Visual evoked potentials in infants and children.

Visual evoked potential (VEP) studies are of great value in a wide variety of pediatric patients, including those with disorders of the sensory visual pathway and those at risk for visual pathway damage. VEPs are simple, non-invasive, and are particularly appropriate for infants and young children who cannot communicate visual symptoms or cooperate for standard vision assessment. VEPs in pediatric patients have the following main purposes: (1) detecting lesions causing dysfunction of the sensory visual pathways (the VEP is a sensitive indicator of subclinical lesions and can be used to differentiate visual impairment from visual inattention in young infants); (2) confirming functional loss when disorders of the visual system are present; (3) quantifying visual impairment in patients with known visual disorders, accomplished either empirically by noting the severity of the VEP abnormality to flash and pattern stimuli or by visual acuity estimation studies (early quantification of vision loss allows referral to early intervention programs, which can ameliorate the long-term consequences of the disability); (4) monitoring patients who are at risk for visual complications either from diseases (such as hydrocephalus or neurofibromatosis) or as a complication of therapeutic intervention (e.g., neurosurgery, chemotherapy) to help detect and avoid long-term sequelae of such therapies on the developing nervous system; (5) establishing prognosis for visual and systemic recovery based on flash VEPs for specific pediatric disorders including perinatal asphyxia in full-term neonates, acute-onset cortical blindness, and, to a fair extent, in comatose children; and (6) in some cases, contributing to the differential diagnosis. Abnormalities of flash and/or pattern VEPs are generally nonspecific to the type of exact location of the lesion, except in distinguishing prefrom postchiasmal lesions. However, in certain conditions, such as the hereditary ataxias of childhood, VEP abnormalities may help in the diagnosis. Similarly, deterioration in VEPs may help differentiate progressive from static encephalopathies. VEPs have become an indispensable tool in pediatric ophthalmology and neurology. They will probably play an increasingly important role in the future, primarily due to the difficulty in assessing visual system function in young or ill children and the VEP's sensitivity to subclinical damage in this aspect of the central nervous system.


The electroretinogram in infants and young children.

Electroretinography (ERG), especially when combined with visual evoked potential recording, can provide valuable information to the pediatric clinician assessing a young child with nystagmus who appears not to see. ERG changes are described in clinical conditions affecting rod and/or cone function, vitreoretinal disease, maculopathies, and disorders involving the retina and central nervous system. The role of ERG in monitoring treatment, and in excluding retinal disease prior to eye surgery, is also covered.


The brainstem auditory evoked potential in infants and children.

The brainstem auditory evoked potential (BAEP) is a neurophysiological study that provides functional information about the auditory system and brainstem. It provides information that is different from any other form of evaluation. This report tries to summarize technical and clinical information that will make the BAEP more meaningful for the practicing technologist and clinician. Attention is focused on the BAEP as it is used in infants and children, starting with a brief review of auditory physiology, then progressing to normative data, clinical utility, physical setup, preparing the patient, comments on technique, and comments on interpretation. This is not an exhaustive review of the topic, and many important elements of clinical utility had to be left out. This review tries to focus on recent references and on practical issues, and it relies on the experience and opinions of the author. Emphasis has been placed on the use of the BAEP by the neurologist, but an attempt has been made to acknowledge the importance of audiology and otolaryngology as well as speech and language science. Particular emphasis has been placed on the use of the BAEP in assessing the premature infant and young infant at risk for neurological and audiological injury. An enormous amount of published data is available in the literature, and much of it had to be left out of this review. However, the reader is encouraged to develop an enthusiasm for the BAEP and to further explore the broad range of its clinical uses.


Event-related potential studies in infants and children.

The current status of event-related potentials (ERPs) in infants and children is discussed based on a review of the relevant literature. Although the N100-P200 component evoked by tone stimuli is clearly detected using an odd-ball paradigm in children over approximately 6 years of age, that component evoked by speech stimuli is not clearly detected until at least 10 years of age. In contrast to the adult N100-P200 component evoked by speech stimuli, infants and young children show a positivity at a latency of about 85-120 ms and a negativity at about 200-240 ms. The definition of P300 in children has not yet been established. P300 latency evoked by both auditory and visual stimuli decreases throughout childhood and reaches the mature value by puberty or young adulthood. However, P300s elicited by auditory and visual stimuli show different developmental time courses from each other, suggesting that they may originate from different neural generators. The Nc component is elicited by a variety of attention-getting events in infants and children. Interestingly, the developmental change in the Nc amplitude parallels the maturational course of synaptogenesis in the frontal cortex, and the Nc latency reaches the mature value at the time when myelinogenesis is complete in the nonspecific thalamic radiation.


Relationship of age to power spectrum analysis of EEG during sleep.

We describe a method of power spectrum analysis of all-night sleep EEGs in 20 normal subjects aged 18-43 years. The analysis calculates the energy of the whole sleep period, the various frequency bands, and selected sleep stages automatically. The numerical value of the energies was directly comparable between subjects, presented in numbers (microV2s) and displayed as a color density spectral array with fixed power values for each color. A significant relationship between age and power spectra was found, in that total energy/minute was higher in younger subjects than in older. The energy in delta sleep/minute also showed an inverse relationship with age.


Effects of age, gender, and stimulus side on the scalp topography of somatosensory evoked potentials following posterior tibial nerve stimulation.

This is the first thorough study to evaluate the effects of age, gender, and stimulus side on the scalp topographies of somatosensory evoked potentials (SEPs) following stimulation of the posterior tibial nerve by using computerized bit-mapped color images and the significance probability mapping method. Seventy-four normal subjects whose ages ranged from 7 to 88 years were studied. Topographic mappings of most components in aged subjects were significantly different from those in young subjects, mainly because of higher amplitudes of the components in the aged group. However, scalp distribution of each component did not show a large difference among different age groups. There was a tendency that amplitudes in women were larger than those in men, and the gender differences of some components were significantly larger for some age groups. Stimulus side and handedness caused no significant difference in amplitudes and topographies of the components. These results were very similar to our previous results of the scalp topographies of SEPs following median nerve stimulation.


High-frequency EEG activity at the start of seizures.

Frequencies above 35-40 Hz are poorly visualized on conventional EEG scalp recordings. We investigated frequency components up to 150 Hz in digitally recorded EEGs of seizures in five patients with implanted subdural grids, as part of their evaluation for epilepsy surgery. Amplifier bandpass was set from 0.1 to 300 Hz, and EEG was digitized at 2,000 samples per second. Seizures with electrodecremental patterns at the start showed a significant increase in spectral power above 35 Hz, with a twofold increase in the 40-50-Hz range, and up to a fivefold increase in the 80-120-Hz portion of the spectrum. Activity above 40 Hz could represent summed action potentials, harmonics of synaptic potentials or transient sharp components of synaptic potentials. High-frequency increases were largely localized to the region of the seizure focus. Grid sites remote from the focus did not show significant energy in the EEG band above 40 Hz at baseline, nor at time of seizure onset. Our findings suggest that high-frequency recordings may be of use in localizing seizure foci.


Lateral shelf acetabuloplasty: an operation for older children with Perthes' disease.

Although 59% of children with Perthes' disease have a good result without treatment, poor results are common when the disease has onset in older children. Femoral osteotomy at this age will control the disease but may leave shortening and a persisting limp if there is insufficient capacity for remodeling and growth. Twenty children aged greater than 8 years with early disease were treated by lateral shelf acetabuloplasty. The results are compared with those in 14 children for whom no treatment had been advised. Lateral shelf acetabuloplasty has improved early outcome for these children as compared with untreated children for whom a poor prognosis has been confirmed.


Slotted acetabular augmentation in childhood and adolescence.

During an 18-year period, 157 hips in 140 patients with hip dysplasia underwent a slotted acetabular augmentation (SAA or shelf) procedure. Indication for the procedure was pain in 71, progressive subluxation in 52, and acetabular insufficiency in 34 hips. Follow-up of 24-168 months (mean 60 months) was obtained in 108 hips in 98 patients. Good or excellent results were recorded in 83% of the hips. Unsatisfactory results were usually due to excessive breadth or insufficient thickness of the augmentation. The SAA is an alternative to the Chiari osteotomy when lateralization of the hip is not excessive.


Computed tomographic assessment of shelf acetabuloplasty.

Eleven children with cerebral palsy were studied after shelf acetabular augmentation for progressive hip subluxation. Evaluation was based on computed tomography (CT) scans and radiographic measurements. We noted significant improvement in subluxation as measured by migration percentage, without increased subluxation of the nonoperated hip. Preoperatively, our patients had anterior acetabular deficiencies and increased acetabular anteversion, but no posterior deficiency by CT scanning. The acetabular shelves were positioned relatively more anteriorly than posteriorly. This appears to be appropriate owing to the relative anterior deficiencies of the acetabuli in our patients.


The value of the acetabular teardrop figure in assessing pediatric hip disorders.

We have observed that the acetabular teardrop figure provides extremely useful information about the development of the hip in young children. Normal development of the acetabulum is associated with progressive narrowing of the teardrop figure and development of a concave shape to its acetabular line. Anatomic and functional abnormalities of the hip can cause abnormalities of the teardrop figure, including absence of the acetabular line, persistent widening, and a V-shaped teardrop figure. In young children, these abnormalities can be reversed to some degree by stabilizing operations, but it is unusual to observe substantial change in appearance of the teardrop figure after a child is aged 8 years.


Arthroscopy for slipped capital femoral epiphysis.

Arthroscopy was performed in five hips with slipped capital femoral epiphysis (SCFE) before pinning in situ. Arthroscopy disclosed erosion of acetabular cartilage in the anterosuperior region and damage to the posterolateral aspect of the acetabular labrum. Cartilaginous erosion and transverse cleft were identified on the anterior surface of the femoral head. These findings support the hypothesis that all pathomechanisms of SCFE are caused by traumatic factors. Arthroscopy for SCFE is also clinically useful in reducing hip pain. Arthroscopy performed simultaneously with pinning in situ can permit early exercise of the joint.


Congenital dislocation of the hip and its relation to swaddling used in Turkey.

A screening program was initiated and performed at five hospitals in Konya, Turkey from 1988 to 1990. Four thousand one hundred seventy-three infants aged 3-24 months were examined. With this study, we hoped to determine the incidence of and contributing factors to the etiology of congenital dislocation of the hip (CDH) in the central region of Turkey. The overall CDH incidence was 1.34%. CDH occurred about three times more often among girls than boys (40 girls vs. 16 boys). No infant with CDH had been delivered by Cesarean section or breech presentation. No teratologic CDH was detected. The relationship between CDH and swaddling (bundled in extension and adduction) was statistically significant.


Ludloff's open reduction of the hip: long-term results.

Long-term results of Ludloff's open reduction of the hip were studied in 62 joints of 56 children with an average follow-up of 11 years (range 5-18 years). Results were considered good in 76% and poor in 24%. A decisive factor in assessing long-term results was a proper centric reduction of the femoral head. The most frequent obstacles to proper reduction were a shortened inferomedial part of a joint capsule with the transverse ligament pulled into the joint cavity (14%), joint capsule contracture (100%), and an inverted limbus (92%), which was accompanied in 17% of patients by an impression of reflected head of the rectus femoris. Earlier nonoperative treatment affected the success of the reduction as well as long-term results.


Comparison of one-stage versus two-stage anterior/posterior spinal fusion for neuromuscular scoliosis.

Twenty-six patients with progressive neuromuscular scoliosis underwent anterior/posterior (AP) spinal fusion. Thirteen of the patients underwent a one-stage fusion, and 13 underwent a two-stage fusion. Although one-stage AP spinal fusion provides adequate correction of severe curves and allows a more expeditious recovery without increasing patient morbidity or mortality, current third-party payor reimbursement policies provide little incentive for 1-day operations. In addition, the procedure is mentally and physically demanding and the apparent benefits must be weighed against the potential harm that can result from surgeon fatigue or lack of appropriate planning.


Spinal cord concussion in pediatric athletes.

Children with a narrowed canal secondary to spinal stenosis or congenital malformation may be predisposed to spinal cord concussion when the canal is further narrowed in hyperflexion or hyperextension. Review of the medical records of the Winnipeg and Ottawa Children's Hospitals disclosed 12 children who had been treated for transient sensory or motor loss after a spinal injury. Measurements of the spinal canal were compared with standard normal measurements, and the spinal canal width was expressed as a percentage of the vertebral width (the Torg ratio). This study shows that narrowing of the spinal canal is an inconsistent predisposing factor to spinal cord concussion in children. A poor correlation between the Torg ratio and comparison with a series of normal control canal widths was noted.


Compression plating for child and adolescent femur fractures.

Twenty-five children ranging in age from 6-16 years underwent AO compression plate fixation for treatment of a femur fracture. Generally, the most common reason for plate fixation was to simplify nursing care and rehabilitation of children with an associated severe head injury or polytrauma. Twenty-three fractures healed in 11 weeks on the average, most by periosteal bone formation. Leg length discrepancy was not a clinical problem. Nursing care and polytrauma rehabilitation were simplified in all children. We believe that plate fixation is a reasonable treatment option for femoral fracture care in children aged less than 11 years with severe head injury or associated polytrauma.


Perthes' disease and posterior lumbosacral union.

Delayed bone development is common in Perthes' disease, and affected children are usually smaller than normal. Somatosensory evoked potentials (SEP) studied in 25 cases of Perthes' disease were normal. Fifty-four patients with active or healed Perthes' disease were examined. Every child aged less than 8 years showed failure of posterior lumbar and/or sacral fusion. With growth, fusion increased so that at age 14 years 50% had a normal fusion and 50% had spina bifida occulta. At age greater than 16 years, the incidence was similar to that in the general population. In Perthes' disease, growth in fusion of the lumbosacral elements is delayed.


Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures.

We evaluated the normal Baumann (humerocapitellar) angle in 114 children aged 2-13 years because the angle has been proposed to be useful in assessing alignment of the elbow in children with supracondylar fractures of the humerus. In this age range, the angle did not change significantly, nor was there any significant difference between the angle in boys and girls. The mean Baumann angle was 72 degrees (SD 4 degrees), and 95% of normal elbows had a Baumann angle of 64 degrees-81 degrees.


Low-dose lidocaine intravenous regional anesthesia for forearm fractures in children.

Intravenous (i.v.) regional anesthesia with low-dose lidocaine (1 mg/kg) lidocaine 1% diluted to 0.125% vol) provided safe and effective anesthesia for closed reductions of pediatric forearm fractures in outpatients. This procedure was prospectively evaluated in 44 children at The Nemours Children's Clinic, Jacksonville, Florida. Forty-three of 44 patients achieved adequate anesthesia (minimal or no pain on closed reduction). No significant complications were noted. Both patients and physicians were satisfied with the procedure. Patient pain was objectively assessed with visual pain charts in the preanesthesic, immediate postanesthetic, and postreduction time periods. The technique was both safe and effective in providing pain relief for reduction of forearm fractures in children.


Acetabular and pelvic fractures in the pediatric patient: value of two- and three-dimensional imaging.

Pediatric trauma is a significant source of morbidity and mortality in pediatric patients. Prompt and accurate assessment of injuries is necessary for the best outcome. Computed tomography (CT) has become a well-accepted, rapid, relatively noninvasive way to assess the trauma patient. In certain cases of pelvic trauma, two- and three-dimensional CT (2D/3D CT) adds detail not otherwise obtainable or appreciated. Although the benefits must be balanced against the slight increase in delivered radiation dose, we believe that 2D/3D CT is often an important part of patient management.


Shoulder arthrodesis in pediatric patients.

Shoulder arthrodesis was performed in 17 pediatric patients. Diagnoses included birth-related brachial plexus palsy (six patients), posttraumatic palsy (three patients), and residual paralysis after poliomyelitis (eight patients). The position of fusion was not as important as the stability gained by the patient. Excessive abduction or forward flexion should be avoided, however, because this can be cosmetically displeasing to patients.


Totally absorbable screws in fixation of subtalar extra articular arthrodesis in children with spastic neuromuscular disease: preliminary report of a randomized prospective study of fourteen arthrodeses fixed with absorbable or metallic screws.

Seven patients with spastic neuromuscular disease and severe hindfoot valgus deformity were treated by subtalar arthrodesis. Arthrodesis was performed in both feet at the same operation and fixed on one side with a self-reinforced poly-L-lactide (SR-PLLA) screw, and with a standard AO screw on the other side. The functional status state was improved, and radiographic union of the arthrodesis occurred in all feet. The radiograph showed better solid fusion in five feet treated with PLLA screws, similar fusion in both sides in one patient, and one slower fusion in the side treated initially with a PLLA screw. Totally absorbable SR-PLLA screws appear to be firm enough for fixation of subtalar extraarticular arthrodesis in children.


Management of congenital fibular deficiency by Ilizarov technique.

Between April 1987 and January 1990, 11 patients with congenital fibular deficiency underwent tibial lengthening of 12 involved limbs by the Ilizarov technique. The average follow-up was 23.2 months. The mean lengthening was 8.3 cm, representing an average lengthening of 31%. No knee or ankle subluxation occurred despite preoperative cruciate ligament laxity and ankle abnormalities in all patients. The most significant complications included regenerate bone deformation and delayed consolidation. With the Ilizarov technique, the limb length discrepancy, angular and rotational deformities, and foot and ankle deformities frequently associated with congenital fibular deficiency can be addressed simultaneously.


Toxic shock syndrome in patients with external fixators.

Toxic shock syndrome (TSS), first described by Todd et al. in 1978, can be a life-threatening entity. Familiarity with the pathogenesis and clinical presentation of TSS may help achieve early diagnosis and prompt appropriate intervention. TSS is not a septicemia, but a toxemia. The most extensively described pathogenesis involves a focus of specific Staphylococcus aureus strains capable of producing an exotoxin (TSST-1). We report two patients who developed TSS while in external fixators and describe their initial symptoms, management, and subsequent problems. This report will serve to alert pediatric orthopaedic surgeons to this entity and enable them to recognize its rather precipitous presentation and initiate appropriate treatment.


Acute pyogenic psoas abscess in children.

In a retrospective study, 24 patients treated at King Edward VIII Hospital from 1985 to 1988 for acute pyogenic psoas abscess were reviewed. The main initial complaints were a painful hip and difficulty in walking. Twenty-two patients had a fixed flexion deformity of the ipsilateral hip. Ultrasonography used as a screening method elucidated the clinical diagnosis in 19 patients. Twenty-two children required incision and drainage, and Staphylococcus aureus was isolated in 20 patients either on blood culture or pus swab. Although the condition is common in the tropics, an acute pyogenic psoas abscess should always be considered in the differential diagnosis of pain in the hip region.


Self-concept dimensions of clinically depressed and anxious outpatients.

Principal components analyses of the Beck Self-Concept Test (BST) were conducted independently for 288 women with primary mood disorders, 230 women with anxiety disorders, 236 men with mood disorders, and 161 men with anxiety disorders. Four self-concept dimensions that reflected (1) Intellectual Ability; (2) Work Efficacy; (3) Physical Attractiveness; and (4) Virtues/Vices occurred within the four samples. For 5-item subscales that represent these four dimensions, a two-way MANOVA found significant effects for sex and type of disorder. Women described themselves as having less intellectual ability than men did. Outpatients with mood disorders considered their physical appearance, work efficacy, and virtues/vices to be less acceptable than did those with anxiety disorders. Findings were discussed with respect to the cognitive content-specificity theory of psychopathology.


Object relations deficits in subtypes of schizophrenia.

Forty-eight subjects with diagnoses of schizophrenia were assessed with the Bell Object Relations Inventory (BORI), the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Premorbid Adjustment Scale (PAS) to determine the distribution of object relations deficits in the whole sample and four subtypes: paranoid, schizoaffective, poor premorbid, and prominent negative symptoms. Results indicate that 92% of the sample had object relations deficits; 85% showed elevations on the BORI Alienation scale. Subjects with prominent negative symptoms produced lower values on Insecure Attachment and higher values on Egocentricity. This suggests that negative symptoms are associated with a reduction in perceived painfulness of attachment and increased egocentric investment. Other subtyping schemes showed no reliable pattern of object relations deficits.


Family functioning and child abuse potential.

Family conflict and the lack of family cohesion are believed to set a foundation for coercive interactions that increase the likelihood of child abuse. The present study investigated the relationship between the family social environment (Family Environment Scale and Index of Marital Satisfaction) and physical child abuse potential (Child Abuse Potential Inventory) in maltreating (n = 376) and comparison (n = 148) parents. As expected, the strongest positive relationship was between family conflict and abuse potential. The strongest inverse relationships were between family cohesion, family expressiveness, marital satisfaction, and abuse scores, which indicates that the lack of positive interactional patterns is related to abuse potential. However, regression analysis revealed that family interactional patterns did not account for the majority of variance in abuse potential.


Musculoskeletal manifestations of Proteus syndrome: report of two cases with literature review.

Proteus syndrome is a recently described hamartomatous condition characterized by macrodactyly, hemihypertrophy, subcutaneous (s.c.) tumors, epidermal nevi, and skull anomalies. Two new cases are described to illustrate the diagnostic features and the orthopedic problems associated with this rare syndrome. Review of available literature shows that 61 patients with proteus syndrome commonly develop macrodactyly, limb overgrowth, spinal deformity, hip dysplasia, genu valgum, exostoses, joint contractures, and hindfoot deformities.


Assessing the severity of depressive illness.

Twenty-five psychiatrists ranked a set of hypothetical patient scenarios, based on the three depression rating scales (Hamilton, Hospital Anxiety and Depression, and Montgomery Asberg), in terms of severity of illness. The results indicate some scope for comparing different condition-specific outcome measures. Although the patient scenarios were context free, the responses of the psychiatrists suggested that they might be used to assess severity of depressive illness.


The influence of weight reduction and exercise regimes upon the personality profiles of overweight males.

In the present study, the MMPI was used to detect personality changes in 53 overweight, yet otherwise healthy, males who were participating in either a weight reduction or an aerobic exercise conditioning program. Analysis of pre- and post-intervention scores revealed that only the participants in the aerobic conditioning group demonstrated the predicted desirable psychological changes. More specifically, this group displayed significant clinically desirable changes on the Hs, PD, and HEA scores. Similar to the weight loss participants, a demographically matched nonintervention comparison group showed none of these desirable changes and actually yielded a significant increase on the D scale. However, when compared to this "normal" group, both intervention programs showed statistically significant differences on at least two MMPI scales.


Bulimia and fear of intimacy.

Many authors have suggested that fear of intimate relationships is a central dynamic in bulimia. However, empirical studies have yielded conflicting results. Eleven women who met the DSM-III-R criteria for bulimia and 23 women who denied binging and/or engaging in purging behavior completed the Fear of Intimacy Scale (Descutner & Thelen, 1991). This instrument is the first instrument to measure fear of intimacy reliably and has been found to be valid for this purpose. As predicted, bulimic subjects evidenced significantly greater fear of intimacy than did control subjects.


Age, stage, and the MMPI: changes in response patterns over an 85-year age span.

Statistically significant and clinically relevant age-related changes in MMPI response patterns have long been known to clinicians. Graphic representations of mean scores that cover an 85-year age span, separately by sex, for each of the 13 basic MMPI validity and clinical scales support the use of adolescent norms and indicate that clinicians should give greater acknowledgement to age-related MMPI changes in adults and their interpretation, particularly among geriatric patients.


Ego-strength revised: a comparison of the MMPI-2 and MMPI-1 versions of the Barron Ego-strength scale.

This study evaluated the equivalence of the original MMPI and the shortened MMPI-2 versions of the Barron (1953) Ego-strength scale, an important research scale. Three hundred fifty-five subjects took the MMPI-2 and the 16 MMPI-1 items dropped from the original scale. The omitted items appear to contribute little to the original scale. The revised version compares favorably with the old in terms of internal consistency, and the two versions are highly intercorrelated. Confirmatory Factor Analysis indicates that four of Stein and Chu's (1967) five groupings of the original items provide a reasonably good fit for the MMPI-2 as well. Compared to the original, the new version was slightly more correlated with other paper-and-pencil measures of psychological health and well-being.


The Bulimic Automatic Thoughts Test: initial reliability and validity data.

The Bulimic Automatic Thoughts Test (BATT) was designed to address some of the limitations found in previous measures of the cognitions of bulimic patients. In this study, bulimic, depressed, obese, and normal subjects were differentiated on the BATT, which suggests that it is a useful measure for detecting cognitions specific to bulimic patients. Scores on the BATT improved after a trial of cognitive-behavioral therapy for the bulimic subjects. The BATT may be useful in predicting which bulimic women will continue to have distorted thinking after treatment and will require additional intervention.


Suicide and time perspective: an examination of Beck and Yufit's suicide-risk indicators.

Both Beck and Yufit have developed indices of risk for suicidal groups. An investigation with 86 university students explored the concurrent and convergent validity of both scales. The current study reports moderate correlations between these two measures as a test of concurrent validity. In addition, both authors argue for the importance of time perspective in the development of these tests. The Hopelessness Scale was found to correlate well with other attitudinal measures of time perspective. The correlational pattern of the Time Questionnaire presented a less coherent pattern of association across temporal orientation, extension, and temporal attitude scales.


The revised Generalized Expectancy for Success Scale: a validity and reliability study.

The Generalized Expectancy for Success Scale (GESS; Fibel & Hale, 1978) was revised and assessed for reliability and validity. The revised version was administered to 199 college students along with other conceptually related measures, including the Rosenberg Self-Esteem Scale, the Life Orientation Test, and Rotter's Internal-External Locus of Control Scale. One subsample of students also completed the Eysenck Personality Inventory, while another subsample performed a criterion-related task that involved risk taking. Item analysis yielded 25 items with correlations of .45 or higher with the total score. Results indicated high internal consistency and test-retest reliability.


Conventional intelligence measurements and neuropsychological concepts of adaptive abilities.

The concept of intelligence and its representation by the Intelligence Quotient have been difficult to define and the subject of criticism for various reasons. Matarazzo and Kaufman have reviewed intelligence measurements and brain functions, but a biologically based explication of intelligence has not been explicitly proposed since the theories presented more than 40 years ago by Halstead and Hebb. The present study explored the overlap and differential sensitivity of intelligence measures (VIQ, PIQ, and FSIQ) and neuropsychological measures (Impairment Index and Category Test) to cerebral damage and educational attainment. The results indicated that neuropsychological measures may serve to broaden the concept of intelligence and that a brain-related criterion may contribute to a fuller understanding of its nature.


Memory and attention.

The effect of attention on memory was examined in three studies. In all three, the subjects were instructed to remember the items of one color from an array that contained items of two colors. Subsequently, the subjects were asked to reproduce items of both colors. Almost all of the items that the subjects remembered were those to which they had attended. The parameters of sex, color, and mode of presentation (verbal and drawing) were not significant. Head injury did not disrupt this effect. On the basis of this effect, it was theorized that the strength of a memory store is related directly to the strength of attention.


Psychotherapist personality characteristics and the perception of self and patients in the treatment of borderline personality disorder.

The influence of certain personality characteristics (tendency to depressive experiences, personal boundary preferences) on psychotherapist reaction to patients with borderline personality disorder was assessed by semantic differential ratings in an analogue study. Vignettes presented one of two patients enacting the Rewarding and Withdrawing object relations unit in two separate therapy sessions. Therapists higher on anaclitic depressive and fusion tendencies evaluated themselves less positively than other therapists (p less than .01) in the Withdrawing condition. They evaluated the patient less positively regardless of condition (p less than .05). High boundary therapists evaluated patients more positively (p less than .05) in the Withdrawing condition. They evaluated themselves more positively regardless of condition (p less than .05) and showed less tendency to devalue self and patient with the lower functioning borderline patient.


Psychotherapist perceptions of self and patients in the treatment of borderline personality disorder.

Psychotherapists' reactions to patients with borderline personality disorder were assessed by semantic differential ratings in an analogue study. Vignettes presented one of two patients who enacted the Rewarding and Withdrawing object relations units in two separate therapy sessions. In response to the Rewarding object relations unit therapists evaluated themselves more positively and perceived themselves as more active and more potent than in response to the Withdrawing object relations unit (p less than .01). They also evaluated the patients more positively and perceived them as less active (p less than .01). These patterns were modified by some order effects and some differences in response to the two vignettes, which represented a lower and higher functioning borderline patient.


Appropriateness of the Draw-A-Person test with Alaskan Native populations.

The appropriateness of the Draw-A-Person test with Alaskan Native populations was assessed by matching 33 White subjects to 33 Alaskan Native subjects, asking them to perform the DAP, and rating their performance according to eight criteria chosen for their clinical relevancy. Results indicated that neither level of commitment to Native culture nor ethnicity per se affected drawing ratings. It is hypothesized that the DAP is a useful clinical tool appropriate for use with Alaskan Native populations.


An archival study of decision-making in child custody disputes.

Investigation files and court records of 282 disputed child-custody cases (San Diego, 1982) were coded and analyzed to determine predictors of judicial decision. Log-linear analysis of physical custody decisions as a function of factors contained in the files suggested that three categories of factors (mother, father, and child) were linked causally to a counselor's recommendation, which was linked subsequently to the judge's decision. Judicial decisions could be predicted accurately by a model that took very few factors into account. Only two factors directly affected the judge; counselor-recommendation and child preference. The major factor that influenced decisions was counselor recommendation (60% of the cases); cases that lacked this recommendation were predicted by an inferential measure of the child's preference (15% of the cases).


Circulating secretory component in relation to early diagnosis and treatment of liver metastasis from colorectal carcinomas.

To evaluate serum secretory component in relation to early detection and clinical management of liver metastasis in patients with colorectal cancer. Secretory component and carcinoembryonic antigen (CEA) were analysed in serial serum samples from 23 patients who had liver metastases as the only apparent recurrence, and in sera from 54 matched controls. Results of surgical treatment of recurrences were classified peroperatively as radical when no residual tumour was apparent and resection margins were free of disease. In total, 18 (78%) patients had increased secretory component during the whole follow up period (median 16 months); 12 (52%) had raised secretory component concentrations before clinical recurrence (median lead time 5.2 months). There was no difference before recurrence between circulating secretory component and CEA in sensitivity and lead times. Seventeen patients underwent surgery for hepatic metastasis; seven had radical hepatic resection of which only two (29%) showed increased secretory component concentrations before clinical recurrence; both had concurrent raised CEA values. By contrast, secretory component was raised in 83% of those cases considered inoperable. Although serum secretory component clearly increases in most patients with liver metastases, its clinical value seems questionable because secretory component apparently indicates mainly inoperable hepatic metastases.


Computerised protocols for laboratory investigation and their effect on use of medical time and resources.

To devise a computerised management system protocol which not only proposes the laboratory investigations to be performed on each patient but also performs related clinical functions. The system was designed by senior members of staff. The protocols defined all laboratory investigations including haematology, biochemistry, immunology and cross-matching, and included static and dynamic rules. Patients can be changed to different or additional protocols, as required; likewise proposed tests can be deleted or added. The software is written in MUMPS and runs on a 386 PC running MSM MUMPS under MSDOS. The number of clinical chemistry tests requested per patient per day fell by 9.5% (p less than 0.01) for transplant recipients and by 28.8% (p less than 0.01) for non-transplant recipients. The average time spent by junior medical staff requesting laboratory investigations and enquiring about results fell from 10 minutes per patient per day to 4.1 minutes (p less than 0.001). The introduction of this system in no way abrogates clinicians' responsibility for the management of patients, because all proposed investigations must be confirmed or modified by the authorising doctor. The system allows for the audit of requesting patterns and subsequent improvement in protocols by recording any alterations made to the proposed investigations. Significant benefits in terms of better use of house officer time and medical resources were also achieved.


Prospective study of necropsy audit of geriatric inpatient deaths.

To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.


Vascular invasion in non-small cell lung carcinoma.

To determine if there is any correlation between vascular invasion and prognosis in non-small cell carcinoma of the lung; and to look specifically at invasion of vascular channels by tumour cells. Eighty seven patients undergoing lobectomy or pneumonectomy for adenocarcinoma or squamous carcinoma were followed up for five years. The histological sections were studied for evidence of vascular invasion using an elastic van Gieson stain. The incidence of intimal fibrosis in arteries and veins was noted and the proportion with vascular invasion evaluated using a scoring system. The presence or absence of lymphatic permeation and tumour necrosis were noted. Survival data were analysed using the log rank test. The overall five year survival was 32%. There were 64 squamous cell carcinomas and 23 adenocarcinomas. Vascular invasion was seen in 77% of patients and lymphatic invasion in 44%. Neither the presence nor absence nor the proportion of blood vessels showing vascular invasion showed any relation to prognosis. Intimal fibrosis and tumour necrosis were unrelated to prognosis. Patients with lymphatic permeation had recurrence and died earlier than those without. The presence of arterial or venous invasion by adenocarcinoma or squamous carcinoma of the lung was unrelated to survival; lymphatic permeation was associated with poor prognosis. The two common non-small cell lung cancers behaved differently from other solid tumours, where vascular invasion was a significant factor in determination of prognosis. The presence of intimal fibrosis was unrelated to prognosis.


Helicobacter pylori serology in patients with coeliac disease and dermatitis herpetiformis.

To investigate whether Helicobacter pylori infection or autoimmune gastritis is responsible for the reported increase in gastric pathology and abnormalities of gastric function in patients with coeliac disease and dermatitis herpetiformis (DH). Serum H pylori IgG antibodies were assayed by enzyme linked immunosorbent assay and intrinsic factor antibodies by radioimmunoassay in 99 patients with coeliac disease and 58 patients with dermatitis herpetiformis from two geographic areas. H pylori positivity in patients with coeliac disease and dermatitis herpetiformis increased with age, reaching 50% and 70%, respectively, in patients over 50 years. The percentage H pylori seropositivity in coeliac disease did not differ from the percentage positivity observed in 250 similarly aged blood donors from the same geographic area (Leeds). Seropositivity in patients with dermatitis herpetiformis was not significantly different from the level of positivity observed in 98 age matched patients without dermatitis herpetiformis attending the same Edinburgh dermatology clinic. Only one patient with coeliac disease had positive intrinsic factor antibodies. H pylori seropositivity in Edinburgh control subjects under 30 years of age (41.9%) was significantly higher (p less than 0.03) than in Leeds controls (18%) of corresponding age. An increasing prevalence of H pylori seropositivity with age in coeliac disease and dermatitis herpetiformis paralleled that of the control groups. Gastritis in coeliac disease and dermatitis herpetiformis is largely caused by H pylori infection at a level that is no different from that of the general population. Any increase in the prevalence of gastritis in these two diseases might be caused by lymphocytic gastritis rather than pernicious anaemia.


Use of polymerase chain reaction for early identification of Mycobacterium tuberculosis in positive cultures.

To develop a readily applicable polymerase chain reaction (PCR) based technique which would permit the identification of Mycobacterium tuberculosis complex isolates from Bactec phials at an earlier stage than currently available methods. Mycobacterial cells cultured in Bactec 12B medium were harvested by centrifugation. The cells were lysed by heating in distilled water. Oligonucleotide primers based on the sequence of the gene coding for the immunogenic protein MPB64 were then used to amplify a 240 base pair fragment of DNA directly from the crude cell lysate. The PCR product was visualised under ultraviolet light following electrophoresis of an aliquot in an agarose gel containing ethidium bromide. The sensitivity of the PCR was adjusted so that about 600 cfu of M tuberculosis gave a positive result. The lowest growth index at which this method of identification might be applied to Bactec phials was determined and a number of routine cultures giving a positive growth index examined. M tuberculosis was positively identified at the lowest growth index, as determined by the Bactec system. Of 45 routine cultures examined, with growth indexes ranging from 6 to 999, the 15 confirmed by conventional means to contain M tuberculosis were correctly identified from 1 ml of culture medium. The method described can be used to identify M tuberculosis isolates cultured in the Bactec system at the earliest detectable rise in growth index. It may therefore allow cultured mycobacteria to be identified at an earlier stage than conventional methods or the commercially available DNA probes adapted for use with the Bactec system.


IgA antibody response during acquired and congenital toxoplasmosis.

Toxoplasma gondii specific IgA and IgM antibodies were quantitated by an antibody capture agglutination assay in 260 patients with acquired toxoplasmosis and from 94 fetuses suspected of congenital toxoplasmosis and 30 infected children. In acquired toxoplasmosis, IgA antibodies to T gondii were found in 95% of the cases. In congenital toxoplasmosis IgA antibodies were more frequently detected (75%) in cord blood than IgM antibodies (61%). They persisted after birth, in some cases for up to 24 months. IgA antibodies were also detected in fetuses whose mothers had toxoplasmosis during their pregnancy. In infected fetuses IgM and IgA antibodies were detected in fetal blood as early as week 24 of pregnancy. Detection of IgA T gondii antibodies may be useful for the diagnosis of some recently acquired infection and for the diagnosis and follow up of the infection in the fetus and neonate.


Detection of Clostridium perfringens and its enterotoxin in cases of sporadic diarrhoea.

To determine the incidence of sporadic and apparently non-food related diarrhoea associated with Clostridium perfringens enterotoxin. Enzyme linked immunosorbent assay (ELISA) and reversed phase latex agglutination (RPLA) were used to detect C perfringens enterotoxin in faecal specimens from 818 sporadic cases of diarrhoea. C perfringens enterotoxin was identified as a cause of sporadic diarrhoea in 56 of 818 (6.8%) cases. Diarrhoea was prolonged (three days or more) in most cases. Ages ranged from 3 months to 89 years, although most patients were over 60 years of age. These results suggest that C perfringens may be a cause of sporadic cases of diarrhoea when causes such as food consumption or cross-infection are absent, particularly in the elderly.


Neuronal network analysis of serum electrophoresis.

To advise a system of neuronal networks which can classify the densitometric patterns of serum electrophoresis. Digitised data containing 83 normal and 132 pathological serum protein electrophoresis patterns were presented to four neuronal networks containing 1900 neurons. Network 1 evaluates the integrated values of the albumin, alpha 1, alpha 2, beta and gamma fractions together with total protein (Biuret method). Networks 2, 3, and 4 analyse the shape of the albumin, beta and gamma fractions. To increase the sensitivity for the detection of monoclonal gammopathies a Fourier transformation was applied to the beta and gamma fractions. After a learning period of 20 minutes (back-propagation learning algorithm) the system was tested with a set of electrophoresis patterns comprising 446 routinely collected samples. It differentiated between physiological and pathological curves with a sensitivity of 97.5% and a specificity of 98.8%, with 86% correct diagnoses. All monoclonal gammopathies were recognised by the Fourier detector. Neuronal networks could be useful for certain medical uses. Unlike rule based systems, neuronal networks do not have to be programmed but have the capacity to "learn" quickly.


Transfusion associated graft versus host disease in an immunocompetent patient.

Transfusion associated graft versus host disease is a rare disorder usually confined to patients who are immunosuppressed. A case is described in a 77 year old woman who was presumed immunocompetent. She was transfused with one unit of blood from an individual who was homozygous for the same HLA haplotype as her. The diagnosis of transfusion associated graft versus host disease should be suspected in a patient who develops aplastic anaemia within 30 days of a transfusion of blood products. It is suggested that blood donations from first degree relatives should not be permitted, unless the donation is irradiated to prevent lymphocyte proliferation.


Plasmacyte-reticulum cell satellitism in multiple myeloma associated with amyloidosis.

A novel morphological feature is described in a patient with myeloma and associated amyloidosis: characteristic clustering (satellitism) of neoplastic plasma cells around macrophages in bone marrow aspirates. Although described in myeloma cell culture, as far as is known, this is the first description of this phenomenon in a patient. This unique association may partly explain the origin of amyloid deposition in tissues and organs.


Progressive multifocal leucoencephalopathy, sclerosing cholangitis, bronchiectasis and disseminated warts in a patient with primary combined immune deficiency.

A 24 year old man presented with an unusual primary combined immune deficiency syndrome characterised by a profound lymphopenia of CD4 cells, selective serum IgG2 subclass deficiency, poor polysaccharide antibody responses, disseminated warts, recurrent sinopulmonary infection and bronchiectasis. The developed progressive multifocal leucoencephalopathy (PML) in association with sclerosing cholangitis. Progressive multifocal leucoencephalopathy (PML) usually occurs as an opportunistic infection in patients with secondary defects in cellular immunity.


Isolation of Legionella pneumophila serogroup 14 from a human source.

A strain of Legionella pneumophila serogroup 14 was isolated during a retrospective study, after death from the sputum of a patient who had had acute leukaemia and pneumonia. This is the third strain of that serogroup to be isolated from a human source. This event emphasises the importance of performing culture as well as serological tests, so as to detect cases of legionellosis caused by strains which rarely cause fatal clinical illness.


Aspergilloma in the frontal sinus expanding into the orbit.

A case of primary frontal sinus aspergilloma in a 79 year old non-immunocompromised woman, who presented with a right sided pyocele expanding into the orbit, is presented. The low susceptibility of the frontal sinus is probably related to the brachycephalic shape of the human skull which locates this sinus far anterosuperiorly to the nasal cavity. In human frontal sinus aspergillosis nasal symptoms are absent; the clinical manifestation of this rare disease is initiated by complications, especially orbital or intracranial invasion. Sinus opacity may raise early suspicion. Treatment consists of surgical debridement and re-aeration. Diagnosis is established by histological analysis of intraluminal contents.


Effects of prolonged processing in standard and isotonic trichloroacetic acid (TCA) on cellular preservation in bone marrow trephines.

The effects of a combined fixing and decalcifying solution, trichloroacetic acid, on prepared bone marrow specimens were evaluated to try to improve the speed of trephine biopsy processing in our laboratory. The morphological preservation obtained immediately after decalcification was complete was assessed, and also after prolonged immersion in each of two solutions. Trichloracetic acid was made up in the standard manner using distilled water and in an isotonic form by the addition of sodium chloride. Prolonged immersion was performed to assess any possible adverse effects of this acidic solution. By the time decalcification was complete, each solution gave morphological preservation sufficient for diagnostic purposes. However, after prolonged immersion, only the isotonic solution performed adequately.


Depth-force patterns of periodontal probing. Attachment-gain in relation to probing force.

It was the purpose of this study to determine whether probing force had an influence on the amount of clinical attachment-gain assessed after treatment by scaling and rootplaning. A probing device was constructed which allowed simultaneous monitoring of probing force and probe penetration and which standardized the insertion pathway for repeated measurements. In 10 periodontal patients, 2 deep pockets were selected which were measured before and after periodontal treatment by scaling and root-planing. Depth-force plots were compared by superimposition. Depth values were determined at 5 different force levels (0.25, 0.50, 0.75, 1.00 and 1.25 N) on each plot and changes of clinical attachment levels were calculated. A significant relationship was seen between probing force and attachment level. The values obtained with 0.25 N were significantly different from the values obtained with higher forces (p less than 0.001). Slight, but non-significant differences were noted in the amount of attachment-gain obtained at the 5 force levels. At a probing force level of 0.25 N, there was 0.80 mm mean attachment gain. With 0.50 N, there was a gain of 0.70 mm; with 0.75 N the gain amounted to 0.67 mm in mean. At 1.00 N and at 1.25 N, a gain of 0.66 mm was recorded.


Probe tine diameter and probing depth.

The aim of this study was to assess the effect of difference in tine diameter on probing pocket depth measurement. 2 sets of tines with Williams markings at 1, 2, 3, 5, 7, 8, 9 and 10 mm, and with a "round" tip, diameter 0.5 mm, were compared. One set was described as parallel-sided, the other as tapered. The parallel-sided tine was almost parallel from the 10 mm marking to the tip (tip diameter mean = 0.46 mm, 95% C.I. 0.456-0.464), while the corresponding diameter for the tapered tine varied (tip diameter mean = 0.48 mm, 95% C.I. 0.473-0.489). Calibration markings appeared highly consistent with the expected value to within 0.01 mm. The tines were mounted in Brodontic handles at 0.25 N. Examiner probing repeatability yielded kappa 0.86 for "parallel-sided" and 0.81 for "tapered" tines in vivo. 412 approximal pockets were assessed in 53 patients with routine chronic adult periodontitis, mean age 42.1 years. Each site had a probing depth of greater than or equal to 5 mm, PlI less than or equal to 1, GI less than or equal to 1, PBI less than or equal to 1. Each site was probed 2x with a 15-min interval. At the first 251 sites, the parallel-sided tine was used initially, and the tapered at the remaining 161 sites. Results indicated a highly significant tendency for the parallel-sided tine to yield a deeper reading when a difference occurred. These findings indicate that with adequate training providing high examiner repeatability, one source of error in probing data can be minimised.


The incidence and severity of nifedipine-induced gingival overgrowth.

The gingival health of 19 patients with cardiovascular problems who were medicated with nifedipine was compared with a similar cohort treated with atenolol and a control group of healthy patients. In the nifedipine and atenolol groups, patients had been taking their respective medication for a minimum period of 6 months. Plaque scores were similar for all three groups. However, patients medicated with nifedipine had a significantly higher gingival index (P less than 0.005), gingival overgrowth scores (P less than 0.02) and probing sites greater than 3 mm (P less than 0.005) when compared with the atenolol and control groups. 4 patients in the nifedipine group experienced clinically significant gingival overgrowth which required surgical excision. Gingival changes in the nifedipine patients were not related to drug dosage or plaque scores. It is concluded that nifedipine therapy results in significant gingival changes, an effect which may be mediated by the drug's action on calcium transport.


Maintenance of new attachment gained through guided tissue regeneration.

The aim of the present study was to evaluate whether new attachment, gained following guided tissue regeneration (GTR) therapy, can be maintained over longer periods of maintenance therapy. 88 sites at 52 teeth with various types of periodontal defects in 39 patients were treated with the GTR procedure during the period 1984-1989. The effect of treatment was evaluated by assessing probing attachment level (PAL) prior to surgery and 6 months post-surgery. Only sites which at the 6-month examination (baseline) had gained 2 mm or more of PAL were regarded as successfully treated and scheduled for further monitoring. At baseline, 80 sites could be identified which fulfilled this criterium. Of the 80 new attachment sites, all have been monitored for 1 year, 65 for 2 years, 40 for 3 years, 17 for 4 years and 9 sites for 5 years. The results demonstrated that the attachment gain, obtained as the result of the GTR treatment, could be maintained over periods up to 5 years.


Elevated levels of the IgG2 subclass in serum from patients with a history of destructive periodontal disease. A case-control study.

The levels of the 4 subclasses of IgG were estimated in the serum from 35 patients with a history of chronic periodontitis and 35 matched controls. The levels of IgG2 were significantly (P less than 0.019) elevated in the patients (3.756 g l-1) compared to the controls (2.882 g l-1). The data suggest that the predominant antibody response to periodontal pathogens in periodontitis may be directed against carbohydrate or glycolipid antigens.


Effect of 4 days of mouth rinsing with delmopinol or chlorhexidine on the vitality of plaque bacteria.

Delmopinol is a new surface active anti-plaque agent that has demonstrated a low antimicrobial effect in vitro. By use of a vitality staining technique, the antimicrobial effect on bacteria in plaque samples was tested after rinsing with delmopinol or chlorhexidine. 6 healthy male subjects volunteered to rinse for 4 days using a double-blind cross-over study design with a wash-out period between the rinsing regimens. No oral hygiene measures were allowed during the test periods and each test period started with a professional tooth cleaning procedure 2 days before the start of rinsing to allow for plaque formation. Rinsing was performed with 0.2% delmopinol hydrochloride or 0.2% chlorhexidine digluconate 2 x a day. Small samples of plaque were collected from the buccal surfaces of premolars and 1st molars before the first rinse on day 1 and then before and 1, 2, 4, 7, and 24 h after the last rinse on the 4th day. The plaque samples were immediately stained with propidium iodide and fluorescein diacetate to visualize dead and vital microorganisms respectively. The vitality of the microflora was evaluated using a fluorescence microscope. The baseline vitality values were 91% for chlorhexidine and 86% for delmopinol. At day 4, the plaque vitality for chlorhexidine was approximately 40% up to 4 h and 50% at 7 h and 60% at 24 h after the last rinse. Corresponding values for plaque vitality after delmopinol rinsing were between 70 and 80% on all sampling occasions.(ABSTRACT TRUNCATED AT 250 WORDS)


Comparison of panoramic and intraoral radiography and pocket probing for the measurement of the marginal bone level.

Panoramic, bitewing and periapical radiography and probing for measurement of the marginal bone level were compared. Altogether 237 sites of 23 patients were examined. Radiographs were taken with a splint containing steel balls to allow calculation of the enlargement of the radiographs. Probing was done before and during flap surgery using the same splint. The open bone measurement represented the true value. All radiographs were assessed by 5 observers. The mean enlargement of panoramic radiography was 27% in the upper and 26% in the lower arch. For bitewing and periapical radiography, it was 8% in the upper and 4-5% in the lower arch. All methods underestimated the bone loss. Probing bone level before surgery was most accurate, deviating at most 5% from the true value. Periapical radiography was more accurate than panoramic and bitewing radiography (p less than 0.001). Panoramic radiography presented a slightly lower mean accuracy than bitewing radiography (p less than 0.05). The underestimation of the bone loss ranged from 13 to 32% in orthopantomograms, 11-23% in bitewing and 9-20% in periapical radiographs. The interobserver variation of the radiographic methods was substantial.


Comparison of a subgingivally placed cannula oral irrigator tip with a supragingivally placed standard irrigator tip.

This study compared the depth of irrigation of periodontal pockets achieved by a cannula subgingival irrigator tip and a standard oral irrigator tip. They were tested on periodontally involved teeth recommended for extraction from 17 patients. Before extraction, reference grooves were made circumferentially in each study tooth at the level of the gingival margin. In one group of 5 patients (29 teeth), a cannula was inserted halfway into the pocket at the facial, mesiofacial, distofacial, lingual, mesiolingual and distolingual surfaces and the surface irrigated for 5 s at 5 psi with a solution of plaque-staining dye from an oral irrigator. A 2nd group of 7 patients (29 teeth) was tested similarly with a standard irrigating tip at 80 psi. A 3rd (control) group of 5 patients (26 teeth) rinsed with the dye solution. Teeth were then extracted. The distance on each tooth from the reference notch to the apical extent of the stained plaque, and also to the coronal limit of the connective tissue attachment, was measured at 4 sites (mesial, distal, buccal, lingual) under a dissecting microscope to determine the extent of dye penetration. Mean linear penetration for the control group was only 0.1 mm. Irrigation with the cannula tip penetrated farther into both the medium (3.5-6 mm) and the deep (greater than 6 mm) periodontal pockets (p less than 0.01) than did irrigation with the standard tip.(ABSTRACT TRUNCATED AT 250 WORDS)


Healing of experimental wounds in sialadenectomized rat.

The present study evaluates the healing of an experimental standardized full thickness excisional wound in the palate of a sialadenectomized rat model. Experimental rats underwent sialadenectomy of the submandibular and sublingual glands and ligation of the parotid ducts. A full thickness circular wound, 3 mm in diameter, was produced in the palate. Wound diameter was measured clinically and the area of inflammation and area of new connective tissue formation were determined histologically at 3, 7, 14, 21 and 28 days post-surgery. Wound diameter was similar in both the experimental and the control groups. The area of inflammation, however, was larger (p less than 0.05) in experimental rats at days 3, 7 and 14. New connective tissue formation was less (p less than 0.05) in sialadenectomized rats at days 14 and 21. The present results indicate that palatal wound healing is altered and delayed in sialadenectomized rats.


Thyrotropin-releasing hormone (TRH)-like immunoreactivity in the grey monkey (Macaca fascicularis) spinal cord and medulla oblongata with special emphasis on the bulbospinal tract.

The distribution of thyrotropin-releasing hormone (TRH)-like immunoreactivity (LI) has been studied in the grey monkey (Macaca fascicularis) spinal cord and medulla oblongata by the use of indirect immunofluorescence and the peroxidase-antiperoxidase (PAP) technique. Furthermore, double-labeling experiments were performed in order to study colocalization of 5-hydroxytryptamine (5-HT)- and substance P-LI. A dense innervation of TRH-immunoreactive (IR) varicose fibers was found in the ventral horn motor nuclei, in the region surrounding the central canal, in the intermediolateral cell column, and in the dorsal horn laminae II and III. In addition, cell bodies harboring TRH-LI were found in the dorsal horn laminae II-IV. In the ventral horn, many of the large cell bodies and their proximal dendrites were totally encapsulated by TRH-IR fibers. From double-labeled sections a high degree of coexistence could be established between TRH-/5-HT-LI, TRH-/substance P-LI, and 5-HT-/substance P-LI in fibers in the motor nuclei; as a consequence, a large proportion of these fibers should harbor TRH-/5-HT-/substance P-LI. A coexistence between TRH-/5-HT-LI could also be demonstrated in the intermediolateral cell column. However, no unequivocal coexistence could be found between TRH-/substance P-LI and 5-HT-/substance P-LI in this region. In the dorsal horn, no clear coexistence could be encountered for any of the above indicated combinations. Electron microscopic analysis of material from the lumbar lateral motor nucleus demonstrated TRH-IR terminals making synapses with large cell bodies and dendrites. In addition, contacts lacking synaptic specializations could also be verified. In the medulla oblongata, with the use of the PAP technique, a large number of cell bodies containing TRH-LI were encountered in the midline raphe nuclei and in nucleus reticularis lateralis. A similar distribution pattern could be found for 5-HT-LI, but no cell bodies containing substance P-LI could be seen in these regions. Chemical analysis of specimens from cervical, thoracic, and lumbar spinal cord revealed higher concentrations of TRH- and 5-HT-LI in the ventral quadrants, whereas substance P-LI dominated in the dorsal quadrants. Thus, the concentrations of TRH-, 5-HT-, and substance P-LI was in accordance with the observed regional variation in density of IR-fibers and varicosities found in the spinal cord. We have shown that TRH-LI has a distribution in the monkey spinal cord and medulla oblongata similar to that previously demonstrated in other species.(ABSTRACT TRUNCATED AT 400 WORDS)


Morphology of single vestibulospinal collaterals in the upper cervical spinal cord of the cat: I. Collaterals originating from axons in the ventromedial funiculus contralateral to their cells of origin.

Vestibulospinal neurons in the medial and descending vestibular nuclei have widespread bilateral terminations in the upper cervical spinal cord. These terminations arise from axons travelling in several funiculi, including the ventromedial, ventrolateral, lateral, and dorsolateral funiculi in addition to the dorsal columns. The purpose of the present study was to examine the morphology of single vestibulospinal collaterals which terminate in the upper cervical spinal cord and which originate from axons located in one of these funicular pathways, the ventromedial funiculus, contralateral (cVMF) to their cells of origin in the vestibular nuclei. The 32 collaterals described were selected from two separate sets of experiments which took advantage of different techniques. Nineteen of the collaterals were labelled following Phaseolus vulgaris leucoagglutinin (PHA-L) injections into the medial vestibular nucleus and medial regions of the descending vestibular nucleus. The remaining 13 collaterals originated from physiologically identified vestibulospinal axons that were stained after intra-axonal injections of horseradish peroxidase (HRP). The combined projection of all cVMF axon collaterals spread from laminae V to IX, and included the central cervical nucleus. There was a high degree of variability in the pattern of terminations of individual collaterals. This variability was more pronounced among PHA-L-labelled collaterals than HRP-labelled collaterals whose terminations were restricted to laminae VIII and IX. Some PHA-L-labelled collaterals had terminations which were focused within a single lamina, whereas others had termination zones spanning as many as four laminae. The differences between collaterals were compounded when the characteristics of branching patterns were considered. Some collaterals which occupied similar termination zones had different branching structures.(ABSTRACT TRUNCATED AT 250 WORDS)


Morphology of single vestibulospinal collaterals in the upper cervical spinal cord of the cat. II. Collaterals originating from axons outside the ventral funiculi.

Recent studies have shown that vestibulospinal axons reach the upper cervical spinal cord of the cat via several different funicular routes. The purpose of this study was to describe the projections of those axons travelling outside the well-recognized pathways in the ventral funiculi. These axons are located in the dorsal columns, dorsolateral funiculi, and lateral funiculi. Collaterals of these axons were stained following extracellular injections of Phaseolus vulgaris leucoagglutinin in the medial and descending vestibular nuclei. The trajectories of individual collaterals were reconstructed from serial histological sections. Collaterals arising from axons in the same funiculus usually had the same characteristic appearance. Axons in the lateral funiculi, ipsilateral or contralateral to their cells of origin, gave rise to collaterals that had a simple structure and usually followed a horizontal trajectory across laminae VII and VIII. The boutons of these collaterals were distributed throughout the mediolateral extent of laminae VI and VII and the dorsal half of lamina VIII. In contrast, axons in the dorsolateral funiculi, ipsilateral or contralateral to their cells of origin, terminated primarily in laminae IV and V. Many collaterals of these axons projected either rostrally or caudally and had a narrow mediolateral distribution. The combined distribution of boutons from collaterals originating from axons in the dorsal columns included the dorsal horn and intermediate zone. Although these collaterals were less common and formed a heterogeneous group, they were easily distinguished from collaterals originating from axons travelling in other funiculi. These results indicate that vestibulospinal axons travelling outside the ventral funiculi comprise several distinct systems. Each system travels by a different funicular route and is distinguished by differences in collateral morphology and termination zones.(ABSTRACT TRUNCATED AT 250 WORDS)


Distribution and characterization of cyclooxygenase immunoreactivity in the ovine brain.

Evidence from tissue culture studies suggests that glial cells are the principal source of prostaglandins in the brain. We have used immunohistochemistry, Western blot analysis, and enzyme activity assays to localize cyclooxygenase (COX), the enzyme responsible for the conversion of arachidonic acid to prostaglandins, in situ in the normal ovine brain. We observed very few immunoreactive glial cells. In contrast, an extensive distribution of COX-like immunoreactive (ir) neuronal cell bodies and dendrites and a corresponding pattern of COX enzyme activity were observed. COXir neurons were most abundant in forebrain sites involved in complex, integrative functions and autonomic regulation such as the cerebral cortex, hippocampus, amygdala, bed nucleus of the stria terminalis, substantia innominata, dorsomedial nucleus of the hypothalamus, and tuberomammillary nucleus. Moderate populations were observed in other regions of the central nervous system implicated in sensory afferent processing, including the dorsal column nuclei, spinal trigeminal nucleus, and superior colliculus, and in structures involved in autonomic regulation, such as the nucleus of the solitary tract, parabrachial nucleus, and the periaqueductal gray matter. We did not observe COXir axons or terminal fields, however. Our results suggest that neurons may use prostaglandins as intracellular or perhaps paracrine, but probably not synaptic, mediators in the normal brain.


Fos-like immunoreactivity in the brain of homozygous diabetes insipidus Brattleboro and normal Long-Evans rats.

Water deprivation induces the production of the transcription factor Fos in neurons of the neurohypophysial system. These neurons, which are located primarily in the hypothalamic paraventricular (PVN) and supraoptic nuclei (SON), produce the antidiuretic hormone vasopressin. The present immunocytochemical study has analyzed the distribution of Fos in brain regions involved in osmoregulation and compared the extent of Fos immunoreactivity (Fos-IR) in vasopressin-deficient Brattleboro and normal Long-Evans rats under stimulated and non-stimulated conditions. Rats were osmotically challenged by means of a single intraperitoneal injection of 1.5 M/L NaCl. Since Fos may be induced by the stress of handling of animals, non-injected and isotonic saline-injected rats were used as controls. Faint nuclear Fos immunostaining was found in the organum vasculosum of the lamina terminalis (OVLT), the median preoptic nucleus (MnPO), subfornical organ (SFO), and SON of non-injected and isotonic saline-injected Brattleboro but not Long-Evans rats. Hypertonic saline injection specifically induced Fos-IR in neurons located in the SFO, OVLT, MnPO, PVN, SON, hypothalamic accessory nuclei (including the nucleus circularis), and arcuate hypothalamic nucleus (Arc) in both Long Evans and Brattleboro rats. No differences in distribution of the induced immunostaining were found between the strains. Stress of handling and (isotonic saline) injection induced Fos-IR in the lateral septal nuclei, central amygdaloid nuclei, medial amygdaloid nucleus, medial preoptic area, the bed nucleus of the stria terminalis, cingulate- and piriform cortex, the lateral hypothalamic area, ventromedial hypothalamic nucleus, and the habenular nucleus. The data are consistent with a role for Fos in the regulation of vasopressin gene expression during acute hyperosmotic stimulation. In addition, this study demonstrated that during chronic osmotic stimulation, as experienced by homozygous Brattleboro rats, Fos-IR is limited but apparently present constantly and that it increased in these animals following acute osmotic challenge. Our observations suggest that c-fos regulatory controls in homozygous Brattleboro rats are different from those in Long-Evans rats.


Distribution of GABAergic interneurons immunoreactive for calretinin, calbindin D28K, and parvalbumin in the cerebral cortex of the lizard Podarcis hispanica.

The types and distribution of cells containing three calcium-binding proteins, calretinin, calbindin D28K, and parvalbumin, have been studied by immunocytochemistry in different areas of the cerebral cortex of lizards. Cross-reactivity of the antisera has been excluded by demonstrating the existence of several cell groups immunoreactive for one but not the other two calcium-binding proteins. In the dorsal and dorsomedial cortices all three proteins coexist in a single subpopulation of gamma-aminobutyric acid (GABA)ergic neurons, the terminals of which form pericellular baskets around cell bodies of bipyramidal neurons. The somata of these neurons are largely restricted to the cellular and inner plexiform layers, but the dendrites usually penetrate all layers, allowing the neurons to sample input from all possible sources. A small number of parvalbumin-containing neurons in the outer plexiform layer do not contain the other two proteins. The medial cortex, which is likely to be homologous to the mammalian dentate gyrus, only contains parvalbumin-immunoreactive neurons. The dendritic trees of these cells appear to avoid the Timm-positive fields receiving input from zinc-rich fiber collaterals, originating from principal cells. The lateral cortex contains calbindin D28K-immunoreactive GABAergic neurons, which lack the other two calcium-binding proteins. These neurons have horizontally running dendrites in the outer plexiform layer, but their axon terminals could not be visualized. The present study uncovered important similarities and differences between the lizard and the mammalian archicortex in the types of neurons containing calcium-binding proteins. As in mammals, different cell types evolved in the lizard to inhibit the perisomatic versus the distal dendritic region of principal cells, the calcium-binding protein-containing neurons being responsible for the former, and neuropeptide-containing neurons for the latter. The results also suggest that further neurochemical diversion of GABAergic interneurons coupled to a functional specialization took place during phylogenetic development from reptiles to mammals.


Erythema annulare centrifugum associated with gold sodium thiomalate therapy.

Two women with rheumatoid arthritis developed erythema annulare centrifugum while receiving gold thiomalate therapy. Both patients had similar clinical and histologic findings. Results of a lymphocyte stimulation test were positive in one patient but not in the other.


Photosensitivity, abnormal porphyrin profile, and sideroblastic anemia.

Cutaneous photosensitivity in a 43-year-old man with idiopathic sideroblastic anemia associated with an abnormal porphyrin profile is reported. This condition was associated with elevated free erythrocyte porphyrin, plasma protoporphyrin, urine porphyrins (predominantly coproporphyrin), stool porphyrins (predominantly protoporphyrin), decreased ferrochelatase activity, and deletion of portions of the long arms of chromosomes 18 and 20. Five other patients with sideroblastic anemia and abnormal porphyrin profiles have been described; all but one of these patients had photosensitivity. The porphyrin profile of this patient is similar to that of three other previously described patients.


Lipoid proteinosis.

Lipoid proteinosis (Urbach-Wiethe disease) is a rare, recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other tissues. It usually appears in infancy with hoarseness. We report a case of lipoid proteinosis in a 10-year-old boy that demonstrates the characteristic clinical, histologic, and ultramicroscopic features of this disease.


Lobular capillary hemangioma (pyogenic granuloma) with satellitosis.

We describe a 43-year-old white man who rapidly developed multiple, extensive angiomatous lesions on the temple and scalp after excision of a solitary lobular capillary hemangioma. This is a well-recognized but rare event. Our case differs from previously reported examples in terms of the age of the patient, the location and extent of the lesions, the histologic features in the form of small foci of angiosarcoma-like infiltration, and possibly with respect to the response to therapeutic intervention. Because of the alarming clinical picture produced by multiple lobular capillary hemangiomas, in addition to the occurrence of disturbing histologic features, the benign and self-limited nature of this disease must be emphasized.


Eruptive xanthomas during pregnancy.

A case of eruptive xanthomas during two successive pregnancies is reported. These xanthomas developed in association with marked hypertriglyceridemia; complications included severe pancreatitis and acute respiratory distress syndrome. This patient most likely had combined familial hyperlipidemia which usually causes only a modest elevation in plasma lipid levels. However, with the added stimulus of estrogens during pregnancy, hypertriglyceridemia and secondary complications developed.


Pachydermodactyly: first report in a woman.

Pachydermodactyly is a rare form of digital fibromatosis that is characterized by acquired, asymptomatic, protracted connective tissue swellings on the back and sides of a few proximal phalanges or proximal interphalangeal joints. This is the tenth reported case of pachydermodactyly. It has previously been reported only in men; to the best of our knowledge, this is the first woman described with this condition.


Papulonodular dermal mucinosis in lupus erythematosus.

We report two cases of lupus erythematosus (LE) in which a truncal papulonodular eruption predominated. Histologically the lesions were characterized by diffuse dermal mucin without the usual inflammatory or epidermal changes of LE. It is uncommon in LE for dermal mucin to be present in a sufficient quantity to produce a papulonodular eruption in the absence of typical epidermal changes.


Linear unilateral basaloid follicular hamartoma.

A 36-year-old woman with a linear and unilateral cutaneous hamartoma is described. The lesions consisted of hypopigmented macules that coalesced into a linear plaque that involved only the left side of her body. Within this plaque were several pearly papules and an ulcerated area that clinically resembled basal cell carcinomas. Histologic features of the hypopigmented linear plaque included multiple and multifocal basaloid proliferations in the papillary and mid dermis. The isolated pearly papules showed the typical findings of basal cell carcinoma.


Generalized perforating granuloma annulare.

Generalized perforating granuloma annulare is characterized by 1 to 4 mm umbilicated papules on the extremities, and is most commonly seen in children and young adults. Transepithelial elimination of mucinous, degenerating collagen fibers and surrounding palisading lymphohistiocytic granulomas are important histologic features. Perforating sarcoidosis and perforating granuloma annulare may be difficult to differentiate because of a similar clinical appearance and the presence of sarcoidal granulomas in biopsy specimens. A particularly high incidence of perforating granuloma annulare has been reported in the Hawaiian Islands.


Rapp-Hodgkin ectodermal dysplasia.

Rapp-Hodgkin syndrome is a rare condition that is characterized by ectodermal dysplasia and palatal abnormalities. We describe a 24-year-old white woman who has Rapp-Hodgkin syndrome that is associated with a chronic palmar keratoderma, which is a finding that has not been previously reported. We review the literature, assign the clinical features into major and minor categories, and suggest therapeutic interventions to limit the significant sequelae of this autosomal dominant syndrome.


Cutaneous T-cell lymphoma with porokeratosis-like lesions.

We describe two black patients who had widespread, sharply demarcated, round, hyperpigmented or hypopigmented macules that clinically resembled disseminated superficial actinic porokeratosis (DSAP). One patient was known to have cutaneous T-cell lymphoma (CTCL), and the other patient had only the DSAP-like lesions. Histopathologic and immunohistochemical studies of the DSAP-like lesions revealed characteristic features of patch-phase CTCL. This unusual variant of patch-phase CTCL should be differentiated from DSAP and the hypopigmented variant of CTCL.


Angiomyolipoma.

Angiomyolipoma is a benign tumor, usually of the kidney, that is frequently associated with tuberous sclerosis. Extrarenal tumors are rare. Cutaneous lesions have only recently been reported. We report a case of cutaneous angiomyolipoma with results of clinical, histologic, and immunohistochemical evaluation.


Generalized nodular cutaneous pseudolymphoma associated with phenytoin therapy. Use of T-cell receptor gene rearrangement in diagnosis and clinical review of cutaneous reactions to phenytoin.

The first reported case of phenytoin-induced generalized nodular cutaneous pseudolymphoma without symptoms of the phenytoin hypersensitivity syndrome is presented. Despite the malignant histologic appearance of the dermal infiltrate, T-cell receptor gene rearrangement studies did not demonstrate monoclonality. The cutaneous nodules resolved within 2 weeks after discontinuation of phenytoin therapy. The literature is reviewed with regard to the spectrum of cutaneous reactions to phenytoin and particularly with regard to the occurrence of lymphoma, pseudolymphoma, and phenytoin hypersensitivity syndrome. We suggest the use of T-cell receptor gene rearrangement studies in similar situations of phenytoin hypersensitivity syndrome and lymphadenopathy. A brief period of discontinuation of the drug will demonstrate the regression associated with benign lymphoproliferation and will forestall needless treatment.


Toxic epidermal necrolysis in early infancy.

Toxic epidermal necrolysis (TEN) is a life-threatening bullous dermatosis characterized by the sudden onset of full-thickness epidermal necrosis. TEN is a disease of both children and adults, but TEN in early infancy is a rare event; only two well-documented cases in infants less than 6 months of age have been reported. We report a third case of a 6-week-old infant with Escherichia coli sepsis who received ampicillin and other antibiotics and subsequently developed TEN. Despite the withdrawal of ampicillin and aggressive systemic and wound care, the infant died. The infants in the other two reported cases also died, which suggests that TEN in early infancy has an extremely poor prognosis.


Annular epidermolytic ichthyosis: a unique phenotype.

A 30-year-old white woman developed bullous and ichthyosiform skin lesions at the age of 8 months. Blistering ceased at puberty, but the hyperkeratotic plaques persisted. She subsequently delivered five children, two of whom were affected with a bullous type of ichthyosis. At the age of 27 years, she developed numerous annular and polycyclic, erythematous, hyperkeratotic plaques on the trunk and extremities that were pruritic, enlarged slowly, and then resolved. Histopathologic examination of these annular plaques revealed epidermolytic hyperkeratosis. Electron microscopic examination of the annular plaques showed interrupted perinuclear tonofilament rings consistent with either bullous ichthyotic erythroderma of Brocq or ichthyosis bullosa of Siemens. This kindred may represent a new phenotype of epidermolytic (acanthokeratolytic) ichthyosis.


Fatal pyoderma gangrenosum in association with C7 deficiency.

Although pyoderma gangrenosum (PG) is often associated with systemic diseases, it has not been reported in association with congenital complement deficiencies. We describe an aggressive and ultimately fatal case of PG in a patient with a congenital C7 deficiency. Deficiencies of C7 can be associated with decreased neutrophil chemotaxis, phagocytosis, and opsonization, similar to the immunologic abnormalities described in patients with PG. Our patient's decreased complement level, if not directly related to the development of PG, may have contributed to the aggressive nature of her disease.


Effect of synergists on the oral and topical toxicity of azamethiphos to organophosphate-resistant houseflies (Diptera: Muscidae).

Dermal and oral toxicities of azamethiphos were determined in two organophosphate-resistant and one susceptible strain of houseflies, Musca domestica L. The 594vb strain was 1,967-fold more resistant to azamethiphos when compared with the susceptible Chemical Specialties Manufacturers Association (CSMA) strain by dermal application. When the compound was administered orally to the 594vb strain, we observed only a 15-fold resistance. In contrast, the Yachiyo strain, which show 1,500-fold resistance to diazinon and which has known multiple mechanisms for organophosphate resistance, showed only 6-fold resistance to azamethiphos by topical application and 4-fold resistance by oral administration. Azamethiphos administered dermally and orally was equally toxic to the CSMA and Yachiyo strains. However, when azamethiphos was administered to the 594vb strain, the insecticide was 71 times more toxic orally than by the dermal route. This result indicated involvement of a cuticular penetration factor in the resistance mechanism. The effect on azamethiphos toxicity of piperonyl butoxide (PB), an inhibitor of the monooxygenases, and tributylphosphorotrithioate (DEF), an esterase inhibitor, was investigated in the three strains. Pretreatment of the flies with PB, DEF, or PB+DEF before topical application of azamethiphos resulted in a significant decrease in LD50s in all the strains. The degree of synergism, however, varied depending upon the strains and the synergists. Similar results were obtained when azamethiphos was administered orally following pretreatment of the flies with PB+DEF. We attribute the high level of azamethiphos resistance in the 594vb strain partly to increased degradation by oxidative and hydrolytic enzymes. The hydrolytic enzymes are more important, but other factors including reduced cuticular penetration and insensitive acetylcholinesterase may be involved.(ABSTRACT TRUNCATED AT 250 WORDS)


Biochemical characterization of hydrolytic and oxidative enzymes in insecticide resistant and susceptible strains of the German cockroach (Dictyoptera: Blattellidae).

We have identified resistance mechanisms in the German cockroach, Blattella germanica (L.), for propoxur and chlorpyrifos in strains of cockroaches that display multiresistance to several organophosphate and carbamate insecticides. The resistance mechanisms involve the combined effects of increased oxidative and hydrolytic metabolism and both strains are resistant to chlorpyrifos and propoxur. Experiments designed to test for similarity in metabolic enzymes suggest that, although the mechanisms involve similar processes, the enzymes responsible for insecticide detoxification are different in the two strains. Both resistant strains exhibited enhanced activity toward alpha-naphtholic esters relative to a standard susceptible strain; however, analysis of the progeny from resistant X susceptible crosses suggests that this general esterase activity is inherited differently than propoxur or chlorpyrifos resistance. Hybrids of the propoxur-resistant strain displayed the highest activity of all cockroaches tested, in contrast to hybrids of the chlorpyrifos-resistant strain, which were similar to the susceptible strain. Native gel electrophoresis of cytosolic preparations provided further evidence for differences in the pattern of hydrolytic enzymes and inheritance of resistance in the two strains. Analysis of components of the cytochrome P450-dependent monooxygenase system and activities toward model substrates indicate that the two resistance mechanisms also involve different oxidative processes. The propoxur-resistant strain displayed significantly higher levels of total cytochrome P450, but no other components were correlated with resistance. In contrast with the chlopyrifos-resistant strain, which was similar to the susceptible strain in all parameters measured, activity toward model substrates was higher in the propoxur-resistant strain than in any of the other strains and hybrids tested.(ABSTRACT TRUNCATED AT 250 WORDS)


Field tests of an acephate baiting system designed for eradicating undesirable honey bees (Hymenoptera: Apidae).

Field evaluations were made of a baiting system designed for use by regulatory agencies in suppressing populations of undesirable feral honey bees, Apis mellifera L. (e.g., bees posing hazards [especially Africanized bees] and colonies infested with parasitic mites). Bees from feral or simulated feral (hived) colonies were lured with honey and Nasonov pheromone components to feeders dispensing sucrose-honey syrup. After 1-3 wk of passive training to feeders, colonies were treated during active foraging by replacing untreated syrup with syrup containing 500 ppm (mg/liter) acephate (Orthene 75 S). In four trials using hived colonies on Grant Terre Island, LA., 21 of 29 colonies foraged actively enough at baits to be treated, and 20 of the 22 treated were destroyed. In the lower Rio Grande Valley of Texas (two trials at each of two trials), treatments killed 11 of 16 colonies (6 of 10 hived; 50 of 6 feral). Overall results showed that all 11 colonies that collected greater than 25 mg acephate died, whereas 3 of 10 colonies receiving less than 25 mg survived. Delivering adequate doses required a minimum of approximately 100 bees per target colony simultaneously collecting treated syrup. The system destroyed target colonies located up to nearly 700 m away from baits. Major factors limiting efficacy were conditions inhibiting foraging at baits (e.g., competing natural nectar sources and temperatures and winds that restricted bee flight).


Performance of gel and paste bait products for German cockroach (Dictyoptera: Blattellidae) control: laboratory and field studies.

Gel and paste bait formulations containing boric acid or hydramethylnon were evaluated in field and laboratory experiments with the German cockroach, Blattella germanica (L.). Bait formulations contained 14-62% water by weight and lost the most water after 1 d of desiccation. Bait age and water content did not alter the toxicity (LT50) of boric acid-based baits. Toxicity of hydramethylnon (Maxforce) bait, however, increased with bait age. In continuous exposure tests without harborage, boric acid formulations had LT50s of 8.5 and 10.1 d for Blue Diamond and IT WORKS, respectively. Maxforce bait had an LT50 of 4.2 d. LT50s determined with cardboard harborage or in Ebeling choice boxes were 1.5 to 2.2 times lower than those from continuous exposure tests without harborage. Relative repellency, measured as the mean percent of live cockroaches in the light side of the choice box, was greatest for IT WORKS (21.4%) and Maxforce (25.4%) formulations, followed by Blue Diamond (10.9%). A performance index that combined choice box repellency and mortality data indicated that Maxforce had the greatest potential for field effectiveness. Blue Diamond and Maxforce significantly reduced German cockroach populations in the field. Maxforce performed best in field trials when applied at 10 or 20 placements per apartment. Apartments treated with IT WORKS had significantly greater cockroach trap catches. Factors that may affect the predictive power of the performance index are discussed.


Susceptibility of cockroaches (Dictyoptera: Blattellidae, Blattidae) to infection by Steinernema carpocapsae.

The susceptibility of American cockroaches, Periplaneta americana (L.); smoky brown cockroaches, P. fuliginosa (Serville); oriental cockroaches, Blatta orientalis L.; German cockroaches, Blattella germanica (L.); and brownbanded cockroaches, Supella longipalpa (F.), to Steinernema carpocapsae Weiser (All strain) was evaluated under laboratory conditions. A 1-ml water suspension containing 500,000 nematodes was placed on filter paper in a petri dish or the pad of a bait station. German, brown-banded, oriental, and smoky-brown cockroaches died within 1 d after placement in the petri dishes. The relative order for the LT50s were American greater than oriental greater than smoky-brown greater than brown-banded = German. All cockroaches actively groomed nematodes from legs and antennae of forced (petri dish) exposure. The LT50s for S. carpocapsae for nonforced (bait station) exposure were significantly greater than those for forced exposure. The LT50s were 3.25, 4.13, 9.86, and 11.38 d for brown-banded, German, oriental, and smoky-brown cockroaches, respectively. The relative order of the LT50s after forced (American greater than oriental greater than smoky-brown greater than German = brown-banded) and nonforced (American greater than smoky-brown greater than oriental greater than German greater than brown-banded) exposure to S. carpocapsae was inversely related to the moisture of their preferred habitats.


Oral toxicity, formulation effects, and field performance of flufenoxuron against the German cockroach (Dictyoptera: Blattellidae).

Laboratory and field studies on the benzoylphenyl urea (BPU) chitin synthetase inhibitor flufenoxuron (DPX EY-059) showed great potential for its use in suppressing infestations of German cockroach, Blattella germanica (L.). When fed continuously to fifth (last) instars, the LC50 of flufenoxuron was estimated at 0.82 ppm (95% FL, 0.76-0.87 ppm). A rating scale specific for BPU effects was developed and shown to be positively correlated with the insect's exposure to concentration of flufenoxuron. Manipulating the particle size of wettable powder formulations of flufenoxuron significantly altered their activity in contact bioassays. Larger particles (volume mean diameter, 12.2 mu; range, 10-20 mu) were more active. Field trials in multifamily housing with this wettable powder formulation at 0.033 and 0.066% (AI) achieved high level (greater than 80%) population suppression within 8 wk of treatment. The potential for the use of flufenoxuron in B. germanica management programs is discussed.