PTC-FB) sample collection sessions. Intensive Care Unit of a referral-based University Hospital. All patients (n = 37) mechanically ventilated for more than 3 days with clinical and radiological criteria of NP between July 1990 and March 1991. Randomized BB and PTC-FB sample collection sessions carried out less than 30 min apart. The two sampling procedures resulted in similar findings with both cultures either negative or positive and identified the same organism and colonies in 31 patients (83.7%). Agreement was 90% when the patients with right or bilateral pulmonary infiltrates were grouped together and 100% when only the right field was considered. Complications arising from BB sampling were much lower than those from the conventional PTC-FB technique. Our results, pending confirmation by other prospective studies, indicate that BB sampling is useful in the diagnosis of NP in ventilated patients with radiological evidence of either right or bilateral pulmonary infiltrates and that it could stand in for PTC-FB in ICU settings where this procedure is not available.


Isoflurane for prolonged sedation in the intensive care unit; efficacy and safety.

To compare isoflurane with midazolam for prolonged sedation in ventilated patients. Randomised controlled study. General intensive care unit in university teaching hospital. Sixty patients aged 17-80 years who required mechanical ventilation for more than 24 h. Sedation with either 0.1-0.6% isoflurane in an air-oxygen mixture (30 patients) or a continuous infusion of midazolam 0.02-0.20 mg/kg/h (30 patients). Sedation was assessed initially and hourly thereafter on a six point scale. The trial sedative was stopped when the patient was ready for weaning from ventilatory support. Measurements were made of haemodynamic, respiratory and biochemical variables regularly during the period of sedation and for a week after stopping the sedative agent. There was no difference in any of the physiological or biochemical variables recorded between the two groups. Patients sedated with isoflurane recovered more rapidly and were weaned from mechanical ventilation sooner than those sedated with midazolam. Isoflurane is a useful agent for prolonged sedation of ventilated patients and does not have any adverse effect on the cardiorespiratory system or on hepatic, renal or adrenal function.


Low dose amiodarone pulmonary toxicity in a patient with a history of pneumonectomy.

A case of amiodarone pulmonary toxicity (APT) is described following a low dosage of amiodarone (200 mg/day) with serious respiratory insufficiency in a patient after right pneumonectomy. The patient was successfully treated by discontinuation of amiodarone, mechanical ventilation and prednisolone (40 mg/day). A literature study indicates that APT is a dose related toxicity. In our opinion a higher pulmonary drug concentration of amiodarone could exist from a change in pharmacokinetics because of a low fat storage in a thin patient and compensatory growth of the remaining lung which occurs after pneumonectomy. Given these findings we suggest that if amiodarone is indicated in such patients both loading and maintenance doses should be adapted.


Myasthenia gravis and steroid-induced myopathy of the respiratory muscles.

We report a case of corticosteroid-induced myopathy with involvement of respiratory muscles observed in a myasthenic patient. A 37-years-old woman, under corticosteroid treatment for two years for typical myasthenia gravis was admitted to ICU for acute myasthenic respiratory failure. Weaning from mechanical ventilation remained impossible despite 4 plasma exchanges and azathioprine. The patient exhibited a progressive 12 kg weight loss with muscular weakness and atrophy. Peripheral and diaphragmatic electromyography as well as histological study were consistent with a steroid-induced myopathy. Discontinuation of corticosteroid treatment was followed by a rapid weight gain with general improvement and allowed weaning from mechanical ventilation with a complete recovery. This case provides evidence that corticosteroid-induced myopathy may be observed in myasthenia gravis and may involve the respiratory muscles as well as the peripheral musculature.


Latent dystrophic myopathy revealed by unsuccessful weaning from mechanical ventilation.

We report a patient who had difficulty in weaning from mechanical ventilation which was due to an unsuspected latent dystrophic myopathy. The association of latent dystrophic myopathy and unsuccessful weaning has not been previously reported.


Fulminant primary Pseudomonas aeruginosa pneumonia and septicaemia in previously well adults.

We report two cases of primary, community acquired, Pseudomonas aeruginosa pneumonia, occurring in previously well adults without any recognisable environmental risk factors. Both patients died within 36 h of the onset of symptoms, despite broad spectrum antibiotics and aggressive supportive care. In neither case was the diagnosis considered in life and neither patient received adequate anti-pseudomonas therapy. Heightened awareness of this rare, fulminant, variant of primary Pseudomonas pneumonia is required if specific anti-pseudomonas therapy is to have any impact on outcome.


Ciprofloxacin levels in a patient undergoing veno-venous haemodiafiltration.

Haemofiltration is a popular technique for removal of fluid and small to medium size molecules in critically ill patients. Whilst there is often good information on drug disposition in chronic renal failure, there is a lack of information available to guide Intensivists on how to prescribe drugs in patients in acute renal failure undergoing haemofiltration or haemodiafiltration.


Symmetrical peripheral gangrene: association with noradrenaline administration.

The syndrome of symmetrical peripheral gangrene is characterised by distal ischaemic damage in two or more extremities, without large vessel obstruction. Four patients with bilateral pedal ischaemia are described and their haemodynamic profiles presented. In all four cases the syndrome developed in association with noradrenaline administration, sepsis and DIC, despite a high cardiac output and a low calculated systemic vascular resistance index. Early treatment with epoprostenol was instituted in the final case and was successful.


Treatment of a patient with severe digitoxin intoxication by Fab fragments of anti-digitalis antibodies.

A massive digitoxin (DGTX) intoxication in a 36-year-old man (35 mg DGTX) was treated by prolonged and repeated i.v.-infusions of Fab fragments of anti-digitalis antibodies (FAB). Blood and urine samples were collected over a 98 h period for monitoring the efficacy and adequacy of FAB treatment. DGTX concentrations were determined after protein precipitation (release of FAB-bound and protein-bound DGTX) in unprocessed serum and urine samples, and after aliquots of these samples had been dialysed in vitro against DGTX-free buffer (elimination of DGTX not bound to FAB). The difference in DGTX concentration between the unprocessed and dialysed samples was the amount of DGTX bound to plasma proteins and the small fraction of unbound DGTX being relevant for the therapeutic and toxic effects of the drug. Before FAB therapy was started, the total serum DGTX concentration was 535 nmol/l. The first FAB infusion (320 mg) was started 11 h after drug ingestion. Since this amount of FAB was insufficient to bind all DGTX present in the serum, cardiac DGTX toxicity (total AV-block) persisted. During a second FAB infusion (400 mg) the patient reverted to regular AV-conduction. At this time most of the DGTX in serum was FAB-bound. Toxic symptoms (sinus arrest) reappeared twice and were accompanied by increasing amounts of non-antibody-bound DGTX in the serum. Additional application of FAB (2 x 80 mg) resulted in the immediate disappearance of arrhythmia. During FAB-treatment total DGTX serum concentrations and renal DGTX clearance rose, indicating redistribution of drug from tissue to serum and urinary elimination of FAB-bound DGTX, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Documenting medication use in adult dental patients: 1987-1991.

The authors surveyed 5,002 dental outpatients to determine the prevalence and patterns of drug use. They found that drug use increased significantly with age and that a significant number of patients took medications that had potential for adverse dental effects. Thus, dentists should be aware of patient medications and the effects those drugs have on dental treatment.


A year of chronic TMPDS: evaluating patients' pain patterns.

In 136 women with TMPDS observed for one year, pain was highly variable. No respondent had a consistent pattern of pain increase or decrease.


Incidence of cleft lips, palates rising.

About 1:700 live human births are affected by cleft lip and palate. Socio-economic factors--teenage pregnancies, pregnancies in women older than 35, increased consumption of teratogens during early months of pregnancy--have resulted in increased numbers of congenital malformations in the United States.


Initial preparations for amalgam restorations: extending the longevity of the tooth-restoration unit.

Tradition has dictated cavity preparation and tooth restoration since the turn of the century. The authors discuss material and technique options that challenge tradition and extend the longevity of restorations.


Panoramic radiographs: necessary for edentulous patients?

With recent concern about the cumulative effects of radiation exposure, routine radiographic examination of edentulous patients is being questioned. While the present study reports a lower incidence of positive findings than previous panoramic surveys, we still find potentially complicating conditions. Radiographic examination of new edentulous patients still appears warranted.


Preserving avulsed teeth for replantation.

We performed a retrospective study of 34 replanted avulsed teeth placed in an EPTS before replantation. Even when extraoral time was 120 minutes or more, 91 percent of the teeth showed excellent or moderate success for follow-up periods ranging from three to 30 months. We think that the success of a replanted avulsed tooth is increased by use of a prefabricated tooth preserving and protecting system as described.


Occult fractures of the talus.

A case presentation of a severe ankle sprain in which the patient was nonresponsive to routine therapies is presented. Repeat radiographs and computerized axial tomographic scans (CAT Scans) lead to the final diagnosis of a sagittal plane fracture of the talus. The clinical and radiographic evaluation leading to the diagnosis will be presented, and the surgical and postoperative managements will be discussed.


Postoperative cellulitis of the foot and lower leg following coronary bypass.

Greater saphenous vein grafts are standardly used for coronary artery bypass grafting. Recurrent acute cellulitis of the saphenous vein-donor extremity is an infrequently reported complication. The authors present a protocol designed to reduce the incidence of the recurrent cellulitis through proper preoperative assessment and postoperative management.


Multiple ruptures of the tendo Achillis.

An abundance of literature has been published regarding rupture of the tendo Achillis. Certain studies review various options for management, while others focus on the mechanisms and pathogenesis of injury. There are, however, significant differences in the outcomes of these studies. This article reviews the basic anatomy of the tendo Achillis, as well as the various parameters relating to the spontaneous rupture of this tendon. A case study of a recurrent tendo Achillis rupture is also presented, to illustrate principles of management of recurrent ruptures.


The offset "V" bunionectomy using cortical screw and buried Kirschner wire fixation.

The offset "V" bunionectomy with cortical screw and buried Kirschner wire fixation offers advantages over previously described distal metatarsal procedures for correction of hallux abducto valgus. The ability to correct an increased intermetatarsal angle (IMA) as well as a proximal articular set angle (PASA) deviation allows for the eradication of postoperative deforming forces, which often lead to recurrence of the deformity. Complete soft tissue release and repair allows for the repositioning of the sesamoidal apparatus, and also reduces the tendency for recurrence. The authors have performed approximately 500 of these procedures in the past 7 years and found it to provide extremely satisfying results. Gaining experience in the aforementioned techniques has lessened the need for base osteotomies and more unstable types of distal osteotomies. The criterion for the use of this osteotomy continues to broaden as the authors gain experience with its use. The offset "V" osteotomy is now utilized as either a primary or ancillary procedure in approximately 90% of the hallux valgus patients upon whom the authors operate.


Sonographic analysis of Morton's neuroma.

A prospective study was performed whereby 73 patients exhibiting clinical symptoms of 109 Morton's neuromas were examined using ultrasound. Reproducible hypoechoic densities were identified as neuromas if they measured greater than 5 mm. in transverse dimension, with those 4 mm. or less in dimensions called "suspicious" if they were well-defined and if the patient had marked pain in the examined interspace. Sixty of the neuromas were surgically excised, with 49 being managed conservatively. Of the surgical cases, all but three (95%) of the neuromas were positively identified on sonographic examination and all excised masses demonstrated pathological findings consistent with Morton's neuroma. Thirty-nine percent of the conservatively treated neuromas were negative on sonogram. The average sonographic size of the resected neuromas was 6.2 mm., while the size of those not resected averaged 4.9 mm. This study provides evidence that preoperative sonography is an additional aid in the evaluation of Morton's neuroma, and reaffirms previous evidence that symptomatic neuromas are likely to be at least 5 mm. in diameter on sonogram.


Calcaneal ostectomy for Haglund disease.

From 1967 to 1987, operative treatment was performed on 28 feet in 22 patients with retrocalcaneal bursitis due to prominent posterior superior margin of the calcaneus (Haglund disease). Through a lateral or medial approach, the prominent bone was removed. The results indicated that excision of the retrocalcaneal bursa was not necessary. Preoperative planning and intraoperative examination was necessary in order to remove an adequate amount of bone, which was the key for a successful result.


The interpositional arthroplasty procedure in treatment of degenerative arthritis of the second metatarsophalangeal joint.

A description of subjective and objective results in patients that received an interpositional arthroplasty procedure of the second metatarsophalangeal joint is presented. The authors evaluated nine patients using an observational, descriptive design. An independent examiner administered a subjective questionnaire at the same time a physical examination was performed. The average follow-up period was 35.5 months, with a range of 7 to 142 months. All patients showed an improvement in postoperative pain and activity. All but one of the patients rated their results as good or excellent. Additionally, the patient population demonstrated limited motion of the second metatarsophalangeal joint without pain or crepitus postoperatively. The subjective and objective results from this small case series were consistently good.


[The prevalence of female urinary incontinence in general practice].

To determine the prevalence of urinary incontinence, a questionnaire was administered to 2,911 women by 60 general practitioners, in April and May 1989. The first 50 women seen by the physician in his practice were included in the study. 1,075 women out of 2,911 (37%) declared the presence of episodes of incontinence. Among these 1,075 women, 77% had genuine stress incontinence, 60% urge incontinence, 35% spontaneous leakage. One out of five had these three conditions together. 12% of women with incontinence were less than 31 years of age, 36% were between 31 and 51 years, 20% between 51 and 70 years, and 31% above 70 years. Incontinent women were more frequently post-menopausal; 83% had children (74% for those without incontinence), but the parity was comparable in the two groups. Perineal tears, use of forceps for delivery, high-birth-weight children (above 3,500 g) were more frequently found in incontinent women; but not episiotomy. Incontinent women had more urinary infections, were more often obese, were slightly older at their first childbirth. Post-partum incontinence was found more frequently in incontinent women. A positive association is found with the presence of diabetes, neurological diseases, and chronic bronchitis and cough. Incontinent women more frequently underwent a gynecological surgical procedure, particularly hysterectomies. Incontinence had been present for more than 5 years in 34% of cases, one year in 77% of cases. Only 47 women out of 2,911 (1.6%) consulted specifically for their incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)


Evaluation of lower extremity ulcerations.

The authors provide a simplified system for the initial approach and diagnostic evaluation of the more commonly occurring ulcerations encountered by the Podiatric physician. This system provides a logical basis for evaluation, identification, and therapeutic intervention of lower extremity ulcers.


Magnetic resonance arthrography of the ankle.

Magnetic resonance (MR) arthrography is a useful technique in evaluating the articular structures of the ankle. With intra-articular administration of gadolinium-DTPA (Gd-DTPA), visualization and delineation of anatomic structures, that would not be depicted by other traditional imaging techniques, are achieved. It is a technique that proves to be advantageous as it does not require the use of ionizing radiation, nor iodinated contrast material as other conventional diagnostic modalities. MR arthrography also allows multiplanar imaging and provides excellent resolution.


[Role of male factors in habitual abortion].

Paternal factors may play some role in habitual abortion in connection with teratospermia, antibodies against spermatozoa, and with chromosome abnormalities in karyotype or in spermatozoa. The role of paternal age and of environmental factors in abortions are discussed.


[Recipients of oocytes donated anonymously. Psychological aspects].

This study concerns fifty patients who were investigated after a semi-directed interview. Several factors came to light: the type of couples who use assisted reproductive techniques (diagnostic and psychological profiles); the stability of the couple when failure and when success occurred; the hope of having a child and their ideas concerning the child's future; secrecy, questions that were asked concerning the practice of anonymity and non-anonymous donation of oocytes; the relationships between the recipients and the donors as well as the specific relationships that develop between the couples and their physicians. The conclusion reached from the studies show that the diagnoses of the various causes for sterility give rise to different problems. Donor anonymity makes it possible for the recipient to stamp their own pattern of identity on the child about to be born and make him part of their family history. Bringing the technique into conception of the child does not seem to interfere with the relationship between the couple and with their desire to have a child. The upbringing of the child is the responsibility of the couple.


Structural metatarsus adductus deformity, surgical case report.

Structural metatarsus adductus deformity may be corrected through the use of closing abductory base wedge osteotomies of all five metatarsals. Although technically demanding, surgical precision is increased through the use of oblique wedges and a combination of screw and cerclage wire fixation. In the severe case, an opening wedge osteotomy of the inner cuneiform (Fowler procedure), with homogenous bone implantation, may be concomitantly used. Both techniques are described in this brief case presentation.


[Four years of screening cervical smears of cervical lesions].

Twelve thousand two hundred and eighty nine Pap smears were collected from public hospitals and from private practices during a four year period (January 1987 to December 1990). 4.2% of Pap smears exhibited condylomatous or dysplastic lesions. 94.5% of such lesions were encountered in Pap smears taken from the transformation zone and which contained endocervical cells. Therefore, these smears represent the only adequate sample for cervical cancer screening. In our study, a close concertation between biologists and clinicians results in an improvement of the smear quality. The percentage of those containing endocervical cells increased from 49% in 1987 to 72% in 1990. Then, more cervical lesions were encountered on smears of patients from a low socio-economic level. New techniques such as detection of human papillomavirus (HPV) DNA on routine Pap smears by in situ hybridization would allow to improve the cytological diagnosis of HPV infections, mainly for non specific cytological alterations (11% in our series for 1990) and for cytological aspects of dysplasia only. These results point out how a cervical cancer screening can be better carried out.


[Low grade malignant ovarian carcinomas. A retrospective study of 132 cases].

to estimate the frequency, the age, the size, the bilaterality and the prognosis for "borderline" tumours according to the type of cell found. MATERIAL STUDIED: 132 low grade malignant tumours found in 845 primary ovarian carcinomas diagnosed between 1975 and 1984 in the Institute of Pathology in Strasbourg. borderline serous carcinomas (63 cases) were 16.9% of cases were serous neoplasias. The mean age at which the diagnosis was made was 50.3 years of age, and the tumour measured 10 cm. They were bilateral in 20% of the cases and the mean age of survival was 134.7 months. The borderline mucinous carcinomas (68 cases) were 18.2% of mucinous neoplasias. The intestinal sub-variety was found at the mean age of 50 years and was 15.3 cm in diameter. It was rarely bilateral and in some cases was accompanied by peritoneal pseudomyxomatosis. The endocervical sub-variety (18 cases) was diagnosed at a mean age of 41.5 years with a mean size of 13.5 cm. It was rarely bilateral. The two varieties of borderline mucinous carcinomas had a mean survival rate of 154 months. Only one borderline endometrioid carcinoma was found among the 54 endometrioid carcinomas, and none had clear cells, Brenner cells or mixed cells. under the heading of "borderline" carcinoma are different types of tumour with different prognoses. Only serous mucinous varieties which are more frequent, have a low potential for becoming malignant. Endometrioid types and clear cell or Brenner types which have a similar architecture are usually found out to be benign.


The offset V modification of the Chevron bunionectomy: a retrospective study.

This is a retrospective study of two different types of fixation for the offset-V modification of the Chevron (Austin) bunionectomy for correction of hallux abducto valgus deformity. Both screw fixation and Kirschner wire fixation were evaluated radiographically for hallux abductus angle, intermetatarsal angle, proximal articular set angle, tibial sesamoid position, and first metatarsal length. In addition, charts were reviewed for complications selective to each type of fixation. Radiographically, there was no apparent difference in preoperative and postoperative measurements between the two types of fixation. However, chart review led the authors to conclude certain advantages to screw fixation, in terms of clinical results and patient satisfaction.


[Ovarian remnant syndrome. A case report of a malignancy].

We operated on a patient who had already had total abdominal hysterectomy with bilateral salpingo-oophorectomy who developed a pelvic mass. The Pouch of Douglas was filled with a friable cystic mass of which the anatomo-pathological diagnosis was of a borderline serous cyst adenoma that probably was ovarian in origin. The case is interesting because of the radiopathological hypotheses that are brought up and by the various ways of treatment that have been suggested.


Propofol (Diprivan)--a new intravenous anesthetic with applications for outpatient ambulatory surgery.

A review of the literature pertaining to propofol (Diprivan) is presented. An overview of the drug's pharmaceutical aspects, pharmacokinetic, and pharmacodynamic properties, as well as its side effect profile are discussed. The qualities of Propofol make it an appealing alternative intravenous anesthetic for outpatient ambulatory surgery.


[Catamenial rectal bleeding and sigmoid endometriosis].

We describe a case of menstrual rectal bleeding due to sigmoid endometriosis. The history led us to the diagnosis and since a small biopsy of the lesion and scanning could not help us to a conclusive diagnosis we carried out histological examination of a piece removed at operation. This case has led us to estimate the incidence, the difficulties of diagnosis and the present therapeutic measures.


Transformation of plantar verruca into squamous cell carcinoma.

The authors present a case study of a long standing plantar verruca undergoing malignant transformation to a squamous cell carcinoma. This case depicts the rapid change in a plantar verruca of some 20 years' duration without any prior symptomatology. Such malignant change, while rare, can occur and any change in the color, shape, size, or sudden onset of pain in a benign lesion should constitute the consideration of possible malignancy.


[Malignant hypercalcemia after treatment of breast cancer].

A premenopausal woman developed hypercalcemia 30 months after treatment for infiltrating breast cancer. After bone metastases had been excluded, primary hyper parathyroidism was suspected. A parathyroid adenoma was removed and histologically confirmed. Hypercalcemia persisted, associated with low plasma phosphate and severely depressed plasma parathormone (PTH) levels. Further investigations showed liver metastases from the primary breast cancer and also secretion of a PTH-like substance. Anti-tumoral treatment was effective on the liver metastases and also normalized calcemia and the PTH-like substance, demonstrating the existence of a paraneoplastic syndrome related to the secretion of a PTH-like substance by disseminated liver metastases of primary breast cancer.


[Ultrasonic estimation of fetal weight. Value of measuring limb fat].

Many ultrasound models for estimating fetal weight have been proposed and for two reasons have not proved to be very successful. First, the weight of the future newborn baby is not necessarily the principal element of neonatal prognosis. Second, the different methods of measurements are so often inaccurate. Many studies dealing with estimates of fetal weight were based on traditional measurements and were therefore not very precise. We suggest a new method based on ultrasound fetal fat measures on a transverse section. This prospective study was made from 274 measurements of which half were used to establish the basic calculation formula and half for the purpose of statistical analysis. The overall accuracy (the median of departure from the means), is 6.3%. This model is particularly good in the case of small foetuses: 6.9% in the 1,000 to 1,500 grams group. Fetal fat seems to be more apt to provide information concerning weight. This measure is inherently a good one for estimating growth and should prove to be particularly interesting in the screening of small for date fetuses.


[Pelvic hydatid cyst and pregnancy. Four cases].

The association of pelvic hydatid cyst with pregnancy is rare. We collected 4 cases between 1981-1990. Our incidence is of 1/30000 deliveries. The diagnosis was suggested in 3 cases by the patient's country of origin and previous history of extra-pelvic hydatid disease. It is confirmed by ultrasonography, which is still the first choice examination. During the 3 pregnancies managed to term, we did not find any modification in the cyst. One patient had vaginal delivery twice; however complications, sometimes fatal, are reported in the literature. The time for surgery and the mode of delivery are discussed because of the rarity of this association.


The neuropathology of pediatric acquired immunodeficiency syndrome.

Central nervous system disease has emerged as an important manifestation of acquired immunodeficiency syndrome in both the adult and pediatric populations, with neurologic abnormalities occurring in up to 90% of pediatric patients in some series. Neuropathologic studies, based primarily on the autopsy, have provided valuable insights into the spectrum and pathogenesis of acquired immunodeficiency syndrome-associated neurologic disorders, including primary human immunodeficiency virus encephalopathy and as the spectrum of infectious, neoplastic, and cerebrovascular diseases that may complicate the course of acquired immunodeficiency syndrome. Progressive encephalopathy represents the single most common neurologic disorder in pediatric acquired immunodeficiency syndrome and appears to be caused in most cases by direct infection in brain parenchyma by human immunodeficiency virus. Central nervous system lymphoma and cerebrovascular disease continue to account for most focal central nervous system lesions in the pediatric population. In contrast to adults with acquired immunodeficiency syndrome, opportunistic central nervous system infections remain relatively uncommon in the pediatric population. Our understanding of acquired immunodeficiency syndrome-associated neurologic disease remains far from complete. A plea is made for regular postmortem examination of the central nervous system in all patients dying with human immunodeficiency virus infection.


Spinal muscular atrophy: new thoughts on the pathogenesis and classification schema.

We have established the first prospective, collaborative study of spinal muscular atrophy, the second most common neuromuscular disease of childhood. One hundred and forty-one patients have been evaluated on at least four occasions over a 3-year period. The patients have been grouped by age of onset, as well as by function at the time of initial evaluation. The muscle strength of 96 patients aged 5 years or older was evaluated at 6-month intervals using a fixed myometry system. The new observations made are: (1) The present classification schema is not valid; for example, 49 patients with onset of weakness before 6 months of age (type I or Werdnig-Hoffmann disease), whose life span is said to be only 2 to 4 years, participated in the study and are 4 months to 31 years of age. (2) Thirty-seven patients were evaluated over an 18-month period. None lost strength during this time but four lost function. Although the period of observation was short, the results suggest that the loss of function in patients with spinal muscular atrophy might be explained by a process other than cell death that allows patient strength to be maintained and simultaneously prevents the motor unit from achieving its normal adult potential.


Lead neurotoxicity and disorders of learning.

Preventable and treatable causes of disorders of learning caused by lead exposure can be recognized by heightened awareness of this potential hazard. The Centers for Disease Control using data from many studies of neurobehavioral effects of lead in children and animals, has redefined the lead exposure threshold for clinical and social intervention from 25 micrograms/dL to 10 micrograms/dL. This article reviews the pertinent studies that provide evidence of the effects of lead exposure on development of the nervous system, effects on neural structures involved in memory and learning, and the impact of early lead encephalopathy on adolescent and adult learning skills and cognitive performance. Physicians, teachers, and child care personnel are responsible for identifying children with behavioral signs of subclinical lead intoxication as early as possible. Screening programs and preventive strategies, such as the multitier Centers for Disease Control approach referred to in this article, are necessary. It is no longer reasonable to assume that lead-exposure children not demonstrating severe encephalopathy will recover completely, without residual brain damage after removal from exposure. Sufficient evidence now exists to clearly demonstrate measurable effects of low levels of lead body burden on behavioral and intellectual performance, resulting in learning disorders.


Atypical presentations of spinal cord tumors in children.

Pain is a frequent presenting symptom of spinal cord tumors in children and usually manifests as local spinal pain in the bony segments overlying the tumor. Two pediatric patients are presented in whom the diagnosis of intramedullary spinal cord tumors was delayed for many months because their pain was atypical. One had recurrent abdominal pain diagnosed as irritable bowel syndrome. The other had very abrupt paroxysmal but infrequent attacks of arm pain and no neurologic abnormalities. Possible mechanisms of their pain, as well as the other features that might have suggested the diagnosis, are discussed.


Nonprogressive type II hereditary sensory autonomic neuropathy: a homogeneous clinicopathologic entity.

Two different clinical subtypes were previously identified within hereditary sensory autonomic neuropathy (HSAN) type II: a stable congenital form and a progressive one. This paper discusses two clinicopathologic cases of nonprogressive HSAN type II with morphometric correlations. In addition, a retrospective literature search was carried out to locate other cases where an accurate histologic examination, including ultrastructural features, was available in order to relate clinical and pathologic aspects of the disease. The combined data support the individualization of this neuropathic form as a homogeneous disease, as has been suggested during the last century and underline the clinical importance of this concept for the prognosis and investigation of sensory, auditory, autonomic, and motor functions in children with sensory neuropathies.


Abnormal magnetic resonance images in hemorrhagic shock and encephalopathy syndrome.

Hemorrhagic shock and encephalopathy syndrome is an acute childhood illness that involves the rapid onset of multisystem failure, including central nervous system, renal, cardiovascular, hepatic, and hematologic dysfunction, and often leads to death or serious neurologic damage. We report the first case of a child with hemorrhagic shock and encephalopathy in which magnetic resonance imaging was used to define the cortical hemorrhagic involvement.


Emotional adjustment of children with hydrocephalus and of their parents.

Emotional and behavioral adjustment after infantile hydrocephalus were investigated. Children's and parents' adjustments were assessed by means of questionnaires (PIC-R, SCL-90-R) in a sample of 48 children with shunted hydrocephalus. The PIC-R patterns of the children were mostly reflective of their anomalous physical and cognitive development, but there was no evidence for a specific "hydrocephalic personality" pattern. Discriminant analyses revealed that there were no strong relationships between distress of the parents (as assessed by the SCL-90-R) and a variety of physical and psychosocial variables, despite the fact that many parents were significantly distressed. It was concluded that the majority of children with hydrocephalus do not present with a specific psychiatric profile, that clinically significant levels of distress are quite common in their parents, and that such distress is typically not related to the hydrocephalus per se.


Predictive value of electromyography in diagnosis and prognosis of the hypotonic infant.

To investigate the diagnostic validity of electromyography in the hypotonic infant, 79 children aged 0 to 12 months, seen over a 20-year period, were studied retrospectively. The diagnoses using clinical, muscle biopsy, and laboratory characteristics were: 25 central hypotonia, 20 spinal muscular atrophy, 20 myopathy, four myotonic dystrophy, four benign congenital hypotonia, two congenital muscular dystrophy, two myasthenia gravis, one infantile inflammatory myopathy, and one arthrogryposis multiplex congenita. Using strict criteria, electromyography accurately predicted the final diagnosis in 65% of infants with spinal muscular atrophy and was consistent with the diagnosis in another 25%. In contrast, electromyography accurately predicted the final diagnosis in only 10% of infants with myopathy and was normal in 88% of infants with central hypotonia. In infants with spinal muscular atrophy, there was no difference in the predictive value of electromyography when performed in the newborn compared to older infants. Normal distal nerve conduction velocities in infants with spinal muscular atrophy may predict prognosis, since these infants had a longer survival. Electromyography thus has a high predictive value for infantile spinal muscular atrophy but not for myopathy.


Rostral transfontanel herniation.

Upward transtentorial herniation as a result of mass effect in the posterior fossa has been described in adults by several authors. We report the case of a premature infant, small for gestational age, who experienced rostral herniation of a portion of frontal lobe through the anterior fontanel as the result of a hemorrhagic cerebellar infarction followed by a large parieto-occipital intracerebral hemorrhage.


Clinical imitators of infantile spasms.

We report 53 infants who by clinical history were thought to have infantile spasms but who video-electroencephalograms showed were having other episodes that closely mimicked infantile spasms. Nine patients had other types of seizures. Forty-five patients had episodic symptoms that were not seizures: 11 patients had spasticity, four had gastroesophageal reflux, and the other patients had nonepileptic myoclonus, including 19 patients with benign neonatal sleep myoclonus. Three patients had more than one type of symptom. Infantile spasms imitators occurred in neurologically normal or abnormal infants, in patients with normal or abnormal interictal electroencephalograms, and in patients who also had previous or current infantile spasms. Differentiation of these episodes from infantile spasms prevented the initiation or continuation of anticonvulsant treatment appropriate for infantile spasms but inappropriate for these other behaviors.


An index for proportion of head size to body mass during infancy.

The index "head circumference (cm)3/body weight (g)" gave an almost constant average (about 10) and standard deviation (about 1) in more than 2000 children at birth and at 4, 10, and 18 months. Application of this index to the data previously published confirms that the average is almost constant throughout the period from birth to 18 months, irrespective of sex or race. Head circumference cubed and body weight correlate significantly. This index seems to be useful to assess the proportion of head size to body mass during infancy, and to contribute to early diagnosis of diseases such as hydrocephalus or microcephaly.


Alterations of urinary acetylcarnitine in valproate-treated rats: the effect of L-carnitine supplementation.

Urinary excretion of acetylcarnitine was measured by high-performance liquid chromatography in two experimental groups of valproate-treated rats. In the urine of mature rats weighing 180 to 200 g treated with valproate (500 mg/kg/day), acetylcarnitine levels were higher than those in controls on days 4 and 7, while L-carnitine-supplemented rats showed lower levels than the valproate group. The valproate-treated rats showed an increased acetylcarnitine/acylcarnitine ratio on and after day 4, while the L-carnitine-supplemented rats showed no significant change compared to the controls on any days. In the urine of immature rats weighing 80 to 90 g treated with valproate (50 mg/kg/day), acetylcarnitine levels were increased after the 14th day of treatment. These results suggest that an increase in urinary acetylcarnitine occurs when small doses of valproate are administered for a longer time. We speculate that increased acetylcarnitine is not a product of beta-oxidation in mitochondria, because L-carnitine supplementation decreases the acetylcarnitine levels. Although the mechanism of acetylcarnitine excretion during valproate administration is not clear, L-carnitine supplementation is effective in decreasing the level of urinary acetylcarnitine and keeping the acetylcarnitine/acylcarnitine ratio normal.


Functional interhemispheric asymmetries at birth as demonstrated by somatosensory evoked potentials.

Functional cerebral hemispheric asymmetries detectable at birth have been suggested by a number of neuroanatomic, neuroradiologic, and clinical neurophysiologic modalities. The aim of this study was to determine whether functional interhemispheric asymmetries can be identified using electrophysiologic measures. As part of a prospective study, somatosensory evoked potentials following median nerve stimulation were recorded in nine healthy full-term newborns on day 2 or 3 of life, and somatosensory evoked potentials were repeated at 2 and 6 months of age. These children were subsequently examined at 1 and 3 years of age by a pediatric neurologist and all had normal examinations. Handedness was determined at 3 years by questioning the parent and by clinical observation. Three of nine were left-handers. All three left-handers had clearly identifiable neonatal N19 parietal potentials over the right hemisphere. Following right median nerve stimulation, contralateral parietal potentials were absent on two of the three and questionable in the third. Asymmetries were not clearly present in right-handers although only one showed an increased maturation of the right hemisphere relative to the left. At 2 months of age, interhemispheric differences were no longer clearly evident. This data suggests that preferential hemispheric asymmetries are masked by 2 months of age. This differential rate of development demonstrated by neonatal somatosensory evoked potentials may be an early indicator of ultimate handedness.


Magnetic resonance imaging evaluation of delayed myelination in Down syndrome: a case report and review of the literature.

Magnetic resonance imaging has been found to be useful in assessing brain myelination and provides information on brain maturation. The normal pattern of brain myelination conforms to a fixed sequence, with good pathologic and MRI correlation. Neuropathologic analysis of myelination has shown delayed central myelination in Down syndrome. Delayed myelination on MRI in Down syndrome has not previously been reported. We report a case of Down syndrome with a significant delay in myelination as demonstrated on MRI. This 18-month-old infant had brain myelination equivalent to that expected for an 11-month-old infant. To determine the relative incidence, extent of delayed myelination, and time for recovery to full myelination in Down syndrome, more cases require examination and assessment. Magnetic resonance imaging has the advantage of serial assessment of myelination during brain maturation.


A note on the occurrence of unusual electroencephalographic sleep patterns in selected normal children.

Polysomnographic recordings were performed in 50 children free from any familial or personal history of seizure or neurologic diseases to evaluate the frequency of epileptiform and unusual electroencephalographic patterns in a normal population. A 9-year-old boy exhibited focal spikes that became bilateral with a density of 24% to 32% during slow wave sleep, and another boy showed a few spikes during slow wave sleep. In seven cases, 14- and 6-Hz rhythms were recorded, mostly in rapid eye movement sleep. A right rhythmic and temporal discharge was observed in one girl. Epileptiform electroencephalographic patterns are not infrequent, and 14- and 6-Hz rhythms during rapid eye movement sleep are common in normal children.


Occipital encephalocele associated with a dermoid cyst.

The case of a neonate with a dermoid cyst originating within an occipital encephalocele is reported. The finding of the tumor was made during the routine repair of the meningoencephalocele. To our knowledge this is the first time that this association has been described.


The mouse as a suitable host for an isolate of Schistosoma haematobium from Niger.

The host-parasite relationships of a Schistosoma haematobium isolate, originating from Niger, and the white mouse are described. Swiss OF1 albino mice were exposed individually to 200 cercariae and worms were recovered 9, 12, 16 and 20 weeks post infection. The mean worm returns ranged between 10.54 and 13.05% and did not alter significantly between 9 and 20 weeks post infection. The sex ratio of worms was always in favour of males; from 7.09:1 at 9 weeks after infection it decreased regularly to 3.28:1 at 20 weeks. Male worms reached a mean length of 8.72 mm at 20 weeks. From the 12th week post infection, a high number of eggs was found in the liver and gut. At 20 weeks, eggs were also found in the bladder. Viable eggs and infective miracidia were obtained. The infection of Bulinus truncatus from Niger succeeded with a mean rate of 61% after the first passage through mice. The isolate of S. haematobium was maintained in the laboratory during 3 successive passages through mice. These entirely new results are very probably linked to genetic characteristics peculiar to the S. haematobium populations from Niger.


On the biological and biochemical nature of cloned populations of Strongyloides ratti.

Seven geographically varied isolates of Strongyloides ratti were cloned. Each clone was examined for the degree of homogonic development of the free-living generation and by enzyme electrophoresis. Considerable variation was found between the clones in the degree of development that was homogonic. In contrast, the clones were indistinguishable by enzyme electrophoresis.


Life cycle of Gnathostoma nipponicum Yamaguti, 1941.

The life cycle of Gnathostoma nipponicum was examined by field survey and by experimental infection of animals with the larvae. Naturally infected larval G. nipponicum were found in loaches, catfish, and snakes. Experimentally, loaches, killifishes, frogs, salamanders, mice, and rats were successfully infected with the early third-stage larvae of G. nipponicum obtained from copepods (the first intermediate host), whereas snakes, quails, and weasels were not. Frogs, snakes, quails, and rats were experimentally infected with the advanced third-stage larvae (AdL3) from loaches. These results reveal that some species of fishes, amphibians and mammals can act as the second intermediate host and that some species of reptiles, birds and mammals can act as a paratenic host. The life cycle was completed in weasels, the definitive host, which were infected with AdL3 from loaches and started to evacuate eggs of G. nipponicun in faeces on days 65-90 postinfection.


Seasonal variation in the prevalence and intensity of canine Gnathostoma spinigerum infection in northeastern Thailand.

Gnathostoma spinigerum was found in gastric nodules in 4.1% of 2940 dogs surveyed in northeastern Thailand. The prevalence and worm burden of G. spinigerum exhibited a seasonal fluctuation. The parasites were more abundant in the rainy season and the early winter (August-December) than in the summer (April-March). Most parasites were sexually mature between August and December while immature worms were observed during March and April. The distribution of gnathostomes within the sampled dogs was highly dispersed and few animals were found to harbour more than five worms.


Seroprevalence of Toxocara canis antibodies in humans in northern Jordan.

Sera of 699 individuals, aged between 5-24 years, from the Irbid area, Jordan, were tested for Toxocara canis antibodies using an ELISA-IgG test. Crude prevalence was 10.9% (76 of 699) but age-adjusted prevalence was 14.3%. The highest prevalence was observed in females aged 5-9 years, 23.3% (7 of 30), and males of 15-19 years of age, 19.5% (16 of 82). The lowest prevalence was observed in females aged 20-25 years, 5.2% (8 of 155). Significant differences (P < 0.05) between the prevalences of the toxocaral antibodies in males and females were observed in the age groups 5-9, 15-19 and 20-24 years. The trend of prevalence in relation to age was different according to sex.


Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991.

Analyze changes that have occurred among U.S. hospitals over a 17-year period, 1975 through 1991, in the percentage of Staphylococcus aureus resistant to beta-lactam antibiotics and associated with nosocomial infections. Retrospective review. The percentage of methicillin-resistant S aureus (MRSA) was defined as the number of S aureus isolates resistant to either methicillin, oxacillin, or nafcillin divided by the total number of S aureus isolates for which methicillin, oxacillin, or nafcillin susceptibility test results were reported to the National Nosocomial Infections Surveillance (NNIS) System. NNIS System hospitals. Of the 66,132 S aureus isolates that were tested for susceptibility to methicillin, oxacillin, or nafcillin during 1975 through 1991, 6,986 (11%) were resistant to methicillin, oxacillin, or nafcillin. The percentage MRSA among all hospitals rose from 2.4% in 1975 to 29% in 1991, but the rate of increase differed significantly among 3 bed-size categories: < 200 beds, 200 to 499 beds, and > or = 500 beds. In 1991, for hospitals with < 200 beds, 14.9% of S aureus isolates were MRSA; for hospitals with 200 to 499 beds, 20.3% were MRSA; and for hospitals with > or = 500 beds, 38.3% were MRSA. The percentage MRSA in each of the bed-size categories rose above 5% at different times: in 1983, for hospitals with > or = 500 beds; in 1985, for hospitals with 200 to 499 beds; and in 1987, for hospitals with < 200 beds. This study suggests that hospitals of all sizes are facing the problem of MRSA, the problem appears to be increasing regardless of hospital size, and control measures advocated for MRSA appear to require re-evaluation. Further study of MRSA in hospitals would benefit our understanding of this costly pathogen.


A comparison of clinical virulence of nosocomially acquired methicillin-resistant and methicillin-sensitive Staphylococcus aureus infections in a university hospital.

To compare the clinical virulence of nosocomially acquired methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) infections in 1989. A retrospective comparison of host factors, in-hospital exposures, sites of infections, and outcomes of patients with nosocomial MRSA and MSSA infections. University of Illinois Hospital, Chicago, Illinois. Forty-four adult patients with nosocomial S aureus infections. The 22 MRSA-infected and 22 MSSA-infected persons were similar regarding mean age, gender, underlying diseases, and exposure to surgery. Before developing infection, MRSA-infected persons were more likely to have received antibiotics (73% compared with 27%, odds ratio = 7.1, 95% confidence interval [CI95] = 2.0-25.8 p = .003) and to have stayed in the hospital > 2 weeks (64% compared with 18%, odds ratio = 7.9, CI95 = 2.0-31.6, p = .002). Bacteremia was the most common presentation in the MRSA and MSSA groups (55% and 59%, respectively). Infectious complications and death were infrequent in both groups. MRSA and MSSA strains infect patients with similar demographic features and underlying diseases, but MRSA infections are significantly more common among patients with previous antibiotic therapy and a prolonged preinfection hospital stay. Clinical presentations and outcomes did not differ significantly between the 2 groups. Thus, similar to studies in the early 1980s, our findings do not suggest greater intrinsic virulence of MRSA.


Investigation of a computer virus outbreak in the pharmacy of a tertiary care teaching hospital.

A computer virus outbreak was recognized, verified, defined, investigated, and controlled using an infection control approach. The pathogenesis and epidemiology of computer virus infection are reviewed. Case-control study. Pharmacy of a tertiary care teaching institution. On October 28, 1991, 2 personal computers in the drug information center manifested symptoms consistent with the "Jerusalem" virus infection. The same day, a departmental personal computer began playing "Yankee Doodle," a sign of "Doodle" virus infection. An investigation of all departmental personal computers identified the "Stoned" virus in an additional personal computer. Controls were functioning virus-free personal computers within the department. Cases were associated with users who brought diskettes from outside the department (5/5 cases versus 5/13 controls, p = .04) and with College of Pharmacy student users (3/5 cases versus 0/13 controls, p = .012). The detection of a virus-infected diskette or personal computer was associated with the number of 5 1/4-inch diskettes in the files of personal computers, a surrogate for rate of media exchange (mean = 17.4 versus 152.5, p = .018, Wilcoxon rank sum test). After education of departmental personal computer users regarding appropriate computer hygiene and installation of virus protection software, no further spread of personal computer viruses occurred, although 2 additional Stoned-infected and 1 Jerusalem-infected diskettes were detected. We recommend that virus detection software be installed on personal computers where the interchange of diskettes among computers is necessary, that write-protect tabs be placed on all program master diskettes and data diskettes where data are being read and not written, that in the event of a computer virus outbreak, all available diskettes be quarantined and scanned by virus detection software, and to facilitate quarantine and scanning in an outbreak, that diskettes be stored in organized files.


6-H3 thymidine uptake in the central nervous system of newt following lesion and cold shock.

The uptake of 6-H3 thymidine in the optic tectum and the forebrain of the newt following injury to one of the two nervous areas, shows a marked proliferative response in the telencephalon in the presence of a lesion on the right optic tectum, and a poor response of the optic tectum after a lesion on the right telencephalic lobe. A similar proliferative response is also obtained when the specimens received only the cold shock. In both experimental conditions maximum uptake is obtained after 7 days. It is assumed that the matrix cells of the forebrain and the undifferentiated cells of the optic tectum respond differently to the regeneration factor released by the nervous tissue following a lesion or a cold shock.


Endocytotic activity of the presynaptic membrane and the morphometric differences of cortical synapses during the excitability changes in the initial phases of kindling.

Cortical sensorimotor areas of the laboratory rats was repeatedly stimulated at 10 min intervals. It led to progressive lengthening of the self-sustained after discharges (SSAD). Ten minutes after termination of the third SSAD the synapses of type I were examined. The ten minutes interval corresponds in electrophysiological experiments with a marked increase of excitability of the investigated cortical area. At the some time, it coincides with the intensification of endocytotic activity on the presynaptic membrane, and with an increase of complex and dense-core vesicles. The exocytotic activity was not changed. The area of the presynaptic elements increased together with their perimeter and maximal diameter. Mitochondria within the presynaptic bags had larger section area. Also the postsynaptic elements became larger, their section area, perimeter and maximal diameter increased. We consider the theory of presynaptic membrane recycling, ion permeability changes, activity of proteosynthesis and the role of contractile proteins during the repeated hyperfunction.


Pineal "synaptic" ribbons evolution over a 24 hour period during two different photoluminous seasons, a comparative and statistical analysis.

A comparative statistical analysis of "synaptic ribbons" evolution over a 24 hour period during two different photoluminous seasons (September, and winter) is carried out. Seventy male rats were used. Statistical analysis involved the Kolmogorov-Smirnov test, variance analysis, the Student t-test and Pearson's correlation test. The results show that "synaptic ribbons" evolve during the circadian phase and through two different seasons, with a clear and marked influence of point-time (p < 0.0001) and season (p < 0.0001).


Effect of gamma butyrolactone on the hypothalamo-neurohypophyseal system of the gerbil brain after ischemic injury.

The effect of exogenous gamma butyrolactone (GBL) on hypothalamo-neurohypophyseal system of the gerbil brain after ischemic injury was studied by electron microscopy. It was mentioned that GBL hasn't a protective action against ischemically induced injury. We postulate that neurosecretory process is slightly disturbed as a result of irreversible damage of some tissue elements; neurons of supraoptic and paraventricular nuclei, glial cells and axonal endings in neurohypophysis.


Do dentate area transplants take the function of damaged dentate area neurons in the rat brain after having replaced them?

Colchicine eliminates selectively dentata area granular cells after topical microinjections. In rats treated this way it was impossible to evoke field potentials by perforant parth stimulation and the animals were unable to learn if perforant path stimulation was used as conditioned signal. After colchicine lesion neonatal dentate area tissue was grafted into the lesioned region. Between 4 and 10 weeks after grafting it was again possible to evoke potentials after perforant path stimulation and the rats were able to learn, whereas colchicine-treated rats without grafts failed. The histological investigation showed well on grown neurons within the grafts. The grafts were well integrated. It was shown that the mossy fibers from the grafts innervated the deserted CA3 sector, and that the grafted neurons were innervated by nervous fibers from the recipient brain. It can be supposed that the granular cells from the grafts were able to taken the function of the damaged granular cells of the colchicine treated dentate area.


Nerve cell rearrangement in neocortical layers of MAM treated foetal mice.

In this study we examined the changes in cortical layers when Methylazoxymethanol-acetate (MAM) was injected on 13th, 15th and 17th day of gestation (MAM13, MAM15, MAM17). Prenatal MAM administration prevents neuron precursor proliferation; the subsequent cell number decrease is followed by an increase in size of surviving cells. When MAM was injected on 13th or 15th day of gestation the significant decrease in cell density, in II and III zone (MAM13) and in the upper layers (MAM15), was compensated by a proportional increase in cell size and synaptic density. When MAM was injected on 17th embryonal day it did not cause a significant change in the neuron density and soma size was not altered while the distribution of cell size among layers showed significant differences with respect to the controls. Our findings of some area and synaptic density show that the cell surface increase is proportional to the decrease in cell number and that in the surviving cells there is a rearrangement in synaptic connections that compensate for the cellular density decrease.


Unusual glial cells in sensory ganglia.

Unusual glial cells not related with perikarya or fibres were observed with the electron microscope in dorsal root spinal ganglia. These interstitial cells were very electron dense, with big and irregularly shaped nucleus and scanty organelles. They occurred immersed in the endoneurial space tissue, with no basal lamina and presented no contacts with other cells. In addition to these interstitial cells present both in kittens and adult cats, younger kitten sensory ganglia contained refringent glial cells.