Obstetrics and childbirth at the Aitape Health Centre, Papua New Guinea.

Routinely collected obstetric data at the Aitape Health Centre, Papua New Guinea over the years 1986, 1988 and 1989 were analyzed and compared with figures from western New Guinea of about thirty years ago and with those of rural African hospitals. Data from 924 deliveries were analyzed. 30% were born before arrival (BBA). The number of abnormal deliveries was high. This was in part due to the high frequency of twin births (4.5%). Among the BBAs puerperal sepsis and stillbirth were significantly higher than among those who delivered in the health centre. The stillbirth frequency was 3.4%. The sex ratio male:female at birth was 120.9. The large number of retained placentae with manual removal (5.2%) was related to high parity; 33.5% of the women delivering at the health centre were para-4 or more. 20% of male and 24% of female newborns had low birthweight (less than 2500g).


[Effect of phases of unemployment on amount of pension--a micro-economic long-term analysis].

"What effect has the latest German pension reform on the future pension payments of individuals who experienced unemployment during their working life?" is the main question raised by this article. Model calculations show an income reduction of just over 2%, assuming 3 years of unemployment and 4 years of uninsured interruption caused by other factors. There by, the pension is certainly not in jeopardy. A comparison of different legal regulations of the past 3 decades shows, however, that the latest reform leads to the most substantial reductions.


The development of rural laboratory services in Papua New Guinea.

The health service of Papua New Guinea is targeted at village level primary health care, through aid posts and health centres. There is an increasing demand for providing these facilities with basic diagnostic laboratory services at the health centre level. To accomplish this, an inservice training program has been established to train existing health workers in specific laboratory skills. A management support scheme has also been instigated to ensure that the most effective use is made of these laboratory-trained staff. This has created a team of rural laboratory workers to support the clinical management of patients in rural locations throughout Papua New Guinea.


[Minimal monetary insurance for the elderly--systematic overview of current regulations and recommendations for an alternative model].

This contribution adds to the intensive discussion about a suitable reform of the German old-age security system with regard to the aim of poverty avoidance. Starting from a multitude of existing and alternatively proposed models, basic forms of a minimum-income protection for the elderly are distinguished by select criteria. The resulting systematic survey is intended as a basis for comparative analyses of economic effects. The results could substantially support the necessary political decision-making process.


[Effects of the survivor and dependent children law on social security of widows and widowers and distribution of pensions].

The article takes up the discussion about the individual social security of spouses in Germany and describes some effects of German legislation which went into effect in 1986 and regulates the social security of surviving dependents and requires declaration of child-care provision by pensioners (the so-called "Hinterbliebenen- und Erziehungszeitengesetz"). The primary question is, what effect the most current family income has on the individual replacement rate for widows and widowers. What additional information is needed to record the distributional effects of the act is also discussed.


A quality assurance for rural laboratories: a report on a trial distribution in Momase Region, Papua New Guinea.

The strengthening of laboratory services in rural health centres is an important component of the Papua New Guinea National Health Plan. As part of the management support scheme for these services a National Quality Assurance Scheme has been formulated to monitor their technical performance. A trial distribution of quality assurance specimens to 44 laboratories in the Momase Region was met with enthusiastic response and encouraging results. The trial will be used as a model for a nation-wide distribution.


Scuba tanks as a compressed air source in positive-pressure ventilation.

Throughout the developing world there is a general problem of ensuring regular deliveries of medical supplies to hospitals. This includes the supply of compressed gases. At one regional hospital in Vanuatu, we were faced with the problem of how to provide economically a source of compressed gas at regulated pressure to drive an anaesthetic ventilator. We eventually adapted the output from a Scuba cylinder for this purpose. This paper describes the simple modifications necessary and suggests other uses for this source of compressed air that could be implemented in hospitals with small to medium case loads and access to a diving compressor.


Prevalence of anaemia and iron deficiency at different levels of urbanization in Vanuatu.

Mean haemoglobin and plasma iron levels and prevalences of anaemia and iron deficiency were determined in three population samples of Vanuatuans aged 20 or more years as part of a noncommunicable diseases survey in 1985. The three samples were drawn from separate urban, semirural and rural populations. Age-adjusted mean haemoglobin levels were highest in the urban sample and lowest in the rural sample, and plasma iron levels were highest in the urban sample and lowest in the semirural sample. Mean values in each location were generally higher in male subjects than in nonpregnant female subjects. The overall prevalence of anaemia was 10.1% in nonpregnant female subjects and 5.3% in male subjects by World Health Organization (WHO) definitions. These prevalences are lower than those reported for most other developing countries, including some Pacific island nations. Iron deficiency was more prevalent in females than in males (females 17.2%; males 5.0%). Approximately 40% of anaemic subjects were also iron deficient, and there was a significant positive correlation of plasma iron levels with haemoglobin concentration. This suggests that haemoglobinopathies may not be a major cause of anaemia as previously reported. Although most anaemic subjects (88%) had only mild anaemia, in view of the physical lifestyle of rural and semirural Vanuatuans it would be important to optimize haemoglobin levels in these populations.


Skin infections in Tanna, Vanuatu in 1989.

Skin infections are an important health problem in Vanuatu and other Pacific island countries. In this study, 18,223 people, representing 90% of the population of the southern island of Tanna in Vanuatu, were examined. Scabies was found in 16% of those screened, with 24% of children under 10 years affected. Other skin infections were predominantly furuncles, abscesses, impetigo and cellulitis and were found in 12% overall and in 16% of children under 10 years of age. These infections were found to be more common in larger households and in the vicinity of the volcano Yasur. Strategies for prevention and management of skin infections in Vanuatu are discussed.


Age at menarche and associated nutritional status variables in Karimui and Daribi census divisions of Simbu Province.

Age at menarche was estimated from data on 310 girls and young women living in Karimui and Daribi census divisions of Simbu Province in 1987. The area has high malnutrition rates among children under five years of age and short adult female stature suggesting that onset of menses should be late. However, other work has shown young ages at the birth of first children and high overall fertility rates among women. The prediction of age at menarche from adult female height is not valid for this population; the actual age at which 50% of girls had commenced menstruating is approximately one and a half years earlier, at 15.8 years, than the predicted age. The nutritional status variables investigated and found to be associated with the age at menarche are height, weight and triceps skinfold thickness. At any given age girls whose nutritional status was better, particularly in terms of weight, were more likely to have commenced menstruation. Menarche appears to be followed closely by onset of reproductive function, with the age at the birth of first children estimated at 17.2 years. A consequence of early entry into reproduction, particularly for girls in areas where undernutrition is common, is a period of considerable nutritional stress during adolescence. Intervention programs should consider this and target these groups for additional health, family planning and nutritional advice.


Compliance profiles of paediatric patients in an outpatient department.

A cross-sectional study was carried out in paediatric patients with acute illnesses attending an outpatient clinic at Angau Memorial Hospital, Lae. The aim of the study was to estimate the level of compliance to previously prescribed medication. 45 sick children were included in this study. Their parents or guardians were interviewed and their health record books carefully examined for details of prescribed and administered medication. Poor compliance to prescribed medication was observed in 38% of cases. A number of reasons for the poor compliance were documented. In a second, closely related study designed to determine the reliability of oral medicine ingestion, 348 children were enlisted. In 7% of them oral medicine ingestion was not satisfactory. These results emphasize the need to carefully consider each sick child individually, especially with regard to optimizing compliance, whenever drugs are prescribed.


[Stability of shy-anxious-inhibited behavior in kindergarten children].

The stability of internalizing disorders was studied over a period of 15 months in a sample of three- to five-year-old children attending preschool (N = 280). Stability coefficients for shyness/inhibition (rT1-T2 = .65/.77), oversensitivity (rT1-T2 = .49/.69) and dependency (rT1-T2 = .43/.64) showed a high to moderate (normative) continuity during this stage of development. There were no sex differences but there were significant age variations: The stability of shyness/inhibition was about twice as high in the oldest cohort as in the youngest age group. Persistence of internalizing behavior dimensions was much stronger in a withdrawn-aggressive group than in a withdrawn-nonaggressive group. Peer status had some predictive utility, but for the sample as a whole there was only a low correlation between sociometric variables (T1) and internalizing scores (T2); the level of correlation was strongly dependent on the children's age and sex.


[Clinical and cytogenetic problems in diagnosis of fragile X syndrome].

The fragile X or Martin-Bell syndrome is the second most common chromosomal cause of mental retardation. It has a prevalence of 1:1000; the clinical and psychopathologic symptoms vary. The difficult diagnosis rests on cytogenetic evidence of the fragile site at Xq 27.3. 18 patients were tested for fragile X syndrome in 4 different laboratories. Of the 32 chromosomal analyses performed 17 were positive and 15 negative. In 11 patients 2 or more analyses were performed in different laboratories for verification. In all 11 cases the findings were discrepant and therefore the initial findings were considered false positive. The clinical and cytogenetic problems are discussed and diagnostic guidelines summarized.


[Periodic psychosis in adolescence].

In view of the fact that in the early part of this century Emil Kraepelin clearly described the relationship between psychotic episodes and the menstrual cycle it is surprising that the scientific elucidation of the phenomenon as a primary endocrine disorder came only decades later. Furthermore, the German literature has paid little attention to the problem, which was given the name "periodic psychosis of puberty" in 1963. In this article an overview of the literature is given, the symptoms and course of the disorder are described and two cases are reported. The course appears to be variable. There can be spontaneous remission after a variable length of time but also a transition into other forms of psychosis. The treatment is pharmacological.


[The effect of life change events on cognitive and socio-emotional development in early childhood].

The present study investigates the role of life events of differing durations in the cognitive and social-emotional development of infants. A total of 354 children were examined at the ages of 3 and 24 months and the children's parents were interviewed about the occurrence of live events in this interval. The total number of life events was a significant predictor of changes in the level of cognitive and social-emotional functioning. Changes in the caregiver and marital discord were the best predictors of a child's social-emotional development, and serious illness in the child and changes in the caregiver were the best predictors of a child's cognitive development.


[Adaptation of the Kaufman Assessment Battery for Children for German- speaking areas. Part 1: Introduction of the battery].

The German version of the K-ABC is an adaptation of Alan and Nadeen Kaufman's test, published in the USA in 1983. The battery comprises a total of 16 subtests, organized in different scales, for the assessment of mental processing and achievement in children in the age range of 2-6 to 12-5 years. The underlying theory of intelligence measurement is based on findings in the fields of cognitive psychology and neuropsychology. It differentiates from sequential simultaneous information processing. The present article provides information about adaptation and structure of the German version, and about the standardization performed with a sample of 3098 children. Part 2 of this article, to appear soon, will survey application of the test battery, diagnostic relevance, and reliability and validity scores.


[Specific developmental disorders and the family--pathogenetic factors in children with behavioral disorders].

121 children aged 5;6 to 8;6 years referred to our center as out-patients because of various types of behavioral problems and showing distinct symptoms of minor neurological dysfunction were investigated with regard to family-related variables, specific developmental disorders, and the extent of the behavioral problems. A comparison of the groups with few and numerous behavioral problems showed a significant difference in the number of familial risk factors, but not in the degree of neurological and cognitive dysfunction. These results indicate the importance of child-independent familial factors, e.g. marital problems and psychosocial stress, in the pathogenesis of behavioral disturbances in children with minor neurological dysfunction. The resulting need for a family-oriented perspective in assessment and therapy is discussed.


Comparison of two media for the isolation of thermophilic Campylobacters from waste waters of different quality.

Counts of thermophilic campylobacters from 31 different waste water samples were parallel estimated with two different cultivation media. The resulting increased isolation sale obtained with an modified Charcoal-Cefoperazone-Deoxycholat-Medium (MCCD-Medium), was statistically significant. An 15.8 fold increased isolation rate, compared with the standard medium, could be estimated with the help of the geometric mean.


[The occurrence of Campylobacter in a mountain brook].

The mountain river showed fecal water pollution at all sample sites studied. The arithmetic mean values of total coliforms ranged between 28 and 196/ml. Campylobacters were isolated from all sample sites studied, with a maximum value of 1,100 Campylobacter/100 ml river water. The MCCD-medium resulted in significantly higher isolation rates of Campylobacter from water samples than the VTPRC-medium compared. Colony counts, total coliforms and Campylobacter showed numerical relations of 3831:100:1 respectively.


Microbiological research on soft drinks: discolouring of natural-flavoured products.

The results of experiments testing the effects of yeasts, sunlight, and temperature on the food dyes tartrazine, ponceau 4R, indigotin and azorubin (used for colouring ginger soft drink) are reported. Light was found to exert a greater influence than heat, and yeasts growth hastened colour degradation. Yeasts assimilated to varying extent the colouring compounds and, when failing to do it, showed a certain power of adsorption by the no longer viable cells.


Enzymatic production of alpha-aminoadipate-delta-semialdehyde and related compounds by lysine epsilon-dehydrogenase from Candida albicans.

L-Lysine epsilon-dehydrogenase [L-lysine:NADP+ oxidoreductase (epsilon-deaminating), EC 1.4.1.15] of Candida albicans was studied emphasizing its application for the production of alpha-aminoadipate-delta-semialdehyde and related compounds. A high enzyme level (240 pkat/mg of protein in the crude extract) could be attained during growth in the presence of L-lysine as sole nitrogen source. After optimization of the reaction conditions a partial purified enzyme (1.5 nkat/mg of protein) was used to produce alpha-aminoadipate-delta-semialdehyde, S-(beta-acetaldehyde)-cysteine, alpha-amino-delta-hydroxyadipate-semialdehyde and alpha-amino-gamma-hydroxyadipate-semialdehyde from the corresponding substrates lysine, S-(beta-aminoethyl)-cysteine, 5-hydroxylysine and 4-hydroxylysine, respectively. After purification of the compounds using Dowex 50 x 4 chromatography a yield of the products between 4.6 and 6.8% was achieved.


Antibacterial activity of N-[2-(dodecanoylmethylamine)ethyl]-alkyl dimethylammonium bromides.

The study contains the results of determination of antibacterial activity of the newly synthesized series of N-[2-(dodecanoylmethylamine)ethyl]-alkyldimethylammonium bromides. The efficiency of the compounds has been characterized towards three species of the genus Clostridium such as Clostridium perfringens, type A, Clostridium bifermentans, Clostridium sporogenes and one strain of the genus Lactobacillus such as Lactobacillus yamanashiensis. The antibacterial activity of the studied compounds has been tested in different time intervals. Out of seven investigated compounds, four compounds exerted the pronounced antibacterial activity on Clostridia (CMIC equals to 0.0039-0.0078 mmol/litre) and three compounds influenced the growth of Lactobacillus yamanashiensis (MIC equals to 0.004-0.006 mmol/litre). The most effective compound was found to be n-octyl derivative. These compounds were more effective towards the tested Clostridia strains than the comparing standard disinfectant such as Ajatin.


Production of ochratoxins by some Egyptian Aspergillus strains.

In all the investigated Aspergillus ochraceus and A. alliaceus strains the maximum quantities of ochratoxins produced on yeast extract-sucrose (YES) medium exceeded that detected on wheat solid medium except A. ochraceus 67. The shake cultures lowered ochratoxins formation. The maximum yields of ochratoxins did not coincide with maximum fungal growth. In most A. strains investigated, the total ochratoxin contents of the culture filtrates highly exceeded that of the mycelia.


[Osteoporosis from the gynecologic viewpoint].

Osteoporosis is a disease of the elderly characterized by a loss of bone mass causing fractures in presence of an inadequate trauma. Osteoporosis has to be considered as a significant ailment in our population. This review outlines epidemiology, pathogenesis and risk factors of primary osteoporosis. The physiological role of sex hormones, especially of estradiol, for the development and maintenance of skeletal bone mass is explained. Principles of preventive estrogen(-progesterone) application for the prophylaxis of postmenopausal osteoporosis are specified by several estrogen replacement studies in postmenopausal women. Individual replacement therapy for the compensation of a long-lasting estrogen deficit in the reproductive age group, in pre- and postmenopausal women is the assignment of the gynecologist in order to protect the skeletal system.


[Shoulder dystocia--a rare obstetrical complication].

Shoulder dystocia is an uncommon complication of delivery with a high neonatal morbidity rate. This review describes the use of the most important shoulder dystocia maneuvers and underlines the demand to perform a written description of all details of the management during delivery.


[Evaluation of the pulsatile curve of the placental blood flow profile by polynomial analysis].

The analysis of uterine and umbilical blood flow velocities using A/B ratio, resistance index and pulsatility index has shown to be a highly specific and sufficiently sensitive method in the evaluation of high risk pregnancies. In situations of high peripheral vascular resistance diastolic velocities are low and index values are high. Additional information of flow velocities curves, as diastolic notching, is not represented in the indices commonly used. A mathematical model was established using polynom analysis of blood flow velocity curves. In a group of 78 patients with intrauterine growth retardation polynome analysis of uteroplacental flow velocity curves was more sensitive than resistance index and pulsatility index.


[Clinical experiences with treatment of granulosa cell tumors].

Symptoms, tumor morphology and clinical course were reviewed in 15 cases of granulosa cell tumors of the ovaries. The main symptoms were irregular menstrual bleedings. In 2 cases were found signs of glandular cystic hyperplasia additionally and in one case an adenocarcinoma of the endometrium. The appropriate treatment was the hysterectomy with bilateral salpingo-oophorectomy performed in most of the cases, followed by additional irradiation and polychemotherapy in 4 cases each.


[New perspectives of in vitro kallikrein treatment. II. Study of the hamster ovum penetration test in relation to the kallikrein-kinin system].

A significant enhancement of the fertilizing capacity of human spermatozoa by Kallikrein has recently been described in a former study. To assess the therapeutic possibilities it would be of great interest to know more about the biochemical effect of Kallikrein on the fertilizing capacity of human spermatozoa. This fact made the authors investigate 64 semen samples in which the binding score and the fertilizing capacity were determined after application of Kallikrein in a HOP-test (hamsterovum-penetration-test) and compared to the control. Furthermore these results were compared to the varying concentrations of the components of the Kallikrein-Kinin-system. An application of Kallikrein in the swim-up preparation resulted in a higher motility in patients with asthenozoospermia, whereas the patients belonging to the group of oligoasthenozoospermia showed a lower progressive motility compared to the control. The binding score (number of affixed spermatozoa) showed nearly the results in both preparations. On the other hand the fertilizing capacity in the Kallikrein preparation was significantly higher. A possible connection with the concentrations of the components of seminal plasma has not been found, yet, but regarding all results a direct enzymatic effect of Kallikrein on fertilizing potential can be assumed.


[The prognostic value of the postcoital and post-insemination test].

Artificial inseminations with the semen of the husband (pre- and intracervical, intrauterine AIH) were carried out on 201 infertile women. Even though 41 women conceived on insemination, 16 of these and 38 of the unsuccessfully treated women actually became later pregnant without medical aid. An attempt to judge the eventual chances of success of AIH from the results of the PCT and PIT failed, as there was no correlation between the number and percentage of motile spermatozoa in cervical mucus post coitum and post inseminationem and the number of pregnancies. There was no clinical correlate for the differences observed between the results of the PCT and PIT.


[Rare metastasis of vulvar cancers].

A report is given on two rare cases of metastases of a primary vulvar carcinoma. One patient got metastases in the uterine cervix and axilla, the other had a local destructive process in the mandibula.


[Plasmid composition of Yersinia pestis strains from different natural foci].

The study of the plasmid composition of 246 Y. pestis strains from different natural foci in the USSR and other countries revealed that 173 strains (70%) carried three known plasmids with a molecular weight of about 6, 45-50 and 60 megadaltons (MD) respectively. In 20 strains (8%) obtained from different sources additional cryptic plasmids were detected. In some cases the absence of one or two typical plasmids was observed. Replicon pPst was shown to have quite constant molecular weight (6 MD), whereas plasmids pCad and especially pFra exhibited certain variations of their molecular weight (45-49 MD and 60-149 MD respectively) in strains of different origin.


[The LPS-protein complex from the outer membrane of Francisella tularensis].

LPS-protein complex containing proteins of 15 kD, 17 kD and 19 kD was isolated from F. tularensis outer membrane by solving with sodium deoxycholate with the subsequent gel filtration on Sephacryl S-200. Protein of 17 kD constituted the main protein component of the complex. The LPS-protein ratio of this complex was 1:1. Proteins contained in LPS-protein complex have mainly the alpha-spiral structure. In the absence of detergent these proteins and LPS formed micelles with molecular weight exceeding 10(7) D. LPS-protein complex was shown to have a protective effect in mice infected with F. tularensis virulent strain 503.


[Biological characteristics of strains of lactobacilli, promising for use as eubiotics].

In the course of in vitro studies 3 Lactobacillus strains with pronounced antagonistic activity against some pathogenic and opportunistic bacteria (shigellae, enteropathogenic Escherichia, Proteus, staphylococci) were selected. In experiments on germ-free rats faint colonization by L. plantarum 37 was observed in the small intestine, as well as in the large intestine when low doses of these bacilli were introduced into the gastrointestinal tract of the animals. In vitro experiments demonstrated the decreased growth rate of this strain. The prophylactic administration of two eubiotic strains, L. plantarum 37 and L. fermentum 39, simultaneously with chloramphenicol to primates inhibited the growth of opportunistic bacteria, though L. fermentum 39 excessively suppressed the content of Escherichia coli in the enterobacterial population. The optimum biological effect was achieved with the therapeutic use of these three strains for the correction of dysbiotic disturbances caused by the administration of tetracycline in volunteers.


[Intestinal microflora in young children with rotavirus infection].

A total of 270 children with rotavirus diarrhea were examined. The quantitative and qualitative composition of their intestinal microflora was studied. Most frequently microorganisms of the genus Enterobacter and most seldom, Serratia were isolated. A decrease in the amount of bifidobacteria, normal Escherichia coli and an increase in the amount of lactose-negative Escherichia were noted. In cases of pronounced dysbiosis in young children the clinical course of rotavirus infection is aggravated and the period of rotavirus excretion is prolonged.


[Studies of AIDS in Lithuania].

The seroepidemiological survey of 400,000 persons aged 20-40 years and belonging to different AIDS risk groups, as well as blood donors, for the presence of antibodies to HIV has been carried out on the territory of Lithuania. This investigation has been made with the use of the assay systems "Antigen", "Peptoscreen" and "Vector" manufactured in the USSR, as well as commercial assay systems from foreign manufacturers, such as Du Pont de Nemours Inc., Organon N. V., Abbott Laboratories, Serodia. The comparison of the results thus obtained has revealed that high frequency of false positive results is characteristic of all assay systems under study, including immunoblotting. These data indicate that test systems based on different acting principles should be used for the detection of anti-HIV antibodies. For the first time a HIV-infected resident of Lithuania has been detected. The investigation carried out in Lithuania has shown that HIV infection is not widely spread in this region, but due to some objective reasons this does not preclude the necessity of the constant epidemiological surveillance of this infection throughout this territory in order to bar the way to this infection.


[Epidemiological features of hospital purulent-septic infections in otolaryngological wards].

Prospective epidemiological observation in an otorhinolaryngological hospital has made it possible to distinguish the specific features of pyoseptic nosocomial infections. Such infections, appearing as cross re- and superinfections, are most frequently induced by staphylococci, as well as by Proteus and Pseudomonas aeruginosa. High risk groups include patients with purulent otitis and sinusitis, who have contacted infection through instruments in examination and dressing rooms. The main sources of infection are patients with pyoseptic infections of the ear and sinuses.


[Stability of bacterial aerosols in static conditions].

The influence of acid exopolysaccharides of some Pseudomonas species on the viability and fractional disperse composition of Salmonella marcescens-9 aerosol under static conditions has been studied. Acid exopolysaccharides have been shown to form membranes around bacteria. These membranes, due to their adsorptive and water-retaining properties, seemingly enhance the viability of bacteria in aerosol, both in the process of its generation and during its suspension in the air under static conditions with different values of relative humidity.


[Etiological structure of dysentery in the republic of Armenia].

In this work materials on the etiological structure of Shigella infections at different territories of Armenia are presented. Four Shigella species have been found to circulate in Armenia. The dominating etiological agent is S. flexneri with S. sonnei also playing an important role. The serological picture of S. flexneri is characterized by the prevalence of subserovar 2a.


[Epidemiological effectiveness of an inactivated three-component flu vaccine with an increased concentration of hemagglutinin in the inoculation dose].

The work presents the results of the evaluation of mass immunization of working adults with inactivated trivalent influenza vaccine under the conditions of an epidemic caused by influenza viruses A (H1N1), A (H3N2) and B. This immunization produced no effect on influenza morbidity in the groups of vaccinees in comparison with those of nonvaccinated persons. The index of effectiveness was 1.0 and less. The ineffectiveness of mass immunization was due to a high level of natural immunity to influenza and the extensive use of influenza vaccine in past years.


[Effect of regional (wound) revaccination with tetanus anatoxin on the functional activity of immunocompetent cells in the region].

The study made with the use of complex methods established that the local (wound) application of tetanus toxoid rapidly made the manifestation of the lysosomal apparatus more pronounced, increased the oxidizing activity (determined in the nitro blue tetrazolium test) and phagocytic activity of the mononuclear phagocytizing system in the wound and in the regional lymph nodes. The wound application of tetanus toxoid significantly increased blast transformation of T lymphocytes in guinea pigs simultaneously with tetanus wound infection. The study confirmed the pathogenetic expediency of the proposed method for the stimulation of anti-tetanus immunity by the application of tetanus toxoid on the wound which specifically inhibited the primary stage of the infectious process.


[Use of highly purified subvirion trivalent flue vaccine ("Grippovak") in groups with a high risk of complications].

During the epidemic season of 1989-1990 the subunit vaccine Grippovac was used in 20 asylums for old people and psychoneurological invalids in Moscow for the protection of the inhabitants and the personnel from influenza. Follow-up of the vaccinees during the period from November 1989 to March 1990 revealed that the use of this vaccine decreased the incidence of influenza-like diseases (ILD) 3.4-4.1 times among the vaccinees in comparison with that in the nonvaccinated control groups and significantly decreased the severity of the course of ILD, as well as the mortality because of ILD, among those vaccinees who had contacted ILD. This is indicative of good prospects of regular vaccinal prophylaxis of influenza at asylums for old people and other persons at a high risk of influenza complications.


[Use of commercial highly sensitive tests for detecting HbsAg in healthy persons].

The study has revealed the possibility of the contamination of serum with HBsAg under laboratory conditions during its treatment and preparation for analysis, which may be the cause of false positive results of HBsAg detection by the enzyme immunoassay (EIA). Excluding the factors of contamination, the authors demonstrate the efficacy of commercial systems, such as the passive hemagglutination test system "Gorky" and the EIA systems "Gorky" and "DIAplus", for the detection of HBsAg in the blood of donors in Moscow and Tashkent.


[Effect of mytilane, a bioglycan from the mussel Crenomytilus grayanus, on the course and outcome of experimental flu infection].

Materials characterizing the antiviral activity of Mytilane, manifested by the protection of 50-60% of mice infected with the lethal dose of influenza virus and by a decrease in the severity of pathological changes in the lungs of mice, are presented. The inhibiting activity of Mytilane with respect to the reproduction of influenza virus in vivo and in vitro under experimental conditions is demonstrated.


[Effect of immunomodulators of various origin on the histamine-sensitizing activity of whole-cell pertussis vaccine].

Changes in the histamine-sensitizing activity of whole-cell pertussis vaccine (PV) under the action of immunomodulators (IM) of bacterial (peptide and peptidoglycans), synthetic (peptidoglycan) and vegetable origin have been studied. The study has revealed that these IM, introduced orally and parenterally, exhibit histamine-sensitizing activity, depending on the nature of IM and the optimum selection of the doses of IM and PV.


[Interventional endoscopy: what is new?].

New trends in therapeutic endoscopy are presented concerning endoprostheses of the esophagus, endoscopic sclerotherapy of varices and non-variceal bleeding, endoscopic therapy of bile duct stones, palliation of malignant stenoses of the bile duct, endoscopic therapy of acute pancreatitis. Advantages and disadvantages of these new techniques are discussed by analysis of preliminary results and compared with the well established techniques of endoscopy, radiology and surgery.


[Therapy of chronic viral hepatitis with recombinant interferon-alpha].

Long term treatment with interferon alpha is the only established therapy for chronic viral hepatitis so far. Depending on the type of viral hepatitis the response rate to interferon alpha is between 15 and 40%. These results can be improved by an appropriate selection of patients and possibly by combination therapy with other immunomodulatory and antiviral substances. The optimal dose in chronic hepatitis B is 5 Mega Units (MU) interferon alpha every other day for 6 months and in hepatitis C 3 MU every other day over 6 months.


[Differential diagnosis of fever after returning from the tropics].

Fever is the cardinal symptom of many infections in travellers returning from the tropics and is second in place only to infectious diarrhea. Once the obvious causes of fever in an individual patient have been eliminated, it may be very difficult to find the cause of fever. Fevers can be distinguished by their length of duration and divided into acute fevers i.e. up to 3 weeks duration and chronic fevers i.e. more than 3 weeks duration. Whether fever goes along with leucopenia or a normal white blood cell count on the one hand or with leucocytosis on the other hand is of differential diagnostic value. A schedule based on these two parameters will be presented to simplify differential diagnostic considerations. Two rules of thumb will be stressed: (1) Each febrile illness, even febrile diarrhea, jaundice or meningitis, is to be considered a malaria until it is excluded. (2) Patients returning from tropical areas might suffer from banal infections such as pneumonia, urinary tract infections, cholangitis, etc. as well.


[Management of patients with traveler's diarrhea].

Traveler's diarrhea starts 5 to 15 days after arrival with 3 or more watery bowel movements daily in 4 to more than 50% of travelers depending on geographical regions. Enterotoxin producing strains of E. coli are isolated in 20 to 50% of patients, followed by shigella, salmonella, campylobacter and vibrio spp. Rarely giardia lamblia, entamoeba histolytica and cryptosporidia are causative organisms. The cornerstone of treatment is oral rehydration. The efficacy of anti-diarrhetics is not convincingly proved and as to loperamid this drug may prolong invasive forms of diarrhea. Antibiotics are indicated if leucocytes or blood are found in stool. Cotrimoxazole and aminopenicillins are loosing efficacy because of growing resistance. The minimal. In a double blind placebo controlled trial with 500 mg ciprofloxacin b.i.d. for 5 days we were able to demonstrate a significant clinical and bacteriologic effect in 132 patients with salmonellosis and campylobacteriosis.


Sound spectrographic studies on the relation between motherese and pleasure vocalization in early infancy.

The relationship between the vocalizations of early infants and their mothers was investigated by acoustic analysis. The subjects were eight infants aged 40-70 days and their mothers. The infants were sufficiently developed to utter pleasure vocalization. The acoustic characteristics of the voices of the infants and mothers while communicating with each other analyzed in terms of pitch, duration, latency and melody types. The results were as follows: 1) Correlation was significant between the average fundamental frequencies of the infants' voices and those of their mothers. Motherese and infants' vocalizations were similar in pitch. 2) There was little individual difference in the duration of infants' vocalizations, but a considerable individual difference in the duration of motherese. No correlation was observed in the duration of the vocalizations of the infants and mothers. 3) The latencies of infant vocalization and motherese showed large differences among the infant-mother pairs. There was a tendency for the latency of the motherese to affect the number of utterances by the infant. 4) Significant correlations in the melody types were observed in three mother-infant pairs. These findings indicate that there are significant correlations in the vocal exchanges between infants and their mothers.


IgG subclass imbalance in children with acute lymphoblastic leukemia receiving maintenance chemotherapy.

Serum levels of IgG subclasses were measured in 18 children with acute lymphoblastic leukemia (ALL) receiving maintenance chemotherapy and in 36 age-matched controls in order to attempt to analyse the effects of chemotherapy. The IgG subclasses were measured by enzyme linked immunosorbent assay. Serum IgG1, IgG2 and IgG4 levels in the patients were significantly (p less than 0.01, p less than 0.005, p less than 0.005) lower than in the controls, but serum IgG3 levels in patients were as high as in controls. Suppression on IgG2 and IgG4 were more profound than IgG1. In six children, the levels of the IgG subclasses were measured at diagnosis, during maintenance chemotherapy and one year after cessation of chemotherapy. The levels of the four IgG subclasses at diagnosis and after cessation of chemotherapy were as high as those in control children except for the IgG4 levels in the post-chemotherapy group. IgG2 and IgG4 may be more susceptible to suppression by chemotherapy than IgG1 and IgG3 may not be suppressed by chemotherapy.


Growth hormone secretory status in patients with Turner syndrome.

The growth hormone (GH) secretory capacities in patients with Turner syndrome aged 5.1-15.9 years and those with constitutional short stature (CSS) aged 5.2-14.2 years were evaluated by pharmacological and physiological means. The GH response to hypoglycemia in the patients with Turner syndrome was lower than that in the patients with CSS. However, the GH response to arginine was not significantly different between the two patient groups. For the physiological test, the integrated concentration of GH (ICGH), the number of episodic peaks and their mean height were evaluated using blood obtained from the patients every 20 minutes for a period of 24 hours. The ICGH and the mean height of the episodic peaks in the patients with Turner syndrome were significantly lower than those in the CSS patients during the night but not during the day. Negative correlation between the bone age and the night-time values of ICGH was observed in the patients with Turner syndrome. Such correlation was not observed in the CSS patients. The patients with CSS showed a significant day-night difference in the ICGH and the mean height of the episodic peaks, but the patients with Turner syndrome did not show any significant day-night difference in either the ICGH or the mean height of episodic peaks. In conclusion, the GH secretory capacity in patients with Turner syndrome is lower than that in CSS patients.


Epidemiological studies on measles in Karachi, Pakistan--mothers' knowledge, attitude and beliefs about measles and measles vaccine.

In order to gather information on the factors affecting the spread of measles vaccine in Pakistan, 287 mothers living in Karachi were interviewed concerning their knowledge, attitude and beliefs about measles and measles vaccine. Measles had been highly prevalent, mainly among infants between 9 and 18 months of age. The severity of the illness and the frequency of complications were well known and the importance of immunizations was well recognized. In traditional combined families grandparents had made the decision to take children for immunization, but many mothers had begun to feel that they were responsible for participation in the programme. The vaccine acceptance rate had increased sharply in recent years, primarily due to local health educators' activities and mass media such as TV programmes. The present findings confirm the importance of continuous effort toward promotion of primary health care by collaboration of motivated mothers and community health workers.


Evaluation of atrial, ventricular and atrioventricular septal defects by cine magnetic resonance imaging.

Cine magnetic resonance imaging (MRI) was performed on 20 patients (mean age: 5.3 +/- 4.4 years) with atrial, ventricular, or atrioventricular septal defects for evaluation of cardiac structure and blood flow. Prior to cine MRI, electrocardiographically gated MRI using multislice acquisition was performed on all patients to localize optimal slice location. Cine-MRI was obtained with a 30 degrees flip angle, 15 msec echo time, and 30 msec pulse repetition time, on a 256 x 256 or 128 x 128 acquisition matrix. Abnormalities of cardiac structure were well defined in all patients by gated cardiac imaging. In 18 of the 20 patients, cine-MRI was able to detect shunt flow, visualized as a low intensity signal in comparison with the surrounding blood flow. Cine-MRI can provide not only accurate anatomy of cardiac structures but functional assessment of the cardiac chamber, wall topology and flow relations. Cine-MRI will become an important noninvasive technique for assessment of anatomy and physiology in congenital heart disease.


A study of psychosocial factors in the psychosomatic symptoms of adolescents in Okinawa.

High school students (N = 902) in Okinawa were asked to participate in a questionnaire survey which was designed to investigate the psychosocial factors in the psychosomatic symptoms of adolescents. The questionnaire focused on mental distress, perception of school and home environment and psychosomatic symptoms. The Japanese Edition Cornell Medical Index-Health Questionnaire (JCMI) for evaluating emotional instability and the New TK Diagnostic Test for Parent-Child Relationship were also utilized. Distress in relationships with family or friends, finding little pleasure in school and/or home, showing emotional instability as diagnosed according to regions III and IV of JCMI, or showing strained parent-child relationships according to the TK Test items were found to be closely associated with psychosomatic symptoms. In addition, students with human relations problems, especially family problems, tended to have a strained relationship with parents and tended to show autonomic hyperactivity represented by orthostatic dysregulation. Students with peer problems tended to have emotional instability and to find little pleasure in school; they had mental as well as urinary and bowel symptoms. The findings of this study suggest that distresses in family or peer relationships, emotional instability and a strained parent-child relationship are important factors in the onset of psychosomatic symptoms in adolescents.


The origin of myoclonus and periodic synchronous discharges in subacute sclerosing panencephalitis.

We report here a case of a patient with subacute sclerosing panencephalitis (SSPE) and we have analyzed periodic events using dipole tracing methods to clarify the origin of periodic synchronous discharges and myoclonus. Both source generators were located in the subcortical part of the cerebrum, an area adjacent to the thalamus. Although the pathophysiology of periodic events in SSPE has been controversial, dipole tracing methods may contribute to clarify the origin of periodic events in SSPE.


Papillary and cystic tumor of the pancreas possibly concealed within a pseudocyst.

A 17 year old girl, with a papillary and cystic tumor of the pancreas, probably concealed within a previous post-traumatic pseudocyst of the pancreas is described. At 10 years of age, she had received a drainage procedure for a pancreatic pseudocyst, following a blunt abdominal trauma. The histological examination of the cyst wall did not show an epithelial lining. Seven years after that, she developed anemia and a computer tomography and ultrasonography of abdomen revealed a 10 cm x 9 cm x 8 cm, cystic, multilocular pancreatic mass with solid parts. On operation, a fist-sized, solid and multilocular cystic tumor, located in the body and tail of the pancreas, and infiltrating into the colonic serosa but with no metastasis, was found and completely excised. Histologic and electron microscopic examination revealed the characteristic features of a papillary and cystic tumor of the pancreas. This report suggests that cystic lesions of the pancreas should be carefully checked to decide the best surgical therapy.


Hydrops fetalis caused by fetal Kasabach-Merritt syndrome.

There have been only 2 previous reports of nonimmunologic hydrops fetalis (NIHF) caused by fetal Kasabach-Merritt syndrome, both of which were pathological studies. This is the first clinical case report of NIHF due to fetal Kasabach-Merritt syndrome that was prenatally diagnosed by sonography, computerized tomography, and percutaneous umbilical blood sampling.


Clinical experience in using a new type of nasal prong for administration of N-CPAP.

Nasal continuous positive airway pressure (N-CPAP) has been used in infants with decreased lung compliance for increasing the functional residual capacity (FRC), decreasing the work of breathing and improving the PaO2/PAO2 (arterial-alveolar PO2 ratio) without intubation. However, the currently available nasal prongs for administration of N-CPAP have presented some problems in fixation, and lesions to the nasal septum or nostrils might be induced by aggressive pressure intended to fix them. We would therefore like to report our experience in using a new type of nasal prong for administration of N-CPAP therapy. The nasal prongs we used were provided by Dr. Wung of Columbia University in New York, who first designed them, and have been used safely, effectively and without any complications.


Dengue encephalopathy.

Dengue encephalopathy or dengue hemorrhagic fever (DHF) with CNS involvement used to be considered a relatively rare condition; but the number of cases reported in human studies has been increasing every year. Diagnosis of dengue encephalopathy is based on clinically diagnosed DHF according to the W.H.O. criteria (1980), with CNS manifestations consisting of abrupt onset of hyperpyrexia, non-transient alteration of consciousness, headache, vomiting--with or without seizures--and normal CSF. Many factors may be considered to be directly or indirectly associated with CNS signs and symptoms in DHF, the main pathology being leakage of plasma into serous spaces and abnormal hemostasis, leading to hypovolemic shock and hemorrhage in many organs of the body. Acute liver failure is considered to be one of the main factors causing brain pathology. One hundred fifty-two cases of dengue encephalopathy admitted during 3 periods at the Cipto Mangunkusumo Hospital in Jakarta were studied retrospectively. The overall incidence was 152 out of 2,441 DHF cases, or 6.2%. The most pronounced symptoms were hyperpyrexia, alteration of consciousness and convulsions. Laboratory examination showed an unusually high increase of serum transaminases, hyponatremia, and hypoxia. Neurologic abnormalities detected were hemiparesis and tetraparesis of the extremities, and second nerve atrophy; such abnormalities were found in 10 out of the 152 cases, or 6.5%.


Neuropathology of HTLV-I-associated myelopathy--a report of two autopsy cases.

A neuropathological analysis was performed in two autopsy cases of HTLV-I-associated myelopathy. The thoracic spinal cords were most severely affected and the histopathological findings consisted of mononuclear cell infiltration, marked destruction of myelin and axons and astrocytic gliosis. More than half the infiltrated cells were positive for pan-T cell marker; B cells were sparse in the parenchyma and subarachnoid spaces. CD4 and CD8 positive cells were found in the early stages of the lesions. CD8, however, predominated over CD4 in the other stages. It appeared that a chronic inflammatory process had started at the middle to lower thoracic cord and had extended gradually in both directions. The middle thoracic spinal cord is known to have the poorest blood supply, and the horizontal distribution of inflammatory cells at this region correlated with the most distal supply of the anterior spinal artery.


Childhood neurocysticercosis--epidemiology, diagnosis and course.

Neurocysticercosis was diagnosed in 0.89% of children enrolled in our Child Neurology Clinic in the years 1979 to 1990. The commonest presenting symptom was seizures (90%) followed by raised intracranial pressure (44%). CT scans revealed a variety of lesions including low and high attenuation cysts, periventricular edema, hydrocephalus and calcification. ELISA was useful in substantiating the diagnosis in almost 70% of cases. Only 18 patients who had active disease merited treatment with praziquantel. The clinical and CT response was good. Follow-up revealed spontaneous quiescence in many patients with inactive disease.


Human immunodeficiency virus infection in central nervous system and myeloid-monocytic lineage.

We established persistent infection with a strain of human immunodeficiency type 1, HTLV-IIIB, in a ++promyelo-monocytic cell line, ML-1 (CD4 antigen nearly negative and CD4 mRNA negative), and a promonocytic cell line, THP-1 (CD4 antigen positive). Different reactions of giant cell formation were found after cocultivation of infected and uninfected cells of ML-1, HL-60, THP-1 and U-937 cell lines with uninfected and infected MOLT4 (a T-lymphoma cell line). Factors affecting the cellular tropism of human immunodeficiency virus were discussed.


Head-down tilt bedrest. HDT'88--an international collaborative effort in integrated systems physiology.

An international collaborative project, initiated by the DLR-NASA Life Sciences Working Group, led to the performance of a head-down tilt bedrest (HDT) study at the DLR Institute for Aerospace Medicine. Scientific and operational questions were addressed in preparation for the D-2 Spacelab mission. Principal areas of interest were cardiovascular regulation and fluid/electrolyte metabolism. The results are detailed in a series of 13 reports to which the present paper serves as an introduction.


Effect of head-down bedrest on blood/plasma density after intravenous fluid load.

Using the mechanical oscillator technique, the mass density of antecubital venous blood and plasma samples was measured in 6 men before and after infusion of 22 ml/kg isotonic NaCl solution before, on day 7 during, and on day 3 after ten days of 6 degrees head-down bedrest. We studied 1) the distribution volumes of the infused NaCl solution, 2) the magnitude and time-course of induced fluid shifts to the extravascular spaces after rapid volume expansion, and 3) the protein concentration of the translocated fluid. The NaCl distribution volume was 16.7 +/- 2.9% body weight (BW) before, 15.0 +/- 3.0% BW during (P less than 0.05) and 13.0 +/- 1.3% BW after the head-down tilt (HDT) period (P less than 0.01). The volume of fluid shifted 120 min after infusion was not different in the control (12.9 +/- 7.4% plasma volume and 8.3 +/- 3.2% blood volume), during HDT (14.7 +/- 3.8% plasma volume and 7.4 +/- 5.6% blood volume), during HDT HDT conditions (14.6 +/- 2.2% plasma volume, and 8.2 +/- 1.3% blood volume, respectively). The density of the shifted fluid which reflects protein concentration was also unchanged (1004.2 +/- 4.2 g/l, 1002.6 +/- 4.3 g/l and 1003.9 +/- 8.2 g/l in the control, during, and after HDT periods, respectively). The mass density of red cells did not change with any condition. It is concluded that the distribution volume of isotonic saline solution decreases with diminished body mass. Densitometry provides a means of monitoring volume changes and protein shifts under the circumstances of our study.


The effects of a 10-day period of head-down tilt on the cardiovascular responses to intravenous saline loading.

We tested the hypothesis that adaptation to microgravity, simulated by a 10-day period of head-down tilt (HDT), alters the responses to an intravenous fluid load by causing a larger fraction of the infused volume to be retained and magnifying the acute hemodynamic effects. HDT caused a significant (p less than 0.01) decrease in blood volume (-0.72 liters) and weight (-1.6 kg). Rapid infusion (22 ml/kg over 20 min.) of isotonic saline before, during, and after HDT produced a transient blood volume expansion with 18% of the infusate retained intravascularly after 2 hours. HDT had no effect on this response. Control hemodynamics were significantly different with lower cardiac output and higher total peripheral resistance (TPR) during and after HDT. Saline caused significant increases in cardiac output, heart rate, and stroke volume and a decrease in TPR. The magnitude and time course of these changes were not altered by HDT. The results refute the hypothesis and suggest that during HDT new set points or operating points were established for the control of intravascular volume and hemodynamic state.


Effects of head-down tilt and saline loading on body weight, fluid, and electrolyte homeostasis in man.

We studied the effects of head-down tilt bedrest (HDT) on body weight, fluid and sodium homeostasis. A fluid load session with rapid intravenous infusion of 22 ml/kg body weight (BW) isotonic saline was performed before, during and after HDT. During the pre- and post HDT periods the test subjects were given a diet containing 2600 kcal/day. The energy intake was reduced to 2000 kcal/day during HDT. Water intake was kept constant at 40 ml/kg BW, sodium intake was 2.2 mmol/kg BW and protein intake was 1.4 g/kg BW, while the daily fat and carbohydrate intake was reduced during the HDT period. As expected plasma volume and BW changed rapidly in the beginning of HDT and during early recovery. A total body water loss of 0.6 l was observed within the second day after tilting. Plasma volume was reduced by 16% during HDT-bedrest. The time course of the body fluid loss paralleled a decrease in body sodium that then remained fairly constant during the HDT-bedrest period (except for the interference caused by the fluid loading on day S06). A restoration of body fluid and body sodium content occurred early in the recovery period. Fluid loading caused a negative fluid balance of 0.6-0.9 l over a 48 hr period following infusion regardless of the phase of the HDT study. These results demonstrate that under our strictly controlled conditions 1) HDT alters body fluid and sodium balances, 2) a standard fluid loading causes a net negative 3-day fluid balance during all phases of the study.


Effect of head-down tilt bedrest (10 days) on lymphocyte reactivity.

Immunological responses of six healthy males to 10 days of head-down tilt bedrest (HDT) were assessed. Lymphocyte responsiveness was severely reduced immediately before, during, and immediately after the HDT, even though the lymphocyte numbers did not change. By contrast, delayed-type hypersensitivity was not affected. No dramatic changes were found in WBC counts and lymphocyte subpopulations, with the only exception of natural killer (NK) cells which transiently decreased immediately after HDT. Plasma cortisol levels were elevated above normal immediately before and during the HDT. The data suggest that the mitogenic response of lymphocytes was affected by psychological and fluid shift stress. These results are compared with data obtained during and after spaceflight. We conclude that the stress of HDT induces changes in immunological responsiveness that are strikingly similar to those arising from the stress of spaceflight.


Cardiopulmonary function during 10 days of head-down tilt bedrest.

Pulmonary and cardiovascular responses to simulated weightlessness, i. e. 6 degrees head-down tilt bedrest (HDT) were investigated in six healthy male volunteers (mean age 26 yrs). Pulmonary diffusing capacity, functional residual capacity, pulmonary capillary blood flow, and lung tissue volume were measured by inert gas rebreathing. Heart rate and mean arterial blood pressure were obtained from finger blood pressure readings using a plethysmographic technique (Finapres). The short-term (20 min) response to HDT consisted of a 22% increase in pulmonary blood flow, and 13% and 31% falls in blood pressure and heart rate relative to standing. Functional residual capacity fell by 33%, while lung tissue volume increased insignificantly. Subsequent measurements during 10 days of HDT and 5 days of recovery revealed no further changes in lung volume, lung tissue volume, or blood pressure. However, diffusing capacity fell gradually and remained 4%-5% below baseline values after the 7th day of bedrest and during recovery (p less than 0.05). Pulmonary blood flow decreased by 16% during head-down bedrest and recovered partially within the following 5 days (p less than 0.05). We conclude that during and after simulated weightlessness marked alterations in cardiovascular function and marginal affections of gas exchange can be demonstrated already at rest. They may be considered as contributing factors to orthostatic and exercise intolerance observed after space flight.


Pulmonary responses to lower body negative pressure and fluid loading during head-down tilt bedrest.

Exposure to microgravity redistributes body fluids with important secondary effects on cardiovascular function. We tested the hypothesis that the fluid shifts also affect pulmonary gas exchange. Microgravity was simulated in six male volunteers by a 10-day period of bedrest at 6 degrees head-down tilt (HDT). Lower body negative pressure (LBNP) and intravenous saline loading superimposed acute changes in fluid distribution on the prolonged effects of HDT. HDT produced relative dehydration and hypovolemia with decreased pulmonary blood flow and diffusing capacity. Before bedrest, pulmonary blood flow decreased by 24% during LBNP and diffusing capacity by 7%, while functional residual capacity increased by 14% (p less than 0.05). Intravenous saline loading caused a 24% increase in pulmonary blood-flow (p less than 0.05). Functional residual capacity decreased by 10% and diffusing capacity by 6% (p less than 0.05). Lung tissue volume did not change significantly. Head-down tilt had only minor effects on the responses to LBNP and saline loading. We conclude that LBNP and intravenous saline loading produce major changes in pulmonary blood-flow and minor effects on pulmonary gas exchange, and that the response to acute changes in fluid distribution is not significantly altered during simulated microgravity.


Cardiovascular response to lower body negative pressure before, during, and after ten days head-down tilt bedrest.

The haemodynamic response to lower body negative pressure (LBNP) was studied in 6 test subjects before (baseline), during, and after (recovery) ten days of 6 degrees head-down bedrest. The LBNP protocol consisted of a 35 min control period, application of a staircase differential pressure profile (15 min at -15 mmHg; 5 min at -30 mmHg; 15 min at -40 mmHg), and a 10 min post-stress observation period. Cardiac output was measured by a foreign gas rebreathing technique. Finger plethysmographic arterial blood pressure (BP), ECG, and heart rate (HR), lower limb crossectional area, and the electrical impedance of three body segments were recorded continuously. As expected, HDT caused a decrease in plasma volume and total body fluid volume. Resting CO at the end of HDT was 16% below the baseline level and similar to CO in the upright position before HDT. Stroke volume (SV) was also reduced, but there were no significant changes in control HR or BP. Absolute changes in CO and SV during LBNP were similar at baseline and during HDT, but the relative changes were larger during HDT. HR and vasoconstriction responses were enhanced, but presyncope occurred in two subjects. Reduced cardiac filling with decreased stroke volume at rest is the apparent primary cause of the altered LBNP response during HDT.


Effects of head-down tilt for 10 days on the compliance of the leg.

The purpose of this investigation was to measure lower leg compliance before, during and after a 10-day period of bedrest at head-down tilt to test the hypothesis that leg compliance and the capacity for venous pooling is increased by the adaptation to stimulated microgravity. Venous occlusion plethysmography with multiple proximal occlusion pressures was used to obtain compliance measurements in six male subjects. Calf circumference decreased significantly during the tilt (corresponding to a decrease in cross sectional area of 7%) and had not returned to baseline seven days after the end of tilt. Compliance post-tilt was significantly greater than pre-tilt, probably mainly due to a reduction in muscle mass. This study supports the need for investigations to define: (a) the degree of protection against orthostatic hypotension that can be achieved by maintaining leg muscle mass and tone, and (b) efficient and specific exercise programs to prevent loss of muscle mass and function-particularly during spaceflight.


Influence of ten-day head-down bedrest on human carotid baroreceptor-cardiac reflex function.

We studied the effects of simulated microgravity on baroreceptor-cardiac reflex mechanisms, with complex pressure changes delivered to neck chambers worn by six healthy young men, before, during (days 1, 3, 6, and 10), and after ten days' 6 degrees head-down bedrest. During held expiration, a computer-driven bellows increased neck pressure to 40 mmHg for about 4 s, and then decreased pressure to -65, by 15 mmHg R-wave triggered decrements. We plotted R-R intervals as functions of carotid distending pressures (systolic less neck chamber pressures). Each experimental session comprised seven stimulus sequences delivered over about 15 min and averaged. Comparisons between results before bedrest and on the tenth day of bedrest showed that average baseline R-R intervals increased from 933 +/- (SEM) 24 to 1077 +/- 35 msec (P less than 0.05, Wilcoxon signed rank test); maximum slopes (R-R interval/carotid distending pressure) decreased from 4.5 +/- 0.4 to 3.6 +/- 0.7 msec/mmHg (P = 0.11); R-R interval response ranges decreased from 263 +/- 31 to 182 +/- 18 msec (P = 0.03); and operational points (positions of R-R intervals at resting pressures on the stimulus-response relation) remained constant. Our results suggest that head-down bedrest progressively impairs baroreceptor-cardiac reflex responses in healthy human subjects.


Influence of posture and prolonged head-down tilt on cardiovascular reflexes.

We investigated the influence of ten days 6 degrees head-down tilt (HDT) on short-term cardiovascular control. To help differentiate between the effects of HDT-induced fluid redistribution and changed autonomic cardiovascular modulation under prolonged HDT, the effect of acute posture changes was investigated as well. Six healthy male volunteers were studied. Continuous finger blood pressure was measured non-invasively by means of Finapres. Heart rate (HR) was derived from the electrocardiogram. Responses to forced breathing (FRSA), Valsalva's manoeuvre (VM), Mental Stress (MS) and Sustained Handgrip (SHG) were measured. Changing posture from HDT to standing enhanced the BP and HR responses to VM, both during straining and after release. During prolonged HDT, responses to VM changed toward the pattern seen in the upright posture before HDT, suggesting a strong influence of fluid redistribution. Neither posture nor prolonged HDT influenced HR variation during FRSA and responses to MS and SHG. BP variation during FRSA was influenced by posture but not by prolonged HDT. Thus, cardiovascular reflex tests which reflect the parasympathetic (FRSA) or the sympathetic (MS and SHG) efferents to the heart were not influenced by posture or prolonged HDT. Only the responses to VM were affected by both posture and prolonged HDT. These results are probably due to a decrease in blood volume and stroke volume under prolonged HDT, an increase in venous distensibility and, to a lesser extent, to inadequate cardiovascular regulatory responses.


Increased orthostatic blood pressure variability after prolonged head-down tilt.

The effect of simulated weightlessness on orthostatic blood pressure regulation was evaluated with passive 70 degrees head-up tilt (HUT) after 10 days 6 degrees head-down tilt (HDT). Six healthy male volunteers were studied. Continuous recording of finger blood pressure (BP) was obtained non-invasively with a FinapresTM device. Instantaneous heart rate (HR) was derived from the electrocardiogram. To quantify orthostatic BP variability, a fast fourier transform (FFT) of the beat-by-beat BP- and RR-interval values was performed. Control HR before HUT after the 10-day HDT period was increased, probably due to an arousal state of the test subjects. The change in BP induced by HUT was not influenced by 10 days' HDT, in contrast to the HR rise which increased from 24 +/- 2 beats/min to 41 +/- 7 beats/min (P less than 0.05). After HDT the total variance in orthostatic BP almost doubled. FFT indicated that this increase in variance can be ascribed to BP oscillations with a frequency of around 0.1 Hz. In three subjects transient HR decelerations during HUT after HDT were observed. Analysis of the relationship between BP and HR in the transients showed that each HR decrease was preceded by a BP increase above normal. These HR decelerations seemed, therefore, to be an effect of the vagal part of the arterial baroreflex and did not necessary signal an impending vasovagal syncope. The present study indicates that although 10 days' HDT do not influence absolute BP responses to 70 degrees HUT BP was maintained by an increased sympathetic activity, reflected by an increased HR response and an augmented variance in BP around 0.1 Hz.


[Tumor thrombosis in inferior vena cava: diagnostic imaging and therapeutic approximation].

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.


[High pressure filling bladder].

A complete urodynamic study was carried out on 41 consecutive patients presenting in the cystomanometry a vesical filling pressure at maximum capacity higher than 30 cm H2O. Two groups were evident: group I with neurogenic etiology, and group II without an obvious neurogenic etiology. From its results it can be seen that a diminished vesical accommodation is not a urodynamic fact restricted to vesicourethral neurogenic dysfunction, but it happens in several non-neurogenic conditions. Within the neurogenic group, the urodynamic element most frequently associated to a diminished vesical accommodation was an inferior motor neuron-like vesicourethral dysfunction. An increased vesical filling pressure was not enough to produce urinary incontinence, being also necessary an added factor to prompt involuntary loss of urine.


[Localized renal adenocarcinoma. Prognostic factors and influence of postoperative irradiation on survival].

Presentation of our experience and results in the treatment of localized renal adenocarcinoma with radiotherapy supplementary to surgery. The influence of post-operative radiotherapy in the subsequent occurrence of relapse and survival is analyzed. Also, the predictive value in our series of pre-surgery VSG, FA and LDH determinations is analyzed.


[Bilateral renal carcinoma].

Presentation of 9 patients with bilateral renal carcinoma, 8 synchronic and 1 asynchronic, diagnosed with intravenous urography, echography and/or CT and all of them treated, in the absence of metastasis, with either radical surgery of one kidney and conservative surgery of the other one, or with conservative surgery of both kidneys. Patients were followed-up until death. Four patients died of cancer, 3 for other reasons and 2 are still alive, mean survival 27.1 months.


[Rigid ureteroscopy. Results and complications].

Analysis of results and complications of retrograde rigid ureterorenoscopies (URS) performed in our unit between August 1985 and June 1990. Our series includes 122 URS performed in 106 patients: 68% female and 32% male. A rigid ureteroscopy Storz 11.5 Ch was used. URS indications were: 72% treatment of ureteral lithiasis, 14% diagnosis, 7% treatment of ureteral tumores and 3% other reasons. Treated lithiasis were predominantly located in the pelvic ureter. Overall success in the treatment of lithiasis was 92.86% in "primary" lithiasis, and 71.43% in post-ESWL. URS allowed us to resolve troubles of differential diagnosis in 93.75% of cases. With a complications rate of 19.7%, only 3.28% were considered relevant.


[Diagnostic and therapeutic criteria of inverted papilloma].

Seven cases of inverted papilloma (IP), two located at the UUT level and five in the bladder, one associated to transitional cells carcinoma. Treatment was conservative for the whole series, and neither co-adjunctive therapy or chemoprophylaxis was applied, except for the last case; after an average follow-up of 19.8 months they all show complete remission. A discussion of urinary tract IP is suggested, studying the epidemiology, histology, pathogeny, clinical characteristics and diagnostic methods, of which endourological investigations are the most effective for a reliable diagnosis, since they allow direct visualization and biopsy sampling. Regarding the therapeutic options, the paper highlights the need for conservative surgery due to its benign biological behaviour. A strict control of the patients is necessary due to likelihood of recurrence and malignant transformation.


[Congenital short urethra: surgical treatment].

Presentation of 6 cases of congenitally short urethra seen in our Unit. The rarity of such malformation, as well as the difficulties to arrive to a presurgical diagnosis are emphasized. Also, review of surgical techniques described in the literature. Contribution of our experience in the use of the urethra's dissecting and elevating technique. We considered this the choice procedure except in extreme cases due to the good results obtained, fewer technical difficulties and lower risk of complications.


[Monotherapy of ureteral calculi with extracorporeal shockwave lithotripsy].

We reviewed our experience with ESWL in the treatment of 401 patients with ureteral stones in order to evaluate if a higher disintegration and clearance rates could be achieved without prior manipulation of ureteral calculi, i.e., ESWL used as "in situ" monotherapy. The global stone free rate were 83%, 85% and 91% at 15 days, 1 month and 3 months after ESWL. We also analyzed the results according to the efficiency quotient (EQ).


[Urinary sepsis as manifestation of a renal angiomyolipoma].

Renal angiolipomas are the most frequent benign renal tumours. Since ultrasound techniques have been in use to study algetic lumbar syndromes, their symptomatic appearance has decreased. Most authors agree that CAT has a 100% specificity. The paper contributes one case of renal angiomyolipoma isolated in a 39-year old woman, its primary interest being the clinical presentation, within an extensive septic milieu of urinary origin, the intra-operative diagnosis, considering the previous false-negative echography and dubious tomographic diagnoses, and the findings of regional node invasion, all exceptional states in the reviewed literature.


[Spontaneous disappearance of pulmonary metastasis secondary to renal cell carcinoma after nephrectomy. Presentation of a case and review of the literature].

Spontaneous disappearance of pulmonary metastasis is an occasionally occurring phenomenon, thus reflected in the literature. The article presents one case of spontaneous disappearance of pulmonary metastasis of clear cells renal carcinoma, histologically confirmed by fine needle puncture aspiration. After 36 months of follow-up, the patient shows no evidence of recurrence.


[Metastatic renal carcinoma: regression of pulmonary metastasis and anemia after interleukin-2r immunotherapy].

Presentation of one case of bilateral renal adenocarcinoma in a 63-year old female patient, undergoing surgical therapy by means of right radical nephrectomy and left partial nephrectomy. Within 6 months, the patient presented pulmonary metastasis and normocytic anaemia associated to paraneoplastic syndrome. After initiating treatment with Interleukin-2 in intravenous continuous infusion, both pulmonary metastasis and anaemia showed evidence of partial regression.


[Erythrocytosis and renal adenocarcinoma].

Contribution of one left renal adenocarcinoma in a 54-year old women, where the initial data was the finding of erythrocytosis discovered during routine laboratory tests performed by her gynaecologist. Review of the diagnostic and therapeutic procedures followed in this case, establishing a differentiation between erythrocytosis and polyglobulia. Normalization of the hemogram following extended nephrectomy is emphasized. This case history is considered to be of interest due to its presentation pattern. Finally, we believe that faced to an erythrocytosis of unknown etiology, a renal tumoral disease, more specifically a renal adenocarcinoma, should be suspected.


[BCG in superficial carcinoma of the bladder. Authors' experience].

Contribution of 95 patients with surface vesical tumour managed with UTR and endovesical BCG. The response was absence of recurrence in 68.4% cases in Ta stage, 63% in T1 and 66.7% in 'in situ' carcinoma. Therapy tolerability was good, with few side-effects. We conclude that BCG endovesical instillation as co-adjunctive therapy to UTR in surface vesical tumours has been shown to be effective for the period under study.


[Mannitol solution (M-400) vs. mannitol solution combined with allopurinol in the prevention of post-transfusion acute renal failure].

Evaluation on the incidence of Acute Renal Failure (ARF) from a total of 41 corpse renal graft receptors, 20 of which received perfusion with mannitol solution at 400 mOsm/kg (Group 1) and 21 the same mannitol solution plus allopurinol (Group 2). No significant differences were present between both groups when they were analyzed for ARF incidence (15% vs 23.8%); overall incidence was 19.5%. 24-hour initial diuresis was shown to be an excellent predictor for long-term graft functionality. We can conclude that the addition of mannitol to the perfusion solution contributes decisively to reduce post-transplantation ARF, while addition of allopurinol does not have further beneficial effects.


[Complete hormonal blockade vs. monotherapy in the management of metastasizing prostatic cancer].

Evaluation of results obtained in 70 hormone-treated patients with disseminated prostate cancer. Thirty-six of them were treated via orchiectomy and 34 received also flutamide. Initial objective response rates were 47% in the monotherapy group versus 58% for those undergoing complete blockade. Decrease of PSA and PAP was also higher in the group given flutamide. Nonetheless, no significant changes were observed with regard to biological and clinical progression or patients survival.


[Epidemiology of urinary calculi in the Marina Alta (Alicante) region].

An epidemiological study on urolithiasis was conducted in the Borough of Marina Alta from December 1989 to December 1990. The Health Care region of Marina Alta includes 11 health care areas, all centralized into one single Local Hospital offering service to an estimated population of 125,290 inhabitants, which experiences a remarkable increase over the summer months. During the study period 1,792 patients, 350 (20%) of which were lithiasis cases were seen in the Urology Unit. 2.80 per thousand of the studied population had urolithiasis-related signs. Incidence is higher in males than in females, as well as in patients with prior lithiasic diseases, surgery and urinary infections. Urinary infection was present in 20% of patients. Nine percent of patients had some type of associated urinary malformation. The most frequent mineral composition of the lithiasis was: Calcium oxalate (52%), uric acid (20%) and oxalate plus uric acid (9%).


[Urethral sonography in the diagnosis and preoperative evaluation of urethral stenosis].

An area of spongiofibrosis can be found proximal and distal to all stenosis of the urethra. The severity of such spongiofibrosis as well as its length are in many instances decisive when choosing an adequate surgical approach. Conventional radiological diagnosis of stenosis of the urethra only shows the area of urethral stricture but is unable to inform on the fibrosis of the spongy body. Sonourethrography or urethral echography affords a dynamic tridimensional examination of the anterior urethra which provides accurate data on the length of the stenosis, as well as the extend and severity of the spongiofribosis. Sixteen patients diagnosed with stenosis of the urethra through sonourethrography were evaluated. This easy-to-perform investigation, allowed the identification of 4 patients with peristenotic intense spongiofibrosis, hypercongenital urethra, who underwent open urethroplastia. The urethra of another 3 patients showed normal echogenicity, but diminished elasticity, and were diagnosed as of moderate spongiofibrosis requiring extensive internal urethrotomy. We believe sonourethrography should become a procedure to be included as part of the routine pre-surgical investigation of the stenosis of the urethra due to its non-invasive nature, easiness to perform, and because it provides highly useful information which would allow a decreased number of re-stenosis following surgery of the urethral stenosis.


[Extracorporeal shockwave lithotripsy: an alternative treatment for lithiasis of caliceal diverticula].

Among all the patients treated in our Lithotrity Unit, 13 of them had lithiasis inside the calyceal diverticulum. They were all treated by extracorporeal shockwaves. In none of the cases complete expulsion of lithiasic mass was achieved. In 3 (23%) cases it was reduced to half. In 2 (15.3%), 75% of the initial mass remained; and in 8 (61.5%) stones were fragmented but none of their debris was eliminated. Out of all the patients who were symptomatic before starting treatment, only 36.6% become asymptomatic. Extracorporeal lithotrity is, therefore, an approach with limited results in the calyceal intradiverticular lithiasis.


[Echodensitometry: a new echographic diagnostic possibility].

The determination and quantification of grey levels in the echography scale, designated by some authors Echodensitometry, is viewed as a new method for diagnosis using ultrasound techniques. This paper advances the results from a study conducted with an echographer equipped with an echographic density measuring device. This model analyzes the number of pixels in the image showing the most frequent level of grey. Normal and pathological parenchymatous urological organs (kidney, prostate and testicle) have been examined. Normal organs show a gaussian distribution of grey with a predominant level of typical grey for each of them. When affected by an acute inflammatory process the organs maintain their gaussian distribution but the predominant grey is lower (darker) due to the edema and the hyperaemia. When the inflammatory process becomes chronic, distribution, although somewhat irregular, is still gaussian but with higher predominance of grey (lighter) probably due to the fibrosis. The tumoral cases of our study also showed a gaussian curve even more irregular and with levels of variable grey. When specific areas of the tumour are analyzed the findings are very distinct depending on whether the areas are hypo or hyperechoic. Hyperechoic areas produce highly irregular maps. Research should be directed to provide more complex, although easy to perform systems of analysis which can correlate adequately with the histological study. It would be desirable that the equipment would be standardized to allow analysis of 'in vitro' images. If and when these objectives can be accomplished we would be able to venture into an echography histological diagnosis, something nowadays yet impossible.


[Ureteral lithiasis. Analysis of 3 series].

Presentation of our experience on 1000 cases of ureteral lithiasis treated over the last five years with ESWL, ureteroscopy and ureterolitotomy, distributed in three series of 396, 265 and 339 cases respectively. In the first series (396 cases), lumbar ureter calculi were treated with ESWL (dornier HM3) and iliopelvian calculi with ureteroscopy. In the second series (265 cases), all calculi were treated with ESWL (Siemens Lithostar). The third series was in turn subdivided in three groups: in the first group, comprising simple ureteral calculi, 'in situ' ESWL was performed; in the second group, of lumbar ureter complex calculi, ESWL was performed assisted by simple endourological techniques; ureteroscopy was performed in the third group, iliopelvian ureter complex calculi. Calculi characteristics (site, size, consistency and number), excretory tract and renal function, designated as CEP/LTS-X were assessed. These parameters allow us to grade ureteral lithiasis in Types I, II and III. A comparative study of the results in the three series was made reaching an overall conclusion that simple or Type I ureteral lithiasis can be treated with 'in situ' ESWL as first choice; in Type II or lumbar ureter complex lithiasis, 'in situ' ESWL is insufficient and other endoeurological support techniques are required, while in Type III, iliopelvian ureter complex lithiasis, ureteroscopy should be recommended.


[Can we do without bone gammagraphy in the staging of prostatic cancer?].

Correlation between findings on bone gammagraphy and PSA levels in 144 patients with untreated prostate cancer are analyzed. With prevalence of metastatic disease in 57.6% cases and considering the predictive cut value of metastasis to be 20 ng/ml, there were positive and negative predictive values of 64.9% and 73.9%, with a diagnostic confidence of 66.6%. We conclude that bone gammagraphy is essential for staging prostate cancer even in patients with PSA below 20 ng/ml.


[Percutaneous treatment of a mycotic renal abscess, caused by Aspergillus fumigatus, in an AIDS patient].

Presentation of one case of renal mycosis by Aspergillus as a primary complication in one patient diagnosed with acquired immunodeficiency syndrome. The importance of conservative treatment at all costs through percutaneous drainage is underlined, specially if we considered the short life expectancy of patients who have developed AIDS.


[Encrusted cystitis. Review of the literature and report of a case].

Alkaline encrusted cystitis is an infrequent process, almost forgotten by urologists. It tends to appear complicating an underlying cystopathy. Consists in a vesical inflammatory state, characterized by precipitation and incrustation of calcareous (phosphate, carbonate) and ammonium-magnesium salts on the vesical mucosa, their genesis being conditioned by the existence of pre-existing mucosa damage, urinary infection by urolithic microorganisms and alkaline urine. The present paper discloses an exceptional case of incrusted cystopathy with alkaline urine associated to uroinfection by E. coli (microorganism of uncertain and questionable urolithic activity). Treatment with urinary antiseptics, acetohydroxamic acid associated with curettage and UTR of calcareous plates was resolutive. With regard to the present cases, we review the limited literature available on the coexistence of incrusted cystitis and E. coli uroinfection and discuss the mechanisms through which E. coli could induce formation of lithiasis and incrustations in the urinary tract.


[Results of treatment with interferon and vinblastine in renal cancer].

Contribution of our experience with Alpha-2a Interferon and Vinblastine, for the treatment of advanced renal cancer in patients formerly not treated with nephrectomy. Pathoanatomical diagnosis was confirmed by puncture biopsy. None of the 4 patients recruited in the protocol showed objective response. In 2 patients no change was observed and in the other 2 the disease progressed. In surviving patients it was impossible to sustain therapy for more than three months. Treatment was discontinued as a result of the Interferon side-effects, such as fever, myalgia, asthenia and neuritis.


[Percutaneous drainage of renal and perirenal abscesses].

The prevalence of renal and perinephritic abscesses has radically changed over the last few decades basically due to two causes: the efficacy of antibiotics and early diagnosis by echography and/or CAT. Between January 1986 and December 1990, 12 cases of renal abscesses have been diagnoses in our Unit which have been treated conservatively through therapy with antibiotics and lumbar percutaneous drainage. Only one case was resolved with antibiotics alone; all other 11 cases needed drainage, in spite of a improvement in the symptoms, which was performed by translumbar puncture. Drainage was effective in 10 cases and the cultures found 5 cases of E. coli, 4 cases of Staphylococcus aureus and 1 case of Gram(-) bacilli. In the two cases where percutaneous drainage was not effective abscesses were produced by fungi: C. albicans and Mucor mycosis which caused highly solid septum and sphacelus requiring in both cases the use of open surgery. Currently this disease no longer represents a serious problem, it has a minimal morbidity and no mortality; only the group of high risk immunosupressed patients (AIDS, HIV (+), ADVEP) shows an increase in the number of cases and management in these patients continues to be problematic.


[Transitional cell tumor of the bladder in childhood].

Presentation of one case of transitional cells tumour of the urinary bladder in a 10-year old patient. We emphasize the rarity of such tumours during the first decade of life as well as their good prognosis, the only management required being just an endoscopic resection.


The effect of taurine on the age-related decline of the immune response in mice: the restorative effect on the T cell proliferative response to costimulation with ionomycin and phorbol myristate acetate.

1. Proliferative responses to the costimulation with phorbol-12-myristate-13-acetate (PMA) and suboptimal doses of ionomycin in the purified T and B cells from old mice were lower than those from young mice. 2. The degree of the age-related decline was more significant in T cells than in B cells. 3. Taurine, a sulfur containing amino acid, augmented the proliferative responses of T cells from both young and old mice. 4. The augmentation of the proliferative response by taurine was more marked in old T cells than in young T cells. 5. The concentration of intracellular free calcium ion ([Ca2+]i) was significantly lower in old T cells when stimulated with PMA and ionomycin than observed in young T cells. 6. In the presence of taurine, the concentration of [Ca2+]i in the old T cells significantly increased under stimulation by PMA and ionomycin. 7. The results indicate that taurine improved the proliferative response in old T cells by restoration of the increment of the concentration of [Ca2+]i under the stimulation by PMA and ionomycin.


The effect of dietary supplementation with cysteic acid on the plasma taurine concentration of cats maintained on a taurine-restricted diet.

The biochemical impairment in the taurine anabolic pathway of the cat has not yet been fully elucidated; however, a number of key enzymes are known to have reduced activity in the cat compared to the rat. There are a series of possible routes resulting in the formation of taurine, one of which is the decarboxylation of cysteic acid. The aim of this study was to investigate the effect of cysteic acid, as a precursor, on the circulating concentration of taurine. A group of twelve adult cats was fed a basal, canned diet containing 0.22 g taurine/kg fresh weight for a period of eighty-four days. The diet was supplemented with 2.0 g/kg fresh weight L-cysteic acid on day fifteen through fifty six and plasma taurine concentration was measured every two weeks throughout the study. The results showed that when the dietary intake of taurine was inadequate to maintain the plasma concentration above 40 mumol/L, the addition of L-cysteic acid to the diet gave rise to an increase in plasma taurine concentration in some cats. Eight of the twelve cats showed a significant rise in plasma taurine after dietary supplementation for six weeks (52.0 +/- 22.3 vs 212.4 +/- 97.9 mumol/L, p less than 0.01) and a subsequent decrease in plasma levels when the cysteic acid was withdrawn (65.6 +/- 37.1 mumol/L). The other four cats showed no significant rise in plasma taurine after six weeks supplementation (13.5 +/- 4.2 vs 35.5 +/- 19.4 mumol/L, ns). However, withdrawal of the cysteic acid resulted in a subsequent decrease in circulating levels of taurine (11.8 +/- 1.5 mumol/L, ns). These data indicate that the addition of cysteic acid to a taurine-restricted, canned diet will, in some cats, result in the biosynthesis of taurine. The plasma taurine concentration of the remaining cats, although not apparently increasing significantly, was maintained at a slightly higher constant level until the cysteic acid was withdrawn. These results suggest that cats are able to synthesise taurine via an alternative pathway utilising L-cysteic acid as a precursor, although the efficiency of this process differs considerably among individual animals.


Characteristics of taurine transport in cultured renal epithelial cell lines: asymmetric polarity of proximal and distal cell lines.

Taurine transport was determined in two continuous, renal epithelial cell lines: LLC-PK1 derived from the proximal tubule of the pig, and the Madin-Darby canine kidney cell (MDCK) from the distal tubule of the dog. In LLC-PK1, taurine transport is maximal at the apical surface, whereas in MDCK cells, transport is greatest at the basolateral surface. Transport is highly dependent on both sodium and chloride in the external medium, and is specific for beta-amino acids. The apical and basolateral surfaces of both cell lines show an adaptive response to extracellular taurine concentration, but only the basolateral surface of the MDCK cell responds to hyperosomolality by increased taurine accumulation. Thus, differential control of the beta-amino acid transport system by substrate and external tonicity exists. The role of the beta-amino acid transport system may differ according to the origin of the cell: in the proximal renal tubular cell, net transepithelial reabsorption of filtered taurine increases the body pool. By contrast, taurine accumulation by distal tubular cells may form a mechanism of cell volume regulation in response to osmotic stress.


Urinary excretion of taurine as a function of taurine intake: potential for estimating taurine bioavailability in the adult cat.

Urinary taurine excretion increases markedly when excess taurine is consumed. Experiments were designed to characterize this response in an attempt to develop an assay system for taurine bioavailability in common cat foods using an adult cat model. Initial studies investigated the time course of changes in urinary taurine excretion in response to alterations in taurine intake. The rate of urinary taurine excretion decreased rapidly when cats were switched from a casein diet supplemented with 0.2% crystalline taurine to a diet containing no supplemental taurine, reaching steady-state in 2 d. In contrast, urinary taurine excretion by cats switched from low to high taurine did not plateau until 6 to 7 d. Subsequently, cats (n = 18) were fed a casein diet containing graded levels of crystalline taurine (0, 0.025, 0.05, 0.10, 0.15 or 0.20%). After a 7-d adjustment period, urinary taurine excretion was quantified over a 5-d collection period and also by cystocentesis, and blood taurine levels were measured on d 6. Plasma taurine increased linearly (r = 0.88) as taurine intake increased, while whole-blood taurine increased asymptotically, reaching 95% of maximum concentration at a taurine intake of 93 mu mole/(kg body weight.d). The rate of urinary taurine excretion increased only slightly as taurine intakes increased to 96 mu mol/(kg body weight.d), but increased markedly (15-fold) thereafter. The same pattern was observed whether urinary taurine excretion was expressed as mu mole/(kg body weight.d) from total urine collection or as mu mole/g creatinine from cystocentesis.(ABSTRACT TRUNCATED AT 250 WORDS)


Long-term treatment of the MRL/lpr mouse with methotrexate and 10-deazaaminopterin.

Female MRL/lpr mice were treated with I.P. doses of methotrexate (MTX) and 10-deazaaminopterin (DAAM) in the range of 1 to 100 mg/kg body weight/week, in two equally divided doses. Treatment began at 7 weeks of age and continued to 30 weeks of age. Joint histopathology scores were tightly correlated with skin lesion-proteinuria scores at 30 weeks of age. MTX at levels of 5, 25, and 100 mg/kg body weight/week and DAAM at a level of 25 mg/kg body weight/week significantly reduced skin lesion-proteinuria scores below controls in a dose dependent manner. Animals receiving MTX at 25 mg/kg body weight/week had a significantly longer median life span and animals receiving MTX at 100 mg/kg body weight/week had a greater than 15% suppression of growth when compared with controls. Longevity and skin lesion-proteinuria scores appeared to be good indicators of drug efficacy while growth suppression appeared to be a good indicator of drug toxicity.


Differential effects of dipyrone, ibuprofen, and paracetamol on experimentally induced pain in man.

In a double-blind cross-over study on 22 healthy subjects the analgesic efficacies of the antipyretic analgesic drugs ibuprofen, dipyrone and paracetamol were tested against placebo using a model of experimentally induced pain. To this purpose interdigital webs were pinched repeatedly for 2 min periods. The painfulness of these stimuli was assessed by the subjects on an electronically controlled visual analogue scale at 10 sec intervals. In addition to the subjective pain ratings the stimulus induced reflex diminution of the blood flow in the stimulated hand was measured with photoplethysmography and laser Doppler flow analysis. The flare response around the stimulated area was assessed with infrared thermography. In this assay system ibuprofen and dipyrone, but not paracetamol, showed statistically significant analgesic effects by preventing hyperalgesia which is normally induced by the repeated stimulation of a skin site. This hypoalgesic effect was not related to the subjective impression of the subjects of the analgesic potency of the respective drug. Sympathetic reflex vasoconstriction was not quantitatively related to the drug induced hypoalgesia. Ibuprofen and, to a minor extent, the other antipyretic analgesic drugs also diminished the stimulus induced flare reaction around the stimulated skin sites.


Calcium channel blockers prevent stress-induced ulcers in rats.

Gastric mucosal damage induced by cold and restraint stress caused increase in gastric lipid peroxidation (LP) and decrease in gastric glutathione levels. Two calcium-channel blockers, verapamil and nicardipine, prevented stress-induced increase in gastric LP, as well as ulcer formation. Both calcium-channel blockers protected against stress-induced ulcers, and inhibition of LP may be among their mechanisms of action.