Community-based treatment of psychiatric disorders in U.S.A. and Norway: insights for new service delivery systems.

This article reports on a successful community-based psychiatric treatment program in Philadelphia, Pennsylvania and describes subsequent experiences seeking approval of similar programs in Philadelphia and in Oslo, Norway. Previous studies have shown that the Philadelphia community-based program, which used patient social networks and indigenous community workers assisted by psychological and psychiatric professionals, provided better treatment outcomes than traditional hospital programs and socioenvironmental treatment programs. On the basis of these experiences a new service delivery system was proposed which integrates patient social networks, community workers, and lay community organizations with mental health center professionals. Examination of differences in official responses to the proposal shows the importance of several factors, including the mental health bureaucracy's perception of patient potential, their openness to social psychological therapy, and the power struggles within the bureaucracy and the professional community.


Pharmacokinetic behavior of gadoteridol injection.

To assess the safety and pharmacokinetics of gadoteridol injection (0.5 M) in 18 healthy male volunteers in a phase I clinical trial. Volunteers were assigned to one of six dosing groups: 0.05, 0.1, 0.15, 0.2, 0.25, and 0.3 mmol/kg gadoteridol (0.5 M), in an ascending dose study. Physical examination, vital signs, electrocardiogram, clinical laboratory tests, and serum and urine samples were obtained at selected time points before and after administration of gadoteridol. No significant changes in vital signs, physical examination, clinical laboratory values, or electrocardiogram, that were believed by the principal investigator to be related to the administration of the contrast agent, were observed. A single adverse event (transient hive) believed to be related to contrast agent administration was observed in one volunteer. Pharmacokinetic data show that the elimination half-life and the distribution half-life were independent of the dose used. The mean distribution half-life was 0.20 +/- 0.04 hours, the mean elimination half-life was 1.57 +/- 0.08 hours, and greater than 94% of the drug was excreted in the urine in 24 hours.


Phase II clinical trial of gadoteridol injection, a low-osmolal magnetic resonance imaging contrast agent.

The safety and efficacy of a new, low-osmolal magnetic resonance imaging contrast medium, gadoteridol injection, were evaluated in a phase II, open-label study at doses ranging from 0.05 to 0.30 mmol/kg. Eighty-six patients with a diagnosis of intracranial tumor received gadoteridol injection followed by magnetic resonance imaging. Two adverse events (headache, taste disturbance) in 2 of 86 (2.3%) patients were reported. Both were of mild intensity and resolved without treatment and without residual effects. In 4 of 86 (4.7%) patients, 5 laboratory changes were reported by the investigators as possibly related to gadoteridol injection. Efficacy evaluation was conducted in 80 of the 86 patients who received gadoteridol injection. In these patients, a total of 119 lesions was identified, and each was evaluated at four time points after contrast administration, yielding a total of 476 lesion studies. Marked enhancement was demonstrated in 402 of 476 (84%) lesions, whereas slight enhancement was demonstrated in 62 of 476 (13%) lesions. The difference in both the incidence and degree of enhancement of pathology between the predose and postdose images was highly significant (P less than .001). Overall, enhanced images provided more diagnostic information and facilitated detection of more lesions than precontrast images. Gadoteridol injection at doses up to 0.3 mmol/kg is a safe and effective magnetic resonance imaging contrast agent for use in patients with intracranial tumors.


Efficacy of gadoteridol for magnetic resonance imaging of the brain and spine.

The efficacy of gadoteridol for contrast enhancement of central nervous system pathology was assessed in a multicenter clinical trial involving 411 patients suspected of having intracranial or spinal pathology. Magnetic resonance imaging was performed before and after intravenous administration of 0.10 mmol/kg gadoteridol. Two groups of images were interpreted by one of two neuroradiologists blinded to patient history. The results were analyzed separately. Patients with radiologic evidence of disease demonstrated enhancement of intracranial pathologic lesions in 44 of 63 (70%) and in 91 of 111 (82%) cases, respectively, whereas enhancement of spinal lesions was observed in 36 of 58 (62%) and in 65 of 78 (83%) cases, respectively. Subjectively, postcontrast scans provided more information than precontrast images in 37 of 63 (59%) and 84 of 111 (76%) intracranial cases, respectively, and in 25 of 58 (43%) and 55 of 78 (71%) spinal cases, respectively. Additional information included the subjective sense that there was improved visualization of pathology and definition of lesion borders. Subjective assessment of magnetic resonance scans suggest gadoteridol is an effective intravenous contrast agent for magnetic resonance imaging.


Phase III clinical studies with gadoteridol for the evaluation of neurologic pathology. A European perspective.

The use of paramagnetic contrast agents has improved the diagnostic sensitivity and specificity of magnetic resonance imaging (MRI) for evaluating diseases of the central nervous system. To assess the safety and imaging properties of the nonionic, gadolinium-based MRI contrast agent gadoteridol, 151 patients and controls were evaluated for safety, and 118 patients with cerebral or spinal pathology were evaluated for imaging efficacy. Precontrast T1- and T2-weighted spin-echo images and postcontrast (0.10 mmol/kg) T1-weighted spin-echo images were read by unblinded investigators at each site. The rate of adverse events possibly or probably related to gadoteridol was 4.0% (vasodilation [facial flushing], 1 patient; nausea, 3 patients; urticaria, 2 patients). Laboratory changes were reported in 6.0%. None of these events or changes was considered to be clinically significant. Contrast enhancement was noted in 75% of cases with brain pathology and 64% of cases involving spine lesions. Gadoteridol is safe in routine clinical use at a dose of 0.10 mmol/kg and provides improved lesion detection compared to plain MRI.


Efficacy of gadoteridol for contrast-enhanced magnetic resonance imaging in children.

This study assesses the efficacy of gadoteridol for contrast-enhanced magnetic resonance imaging (MRI) in children. Patients were examined by MRI before and after receiving 0.10 mmol/kg gadoteridol. Blinded and unblinded readers analyzed brain and spine MRI studies from a multicenter clinical trial involving 101 patients at 11 sites. Ninety-two cases (76 brain, 16 spine) were evaluated by unblinded investigators, and 91 cases (76 brain, 15 spine) were evaluated by three neuroradiologists unaffiliated with any investigational site and blinded to clinical information. Unblinded readers noted enhancement of brain pathology in 70% of cases versus 50% to 67% among blinded readers. Unblinded readers determined that additional diagnostic information was available after contrast in 82% of brain studies (average, 64% for blinded readers) and would have changed patient diagnoses in 48% of these studies (average, 46% for blinded readers). In spine cases, enhancement of pathology was noted in 38% (unblinded) and 33% to 40% (blinded). Additional diagnostic information was available after contrast in 63% of spine studies (unblinded), or an average of 58% (blinded), and patient diagnoses would have changed in 20% (unblinded), or an average of 59% (blinded). Gadoteridol is suitable for enhanced MRI detection, localization, and characterization of central nervous system pathology in children.


Efficacy of gadoteridol for magnetic resonance imaging of extracranial head and neck pathology.

This study evaluated the efficacy of gadoteridol in patients with extracranial head and neck pathology. One hundred twenty-two magnetic resonance imaging (MRI) cases from a multicenter safety and efficacy trial of gadoteridol in patients with suspected head and neck pathology were randomly assigned for evaluation to one of two blinded neuroradiologists. Enhancement of pathology after gadoteridol injection was noted in 96 cases (78.7%) and provided additional diagnostic information in 57 cases (46.7%). Improved lesion visualization was noted in 37 (64.9%) of these 57 cases; an increase in the number of lesions seen was noted in 4 (7.0%) of 57 cases. Blinded readers determined that additional diagnostic information provided by gadoteridol would have resulted in a change in diagnosis in 20 (35.1%, or 16.4% of total population) of 57 patients. These results demonstrate that gadoteridol is an efficacious agent for enhanced MRI of head and neck pathology.


Summary of preclinical safety evaluation of gadoteridol injection.

To support clinical use of gadoteridol (0.5 M) injection, a battery of in vitro and in vivo safety studies was conducted. In mice, the acute intravenous LD50 for gadoteridol (0.5 M) injection was 11 to 14 mmol/kg, and the intravenous minimal lethal dose in rats was greater than 10 mmol/kg. In 2-week studies with gadoteridol, no serious effects were observed in mice given 3 mmol/kg or dogs given 1.5 mmol/kg daily. In a series of reproduction studies, no treatment-related adverse effects on fertility, reproductive performance, or postnatal development were seen in rats at doses of 1.5 mmol/kg or less, and no teratogenic effects were observed at doses as high as 6 mmol/kg in rabbits and 10 mmol/kg in rats. In an in vitro test, gadoteridol did not demonstrate any potential to hemolyze human erythrocytes when incubated in high concentrations with whole blood, suggesting there is little probability gadoteridol will cause hemolysis in vivo. A substantial margin of safety exists for the clinical use of gadoteridol in magnetic resonance imaging procedures.


Endometrial and pulmonary sarcoidosis.

A 33 year old woman with irregular menses due to endometrial sarcoidosis and a family history of sarcoidosis is described. Its relative increase in importance in the wake of the decline in the incidence of genital tract tuberculosis in Ireland is discussed.


Congenital diaphragmatic hernia in the newborn. Outcome in 59 consecutive cases over a ten year period (1980-1989).

A ten year review (1980-1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady's Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arrival in the hospital. Recurrent chest infections and gastro-oesophageal reflux were the most common long term complications. The prognosis was better for late presenters. A period of prolonged ventilatory stabilisation with appropriate inotropic support to help correct acidosis before surgery improved results. Surgery should be postponed until ventilatory stabilisation is established. A protocol for safe transport of patients to the referral centre is recommended. It is advisable that all patients with congenital diaphragmatic hernia be intubated as soon as the diagnosis is made and that a doctor accustomed to airway management accompanies the patient to the neonatal surgical centre.


Blood cultures and antibiotic use in a neonatal intensive care unit.

A review of the duration of antibiotic courses in our Neonatal Intensive Care Unit (N.I.C.U.) has shown that in a significant number of cases there was non compliance with the antibiotic policy. An audit of neonatal sepsis and antibiotic usage over a six month period was performed in the N.I.C.U. at the Rotunda Hospital. Three hundred and forty-nine of the 3,163 infants born during this time were admitted to the N.I.C.U. One hundred and fifty-two infants had one or more episodes of suspected sepsis. In 168 instances this preceded a course of antibiotic therapy lasting longer than 48 hours. In 56 (33%) the infant was clinically septic and in 16 (9.5%) of those there was bacteriological proven sepsis. There were 112 episodes (60%) where there was no strong clinical evidence of sepsis and a negative investigation for sepsis where antibiotics were continued for more than 48 hours. The possible reasons why antibiotics were not stopped include the non specific nature of signs of sepsis in neonates, physicians' reluctance to discontinue antibiotics once started, and the logistic difficulty of obtaining routine culture results at weekends. The study emphasizes the need for regular surveillance of antibiotic usage in a N.I.C.U.


Interlocking intramedullary nailing for the treatment of tibial fractures.

Thirty-seven tibial shaft fractures in 34 patients were treated with the Grosse-Kempf interlocking intramedullary nail over a two year period. Thirty-six tibiae were consolidated at a median of 17 weeks; one had re-fractured following nail removal in a separate injury, but was now uniting on conservative treatment. Using very detailed clinical and radiological analysis, and excluding the patient who had re-fractured, the results were excellent in 19, good in 8, fair in 6 and poor in 3. The most significant complications were haematoma formation and additional comminution during nail insertion. Overall, we found tibial nailing to be a satisfactory procedure, facilitating rapid rehabilitation with early weight bearing and resulting in predictable fracture healing in good alignment.


Worksite screening for high blood cholesterol: implications for detection, evaluation and treatment--the Israel CORDIS Study.

Current recommendations for optimal blood cholesterol levels could have major implications for the detection, evaluation and treatment of high blood cholesterol in Israel. During 1985-87, in the framework of the CORDIS Study, a sample of 3,556 males and 1,558 females, aged 20-64, employed in Israeli industry were screened at the worksite for lipids, lipoproteins and other cardiovascular risk factors. From the age-group 20-24 to 60-64 years, the prevalence of high blood cholesterol (greater than 239 mg/dl) increased from 1.6% to 34.3% for males and from 5.4% to 36.7% for females. Ethnic differences were present, with those from Western countries generally having the highest prevalence. When examined in two age-groups, 20-44 and 45-64 years respectively, 28.6% and 54% of males and 8.8% and 37.5% of females had a combination of cholesterol levels and coronary heart disease (CHD) risk factors for which lipoprotein analysis is currently recommended. There was an increase in the prevalence of high blood cholesterol with increased number of non-lipid CHD risk factors (for 0 to greater than or equal to 3 risk factors, age-adjusted prevalence ranged from 18.2 to 37.5% for males and 9.6% to 41.4% for females). Less than 5% of those with high blood cholesterol were aware of their condition, and less than 1% were under treatment. The prevalence of high blood cholesterol in the working population is Israel appears to be similar to that of the United States. Age-related changes in low density and high density lipoprotein cholesterol levels are such that monitoring of cholesterol in most people need not be more frequent than every 3-5 years. Any cholesterol screening program should be designed to allow for varying schedules according to age, sex and the presence of other risk factors for cardiovascular disease.


Is eye cosmetic a source of lead poisoning?

Kohl is a lead-containing eye cosmetic applied to many infants in Israel and in other countries in the Middle East. Seven samples of kohl used in our region contained 17.3%-79.5% lead. We assessed 24 kohl users and 30 non-kohl users, aged 6-16 months, for blood lead, zinc protoporphyrin, hemoglobin, mean corpuscular volume (MCV), serum iron and calcium. Blood lead levels were significantly higher in the infants to whom kohl was applied (11.2 vs. 4.3 micrograms/dl, P less than 0.001) and were greater than 20 micrograms/dl in three of them. In the non-kohl users, blood lead levels were significantly higher in infants whose mothers used kohl (5.2 vs. 2.8 micrograms/dl, P less than 0.02). No significant differences were found in the other parameters. The kohl-using infants were significantly shorter at 3-5 weeks of age (P less than 0.005) but not at the time of the study. No significant differences were found in weight and head circumference at birth or at the time of the study between kohl-using infants and controls. Regression analysis showed that among the analyzed variables the infant's blood lead level was related only to the use of kohl. We conclude that application of kohl to the infant's or mother's eyes is associated with a significant increase in the infant's blood lead levels and in the minority of cases with asymptomatic lead poisoning.


A multidimensional autoantibody analysis specifying systemic lupus erythematosus patients with neuropsychiatric symptomatology.

Utilizing a newly perfected multiple-response permutation procedure, we analyzed the autoantibody titer of systemic lupus erythematosus (SLE) patients during active and convalescent periods of disease, SLE patients without neurological involvement, and three other comparison groups (patients with active tuberculosis, patients with multiple sclerosis, and healthy normal controls). The multidimensional analysis we used distinguished those SLE patients with neurological involvement from the other SLE patients. Differences were noted by a univariate analysis measuring antibodies to single- and double-stranded DNA, poly (G), Sm, RNP, Ro, La, and gangliosides. Elevated concentrations of the common anti-DNA idiotype 16/6 were also noted among SLE patients with neuropsychiatric illness. This report stresses that increased disease activity in SLE patients with neuropsychiatric phenomena is reflected by their autoantibody profile.


Premature mortality, Israel 1986.

Mortality statistics serve as the most common tool for health policy planning. However, this method suffers from several shortcomings. The mortality patterns in Israel in 1986 are presented in this article using the measure of years of potential life lost (YPLL), which better expresses premature mortality and the burden of diseases on society. Ischemic heart disease, cancer, and accidents of all types are responsible equally for most premature deaths in males in Israel, whereas cancer is the leading cause of premature mortality in women in Israel. Planning future health policy should rely more heavily on measures such as YPLL.


Falls among elderly people living at home: medical and social factors in a national sample.

Falls are the most common accidents among the elderly, and while medical risk factors are well known, less is known about the association of falls with social factors. The aims of this study were to estimate the incidence rate of falls in a national, representative sample of Israeli elderly and to examine the association of falls with selected medical and social factors. A special national survey conducted in 1985 by the Israel Central Bureau of Statistics showed that among a representative sample of 3,494 community-dwelling elderly persons aged greater than or equal to 65, 24% reported a fall in the past year; the rate was 16% among men and 31% among women. The majority of falls reported happened out of doors. Of those who fell 37% subsequently visited the emergency room. Analyses adjusted for age and sex showed that single persons, particularly women, living alone reported falls at a higher rate than their married counterparts. Analyses adjusted for age, sex and mobility level showed that frequency of social interaction was inversely related to reported falls. Use of sleeping pills, problems with vision, and mobility restrictions were associated with falls in age- and sex-adjusted analyses. Advanced age (greater than 75 years) was associated with repeated falls that occurred both in the home and outdoors.


Quotation accuracy: fact or fiction?

Results from original studies are not always correctly represented in subsequent medical publications. In this study, randomly selected quotations from Israeli medical journals were examined. Less than 80% of the examined statements were in complete agreement with the original source. In about 7% the cited reference failed to substantiate the previous author's statement. Similar results were found over a range of American and European general and speciality journals. It is concluded that errors in quotation are a widespread problem in the biomedical literature. Editors and peer reviewers can improve quotation accuracy by stressing this issue in decisions regarding publication. Nevertheless, it seems that the most efficient solution would be for authors to increase their vigilance in accurately quoting results and statements from previous publications.


The delivery of interim discharge summaries to general practitioners by the elderly.

Two hundred and four patients discharged from an acute geriatric unit were given an interim discharge summary for delivery to their General Practitioner (GP). All but three summaries were received by the practices. Information regarding mode and timing of receipt was available in 191 patients. The summaries were received in a median of 1.0 day in both those living alone and those living with family; 75% of summaries had been received within two days of discharge and 93% within four days. General practitioners collected the summaries from patients' homes in a high proportion of both groups. Interim discharge summaries should be given to elderly patients for delivery to their GPs: this is both reliable and rapid, and clearly more cost-effective than any other form of delivery.


Bed blocking in Edinburgh hospitals.

A point prevalence survey of in-patients in all acute hospitals within the city of Edinburgh in 1988 identified 224 elderly patients (65 and over) waiting for long stay care. This represents a 'bed blocking' rate of 19% across all specialties. The highest rate was found in Orthopaedic second line beds (approximately 33%) followed by Geriatric Assessment beds (approximately 30%); Acute General Medical Beds had approximately 13% of their beds blocked. Some 75% of the 224 patients were waiting for Geriatric long stay beds, 5% for Psychogeriatric, and a substantial proportion waiting for continuing care outwit the NHS (nearly 9% for Private Nursing Homes and 11% for residential accommodation). A repeat of this survey in 1990 revealed a small overall drop in bed blocking rate (18%) with moderate changes within the specialty groupings. However a substantial increase (from 20% to 32%) had occurred in those awaiting non-NHS accommodation, and a drop in those waiting for Geriatric Care (75% to 62%).


Telephone calls to a paediatric accident and emergency department.

We report a survey of telephone calls to an Accident and Emergency Department. Telephone calls form a significant part of the workload of an Accident and Emergency Department. The differences between telephone advice from an Accident and Emergency Department and general practice are highlighted. In general telephone advice from the Department is a useful adjunct to the service provided by the NHS. The possibility of medico-legal implications is discussed.


Child sexual abuse in general practice in north east Scotland.

All Grampian and North Tayside General Practitioners (GPs) were surveyed by a postal questionnaire to find out how often they had seen victims of child sexual abuse in the last two years; how they managed these patients; and whether any measures were needed to improve interagency working, especially at Case Conferences. A total of 73% of GPs replied, and 73% of these had seen at least one victim of child sexual abuse in the last two years. From this survey GPs saw approximately 2.5 victims per 1,000 per year for girls aged under 16 years. GPs' experience, views and practice varied considerably, even in one geographical area, and 72% of them felt they needed more information on child sexual abuse.


Scottish gynaecologists: their views on hormone replacement therapy.

In a postal questionnaire Scottish gynaecologists were asked their views on the use of Hormone Replacement Therapy (HRT). They were almost unanimous in support of HRT, but varied in the circumstances in which they would recommend it and in the length of time they would prescribe it. The need for designated Menopause Clinics was seen to be limited, with most smaller Units preferring the present practice of menopausal patients being seen at general Gynaecology Clinics. Most of those replying thought that General Practitioners (GPs) should continue to be the main providers of the therapy but 89 (77%) felt that Well Women/Family Planning Clinic (WW/FPC) doctors could be an alternative source. Several problems associated with the use of the therapy were indicated. These included uncertainties about the risks of long term use and the management of unscheduled vaginal bleeding, but there was also concern over the administrative and prescribing costs if the therapy is to be widely used as prophylactic medication.


The ergonomic analysis of a trauma resuscitation room.

Ergonomics is the practical and scientific study of people in relation to their working environment. We describe its application to the operation of a trauma resuscitation room. We used specifically designed computer software. This methodology enables a unique and objective assessment of the design and operation of a clinical system. It may be particularly applicable to other hospital areas where the efficient interaction of staff, patients and equipment is crucial to the optimal clinical outcome.


The roles of general and geriatric medicine in the provision of acute medical care for elderly patients.

To determine whether there are differences between elderly patients admitted acutely to general medicine and those admitted to geriatric medical wards, and whether the patients are appropriately referred, a prospective survey of 426 consecutive patients aged 65 years or over admitted acutely to general medical and geriatric wards over a three month period was performed. A total of 286 patients were admitted to general medicine (GM) and 140 to the geriatric unit (GER). GER patients were older (81.0 v. 75.8 years) and had greater pre-morbid functional impairment and incontinence. Fewer GER patients presented with readily apparent organ specific diagnoses (56% v. 94%). Median length of stay was longer in GER patients (23 days v. 9 days). Variables independently predictive of GER admission were increasing age, increasing duration of illness, poor pre-morbid functional status and prior reliance on a carer. Length of stay was not associated with unit of admission allowing for the variables described above. GER patients are a different population. They have more chronic illness and functional impairment, and are more likely to require multidisciplinary assessment and rehabilitation in addition to treatment of presenting illness. Elderly patients are appropriately referred by General Practitioners (GPs) without a formal admissions policy.


The Chief Scientist reports.... Voluntary agency support for people with mental health problems.

The development of a cohesive support system is vital to the success of community based services and day care is an essential component of any system of support. McCreadie et al in a Scottish study of psychiatric hospital provision showed that while there was wide variation around Scotland in the provision of hospital based care, there was a general dearth of health service and local authority community-based services. Philip and Stuckey in a survey of NHS long term non-resident patients of the Royal Edinburgh Hospital found that hospital staff felt that such patients would have benefited from additional daytime activity different from that provided in the health service. These authors found that some patients did make significant use of voluntary agencies, but were unable to elicit any systematic reasons for using or not using these agencies. Surveys in the statutory and voluntary sectors completed to date have tended to concentrate on the opinions of staff groups about the requirements and needs of clients. There has been no systematic survey of the facilities and opportunities most desired by users of voluntary sector support agencies. This survey, which received support from the Chief Scientist Organisation Mini-Project Scheme, aims to remedy this lack and to provide a factual basis from which the NHS, local authorities and voluntary agencies can draw, in their mutual aim of helping people with mental health problems. The results of the survey, while carried out in Edinburgh, may have relevance to planners and providers further afield in Scotland.


[The effect of cosmetics and dermatologic agents on skin lipids].

The composition of stratum corneum lipids and of sebum lipids is described with respect to their biological function, with special reference to dry skin. In this context, we discuss desiccation and lipid removal by surfactants and the protective and refatting effects of oil bath products and other lipid-containing preparations for topical use.


[Osteoma cutis. Pathogenesis and therapeutic possibilities].

No efficacious therapy for the treatment of increasing and spreading cutaneous ossification is yet established. We report a 52 year old white female with multiple miliary osteomas of the skin involving face, chest and back. The patient has a history of acne vulgaris. A therapeutic trial with a diphosphonate (etidronate disodium) was started in order to stop marked progression and appearance of new lesions. In accordance with the two previously described cases of the literature we failed to achieve any improvement. Clinical features, etiology, classification and therapy of osteoma cutis are discussed.


[Sulzberger-Garbe exudative discoid and lichenoid chronic dermatosis ("Oid-Oid disease")--reality or fiction?].

In 1937, Sulzberger and Garbe singled out an exudative discoid and lichenoid chronic dermatosis characterized by the combination of various symptoms which by themselves are not specific from the heterogeneous eczema group. The report of a 7-year-old girl is used as a basis to describe the characteristics of the disease and to present the authors' own interpretation. Clinically, there were discoid and lichenoid lesions with severe pruritus. Blood examination revealed eosinophilia. Histopathological examination of skin lesions showed psoriasiform, spongiotic, lichenoid dermatitis. A therapeutic regimen of oral corticosteroids led to complete regression of the skin changes. We feel that there are no clinical or histological findings to differentiate Sulzberger-Garbe disease definitely from extensive nummular eczema.


[The growth modifying effect of wound ointments on cell cultures].

Ointments are often used for the treatment of wounds with impaired healing or for patients with severe burning. Therefore, some information about their pharmacological effects is necessary. This paper presents an in vitro model for testing the effects of ointments on an isolated cell type with the possibility of quantification. In this study fibroblasts of the human gums and 12 ointments available without prescription were used. To investigate the toxic effects, we examined the morphological changes and autoradiography. The results and their clinical implications are discussed.


[Eosinophilia-myalgia syndrome. Clinical aspects and follow-up of 10 patients].

A retrospective study (1985-1989) of patients suffering from diffuse fasciitis with eosinophilia revealed that five of eight patients had taken L-tryptophan-containing drugs before the onset of the disease. In addition, since this drug-disease association was first described five patients have been diagnosed during the year 1990. All ten patients developed peripheral eosinophilia, myalgia and deep skin involvement indistinguishable from eosinophilic fasciitis. Corticosteroids were able to reduce the pain and inflammatory parameters, but did not prophylactically improve the long-standing sclerodermalike skin thickening. In 2/5 patients with symptoms longer than 1 year, low-dose corticosteroid maintenance therapy has been continuously required to control joint and muscle pain.


[Multiple woolly hair nevi with linear epidermal nevus and persistent pupillary membrane].

The woolly hair nevus is a very rare disease that only occurs sporadically. So far, approximately 48 patients with woolly hair nevus have been described in the world literature. Both sexes are equally affected. Mostly, the dermatosis manifests itself from birth or within the first 2 years of life. Up to 5 circumscribed areas with clearly lighter curly hairs can be observed. About 50% of the patients present a linear epidermal nevus at the same time. Microscopically, the hair shaft diameter of the woolly hair is significantly reduced. Next to oval structures the cross-sections of the hair often show triangular and irregular forms. Furthermore, pili canaliculi and pili torti as well as circumscribed cuticula defects can be observed. We present a 5-year-old boy, who manifested 4 woolly hair nevi on the capillitium in the 9th month of life. From the 2nd year of life onwards he developed a linear epidermal nevus. The ophthalmological examination showed a persistent pupillary membrane. Based on this case and a bibliographical overview, the light and electron microscopical peculiarities are presented.


[Mycetoma with black granules: first case in a native of Israel].

We present a case of black grain mycetoma caused by Madurella mycetomatis. The diagnosis was made on the basis of conventional light microscopy and mycological studies. After 12 months of oral therapy with ketoconazole, the patient showed partial response. This is the first native Israeli case of black grain mycetoma.


[Botryomycosis caused by fusobacteria].

In the Anglo-American literature botrymycosis is described as a chronic cutaneous granulomatous reaction to bacterial infection, containing granules resembling the sulphur granules seen in actinomycosis. The diagnostic and therapeutic aspects are discussed with reference to a recently observed patient. Fusobacterium nucleatum was isolated as the bacterial cause of the pathologic disorder.


[Leukonychia longitudinalis as the primary symptom of Hailey-Hailey disease].

Longitudinal white bands on the fingernails were observed in a 58-year-old male patient with perianal intertrigo. His nail changes were a first clue to the diagnosis of Hailey-Hailey disease, which was later confirmed histopathologically. Similar nail abnormalities were found in the patient's son who was also affected with Hailey-Hailey disease. These findings support the concept that those nail changes, first described by Burge in 1991, constitute a useful diagnostic marker in Hailey-Hailey disease.


[Hutchinson-Gilford syndrome].

A case report on a 6-year-old boy suffering from the extremely rare Hutchinson-Gilford syndrome (progeria) is presented. The results of histopathological and immunohistological examination of the scar-like skin lesions are reported. Subcutaneous amorphous nodules were eosinophilic, PAS- und elastica-negative und remained unstained with antibodies against collagen type IV, vimentin, and collagenase. The dense perivascular infiltration consisted of CD4+, CD8-, alpha-1-antichymotrypsin-, MAC 387-, and some vimentin-positive cells. Perinodular blood vessels were more abundant and had a thickened wall. Collagen bundles were swollen. The epidermis appeared atrophic with focal basal cell degeneration.


[Chemically-induced scleroderma].

Scleroderma-like diseases can be induced by a number of chemical compounds, such as plastics, solvents and drugs. Contaminated rapeseed oil was the cause of the toxic oil syndrome and L-tryptophan induces the so-called eosinophilia-myalgia-syndrome. On the other hand, paraffin and silicon can trigger so-called adjuvant disease, while long-term exposure to silica can lead to idiopathic scleroderma (associated with silicosis in some cases). In addition to the clinical features, some pathogenetic data in the literature, such as genetic factors (HLA, chromosomal anomalies, enzyme deficiencies) and the metabolism of chlorinated ethylenes via reactive epoxide intermediate products, and our own findings are reported. Silica-induced scleroderma cannot be distinguished from the idiopathic form by epidemiological, clinical or immunological studies or by parameters referring to the blood vessels or collagen metabolism. In cell culture studies it has been shown that macrophages/monocytes release IL1, IL6 and TNF after ingestion of silica, which affects fibroblasts, T-helper cells and endothelial cells. Comparative results from the silicosis literature are reported. Finally, the possibly stimulating role of ionizing irradiation (uranium mining) in favouring the development of scleroderma is discussed.


[Homeopathy. Basic aspects and principles of use in dermatology].

Homoeopathy was established in 1796 by Samuel Hahnemann (1755-1843). This method is an alternative form of therapy involving treatment by natural remedies. The basic principles of homoeopathic medicine, "similia similibus curentur", "experimenta in homine sano", "doses minimae" and "unitas remedii", are founded upon the idea of illness as a disorder of the internal equilibrium at the physical, mental and psychic levels. The entire picture of symptoms is ascertained in each individual case by scrupulous history taking. A remedy which provokes a similar picture of effects in healthy persons is finally employed as the homeopathic therapeutic agent (law of similars). According to the homoeopathic view, skin diseases are manifestations of an internal or constitutional disorder. Thus, homoeotherapy of skin diseases is based on morphological, local and constitutional criteria.


[The possible nephrotoxicity of a bituminous coal dermatologic agent].

Nephrotoxic effects are discussed as a possible risk of dermatological coal tar preparations. Therefore, we have performed a renal tolerance study with a modern coal tar preparation for the scalp, Berniter. 15 healthy volunteers, randomly subjected to 3 different modes of application, applied the preparation: twice weekly (mode I) or daily (mode II) for a period of 8 weeks. In both modes, application time was 15 min. In mode III, the preparation was used under occlusion for 30 min every second day for a period of 4 weeks. Before, during and after treatment, renal functions and urinary phenol levels were assayed. No pathological change or impairment of renal functions was detected. A relationship between urinary phenol content and the coal tar treatment was not observed, either. We conclude that the coal tar preparation investigated here has no nephrotoxic properties.


[Epiluminescent microscopy score for differential diagnosis of dysplastic nevi].

Specific epiluminescent microscopical criteria of histopathologically defined dysplastic nevi are yet unknown. The diagnostic evaluation of dysplasia and atypia is especially based on microscopic assessment of combined morphologic and coloured details of melanocytic lesions. Differences, skin microscopically analysed, between a group of 55 dysplastic nevi and a comparative group of 130 junctional and compound nevocellular nevi were statistically significant for 12 characteristics. Thus a score could be established for surface microscopic differential diagnosis of dysplastic nevi.


[Unilateral lentiginosis--a segmental neurofibromatosis without neurofibromas].

Segmental neurofibromatosis (NF) is a usually non-inherited form of NF that is characterized by unilateral neurofibromas and/or café-au-lait spots. In partial unilateral lentiginosis (PUL), apart from unilateral lentigines, café-au-lait spots of different dimensions have been described in some patients without fulfilling the diagnostic criteria for NF. We report on three patients representing the 4th to 6th cases of segmental NF without neurofibromas. The diagnosis resulted from unilateral café-au-lait spots of different sizes in all patients and axillary "freckling" and associated skeletal alterations in two patients each. As these findings are clinically and histologically comparable to reported cases of PUL and moreover fulfil the diagnostic criteria for segmental NF, our cases support the hypothesis that PUL is a segmental NF lacking neurofibromas.


[Family study of erythrokeratodermia figurata variabilis].

Erythrokeratodermia figurata variabilis (EKV) is a rare disorder of cornification inherited as an autosomal dominant trait. Genetic linkage to the Rh locus on chromosome 1 has been recently documented. In 1957, Sommacal and Schnyder reported on a family with 14 affected members. We have reexamined this pedigree, which counts 77 members with 29 affected persons over five generations (45 females, 31 males). Twenty females and 9 males were affected. In all patients EKV presented in the first year of life, and several mothers noted the erythematous lesions at birth of their children. The hyperkeratotic lesions appeared later. The reddish macules changed within hours to days. The erythematous areas were sharply outlined and sometimes surrounded by an anemic border. Only few members stated that their erythema could persist for more than a week. Clear triggers were emotional stress and changes of temperature. In all but two of the patients erythema was prominent and in the others hyperkeratotic lesions were more severe. Most patients had a burning sensation in their red areas. There was a marked tendency for improvement of EKV after puberty. Five females reported regular superficial skin peeling on hands and feet. The features in these patients had some similarities with erythrokeratolysis hiemalis.


[Loose anagen hair].

We report on a 5-year-old girl whose hair could be pulled out with no effort and without causing pain. Occipital alopecia in a patchy pattern and with no sign of scalp inflammation or scarring was noted. A trichogram from the clinically involved area disclosed a striking predominance of anagen hair with absence of external root sheaths. Histological examination of the hair suggests abnormal premature keratinization of the inner root sheath, resulting in the loss of its anchoring function between the hair shaft and the follicle. Zaun first reported this new type of hair loss in children in 1984. The name loose anagen hair of childhood has recently been suggested for this disease. The differential diagnosis includes alopecia areata, trichotillomania, and congenital hypotrichosis.


[Curling and kinking of hair caused by etretinate].

In two female psoriasis patients, curling and kinking of the scalp hair developed subsequent to a long-term etretinate therapy. Scanning electron microscopic examination of kinking hair revealed twists with sharp-edged defects and splitting of the cuticle cells in several hairshafts. The quantitative determination of the mechanical parameters of these hairs using a computerized system revealed statistically significant changes from the pattern in the scalp hair of untreated psoriasis patients. This finding suggests etretinate-induced alteration of the expression of the psoriatic phenotype in the keratin composition of hair in psoriasis patients.


[Grouped and combined blue nevi].

The simultaneous occurrence of blue and naevocytic naevus in the same lesion is rare and can be difficult to diagnose. Precise differentiation from nodular melanoma may only be possible by histopathological examination. Agminated blue naevi, first described by Upshaw et al. [25] in 1947, are also rare. It is important to differentiate these lesions from nodular melanoma with satellite metastases. We describe two patients with such unusual blue naevi.


Breastfeeding. Setting a standard: the challenge for health visiting.

Health visitors agree that breast is best. But how far is this principle translated into practice? Copious evidence exists of conflicting advice and views on breastfeeding among health professionals and even between health visitors themselves. Marianne Cowpe, Ann MacLachlan and Elizabeth Baxter describe how north east Fife health visitors drew up an agreed standard of practice to boost local breastfeeding rates.


Breaking down the barriers.

In theory, health visitors support a social model of health. But the reality of their practice is very different. Drawing on her own experience in a health visiting community development post, Yvonne Dalziel argues that constraints to this new way of working can be overcome.


Games health visitors play: interaction on home visits.

Health visitors routinely use a number of verbal ploys to control and direct interactions with clients. Shona Cameron describes some of the findings of a recent study of conversations between health visitors and clients on home visits.


Proactive health visiting in Falkirk.

Isolation and low morale prompted health visitors in Forth Valley health board to set up a group which could work together proactively at a time of uncertainty and change. Sally Johnson describes the group's beginnings and achievements so far.


The children's hearing system and the health visitor's role.

Scotland's legal system is widely acknowledged to deal more sensitively with child protection cases. Here Karen Devlin describes the children's hearing system and discusses the role of the health visitor working with families in crisis and coming before a panel hearing.


Implementing an annual screening programme.

Anna May describes a programme to screen annually the health of people over 75 on her caseload and the opportunities it offers for active health promotion.


Enzyme histochemistry and immunohistochemistry with freeze-dried or freeze-substituted resin-embedded tissue.

Freeze-drying or freeze-substitution, combined with low-temperature resin-embedding, represents a new approach to the optimum preservation of tissue for enzyme histochemistry and immunohistochemistry. This method, which avoids tissue fixation, combines excellent tissue morphology with the preservation of enzyme activity and immunoreactivity and allows high-resolution enzyme histochemical and immunohistochemical studies to be performed. The activity of a wide range of enzymes can be demonstrated in sections of freeze-dried or freeze-substituted resin-embedded tissue. Enzymes are retained in situ with high activity, accurate localization and no diffusion. Immunohistochemical studies can also be performed on resin sections, and antigens--especially labile antigens--are immobilized in situ without denaturation and can be demonstrated with high sensitivity and accurately localized. This method allows the localization and distribution of enzymes and antigens to be studied in relation to excellent histological and cytological detail.


Light-microscopic detection of acidic glycoconjugates with sensitized diamine procedures.

To enhance the efficiency and specificity of diamine methods in light microscopy, these methods were sensitized by silver enhancement in combination with trichloro(ethylene) platinate (KTP). The sensitized diamine methods consisted of a diamine (high or low iron diamine: HID or LID), KTP, borohydride reduction (BH) and a physical development (PD) sequence. The new methods have been successfully applied to routinely prepared tissue sections obtained from rat organs, such as salivary glands, stomach, colon, kidney, lung and trachea. In the tissues subjected to the sensitized diamine methods, weakly diamine-stained histological structures exhibited vivid positive reactions. The combined sensitized diamine methods and selective procedures, such as enzyme digestion and chemical modification, have substantiated that these methods were of sufficient efficiency and specificity.


Cationic colloidal gold--a probe for light- and electron-microscopic characterization of acidic glycoconjugates using poly-L-lysine gold complex.

Cationic colloidal gold (CCG) was used to characterize acidic glycoconjugates in semithin and ultrathin sections of rat large intestine and salivary glands embedded in hydrophilic Lowicryl K4M resin. It was prepared from poly-L-lysine and 10 nm colloidal gold solution. The staining of CCG in semithin sections was amplified after photochemical silver reaction using silver acetate as a silver ion donor and examined under bright-field and epi-illumination microscopy. CCG adjusted to various pH levels was tested on various rat tissues whose histochemical characteristics with regard to acidic glycoconjugates are well known. At pH 2.5 CCG labelled tissues containing sialylated and sulphated acidic glycoconjugates such as the apical cell surface, mucous cells in the distal and proximal colon, and acinar cells of the sublingual gland. In contrast, CCG at pH 1.0 labelled tissues containing sulphated acidic glycoconjugates such as mucous cells in the upper crypt of the proximal colon and mucous cells in the whole crypt of the distal colon. This specificity of CCG was verified by the alteration of CCG staining following several types of cytochemical pretreatment. These results were further confirmed by electron microscopy. CCG staining is thus a useful postembedding procedure for the characterization of acidic glycoconjugates at both the light- and electron-microscopic levels.


Species differences in adenosine metabolic sites in the heart.

5'-Nucleotidase and purine nucleoside phosphorylase, two key enzymes in nucleoside metabolism, have been localized electronmicroscopically in left ventricular myocardium of the human, dog, pig, rabbit, guinea pig and rat. Ectonucleotidase activity was present in all species at the plasma membrane of pericytes. Reactive endothelial cells in the microcirculatory bed were restricted to those covering resistance arterioles. Cardiomyocytes were reactive only in the rat. Purine nucleoside phosphorylase was localized uniformly in the vascular endothelium of all species. The strongest activity was seen in the pericytes of guinea pig, rat and dog. Pericytes of rabbit and pig were virtually unreactive, whereas a minority of cells in human samples were positive. Cardiomyocytes were unreactive in all species. These variations in the distribution pattern of adenosine metabolic sites may have definite consequences for disposal and recovery of adenylates and their breakdown products in ischaemia and for the effects to be expected from interference with nucleoside transport inhibition.


A dot blot technique for the analysis of interactions of lectins with glycosaminoglycans.

Glycosaminoglycans are polysaccharides which are widely distributed throughout connective tissue, where they form an essential part of the extracellular matrix. Connective tissue is often stained by lectins, and it is not known whether this staining is due to the interaction of lectins with the glycosaminoglycans or due to the binding of lectins to other glycoconjugates within the matrix. A dot blot technique is presented by which the interaction of lectins with glycosaminoglycans can be analysed.


Immunogenicity and efficacy study of a commercial Borrelia burgdorferi bacterin.

The immunogenicity and efficacy of a commercial Borrelia burgdorferi bacterin was evaluated for stimulation of the host immune response and protection against clinical disease associated with experimentally induced borreliosis in dogs. A total of 30 vaccinated and 24 control dogs were used in 3 separate studies. The vaccine was given IM as two 1-ml doses separated by a 3-week interval. Two weeks or 5 months following the last vaccination, the dogs were challenge inoculated with 7 daily doses of a virulent preparation of a B burgdorferi field isolate through intraperitoneal, subcutaneous, and intradermal routes with or without glucocorticoid administration at the same time. The development of B burgdorferi spirochetemia and clinical disease in the dogs after challenge exposure was studied. Serum samples were obtained from the dogs at various times during the study for serum neutralizing antibody determination and protein immunoblot antibody assay against various geographic isolates of B burgdorferi. Challenge exposure induced limb/joint disorder, fever, anorexia, signs of depression, and B burgdorferi spirochetemia in the nonvaccinated control dogs. The vaccine was found to elicit cross-reactive serum neutralizing and protein immunoblot antibody responses in dogs to various isolates of B burgdorferi and to protect the vaccinated dogs against experimentally induced borreliosis.


Comparison of applanation tonometers in dogs and horses.

Two Mackay-Marg tonometers and 2 Tono-Pen tonometers were evaluated in eyes in which intraocular pressure (IOP) had been altered and measured by use of a manometer. Eyes of anesthetized dogs and enucleated horse eyes were used. Compared with the manometer, none of the tonometers accurately measured IOP over the range between 0 and 100 mm of Hg. However at manometer measurements from 0 to 30 mm of Hg, several of the tonometers accurately measured IOP. In addition, significant differences were observed when the measurement accuracy of one tonometer was compared with that of another, especially at high IOP. Coefficient of determination (r2) values for a linear model ranged from 0.979 to 0.991 in dogs, and from 0.982 to 0.996 in horse eyes.


Plasma concentrations of 13,14-dihydro-15-ketoprostaglandin F2 alpha in mares during uterine involution.

Twelve mares were allowed to foal naturally, after which they were monitored to study uterine involution. Starting on day 3 after parturition, the internal genital tract was examined per rectum manually and ultrasonographically every other day for changes in uterine characteristics and ovarian activity. By day 5, gravid and nongravid uterine horns were similar in size, and by day 7, uterine fluid was absent. On day 7 after parturition, endometrial biopsy samples were obtained for histologic evaluation, and uterine swab specimens were obtained for microbiologic culture. Uterine swab specimens from 10 of 12 mares had slight bacterial growth. The uteri of 8 of the 12 mares were histologically involuted by day 7. All mares ovulated 7 to 12 days after parturition. Concentrations of 13,14-dihydro-15-keto-PGF2 alpha (PGFM) were measured in jugular plasma samples obtained daily for 21 days after parturition. Concentrations of PGFM were low by the day after parturition, and there was no significant correlation between uterine involution and PGFM concentrations in these mares. All 12 mares were bred at the first estrus after parturition, and 9 became pregnant.


Effect of repeated collection of multiple endometrial biopsy specimens on subsequent pregnancy in mares.

Endometrial biopsy specimens (4 or 5 on each occasion) were collected from 7 mares 2, 3, or 4 times over a 50-day period prior to breeding. Four of the collection days were within 6 days of breeding. Six of the 7 mares were diagnosed as pregnant by use of ultrasonography at day 14 after ovulation. This pregnancy rate was the same as that achieved by these mares when they were bred at estrus before the start of the study. It appeared that repeated collection of multiple endometrial biopsy specimens from genitally normal mares did not adversely affect pregnancy rate.


Milk production, water consumption, and somatic cell count responses of cows subject to one to two volts of alternating current.

A dairy farm located in central New York was visited because of complaints of electrical shock in the farmhouse shower and the milk house sink. As much as 2 volts AC of potential difference was measured between the waterline and the cow platform (cow-contact voltage). Voltage was coming from the primary neutral wire. The farm's electrical service was modified so that the farmstead could be connected or disconnected from the primary neutral wire at 2-week intervals for 12 weeks. When connected to the primary neutral wire, voltage between waterline and floor ranged between 0 and 1.8 volts, producing estimated current flow through cows of 3.6 to 4.9 mA; when disconnected from primary neutral wire, voltage between waterline and floor was less than 0.1 volt. There was no difference in mean milk production, bulk tank milk somatic cell count, or water consumption among periods when cows were exposed or unexposed to voltage. Despite statistical nonsignificance, the values for somatic cell count were lower and water consumption was higher when cows were exposed to voltage than when they were not.


Colostral transfer of Bacteroides nodosus antibodies in sheep.

Ovine contagious foot rot may cause lameness in sheep, resulting in decreased wool growth and low weight gain. Affected neonatal lambs are difficult to treat, and treatment is labor intensive; thus, a method of prevention is warranted. Vaccination of ewes with a multivalent vaccine in an oil adjuvant induced development of antibody to the somatic O antigen of Bacteroides nodosus, and this antibody was detected in serum of newborn lambs after consumption of colostrum from the vaccinated ewes. Antibody titers were determined in 48 unvaccinated ewe/lamb pairs, and in 50 once-vaccinated and 78 twice-vaccinated pairs. Serum and colostrum O-agglutinin titers to B nodosus were determined by a microtitration agglutination test. Lambs from vaccinated ewes had significantly (P less than 0.05) higher O-agglutinin titers than those from unvaccinated ewes, and double vaccination of ewes resulted in the highest potentially protective titers (greater than 1:2,400) in ewes and lambs.


Resection and anastomosis for treatment of strangulating volvulus of the large colon of horses.

Strangulating volvulus of the large colon was treated by resection and anastomosis of the colon in 9 horses. Tissue specimens were obtained at the site of the resection for histologic evaluation. An attempt was made to correlate the appearance of the colon at the time of surgery to the histologic evaluation and the eventual outcome. Six of the 9 horses (66%) survived. This is in contrast to a reported survival of 34.7 to 36% after decompression and reduction of colonic volvulus. Survival after surgery could not be predicted on the basis of visual assessment or histologic examination.


Comparison of anthelmintic control programs for sheep in Virginia.

Haemonchus contortus is the most serious parasitic problem encountered by sheep producers in southwestern Virginia. Four anthelmintic control programs for grazing lambs were tested. Group TR received monthly SC injections of ivermectin (200 micrograms/kg of body weight). Group SI received the same dose of ivermectin at 0, 3, 6, 9, and 12 weeks after the start of the grazing season. Group SL was given levamisole (8 mg/kg, PO) 0, 3, 6, 9, and 12 weeks after the start of the grazing season, and group TA received ivermectin (200 micrograms/kg) 0, 8, 16, 20, and 24 weeks after the beginning of grazing. None of the 4 programs provided satisfactory control of parasites as indicated by fecal egg counts and serum pepsinogen concentrations, although group-TR lambs gained significantly more weight than lambs in groups SI and TA. Group-TA lambs developed clinical haemonchosis in early August and required additional treatment at that time. These findings suggest that reliance on anthelmintics alone may not provide the most effective and economic control of parasitic infection.


Septic peritonitis associated with caudal myotomy in a Tennessee walking horse.

A 2-year-old Tennessee Walking Horse colt was admitted for evaluation of signs of abdominal pain, inappetence, and constipation of 5 days' duration. Two days prior to the onset of signs, the owner had cut the sacrococcygeal muscles as part of a tail-setting procedure. On examination, the horse was febrile and lethargic, and intestinal sounds were not heard on auscultation. Results of peritoneal fluid analysis were indicative of peritonitis. The horse continued to deteriorate and died despite treatment with antimicrobials, flunixin meglumine, and balanced electrolyte solution. At necropsy, the peritoneal cavity contained approximately 20 L of serosanguineous fluid. One of the myotomy wounds was filled with yellow-green material that extended from the base of the tail along the ventrolateral aspect of the rectum and into the peritoneal cavity. Escherichia coli was isolated from the myotomy site and peritoneal fluid.


Laryngeal granuloma in a bull.

Dyspnea in an adult bull caused by a large laryngeal granuloma was corrected by use of a surgical technique that allowed resection of the mass without ventral laryngotomy. Endoscopy was used for visualization of the mass during the oral surgery. The technique may be performed in the field.


Adenocarcinoma of the middle ear with osteolysis of the tympanic bulla in a cat.

Peripheral vestibular disease and lethargy were attributed to an adenocarcinoma in the middle ear of a 10-year-old cat. The tumor was invasive, inducing severe lysis of the tympanic bulla and adjacent temporal bone. Direct invasion to the meninges and brainstem also was observed. Neoplasms of the middle ear are rare in cats, with squamous cell carcinomas reported most commonly, but should be considered as causes of chronic otitis or signs of peripheral vestibular disease.


Pancreatic adenocarcinoma with metastasis in two ferrets.

Exocrine pancreatic adenocarcinoma with carcinomatosis was diagnosed in 2 ferrets. Clinical signs included abdominal distention and hind limb weakness. Ultrasonography revealed moderate ascites in both ferrets, an irregular abdominal mass in 1 ferret, and multiple abdominal masses in the other ferret. The ferrets were euthanatized, and necropsy of 1 ferret revealed carcinomatosis without visceral metastasis.


Bromide toxicosis (bromism) in a dog treated with potassium bromide for refractory seizures.

A 4-year-old German Shepherd Dog was evaluated because of chronic hind limb lameness and recurrent seizures. Diagnostic evaluation of the dog confirmed rheumatoid arthritis and idiopathic epilepsy. The rheumatoid arthritis was treated with prednisone and piroxicam. The seizures were treated with phenobarbital plus clonazepam. The seizures were refractory and potassium bromide was substituted for clonazepam. The dog was reevaluated 4 months after initiation of potassium bromide treatment because of recurrence of arthritis signs. During hospitalization, the dog had neurologic signs, which progressed from depression to recumbency and stupor. Anisocoria, muscle pain, and hyporeflexia were noticed. Bromide toxicosis was diagnosed on the basis of toxic serum bromide concentration (2.7 mg/ml; therapeutic range, 1.0 to 2.0 mg/ml). Following cessation of potassium bromide treatment, the neurologic signs resolved. The seizures recurred 6 weeks after potassium bromide was discontinued. Bromide treatment was reinitiated at half the initial dosage. After 6 weeks, the serum bromide concentration was 1.9 mg/ml, and no seizures had been reported by the dog's owners. Therapeutic serum bromide concentrations in dogs has been reported to be 0.5 to 2.3 mg/ml. The serum bromide concentration at which toxic signs are expected is variable in human beings because individuals differ in their tolerance of the drug. Clinical trials are necessary to determine the toxic serum bromide concentrations in dogs. This case of bromism in a dog suggests that the dosage of potassium bromide should be based on serial measurement of serum bromide concentrations.


Morbidity and mortality in pups from pet stores and private sources: 968 cases (1987-1988).

Morbidity (greater than or equal to 1 disease condition) for pups sold from 3 pet stores from January 1987 through December 1988 ranged from 54 to 68%. In 1 store, morbidity was higher for store pups, compared with pups originating from private parties, for such disease conditions as "kennel cough," diarrhea, and several species of gastrointestinal parasites. In-store mortality ranged from 5 to 9.5% of pups arriving for sale.


Nonsteroidal anti-inflammatory drug toxicosis in dogs and cats: 240 cases (1989-1990)

A search of medical records at the Georgia Animal Poison Information Center over a 19-month period revealed 240 cases of dog and cat exposure to nonsteroidal anti-inflammatory drugs (NSAID). The most common NSAID consumed were ibuprofen, acetaminophen, aspirin, and indomethacin. The most common clinical signs of toxicosis were vomiting and diarrhea, CNS depression, and circulatory manifestations. Pets are at risk from NSAID toxicosis through administration by the owners or accidental consumption of improperly stored drugs.


Clinical and laboratory findings associated with actual or suspected azoospermia in dogs: 18 cases (1979-1990).

Eighteen dogs were evaluated for azoospermia, 8 of which had sired pups. On the basis of history, physical examination, and various laboratory evaluations, the cause and site of azoospermia varied. Two dogs that had never sired pups had likely been azoospermic from puberty (congenital azoospermia). Two dogs were azoospermic as a result of tumors (Sertoli cell tumor and malignant astrocytoma of the pituitary gland). Deposits of IgG were observed in testicular biopsy samples, which suggested an auto-immune cause for azoospermia in 5 dogs. One of the 5 dogs with IgG deposits in testicular tissues also had evidence of immune-mediated thyroiditis. Culturing of microbes in the semen was not helpful in determining potential causes of azoospermia, and results did not correlate with organisms isolated from testicular biopsy samples or with the finding of inflammation in biopsy samples. Because 6 dogs had relatives with histories of reproductive dysfunction, inbreeding also must be considered when evaluating dogs for azoospermia.


Complications of nasogastric intubation in horses: nine cases (1987-1989).

Pharyngeal or esophageal trauma was diagnosed in 9 horses after nasogastric intubation. Evidence of trauma (edema or ulceration) was detected in the pharynx of 3 horses and in the esophagus of 6 horses. Complications associated with nasogastric intubation were first observed in 5 horses while they were intubated and in 4 horses after extubation. Clinical signs of pharyngeal or esophageal trauma were similar, and included salivation, bruxism, coughing, and nasal discharge. Treatment, including extubation, enteral feeding through a small nasogastric tube, or esophagostomy distal to the affected site, was attempted in 6 horses. Three of 6 treated horses survived, but 4 of 5 horses with perforated esophagus were euthanatized.


Successful graft of HTLV-I-transformed human T-cells (MT-2) in severe combined immunodeficiency mice treated with anti-asialo GM-1 antibody.

To develop an experimental model of adult T-cell leukemia/lymphoma in small animals, severe combined immunodeficiency (SCID) mice treated with anti-asialo GM-1 antibody were inoculated with MT-2 cells, a cell line transformed by the human T-cell leukemia virus (HTLV-I). Three mice injected with 4 x 10(7) cells subcutaneously or intramuscularly developed tumors at or near inoculation sites. Immunofluorescent antibody (IFA) staining for HTLV-I structural protein, p19, revealed the specific antigen in the cytoplasm of most cells from tumors and the DNA signals of HTLV-I proviral DNA were also positive in cellular DNA by polymerase chain reaction assay with HTLV-I tax gene primers, SK43/SK44. The MT-2 cells did not invade in mouse organs.


A novel tetracyclic peptide, trapoxin, induces phenotypic change from transformed to normal in sis-oncogene-transformed NIH3T3 cells.

A novel tetracyclic peptide, trapoxin [cyclo(L-phenylalanyl-L-phenylalanyl-D-pipecolinyl-L-2-amino-8-oxo -9,10-epoxy - decanoyl)], was found to induce the flat phenotype in v-sis-transformed NIH3T3 cells at a quite low concentration of 1 ng/ml. Actin stress fiber could be detected after trapoxin treatment. Almost complete reversion into the flat phenotype was observed at 6 h after the administration of the compound. The effect of trapoxin was reversible, when the cell culture was incubated for more than 24 h after its removal. The intracellular level of sis-mRNA did not decrease with trapoxin treatment at a concentration (50 ng/ml), sufficient to reverse the transformed morphology. Substitution of pipecolinic acid with proline in trapoxin did not change the activity. WF3161, in which leucine was substituted for a phenylalanine of trapoxin, showed only one-sixteenth of the activity of trapoxin. Reduction of the epoxide residue of trapoxin destroyed the activity.


Second primary cancer following laryngeal cancer with special reference to smoking habits.

The risk of developing a second primary cancer following laryngeal cancer was estimated by following-up 472 male laryngeal cancer patients for an average of 8.6 years by means of record linkage to the Osaka Cancer Registry. Of these patients, 115 developed a second cancer other than laryngeal cancer, whereas the expected number derived from the incidence rates among Osaka residents was 51.4 (relative risk (RR) = 2.2, 95% confidence interval = 1.85-2.69). Cumulative risk of developing a second primary cancer was estimated to be 31.1% at 15 years after laryngeal cancer. By site, the risks were significantly increased for tobacco-related cancers, RR = 24.5, 6.1 and 2.3 for cancers of the oral cavity & pharynx, esophagus and lung, respectively. Also, the risks were higher among heavy smokers for cancer of the oral cavity & pharynx and esophagus than among light smokers. No adverse effects of radiotherapy for laryngeal cancer on the development of thyroid cancer, lymphoma and leukemia were observed. The present study suggests the necessity of following-up laryngeal cancer patients over a long period in order to enable the early detection of tobacco-related cancer.


Illiteracy, ignorance, and willingness to quit smoking among villagers in India.

During the field work to control oral cancer, difficulty in communication was encountered with illiterates. A study to define the role of illiteracy, ignorance and willingness to quit smoking among the villagers was undertaken in a rural area surrounding Doddipatla Village, A.P., India. Out of a total population of 3,550, 272 (7.7%) persons, mostly in the age range of 21-50 years, attended a cancer detection camp. There were 173 (63.6%) females and 99 (36.4%) males, among whom 66 (M53 + F13) were smokers; 36.4% of males and 63% of females were illiterate. Among the illiterates, it was observed that smoking rate was high (56%) and 47.7% were ignorant of health effects of smoking. The attitude of illiterate smokers was encouraging, as 83.6% were willing to quit smoking. Further research is necessary to design health education material for 413.5 million illiterates living in India (1991 Indian Census). A community health worker, trained in the use of mass media coupled with a person-to-person approach, may help the smoker to quit smoking.


The effect of breast self-examination on early detection and survival.

To investigate the effect of breast self-examination (BSE), we compared the stages, survival, and the risk of death for 355 patients with breast cancer detected by BSE with those for 1,327 patients with breast cancer detected by chance. The early stages of the disease were found to be more common among the symptomatic breast cancer patients detected by BSE than those by chance. The 5-year overall survival rate was 94.4% for the symptomatic patients detected by BSE, and was significantly higher by 8.7% than that (85.7%) for patients detected by chance (P less than 0.001). The 10-year survival rate was 81.6% for patients detected by BSE, and 76.6% for cases detected by chance (the difference was not significant). The overall difference between the two survival curves was statistically significant by the logrank test (P less than 0.01). A multivariate analysis using the Cox proportional hazards model showed that the risk of death for patients detected by BSE was smaller by 0.570 times than that for patients detected by chance, which was statistically significant (P less than 0.05). The effect of biases inherent to BSE in the survival analysis cannot be controlled completely even after conducting multivariate analysis. These results suggest that BSE may contribute to the reduction of the risk of death through early detection of breast cancer. However, further examination should be conducted by other methods to obtain conclusive evidence.


Ubiquitous presence in mammalian cells of enzymatic activity specifically cleaving 8-hydroxyguanine-containing DNA.

Here we report the finding of enzymatic activity that specifically cleaves DNA containing 8-hydroxyguanine (oh8Gua) residues in various mammalian cells. To detect this activity, we used a synthetic double-stranded DNA containing a single oh8Gua at a defined position as the substrate, and analyzed the products of enzymatic digestion by polyacrylamide gel electrophoresis. Two cleavage sites near the oh8Gua residue were detected with partially purified fractions from cow brain and rat liver, and also with preparations from all mammalian tissues examined. These results suggest that enzymatic activity for the removal of oh8Gua from DNA is widely distributed in mammalian cells.


Growth inhibition by anchorage-deficiency is associated with increased level but reduced phosphorylation of mutant p53.

Human breast carcinoma MCF-7 cells seeded on type I collagen-coated dishes were provided with an anchor via the collagen receptor, integrin, and grew as actively as those in plastic tissue culture dishes. In contrast, cells seeded on a layer of soft agar became anchorage-deficient and their growth was significantly inhibited, although the cell viability and the cell cycle distribution were unaffected. Immunoprecipitation analysis revealed that mutant p53 was phosphorylated at tyrosine in the anchorage-provided cells. In contrast, the p53 in the anchorage-deficient cells was present in 2-fold greater amount, but was phosphorylated to a lesser extent. Addition of a potent protein-tyrosine kinase inhibitor, herbimycin A, to the anchorage-provided cells caused an elevated level of p53, and inhibitions of cell proliferation and p53 phosphorylation, without interfering with the cell adhesion to the substratum. These results demonstrated that the growth inhibition by anchorage-deficiency or by herbimycin A is associated with an elevated p53 level and reduced p53 phosphorylation at tyrosine.


Soluble interleukin-6 receptor is released from receptor-bearing cell lines in vitro.

Soluble interleukin-6 receptor (sIL-6R) was found to be spontaneously released from human myeloma cell line U266 cells into culture supernatant, and was quantitatively measured with a fluorescence sandwich enzyme-linked immunosorbent assay employing antibodies specific to IL-6R. The supernatant IL-6R was generated only from IL-6R-positive cell lines; myeloma cell lines RPMI8226 and PRMI1788, and myelomonocytic cell lines U937, THP-1, and HL-60. In contrast, it was not released from the IL-6R-negative cells; T cell line Molt-4 and Burkitt lymphoma cell line Raji. SDS-PAGE analysis of the soluble IL-6R from U266 cells suggested a molecular weight of approximately 50-55 kDa, 25-30 kDa smaller than the mature cell surface receptor. These results suggest that the generation of soluble IL-6R may be a maker of myeloma cells and myelomonocytic cells.


Autoradiographic analysis of radiolabeled anti-carcinoembryonic antigen monoclonal antibody CEA102 in colorectal cancer using computed radiography.

Anti-carcinoembryonic antigen monoclonal antibody (MAb) CEA102 was produced by immunization with purified CEA and the specific accumulation of radiolabeled CEA102 in colorectal cancers was investigated by autoradiography of surgical specimens using Fuji Computed Radiography (FCR). Five patients with colorectal cancer were injected intravenously with 131I-labeled intact CEA102 or its F(ab')2. Primary tumor and liver metastases were successfully detected by external scanning with a gamma camera in 4 cases. Autoradiographic study of the surgical specimens using FCR showed predominant localization of 131I-labeled CEA102 in primary tumors and liver metastases in all cases. Even a small liver metastasis (0.5 cm) was clearly visualized in the autoradiogram by FCR. The pixel distribution curves of the density of the respective tissues in the autoradiograms by FCR showed the heterogeneity of the distribution of administered radiolabeled MAb in individual tumors, but the density of the tumors was higher than that of the normal tissues. In the quantitative distribution analysis of CEA102, the uptake of the primary tumor (mean 1.10%ID/kg) was ten-fold greater than that of the normal colon mucosa (mean 0.10%ID/kg). These results revealed that the application of MAb has great potential in radioimmunodetection as well as in antibody-directed therapy.


Metabolism of tegafur in rat liver observed by in vivo 19F magnetic resonance spectroscopy and chromatography.

Metabolism of tegafur in the rat liver was observed by in-vivo 19F magnetic resonance spectroscopy (MRS). After MRS observation, tegafur and q-fluorouracil (5-FU) in the liver were determined by a chromatographic method for comparison with the results of 19F-MRS. Rats were divided into 3 groups: 1) CCl4-induced liver injury group, 2) uracil combined group, 3) control group. Catabolism to fluoro-beta-alanine was suppressed in both the liver injury group and the uracil combined group. Low peaks of 5-FU and fluoronucleotides could be found only in the uracil combined group. The result of 19F MRS observation of each group was in agreement with the result of determination of tegafur and 5-FU by chromatography. This showed that substances which could be observed by 19F-MRS were in proportion to all intracellular fluoro-containing substances. 19F-MRS can provide direct information on the metabolism of fluoropyimidines non-invasively and it might be a useful aid in choosing suitable chemotherapy for patients.


Effects of antitumor agents on subcutaneous implants and hepatic metastases of colon carcinoma 26 in mice.

We investigated the responses of experimentally produced hepatic metastases of colon carcinoma 26 tumor and subcutaneously (SC) implanted colon carcinoma 26 tumor in mice to 17 clinically-used and one under-development antitumor agents using same dose regimen. In intravenous administrations on days 7 and 14, there were no significant differences in their responses to most of the tested agents. However, there were big differences in the responses to some of the agents. Nimustine more effectively prolonged the lifespan of SC implanted tumor-bearing mice than of mice bearing hepatic metastases. Mitomycin C was, however, considerably more effective on hepatic metastases than on SC implanted tumor. ME2303, a new fluorinated anthracycline derivative, showed a similar effect to doxorubicin on both tumors. However, administrations of ME2303 on days 7, 11 and 15 showed more marked antitumor effect only on hepatic metastases than administrations on days 7 and 14. Doxorubicin was less active against both tumors for administrations on days 7, 11 and 15 than for those on days 7 and 14. These results suggest the importance of the site of tumor growth for the action of some drugs. ME2303 may be active against hepatic metastases if it is administered by multiple injections.


Cell-killing activity and kinetic analysis of a novel antitumor compound NC-190, a benzo[a]phenazine derivative.

A novel antitumor compound, N-beta-dimethylaminoethyl 9-carboxy-5-hydroxy-10-methoxybenzo[a]-phenazine-6-carboxamide sodium salt (NC-190), was evaluated for antitumor activity in vitro against cultured tumor cell lines, and the kinetics of cell killing was elucidated. NC-190 strongly inhibited the growth of all of 3 murine tumor cell lines, 7 human tumor cell lines and 2 normal cell lines. With continuous exposure, the 50% inhibition concentrations were in the range of 0.005-0.06 micrograms/ml, except for KATO-III (2.15 micrograms/ml). By colony-forming assay, concentrations of NC-190 giving 90% cell kill (IC90) at various exposure times were obtained with HeLa S3 cells. The plot of IC90-exposure time on a log-log scale was linear for NC-190 with a slope of -1, which is typical for cell cycle phase-nonspecific agents. A 2 h treatment with NC-190 induced a rapid reduction in cell viability at doses of more than 3 micrograms/ml. At the dose where colony formation was completely inhibited, cell viability was persistently reduced to below 20% during the cell culture period. NC-190 caused a dose- and time-dependent reduction in DNA synthesis. The inhibitions of RNA and protein synthesis were less than that of DNA synthesis. Spectroscopic studies of NC-190 mixed with calf thymus DNA demonstrated that NC-190 was capable of interacting with DNA. However, DNA thermal denaturation studies suggested that intercalation of NC-190 was weak in comparison with those of classical intercalating drugs.


Radiosensitization and hypoxic cell toxicity of NLA-1 and NLA-2, two new bioreductive compounds.

Two new bioreductive compounds, 9-[3-(2-nitro-1-imidazolyl)propylamino]acridine hydrochloride (NLA-1) and 9-[2-(2-nitro-1-imidazolyl)ethylamino]acridine hydrochloride (NLA-2), have been prepared. They feature an acridine ring to intercalate with DNA, a 2-nitroimidazole ring as the radiosensitizing moiety and an amino functionality for increased DNA-binding and hydrophilicity. Time and concentration dependent cytotoxicity as well as radiosensitization efficacy of the two compounds under hypoxic or aerobic conditions were determined in vitro using V-79 cells and an MTT colorimetric or clonogenic assay. The isosensitization point (ISP), defined as that drug concentration which results in the same survival decrement upon exposure of hypoxic or oxygenated cells to a given radiation dose, has been determined for both compounds at 7.5 Gy and the values are significantly lower than the ISPs of 5-[3-(2-nitro-1-imidazolyl)propyl]phenanthridinium bromide, 2-(2-nitro-1-imidazolyl)ethylamine or misonidazole (MISO). NLA-1 and NLA-2 are potent hypoxic cytotoxins and on a concentration basis, more potent than MISO as radiosensitizers in vitro. The sensitization enhancement ratios were significantly increased when 1 h drug preincubation under hypoxia at 37 degrees C was applied, before irradiation at room temperature.


Ossification of the membranous portion of the squamous part of the occipital bone in man.

The squamous part of the occipital bone consists of 2 parts, supraoccipital and interparietal. The supraoccipital develops both in cartilage and membrane. At the upper margin the bone lying between the superior and highest nuchal lines known as the torus occipitalis transversus is ossified in membrane by a pair of centres. This part of the supraoccipital represents the original membranous part of the primitive occipital bone of lower animals where the interparietals form part of the parietals. This segment of bone is labelled as the intermediate segment which probably never separates from the cartilaginous supraoccipital. The interparietal bone lying above the highest nuchal lines develops in membrane by 2 pairs of centres, 1 pair for the lateral plate and the other for the medial plate. Each centre consists of 2 nuclei. Failure of fusion between these centres or their nuclei with each other and the supraoccipital may give rise to various anomalies in the interparietal region which are discussed. This is the true interparietal bone which has migrated from the parietals of lower animals during evolution to become part of the occipital bone in man. When it appears as an anomaly in the form of an independent separate bone, the suture between it and the supraoccipital lies at the level of highest nuchal lines. There is no pre-interparietal bone.(ABSTRACT TRUNCATED AT 250 WORDS)


The vasa vasorum of the rabbit carotid artery.

The anatomy of the vasa vasorum of the carotid arteries was assessed by light and electron microscopy in a series of 25 New Zealand White male rabbits. The low viscosity acrylic resin, LR White, was used to cast the microvasculature. The carotid artery was found to have an endothelial monolayer placed directly upon a broad fenestrated internal elastic lamina. The media consisted of 12-18 laminae comprised of smooth muscle cells, elastin, collagen and ground substance. Vasa vasorum were confined to the adventitial layer, with no penetration into the media. They arose directly from the lumen of the carotid artery in addition to the arterial branching points. The potential role of the vasa vasorum in the aetiology of atherosclerotic plaques is discussed.


The structure and development of the 'plana semilunata' of the labyrinth of the trout.

Five plana semilunata consisting of tall epithelial cells were found in the semicircular canal ampullae of the trout labyrinth. All these areas began to develop after hatching. Their cells were cuboid at fry stages and prismatic in juveniles and adults. Cell outlines were smooth, with no basal infoldings of the plasma membrane or apical microvilli. The cell nucleus occupied basal locations in juveniles but migrated centrally in adults. The most conspicuous organelle, the smooth endoplasmic reticulum, was continuous with a well-developed vacuolar system. These cells stored numerous glycogen granules. The ultrastructural features of the plana semilunata strongly suggest their involvement in endolymph secretion.


A quantitative description of the epididymis and its microvasculature: an age-related study in the rat.

The morphology of the epididymal duct and, in particular, the epididymal microvasculature was examined at the light microscope level in young sexually-mature rats (3-5 months) and aged rats (18 months) to investigate the structural changes that may occur within the organ as a result of ageing, and which may predispose the organ to pathological changes. Quantitative data on the microvascular network of the epididymis (percentage of capillaries in the interstitial region, average area and surface density of the capillary lumen) were collected in 4 regions of the epididymis: the initial segment, caput, corpus and cauda. Epithelial cell height, epididymal lumen diameter, number of smooth muscle cells and percentage of smooth muscle surrounding the duct were also assessed within the same 4 regions. The data for both young and aged groups revealed a trend of decreasing capillary size from the initial segment of the epididymis to the cauda by 23%. Further, the percentage of capillaries within the interstitial region of the epididymis decreases dramatically (52%) in the same direction. The possible contribution of lymphatic capillaries to the data is discussed. The data revealed that none of the parameters assessed changed significantly up to 18 months of age. The quantitative data on the microvascular morphology of the epididymis presented in this study provide the basis for subsequent studies directed at the blood flow dynamics of the organ.


Scanning electron microscopy of the rabbit gallbladder mucosal microvasculature.

The arrangement of the microvasculature of the rabbit gallbladder was studied by means of scanning electron microscopy (SEM) of vascular corrosion casts and parallel uncorroded samples, together with correlated light microscopy (LM) observations. The outer layers of the gallbladder wall possess a coarse capillary network supplied by long and straight vessels which also give off numerous smaller twigs for the mucosal layer. Thin richly branched and anastomosing capillaries originate from the mucosal twigs. The mucosal capillaries are arranged in structures having a bowl-like configuration with the convexity facing towards the serosal layer, and the concavity corresponding to the epithelial lacunae seen by SEM of uncorroded samples. These structures were polygonal or irregularly rounded, and limited by vessels arranged in folds. The vessels running in these folds were capillaries and/or venules. The vascular folds corresponded to the epithelial folds demonstrated by SEM and LM of uncorroded samples.


A stereological analysis of kidney structure of honeyeater birds (Meliphagidae) inhabiting either arid or wet environments.

Stereology was used to quantify components within the kidney of honeyeater birds. Arid zone and wet zone inhabiting 'matched' body mass pairs of birds were examined. The kidney structure of the arid zone white-fronted honeyeater, Phylidonyris albifrons (16.9 g), was compared with that of the wet zone New Holland honeyeater, Phylidonyris novaehollandiae (21.9 g), and that of the arid zone spiny-cheeked honeyeater, Acanthogenys rufogularis (42.5 g), with that of the wet zone little wattlebird, Anthochaera lunulata (62.0 g). Both arid zone honeyeaters had a significantly higher (P less than 0.001) percentage of medulla in the kidneys, while the wet zone birds had a significantly higher (P less than 0.001) percentage of cortex. There were few differences between arid and wet zone honeyeaters in the percentage of nephron components in the cortex and medulla. Both arid zone bird species had a significantly larger volume of medulla, a feature characteristic of a high ability to conserve water by producing a concentrated urine. Both wet zone species had a higher volume of cortex but the difference was not significant. Few differences were found in the volumes and surface areas of tubules within the nephron. Differences that did occur were not always consistent with a high ability to conserve either ions or water more efficiently. The volume and surface area of brush border in the proximal tubule were significantly higher in the little wattlebird. This characteristic may lead to a greater capacity of its kidneys to absorb both water and ions.


Oocyte numbers are reduced in developing mouse ovaries cultured in testis-conditioned medium.

Reduced numbers of oocytes were present in fetal ovaries of 13 d post coitum (dpc) mice, cultured for 4 d in medium conditioned (-CM) for 2 d by 13 dpc testes, compared with ovaries maintained in standard unconditioned medium. This effect was abolished by heat-inactivation of the testis-CM. Electrophoretic analysis of conditioned media revealed differences between testis-CM and ovary-CM. Ovarian differentiation was otherwise unaffected by the testis-CM and gonadal volume was not significantly reduced. Organisation of ovigerous cords proceeded, even though the full complement of oocytes was absent, and connective tissue septa developed normally between the small cords. The reduction in oocyte numbers occurred without any inhibition of müllerian duct development. Since others, using transgenic mice, have shown, that higher concentrations of antimüllerian hormone are required to decrease oocyte numbers than are necessary for duct regression, our results suggest that an additional factor is involved in producing this modified effect.


Principles and mechanisms of automatic rotation during terminal extension in the human knee joint.

The mechanisms solely responsible for automatic rotation during terminal extension were investigated by means of destruction experiments on knee joint structures. These are the posterior cruciate ligament (PCL), the anterior cruciate ligament (ACL) and the curvature of the medial femoral condyle. The first mechanism is based on the extraordinary obliquity of the constantly taut PCL guiding bundle, which produces torque in the final extension stage. The second mechanism depends on the fact that the ACL becomes 'too short' towards the final extension stage, which in turn is due to the shape of the articular surfaces. The third mechanism is caused by the deflection of the medial femoral condyle by the intercondylar eminence of the tibia. Each of the collateral ligaments can, in their own right, prevent excessive automatic rotation. On the one hand, the mechanism of the automatic rotation is reversed during initial flexion by the medial collateral ligament (this would be 'too short' in the case of nonreversal). On the other hand, it is reversed by the popliteus muscle. It is suggested that automatic rotation is not related to securing an amuscular stance (locking mechanism).


The intraglandular submandibular ganglion of postnatal and adult rats. I. A light and electron microscope study.

The structure of the intraglandular submandibular ganglion is described in both postnatal and adult rats. The ganglion is localised mainly at the hilum where the majority of the cell bodies are observed. Ganglia are also present in the intralobular septa of both the submandibular and the sublingual glands. Often they are found along the main salivary ducts with the larger ganglia being encapsulated by connective tissue. On electron microscopy, the submandibular ganglion cells show the usual features of autonomic neurons. The cells contain a prominent round nucleus. Numerous short processes project from the soma together with a few long dendrites. The organelles are randomly distributed throughout the soma. Most of the synapses observed were on the short processes with occasional axosomatic synapses. Nonsynaptic desmosome-like contacts are a common feature among the ganglion cells. Especially noteworthy are contacts made by the dendrites which deeply invaginate the soma of an adjacent nerve cell. The ganglion cells of the postnatal and adult submandibular ganglia show minor differences. Ultrastructurally, the postnatal cells show signs of immaturity such as abundant free ribosomes, well developed Golgi complexes and disorganised rough endoplasmic reticulum. Mitotic satellite cells were observed associated with the postnatal ganglion cells. The study has confirmed that all the submandibular ganglion cells show a positive reaction for acetylcholinesterase. Enzyme activity is localised in the cisternae of rough endoplasmic reticulum, the Golgi complex, plasma membrane and nuclear envelope.


An ultrastructural study of the cytoplasmic aspects of erythrocyte membranes by a quick-freezing and deep-etching method.

A novel method for preparing exposed cytoplasmic aspects of erythrocyte membranes is described which improves the resolution in direct electron microscope images. Normal human erythrocytes were briefly fixed with paraformaldehyde and pelleted. Glass coverslips were coated with 3-aminopropyl triethoxysilane and glutaraldehyde to make erythrocytes stick to them. A drop containing the erythrocyte pellets was sandwiched between 2 coverslips. The attached erythrocytes were split open mechanically and postfixed with glutaraldehyde. Some were treated with Triton X-100 or postfixed with osmium tetroxide. All specimens were quickly frozen in an isopentane-propane mixture, deeply etched and rotary shadowed with platinum and carbon. Filamentous structures were seen to form networks on the cytoplasmic sides of the erythrocyte membranes. Triton X-100 and osmium tetroxide fixation distorted the fine network structure. This quick-freezing and deep-etching method will be useful in the analysis of the in situ ultrastructure of the cytoplasmic sides of erythrocyte membranes.


Variations in the intertubercular sulcus of the humerus related to handedness.

Measurements of the maximum width and depth of the intertubercular sulcus (ITS) and the angles formed by the medial and lateral walls of the ITS with the plane of its floor were recorded in 200 adult human humeri, 100 each from the right and left sides. The ITS was more often wider and its medial wall formed a more acute angle with the plane of its floor in right-sided humeri. A supratubercular ridge on the humerus was present more frequently on the right than on the left. The presence of this ridge is probably more necessary on the right to prevent medial displacement of the long head of the biceps tendon from the ITS. The greater thrust exerted by the taut tendon of the long head of the biceps in the upper limb that is used preferentially probably induces structural differences in the ITS.


The structure of the insertions of the tendons of biceps brachii, triceps and brachialis in elderly dissecting room cadavers.

The terminal portions of the tendon of brachialis, and the distal tendons of biceps brachii and triceps, were compared by routine histology. All tendons came from elderly dissecting room cadavers. There were pronounced quantitative differences between the 3 tendons in (1) the thickness of the attachment-zone fibrocartilage, (2) the thickness of cortical calcified tissue, and (3) the percentage of bone to marrow. There was significantly more uncalcified fibrocartilage at the attachment of biceps than at the other sites, reflecting greater range of movement of the tendon at this site. The thickness of cortical calcified tissue and the percentage of bone to marrow were significantly greater at the attachment of brachialis than either biceps or triceps. The large quantities of bone at the attachment of brachialis may be related more to the importance of the coronoid process in buttressing the elbow joint than to any special requirement for large amounts of calcified tissue at the tendon attachment. Near its attachment zone, the biceps tendon splits into superficial and deep laminae that are distinct from the macroscopic subdivision of this tendon. It is suggested that the lamination may facilitate the movements of pronation and supination. In support of this, the deep portion of the superficial lamina contained fibrocartilage where it rubbed against the attachment-zone of the deep lamina. In one body, the fibrocartilage of the biceps attachment-zone was subject to degenerative changes, including cell clumping and matrix fissuring.