Heterozygous protein C deficiency and coumarin necrosis of the skin.

An obese female patient aged 47 with a personal and familial history of recurrent venous thrombosis, who developed a coumarin-induced skin necrosis is presented. Laboratory investigations, performed three months after the acute event and in absence of coumarin therapy, emphasized a decreased anticoagulant activity of her plasma protein C (50% of the normal). These results as well as the high incidence of thrombotic disease in her relatives point to a familial heterozygous protein C deficiency. The antithrombotic role of the protein C system and the mechanism of coumarin induced necrosis of the skin are briefly discussed.


The variations of the serum IgD and of the circulant immune complexes in diabetic patients.

The levels of serum IgD and of the circulating immune complexes (CIC) were determined in 168 diabetic patients, of whom 78 with type 1, 59 with type 2 and 31 with the so-called "intermediary" type of the disease, in comparison with 124 non-diabetic subjects for IgD and 100 for CIC. The results revealed very low IgD titres (less than 1 mg%, considered undetectable) in almost 3/4 of the cases; values over 1 mg% were recorded mostly in the cases of type 1, followed by those of "intermediary" and of type 2 diabetes. The mean CIC values of 67.13 +/- 36.53 optic density units (O.D.U.) were significantly higher than in the non-diabetic controls. Certain differences with respect to age, diabetes type, duration of the disease and of the insulin therapy were also recorded. The data are interpreted with caution, further investigations being necessary to the assertion of definite conclusions.


Circulating immune complexes and the complements system in lupus nephropathy.

From a group of 75 patients with systemic lupus erythematosus (SLE), 30 patients with lupus nephropathy presenting concomitant changes of the CIC level, of the complement system (C3 and C1q factors) and proteinuria were chosen for the study. In these 30 patients, no statistically significant correlation was observed between CIC level and the value of serum complement. Low serum complement was observed in 89% of the cases while low complement values associated with increases of the CIC level were observed only in 57.8% of the cases. From the values of the C3 and C1 complement factors it results that in 76.6% of the cases of lupus nephropathy the activation of complement was achieved in the classical way. The value of proteinuria presented no significant correlation with any of the parameters investigated. The serum immunogram presented varied aspects and the components of the CIC structure revealed a great diversity of this structure.


The in vitro action of a succussed substance on the proliferative response of human lymphocytes stimulated with phytohemagglutinin.

Human peripheral blood lymphocytes from healthy controls, immunodepressed patients presenting chronic bacterial infections or neoplasias and from allergic patients were stimulated in vitro with phytohemagglutinin (PHA) in culture medium supplemented or not with 1 x 10(-7), 1 x 10(-15) or 1 x 10(-30) succussed dilutions or bee venom or phosphorus in tridistilled water. The most significant inhibition due to DNA incorporation was noted in lymphocytes from allergic patients cultivated in media supplemented with 1 x 10(-30) succussed substance dilution in the presence of PHA. The cells from immunodepressed patients did not show a significant inhibition at 1 x 10(-30) dilution. Hypothetically, we try to explain these findings as the expression of the changes induced by the succussed solution on the water molecule which in turn, influences the chemical structure of the cellular membrane and implicitly, its functions.


[Fracture of the upper extremity of the femur in elderly women: respective role of fall and bone demineralization].

Fractures of the proximal femur in elderly individuals are becoming increasingly common in the industrialized world and represent a heavy burden in both socioeconomic and human terms. Two factors are key to the pathophysiology of these fractures: falls and decreased bone strength due to osteoporosis. Femoral and vertebral bone density was measured in 40 elderly women (83 +/- 5 years) who experienced a fall; in those who developed a femoral fracture as a result of the fall, femoral bone density was lower by 12 to 21% (z score: -0.7 to -1.04) than in those with no fracture, after adjustment for age, height and weight. Femoral neck and trochanteric area measurements had the best predictive value (area under the RoC curve: 75% +/- 8%). These was no difference by anatomic fracture type (neck or trochanter). Patients with pertrochanteric fractures had lower vertebral bone densities than controls. These findings, together with recent prospective data, demonstrate that in addition to falls, bone loss (osteoporosis) promotes the occurrence of fractures of the proximal femur in elderly patients. This has important practical implications for the detection and prevention of these fractures.


The changes of peroxides and total antioxidants in the plasma of patients who received 131I therapeutically.

Fifty patients with thyroid cancer were studied during administration of high doses of 131I (5-50 mCi). Peroxides, total antioxidants and free sulphydryl-groups were measured in the blood samples obtained before and after administration of radioactive iodine. After the administration of iodine, significant increases of peroxides and free SH groups were observed, as well as the decrease of total antioxidants. These biochemical changes were in agreement with significant decreases of blood platelets and lymphocytes. The data obtained brought forward again the much debated problem of peroxidation and antioxidants in cancer, since comparatively, the patients with other localizations of tumors presented decreases of peroxides and variable amounts of antioxidants. The influence of iodine and thyroid hormones is discussed, with reference to a previous paper in which high levels of peroxides had been found both in hyper- and in hypothyroidism but with different mechanisms. The biochemical changes observed in the patients treated with radioactive iodine confirmed the involvement of peroxides in the consequences of internal irradiation.


Echographic diagnosis of cardiac involvement in systemic lupus erythematosus and systemic scleroderma.

The great frequency and severity of cardiac involvement in collagen diseases have proved to be an important diagnostic, prognostic and therapeutic problem. In the last few years the value of echographic examination in the estimation of the pathologic cardiac changes in the course of systemic lupus erythematosus (SLE) and of systemic scleroderma (SS) has considerably increased making the object of numerous studies. In this paper the results obtained in some of these studies are estimated comparatively.


[Bone density in differentiated cancer of the thyroid gland treated by hormone-suppressive therapy. Study based on 51 cases].

The effect of L-Thyroxine suppressive therapy (207.3 +/- 46.1 mcg/d) on lumbar spine bone density (BMD) was assessed in 51 patients thyroidectomized for carcinoma since 1 to 19 years (mean = 6 +/- 5.4 years); the bone densities of these patients were compared with those of 51 age sex weight-matched control subjects. Trabecular bone density was evaluated by single energy quantitative tomography. The vertebral BMD was not significantly different between the patients receiving suppressive doses of L-T4 and the control group (162.8 +/- 40.4 vs 162.7 +/- 39.8 mg/cm3). We found no relationship between the duration of L-Thyroxine therapy and BMD. Thus, doses of L-T4 sufficient for suppressing plasma thyroid stimulating hormone but no high enough for causing biochemical thyrotoxicosis have no harmful effect on trabecular bone mineral density.


[Erythromelalgia in adults. Apropos of 16 cases].

The authors report sixteen consecutive cases of erythromelalgia, an infrequent disease in which local heat, redness, and pain develop in the hands and/or feet in recurrent attacks. The disease was essential in nine patients; in the remaining seven, the cause was a myeloproliferative syndrome (polycythemia vera in 3 cases and thrombocythemia in 1 case) or a drug (bromocriptine, nicardipine, and nifedipine, one case each). Acetylsalicylic acid was effective in only six of the nine essential cases. Intravascular platelet activation and aggregation with plugging of the arterioles has been suggested as the mechanism of erythromelalgia in patients with myeloproliferative disorders. Other, as yet unelucidated pathophysiologic events underlie the juvenile-onset forms, which usually fail to respond to acetylsalicylic acid.


[Mode of action of non-narcotic analgesics].

According to Lim's experiments, non-narcotic analgesics are usually considered as "peripherally" acting drugs. Conversely, most of these compounds were shown to easily cross the blood-brain barrier, and hence partly produce their effects by a central mechanism. The relative contribution of each site of action may vary from one drug to another. Aspirin-like drugs may act by inhibiting arachidonate cyclooxygenase in both the damaged tissues and the central nervous system. Finally, these drugs appear to be either selective, or dose-dependent, or nonspecific inhibitors of prostaglandin-synthetases.


Comparative value of arm and leg exercise testing.

Arm exercise test (AET) is described as an alternative to the classical leg exercise test (LET). The value of these two types of exercise was studied in a group of 32 patients aged 34 to 65 years. The patients performed LET for several reasons and, after 24 hrs, AET under the same conditions. The effort level reached under LET was always greater than that achieved under AET and the calculated functional aerobic impairment (FAI) was 50% greater during AET thus supporting the idea that AET cannot be used instead of LET in determining the functional capacity (NYHA) of cardiac patients. However, AET remains useful for the determination of the occupational working capacity in certain occupational categories. The double product (DP) (or index tension time (ITT) calculated after AET represented 85% of the calculated value after LET. The results proved that MVO2 is similar for both LET and AET, but in the latter at lower levels of exercise (VO2). The LET-DP was greater than the AET-DP in 66.5% of our cases, thus suggesting that AET should be reserved for situations in which LET cannot be performed. This is also supported by the presence of ST depression during AET in only 66% of the 18 subjects with ST depression during LET and in five of the six patients without ST depression, DP-AET was lower than DP-LET.


[Post-traumatic osteoid osteoma. Apropos of 2 cases and review of the literature].

Two cases of osteoid osteoma which became clinically apparent after a prolonged silent period are reported. One was located in the tibia in a 30-year-old female and the other in the femur in a 26-year-old male. Both developed after a surgical procedure, at the site of the operation; one was located on the track of an internal fixation screw. Diagnosis was delayed despite the suggestive timing of the pain; isotopic scanning, CT scan and angiography provided suggestive data and diagnosis was confirmed by histologic studies. A review of the literature found 13 other cases meeting the following criteria: initial trauma, silent period, suggestive pain, discovery of an osteoid osteoma at the site of the trauma, and recovery following surgical treatment. The role of the trauma is discussed.


[Pseudo-eventration: unusual complication of vertebral osteoporotic compression].

A new case of neurological complication of an osteoporotic vertebral fracture is reported. Authors emphasize electromyography which explained the clinical presentation of pseudo-evisceration by showing an injury of the 12th spinal nerve. To their knowledge, this kind of complication was never reported before, but they think that the development of electromyographic practice would allow to find many others cases. Authors emphasize MRI which gives strong argument for osteoporotic nature of a vertebral fracture and could avoid having recourse to vertebral biopsy.


[Rhabdomyolysis due to simvastin. Apropos of a case with review of the literature].

A new case of simvastatin-induced acute rhabdomyolysis with heart failure after initiation of treatment with fusidic acid is reported. In most reported instances, statin treatment was initially well tolerated with muscle toxicity developing only after addition of another drug. The mechanism of this muscle toxicity is unelucidated but involvement of a decrease in tissue Co enzyme Q is strongly suspected.


[Efficiency of cyclophosphamide bolus in Still's disease in adults. A case].

The value of monthly intravenous injections of cyclophosphamide in adults with steroid-dependent Still's disease is documented by the report of a case. In the short term and perhaps also in the long term, this regimen reduces the amount of prednisone needed.


[Systemic urticaria, sclerosing osteopathy, monoclonal gammopathy (Schnitzler syndrome). Apropos of a case].

A 65 years old man has been suffering from the upper limbs and legs for 2 years. Bone pain was associated with a non pruritic chronic urticaria and fever. Bone scintigraphy showed lesions of the lower limbs. X rays showed only one sclerotic bone lesion. Immunoelectrophoretic analysis showed an IgM kappa monoclonal gammapathy. Bone marrow aspirate and bone marrow biopsy were normal. The association of chronic urticaria, bone pain and macroglobulinemia has been first reported by L. Schnitzler. Seventeen other cases have been reported in the literature. The pathogenesis of the syndrome is unknown although anti-interleukin 1 alpha autoantibodies were found in several cases (8 out of 13).


Techniques and complications of substitution and augmentation cystoplasties.

Techniques of achieving a docile lower urinary tract and continence mechanisms using bowel segments have improved unmeasurably over the last decade. The medium term complications are well documented. The long term problems of chronic infection are being addressed but it remains to be seen whether tumour formation occurs eventually in some patients and whether renal function is better preserved by a continent reconstruction rather than a surface diversion.


Lower urinary reconstruction in patients with severely impaired renal function.

With the current techniques available for reconstruction no patient should be transplanted into a surface diversion. Although rigorous follow-up of patients with vesicourethral dysfunction should prevent renal failure occurring, such patients continue to appear. Both groups require reconstruction before transplantation preferably before end stage renal failure is reached since healing is better and the problems of the dry bladder reconstruction avoided. The results from this multidisciplinary group have been rewarding.


Hydraulic valve for continence and antireflux. A 17-year experience of 210 cases.

The hydraulic ileal valve ensures urinary continence and can be employed in many different reservoirs. The valve is constructed by isolating a 14 cm long intestinal loop with its mesentery. The isolated ileal segment is then folded inward on itself throughout its length. This hydraulic valve was used in the construction of 210 continent urostomies--ileocaecal reservoir in 184 cases (including 8 detubularized), ileal reservoir in 15, sigmoid in three, rectum and transverse colon one each, and bladder (continent cystostomy) in six cases. The indications for continent urostomy included bladder tumour (45.5% of cases), complex vesicovaginal fistula (31%), neurogenic bladder (11%) and bladder exstrophy (7%). Continence was immediately achieved in 155 patients (75%), rising to 91.5% after valve repair. The mean postoperative follow-up was 56 (range 3-205) months.


Appendix as continent urinary reservoir outlet.

The submucosally embedded in situ appendix offers an ideal continence mechanism in patients with ileocaecal urinary reservoir. Ninety-two patients who underwent this procedure at three urology centres (48 patients in Mainz, 20 in Wuppertal-Barmen and 24 in Marburg) are reviewed. The appendicocutaneous stoma was placed in the lower right abdominal quadrant in 12 patients (most of whom previously had bladder exstrophy) and into an umbilical or, in some exstrophy cases, a neoumbilical tunnel in 80 patients. Urodynamic investigations of the submucosally embedded appendix showed maximum closure pressure greater than 80 cm H2O.


Condom use due to the risk of AIDS. Trends in the general population of Sweden.

This study examines the use of condoms due to the risk of AIDS in the general population of Sweden during 1986-1989. The study is based on annual mail surveys (1986-1989) of random population samples aged 16-44 years - 4000 individuals in each sample. The response rate was 71%. The study indicates that the use of condoms increased significantly during the first years of the study period, particularly among 18-24-year-olds. Roughly the same tendency was observed regarding the perception of personal risk related to HIV infection. In 1988 a positive connection was established between condom use and personal risk perception. Between 1988 and 1989 (as the public interest in the AIDS issue declined) no further increase in condom use was observed but rather a tendency of reversal towards previous levels. Having several sexual partners was not significantly associated with a more frequent use of condoms, nor was the occurrence of casual sexual contacts. In most of the casual sexual contacts reported condoms were not used.


Waiting time to pregnancy and pregnancy outcome among Danish workers in the textile, clothing, and footwear industries.

The relationship between time from planned to achieved pregnancy and pregnancy outcome has been studied in a group of 18,658 workers in the textile, clothing and footwear industries. Information on pregnancy outcome and delay in conception in the period 1979-84 was collected by self administered questionnaires in 1985. The response rate was 70.3%. During the study period there had been 5,171 live births and 708 spontaneous abortions. Information on delay in conception was collected in broad categories. The data were analysed by means of a newly developed statistical parametric model in order to collect all possible information from the highly grouped data. Median waiting time before a pregnancy which ended in spontaneous abortion was 1.68 times longer than median waiting time before a pregnancy leading to a live birth. There seems to be a correlation between the length of the waiting time and abortion.


Nurses' attitudes towards shiftwork and quality of life.

The repercussions on the social and family life of shiftworkers are important. The objectives of this work are to compare the attitudes to permanent and rotating shiftwork, and the impact of shiftwork on social and family life. A cross-sectional epidemiological study was carried out in 606 female and 367 male nurses chosen at random from public hospitals in the Valencian region. Information was gathered by means of a questionnaire, and descriptive analysis was carried out. It can be concluded that workers on rotating shifts who are dissatisfied with their working hours give incompatibility with social and family life as the main reason. Furthermore, working nights (permanently or rotating) disturbs harmony between working hours and days off of the spouse.


Feasibility of a 2-km walking test for fitness assessment in a population study.

A simple 2-km Walking Test has been developed for determining the cardiorespiratory fitness of healthy adults. In the present study the following aspects of the feasibility of this test for population assessment were investigated: participation willingness, the percentage of test qualified subjects, the percentage of acceptable test performances and the resources needed for field test administration. A representative sample was drawn from the 27 to 65-year-old population in a rural municipality in northeastern Finland. Subjects were recruited on the basis of the results of health questionnaires and interviews. One fourth of the volunteers were excluded from the test because of health problems. The 2-km walking tests were administered outdoors in the municipality center. More than 50% of the subjects successfully completed two consecutive walking tests. This study indicated that the 2-km Walking Test is a feasible alternative as a measure of cardiovascular fitness for large population groups and could potentially be used in exercise related health promotion programmes.


Suicide among young people aged 10-29 in Sweden.

This study analyses the incidence of suicide among children and young people aged between 10 and 29 in Sweden, during the period 1974-1986. The study comprises 4,624 individuals whose deaths were the outcome of verified, E950-E959 (n = 3,511) and undetermined, E980-E989 (n = 1,113) suicides. Regression analysis of different age groups separately and all age groups combined shows that the frequency of suicide among children and young people in Sweden did not increase in this period. Nonetheless, mortality figures are high, especially for boys and young men aged 15-29. The maximum suicide-mortality rate (43.2 per 10,000) is noted for young men aged 25-29 in 1984. The male-female ratio with respect to deaths from suicide is 2.5 for the entire group, the smallest difference being in the 15-19 age group (1.7) and the largest in the 25-29 age group (2.8). Methods of committing suicide vary between the sexes and the various age groups. Boys and young men use violent methods more often, and this situation has remained stable throughout the 13-year period. Girls use non-violent methods to a greater extent, but young women aged 18-29 use violent and non-violent methods to almost the same extent. During the 13-year period studied, a change took place in the girls' and young women's choice of methods towards more violent methods in the 1980s compared with the 1970s. Regardless of sex, there are significantly (p less than 0.001) fewer married and more divorced people among those committing suicide compared with corresponding age groups in the overall population.


Heritability of defects of far vision in young adults--a twin study.

A questionnaire to study defects in far vision in the Finnish Twin Cohort Study was sent to 600 twin pairs of 30 and 31 years of age divided equally by gender and zygosity. An excess in female prevalence of defects in far vision was observed (p less than 0.001). Validation of the questionnaire method to assess negative spherical equivalent of refraction was performed by asking the twins to send their last prescription for glasses. Accuracy of the questionnaire method to detect in far vision was tested using a subsample of cases where actual refraction obtained from the prescription for glasses was available. This actual refraction value was compared with the individuals answers to the questions of far vision. Of the subjects 5.5% were false negatives and 1.8% of the individuals were false positives. In 152 pairs one or both twins had a defect in far vision. Under a threshold liability model, the proportion of total (phenotypic) variance in liability attributable to additive genetic effects was 0.91 in this twin data, while no evidence for effects due to dominance was found.


Diseases and symptoms as predictors of hospital care in an aged population. A prospective register-based study.

The association between diseases and symptoms and general hospital care was studied in a geographically defined population of 1040 persons aged 65 years or over (90% of the eligible non-institutionalized elderly). In eight years, 25% of the subjects used over 60 hospital bed-days. In age-controlled analyses high use of hospital care was predicted by chronic urinary infections and in women also by chronic bronchitis, diabetes mellitus and heart failure. Among men, the risk of high use of hospital care was greatest in those reporting chronic urinary infection (risk ratio 1.9), and among women in those reporting chronic bronchitis (2.1) and diabetes (2.0). As far as symptoms were concerned, the highest risks of hospital care were found in men reporting tremor (risk ratio 1.6) and depressive symptoms (1.5); and in women reporting memory disturbances and dizziness (risk ratios 1.9 and 1.7, respectively). High use of care was predicted by six symptoms in men and seven in women. Reported symptoms proved to be better predictors of high use of hospital care than reported diagnoses.


Alcohol consumption in a Danish cohort during 11 years.

A cohort living in Copenhagen County, originally consisting of 1198 persons, 577 men and 621 women, 40-years of age in 1976, was reexamined in 1981, and again in 1987. Of the original cohort 1052 (88%) participated in 1976, 992 (84%) in 1981, and 965 (85%) in 1987. The purpose of this study was to describe changes in alcohol consumption in the cohort, with the view of identifying subgroups, who have changed their alcohol consumption behaviour to a certain extent. Alcohol consumption was measured by the same questionnaire all three times as to the level of consumption and frequency. Alcohol consumption peaked in 1981 (45-year olds) with 10.4 drinks on average a week. Men increased their consumption by 8% and women by 37%. There was an overall downward tendency in the consumption frequency among men, whereas the opposite was the case among women. The two groups are converging toward a weekly consumption frequency. It seems now that women are leading the change toward a greater wine consumption in relative and absolute terms. It is therefore concluded that female consumption should be considered as a target in future preventive programmes.


Intravenous drug abuse in young men: risk factors assessed in a longitudinal perspective.

The role of family background as well as behavioural and psychological factors as risk factors for intravenous drug abuse was analysed in a longitudinal study of 8168 Swedish men conscripted for military service in 1969-70. Information about risk factors was obtained from a survey of all Swedish conscripts. Records on intravenous drug abuse, during a followup ending in 1986, were obtained from a survey of intravenous drug abusers among persons brought to the Central police arrest in Stockholm. Strong predictors of intravenous drug abuse were contact with the police of juvenile authorities (RR = 22.3 95% CI 15.1-33.0), high alcohol consumption (RR = 9.2 95% CI 6.7-12.7) and psychiatric diagnosis at conscription (RR = 6.0 95% CI 4.5-8.1) and low social class (RR = 3.6 95% CI 2.2-5.9). In multivariate analyses, these factors and indicators of deviant behaviour still carried significantly increased relative risk for intravenous drug abuse, although several of them are interrelated. Low emotional control, nervousness, sleeping problems and other nervous problems were associated with an increased relative risk in univariate but not in multivariate analyses.


[Various molecular mechanisms involved in the pathogenesis of type II diabetes and their potential therapeutic importance].

The pancreatic beta cell presents functional abnormalities in the early stages of development of non-insulin dependent diabetes mellitus (NIDDM). The disappearance of the first phase of insulin secretion induced by a glucose load is a early marker of NIDDM. This abnormality could be secondary to the low expression of the pancreatic glucose transporter GLUT2. Together with the glucokinase enzyme, GLUT2 is responsible for proper beta cell sensing of the extracellular glucose levels. In NIDDM, the GLUT2 mRNA levels are low, a fact which suggests a transcriptional defect of the GLUT2 gene. The first phase of glucose-induced insulin secretion by the beta pancreatic cell can be partly restored by the administration of a peptide discovered by a molecular approach, the glucagon-like peptide 1 (GLP-1). The gene encoding for the glucagon is expressed in a cell-specific manner in the A cells of the pancreatic islet and the L cells of the intestinal tract. The maturation process of the propeptide encoded by the glucagon gene is different in the two cells: the glucagon is the main hormone produced by the A cells whereas the glucagon-like peptide 1 (GLP-1) is the major peptide synthesized by the L cells of the intestine. GLP-1 is an incretin hormone and is at present the most potent insulinotropic peptide. The first results of the administration of GLP-1 to normal volunteers and diabetic patients are promising and may be a new therapeutic approach to treating diabetic patients.


[Role of thrombolysis in the treatment of cardiogenic shock following myocardial infarct].

Of a total of 329 consecutive patients treated by thrombolysis with recombinant tissue-type plasminogen activator following myocardial infarction, 13 (4%) were in cardiogenic shock at the time of admission to hospital, and 4 others (1.2%) developed cardiogenic shock during their hospital stay. Overall hospital mortality for shock was high at 88% (15 of 17 patients), and shock was responsible for 57.6% (15 of 26) of all hospital deaths. Although several studies have shown that thrombolysis reduces the likelihood of cardiogenic shock developing after admission, our data confirm that it does not constitute effective treatment of established shock. More aggressive approaches, using thrombolysis together with angioplasty and mechanical ventricular assist devices, need to be evaluated.


[Bone mineral density of the lumbar spine, the femoral neck and femoral diaphysis in a Genevan population sample].

Bone mineral density (BMD) was measured by dual photon absorptiometry in the lumbar spine, femoral neck and midfemoral shaft in 209 women and 165 men aged 20 to 98 years recruited among the Geneva population. The prevalence of various factors (life style, calcium intake, body weight) which may be associated with a higher risk of osteoporosis was evaluated. Between the different skeletal sites, BMD was closely correlated. Nevertheless, BMD at one site failed to accurately predict BMD of another site. In each age class, BMD was dispersed over a wide range. Women and men had similar lumbar spine BMD. In women, BMD decreased after the fifth decade by 1.3, 1.0 and 2.6% year in the lumbar spine and femoral neck and shaft, respectively. Daily calcium intake from dairy products was 430 g and 750 g in women and men, respectively. Femoral shaft BMD was positively correlated with calcium intake. These BMD values obtained in a sample of the normal Geneva population should be of major help for the diagnosis of osteoporosis.


[Severe herpes simplex encephalitis: course 15 years following decompressive craniotomy].

Decompressive craniotomy with brain biopsy was carried out in two patients with herpes simplex virus encephalitis (HSE). In both cases the indication for surgery was based on the clinical picture of coma with rapidly progressive hemiparesis and on the computer tomographic finding of a large space-occupying lesion of in the temporal lobe accompanied by brain stem compression not controllable by medication. Both patients were treated with a standard dosage of vidarabine (Ara-A 15 mg/kg/24 h) and corticosteroids after the operation. The improvement attained by surgery was very impressive in both cases. The massive neurological deficits (which also included subtotal aphasia in one case) regressed to a minimum in the following weeks. Both patients were followed up at yearly intervals for 15 years. They are now 36 and 76 years of age, both in a very satisfactory condition. Our observations show that decompressive craniotomy with duraplasty may be the crucial therapeutic measure in HSE with brainstem compression not controllable by medication.


[Pathophysiology, prevention and therapy of altitude pulmonary edema].

Alveolar hypoxia and resulting tissue hypoxia initiates the pathophysiological sequence of high altitude pulmonary edema (HAPE). Very rapid ascent to high altitude without prior acclimatization results in HAPE, even in subjects with excellent tolerance to high altitude. Upon acute altitude exposure, HAPE-susceptible individuals react with increased secretion of norepinephrine, epinephrine, renin, angiotensin, aldosterone and atrial natriuretic peptide. In response to exercise at high altitude, subjects developing acute mountain sickness and HAPE secrete more aldosterone and antidiuretic hormone than subjects who remain well. This results in sodium and water retention, reduction of urine output, increase in body weight and development of peripheral edemas. The hypoxic pulmonary vascular response is enhanced in HAPE-susceptible subjects, thus favouring the development of severe pulmonary hypertension on exposure to high altitude. It has been postulated that uneven pulmonary vasoconstriction enhances filtration pressure in non-vasoconstricted lung areas, leading to interstitial and alveolar edema. The high protein content of the edema fluid in HAPE characterizes this edema as a permeability edema. The prophylactic administration of nifedipine prevents the exaggerated pulmonary hypertension of HAPE-susceptible subjects upon rapid ascent to 4559 m and thus prevents HAPE in most cases. This finding illustrates the crucial role of hypoxic pulmonary hypertension in the development of HAPE. The causal treatment of HAPE is descent, evacuation and administration of oxygen. Treatment of HAPE patients with nifedipine results in a reduction of pulmonary artery pressure, clinical improvement, increased oxygenation, decrease of the alveolar arterial oxygen gradient and progressive clearing of pulmonary edema on chest x-ray. Thus nifedipine offers a pharmacological tool for the treatment of HAPE.


[Identification of alcoholism and therapeutic proposals: a study in a general hospital].

Alcoholism is a frequent condition in patients admitted to general hospitals. The rate of identification of patients suspected to be alcoholic, the therapeutic measures proposed to such patients and their destination at hospital discharge were among the issues studied in the general wards of a department of internal medicine of an hospital in the French-speaking region of Switzerland. The Michigan Alcoholism Screening Test (MAST) was utilized systematically among all patients aged 20-75 years who where admitted consecutively to the department. Two cohorts matched for age and sex were thus formed: 102 alcoholics (MAST greater than or equal to 8) and 102 non-alcoholics (MAST less than or equal to 4). A diagnosis of alcoholism or of a syndrome of alcohol dependence was found in only 50% of all exit reports of the alcoholic cohort, whereas alcohol-related problems were identified on a verbal basis by the attending physician in 89% of cases. Therapeutic measures were proposed to 69% of female alcoholics and to 43% of male alcoholics, more frequently among patients with the highest MAST scores. In addition, at hospital discharge, alcoholic patients were more likely to be sent to a destination other than their place of residence than were the non-alcoholic patients. This study illustrates the low rate of identification and subsequent treatment of alcoholism among hospitalized patients. It also suggests that hospital stays should be used more frequently to increase the systematic identification of alcohol problems, increase awareness of alcoholism and provide information to both patients and those caring for them.


[Bacillary angiomatosis: apropos of a case].

We report a case of bacillary angiomatosis (BA), a recently described opportunistic infection, in a 30-year-old patient with Aids who was referred for a purplish vascular nodule on the forehead, of one-month duration, surrounded by similar smaller papules. For the previous 4 months he had suffered from progressive cachexia with fever, chills, night sweats, arthralgias and bone pain for which no infectious or malignant cause had been discovered after an extensive medical work-up. Histological examination of the skin lesions using Warthin-Starry staining revealed lobular vascular proliferation and protuberant endothelial cells with clumps of small bacilli. These findings were confirmed by electron microscopy. We believe that this is the first case of BA diagnosed in Switzerland and discuss the skin lesions, systemic symptoms and evolution under antibiotic treatment.


[Spondylitis due to Citrobacter diversus. Case report and review of Citrobacter diversus infections].

Citrobacter diversus (C.d.) is an unusual human pathogen. Its pathogenic potency is small or nil, and in most cases it is isolated in combination with other organisms. Most isolates are of indeterminate clinical significance. Occasionally C.d. may cause opportunistic infections, especially in subjects with primary or secondary conditions of poor host defense, immunosuppressed patients or neonates. We report a case of C.d. vertebral osteomyelitis following C.d. pneumonia. The osteomyelitis was cured by surgery and chemotherapy. This case is interesting since it involves an otherwise healthy subject with no underlying disease. C.d. was isolated in blood during the episode of pneumonia and in bone four weeks later. No other case of Citrobacter diversus vertebral osteomyelitis has hitherto been described.


[Neurogenic pain syndrome].

Several pathophysiologic mechanisms are known which induce neuropathic pain in presence of peripheral nerve damage. They help to explain the clinical features of neuropathic pain syndromes and why causal and symptomatic treatments can be effective. However, careful analysis of every pain syndrome is necessary in order to select the type of pain management required.


[The status of the dentition in 2 Swiss population groups before the introduction of refined sugar].

Caries and parodontitis have been one of the most spread diseases of mankind. In an archaeological study, 53 graves of Bernese patricians were exhumed. 22 skulls of adults with 392 teeth were examined. They lived between the 16th and the 18th century in the community of Worb BE. In some cases identification could be accomplished by comparison of oil paintings with skulls, using a computerized technique. The aim of this study was to evaluate the prevalence of caries, the loss of periodontal bone, the amount of calculus and of abrasion. To compare the dental situation with another population segment sex- and age-matched dates were used. This second population segment lived between the 12th and 18th century and belonged to a lower social class than the patricians from Worb. The comparison of these two groups showed significant differences only in the abrasion pattern. We conclude that the social class did not significantly influence most of the parameters studied here. The different abrasion pattern could be due to different dietary habits.


[Experimental studies on the systemic toxicity of dental alloys free of precious metals].

The systemic toxicity of five non-precious dental alloys was evaluated by help of an animal study. The pulverized dental alloys, filled in gelatine capsules, were orally administered to laboratory rats using a special esophageal application device. For each alloy examined randomized groups of ten experimental animals and ten control animals were used. For a period of seven days the experimental animals received daily 1000 mg alloy powder per kilogram body-weight. The animals of the control groups received daily empty gelatine capsules (placebo application). After two weeks all animals were killed and autopsies of the animals were performed. Histopathologic examinations of the lungs, kidneys, liver, small intestine and large intestine of all animals were done. With statistic significance (p less than 0.001) rats whom nickel-chromium alloys were administered orally showed serious pathologic reactions more frequently than placebo-treated control animals. Nickel-chromium alloys containing beryllium and/or gallium caused the strongest organic lesions. In contrary to this a dental cobalt-chromium alloy showed a very low systemic toxicity. The results of the study underline that preclinical toxicity testing of dental alloys is necessary in order to avoid systemic toxic lesions in man.


Initial experience of an emergency helicopter transport service in the Outer Hebrides.

The outcome of patients transported by coastguard helicopter to the Lewis Hospital, Stornoway was studied for the first 30 months of the service. Although undoubtedly life-saving in some cases, some patients were transferred for trivial reasons. Feedback between the hospital and ships' captains and owners may reduce possible abuse of this service. Most patients were uplifted entirely appropriately.


Surgical correction of congenital heart defects in adults.

From April 1987 to April 1991, 30 patients over the age of 15 years underwent surgery for congenital heart defects in the adult department of the Professorial Unit of Cardiothoracic Surgery, Royal Infirmary of Edinburgh. Eighteen were females (60%) and 12 were males (40%). Ages ranged from 15 to 68 years (mean 38.1). Six patients 20% had undergone previous cardiac surgery. Operative and hospital mortality was zero. Major postoperative complications occurred in three patients. In the follow-up period between three months and four years, there has been one late death. The spectrum of patients with congenital heart defects over the age of 15 was reviewed. The relatively late presentation of these defects and the indications for operating in adult life are discussed.


Co-ordinating geriatric and general medical services; experience of a geriatric assessment ward in the Royal Infirmary of Edinburgh.

The paper describes the work of an assessment unit setup to provide a service for frail elderly patients admitted to general medical units at the Royal Infirmary of Edinburgh during the period of April 1989 to March 1990. Patients were selected on the basis of diagnosis, mental and physical function, age and social background and transferred to the assessment ward within 24 hours of admission to a medical ward. Most of the 376 patients admitted to the ward had a high level of multiple pathology and physical incapacity and a third had an acute confusional state. The mean length of stay was 19.4 days. There was a 13% mortality with 71% of survivors returning to their own homes. Review of mobility and self care capacity of the group revealed a striking increase in function during their stay in the ward. Factors increasing the likelihood of discharge included having a spouse, receiving support at home, having a low initial dependence rating. Adverse factors included having cerebrovascular disease, having dementia and initial maintenance of urine and faeces.


Alcoholism, hyponatraemia and central neurological damage: more than pontine myelinolysis?

Three patients with alcoholism and severe hyponatraemia are described. Permanent neurological damage occurred in each case with cerebral, cerebellar or pontine damage from infarction or haemorrhage following correction of the biochemical disturbance. No patient developed Central Pontine Myelinolysis (CPM), the condition usually associated with profound hyponatraemia and its correction.


A case of spontaneous hypothermia.

It is important to recognise any condition, however rare, which can be cured. We report a case of chronic hypothermia and its dramatic response to treatment.


Directed evolution of an RNA enzyme.

An in vitro evolution procedure was used to obtain RNA enzymes with a particular catalytic function. A population of 10(13) variants of the Tetrahymena ribozyme, a group I ribozyme that catalyzes sequence-specific cleavage of RNA via a phosphoester transfer mechanism, was generated. This enzyme has a limited ability to cleave DNA under conditions of high temperature or high MgCl2 concentration, or both. A selection constraint was imposed on the population of ribozyme variants such that only those individuals that carried out DNA cleavage under physiologic conditions were amplified to produce "progeny" ribozymes. Mutations were introduced during amplification to maintain heterogeneity in the population. This process was repeated for ten successive generations, resulting in enhanced (100 times) DNA cleavage activity.


The location of bound lipid in the lipovitellin complex.

The location of the bound lipid in the soluble lipoprotein lipovitellin has been determined by neutron crystallographic techniques. With the use of the contrast variation method, whereby the crystals are soaked in different H2O-D2O mixtures, the lipid has been found to occupy a large cavity in the protein whose structure had previously been determined by x-ray crystallography. The lipid appears to be bound in the form of a bilayer with the major protein-lipid interactions being hydrophobic and with the lipid headgroups projecting into the bulk solvent and into a solvent-filled space in the cavity.


Vacuolar chitinases of tobacco: a new class of hydroxyproline-containing proteins.

The fungicidal type I chitinases contribute to the defense response of plants against pathogens. Two tobacco chitinases represent a different class of hydroxyproline-containing proteins. Hydroxyproline-rich proteins are predominantly extracellular, structural glycoproteins proteins that lack enzymatic activity and contain many hydroxyproline residues. In contrast, type I chitinases are vacuolar enzymes. They are not glycosylated and contain a small number of hydroxyproline residues restricted to a single, short peptide sequence.


Neuronal domains in developing neocortex.

The mammalian neocortex consists of a mosaic of columnar units whose development is poorly understood. Optical recordings of brain slices labeled with the fluorescent calcium indicator fura-2 revealed that the neonatal rat cortex was partitioned into distinct domains of spontaneously coactive neurons. In tangential slices, these domains were 50 to 120 micrometers in diameter; in coronal slices they spanned several cortical layers and resembled columns found in the adult cortex. In developing somatosensory cortex, domains were smaller than, and distinct from, the barrels, which represent sensory input from a single vibrissa. The neurons within each domain were coupled by gap junctions. Thus, nonsynaptic communication during cortical development defines discrete multicellular patterns that could presage adult functional architecture.


Mechanistic aspects of signaling through Ras in NIH 3T3 cells.

Serum and growth factors can increase the proportion of Ras in the active guanosine triphosphate (GTP)-bound form. Growth factors might stimulate guanine nucleotide exchange or decrease the activity of the guanosine triphosphatase-activating proteins GAP and neurofibromin (NF1). In NIH 3T3 cells that overexpress the mutant Ras protein His116, which releases bound guanine nucleotide at a constitutively high rate and retains sensitivity to GAP and NF1, the proportion of GTP bound to the His116 protein was not altered by serum or platelet-derived growth factor. However, these mitogens increased the proportion of Ras in the GTP-bound form in cells that overexpressed control Ras proteins with a normal intrinsic rate of guanine nucleotide release. The amount of GTP-bound His116 or control Ras proteins was higher in cells at low density than in cells at high density, which have more GAP-like activity. The lower proportion of GTP-bound Ras in NIH 3T3 cells at high density may result from increased GAP-like activity. By contrast, serum and platelet-derived growth factors appear to stimulate guanine nucleotide exchange.


Specialized role for a murine class I-b MHC molecule in prokaryotic host defenses.

Although nonclassical (class I-b) gene products represent the majority of murine major histocompatibility complex (MHC) genes, the role of these relatively nonpolymorphic molecules remains uncertain. Recently, one such protein, H-2M3 (formerly designated Hmt), was shown to bind and specifically present N-formylated peptides to cytotoxic T lymphocytes. Because N-formylation is characteristic of prokaryotic proteins, this MHC molecule may be especially adapted for a role in the mammalian defense against bacterial attack. The current studies demonstrate that an MHC molecule, indistinguishable from H-2M3, presents antigens derived from the intracellular pathogen Listeria monocytogenes to Listeria-specific CD8+ cells.


A protein kinase substrate identified by the two-hybrid system.

A genetic method, the two-hybrid system, was used to identify four genes encoding proteins that interact with the SNF1 protein kinase from yeast. One of the genes, SIP1, was independently isolated as a multicopy suppressor of defects caused by reduced SNF1 kinase activity, and genetic evidence supports its function in the SNF1 pathway. The SIP1 protein co-immunoprecipitated with SNF1 and was phosphorylated in vitro. Thus, the two-hybrid system, which is applicable to any cloned gene, can be used to detect physical interactions between protein kinases and functionally related substrate proteins.


Participation in normal immune responses of a metastasis-inducing splice variant of CD44.

A variant of the glycoprotein CD44 (CD44v) that shares sequences with variants causally involved in metastasis formation is transiently expressed on B and T lymphocytes and macrophages after antigenic stimulation and in the postnatal period. Antibodies to the variant hinder in vivo activation of both B and T cells. The observation that a protein domain that is expressed on CD44 and required for the lymphatic spread of tumor cells can catalyze an essential step in the process of lymphocyte activation supports the idea that metastasizing tumor cells mimic lymphocyte behavior.


Stagnation in the decline of the world population growth rate during the 1980s.

The world human population growth rate after World War II passed through three phases: the rise in the 1950s and 1960s, the fall (though still at a positive level) in the 1970s, and the plateau in the 1980s. The rise was produced by the global decline in death rates, the fall was mainly due to the reduction of fertility in a number of developing countries, and the stagnation of growth rate decline was attributable to three major factors. First, substantial fertility declines started around 1970 and stalled around 1980 in both China and India. Second, the age structure of population changed in favor of higher birth rates. Third, although fertility started to decline significantly around 1970 mainly in East Asia, Southeast Asia, and Latin America, few countries have begun fertility declines since then. Many countries in sub-Saharan Africa and South Asia have not started substantial fertility reductions, deepening the gap between developing countries that are moving to lower fertility levels and those that are left behind.


Uranium bioaccumulation by a Citrobacter sp. as a result of enzymically mediated growth of polycrystalline HUO2PO4.

A Citrobacter sp. accumulates heavy deposits of metal phosphate, derived from an enzymically liberated phosphate ligand. The cells are not subject to saturation constraints and can accumulate several times their own weight of precipitated metal. This high capacity is attributable to biomineralization; uranyl phosphate accumulates as polycrystalline HUO2PO4 at the cell surface. The precipitated metal is indistinguishable from crystalline HUO2PO4.4H2O grown by chemical methods.


Evidence from 18S ribosomal RNA sequences that lampreys and hagfishes form a natural group.

Lampreys and hagfishes (cyclostomes) traditionally were considered to be a natural (monophyletic) group. Recently, the consensus of opinion, based largely on morphological analyses, has shifted to a view that lampreys are more closely related to jawed vertebrates (gnathostomes) than to hagfishes. Phylogenetic comparisons of 18S ribosomal RNA sequences from two hagfishes, two lampreys, a tunicate, a lancelet, and a number of gnathostomes support the monophyly of the cyclostomes. These data force a reassessment of several features of early vertebrate evolution.


Immunosuppression in vivo by a soluble form of the CTLA-4 T cell activation molecule.

In vitro, when the B7 molecule on the surface of antigen-presenting cells binds to the T cell surface molecules CD28 and CTLA-4, a costimulatory signal for T cell activation is generated. CTLA4Ig is a soluble form of the extracellular domain of CTLA-4 and binds B7 with high avidity. CTLA4Ig treatment in vivo suppressed T cell-dependent antibody responses to sheep erythrocytes or keyhole limpet hemocyanin. Large doses of CTLA4Ig suppressed responses to a second immunization. Thus, costimulation by B7 is important for humoral immune responses in vivo, and interference with costimulation may be useful for treatment of antibody-mediated autoimmune disease.


Hypovirulence of chestnut blight fungus conferred by an infectious viral cDNA.

Strains of the chestnut blight fungus Cryphonectria parasitica that contain viral double-stranded RNAs often exhibit reduced virulence. Such hypovirulent strains act as biocontrol agents by virtue of their ability to convert virulent strains to hypovirulence after anastomosis. Transformation of virulent C. parasitica strains with a full-length complementary DNA copy of a hypovirulence-associated viral RNA conferred the complete hypovirulence phenotype. Cytoplasmic double-stranded RNA was resurrected from the chromosomally integrated complementary DNA copy and was able to convert compatible virulent strains to hypovirulence. These results establish viral double-stranded RNA as the casual agent of hypovirulence and demonstrate the feasibility of engineering hypovirulent fungal strains.


Interferon-dependent tyrosine phosphorylation of a latent cytoplasmic transcription factor.

The interferon-alpha (IFN-alpha)-stimulated gene factor 3 (ISGF3), a transcriptional activator, contains three proteins, termed ISGF3 alpha proteins, that reside in the cell cytoplasm until they are activated in response to IFN-alpha. Treatment of cells with IFN-alpha caused these three proteins to be phosphorylated on tyrosine and to translocate to the cell nucleus where they stimulate transcription through binding to IFN-alpha-stimulated response elements in DNA. IFN-gamma, which activates transcription through a different receptor and different DNA binding sites, also caused tyrosine phosphorylation of one of these proteins. The ISGF3 alpha proteins may be substrates for one or more kinases activated by ligand binding to the cell surface and may link occupation of a specific polypeptide receptor with activation of transcription of a set of specific genes.


Activation of transcription factors by interferon-alpha in a cell-free system.

The signal transduction mechanisms of interferons (IFNs) remain unclear partly because no effect of IFN has been reproducible in a cell-free system. IFN-alpha rapidly induces the transcription of a set of early response genes, and a multicomponent transcriptional activator, interferon stimulated gene factor 3 (ISGF3), is activated within minutes after binding of IFN-alpha to its receptor. A system was developed in which IFN-alpha activated ISGF3 in homogenates of HeLa cells. Subcellular fractionation revealed that incubation of a plasma membrane-enriched fraction with IFN-alpha was sufficient to activate the regulatory subcomponent of ISGF3.


Structured ambiguity and the definition of psychiatric illness: adjustment disorder among medical inpatients.

Adjustment disorder is one of the most common psychiatric diagnoses given to patients hospitalized for medical and surgical problems. This article argues that the diagnosis, in this context, often serves strategic, non-clinical ends for consultation-liaison psychiatrists, who must negotiate their interstitial position through an essentially ambiguous diagnosis. In these cases, 'adjustment disorder' emerges from and reproduces tensions between such cultural dichotomies as mind/body and social/individual that marginalize psychiatry in medical settings.


Toward a cultural history of the personality disorders.

Psychiatric categories in general, and the personality disorders in particular, remain problematic and contested. This is no where more clearly evident than in the case of the 'antisocial' and 'histrionic' personality disorders. In part, the problem is related to the observation of differences in gender distribution. Men are more likely to be diagnosed 'antisocial' than women, and women are more likely to be diagnosed 'histrionic' than men. Confusion results partly from the suspicion that these categories may be culturally conditioned and therefore spurious as medical labels true in some 'absolute' sense. This paper argues that the antisocial and histrionic disorders have cultural histories, representing (in extreme form) values strongly congruent with familiar cultural stereotypes: the 'independent' male and the 'dependent' female. The process by which these values were delegated to men and women is examined, and then shown to be at least partly determinative of later developments in the formation of psychiatric categories.


The social construction of premenstrual syndrome.

In 1931 a physician coined the term Premenstrual Tension, thereby commencing an extensive biomedical inquiry into the relationship between women's menstrual cycle and the occurrence of physical, emotional and behavioral changes. However, despite 58 years of scientific research, fundamental questions remain unanswered. For example, there is still no consensus on the definition of PMS. This, in turn, has led to disagreement among researchers about which medical specialty is best suited for diagnosing and treating PMS. Is PMS a disease whose pathology is best understood by physicians in reproductive medicine or in psychiatry? This paper argues that the inconclusiveness surrounding PMS is symptomatic of the persistence of cultural beliefs in the production (and reproduction) of medical knowledge. The roots of these cultural beliefs and their 'naturalness' in the context of Western ideas about reason, rationality and women are explored in the first section. The second section discusses the ubiquity of these same cultural beliefs in contemporary scientific research of PMS and in the controversy surrounding the proposed psychiatric diagnostic category of Late Luteal Phase Dysphoric Disorder (LLPDD). Finally, a new, anthropologically and sociologically informed approach to understanding the phenomenon of PMS is suggested.


Psychiatry as social ordering: anorexia nervosa, a paradigm.

From a psychiatric perspective, anorexia nervosa (hereafter referred to as 'anorexia') is an enigmatic illness. This paper attempts to explain why this is so, describing anorexia as a western cultural phenomenon whose psychiatric explanations and treatments actually participate in the sociocultural processes that inform this syndrome. Anorexia reveals a form of contemporary control over the female body, and psychiatry, as a western discipline, institutionalizes a mind-over-body (objective) ideology that is part of this project. Various psychiatric theories of anorectic etiology and their corresponding methods of treatment are analyzed in this light, and a general framework for understanding the discipline of psychiatry as a mode of social control is offered.


Adolescence as a culture-bound syndrome.

In keeping with an expanded definition of culture-bound syndromes, this paper argues that adolescence in American society has been 'medicalized' into a full-blown symptom complex or pathologic condition. Culture-bound syndromes in highly differentiated societies such as the U.S., may be taxonomically sorted by distinctive cultural identity system domains of age, gender, family, vocation and ethnicity.


DSM-III-R and religion.

The interpretation of religion in DSM-III-R contains considerable negative bias and contributes to unfair stereotypes of religious persons. Particularly new religious movements and religious conversion are unfairly interpreted under the DSM-III-R heading, 'Dissociative Disorder Not Otherwise Specified'. It is suggested that a more balanced and respectful interpretation of religion is needed in DSM-III-R, since psychiatry through its official nomenclature should not contribute to social intolerance of religious nonconformity.


The role of culture in a theory of psychiatric illness.

A medical theory of phenomena thought of as psychiatric would rely on concepts and seek explanations that pertain to the concerns of biomedicine. A social theory of the psychiatric needs concepts and seeks explanations that pertain to concerns of the social and cultural sciences. Some of the requirements of such a social theory are reviewed with an emphasis on why and how the concept of culture is important. The Western medical bias of psychiatric illness needs to be faced as well as the problem of cultural relativism. The paper discusses the heuristic usefulness of a concept of human behavioral breakdowns. The many ways in which culture influences knowledge and practice of biomedical psychiatry are examined critically. The scope of a social theory of the psychiatric is also outlined.


Isolation and characterization of radiation-reduced hybrids containing portions of the proximal long arm of the human X chromosome: identification of hybrids containing the Menkes' disease locus.

The proximal long arm of the human X chromosome (Xcen----Xq13) encompasses an estimated 23 megabases of DNA and contains numerous identified genetic loci. In order to generate a highly enriched source of DNA from this region, radiation-reduced human-hamster hybrids were constructed and screened to identify those that contained at least part of proximal Xq. Eight such hybrids were identified and characterized by Southern blot and fluorescence in situ hybridization analyses to determine more precisely the human DNA complement in each. One hybrid contains the entire proximal long arm and will be useful for mapping Xcen----Xq13 in its entirety and for localizing genes within this region. Another hybrid contains a smaller portion of the proximal long arm that includes the region reported to contain the gene for Menkes' disease.


At least two distinct epigenetic mechanisms are correlated with high-frequency "switching" for APRT phenotypic expression in mouse embryonal carcinoma stem cells.

A series of clones displaying high frequency "switching" phenotypes for expression of the adenine phosphoribosyltransferase (aprt) gene were previously isolated from the P19 mouse embryonal carcinoma stem cell line. Most clones contained only one aprt allele. We report here the characterization of each of these clones with regards to enzymatic activity, mRNA steady state levels, DNA methylation, and chromatin conformation. When clones were selected for resistance to the purine analog 2,6-diaminopurine, which requires markedly reduced levels of APRT enzymatic activity, two distinct classes were observed. The first class was associated with reduced or undetectable levels of aprt mRNA, hypermethylation of the 5' CpG island, and a closed chromatin conformation within this region. When clones of this class were selected for reacquisition of APRT enzymatic activity they were found to have increased mRNA levels, a hypomethylated CpG island, and an open chromatin conformation. In contrast, the second class of clones displayed wild-type levels of mRNA, CpG island hypomethylation, and an open chromatin conformation regardless of whether they were selected for the presence or absence of APRT enzymatic activity. The implications of these results for general mechanisms of epigenetic change in somatic cells and the possibility that expression of the mouse aprt gene may be developmentally regulated are discussed.


Human chromosome 19 contains the neurotrophin-5 gene locus and three related genes that may encode novel acidic neurotrophins.

Differentiation, survival, and function of the vertebrate neurons are controlled by multiple, target-derived neurotrophic factors. The best characterized mammalian neurotrophic factors are four structurally related 13 to 14 kDa basic proteins, collectively known as neurotrophins. Here we describe the identification of a gene cluster localized on human chromosome 19 that contains neurotrophin-5 (NT-5) and that may encode three additional acidic members of this protein family. The three novel partial open reading frames (ORFs), designated neurotrophin-6-alpha (NT6-alpha), NT6-beta and NT6-gamma, are 95% identical to each other and 75% identical to NT5. The putative mature N-terminal portion of NT6 ORFs does not contain a typical dibasic cleavage site and lacks two out of six cysteines that are conserved among the neutrophins. The unique structures of NT6-alpha, -beta, and -gamma suggest that if the NT6 open reading frames indeed code for functional proteins, these proteins may display novel functions and may act through a distinct class of receptors. In the human, both NTF5 and NTF6 gene loci were mapped to chromosome 19 by Southern analysis of somatic cell hybrid panels. In mouse, the NT5 gene (Ntf-5) was assigned to chromosome 7 and no sequences representing NT6 homologs were identified.


Circulating human or canine factor IX from retrovirally transduced primary myoblasts and established myoblast cell lines grafted into murine skeletal muscle.

We have used retroviral vectors to introduce human or canine factor IX cDNAs into cultured primary murine and canine myoblasts and into the established murine myoblast cell line C2C12. In all cases, the stably infected cells produced biologically active factor IX in culture and secreted detectable amounts into the culture medium both before and after differentiation of the cells into myotubes. Myoblasts and differentiated myotubes are therefore capable of performing all the posttranslational modifications of the coagulation factor required for biological activity. We have grafted the genetically modified myoblasts into skeletal muscles of nude mice and have detected stable levels of circulating human factor IX for up to two months after grafting. We propose that grafting genetically modified primary myoblasts or established myoblast cell lines into skeletal muscle may represent a useful approach to gene therapy for a variety of genetic diseases, including intrinsic muscle disease and defects in circulating proteins as in the hemophilias.


Directed isolation of human genes that escape X inactivation.

Existing methodologies have been combined to produce a directed approach to the isolation of human genes that escape X inactivation. A mouse-human somatic cell hybrid line was established that has an inactive X as its only human chromosome, and nuclear RNA from this cell line was used to construct a cDNA library. Transcribed human sequences were isolated by screening the library with labeled human DNA. The corresponding genomic sequences were isolated in phage or cosmid clones, and exons were identified by detection of transcripts on northern blots. By these means three human loci have been identified that contain genes expressed from an inactive X chromosome. Fluorescence in situ hybridization has been used to map these genes to Xp21.1-22.1, Xp22.1-22.2, and terminal Xp/Yp. One of the three genes (XE45) corresponds to the ZFX gene, while the other two genes (XE7 and XE59) represent novel cloned sequences. Physical and genetic evidence indicate that XE7 is a newly identified pseudoautosomal gene.


Generation and characterization of a human chromosome 9 cosmid library.

A cosmid library has been constructed from the hamster-human hybrid cell line PK-87-9, which contains chromosome 9 as its sole known human component. Ten thousand colonies were produced, of which approximately 200, or 2%, contain human material. Fifty of these 200 were regionally mapped by an Alu-primed PCR product hybridization procedure. These cosmids were localized to all regions of chromosome 9, but were especially concentrated in the distal portion of 9q. The map location derived by the Alu-primed PCR product hybridization procedure was compared to the map location derived by fluorescent in situ hybridization. Assignment of chromosomal location by the two methods was correspondent in all but a few cases. The presumptive presence of HTF islands was investigated for 130 cosmids by digestion with the restriction enzyme NotI. Twenty percent of cosmids contained at least one NotI site. A number of simple sequence repeat polymorphisms identified from the cosmid set were characterized and will provide a link between the genetic and physical maps for this chromosome.


Construction and characterization of radiation hybrids for chromosome 9, and their use in mapping cosmid probes on the chromosome.

Radiation hybrids were produced from a monochromosomal microcell hybrid (PK87-9) which contains only human chromosome 9 with an inserted marker on 9p. Doses of radiation ranging from 1000 to 8000 rads were used to produce a series of hybrids with different size fragments of human chromosome 9. The inserted dominant selectable marker was used to select for hybrids that preferentially maintain fragments of 9p. A panel of 53 radiation hybrids were characterized for 17 chromosome 9 markers. In addition, 17 hybrids were analyzed by fluorescent in situ hybridization (FISH). Hybrids were produced with breaks on both 9p and 9q, many of which appear to contain a single fragment of human chromosome 9. These hybrid cell lines were used to regionally localize 31 cosmids isolated from a chromosome 9 cosmid library. Six cosmids were mapped to intervals on 9p, six cosmids mapped to the centromeric region of the chromosome, and 19 mapped to 9q.


Diseases of unusual occupations: an historical perspective.

A compilation of conditions deemed unusual from previous eras serves to highlight now obsolete jobs and remind that even relatively prevalent occupational disorders of today will be viewed retrospectively as strange in the proximate future. Discussed are coal miners' nystagmus, scrotal cancer in chimney sweeps, phossy jaw, hatters' shakes, painters' colic, potters' rot, chauffeurs' knee, glanders, caisson disease, and others.


Unusual occupationally related disorders of the lung: case reports and a literature review.

Diseases of the lung are among the work-related conditions most widely recognized among nonspecialists and the lay public. Five pulmonary conditions for which occupational or environmental exposures are not typically emphasized are reviewed here in their clinical-pathologic context. These are diffuse alveolar hemorrhage, lipoid pneumonitis, granulomatous lung disease, pulmonary alveolar proteinosis, and pulmonary vascular disease.


Unusual occupational rheumatologic and musculoskeletal disorders.

Musculoskeletal disorders are among the most common clinical occupational problems, but occupational rheumatologic diseases are among the rarest. The identification of one or more cases of unusual diseases or epidemiologically unusual presentations must alert the clinician to the possibility of group exposure and risk and emphasizes the need to explore these using the model of "sentinel health event." Cumulative trauma disorders, including thoracic outlet syndrome and reflex sympathetic dystrophy syndrome, and occupational rheumatologic disorders of other etiology (Raynaud's phenomenon, scleroderma, fluorosis, osteomalacia, aseptic necrosis, and Caplan's syndrome) are reviewed.


Unusual occupational gastrointestinal and hepatic disorders.

Acute centrolobular necrosis, cancers related to occupational chemical exposures, and infectious hepatitis are widely recognized, but other occupational and environmental diseases of the gastrointestinal tract are underemphasized by comparison. This review explores the associations between workplace exposures and steatosis, increased liver microsomal activity, cholestatic liver injury, portal fibrosis and hepatic sclerosis, granulomatous liver disease, porphyria cutanea tarda, peptic ulcer disease, pancreatitis, gastroenteritis, celiac disease, and pneumatosis cystoides intestinalis.


Cardiotoxicity in the workplace.

A number of chemicals have been implicated in the causation of cardiovascular disease, although often in individual patients causality for any specific toxic exposure is difficult to establish. This review discusses toxic cardiovascular disease from specific toxins from the perspective of the types of injury and details epidemiology, mechanisms of toxicity, and clinical features. Discussed are carbon disulfide, carbon monoxide, organic nitrates, halogenated hydrocarbons, lead, cobalt, arsenic/arsine, and cadmium and antimony.


Renal diseases of occupational origin.

Environmental toxicants, including those from industrial sources, represent potentially preventable causes of chronic kidney disease. The etiology of chronic renal failure of recognized occupational origin (other than malignancies) is reviewed, including that for heavy metals, organic solvents, beryllium, and silicon.


Endocrine disorders of occupational and environmental origin.

Many compounds used and produced in industry are potentially toxic to the endocrine system. The importance of medical surveillance in the workplace is emphasized in light of the increasing numbers of women in industry and the associated potential reproductive risks. Endocrine-toxic compounds also can gain wider access to entire communities through designed release to the environment (as with pesticides), accident, or disposal of toxic waste. The mechanisms of various industrial toxins in causing disease of the thyroid, testes and ovary, and pancreas are reviewed.


Political issues in endovascular surgery.

"Political issues" may determine the relative progress if not the ultimate success and acceptance of endovascular surgery as much as its intrinsic merits. These issues include turf battles, commercialization of newly developing technologies, unethical advertising, and self-serving reporting practices in presenting clinical results. Acceptable indications, methods of evaluating results, standardized reporting practices, appropriate "gold standards" for comparison, and controlled trials (without premature release) are recommended, as well as an emphasis on the future need for proper training and credentialing and quality assurance programs.


Surgical recanalization of occluded peripheral arteries.

This article, reflecting on the surgical recanalization of occluded peripheral arteries, has exposed the very essence of vascular surgery. Only the pioneering cardiac anomalies repaired by Gross (patent duct arteriosus, 1938), Blalock and Taussig (tetralogy of Fallot, 1944), and Crafoord and Nylin (coarctation, 1945) and the legendary aortic grafting operations of Oudot (occlusion, 1950) and Dubost and coworkers (aneurysm, 1951) are not a part of this article. The contributions to surgical recanalization of the occluded peripheral arteries are numerous. Some are well conceived, and others are innovative. Perhaps the most significant technique of all, endarterectomy itself, began purely as a serendipitous event. The startling impact of dos Santos' revolutionaly "disobliteration" was realized at once. Intimal injury during the operation did not cause inevitable thrombosis, as historically taught. Thus, all vascular interventions, either endarterectomy, graft repair, or the newer endovascular techniques discussed in this issue, would not have been developed without the understanding of the tolerance of the human intima to injury. Thromboendarterectomy, the basis of surgical recanalization of occluded arteries, unlocked the mystery of arterial rethrombosis after intervention. Recognizing these crucial facts, it will have a lasting place in the expanded discipline of vascular disease and its treatment. Dos Santos, the European founder of endarterectomy, and Wylie, the American pioneer and proponent of endarterectomy, were great friends in life (Fig. 4) and would certainly be pleased to see the further development of technology aimed at the treatment of atherosclerotic obstruction of the peripheral arteries.


Occupational and environmental causes of parkinsonism.

Occupational causes of parkinsonism have usually been identified by direct temporal association of an exposure with disease symptoms, although recently a latent period between exposure and disease causation is being investigated. This review presents the definition of parkinsonism as contrasted with Parkinson's disease, notes the general concepts important to the consideration of toxic effects on the central nervous system, and addresses each group of agents known to cause parkinsonism, including common sources of exposure, clinical course, and proposed mechanisms of toxicity. Agents discussed include manganese, carbon disulfide, organic solvents, carbon monoxide, and MTPT and similar agents.


Angiography of the lower extremity in atherosclerotic vascular disease. Current techniques.

With the vast array of technology available, detailed diagnostic information is now routinely obtained in patients with peripheral vascular disorders. In addition, percutaneous intervention and advanced surgical techniques now safely permit the patient to return to an active life, and in advanced vascular disease, the extremity can be salvaged when previously the only option was amputation. We feel strongly that the maximum amount of information about the arterial system should be obtained throughout the patient's management. In addition, these complex procedures require considerable experience and judgment, and our practice of ongoing communication with the vascular surgery staff during both the diagnostic and the therapeutic phases of the patient's treatment has been extremely beneficial.


Occupational health effects of nonionizing radiation.

Nonionizing radiation includes electromagnetic energy distributed as near-ultraviolet and visible light, infrared radiation, microwaves, radio frequencies, and very low frequency and extremely low frequency alternating electric and magnetic fields, and almost every member of modern society is exposed to it in some form. Usually the intensity of exposure is low in the general population but can be greatly increased in the workplace. The forms of nonionizing radiation are described and their physical characteristics, occupational sources, biologic effects, and exposure criteria are delineated.


Angioscopy.

Endoscopy of the vascular system has evolved over recent years from an experimental procedure to a sophisticated diagnostic and therapeutic technique for surgical or percutaneous interventions of the peripheral vascular system. Particularly in procedures involving remote instrumentation of arteries, the angioscope provides a method of controlled guidance and a monitor of the effects of the various instruments on the vessel wall and allows immediate assessment of results. Angioscopic examination reveals the extent of intimal injury after angioplasty, in situ vein preparation, trauma, and thrombectomy and gives insights into the mechanisms and effects of endovascular devices.


Occupational and environmental disorders of the special senses.

Occupational hazards to vision, hearing, balance, olfaction, and taste typically constitute a small fraction of specialty medical practices in ophthalmology and otolaryngology. With the possible exception of noise-related hearing loss and VDT eye hazards, the scientific literature regarding these hazards tends to be scattered and variably accessible to occupational medicine practitioners. It is hoped that the current review will heighten the appreciation of these hazards among both generalists and specialists, and will encourage future documentation and reporting of this interesting group of disorders.


Intravascular ultrasonography.

Intravascular ultrasonography is developing rapidly as a method for defining the transmural anatomy of vascular structures, with diagnostic and therapeutic applications. The ultrasound technology not only has unique diagnostic capabilities by defining the distribution and character of lesions, but also provides accurate control information regarding efficacy of angioplasty methods. An exciting recent development is the three-dimensional reconstruction of two-dimensional images which permits global examination of luminal and transmural vessel morphology. This technology may enable improved guidance of intraluminal devices to enhance lesion removal without damaging adjacent normal wall structure and appropriate device selection by differentiating specific plaque characteristics.


Laser angioplasty.

Laser energy has the potential for selective ablation of atherosclerotic plaque through minimally invasive means. As currently practiced, laser angioplasty requires the adjunct of balloon angioplasty in most cases and has limited application compared with more conventional methods of revascularization. However, new advances in guidance systems, delivery devices, and laser sources may allow realization of the full benefit of this technology at some point in the future.


Status of peripheral atherectomy.

So far, all atherectomy devices have failed to reduce the restenosis rate of standard balloon angioplasty. Despite actual removal, debulking, and even polishing of the atherosclerotic intima, the arterial wall trauma invariably incites intimal hyperplasia. Until the problem of restenosis can be solved, atherectomy will be limited to those instances when balloon angioplasty is ineffective or contraindicated. Each device has its own peculiarities. We prefer to use the Simpson catheter for eccentric lesions in the iliofemoral or femoropopliteal regions, the Auth Rotablator for short lesions in the infrageniculate vessels, and the TEC for longer lesions in the femoropopliteal regions. Adjunctive balloon angioplasty may or may not be required. Ahn and Moore have illustrated specific clinical strategies for peripheral atherectomy.


Thrombolytic therapy.

Thrombolytic therapy may be used as either sole treatment or an adjunct to surgery in both arterial and venous disease. The age of the clot, particularly with venous thrombosis, determines the probability of successful lysis, with recent clot being highly susceptible to lytic therapy. The technique of thrombolysis is also an important determinant of the outcome, with high doses delivered directly into the clot over short time periods associated with the highest success and the lowest complication rates. Because systemic therapy increases the risk of bleeding from a remote site, techniques to concentrate the lytic agent within the clot, such as intraoperative high-dose and isolated-limb therapy, may achieve a higher success with a lower complication rate. Newer agents, which are clot specific, will be available for lytic therapy and should result in even higher success rates while minimizing systemic complications.


Intravascular stents. Status of development and clinical application.

A variety of intravascular stents are currently under investigation and in various stages of achieving governmental approval for clinical application. The Palmaz balloon-expandable stent has recently been approved for use in the iliac arteries based on specific indications for application. Stents are generally described according to their method of deployment and are either balloon-expandable or self-expanding. Clinical application has been proved in the iliac arteries, where the use of stents has greatly enhanced the treatment of patients with total occlusions, complex dissections, and restenoses. Additionally, there is promise that stents will enhance the percutaneous treatment of renal artery ostial lesions, infrainguinal arterial lesions, and strictures in large veins. Clearly, the increasing application of intravascular stents has ushered in a new era of percutaneous intervention.


Endovascular grafting for the treatment of abdominal aortic aneurysms.

Endovascular repair of an aortic aneurysm will allow aneurysm exclusion using a graft passed inside the aorta either percutaneously or from a small groin incision. Morbidity and mortality associated with this procedure should be decreased considerably. The first grafting systems currently being developed will be appropriate for repair of aneurysms of the abdominal and descending thoracic aorta that can be repaired using tube grafts. Several research groups have shown that endovascular grafting of the aorta can be accomplished successfully.


Endovascular therapy of venous thromboembolic disease.

This article discusses the background and status of inferior vena caval filtration and transvenous catheter techniques for pulmonary embolectomy in the management of venous thromboembolic disease.


Unusual occupational toxins.

Occupational and environmental medicine affords encounters with many unusual toxins, ranging from exotic metals to rocket fuels. Twelve of the most unusual industrial toxins are reviewed here and their clinical manifestations and treatments explored: acetonitrile, acrylonitrile, boron hydrides, dimethylaminopropionitrile, dimethylformamide, hydrazines, methyl isocyanate, 2-nitropropane, phosphine, Stalinon, tellurium, and vanadium.


[The hyperfractionated radiotherapy of tumors in the head-neck area].

This paper provides a survey on investigations that deal with the effects of hyperfractionation. The influence of relevant parameters on treatment results is explained. Furthermore, clinically practicable hyperfractionated treatment schedules for therapy of head and neck tumours are proposed. Clinical and experimental reports reveal that with hyperfractionation two strategies can be realised: 1. Late normal tissue reactions can be reduced without changing total dose. In this case local tumour control rate remains unchanged. 2. To enhance tumour control rates a higher total dose can be administered, if late reactions were dose limiting in the reference schedule. In this case a reduced dose per fraction and an appropriately increased total dose will leave late reactions unchanged. Applying two fractions per day the dose per fraction should not exceed 1.4 Gy. Otherwise severe acute reactions could require treatment interruption. A time interval of at least six hours between fractions reduces the risk of acute and late reactions considerably.


Radiation therapy of para-aortic lymph nodes in gynaecologic cancers: techniques, results and complications.

From 1965 to 1986 the para-aortic lymph nodes of 141 patients with gynaecologic cancers were irradiated directly after initial treatment of the primary site was completed. Another 32 patients only received para-aortic radiation treatment when para-aortic metastases became clinically apparent some time later. Radiation therapy was performed using a biaxial-four-segmental-rotating-field-technique. Crude survival of the group with initial para-aortic radiation treatment is far better than of the second group. Only five cases of severe complications due to para-aortic treatment were reported. In order to analyze the reason for such a low number of complications, CT-treatment planning for a typical patient was performed for different methods as they have been described in the literature, also referring to treatment data such as success, total dose and dose-distribution, thus influencing the complication rate. Obviously, the biaxial-four-segmental-rotating-field-technique is a method allowing to deposit a certain dose into the target volume without considerably damaging tissues in the vicinity.


[The importance of axillary diagnosis in breast cancer from the viewpoint of radiotherapists. The results of a retrospective study of 671 patients].

We reviewed the clinical evolution and survival of 671 post mastectomy breast cancer patients. 561 patients underwent a postoperative radiotherapy, whereas 110 did not. After grouping for N0 and N+, the median number of examined axillary lymph nodes in the not irradiated group was for N0 status three and for the N+ status eight axillary lymph nodes. In the latter group the median number of the involved axillary nodes was three. In the post mastectomy irradiated N0 group the median number of examined axillary nodes was five, whereas in the N+ group the corresponding number was seven. The median number of involved nodes was two. The majority of the N0 patients who were not postoperatively irradiated were referred to our clinic with a local recurrence. The study shows that axillary staging of the N0 group was not performed corresponding to the today's accepted oncological norms for the minimum number of axillary nodes to be examined to determine a "true" N0 axillary status. Thus, it was not a surprise to find out, for N0 patients, a dependency of the survival rate on the number of examined axillary nodes. Patients with more than nine examined nodes showed better survival rates than patients with less than five examined nodes (p less than 0.05). The irradiation of the axilla is obligatory in case of incomplete axillary dissection (less than ten negative examined nodes from level I and II and less than 18 nodes for a positive axillary dissection). The irradiation of the axilla is not indicated after a complete axillary clearance.


Determination of virtual SSDs for electron beams from a dual energy linear accelerator.

Electron beams from an accelerator appear to originate from a point away from the vacuum window designated as virtual source. Virtual source to isocenter distances are determined experimentally by measurements in a polystyrene phantom with inverse square law method. Corrections required for percentage depth dose are also determined. Results of our study are compared with that of other investigators.


Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons. Part II: Evaluation of the effect of the induced Na-24 activity on the chromosomal aberration yield.

Blood samples were spiked with Na-24 to study the separate effect of this nuclide on the incidence of chromosomal aberrations in neutron irradiated blood samples. A delay of 96 h was allowed before cultivation, so the results of chromosomal aberration analysis could be compared with the results obtained by direct irradiation of blood samples with U-235 fission neutrons [7]. The absorbed dose was calculated using a simple conservative model. From the results obtained we can conclude that Na-24 alone was not the reason for the difference in the incidence of chromosomal aberrations between blood samples cultivated immediately after "in vitro" irradiation by U-235 fission neutrons and samples which were cultivated after 96 h storage.


[Acute and chronic disorders in gastric emptying after the x-ray irradiation of the rat stomach and their therapeutic modification].

After localized 300 kV X-irradiation of the rat stomach the stomach emptying time of a liquid and a solid test meal was examined with a non-invasive radiological method. In the acute period one to three weeks after irradiation with single doses between 10.7 and 21.3 Gy we observed a faster emptying of the liquid and a delayed emptying of the solid test meal. The faster emptying of the liquid test meal was treated successfully with atropine. In the chronic period we observed a delayed emptying of the liquid and of the solid test meal. These emptying disorders were treated partially successfully with the parasympathomimeticum carbachol and they were treated completely successfully with the dopamine antagonist metoclopramide.


[Plasma-membrane fluidity studies of murine neuroblastoma and malignant melanoma cells under irradiation].

Murine neuroblastoma (C-1300 NMB) and malignant melanoma (B16) cells were radiated in presence of radiopharmaceutics. Sensibilization was carried out with BSO and protection with TMX. Changes in fluidity of the plasma membrane, in cellular GSH contents and cell cycle were observed. After radiation fluidity of the plasma membrane is increased, whereas intracellular GSH decreased. These changes were intensified by BSO and reduced by TMX. Fluidity of the plasma membrane correlates with intracellular GSH and also with cell cycle. It is suggested that changes in plasma membrane fluidity can be used as an additional parameter for the determination of sensitivity towards radiation.


Megavoltage grid total body irradiation of C3Hf/SED mice.

The effect of a grid on whole-body megavoltage radiation tolerance in C3Hf/SED mice was studied. Adult mice were irradiated beneath a 50% megavoltage grid. LD50 (50% lethality) values were measured at ten and 30 days. LD50/30 day increased by a factor of 1.5 for mice receiving both single and two fraction irradiation beneath the grid. LD50/ten day increased by factors of 1.1 to 1.2 for single, two, and five fraction irradiation beneath the grid.


Radioprotection of spleen by a combination of 5-hydroxy-L-tryptophan and 2-aminoethylisothiuronium bromide hydrobromide in lethally irradiated rats.

Radioprotective efficiency of the combination of 5-hydroxy-L-tryptophan (5-HTP, 100 mg/kg) with 2-aminoethylisothiuronium bromide hydrobromide (AET, 20 mg/kg) in protecting splenic tissue following 8 Gy whole-body gamma radiation (WBGR) has been studied in adult male Sprague Dawley rats. Loss in splenic weight, splenic cells and DNA was observed following & Gy WBGR, which was modified significantly in 5-HTP+AET (ip) pretreated group. The study further showed that pre-treatment with this formulation led to an increased superoxide dismutase (SOD) activity and a decrease in lactate/pyruvate ratio in the cytosol fraction of the spleen.


Caries experience in teenagers related to changes in a dental health programme.

Comparisons were made of the number of approximal DF-surfaces radiographically recorded at the ages of 13 and 16 years between two groups of children, born in 1964 and 1971, respectively. The aim of the study was to examine if the differences in caries prevalence could be related to the effects of the changes in the dental health programme with time in Göteborg, Sweden. The caries prevalence at 16 years of age was significantly lower in the 1971 group. This was mainly due to a decrease in the number of fillings and caries lesions in girls. However, no statistically significant differences were found between the groups with regard to the mesial surfaces of the first permanent molars. In comparisons between the 20 per cent of children of both sexes with most caries, the 1971 group presented significantly lower DF-values at 16 years of age. The children in the 1971 group had a lower age at the start of organized dental care, had had more topical fluoride applications and, especially the girls, had probably used fluoride dentifrices more frequently. These factors, taken singly as well as in combination, are presumed to have contributed to the lower caries prevalence in the 1971 group.


The castability of unalloyed titanium in three different casting machines.

The general demand for a variety of fine detail work made of titanium has resulted in the development of equipment/systems for the casting of this metal. Dental casting machines suitable for the casting of titanium are now also available. The aim of the present study was therefore to evaluate the possibility of precision casting of dental crown restorations of unalloyed titanium. The three kinds of casting equipment currently used in Sweden were tested by evaluating the crown edge diameter of 10 titanium crowns processed by each one of the titanium casting machines. The results revealed that clinically acceptable margins can be obtained but also that further improvements in processing have to be achieved before titanium casting can be considered as uncomplicated as the casting of traditional dental gold alloys.


Base plate wax, dimensional stability and sorption of active components following treatment with disinfectant solutions.

The influence of seven disinfectants on the dimensional stability of a base plate wax, Tenax, was studied. Two methods for treatment were tested - immersion for one hour and spraying respectively. After spraying no significant influence on the wax could be established and after immersion four of the seven disinfectants, including Cidex and K-644, likewise had no significant influence on the dimensional stability. The wax specimens did not show any significant weight increase (less than one per cent) after immersion for four days but in four disinfectant solutions the surface properties of the wax specimens had changed showing that active components of the disinfectants were absorbed into or adsorbed on the wax surface.


Amalgam, composite resin and glass ionomer cement in Class II restorations in primary molars--a three year clinical evaluation.

Amalgam (ANA 2000), composite resin (Occlusin), and glass ionomer cement (ChemFil) were compared in conventional Class II restorations in second primary molars. Twenty-five restorations of each material were placed by two dentists in 50 patients. The restorations were evaluated during a three year period using the USPHS criteria. Great differences could be found between the materials. The failure rate (USPHS ratings Charlie) was after three years 8 per cent for the amalgam, 16 per cent for the composite resin and 60 per cent for the glass ionomer cement restorations.


Glass ionomer cement used as surgical dressing after radical surgical exposure of impacted teeth.

GPA cement was tested as an alternative to conventional surgical dressings in connection with radical surgical exposure of teeth. The material comprised 29 patients (mean age 14 4/12 years) with 35 impacted maxillary canines in palatinal position. Soft tissue and bone covering one fifth to one quarter of the tooth crown were removed. The enamel was cleaned with physiological saline and dried with gauze pads. Ketac-Fil was applied using the ESPE Aplicap system. Application stopped when the level of intact mucosa was reached. At control after 1-2 weeks (35 teeth) all packs were in place. Healing conditions were normal and soft tissue regrowth was not seen. At control after 1-6 months (23 teeth) 10 dressings were in place. Surrounding mucosa was healthy regardless of the presence of absence of pack. Soft tissue regrowth was not seen. 6-16 months postoperatively (12 teeth) all packs except 1 had been lost. Soft tissue regrowth in combination with eruption failure was seen in 2 patients. In these cases the packs had been lost soon after the first control, i.e. before healing had been completed. The results indicate that GPA cement can be recommended as an alternative to conventional surgical dressings in connection with radical surgical exposure of teeth.