Use of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department.

The combination of tetracaine, epinephrine, and cocaine has gained wide acceptance as a topical anesthetic agent for use on pediatric dermal lacerations in the ED. This is despite the fact that the optimal dose and formulation have yet to be determined. TAC can be applied painlessly to wounds and is about as effective as lidocaine infiltration for anesthetizing pediatric facial and scalp lacerations. It is relatively ineffective on lacerations located elsewhere or in adults. The most commonly used TAC solution contains high concentrations of cocaine, tetracaine, and epinephrine, drugs that individually can cause serious toxicity if absorbed in sufficient amounts. In addition, the three components of TAC may interact to potentiate their intrinsic toxicities. The deliberate and inadvertent application of TAC to mucous membranes has caused status epilepticus and two pediatric deaths. The risk of toxicity from misapplication of TAC is heightened because TAC is most effective and therefore most widely used on pediatric facial and scalp lacerations. Cocaine is also absorbed after TAC is applied to dermal lacerations and may cause toxicity by this route. Until additional research is performed to establish the minimum effective dose of TAC and its potential toxicity and until FDA approval is granted, we do not think that it can be recommended as the drug of choice for pediatric facial and scalp lacerations in the ED. If TAC is administered, a maximum dose of 2 to 3 mL of the "half-strength" formula proposed by Bonadio and Wagner should be used, and application should be performed by medical personnel, using a soaked gauze or cotton ball. Care should be taken to make sure none of the solution comes in contact with mucous membranes, and TAC should not be applied to lacerations involving the vermillion border of the lip or the lip itself. Close medical monitoring of the patient is essential to detect signs of toxicity. Research on other topical agents such as tetracaine with epinephrine is also needed. Although anesthetizing wounds painlessly remains a worthy goal, exposing patients to added and unknown risks and increasing the cost of health care is unacceptable.


Encainide overdose in an infant.

Ingestion of as little as a single tablet of encainide resulted in life-threatening ventricular arrhythmias in a child. Insertion of an intraosseous line permitted prompt delivery of medications and fluids. Prehospital care providers must be aware that apparently trivial amounts of some adult dosage forms can be toxic to small children.


Percutaneous ultrasound-guided cholecystocentesis in cows.

A method was developed for percutaneous ultrasound-guided cholecystocentesis in cattle. The procedure was performed on the right side in the 9th, 10th, or 11th intercostal space of 30 cows. Of the 30 cows, 20 were slaughtered 24 hours after cholecystocentesis and the remaining 10 cows were slaughtered after a 10-day observation period. Changes in the peritoneum and gallbladder wall, observed at slaughter, were minimal. During the 10-day observation period, general behavior, attitude, and appetite of the 10 cows were normal. A transient, slight increase in rectal temperature was observed in 6 cows at 4, 5, or 8 days after cholecystocentesis. Total and differential WBC counts and total protein and fibrinogen concentrations, determined daily, were all within normal ranges. Bile samples from 20 cows were examined microscopically and biochemically. Fasciola hepatica and Dicrocoelium dendriticum eggs were observed in bile from 7 and 12 cows, respectively. Fecal examination revealed F hepatica eggs in 4 cows; D dendriticum eggs were not identified in any of the fecal samples. In 1 cow, F hepatica eggs were observed in the feces, but not in the bile. Bile acids concentration in bile varied from 12.5 to 68.5 mmol/L (mean +/- SD, 45.3 +/- 3.05 mmol/L) and in serum from 3.8 to 281.0 mumol/L (41.6 +/- 17.24 mumol/L). Negative correlation was obtained between bile acids concentration in bile and that in serum (r = -0.60, P less than 0.01). It was concluded that percutaneous ultrasound-guided cholecystocentesis in cows is a safe procedure and that microscopic and biochemical examinations of obtained bile can be useful diagnostic aids.


Factors affecting skim milk progesterone assay results.

Five studies were performed to determine factors affecting progesterone concentration in skim milk. Results of the first study indicated that progesterone concentration was higher in skim milk of samples kept 16 hours in an ice bath (0 C) than of those left at room temperature (21 C). In the second study, this temperature effect was found to be reversible, with skim milk progesterone concentration increasing when whole milk samples were cooled prior to centrifugation. In the third study, [3H]-labeled progesterone was used to determine the relationship between fat content of foremilk (the first milk obtained from the teats), midmilk (milk obtained midway through milking), and strippings (milk obtained immediately after milking machines have been removed) samples and temperature (4 C and 21 C) on the percentage of progesterone in the skim milk fraction. The relationship between percentage of butterfat and percentage of progesterone in skim milk was linear when the log of these variables was used for calculations. In the fourth study, assayable progesterone in the skim milk fraction of foremilk, midmilk, and strippings was affected by temperature. In the fifth study, a multiple-regression procedure was used to determine the amount of variation in percentage of radioactive progesterone in the skim milk fraction. Independent variables (whole milk butterfat and temperature of incubation [1, 3, 13, 22, 37, and 50 C]) and the natural log of each variable, were entered into a stepwise multiple-regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)


Canine bone shape analysis by use of a radiographic image-classification system.

A radiographic image-classification system was developed to analyze and compare the shape of the humerus of neonatal Labrador Retriever and Labrador Retriever x Beagle pups that were either phenotypically normal or affected with an ocular-skeletal dysplasia syndrome. The system consistently defined the shape of the humerus within the groups of pups studied and indicated a difference in the shape of the humerus between normal and affected pups. Results indicated that the radiographic image-classification system may be able to identify Labrador Retriever pups affected by the ocular-skeletal dysplasia syndrome at or shortly after birth.


Effects of analog filtering on brain stem auditory-evoked potentials in dogs.

Effects of analog filter frequency on brain stem auditory-evoked potentials (BAEP) were investigated in 7 non-sedated dogs. The BAEP were recorded successively at various low-pass (LP) and high-pass (HP) filter frequency settings. The analog filters had a rolloff of 6 dB/octave. Decrease of LP filter frequency from 30 kHz to 100 Hz caused prolongation of the peak latency and reduction of the peak-to-peak (from a positive peak to the following trough) and absolute (from a positive peak to the baseline) amplitudes for all peaks, except the peak latency for P5 and the absolute amplitude for P4. Changes in these variables were statistically significant (P less than 0.05) at different cutoff frequencies specific for the individual peaks. The interpeak latency between P1 and P4, and P4/P1 peak-to-peak amplitude ratio were not changed significantly. At the lowest LP filter frequency of 100 Hz, positive peaks (fast waves) seemed to be superimposed on a slow positive wave (slow wave). In contrast, increase of HP filter frequency from 0.53 to 160 Hz did not result in significant changes for any peaks, except for reduction in the absolute amplitude of P4. The various effects of LP filter frequency and negligible effects of HP filter frequency on individual peaks may be attributable to their frequency composition and/or elimination of the slow wave at higher HP filter frequency settings. On the basis of our results, LP filter setting of 3 kHz and HP filter setting of less than or equal to 53 Hz are recommended for recording of BAEP in dogs.(ABSTRACT TRUNCATED AT 250 WORDS)


Quantitative renal scintigraphic determination of the glomerular filtration rate in cats with normal and abnormal kidney function, using 99mTc-diethylenetriaminepentaacetic acid.

The nuclear imaging technique known as quantitative renal scintigraphy was validated as a means to assess the kidney function of cats. Renal function tests were performed in 6 healthy cats and 3 cats with clinical manifestations of kidney failure. In addition, the nephrotoxic drugs, gentamicin sulfate, or amphotericin B were used in an attempt to induce renal failure in 4 cats. Using linear regression analysis, equations were derived to estimate the glomerular filtration rate (GFR) on the basis of the renal percent uptake of 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA). One-way ANOVA and Student's t test were used to evaluate treatment effects on clearances of inulin and creatinine, percent uptake of 99mTc-DTPA, and serum creatinine concentrations. The results show that the percent uptake of 99mTc-DTPA by the kidneys correlated well with the GFR obtained through the clearance of inulin. Thus, it was concluded that quantitative renal scintigraphy, using 99mTc-DTPA as a marker of kidney function, is an adequate technique to estimate the kidney function of healthy cats and cats with functional renal impairment. The best estimate of the GFR of cats, using the percentage dose of 99mTc-DTPA, was obtained on the 1- to 3-minute postinjection interval of the marker, using data that was background-subtracted, but not corrected for tissue absorption of gamma rays or binding of 99mTc-DTPA to plasma proteins. There was no significant difference in the mean inulin clearance, creatinine clearance, or percent uptake of 99mTc-DTPA between the 3 treatment groups of this study.(ABSTRACT TRUNCATED AT 250 WORDS)


Polypeptides associated with Pasteurella multocida infection in rabbits.

Polypeptides from whole cell preparations of Pasteurella multocida serotypes A:12 and A:3 were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and transferred to nitrocellulose paper. Antigens were detected by immunoblot analysis, using sera from 3 groups of rabbits. Sera were obtained from rabbits inoculated intranasally with P multocida serotype A:12 or A:3, from rabbits maintained in a rabbitry with enzootic P multocida A:12 infection, and from rabbits maintained in a rabbitry with enzootic P multocida A:3 infection. Immunoblot analyses of pre- and postinoculation sera from experimentally infected rabbits, using serotype A:12 antigen, revealed 3 polypeptides with approximate molecular mass of 28, 30, and 37 kDa that consistently detected antibodies after P multocida-induced infection. Sera from rabbits naturally infected with either serotype, tested against serotype A:12 and A:3 antigens, detected the same polypeptides in both serotypes. Thus, immunologic reactivity to these polypeptides may be useful for serologic detection of P multocida infection.


Stimulation and suppression of the oxygenation activity of porcine pulmonary alveolar macrophages by Actinobacillus pleuropneumoniae and its metabolites.

The effects of Actinobacillus (Haemophilus) pleuropneumoniae and its metabolites on the oxygenation activity of porcine pulmonary alveolar macrophages (PAM) were studied, using a chemiluminescence technique. Actinobacillus pleuropneumoniae strains of serotypes 2, 3, and 9 in a dose of 1, 10, and 100 colony-forming units/macrophage first stimulated the oxygen radical production of PAM. After having reached a peak value, oxygenation activity decreased, finally resulting in total suppression of PAM. All these effects were neutralized by homologous convalescent pig sera that had been adsorbed onto inactivated A pleuropneumoniae strains. Moreover, cross-neutralization was shown between serotypes 2 and 3. Inactivated A pleuropneumoniae strains did not influence the oxidative activity of PAM. Undiluted and lower dilutions of sterile A pleuropneumoniae culture supernatants were toxic for PAM, whereas higher dilutions of the supernatants stimulated oxygen radical production of the macrophages. These effects were heat-sensitive and were neutralized by homologous convalescent pig sera. Cross-neutralization was shown between serotypes 2 and 3. These findings indicated that stimulation and inhibition of the oxygenation activity of PAM are attributable to heat-sensitive metabolites produced by A pleuropneumoniae.


Double-antibody sandwich enzyme-linked immunosorbent assay and immunoblot analysis used for control of caseous lymphadenitis in goats and sheep.

A double-antibody sandwich ELISA for detection of antibodies directed against the exotoxin of Corynebacterium pseudotuberculosis, the cause of caseous lymphadenitis (CL) in small ruminants, was developed. A concentrated exotoxin was used. For interpretation of ELISA results, these sera were tested: sequentially obtained sera of C pseudotuberculosis-inoculated goats and sheep that were monitored for 68 weeks; sequentially obtained sera from 80 goats of 3 flocks with CL; sera from 652 goats of 7 flocks without CL; sera from 160 sheep of 4 flocks without CL; and 2,265 caprine and 208 ovine sera submitted for diagnostic testing. Data regarding the infection status and history of 10,454 of the 23,302 animals were collected after testing; most of these were goats that had been part of a CL control program. Specificity and sensitivity of the ELISA were nearly 100%. Subsequently, 31,978 animals from which no data on infection status of flocks had been collected were then tested. It was concluded that the ELISA is a useful diagnostic test for CL eradication programs. Sera with doubtful or inconclusive ELISA results were examined by use of immunoblot analysis. Proteins from C pseudotuberculosis culture supernatant were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and blotted onto nitrocellulose. Six proteins with molecular mass of 68, 65, 39, 38, 31, and 29 kDa reacted with sera from goats and sheep with experimentally induced or naturally acquired infection. Immunoblot analysis was valuable in classifying sera with doubtful or inconclusive results by ELISA.


Antigenic variation of Mycoplasma gallisepticum, as detected by use of monoclonal antibodies.

A panel of monoclonal antibodies (MAb) developed against Mycoplasma gallisepticum strain PG31 was used to probe the antigenic profiles of 5 recognized strains (PG31, R, S6, F, A5969) and 6 field isolates of M gallisepticum. Monoclonal antibody G9 predominantly recognized antigens at apparent molecular mass positions of 90 to 98 kDA. The MAb reacted with all strains and isolates, but the molecular mass position of the antigens varied among some mycoplasmas. Monoclonal antibody G12 reacted with all strains and isolates of M gallisepticum and had an identical banding pattern. However, MAb G10 and G11 reacted selectively only with a limited number of strains and/or isolates. Surface distribution of the MAb-recognized antigens was revealed by immunoelectron microscopy. Partial physicochemical characterization of MAb G9-recognized antigens identified glycopeptide characteristics. Monoclonal antibody G9 reacted with surface antigens and, hence, participated in agglutination of M gallisepticum. However, the degree of agglutination varied among the various strains and isolates, indicating a quantitative or conformational limitation or an alteration in the anomeric expression of the epitopes. Antigenic variation in M gallisepticum may be mediated by immunologic selective pressures, or a proclivity for habit niche in the host.


Myoelectric activity of the small intestine in enterotoxin-induced diarrhea of calves.

Electrodes were surgically implanted at 15-cm intervals in the jejunum and ileum of 4 healthy neonatal calves so that myoelectric activity could be recorded on 2 consecutive days. On the first day, each calf received a control treatment, and myoelectric activity was recorded for 340 minutes. Phase I was recorded for a mean of 175.8 +/- 22.8 minutes (51.5%), phase II for 124 +/- 27.4 minutes (36.5%), and phase III for 40.3 +/- 6 minutes (11.9%). On the second day, each calf was treated with approximately 200 micrograms of heat-stable enterotoxin (STa) of Escherichia coli orally. All calves developed diarrhea after the administration of STa. Phase I was recorded for a mean of 92.5 +/- 42.3 minutes (27.2%), phase II for 227.3 +/- 52.5 minutes (66.9%), and phase III for 20.3 +/- 11.4 minutes (6.0%). Increase in phase II and decrease in phases I and III after STa administration were significant (P less than 0.05). Duration of the migrating myoelectric complex was longer after STa administration (median, 64 minutes), compared with the control treatment (median, 54 minutes). Minute rhythms, recorded on the day of toxin administration, ranged from 49 to 153 minutes. There was no difference between the number of migrating action potential complexes on the control days (range, 1 to 10), compared with those on treatment days (range, 1 to 14). These findings are suggestive that enterotoxin-induced diarrhea of calves is accompanied by increased total spiking activity and minute rhythms in the distal portion of the jejunum and ileum.


Temporal effects of plasmapheresis on serum proteins in horses.

The temporal response of blood and serum proteins to chronic plasmapheresis was determined in 8 horses used in a commercial antibody enterprise. Plasmapheresis of between 4 and 11 L induced significant decreases in total protein, albumin, and IgG values. With the exception of a high hematocrit value for the first postplasmapheresis blood sample, there were no changes in erythrocyte or leukocyte measurements, and no changes in the proportions of serum protein in an electrophoretic profile. Regression equations generated for recovery of proteins after plasmapheresis indicated a return to preplasmapheresis values of total protein and albumin at approximately 1 month. Complications of repeated plasmapheresis were not detected when plasma extractions were done between 7 and 19 times at 30-day intervals.


Parasympathetic influence on the arrhythmogenicity of graded dobutamine infusions in halothane-anesthetized horses.

We investigated the influence of parasympathetic tone on the arrhythmogenicity of graded dobutamine infusions in horses anesthetized under clinical conditions. Six horses were used in 9 trials. Two consecutive series of graded dobutamine infusions were given IV; each continuous graded dobutamine infusion was administered for 20 minutes. The dobutamine infusion dosage (5, 10, 15, and 20 micrograms/kg of body weight/min) was increased at 5-minute intervals. Isovolumetric saline solution vehicle (v) or atropine (A; 0.04 mg/kg) was administered IV, or bilateral vagotomy (VG) was performed as a treatment before the second series of dobutamine infusions. Treatment was not administered prior to the first dobutamine infusion. Significant interaction between treatment and dosage of dobutamine infusion existed for differences from baseline for mean arterial pressure, systolic arterial pressure, diastolic arterial pressure, heart rate, and cardiac index at dosages of 5 and 10 micrograms of dobutamine/kg/min, given IV and for heart rate at dosage of 15 micrograms of dobutamine/kg/min, given IV. Results for group-V horses were different from those for group-A and group-VG horses, but were not different between group-A and group-VG horses in all aforementioned cases, except for heart rate and cardiac index at dosage of 5 micrograms of dobutamine/kg/min, given IV. Normal sinus rhythm, second-degree atrioventricular block, and bradyarrhythmias predominated during low dobutamine infusion rates during the first infusion series (nontreated horses) and in group-V horses during the second infusion series. Only tachyarrhythmias were observed during the second infusion series in the horses of the A and VG groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Urethral pressure response to alpha-adrenergic agonist and antagonist drugs in anesthetized healthy male cats.

Urethral smooth muscle tone in response to treatment with phenylephrine, a selective alpha 1-adrenergic receptor agonist, and prazosin a selective alpha 1-adrenergic receptor antagonist, was evaluated in 12 anesthetized healthy adult sexually intact male cats. Intravenous administration of prazosin (20 to 30 micrograms/kg of body weight) decreased the average preprostatic and prostatic intraurethral pressure, compared with baseline and postphenylephrine (20 to 30 micrograms/kg) administration, values. Neither prazosin nor phenylephrine administration had an effect on functional urethral length. Results have implications for the pharmacologic management of lower urinary tract disorders in male cats.


Evaluation of the Doppler ultrasonic method of measuring systolic arterial blood pressure in cats.

The accuracy of the Doppler technique for indirect systolic blood pressure measurement was assessed in 16 anesthetized cats. Eight cats were anesthetized with isoflurane and 8 were anesthetized with halothane. Anesthetic depth and mode of ventilation were varied to obtain a wide range of arterial blood pressure. A Doppler transducer was placed on the palmer surface of the left forelimb over the common digital branch of the radial artery to detect blood flow, and a blood pressure monitoring cuff with a width 37% the limb circumference was placed half way between the elbow and the carpus. To enable direct arterial pressure measurements, the left femoral artery was catheterized and the blood pressure waveforms recorded simultaneously. Systolic blood pressure measured by use of the Doppler ultrasonic technique was significantly lower than that obtained from the femoral artery catheter. Using linear regression, we determined a clinically useful calibration adjustment for Doppler indirect blood pressure measurement in cats: femoral systolic pressure = Doppler systolic pressure + 14 mm of Hg.


Efficacy of two formulations of albendazole against liver flukes in cattle.

Albendazole (10 mg/kg of body weight) was administered as a drench suspension or as a feed additive to 24 cattle with naturally acquired infections of Fasciola hepatica and Fascioloides magna. Cattle were euthanatized 16 to 30 days after treatment, and the number of viable flukes was counted. Viable F hepatica and F magna were decreased by 91.4% and 70.6% for drench administration and by 82.9% and 71.9% for the feed additive treatment, respectively. There was no significant difference between the efficacy of the 2 formulations in decreasing viable fluke numbers, compared with untreated controls.


Cytologic findings of tracheobronchial aspirates from 66 thoroughbred racehorses.

Tracheobronchial aspirates obtained from 66 healthy Thoroughbred racehorses in training at the same track were examined. Twenty-seven percent of the horses had greater than 20% neutrophils in the aspirate. Eosinophils, mast cells, giant cells, and Curschmann's spirals of mucus were observed in 94, 83, 65, and 42% of the horses, respectively. Hemosiderophages were observed in 86% of the horses, half of which had previous confirmation of exercise-induced pulmonary hemorrhage. Although fungal elements were seen in 70% of the horses, bacteria were detected in only 3% of the horses. The authors conclude that inflammatory airway disease is widespread in the racing Thoroughbred population.


Intestinal permeability in pigs during rotavirus infection.

Macromolecular permeability of the small intestine was tested in four 3-week-old gnotobiotic pigs inoculated with porcine rotavirus strain RV277 (group A). Pigs were administered 125I-labeled polyvinylpyrrolidone (molecular weight [mol wt], 40,000) orally 1 day before and 2 and 24 hours after virus inoculation, and blood samples were obtained every 6 hours. Eight hours after rotavirus inoculation, pigs had watery diarrhea. Increased permeation of 125I-labeled polyvinylpyrrolidone was not observed after clinical signs of infection had developed. Serum total protein and urea nitrogen concentrations increased slightly at the end of the study, probably as a consequence of dehydration. Differences in blood glucose concentration were not seen. At 48 hours after viral inoculation, macromolecular permeability was tested morphologically by injecting horseradish peroxidase (mol wt, 40,000) into the jejunal lumen just distally to the ligamentum colicoduodenale. After an incubation period of 20 minutes, small segments of jejunum were obtained for stereomicroscopic, histologic, and ultrastructural investigations. Moderate hyperregenerative villus atrophy was found. Ultrastructural changes of the villus epithelium were minor, and increased macromolecular permeation was not observed.


Risk factors for abomasal volvulus and left abomasal displacement in cattle.

A hospital-based case-control study was conducted to evaluate and compare risk factors for abomasal volvulus (AV) and left displaced abomasum (LDA) in cattle. Medical record abstracts were derived from 17 North American veterinary schools by the Veterinary Medical Data Program for all cattle admitted between Jan 1, 1977 and Dec 31, 1986, and for those with a diagnosis of AV or LDA. From a total of 108,956 individual cattle records, 1,036 cases of AV and 7,695 cases of LDA were identified, with a ratio of LDA to AV cases of 7.4 to 1. In-hospital mortality was 23.5% for AV and 5.6% for LDA. Age, breed, gender, and season each had significant (P less than 0.05) effects on risk for AV and LDA. Risk for AV and LDA increased with increasing age, with greater risk in cattle aged 4 to 7 years. Dairy cattle were at higher risk of developing AV (adjusted odds ratio, 36.4) and LDA (adjusted odds ratio, 95.2) than were beef cattle. The odds of AV in Brown Swiss cattle were significantly (P less than 0.0001) lower, and the odds of LDA in Guernsey cattle were significantly (P less than 0.0001) higher than those in Holstein cattle. Female cattle were also at higher risk of developing AV (adjusted odds ratio, 3.3) and LDA (adjusted odds ratio, 29.1) than were male cattle. The odds of AV and LDA varied considerably throughout the year, with the lowest number of cases observed in autumn. Seasonal development of AV differed significantly (P less than 0.0001) from that of LDA, with the odds of AV and LDA being highest in January and March, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Evaluation of intra-articularly administered sodium monoiodoacetate-induced chemical injury to articular cartilage of horses.

Three doses of sodium monoiodoacetate (MIA) were used to induce degenerative changes in articular cartilage in middle carpal joints of horses. Twelve young (2- to 5-year-old) horses, free of lameness, were randomly allotted to 3 groups. One middle carpal joint of each horse was injected with 0.9% NaCl solution (control joint). The contralateral middle carpal joint was injected with 0.09 mg of MIA/kg of body weight (group 1); 0.12 mg/kg (group 2); or 0.16 mg/kg (group 3). After MIA administration, horses were allowed ad libitum exercise in a 2-acre paddock for 12 weeks. At the end of the study, gross and microscopic tissue changes were evaluated and biochemical analyses of articular cartilage were done. Grossly, diffuse partial-thickness articular cartilage lesions were observed in group-2 (n = 2) and group-3 (n = 4) horses, but not in group-1 horses. Articular cartilage uronic acid content was significantly (P less than 0.03) decreased in all MIA-injected joints, compared with controls. Articular cartilage matrix staining with safranin-O was decreased in 3 of 4 MIA-injected joints of group-1 horses and in all MIA-injected joints of group-2 and group-3 horses, compared with controls (P less than 0.06). Microscopic degenerative changes in articular cartilage were not significantly different between MIA-injected and control joints in group-1 horses, but were increased (P less than 0.06) in all MIA-injected joints of group-2 and group-3 horses, compared with controls. Qualitatively, decreased matrix staining and degenerative changes were more severe in group-3 horses. On the basis of articular cartilage gross and microscopic changes, as well as biochemical changes, 0.12 mg of MIA/kg injected intra-articularly was determined to induce moderate degrees of articular cartilage degeneration. This model of chemically induced articular cartilage injury could be useful for evaluating treatment effects of anti-arthritic drugs in horses.


Evaluation of support bandaging during measurement of proximal sesamoidean ligament strain in horses by use of a mercury strain gauge.

Liquid mercury strain gauges were implanted in the forelimb proximal sesamoidean ligaments (PSL) of 8 adult horses. The gauges measured PSL strain while horses were standing with or without external support. In 6 of the horses, the gauges also measured PSL strain in horses at a walk, with or without external support. Gauges were enclosed within sliding polypropylene tubes to prevent nonaxial deformation. Each gauge was placed in 1 arm of a low-resistance half-bridge circuit. To provide temperature compensation, a dummy gauge was placed in the adjacent arm of the bridge circuit and was implanted next to the active gauge in the surrounding fascial tissue. External support included fiberglass cast support (CAST), dorsal fetlock splint support (DFS), support wraps of 3 bandage materials (SW1, SW2, and SW3), and support wrap with caudal splint (SW4). The cast was applied, with the fetlock and foot in weightbearing position, from the proximal portion of the metacarpus distal to and including the foot. The DFS was applied by placing the cranial half of the fiberglass cast on the dorsal aspect of the instrumented limb. The SW1, SW2, and SW3 were applied in a figure-8 pattern around the fetlock, using 50% of the linear stretch capacity of the bandage material, with the horse standing squarely on all 4 limbs. The SW4 was applied identically to the other support wraps, with the exception of addition of a flexible caudal splint incorporated in the support wrap. Mean maximal strain while standing (epsilon S) without external support for 8 horses was 6.0% (range, 3.8 to 7.5%).(ABSTRACT TRUNCATED AT 250 WORDS)


Histomorphometric analysis of the rumen of sheep during development.

Histomorphometric and scanning electron microscopic analyses were carried out on 74 embryos and fetuses and 20 sheep (early postnatal to adult age). Histodifferentiation of the rumen took place at 33 days of fetal life. Ruminal pillars were observed at 42 days, and at 61 days, ruminal papillae appeared as evaginations of the epithelial stratum basale. Neutral mucopolysaccharides first appeared in epithelial cells at 46 days of fetal life; thereafter, numbers decreased gradually and subsequently stabilized in postnatal life. Acid mucopolysaccharides, mucins, and mucoid compounds were not detected. Age and diet were recognized as factors that determine the structure of the ruminal mucosa. Growth curves and formulas were set out for each tissue layer.


High-resolution computed tomography of the mammalian lung.

High-resolution computed tomography (HRCT) was performed in 21 isolated animal lungs, from 4 mammalian species (pigs, rabbits, dogs, sheep). Gross and subgross central and peripheral lung morphology was determined by HRCT. Three distinct types of lungs can be identified, principally based on the extent of interlobular septal development; the relationship of major vessels to airways; and the thickness of the visceral pleura. Type-I lung is found in pigs, sheep, and cattle; type-II lung is found in rabbits, dogs, cats, and monkeys; and type-III lung is found in human beings and horses. These mammalian lungs were compared with human lungs. The potential use of HRCT to investigate specific human lung diseases in the aforementioned species also was considered.


Effects of dialyzable lymph node extracts on lymphoblast proliferative capacity of blood mononuclear cells in cattle with chronic paratuberculosis.

Dialyzable lymph node extracts (DLE) containing transfer factor prepared from calves sensitized to Mycobacterium paratuberculosis and keyhole-limpet hemocyanin (KLH) were administered to 4 adult cows with chronic paratuberculosis. Cutaneous delayed hypersensitivity, lymphocyte blastogenesis, monocyte migration-inhibition, and lymphoblast proliferative capacity as a reflection of interleukin-2 (IL-2) activity were measured in response to M bovis purified protein derivative, johnin, and KLH before and after treatment with DLE. Change in cutaneous delayed hypersensitivity was not evident after DLE treatment. Alterations in histologic features of pre- and posttreatment sections of ileum and mesenteric lymph nodes were not detected. Lymph node extract treatment significantly (P less than 0.05) increased IL-2 activity and migration-inhibition in response to johnin and KLH in vitro. Treatment had no effect on lymphocyte blastogenesis. The data indicate that cattle with chronic paratuberculosis may benefit from DLE treatment, by virtue of increased IL-2 activity, and that effects of DLE are at least partially mediated by an increase in IL-2 activity.


Systemic toxicosis associated with azathioprine administration in domestic cats.

Five cats were treated with an azathioprine suspension (2.2 mg/kg of body weight on alternate days) and 2 cats were given vehicle (controls) for 9 weeks. Complete blood and platelet counts and serum biochemistry variables were monitored weekly. Bone marrow aspirates were evaluated every 3 weeks, and core bone marrow biopsy was performed at the end of the study. Profound neutropenia (less than 600 cells/microliters) was observed in all treated cats, and 1 cat developed pancytopenia. Treatment was discontinued if the WBC count was less than 3,000 cells/microliters. Four weeks after discontinuation of azathioprine, 1 treated cat again was given azathioprine at a lower dosage (1.1 mg of azathioprine/kg on alternate days) and neutropenia recurred within 2 weeks. During treatment, 3 cats developed thrombocytosis, and 2 developed thrombocytopenia. In 4 of 5 cats, neutropenia and thrombocytopenia resolved when azathioprine was discontinued. Bone marrow cytologic examination during treatment revealed reduction of the neutrophil line, with relative increase in monocytes. Core bone marrow biopsy at the completion of the study revealed hypocellular marrow with marked decrease in the myeloid series in cats given azathioprine. One of the cats that was treated with azathioprine had a hypercellular marrow with increased numbers of mature granulocytes and precursors; however, azathioprine had been discontinued 3 weeks prior to biopsy. Alterations in serum biochemical variables were not associated with azathioprine. Two cats that were treated with azathioprine developed respiratory tract infections, and 1 of them was euthanatized during the study.


Effects of fluoride on secretory and postsecretory phases of enamel formation in sheep molars.

Effect of fluoride was assessed on molars during and after mineralization. Two groups of 7 sheep each were dosed orally with 3.5 mg of fluoride/kg of body weight daily for 4 months (from 5 to 9 months after birth). Sheep of the first group were slaughtered immediately after fluoride administration; those of the second group were slaughtered 4 months later at the age of 13 months. Three control groups of 7 sheep each were slaughtered at 5 months (to determine the state of the teeth at the beginning of fluoride administration), and at 9 and 13 months. During fluoride administration, plasma fluoride concentration rapidly increased to about 0.50 microgram/ml; after fluoride administration, it stabilized at 0.20 microgram/ml in treated sheep, whereas controls had concentration of 0.10 micrograms/ml (P less than 0.01). Parts of the molars that were in the process of mineralization during fluoride administration (mainly second molars) had thinning enamel, with pits, mainly close to the apex, marked decrease in hardness throughout the layer (less than 100 Vickers U, compared with 240 Vickers U), and fluoride accumulation twice as high as that in controls (1,000 to 2,500 mg/kg [dry weight]). Fluoride accumulation was higher in dentine (2,700 to 4,200 mg/kg), but hardness was less affected. On parts of the molars that were already mineralized (mostly, the first molar), changes in the appearance of enamel and cementum, decreased hardness (less important than in teeth during mineralization) affecting outer enamel more than inner enamel, high fluoride concentration (4,000 to 5,500 mg/kg [dry weight]) in outer enamel extending over 200 microns were observed.(ABSTRACT TRUNCATED AT 250 WORDS)


Blood types in cattle of Iberian ancestry and in Holsteins at various altitudes.

Gene frequencies of RBC antigens were determined in Holsteins and Colombian (criollas) cattle living at 3,000 m, and in cattle descended from fighting bulls (Vacas de lidia) living at 2,500 m. These frequencies were compared with those of Holsteins, cattle native to Florida (scrub cattle), longhorns, and native cattle from Brazil (caracu cattle) living at sea level. The criollas, Vacas de lidia, scrub cows, longhorns, and caracu are descendants of original Iberian stock introduced to the Americas. We found that despite common ancestry (scrub cattle, long-horns, criollas, and caracu), genetic differences may have been derived through years of demographic isolation. The most remarkable blood-group differences were found in the high prevalence of the B system phenogroup (heritable group of antigenic factors) BQA'G'34 in the Vacas de lidia, and of the S system phenogroup U1H' in these cattle and in caracu. Furthermore, the gene frequencies differed in the Holsteins maintained at moderately high altitude (descended from Holsteins kept at sea level), and may have been reflective of the need to adapt to moderately high altitude and chronic hypoxemic conditions. Blood group polymorphism was found in all groups of cattle, although it was reduced in the Vacas de lidia, possibly because their breeding has been carefully controlled and they appear to be highly inbred.


Serum lipoprotein concentrations and hepatic lesions in obese cats undergoing weight loss.

Serum lipoprotein concentrations, routine serum biochemical values, and morphologic changes of the liver were evaluated in cats undergoing weight loss. Food was withheld from 6 obese and 6 control cats for 3 days (days 0 to 2), followed by feeding 50% of previous food intake for 26 days (days 3 to 28). Percutaneous liver biopsy specimens were obtained from all cats on days 0, 7, 14, and 28. Blood samples for serum biochemical analysis and lipoprotein profiles were obtained on days 0, 3, 7, 14, and 28. All cats lost weight throughout the study, and none developed signs of clinical illness, including those of idiopathic hepatic lipidosis syndrome. Serum total cholesterol concentrations decreased initially in all cats, but rapidly returned to normal after day 3 in obese cats, suggesting altered cholesterol metabolism during dietary restriction. Low-density lipoprotein concentrations decreased throughout the study in control cats, but were unchanged in obese cats. Examination of liver biopsy specimens from each cat revealed minimal lipid accumulation in all specimens, although some specimens contained hydropic degeneration.


Fibrinogen-degrading proteins from Haemonchus contortus used to vaccinate sheep.

Sixteen nonsibling sheep, approximately 12 months old, that were raised in a helminth-free environment, were used for 2 protection studies 6 months apart. Sheep were vaccinated weekly for 5 weeks by IM injection of fibrinogen-degrading proteins derived from the intestinal tract of adult Haemonchus contortus. Ten days after the last vaccination, sheep were given 2,500 infective H contortus larvae by intraruminal injection. Vaccinated sheep produced specific antibodies, and were protected from the worm challenge. Significant differences in mean fecal worm egg counts for 56 days after worm challenge, in mean numbers of H contortus worms, and female fecundity ratios at necropsy were detected in vaccinated sheep, compared with those in control sheep. These data suggest that the fibrinogen-degrading proteins have a protective role in vaccination of sheep against H contortus.


Evaluation of the dermal effects of cast padding in coaptation casts on dogs.

Three configurations of cast padding and no cast padding were evaluated for their effects on skin in dogs. Padding was placed over bony prominences, between bony prominences, and over both areas for full-length padding under short-limb walking casts applied to 1 pelvic limb of Greyhounds. Evaluations were performed by pressure measurement over the calcaneal tuberosity, measurement of skin thromboxane B2 (TxB2) concentrations in skin over bony prominences, and measurement of plasma TxB2 concentrations. Pressure studies were performed to evaluate cutaneous pressures related to no cast padding and various configurations of cast padding. Concentrations of TxB2 in the skin were determined to evaluate the skin inflammatory effects of no padding and the padding configurations, and TxB2 concentrations in the plasma were analyzed to ascertain whether they could be used to predict impending dermal pressure lesions. Flexion of casted limbs revealed the greatest pressure over the calcaneal tuberosity with full-length cast padding. This was followed in decreasing order by no cast padding, padding over the prominences, and padding between the prominences. Compared with all other bony prominences and padding configurations, TxB2 skin concentrations were significantly higher over the calcaneal tuberosity when no padding was used and over the lateral base of metatarsal V when padding was placed between the prominences. Over the calcaneal tuberosity, this was attributed to the sharpness of the prominence and its potential for movement. This high TxB2 concentration corresponded to the high pressure found in the pressure studies. Over the lateral base of metatarsal V, the increase in TxB2 concentration was related to the mass of the prominence and the tendency for localized padding to settle around the area.(ABSTRACT TRUNCATED AT 250 WORDS)


Serum and skin concentrations after multiple-dose oral administration of trimethoprim-sulfadiazine in dogs.

Six healthy adult mixed breed dogs were each given 5 oral doses of trimethoprim (TMP)/sulfadiazine (SDZ) at 2 dosage regimens: 5 mg of TMP/kg of body weight and 25 mg of SDZ/kg every 24 hours (experiment 1) and every 12 hours (experiment 2). Serum and skin concentrations of each drug were measured serially throughout each experiment and mean serum concentrations of TMP and SDZ were determined for each drug for 24 hours (experiment 1) and 12 hours (experiment 2) after the last dose was given. In experiment 1, mean serum TMP concentration was 0.67 +/- 0.02 micrograms/ml, and mean skin TMP concentration was 1.54 +/- 0.40 micrograms/g. Mean serum SDZ concentration was 51.1 +/- 12.2 micrograms/ml and mean skin SDZ concentration was 59.3 +/- 9.8 micrograms/g. In experiment 2, mean serum TMP concentration was 1.24 +/- 0.35 micrograms/ml and mean skin TMP concentration was 3.03 +/- 0.54 micrograms/g. Mean serum SDZ concentration was 51.6 +/- 9.3 micrograms/ml and mean skin SDZ concentration was 71.1 +/- 8.2 micrograms/g. After the 5th oral dose in both experiments, mean concentration of TMP and SDZ in serum and skin exceeded reported minimal inhibitory concentrations of TMP/SDZ (less than or equal to 0.25/4.75 micrograms/ml) for coagulase-positive Staphylococcus sp. It was concluded that therapeutically effective concentrations in serum and skin were achieved and maintained when using the manufacturer's recommended dosage of 30 mg of TMP/SDZ/kg (5 mg of TMP/kg and 25 mg of SDZ/kg) every 24 hours.


Perceiving and re-perceiving objects.

A number of experiments exploring priming effects and automatization in the perception of novel objects are described, and a framework for understanding the benefits and costs of re-perceiving previously seen objects is proposed. The suggestion is that perceiving an object creates a temporary representation in an object file that collects, integrates, and updates information about its current characteristics. The contents of an object file may be stored as an object token and retrieved next time the object appears. This facilitates its re-perception when all of the attributes match and may impair it if some are changed. Thus, the world molds our minds to capitalize on earlier experiences but at the same time leaves us able readily to detect and represent any novel or unexpected objects and events.


Scientific rewards and conflicts of ethical choices in human subjects research.

The primary responsibility of the American Psychological Association's (APA) Committee on Standards in Research (CSR) is to advise the APA on issues and standards related to the protection of human participants in psychological research. A related goal is to enhance the use of good ethical practices by APA members. The purpose of this article is to foster the view of research ethics not as an affront to the integrity of sound research, but as opportunities for scientific rewards, including increased understanding of the meaning of data, enhanced recruitment, and the inclusion of more representative samples. Three ethical practices are discussed as examples of this general premise: respect for confidentiality, use of debriefing, and assurance that participants are noncoerced volunteers. The Committee's intent is to promote consideration of these issues, not to promulgate specific guidelines or procedures.


[Attitude towards parents after the death of their newborn infant in a neonatal unit].

We have analyzed the neonatology team's actions, as well as the parent's reactions, after the death of a newborn baby in the Intensive Care Unit. A questionnaire was drawn-up and sent to 180 parents of decreased newborn babies in order to get to know their opinions about certain aspects related to their experience in the hospital. Only 49 out of the 180 (27.2%) questionnaires were sent back. From their answers, we would like to stress their positive opinion regarding both the medical care (95%) and the information that they received (93%). The suggestion that the hospital should have a trained team of trained professionals available to provide psychological support in such situations was made in 95.9% of the questionnaires. This analysis has justified changes in our team's procedure when confronted with newborn deaths.


[Clinical and laboratory indicators of etiology of diarrhea].

Several clinical symptoms and laboratory findings from 352 pediatric patients, seen in the Emergency Room for acute diarrhea, were evaluated in order to develop a method to predict the bacterial etiology of the diarrhea. According to the microbiology findings, the patients were classified into two groups: proven bacterial diarrhea and diarrhea of another etiology. Among all clinical symptoms recorded, only the following were found to be useful for the prediction score: fever greater than 38 degrees C (8 points), fecal mucus (8 points), over fecal blood (6 points) and the presence of fecal leukocytes in a wet mount (7 points). An alternative score useful for outpatients was developed that does not include a score for the wet mount. When the fecal leukocyte score was included and a cutoff value of 20 points was assigned, a sensitivity of 74% and a specificity of 83% were obtained. When the score for the fecal leukocytes was excluded and a cutoff value of 13 points assigned a sensitivity of 84% and specificity of 59% were obtained. These rapid and simple scores may be useful methods for predicting acute bacterial diarrhea in children.


[Suicide attempts in childhood and adolescence: risk factors].

The rate of suicides among adolescents has shown a disturbing increase during the last decades, becoming one of the most important issues in child and adolescent psychiatry. Suicide attempts increase steadily with age, especially among girls, who grossly out-number boys in the number of attempted suicides. However, clinicians face a difficult dilemma in identifying those children who are at the greatest risk for medically serious suicide attempts. This paper presents the results of the risk factors studied in 30 children and adolescents who have made suicide attempts compared to a matched control group. A broken home or loss of the father, alcoholism, disturbed upbringing and family relationships, previous suicide attempts, school failure and social isolation of the family were among the risk factors most frequently present.


[Bone marrow transplantation in malignant diseases in childhood using reverse isolation technics: evaluation of results].

Between July 1985 and March 1990, 31 pediatric patients with neoplastic diseases underwent bone marrow transplantation (22 allogenic and 9 autologous). Routine reverse isolation techniques with sterilization of the gastrointestinal tract were used in all cases. Of these patients, 55% had fever and 32% had a documented infection. In allogenic bone marrow transplants, 23% developed graft-versus-host disease, grade I-IV. The incidence of infection and graft-versus-host disease compares favorably with other published reports from centers utilizing laminar air flow rooms during bone marrow transplantation. This suggest that standard reverse isolation techniques may be used without increasing the morbidity and mortality in these patients.


[Evaluation of the Andalusia Vaccination Program in the Sierra de Cádiz Sanitary District].

One of the foundations for good child care is the application of a vaccination program. With this report we evaluate the vaccination coverage (January 1991) of a group of children (1319), born during 1988 between January 1st and October 1st, in the Sierra of the District of Cadiz. Our results show that 87.64% participated in the Vaccination Program. The first vaccination was received by 80.06% of these children. This rate decreased as we advanced through the vaccination calendar, reaching 76.34% for the measles/mumps/rubella vaccination and 66.71% for the vaccination at 2 years of age. Therefore, one-third of this child population did not complete the vaccination schedule. The most frequently found complication was a local reaction, whereas the counter-indication most frequently observed was an acute infectious illness.


[Pneumococcal meningitis in the infantile population of Cantabria].

A retrospective study of pneumococcal meningitis was carried out. This study included 22 cases of this illness that occurred in 17 pediatric patients in Cantabria between 1977 and 1990, inclusive. Three children suffered from recurrent meningitis. The age range of the patients was 0.3-14 years, with a mean age of 4 years. Of these cases, 77.4% occurred in the winter or spring. In 14 cases of meningitis (63.6%), corresponding to 9 patients, underlying pathology was observed: cranial fracture, occipital dermoid cyst, splenectomy, congenital cardiopathy, epilepsy and gastroduodenal "situs inversus". The isolated pneumococci were found to be resistant to penicillin and chloramphenicol in 4 cases. One patient suffered from septic shock. The outcome was complete recovery in 19 cases (86.4%), recovery with sequelae (deafness and epilepsy, respectively) in 2 cases (9.1%) and death in another 2 cases. CSF protein levels elevated above 150 mg/dl and the absence of glucose in the CSF were found to be the most useful analytical indicators of the seriousness of the illness.


[Prognosis in recurrent peripheral idiopathic facial paralysis in childhood].

Fifty-nine cases of idiopathic peripheral facial palsy were diagnosed in our unit during the period from January 1, 1984 to December 31, 1989. During follow-up examinations we observed a relapse in eleven cases, corresponding to 18.6% of the patients. Nine patients suffered a relapse once, one case twice and another case four times. The children that presented more than one recurrence have later shown functional sequelae, both clinical and neurophysiological. We conclude that in our series of patients relapse of facial palsy is a factor that worsens the prognosis for recovery. Furthermore, the existence of facial palsy in the family history leads to a greater risk of a recurrence.


[Esophageal atresia and associated anomalies].

Twenty-seven newborns with esophageal atresia were reviewed for the presence of other congenital associated anomalies. The incidence of esophageal atresia was 2.6 cases for every 10,000 live births. Associated anomalies were present in 59.25% of these cases. Cardiac malformations were the most frequent associated defect (40.7%). Ten infants met the criteria for VACTERL association. The birth weights and gestational ages were similar for both the surviving and deceased infants. Broncho-aspiration was the only significant factor associated with mortality: 75% of the infants who had broncho-aspiration died, versus only 26.3% if aspiration was not present. When associated anomalies were present, mortality was 56.25%, whereas only 18.18% of the infants without these anomalies died (p = 0.055). We conclude that only broncho-aspiration and associated anomalies relate to mortality in esophageal atresia, whereas the birth weight, the other Waterston's prognosis factor, is not important.


[Renal function in diabetic children and adolescents. Relation to the duration and level of control of the disease].

We have evaluated different aspects of the kidney function of 68 diabetic children and adolescents with the aim of estimating the prevalence of nephropathy and its influential factors. In addition, the kidney function is followed for an additional 18 months. The results are compared with those obtained from a group of healthy children of the same ages. No clinical nephropathy existed, with only 4 (5.97%) and 8 cases of incipient nephropathy and microalbuminuria, respectively, being demonstrated. The urinary albumin excretion rate (AER) is very clearly connected with the duration and the metabolic control of diabetes. Elevated values for AER were also observed in poorly controlled diabetics and those with prolonged evolution. Nevertheless, the last point may be secondary to the development of puberty, since with the same duration of diabetes (under 5 years), the proportion of pubertal patients with microalbuminuria is higher than that for prepubertal children.


[Piriform sinus fistula, a new disease].

Pyriform sinus fistula has recently been described as a new, rare and little known pathology. The process develops as latero-cervical suppurative adenitis or acute suppurative thyroiditis, usually on the left side. Radical surgery is mandatory to avoid recurrence. This congenital malformation must be present in the differential diagnosis of recurrent infectious cervical processes, especially in acute thyroiditis. The only curative treatment is complete exeresis of the fistula after meticulous dissection of the fistulous tract. We present three cases of this pathology. The diagnostic approach and surgical treatment are discussed. The recent literature on this topic is reviewed.


[Epidemiology of malignant tumors of the larynx and lung].

Respiratory tract cancers, unlike most other cancers, have known causes and are susceptible to primary prevention. According to a large population-based case-control study in Southern Europe, over 90% of the present incidence of laryngeal cancer could be prevented by avoiding smoking and alcohol consumption. Most of the risk is attributable to tobacco, but reducing alcohol alone could still prevent a quarter of the cases. Tobacco smoking, on the other hand, explains 80 to 90% of lung cancer incidence in Italy. Other known causal factors include: occupational exposures, which, according to several studies, may account for one third of the cases in the highly industrialized areas of Northern Italy; environmental pollution; passive smoking; radon; and dietary factors. Factors associated to a diet rich in fruit and vegetables have been found to be protective for both larynx and lung cancer in several studies carried out in Italy and elsewhere. The factors associated to this diet may be a major determinant in the North/South gradient in incidence and mortality consistently observed in geographical and migrant studies on respiratory cancers in Italy. Cigarette smoking, however, remains by far the most important cause of respiratory cancer, and geographical and temporal trends in incidence can easily be interpreted in terms of market trends, both in Italy and worldwide. According to several population surveys in Italy, the prevalence of smokers in successive male cohort generations reached a maximum (almost 80%) in the 1920-1930 birth cohorts and decreased to about 60% among males born in the forties and fifties. In the same period, the mean number of cigarettes per day for smokers increased, and the age of starting smoking decreased; however, the market changed from unfiltered black tobacco to filtered low-tar cigarettes. This market trend is consistent with the observation of decreasing incidence and mortality of both larynx and lung cancer in young male cohorts and the persistent increase of both cancers in older males. As for women, the prevalence of smokers increased from less than 10% in the 1920's birth cohorts to over 30% among women born in the late forties. This is reflected by a steady increase of respiratory cancers mortality which, however, is still lower than the mortality for males.


[Etiological epidemiology of tumors of the nasal cavities and the paranasal sinuses].

Etiologically-oriented epidemiologic studies on cancer of the nasal cavities and paranasal sinuses have been carried out since the beginning of the century. These studies showed that several chemical agents (chromates, nickel compounds, isopropylic alcohol, and mustard gas), and two occupational exposures (wood dust in the furniture industry and exposure to leather in shoe factories) were causally associated with nasal cancer. An increased risk has also been associated with several occupations (i.e. metalworker, textile worker, construction worker, and farmer) even in the apparent absence of causal agents. The first reports of an increased risk of nasal cancer in woodworkers and leather workers in Italy date back to 1980. Subsequent studies have provided estimates of the relative risk, ranging from 3.0 to 11.0 among woodworkers and from 8.1 to 47.1 among leatherworkers. Increased risks have been associated to the metal industry (relative risk ranging from 3.1 to 5.9), the textile industry (ranging from 2.9 to 17.0), the mining and construction industry (ranging from 2.3 to 5.3), and the agricultural industry (ranging from 1.9 to 3.3); all of these estimates are time- and place-specific. Moreover, the estimates are not reliable because of the small sample size, resulting from the low occurrence of the disease. The etiologic fraction for the population, taking into account both verified and suspected carcinogenic exposures, ranges between 50% and 65% in males. Relatively few cases of nasal cancer (all of them occurring in woodworkers) have been notified for workman's compensation; woodworkers with nasal cancer have received monetary compensation in Italy since 1988. Nasal cancer is an often fatal but largely preventable disease. Several verified and suspected occupational exposures are associated with this neoplasm. The reduction of dust and fumes in the air of the above mentioned work environments is recommended for reducing the occurrence of this disease.


[Use of mortality data for the study of the distribution of respiratory tract tumors in Italy: characteristics and quality of the data].

This paper reviews Italian studies that deal with the accuracy of death certificates in patients with cancers of the respiratory system, particularly cancers of the larynx, lung, and pleura. These studies consider death certificates vs postmortem examinations, diagnoses histologically confirmed, and clinical and cancer registry records. The large number of cases cured by surgery is reflected in the lower levels of larynx cancers mortality vs incidence. Site misclassifications, and erroneous reports of cancer on death certificates for patients cured of the disease, lead to an overreporting of death certification vs autopsies. The death certificates for lung cancer have a high agreement with clinical diagnoses, but present underreporting when compared to autopsies, which frequently discover tumors at postmortem examination. Pleura cancer is often misclassified as lung cancer. Improvement in death certification over time could have influenced the observed increase in the mortality trend for this tumor.


[Estimation of the impact of cigarette smoking reduction on mortality from tumors of the lung and larynx].

In 1987, in Italy, 27,106 men and 4,159 women died from lung cancer or larynx cancer. Taking into consideration the smoking habits of the Italian population and the relative risks for pulmonary cancer, of smokers and ex-smokers versus nerve smokers, we estimate that 87% of deaths can be attributed to smoking. We know from previous studies that quitting smoking results in the reduction of the risk elapsed since quitting and that this reduction depends on the time and on the quantity of tobacco previously smoked before the cessation. We estimated the reduction in the number of deaths due to respiratory cancer if part of the population were to quit smoking. In males aged 35-74 years after 12 years, there would be 3,604 fewer deaths if 10% quit smoking and 11,915 fewer deaths if 100% quit smoking.


[Trends in mortality from respiratory tract tumors in Italy, 1969-1987].

Trends of Italian death certification for cancers of the lung, larynx, pleura and nasal sinuses were analyzed for both sexes in the period from 1969 to 1987. For lung and laryngeal cancer, the analyses have been conducted for broad geographical areas within Italy (North, Center and South). Mortality rates for males aged 35-44 years consistently decreased in the North; increased until the late 1970's, and then decreased in the Center; and consistently increased in the South. In the 45-54 age group, mortality rates peaked in all areas between the late 1970's and the early 1980's, subsequently decreasing. For ages over 54 years, the rates continued to increase even in the 1980's. Female lung cancer rates increased in all areas and in all age groups over 35 years. In the 25-34 years old age group the rates decreased in the North and tended to increase in the Center and in the South. Below age 50, the increases were proportional in the three areas, while for older ages the increase was greater in the North both in absolute and proportional terms. Cohort effects showed a general increase for the generations born up to 1930, in both sexes and in all geographical areas. Different trends were observed for cohorts born after 1940: decreasing for both sexes in the North, and steady for men and increasing for women in the other areas. From the mid 1970's, laryngeal cancer standardized rates for 35-64 age group decreased, or at most remained constant, in all geographical areas. The decreasing tendency was more marked in men. Larynx cancer cohort effects for men were at a maximum for cohorts born around 1990, decreasing thereafter. In women, cohort effects appeared to consistently decrease. Overall rates of pleural cancer mortality increased during the period 1969-1987, and the sex ratio was stable, from 1980 onwards, at a value of about 2.4. Cohort effects showed, for pleural cancer, a general increase for all the cohorts. The increase was particularly apparent in male cohorts born after 1930. Overall mortality rates for cancer of the nasal sinuses was rather stable in both sexes from 1975 onwards. However, in the 35-64 year age group, mortality rates increase for males and decreased for females.


[Analysis of the geographic distribution of mortality in Italy caused by tumors of the respiratory system].

This paper describes the geographical distribution of respiratory cancers in Italy during the period 1970-87. We analysed mortality rates for cancers of the larynx, of the lung, of the paranasal sinuses, and of the pleura in the 95 Italian provinces. For all considered sites, Northern Italy showed the highest levels of mortality. Only Rome and Naples, the most urbanized provinces in the Central and Southern Italy respectively, presented mortality rates comparable to the Northern provinces, particularly in the early 1970's. The geographical distribution of mortality for all considered sites appears to be consistent between the two sexes. For lung cancer, however, the difference between the North and the rest of the country during the considered period decreased in men but steadily increased in women.


[Analysis of mortality in relation to various demographic phenomena: migration and marital status].

This paper analyzes the mortality of major respiratory cancers, certified in Italy in the years 1981-84, by two demographic phenomena: migration and civil status. Direct standardized rates were computed using the total population as reference; a partial analysis of mortality by all causes was also performed. Because of the industrial development in some areas of Italy, great migrations took place in the past within the country, with specific and well known geographic and time patterns. This paper mainly considers migrations towards the industrialized regions of the north-west both from the north-east, occurring between the two world wars, and from the south regions, occurring from the fifties to the seventies. Various studies have shown that cancer mortality decreases with the geographic latitude of the area studied, and that there is a protective effect associated with being born in the southern part of the country. Italian regions were grouped into five areas: north-west, north-east, north-central, south-central and south. Individuals born in the same area of the last residence were defined as "stable", while "migrant" indicates that the area of birth differed from the last residence; for "internal migrant" both regions of birth and last residence are in the same area. For migrants to the north-west, rates by age are reported. For larynx cancer, only mortality of males is discussed. Our study's results confirm that lung cancer mortality is always higher for migrants than it is for stables from the same birth area. Immigrants also show higher rates of lung cancer mortality than the stables in the host areas. The rate ratio of emigrants versus stables in the birth area increases towards the south. The increasing protective role of birth area with decreasing latitude is confirmed for both stables and immigrants. Subjects in the north-west who emigrated from the north-east show age-specific mortality rates higher than stables, both in host and birth areas. Immigrants from southern areas show rates equal to the stables of the host area with increasing age. Results for lung cancer mortality suggest that migrants differed from the stables in socio-economic characteristics not only in the birth areas but also in the host regions. For larynx cancer, migrants and stables show similar rates. Mortality rates for internal migrants and stables decrease with latitude; the protective role of birth area in immigrants is less evident.(ABSTRACT TRUNCATED AT 400 WORDS)


[Incidence of respiratory tract system tumors in Italy: data from the Tumor Registry].

Nine population-based cancer Registries are active in Italy, covering about one tenth of the population. Six Registries (Torino, Varese, Trieste, Genova, Parma, and Forlì) are located in the North of Italy, two Registries (Firenze and Latina) in the Center and one (Ragusa) in the South. Incidence data (total number of registered cases; age-specific, age-standardized, truncated, and cumulative rates) and indices of reliability (% of cases with histological verification of diagnosis; % of cases registered only as a result of death certification; and mortality/incidence ratio) are tabulated for the period 1983-87. Respiratory tumors are classified according to the three-digit codes of the International Classification of Diseases, ninth revision: 160, nose and sinuses; 161, larynx; 162, lung; 163, pleura. Standardized incidence rates for lung cancer range between 48.8 x 10,0000 (Ragusa) and 115.3 (Trieste). All the Registries in the North and in the Center show high levels of risk; rates are reduced to half for the two southern Registries. Laryngeal tumors show a similar pattern: the highest rate is observed at Trieste (21.1), and the lowest is for Ragusa (10.1). The risk of primitive pleural cancer is very high for Trieste (6.1) and Genova (5.3), where the shipyard industry is present, and homogeneously low for the other Registries. Frequency of nasal tumor is too low to establish descriptive comparisons. As a whole, for larynx, lung, and pleura, the figures from incidence data confirm those from mortality data.


[Survival in respiratory tract tumors: Italian population-based data and international comparisons].

Population survival studies are usually carried out within population-based cancer registries and are useful mainly for geographical and temporal survival comparisons. Survival studies based on clinical series of patients are traditionally executed to evaluate the efficacy of a given treatment or to analyze the prognostic role of clinical factors. Subjects from a case-control study on incidence of larynx and hypopharynx cancers in Turin, for the period 1979-82, were followed-up in order to study their survival. The analysis was based on 347 cases of larynx cancer (319 males and 28 females) and 48 cases of hypopharynx cancer (47 males and 1 female). For larynx cancer, observed five-years survival was 59% in males and 64% in females. Hypopharynx cancer had a worse prognosis (21%). In males suffering from larynx cancer, older age, extent of spread, birth in Northern Italy, and being unmarried proved to be statistically significant negative prognostic factors. The same variables were also predictive of survival for hypopharynx cancer. The one- and three-year relative survival for larynx cancer in Turin was higher than that reported by other cancer registries. For males, relative five-year survival figures range from 47% to 65%. Survival for hypopharynx cancer is considerably lower, five-year figures ranging from 13% to 35%. The survival study on lung cancer was based on all the incident cases recorded by the Lombardy Cancer Registry (L.C.R.) from 1976 to 1981; during this period there were 2042 cases of primary lung cancers occurred in males and 217 in females. Observed survival at one, three and five years from diagnosis was 29%, 8% and 5%, respectively. Survival decreased with increasing age; no important differences between sexes are evident. Information on tumor stage was available in 1904 cases and histotype was known in 1605. Three-year survival was 17% for localized tumors, 8% for tumors with regional metastasis, and 1% for tumours with distant metastasis. Epidermoid carcinomas had a better prognosis than non-epidermoid carcinomas in the first year of follow-up, survival being 38% and 29%, respectively; among non-epidermoid carcinomas the worst prognosis was for small-cell carcinomas. Comparisons between the LCR relative survival and that reported by other cancer registries did not show important differences, five-year figures ranging from 5% to 10% in males.(ABSTRACT TRUNCATED AT 400 WORDS)


[Prospects and indications for the prevention of respiratory tract tumors].

Respiratory cancers are suitable targets for primary prevention, since their causes are largely known and can be eliminated. Reasonable short-term objectives include the reduction of tobacco use (and alcohol abuse), the control of exposure to carcinogens in the workplace, as well as the reduction of air pollution in the general environment. The International Agency for Research on Cancer has estimated that in countries like Italy the elimination of cigarette smoking could reduce larynx cancer by 85% (if accompanied by a decrease in alcohol consumption), and lung cancer by 80% in males and 60% in females. An almost complete elimination of exposure to carcinogens in the workplace could potentially reduce lung cancer by 10%, whereas eliminating exposure to asbestos could certainly reduce pleural cancer by more than 50%. The proportion of lung cancer attributable to pollution in the general environment is unclear. Preventive measures require legislative support. Since October 1991, stores throughout Italy, in compliance with a new law, started carrying the first cigarette packages that included warnings against the hazards of smoking. Not since Law 584 of 1975, which forbids smoking in public places, has such an important legislative measure been passed. As a consequence of Law 584, smoking in many public places (e.g. movie theaters and, more recently, domestic flights) is today unthinkable, and these restrictions have been widely integrated into the Italian way of life. In developed countries, there is no doubt that the reduction of cancer due to the elimination of tobacco would be greater than that due to eliminating exposure to risk factors in the workplace.(ABSTRACT TRUNCATED AT 250 WORDS)


[Incidence and prevalence of respiratory tumors in Italy. Estimation from mortality data].

This study estimates the incidence and prevalence of larynx and lung cancers using a mathematical model based on available data on specific mortality and survival. In Italy, larynx and lung cancers account for more than 95% of respiratory cancers. In this paper, estimates of age/sex-specific and age-standardized incidence rates and prevalence are presented for the years 1970 and 1987. Age and birth-cohort effects on incidence are also presented by sex and broad geographical area. The procedure was firstly validated using data from four cancer registries: Varese (Northern Italy), Parma (North-Central Italy), Florence (Central Italy), and Ragusa (Southern Italy). Estimates were then carried out at the national level and for each major geographical area (i.e. North, Center and South). Larynx cancer age-standardized incidence rates increased for men by about 25% from 1970 to 1987. Age-specific rates increased for ages greater than 44 years, but decreased for younger ages. Cohort effects are low for older cohorts; they steeply increase and plateau for the 1900-1905 cohorts, and then peak for the 1930 cohort. The risk for cohorts born after 1930 systematically decreases. We estimated that the 1930 birth cohort has a risk five times higher than the 1890 cohort. For women, the incidence rates increased by about 30% from 1970 to 1987, for all age classes. Cohort effects steadily increase from the 1886 birth cohort to the 1960 cohort. The estimated prevalence between ages 30 and 84 increased from about 24,400 cases in 1970 (23,000 males and 1,400 females) to about 51,400 cases in 1987 (48,600 males and 2,800 females). For men, 42% of the increase can be attributed to an increase in the incidence of the disease; 45% can be attributed to population aging, and only 13% to an increase in the survival probability. Corresponding figures for women are 42%, 48%, and 10%. For lung cancer, we estimated 32,000 incident cases for 1987 (28,000 men and 4,000 women), two times the corresponding figures for 1970 (14,000 men and 2,000 women). Looking at age-adjusted rates, the overall risk of lung cancer increased by about 60% for men and 52% for women during a period of 17 years. Age-specific incidence rates increased proportionally with age for ages greater than 50 years. By contrast, there was a slight but systematic risk reduction in younger age classes.(ABSTRACT TRUNCATED AT 400 WORDS)


Event-related potential investigations of cognitive development and aging.

Comparison of the results of the studies of cognitive development and normal aging suggests a large degree of commonality in both behavioral and ERP effects across a wide age range. Whether measured in young children, adolescents, young, middle-aged or elderly adults, the size of the ERP repetition effect did not differ among the various age groups. This was true whether memory was tested directly during continuous recognition or indirectly during variants of semantic categorization tasks. Similarly, in the studies of adult aging, the degree of RT facilitation during the semantic task did not differ with age and, in both the studies of cognitive development and aging, the degree of RT prolongation during the explicit tasks did not appear to differ as a function of age. Moreover, in the studies of adult aging, the effects of three versus two exposures of a word assessed in the PM session (TABLE 1), modulated RT similarly in all three age groups. These data argue for continuity of information processing across a very wide age range during both direct and indirect memory tasks, when retention is assessed during the recognition (for explicit testing) and repetition (for implicit testing) phases of the task. Since ERP and RT modulation do not appear to differ with age during the retrieval phases of these experiments, how can the performance differential seen in young children and older adults be explained? Some evidence comes from the ERP data recorded during the study phases of our explicit tasks. During continuous recognition, both young children and elderly adults did not show the typical subsequent "memory effect." In the case of the children, the subsequently unrecognized ERP was larger than the subsequently recognized ERP, whereas for the older adults, there was no difference between these two ERPs. Moreover, during these same tasks, the young children did show the "crossover" (new greater than old) pattern for slow wave activity, whereas the older adults did not. Since these ERP findings were obtained during the acquisition phase (i.e., to new items that had to be encoded for subsequent retrieval), the data argue for encoding difficulties as one means of explaining the performance differences seen at the two ends of the age spectrum. However, since the older adults displayed a different new/old pattern for slow wave activity, the two age groups may differ qualitatively in the strategies employed to encode items for subsequent retrieval.(ABSTRACT TRUNCATED AT 400 WORDS)


Attention and para-attentional processing. Event-related brain potentials as tests of a model.

In 1972 when we began to analyze the vast amount of material from the laboratories of physiological psychologists, we had only a vague conceptualization of what a model of attention might look like. We began where everyone else had, with the view that everything had something to do with "arousal" but with Lacey's (1967) warning in mind that all of the dependent variables might not actually be measuring aspects of the same process. With this warning in mind, we were forced by the data to organize them into a three-systems mode. Since the first publication of this model in 1975, we have found increasing amounts of evidence to support and extend it. This evidence is briefly reviewed in the present paper in terms of the techniques employed in various types of investigation. Further, the current review of data has made it possible to specify the para-attentional substrate (the extrinsic lemniscal primary projection systems) upon which the three systems described in the earlier model operate. The earlier model was based on psychophysiological, neurobehavioral and neurochemical analyses while the current specification results from the results of recordings of event-related brain electrical responses. The conclusions derived from these results can be summarized as follows: First. It has become possible to distinguish controlled attention from the para-attentional pre- and post-attentive automatic processes upon which controls operate. Second. The pre- and post-attentive processes appear to be coordinate with activity in the extrinsic lemniscal primary sensory projection systems. Processing in these systems is reflected in the early components of event-related brain electrical potentials. These extrinsic systems are, however, not just throughputs for further processing. Rather, they are sensitive to the history of reinforcement which the subject has experienced. The concept of a limited channel capacity must, therefore, be modified to encompass this ability of organisms to improve, through practice, their competence to process a great deal of information in parallel. Competence, not capacity, limits central processing span. Third. A set of intrinsic extralemniscal processing systems has been identified to operate via a tecto-tegmental pathway to the reticular nucleus of the thalamus. The later components (N2P3, etc.) of event-related potentials have been shown to reflect processing in these systems and those that control them. Activity in these systems has been related to targeted conscious awareness.(ABSTRACT TRUNCATED AT 400 WORDS)


Selected problems of analysis and interpretation of the effects of sleep deprivation on temperature and performance rhythms.

One of the major methodological-analytic problems encountered by researchers in sleep deprivation involves the examination and analysis of the relationship between sleep loss and rhythmic influences on performance. The comparison of performance rhythms with physiological rhythms, e.g., body temperature, generated under the same conditions of sleep deprivation, has become an important means of testing for an endogenous source of the rhythmicity in the data and for clarifying the nature of the proposed oscillator system. Should the data sets be correlated before or after their separation into monotonic and rhythmic parts? Correlating the raw data without separating them into their components can yield negative results, while, in reality, some of the major underlying rhythms may be highly related. The example used in this chapter showed strong cross correlations of the circadian components of temperature and two performance tasks. Sleep deprivation is thus seen to interact with performance rhythms. This interaction is only revealed after the data are analyzed and broken into their component parts. This procedure leads to the conclusion that certain performance rhythms and temperature may share the same generating oscillators.


Electrophysiologic investigation of lower cranial nerve diseases by means of magnetically stimulated neuromyography of the larynx.

Zoom endoscopic electromyography of the larynx, as introduced in 1979, has contributed greatly to the diagnosis of lower cranial nerve palsies, but in the early stage of a vagus nerve disorder one cannot investigate the nerve conduction from the brain stem to the laryngeal muscles with electrical stimulation. As with the early diagnosis of facial nerve palsies, up to now the intracranial part of the motoric brain nerves could not be stimulated directly. With a new magnetic coil device (Novametrix, Magstim 200) this intracranial stimulation is easily possible in the awake patient with painless magnetic stimuli that induce a muscle action potential into the laryngeal muscles. Hence, an immediate diagnosis is possible. Two coils with mean diameters of 8.5 or 3 cm were used. The stimulator delivered current pulses of peak amplitude up to 5,000 A with rise times of 140 microseconds and 65 microseconds, respectively, that generated peak fields of up to 2 T. In a healthy population, cisternal stimulation of the vagus nerve leads to a muscular response in the vocal muscle after 4 to 6.6 milliseconds (mean 5 milliseconds). Cortical stimulation leads to such a response after 9.5 to 12 milliseconds. Potentials in healthy individuals have been shown to be very uniform. Stimulation in recurrent nerve palsies may show prolongation of these latencies up to 30 milliseconds. The method is limited by the fact that complete neural blocks cannot be overcome by proximal stimulation. We have applied magnetic stimulation to 190 patients with different disorders of the vagus nerve.(ABSTRACT TRUNCATED AT 250 WORDS)


Does intervention improve the natural course of glomus tumors? A series of 108 patients seen in a 32-year period.

To acquire more insight into the results of treatment versus the "natural" course of glomus tumors, we studied the clinical data of 108 patients, in 58 of whom the disease was hereditary. During a period of 32 years (1956 to 1988), 175 tumors were diagnosed: 52 glomus jugulotympanic tumors, 32 vagal body tumors, and 91 carotid body tumors. The results of radical surgical treatment were disappointing for tumors located at the skull base, ie, nonradical in 59% (n = 23) of the cases, but very good for the carotid body tumors, for which 96% (n = 68) radical excision was achieved. Moreover, surgery at the level of the skull base dramatically increased morbidity, since it frequently induced cranial nerve palsy. During the follow-up period (maximal observation time 32 years, mean 13.5 years) none of the patients died of residual or recurrent tumor or developed distant metastases, irrespective of the mode and outcome of treatment. When these results are combined with the results of pedigree analysis, a realistic approximation of the "natural" course of the disease for both hereditary and nonfamilial tumors can be made. The results raise the question of whether this natural behavior is really improved by intervention. We conclude that removal of carotid body tumors and solitary vagal body tumors should be considered in order to prevent future morbidity. However, for skull base and bilateral glomus tumors a more conservative monitored "wait and see" policy can be sensible and should be considered in any proposal for treatment of head and neck paragangliomas.(ABSTRACT TRUNCATED AT 250 WORDS)


Off-vertical axis rotation: a test of the otolith-ocular reflex.

The vestibulo-ocular reflex was studied via off-vertical axis rotation (OVAR) in the dark. The axis of the turntable could be tilted from vertical by up to 30 degrees. Eye movements were measured with electro-oculography. Results from healthy asymptomatic subjects indicated that 1) a reliable otolith-induced response could be obtained during constant velocity OVAR using a velocity of 60 degrees/s with a tilt of 30 degrees; 2) constant velocity OVAR rotation was nausea-producing and, especially if subjects were rotated in the dark about an earth-vertical axis prior to being tilted, disorienting; and 3) sinusoidal OVAR produced minimal nausea; the eye movement response appeared to be the result of a combination of semicircular canal and otolith components. We conclude that OVAR has the potential of becoming a useful method for clinically assessing both the otolith-ocular reflex and semicircular canal-otolith interaction.


Stenting for pediatric laryngotracheal stenosis.

The treatment of pediatric laryngotracheal stenosis using open surgery to expand the airway has become a widely accepted and effective method. Stents and cartilage grafts represent the main features of expansion laryngotracheal surgery, which is indicated after failure of endoscopic treatment and/or in the presence of severe stenosis. Stenting is needed in all situations with the exception of using a single cartilage graft in the anterior subglottic lumen. There are several options available for stenting. The most valuable and commonly used stents are the Aboulker stent and the Silastic sheet roll. In looking for the features of an ideal stent, I analyzed 51 procedures using the Aboulker stent on 48 patients. The purpose of this report is to discuss these features and relate them to the Aboulker stent.


Pediatric airway reconstruction at Great Ormond Street: a ten-year review. III. Decannulation and suprastomal collapse.

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Ninety (83%) of the patients were decannulated. Over three quarters of the decannulations took place within 20 months of primary reconstruction. More than half of the patients (47, or 52%) had persistent tracheocutaneous fistulae after decannulation, which required elective closure. The likelihood of a persisting tracheocutaneous fistula is directly related to duration of cannulation.


Comparison of speech recognition ability with different speech processing strategies by Korean cochlear implantees.

Many variables affect the audiologic performance of cochlear implantees. With current methods of evaluation, it is difficult to directly compare auditory function with different speech coding strategies. We compared the audiologic performance directly with F0F1F2 and multipeak speech coding strategies in the same implanted ear of eight Korean cochlear implantees. We tested word and phoneme recognition abilities using Korean word lists for speech audiometry and two-syllable nonsense words, respectively. With the multipeak coding strategy, a significant difference in discrimination ability was found in the initial fricative consonant phonemes (/s/,/ss/,/h/). Our results suggest that the improvement of speech recognition ability with the multipeak coding strategy comes primarily from the better understanding of the initial fricative consonants.


Solitary plasmacytoma of the skull base.

Plasmacytomas involving the skull base are rare lesions that may be well advanced by the time of diagnosis. Because of their anatomic site they may produce a variety of signs and symptoms, some of which may be vague, often resulting in delays in presentation and in appropriate investigations. We present such a patient, discuss the diagnosis and management, and give a review of the literature.


Macroporous biphasic calcium phosphate efficiency in mastoid cavity obliteration: experimental and clinical findings.

Following our previous experimental studies on the performance of macroporous biphasic calcium phosphate (MBCP) in canine mastoid cavities, we used this material in patients requiring surgical intervention. Twenty-two cases were selected, and in eight specific cases a biopsy specimen was taken. Histologic, ultrastructural, and microanalysis studies were performed. This study demonstrates the effectiveness of MBCP implants as bone graft substitutes for mastoid cavity obliteration. Clinical evaluation of the series and histologic and ultrastructural results demonstrated the bioactivity and osteo-conduction of this material, with partial transformation of MBCP granules into lamellar bone after several months.


Airflow study of pathologic larynges using a constant temperature anemometer: further experience.

Phonatory airflow was recorded in 361 laryngeal disease patients and 59 normal subjects by using a constant temperature anemometer to measure Isshiki's proposed parameter, the AC/DC percentage. The pathologic groups displayed AC/DC percentage values smaller than those of the normal group. The value differentials observed among the various diseases suggest that the AC/DC percentage may reflect the vibrational capacity of the vocal cords.


Corneal autoimmunity in Cogan's syndrome? Report of two cases.

Autoimmune reactivity against corneal antigens is described in two patients with Cogan's syndrome, a nonsyphilitic deep interstitial keratitis with vestibuloauditory symptoms. In both cases corneal antibodies were found at the beginning or during an exacerbation of the disease. After administration of high doses of corticosteroids the corneal antibodies diminished. Interstitial keratitis can generally be controlled by local or systemic corticosteroids. The effect of corticosteroid therapy on the audiovestibular symptoms is variable. The possibility of an autoimmune pathogenesis of Cogan's syndrome is discussed.


Giant air cell of the petrous apex: a possible cause of facial hypalgesia.

A giant air cell of the left petrous apex was found in a 23-year-old man with ipsilateral facial hypalgesia. The size of the giant air cell depicted on computed tomography was 1.5 x 2.0 x 2.0 cm. A coronal T1-weighted magnetic resonance image showed that the trigeminal nerve was compressed superomedially by a large signal void area that was probably a result of excessive pneumatization of the petrous apex. It is suggested that the facial hypalgesia was caused by the compression by the giant air cell of the petrous apex on the trigeminal nerve.


Bovine temporal bones as a source of inner ear antigen.

Modern immunologic techniques of immunostaining, immunoblotting, and creation of monoclonal antibodies are gaining wide application in studies of development, function, and pathology of the ear. These techniques require a source of inner ear tissue for production of antigen extract. Human tissue is not readily available, and other mammalian species common in auditory research are small in size. Bovine temporal bones are readily available, and the membranous portions of the inner ear are abundant and easily accessible. Herein we report our technique for acquisition and dissection of bovine temporal bones and preparation and preservation of inner ear antigen.


Quantitative ultrastructural study of cat abducens interneurons.

Abducens interneurons project to the medial rectus subdivision of the contralateral oculomotor nucleus and have a role in the mediation of horizontal conjugate gaze. Two types of interneurons have been reported based on shape (fusiform and circular) and differences in organelles. In this study, 41 abducens interneurons from three young adult cats were examined in the transmission electron microscope and were classified, on the basis of eccentricity (e), as circular (e less than 0.82; N = 18) or fusiform (e greater than or equal to 0.82; N = 23). The volume fraction of nucleus, nucleolus, mitochondria, rough endoplasmic reticulum, polyribosomes, and Golgi complex and the number of synaptic profiles per 100 microns of membrane were determined. Although there is a qualitative difference in these cell types, statistical analyses indicate no significant differences in organelle content, mean area, number of synaptic profiles per 100 microns of membrane, or diameter. While the differences in shape may possibly indicate different functional groups, this notion is not supported by the variables examined or by physiological studies.


Anatomy of the guinea pig temporal bone.

The middle ear of guinea pigs has long been used for experimental studies, but no detailed information about its temporal bone anatomy is available. In 18 adult guinea pigs, the temporal bone, eustachian tube, and inner ear anatomy, in addition to the anatomy of the middle ear, were investigated under the dissection microscope. In addition to properties of the eardrum, ossicles, air cell system, and cochlea previously described, the appearance of Huschke's foramen and the crista stapedis in an adult guinea pig ear, the structure of the eustachian tube, the architecture of the internal auditory canal, and the communication of the mastoid cells with the tympanic bulla are described. Differences and similarities among guinea pigs, other experimental animals, and humans are discussed to show the advantages and disadvantages of the guinea pig ear for experimentation.


[Drug therapies in anxiety disorders of children].

Although childhood anxiety disorders are currently generating new interest, they continue to pose problems in everyday clinical practice. Drug treatment is far from being the only therapeutic approach but does undeniably have a place which should be clearly defined. The main drugs, dosages, indications, and adverse effects of antidepressants, benzodiazepines, antihistamines and neuroleptics which may be used in children with anxiety disorders are discussed.


[Recurrent bronchopneumopathies in the infant due to swallowing dyspraxia. Two cases].

In two infants with recurrent lower respiratory tract infections starting within a few weeks of birth, dynamic electromyographic studies of sucking and swallowing evidenced a disorder of lingual and pharyngeal activities responsible for the episodes of aspiration. The central location of the anomaly was demonstrated by the absence of peripheral neuromuscular anomalies and by the presence of impaired blinking reflexes and brain stem potential anomalies. These neurofunctional anomalies improved over time and magnetic resonance imaging failed to disclose and structural anomalies of the central nervous system. The occurrence of the swallowing disorder as an isolated manifestation and its long duration, with follow-ups of 23 months and 4 years, are two unique features in these cases. Neurophysiologic investigations are essential for documenting the neurologic etiology of the swallowing disorders, demonstrating their location above or within the medulla oblongata, and differentiating functional and organic anomalies.


[Compliance with treatment in diabetic adolescents].

The study of compliance with therapy among teenagers with diabetes mellitus is a challenging task. Although several studies have addressed this problem, available knowledge in this field remains scant and the lack of understanding of factors which determine compliance with therapy hinders the development of interventions capable of helping diabetic teenagers to improve their quality of life. On the basis of a review of the relevant literature, this paper discusses compliance with therapy in the light of the specific features of teenage development. The two main theoretical models used to explain compliance with therapy in adolescent diabetics are presented. Parameters of compliance with therapy and the methods used to measure these parameters are also discussed.