Loracarbef (LY163892) vs. penicillin VK in the treatment of streptococcal pharyngitis and tonsillitis.

A double blind, randomized clinical trial compared loracarbef (LY163892) with penicillin VK. Two hundred thirty-three pediatric patients (less than or equal to 12 years) with a diagnosis of pharyngitis or tonsillitis resulting from Group A beta-hemolytic streptococci were randomized to treatment. Patients in the loracarbef group (n = 120) received loracarbef as a 15-mg/kg/day oral suspension or 200-mg capsule taken twice daily for 10 days. Patients in the penicillin group (n = 113) received penicillin VK as a 20-mg/kg/day oral suspension or 250-mg capsule taken four times daily for 10 days. Successful clinical responses were demonstrated in 101 of the 104 (97.1%) evaluable patients treated with loracarbef compared with 83 of 88 (94.3%) of evaluable patients treated with penicillin. The clinical relapse rate for the loracarbef group was 2.9% vs. 5.7% for the penicillin group. Bacteriologic response data approximated the clinical response data, as eradication of Group A beta-hemolytic streptococci was found in 86.5 and 81.8% of the loracarbef group and the penicillin group, respectively. No statistically significant difference in the incidence of treatment-emergent adverse reactions was noted between the two groups. The results indicate that loracarbef taken twice daily was comparable in safety and efficacy to penicillin VK taken four times daily in the treatment of Group A beta-hemolytic Streptococcus-associated pharyngitis and tonsillitis in children.


Loracarbef vs. cefaclor in pediatric skin and skin structure infections.

A double blind, randomized clinical trial involving 214 children, ages 6 months to 12 years, compared the safety and effectiveness of the new carbacephem loracarbef and the cephalosporin cefaclor for the treatment of skin and skin structure infections. The two agents were given primarily as oral suspensions. Dosages were 15 mg/kg/day in two divided doses for loracarbef and 20 mg/kg/day in three divided doses for cefaclor. Assessment 72 hours after completion of the 7-day course of treatment indicated a favorable clinical response plus eradication of the pretherapy pathogen in 97.3% of the 74 loracarbef-treated patients eligible for evaluation and 92.3% of 78 evaluable cefaclor-treated patients. Favorable response rates at a second posttreatment visit 10 to 14 days after the end of therapy were 95.6% in 68 evaluable loracarbef-treated patients and 86.2% in 65 treated with cefaclor. The incidence of adverse reactions, including gastrointestinal effects, was low in both groups. No statistical difference in clinical or bacteriologic efficacy or safety was detected between patients treated with loracarbef and cefaclor.


Infectious diseases and child day care.

It is estimated that more than 5.3 million children attend out-of-home child day care in the United States. This includes 2.1 million children who attend approximately 63,000 licensed child day-care centers. An additional 500,000 children receive care in 105,000 regulated day-care homes. Since the total regulated child care slots available in centers and homes are only 2.6 million, some 2.7 million additional children are likely attending unregulated family day-care homes. As a result infants and preschool children are intermingled in child care facilities that often lack adequate toilet and hand-washing facilities and are frequently staffed by individuals with little or no training in the area of infection control. Placing children in out-of-home care should not compromise their health and that of the community. The risk of infection can be lessened by teaching hygiene, supervising unregulated day-care facilities and regular antibiotic use so that bacterial resistance may be prevented.


Ten-year review of otitis media pathogens.

Data collected from 1980 to 1989 by investigators at the Pittsburgh Otitis Media Research Center were examined to detect changes over time in the prevalence of bacteria isolated from middle ear effusions in patients with otitis media. The organisms isolated most commonly from the 7396 effusions cultured at the center were Streptococcus pneumoniae and Haemophilus influenzae. S. pneumoniae predominated in the subgroup of patients with acute otitis media, whereas H. influenzae was isolated most frequently from patients with otitis media with effusion. The most notable changes to occur during the 10-year period were a statistically significant increase in the prevalence of S. pneumoniae in patients with acute otitis media and a progressive rise in the percentage of beta-lactamase-producing strains of H. influenzae and Moraxella (Branhamella) catarrhalis. The latter finding suggests the need for therapeutic alternatives to amoxicillin, which is not active against beta-lactamase-producing organisms, when these organisms are suspected or cultured from the middle ear.


Temperament and the psychobiology of childhood stress.

This paper provides a conceptual overview of recent research on the developmental psychobiology of childhood stress. We propose that the construct of temperament can be regarded as an organizing principle in children's responses to environmental adversity, and we review three physiologic "windows" through which such responses can be usefully examined. It is concluded that individual differences between children in their psychobiologic reactivity to stressors may constitute an important and novel point of departure for future studies of stress and childhood morbidity.


Individual differences in response to stress.

Observation of newborns and infants reveals individual differences in reactivity to stress. A measurement system based on threshold, dampening, and reactivation is described to assess these individual differences in the newborn period and thereafter. The three features are independent and, therefore, represent different aspects of reactivity. There is some evidence for stability of individual differences in reactivity between birth and 2 months of age. This stability is more apparent for infants who were highly reactive as newborns. The role of dispositional factors of reactivity, their stability, and the effects of the environment are discussed.


Vagal tone: a physiologic marker of stress vulnerability.

Vagal tone is proposed as a novel index of stress vulnerability and reactivity with applications in all branches of medicine, and with particular value in pediatrics. The paper proposes a model emphasizing the role of the parasympathetic nervous system and particularly the vagus nerve in mediating homeostasis and defining stress. Measurement of cardiac vagal tone is proposed as a method to assess on an individual basis both the stress response and the vulnerability to stress. The method monitors the neural control of the heart via the vagus (ie, vagal tone) as an index of homeostasis. The method provides a standard instrument with statistical parameters that are comparable between patients and throughout the life span. This noninvasive method will allow the assessment of the stressful impact of various clinical treatments on the young infant and permit the identification of individuals with vulnerabilities to stress.


Early rearing conditions alter immune responses in the developing infant primate.

The influence of early rearing conditions on immunologic development was investigated in infant monkeys. Lymphocyte proliferation, natural killer cell activity, and antibody responses to tetanus vaccination were compared in 30 rhesus monkeys reared under five different conditions. Lymphocyte responses to two mitogens (concanavalin A and pokeweed) were significantly increased in infants from disturbed rearing conditions compared with control infants that had been reared in an undisturbed manner by their mothers. The largest increases occurred in nursery-reared monkeys that had been fed Similac infant formula. The nursery-reared monkeys also tended to show lower natural killer cell activity, but there were no significant differences in response to vaccination. These findings support other research indicating that psychologic and nutritional aspects of the early rearing environment may have long-lasting effects on some, but not all, immune responses in the developing infant.


[State of hemostasis in hemorrhagic vasculitis in children].

The purpose of the study was to explore hemostasis in children suffering from hemorrhagic vasculitis (HV) by means of the new amidolytic methods using chromogenic substrates. The patient's plasma was studied for the content of thrombin, trypsin, factor Xa, AT-III, kallikrein, plasmin, free heparin, urokinase, factor 3 of platelets, prothrombin and Willebrand's factor. 69 children with HV were entered into the study. All of them were examined during crises. In cutaneous HV, the content of trypsin decreased 3-fold, the content of factor Xa increased 5-fold; there was a negligible increase in the plasmin and AT-III levels; the content of kallikrein rose 2-fold, that of urokinase 60-fold; the release of platelet factor 3 was intensified 1.5-fold, the activity of prothrombin 3-fold. These data indicate that in cutaneous HV, blood coagulation increased. However, the signs of disseminated intravascular coagulation were lacking because of the high blood anticoagulant activity. In mixed HV, the phase of hypercoagulation was not made for by the blood anticoagulant activity, since the latter one was depleted. The capillary toxic nephritis may give rise to disseminated intravascular coagulation associated with the depletion of the anticoagulant component. The gravity of HV and its complications can be predicted according to the characteristics of the anticoagulant component of hemostasis, especially according to the levels of urokinase and AT-III.


[Histiocytic proliferative diseases in children].

The course of histioproliferative diseases was analyzed in 308 children treated at the All-Union Cancer Research Center, USSR AMS. Of these, there were 8 children with benign proliferation (Rosai-Dorfman disease). Histiocytosis-X was revealed in 232 children. The authors describe the regularities of histiocytic proliferation manifestations depending on the patients' age. Provide morphological (cytological) criteria for different types of histioproliferative diseases and characterize the treatment data.


[State of the reproductive function in women who had lymphogranulomatosis in childhood and adolescence].

As many as 33 women who received combined treatment (fully successful) at an age of 5-26 years for lymphogranulomatosis were examined. In 30 patients, the structure and function of the reproductive organs was within age norm. In 20 women, there were 20 deliveries at an age of 19-33 years, with the mean age amounting to 23 years; 10 boys and 10 girls were born. The children are healthy. The selective toxicity of the treatment as a whole and of each of its components with regard to the reproductive organs was not proved. In the authors' opinion, two cases of disease relapses in pregnant women do not form basis for recommending the woman do refrain from pregnancy in the long-term periods after the treatment of lymphogranulomatosis.


[Characteristics of immunobiological resistance of children with diabetes mellitus].

Immunoglobulins and nonspecific defence factors (complement, properdin, lysozyme) were studied over time in 194 children suffering from diabetes mellitus. In 145 children, diabetes mellitus was associated with chronic tonsillitis. Resistance in 49 children was examined depending on the phase of diabetes mellitus. The data obtained indicate that diabetes mellitus is marked by imbalance of nonspecific defence factors and humoral immunity. These changes are obviously related to the disease gravity, phasic nature of the process, diabetes mellitus standing, and the presence of concomitant diseases. No parallelism was established between the level of nonspecific defence factors and specific immunity activity.


[Hormonal-metabolic disorders in children with diabetes mellitus in the preclinical stage of diabetic retinopathy].

A relationship was established between alterations in vessels of the fundus of the eye and diabetes mellitus standing, the character of metabolic disorders, hereditary load with regard to cardiovascular diseases. The risk factors of the development of the preclinical stage of diabetic retinopathy are as follows: hereditary load with regard to cardiovascular diseases, parship, an increase of the content of lactate, a reduction of the content of 2,3-diphosphoglycerophosphate, a rise of the content of glycosylated hemoglobin, high content of cholesterol esters in red blood cell membranes, of free cholesterol and malonic dialdehyde in blood serum, a decline of the level of phospholipids and a rise of cardiolipin content in red blood cell membranes, and increase of blood serum cortisol.


[State of the renin-angiotensin system in children with different clinical variants of congenital adrenal cortex hyperplasia caused by 21-hydroxylase deficiency].

A study was made of plasma renin activity (PRA) and serum aldosterone (A) in 52 children with congenital hyperplasia of the adrenal cortex due to 21-hydroxylase deficiency. There were 40 girls and 12 boys aged 1.5 months to 14 years. Of these, 35 had the salt-losing form (group 1), 12 were with a simple virile form (group 2), and 2 with the typical disease form (group 3). By the moment of the first examination the majority of the group 1 patients had received glucocorticoids (GC) combined with mineralocorticoids (MC), group 2 had been given GC alone, and the group 3 children had been untreated. Initially PRA in both the first and second groups was higher than in the controls. However, in group 2 that difference was insignificant. The concentration of A in group 2 noticeably exceeded that in the controls and group 1. In group 3, PRA and A did not differ from normal. After the treatment was potentiated by MC (including MC administration to the group 2 patients) there was a decline of PRA and of the A level. The changes in PRA and A did not often manifest clinically and were not associated with electrolyte disturbances. In the authors' opinion, to choose adequate doses of MC, it is necessary to examine PRA and blood A level.


[Characteristics of the morphology of peripheral blood erythrocytes of healthy children 1 to 6 years of age (scanning electron microscopy data)].

The authors provide classifications of the forms of peripheral red blood cells examined by scanning electron microscopy (SEM). The authors' working classification is presented in which the following types of red blood cells are distinguished: discocytes; transitory, namely, echinocytes, stomatocytes, spheroids; spherocytes, reticulocytes, deformed, target-like, bifoveal hypochromic, elliptocytes, destructive. SEM was used to study capillary blood red blood cells in 30 healthy children aged 1 to 6 years. The ratio of the morphological types of red blood cells in this group children is presented.


[Immunological aspects of food intolerance in children during first years of life].

A study was made of the morphofunctional status and local defence of the gastrointestinal tract in 122 children aged 4 months to 6 years, suffering from food intolerance showed up by atopic dermatitis in 52 children and by chronic diarrhea in 70 children. Based on the allergological anamnesis, scarification cutaneous tests with food allergens, detection of antibodies to food antigens (RAST, HAIT) food allergy was revealed in all the children. Chronic gastroduodenitis was identified in all the children suffering from atopic dermatitis and in 95% of the children with chronic diarrhea. It should be mentioned that one-third of that group had a graver illness--diffuse duodenitis with sub-atrophy of the villi. The allergic genesis of the impairment of the gastroduodenal mucosa was confirmed. It was more remarkable in atopic dermatitis (tissue eosinophilia and high content of IgE-plasmacytes in the duodenal mucosa). The decrease of local immune defence of the mucous membrane, lactase deficiency, elevated growth of microorganisms in the duodenal contents promote the rise of intestinal barrier permeability for food antigens and enhancement of sensitization.


[Characteristics of the functional state of the pancreas, lipid peroxidation and antioxidant defense in food hypersensitivity in children].

Pancreas function, lipid peroxidation and antioxidant defence were studied in 154 children aged 1 to 14 years with food allergy. Allergic inflammation due to food allergy favours the origin of different abnormalities of pancreas function: functional (39.4%), reactive pancreatitis (31.3%), chronic pancreatitis (20.1%), and sclerosing chronic pancreatitis (9.2%). They occur in combination with lipid peroxidation activation and a decrease in antioxidant defence. The intensity of the latter ones is dependent on the variety of pancreas function disturbance. The most significant changes in lipid peroxidation and antioxidant defence were discovered in chronic pancreatitis.


[Bronchial asthma in children with sensitization to mites].

Overall 180 children with bronchial asthma induced by sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae were examined clinically and immunologically. The patients' age ranged from 1 to 14 years. A relationship was established between bronchial asthma exacerbation and the stay at home. In that disease pattern, asphyxia attacks were noted to occur more frequently in the evening and night hours. Emphasis is laid on the leading part played by the IgE-mediated mechanism in bronchial asthma induced by tick-borne sensitization. In children suffering from that pattern of bronchial asthma, specific hyposensitization with Dermatophagoides pteronyssinus allergens and antiallergic immunoglobulin were found to be highly effective.


[Allergies in children with metabolic nephropathies].

The authors describe the results of the follow-up of children of the early age (n-68) and senior age (n-42) with different allergic diseases and 77 children with metabolic nephropathies (oxalate nephropathy, pyelonephritis associated with metabolic disorders, interstitial nephritis). In both age groups, an interrelationship was established between renal pathology in the form of metabolic nephropathies and allergo-pathology. Children with different allergies manifested the high incidence of metabolic disorders, with crystalluria and erythrocyturia being mostly encountered in respiratory allergies whereas leukocyturia largely occurred in skin allergies. At the same time the high incidence of allergic reactions was revealed in children with metabolic nephropathies. A relationship was established between the signs of atopy with graver varieties of nephropathies. The presence of the common pathogenetic components in the development of allergic and renal pathology requires the inclusion of immunologic and nephrologic methods into the complex of those patients' examination and the consideration of those factors in the treatment policy.


[The state of the immune system in children with congenital abnormalities].

As many as 618 children with different varieties of congenital developmental abnormalities were examined for the status of the immune system. Immunologic studies were carried out in 89 patients. They included the NBT test, determination of the content of T-, B- and O-lymphocytes, IgA, IgM and IgG. Morpho-histological studies of the spleen and thymus were performed according to the data of 529 autopsies. It has been established that 3/4 of cases with congenital developmental abnormalities are characterized by morphofunctional immune deficiency, which is more pronounced in multiple abnormalities (of chromosomal etiology in particular) as well in some systemic abnormalities, largely of the CNS.


[Subpopulation state of T and B lymphocytes in hemolytic-uremic syndrome in children].

A study was made of the quantitative characteristics of T and B lymphocytes and of their subpopulations (A-RFC; E37-RFC; auto-RFC; EAC-RFC; Ig(+)-cells) as well as of 0-lymphocytes in the peripheral blood of 20 children aged 6 to 24 months with different clinical stages of the hemolytic-uremic syndrome (oligoanuria, diuresis onset, polyuria, clinical improvement). It is concluded that all the stages of the disease are characterized by the deficiency of certain subpopulations of T cells (especially A-RFC, E37-RFC), B lymphocytes, and 0-cells. By the moment of the clinical improvement, the cellular characteristics of the immune status do not return to normal.


Temporal integration of spatially filtered visual images.

Factors which govern the temporal integration of spatial information were examined in a group of five experiments. A series of high-pass and low-pass spatially filtered versions of a visual scene were generated. Observers' ratings of these filtered versions of the scene for perceived image quality indicated that quality was determined both by the bandwidth of spatial information and the presence of high-spatial-frequency edge information. When sequences of three different versions of the scene were presented over an interval of 120 ms the perceived quality of the resulting composite image was determined both from the ratings of the individual components of that sequence and from the order in which these components were presented. When the order of spatial information in a sequence moved from coarse to fine detail the perceived quality of the composite image was significantly better than when the order moved from fine to coarse. This evidence of a coarse-to-fine bias in pattern integration was further investigated with a detection paradigm. The pattern of errors once again indicated that temporal integration of spatial information was superior when a coarse-to-fine mode of information delivery was employed. Taken together the data indicate that the pattern-integration mechanism has an inherent order bias and does not accumulate spatial information so efficiently when the 'natural' coarse-to-fine order is violated.


The perceived duration of gratings.

Since visible persistence of grating patterns increases with spatial frequency, it is often inferred that the perceived duration of a grating is also longer at higher spatial frequencies. However, other work has demonstrated that the perceived onset of a grating is also delayed at higher spatial frequencies. Thus it is impossible to infer the subjective duration from the results of visible persistence studies alone. In order to estimate perceived duration in the present study, reaction times (RTs) to grating onsets and offsets were measured for a range of spatial frequencies. The results indicate that although the perceived duration (ie the difference between offset and onset RTs) was consistently longer than the physical duration, the estimates of perceived duration did not vary with changes in spatial frequency. Differences between the present results and earlier findings are interpreted in the context of the different methods used to measure perceived offset.


Anatomy of a flash. 2. The 'width' of a temporal edge.

In a previous study it has been found by using the Crawford masking paradigm with spatially coextensive stimuli that the end points of even a weak flash have a strong masking effect on the probe pulse, but no threshold elevation was observed when the probe was 100 ms or longer from flash onset and offset. The relationship between the strength of a temporal edge (eg the amplitude of a sudden increase in field luminance) and the duration of masking has not been systematically investigated. In the present experiments the duration of masking produced by a step of luminance as a function of step size was measured. With steps whose amplitude was between ten and five hundred times detection threshold, the duration of masking was about constant, ie 70 and 50 ms for on-responses and off-responses, respectively. This refractory period defined the 'width' of a temporal edge. Unless two suprathreshold unidirectional luminance changes are separated by an interval exceeding the width of a temporal edge, they are perceived as a single change in brightness. A linear systems analysis led to predictions for ramp stimuli that were confirmed by experiment.


Illusory occluding contours and surface formation by depth propagation.

A novel kind of depth-spreading effect which should be distinguished in various aspects from the known interpolation, averaging, or 'filling-in' phenomena is reported. The demonstrations and experiments suggest that depth from an uncrossed disparity can be extrapolated from, not just interpolated between, illusory or real contours to form perceptually a background surface. In addition, the form of the illusory contour itself could be drastically changed in configuration and sharpness, contingently with perceptual background-surface formation. No such effects of surface and contour formation were observed in the crossed disparity case. Because the illusory contours were enhanced and perceived as illusory 'occluding contours', these effects may be closely related to the 'occlusion constraints' in the real world.


Cooperative representation of visual borders.

Recently it has been reported that the visual cortical cells which are engaged in cooperative coding of global stimulus features, display synchrony in their firing rates when both are stimulated. Alternative models identify global stimulus features with the course spatial scales of the image. Versions of the Munsterberg or Café Wall illusions which differ in their low spatial frequency content were used to show that in all cases it was the high spatial frequencies in the image which determined the strength and direction of these illusions. Since cells responsive to high spatial frequencies have small receptive fields, cooperative coding must be involved in the representation of long borders in the image.


Anomalous spiral aftereffects: a new twist to the perception of rotating spirals.

Stationary spirals viewed after inspecting rotating sectored disks appear to rotate and to expand or contract radially, even though the rotating disks contain no perceptible components of radial motion. Moreover, the relative directions of illusory rotation and radial motion observed in these instances are 'impossible' under the stimulus constraints normally imposed by the geometry of a spiral under rotation: the stationary spirals appeared to expand/contract in directions opposite to those normally observed under conditions of actual spiral rotation, and under conditions of illusory spiral rotation in classical spiral aftereffects.


Movement and proximity constrain miscombinations of colour and form.

A relatively frequent error when reporting brief visual displays is to combine presented features incorrectly. It has been proposed that Gestalt grouping constrains such errors so that miscombined features tend to come from the same perceptual group. In three experiments it was examined whether this principle applies to grouping by motion, and to grouping by proximity. Miscombinations of colour and form were more likely to consist of a colour and form that had moved in the same direction than features which had moved in opposite directions. Miscombinations were also more likely for adjacent items. The implications of these results for the mechanisms of feature integration are discussed.


Vision with equiluminant colour contrast: 2. A large-scale technique and observations.

A simple technique is described for producing large-scale, tritanopic displays. The technique reproduces the various phenomena of vision with equiluminous-colour contrast that have previously been reported with red/green stimuli. It is, however, much less demanding technically, robust against artifacts, and can be used on large-scale scenes. One advantage of the technique is that a piece of blue filter can be used individually by each observer to compare quickly tritanopic and luminance conditions.


Learning to see random-dot stereograms.

In the present study some specific properties of the learning effects reported for random-dot stereograms are examined. In experiment 1 the retinal position-specific learning effect was reproduced and in a follow-up experiment it was shown that the position specificity of learning can be accounted for by selective visual attention. In experiments 2 and 3 evidence was obtained that suggests that observers can learn, to a certain degree, monocular random-dot patterns and that this learning facilitates the depth percept. This result indicates that the traditional belief that random-dot stereograms are devoid of monocularly recognizable or useful forms should be reconsidered. In the second set of experiments the learning of two binocular surface properties of random-dot stereograms, depth edges and internal depth regions, was investigated. It was shown in experiment 4 that the depth edges of random-dot stereograms are not learned, whereas the results of experiment 5 indicate that the internal depth regions are learned. Finally, in experiment 6 it was shown that depth edges are learned when the internal depth regions of the stereogram are ambiguous. The results are discussed in terms of the importance of the particular type of stimulus used in the learning process and in terms of perceptual learning and attention.


Use of a distracting task to obtain defensive head movements to looming visual stimuli by human adults in a laboratory setting.

Defensive responses to looming visual stimuli have been obtained in a wide variety of species, including human infants as young as one week. This phenomenon has not, however, been formally demonstrated for adults under laboratory conditions. In this paper it is reported that similar responses, namely avoidance movements of the head, can be obtained in most human adults provided that they are suitably distracted by playing a computer tracking game. Such behaviours were not obtained when subjects were not so distracted. The use of control conditions also ruled out the possibility that simple movement cues from stimuli presented on a noncollision trajectory are sufficient stimulus to obtain defensive responses. It is of interest to note that latencies for avoidance movements were significantly shorter than those for orienting movements in the same situation, but were no different from the latencies for orienting movements when subjects were not distracted. It is argued that these findings are consistent with the proposition that defensive head movements to looming stimuli, like orienting movements to novel peripheral stimuli, represent a basic visual competence that is normally suppressed (or subsumed) by higher competences. The decision to avoid is probably based on the computation of time to contact, and may reflect the operation of a subcortical system for elementary analysis of optic flow.


The apparent shape of afterimages in the Ames room.

When observers project afterimages of circular patterns onto a surface slanting away from them the images are reported as being oval in shape. In this paper it is reported that this does not occur when similar afterimages are projected onto the slanting rear wall of an Ames room. Instead of appearing as ovals, the afterimages remain circular. It appears as though the actually-slanted rear wall of the room not only looks as if it is normal to the line of vision, but also that it functions as if it was in such an orientation as far as a projection surface for afterimages is concerned. While these results are consistent with Emmert's law and with traditional accounts of shape and size constancy, they raise once again the age-old issue of whether the 'image on the retina' constitutes an object of perception that can be described in terms of its shape or size.


The Müller-Lyer illusion Mark II.

A new illusion of size is described. A passage of print occupying about half a standard A4 sheet appeared larger than the same passage when the sheet was cropped immediately above and below it. This illusion is demonstrated and explained in terms of perceptual compromise between the vertical extent of the printed passage and the sheet of which it is an intrinsic feature. In this sense it is held to be essentially the same as the Müller-Lyer illusion of extent in which the spaces between the apexes are intrinsic to the figure.


Human HIV vaccine trials: does antibody-dependent enhancement pose a genuine risk?

Antibody-dependent enhancement is a general in vitro property of enveloped viruses. In certain circumstances, antibody-dependent enhancement is a bona fide pathophysiologic mechanism in vivo. There are several examples of virus disease of humans and animals in which incomplete or partial immunity can lead to enhanced infection and/or disease. In some cases, this appears to be attributable to antibody-dependent enhancement. Conversely, there are several examples of viruses for which in vitro antibody-dependent enhancement has been demonstrated, but for which vaccines have been used safely in millions of persons for decades. Finally, antibody-dependent enhancement of HIV is a genuine concern. However, to date there is no direct clinical, experimental, or epidemiological evidence that HIV enhancement can be operative in vivo. Such evidence should be actively sought.


Intraosseous versus intravenous epinephrine infusions in lambs: pharmacokinetics and pharmacodynamics.

Intraosseous and intravenous administrations of epinephrine were compared in newborn lambs. Plasma epinephrine levels were measured during each route of drug administration and used to calculate steady-state epinephrine clearance rate and to compare cardiovascular responses with plasma levels. Epinephrine was administered at a dose of 0.5 to 5 micrograms/kg/min. We observed first-order (linear) clearance kinetics by both routes of drug administration. The plasma epinephrine clearance rate was 186 +/- 17 ml/kg/min by the intraosseous route versus 174 +/- 11 ml/kg/min by the intravenous route. Dose responses were analyzed by computerized fit to a threshold model. The plasma epinephrine threshold, or lowest plasma level beyond which discernible increases in blood pressure occur, was slightly lower after intravenous than after intraosseous drug administration, 2.0 +/- 0.6 ng/ml versus 4.0 +/- 0.9 ng/ml of epinephrine. Both thresholds were within the ranges of plasma epinephrine levels that would be achieved at doses of 0.4 to 0.6 microgram/kg/min by either route. Other hemodynamic responses, including the maximum systolic blood pressure and degree of reflex bradycardia, were comparable. These results support the effectiveness of the intraosseous route for epinephrine administration.


The use of nebulized albuterol in wheezing infants.

Using a double-blind, placebo-controlled protocol, we evaluated the efficacy of nebulized albuterol in the treatment of infants aged 0 to 24 months who presented to the emergency department with wheezing. Twenty-five infants were randomly assigned to receive two identical treatments of either nebulized albuterol (0.15 mg/kg) or placebo (saline). Assessment after each treatment included a wheeze and retraction score, respiratory and heart rates, and pulse oximetry. After two treatments, there was a significant improvement in the wheeze scores (P less than 0.05) and total scores (P less than 0.05) of the albuterol group compared with the placebo group. After one treatment, there was an initial decrease in oxygen saturation in the albuterol group, which improved after the second treatment. There were no significant differences between the two groups in heart rate or respiratory rate. This study supports the use of nebulized albuterol in the treatment of wheezing infants in the emergency department.


Review of 180 episodes of chest pain in 134 children.

This study intends to establish the etiology of chest pain in the pediatric population, to determine the causal relationship between a cardiac problem and chest pain in acutely sick children, and to provide a systematic approach to the management of these patients. The charts of 134 patients, up to 19 years of age, seen in the emergency department (ED) of Children's Hospital of Wisconsin (CHW) with the primary diagnosis of "chest pain" during a five-year period were reviewed. In 15% of these patients, a relationship was established between chest pain and actual cardiac disease. A thorough history and physical examination are the diagnostic "keys" in evaluating pediatric patients with chest pain; laboratory tests are often helpful when indicated by the history and physical examination. In the majority of the cases, reassurance is all that is required; occasionally, pharmacologic treatment is recommended. Hospitalization is rarely necessary.


Prophylactic oral antibiotics for low-risk dog bite wounds.

The use of prophylactic antibiotics in the initial treatment of noninfected dog bite wounds is controversial. All patients with noninfected dog bite wounds who presented to our emergency department (ED) over a two-year period were considered for entry into a randomized prospective study. Patients were excluded from the study if they had any high-risk criteria for infection: puncture wounds, hand or foot wounds, wounds greater than 12 hours old, a history of immunocompromising disorders, or the use of immunosuppressive drugs. Patients in the antibiotic group (n = 89) were treated with local wound care and given either dicloxacillin, cephalexin, or erythromycin orally for seven days. Patients in the control group (n = 96) received local wound care only. All patients had their wounds irrigated with a 1% povidone-iodine solution and debrided and sutured if clinically indicated. All patients were subsequently reevaluated for clinical signs of wound infection. The groups were similar in age, sex, time of delay in seeking treatment, anatomic sites of wounds, depths and types of wounds, and number of wounds requiring suturing. The wound infection rates for the antibiotic and control groups were 1.1 and 5.1%, respectively. This difference was not significant (P = 0.212). There were 36 wounds in the antibiotic group and 37 wounds in the control group that were full thickness. The infection rates for these wounds were 2.8 and 13.5%, respectively. This was not statistically significant (P = 0.132). This study suggests that prophylactic oral antibiotics in low-risk dog bite wounds are not indicated.


Uvulitis in three children: etiology and respiratory distress.

Uvulitis is an uncommonly reported disorder with the potential for significant morbidity. We describe three cases of uvulitis seen within a six month period in our emergency department. In two cases with respiratory distress, but without epiglottitis, Haemophilus influenzae was isolated from throat or blood cultures. The third case was associated with group A streptococcus tonsillitis and no respiratory compromise. Atypical presentations of upper airway infection with H. influenzae may be increasingly common.


Pediatric streptococcal toxic shock syndrome.

Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome. These cases are reported to remind physicians who care for acutely ill children that exotoxin-producing streptococci can produce clinical features and multisystem failure similar to staphylococcal toxic shock syndrome.


Development of Kasabach-Merritt syndrome following needle aspiration of a hemangioma.

A case of Kasabach-Merritt syndrome that developed following needle aspiration in an infant with hemangioma is presented. Enlargement of the tumor leading to severe respiratory distress accompanied by hemorrhages occurred within six to eight hours after this simple intervention. The symptoms continued despite repeated thrombocyte transfusions and prednisolone therapy. Radiotherapy and local intraarterial corticosteroid therapy were attempted and led to some improvement. It took approximately three months for the platelet count and one year for the clinical state to revert to normal. This case illustrates that minor trauma may lead to life-threatening symptoms in a young infant with congenital hemangioma.


Racial differences in childhood hospitalized pedestrian injuries.

This research provides an epidemiologic analysis of pedestrian-related injury discharges from The Children's Hospital of Alabama in Birmingham, utilizing a case-control design. Evidence is provided supporting the racial disproportionality of serious, nonfatal pedestrian injuries in children. These data indicate that pedestrian injuries resulting in hospitalization are more common among black children than among white children (odds ratio = 2.95) when compared with an age- and gender-matched control group of other hospitalized injuries. This racial association with pedestrian injury remained significant when the data were stratified by payment class, a proposed surrogate measure of socioeconomic status (adjusted odds ratio = 2.59). A catalog of harmful environmental factors that may be pervasive in black children's lives is provided as an aid in planning intervention programs and their evaluation.


An aseptic meningitis picture from incipient brain abscess.

A preadolescent with headache and stiff neck presented for emergency department care. The presumptive diagnosis of viral meningitis was entertained on the basis of clinical examination and cerebrospinal fluid analysis. Events subsequent to his release from the department formed the stimulus for this report. It is apparent that patients with complicated sinusitis may present with a constellation of findings consistent with viral meningitis.


Proposal for an administrative curriculum in pediatric emergency medicine fellowship training.

Administrative tasks make up a significant component of the practice of pediatric emergency medicine (PEM) physicians. Our survey of 10 academic pediatric emergency departments revealed that PEM physicians who are primarily clinical spent an average of 15% of their time on administrative tasks, and PEM physicians whose positions are administrative as well as clinical spent 30 to 60% of their time on administrative tasks. Of the 101 programs responding to our survey of 220 pediatric residency programs, 80% did not address hospital administrative issues, and many that did address these issues allowed these topics only one hour of presentation time per year. It is clear that there is a discrepancy between the demands placed upon PEM physicians to perform administrative tasks and the sparse or nonexistent opportunities for learning about administrative issues during residency training. It is incumbent upon pediatric emergency fellowship programs to provide an inclusive and well-structured administrative curriculum for their trainees. This article suggests a framework for such a curriculum.


Neurotrophic factors: from physiology to pharmacology?

The recent cloning of new members of the nerve growth factor (NGF) family, namely brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), as well as the ciliary neurotrophic factor (CNTF) has greatly expanded our knowledge of the structural properties and neurotrophic activities of these proteins. Elucidation of their developmental and topographical expression and associated receptors in both the central nervous system (CNS) and peripheral nervous system (PNS) is proceeding at a brisk pace, leading us to propose a potential pharmacological use of these proteins. This possibility will ultimately rely upon a more complete understanding of the roles of these trophic factors in nervous system physiology and pathology.


Trisomy 5 mosaicism detected prenatally with an affected liveborn.

This paper reports a case of chromosomal mosaicism for trisomy 5 recovered from amniotic fluid cells and from skin fibroblasts of a liveborn dysmorphic male. Routine amniocentesis was performed at 16 weeks' gestation because of parental concern. Trisomy 5 cells were measured from 25 per cent of amniocytes from two culture vessels. No further invasive testing was performed until 32 weeks' gestation, at which time ultrasound examination showed a fetus with intrauterine growth retardation. Fetal blood sampling was then performed, with only karyotypically normal cells recovered. At birth, the child was found to have multiple dysmorphic features and congenital anomalies, including an eventration of the diaphragm and ventricular septal defect, both of which required surgical correction. Chromosomal analysis of cord blood lymphocytes indicated 46,XY; however, 20 per cent of the cultured fibroblasts obtained from the chest skin at the incision site for diaphragmatic repair had a 47,XY, +5 karyotype. Trisomy 5 mosaicism may be another example of tissue-limited mosaicism. Fetal blood sampling can then be falsely reassuring. Furthermore, because some cell lines rarely appear in lymphocyte populations, cytogenetic analysis of multiple tissues is warranted as part of the evaluation of individuals with developmental delay and dysmorphic features.


The pharmacology of the respiratory epithelium.

The airway epithelium is composed of a heterogenous population of cells and investigations on the epithelium have realized a number of important functions. With increasing use of cell isolation techniques, the function of individual cells within the epithelium is currently under investigation which will assist in the understanding of the role of airway epithelium in health. It is known that epithelial damage and/or impairment of epithelial cell function is a consistent feature of some respiratory conditions and whether such damage contributes to the disease is also under investigation. This review will summarize the current literature on the function(s) of the epithelium and its possible role in respiratory disease.


In situ hybridization studies for the detection of common aneuploidies in CVS.

We have attempted to evaluate the efficiency of interphase cytogenetics in the detection of specific aneuploidies in chorionic villus samples. For this purpose, we used alphoid repetitive sequences specific for the chromosomes involved in the common aneuploidies, namely probes for chromosomes 13, 18, 21, X, and Y. These probes were applied to normal and abnormal CVS cases, as well as to a few mosaic cases. Results from these preliminary studies indicate that the technique can be very efficient for the detection of specific aneuploidies and can be particularly useful in the analysis of mosaic cases, which usually requires the screening of a high number of metaphases.


The inhibitory effect of differently classified calcium antagonists on the calcium- and epinephrine-induced responses of isolated guinea-pig atria.

The effects of calcium antagonists diltiazem, flunarizine and N-(6-aminohexyl)-5-chloro-1-naphthalenesulfonamide (W7) were investigated on the calcium- and epinephrine-induced responses of guinea-pig spontaneously beating atria. All these calcium antagonists showed negative chronotropic and inotropic effects. Diltiazem (3 x 10(-8) M to 1.8 x 10(-7) M) antagonized both the action of epinephrine and calcium in a different manner but at the same concentrations. Flunarizine (1 x 10(-6) M to 1 x 10(-5) M) also antagonized both the action of epinephrine and calcium; but flunarizine weakly inhibits the calcium response at concentrations which have considerable antiadrenergic action. Only at the highest concentrations did both calcium antagonists show a decrease of the epinephrine maximum effect. W7 (1 x 10(-5) M to 1 x 10(-4) M) showed a mainly non-competitive antagonism against epinephrine but was practically ineffective against calcium. The results obtained suggest that a pharmacological prerequisite exists for classifying a calcium antagonist as a calcium entry blocker in the atrial muscle. Such a drug does not produce selective inhibition to calcium- and epinephrine-induced responses. The ability or inability to inhibit the response to calcium represents the discriminant parameter for the action site of the calcium antagonist which are transmembranal fluxes or intracellular mechanisms respectively.


Influence of profound hypothermia on the blood-brain barrier permeability during acute arterial hypertension.

In hypothermic rats with acute hypertension induced by intravenous injection of adrenalin, regional changes in blood-brain barrier permeability to macromolecules were investigated using Evans blue as indication. Evans blue albumin extravasation was determined as a macroscopic finding and a quantitative estimation with a spectrophotometer using homogenized brain to release the dye was also performed to evaluate the macroscopic findings. Five groups of rats were studied: Group I: normothermia + acute hypertension; Group II: hypothermia + acute hypertension; Group III: control hypothermia; Group IV: normothermia + hypotension; Group V: control normothermia. The rats were anaesthetized with diethyl-ether. Body temperature was lowered by submerging anaesthetized animals in an ice water bath. The colonic temperature was reduced to 20 +/- 1 degrees C. During adrenaline-induced acute hypertension the mean arterial blood pressure increased in both normothermic and hypothermic animals. Blood-brain barrier lesions were present in 40% of normothermic rats, and 60% of hypothermic rats after adrenaline-induced hypertension. Mean value for Evans blue dye in the whole brain was found to be 0.530 +/- 0.202 mg% in the normothermic rats and 0.752 +/- 0.256 mg% in the hypothermic rats during adrenaline-induced hypertension. This difference between normothermic and hypothermic rats was found to be statistically significant (P less than 0.01). Our results showed that the extravasation of Evans blue albumin was most pronounced in the brains of hypothermic rats compared to normothermic rats after adrenaline-induced acute hypertension.


A rare case of a false-negative finding in both direct and culture of a chorionic villus sample.

A discrepancy is reported between the karyotype of both direct and cultured chorionic villus cells (46,XX) and a fetal skin biopsy (47,XX, +18). The significance of this result is discussed and compared with similar discordant findings reported in the literature.


Epinephrine-induced pulmonary oedema in rats is inhibited by corticotropin-releasing factor.

In various animal models of injury to skin, mucous membranes, muscle and brain, corticotropin-releasing factor (CRF) attenuated vascular leakage in the injured tissues. Here, the effects of CRF on a rat model of pulmonary oedema were examined. Male albino rats (220-290 g) received saline or CRF s.c., 30 min before pentobarbital anaesthesia, 60 mg/kg i.p., and 1 h before 1-epinephrine bitartrate (Epi), 30 micrograms/kg i.v. Within 30 min after Epi all (n = 27) saline-pretreated rats were dead from pulmonary oedema, but animals receiving human/rat CRF at doses of 7 to 57 micrograms/kg s.c. (n = 25) were all alive. Body wt, wet and dry wt of lungs were used to calculate an oedema index. This index increased from 3.6 +/- 0.1 to 9.6 +/- 0.3 after Epi but was inhibited by 87% after CRF 28 micrograms/kg s.c. The ED50 of CRF for reducing pulmonary oedema was 3.2 (1.3-7.4) micrograms/kg s.c. Mean arterial pressure increased from 119 +/- 4 to 167 +/- 2 mmHg after Epi 10 micrograms/kg i.v., but was not different (118 +/- 3 to 169 +/- 4 mmHg) after CRF pretreatment, 6 micrograms/kg s.c., a dose which reduced lung oedema. Pharmacokinetic estimates suggest that plasma levels of CRF sufficient to attenuate lung oedema in rats approximate those seen in pregnant women at delivery, raising the possibility that endogenous CRF may protect the maternal organism during parturition.


A further prenatal diagnosis of mosaic tetrasomy 12p (Pallister-Killian syndrome)

A case of mosaic tetrasomy 12p was detected in amniotic fluid cell cultures from a 28-year-old woman referred to us at 26 weeks' gestation because of hydramnios. The fetus was shown on ultrasonography to have an omphalocele and a short femur length. Labour was induced at 32 weeks. An infant with multiple congenital anomalies was delivered and died after 10 min. The diagnosis of i(12p) or Pallister-Killian syndrome was confirmed cytogenetically in fibroblast and lymphocyte cultures. Increased LDH-B activity was demonstrated in fibroblasts.


Prenatal sonographic diagnosis of diastematomyelia in a diabetic woman.

Diastematomyelia is a structural anomaly which concerns primarily the spine and secondarily the nervous structures contained in it. A case of early prenatal diagnosis (20th week) by ultrasound of diastematomyelia with associated diplomyelia in a diabetic woman is reported. Radiological and pathological examination of the fetus after therapeutic abortion confirmed the diagnosis.


A heat released substance from rat ileal muscle.

Change in body temperature is reported to induce changes in muscle contraction by unconfirmed mechanisms. Therefore, the changes in isolated rat ileal muscle contractions at different surrounding temperatures were studied. The contraction was decreased by increase of the surrounding temperature from 37 degrees C to 40 degrees C, while it was increased by decrease of the temperature to 30 degrees C. Further, bathing the muscle in a conditioned medium prepared by incubation of the ileal muscle at 40 degrees C caused a decrease in contraction at a surrounding temperature of 37 degrees C. This indicates that increase of the temperature around muscles induces a release of the substance that causes a decrease in the contractile response. The effects of this heat-released substance were not blocked by propranolol, phentolamine and naloxone, or edrophonium, which indicates that these effects are not produced through an interaction with cholinesterase enzyme, alpha or beta adrenergic receptors or opiate receptors.


Ultrasonic diagnosis of mediastinal cystic hygroma.

The incidence of cystic hygroma, which represents dilated obstructed jugular lymph sacs, is 1 in 6000 pregnancies. Cystic hygromas can be located in the nuchal area or in any other location. The prenatal ultrasonic diagnosis of a cystic hygroma in the mediastinum is presented.


[Change of the complement level in patients with insulin-dependent diabetes mellitus in the course of intensified insulin therapy].

Intensified insulin therapy in patients with type I diabetes mellitus is accompanied by a decrease in a total daily dose of insulin and the activity of the first 5 components of the classical pathway and CH50. A decrease in function of the first 5 components of the complement against a background of intensified insulin therapy can serve as a positive prognostic criterion of stabilization of development of diabetic angiopathies.


[C-peptide and insulin ratio in patients with juvenile dyspituitarism in varying symptomatology].

Altogether 24 adolescents with pubertal juvenile dyspituitarism (PJD) were investigated in the course of an oral GTT for 3 hours. The patients were divided into 3 groups: (1) with liver dysfunction and normal BP; (2) with normal liver and arterial hypertension; (3) with normal BP and normal liver function. The levels of glycemia, immunoreactive insulin, C-peptide and a molar C-peptide/insulin ratio were measured. All the examinees were characterized by basal and stimulated hyperinsulinemia against a background of a normal C-peptide value, the absence of a tendency to IRI reduction by the end of the GTT. A decrease in the C-peptide/IRI ratio was marked in the 1st group. One of the reasons of hyperinsulinemia in PJD in parallel with high insulin secretory pancreatic function can be a decrease in the metabolic clearance of liver insulin, especially noticeable in patients with hepatocyte dysfunction.


[Disorders of pulmonary hemodynamics in patients with diabetic nephroangiopathy and its correction with antioxidants].

Hemodynamic changes of lesser circulation were investigated in 108 patients with diabetic nephroangiopathy. They were also given vitamin E therapy (8 micrograms/kg of body mass) for 2 weeks to correct metabolic derangements and indices of pulmonary hemodynamics. Partial renal function was determined with 131I-hippuran and 99mTc-DTPA renoscintigraphy. Pulmonary hemodynamics was assessed with pulmonary scintigraphy (MAA 99mTc). The results have shown that vascular renal lesions in diabetes mellitus cause hypertension of lesser circulation and disorders in pulmonary microcirculation, and disorders of lipid metabolism and activation of lipid peroxidation (LPO) progress with augmentation of severity of disease. Vitamin E therapy improves pulmonary hemodynamics, lipid metabolism and LPO. Antioxidant correction was most effective at the initial stages of diabetic nephroangiopathy.


[Somatotropic function of the pituitary gland in patients with genetically determined forms of growth retardation].

Altogether 144 patients with various forms of retardation of growth aged 1 to 24 were investigated. Somatotropic function of the pituitary body was assessed by the results of a stimulation test with clopheline. A STH level was determined by a radioimmunoassay. Somatotropic function was undisturbed in an overwhelming majority of cases of genetically determined retardation of growth. Hormone therapy was not indicated in these cases as it could lead to unfavorable results: decreased indices of definitive growth resulting from the formation of antibodies to the growth hormone.


[Glucose tolerance disorders in patients with hypothyroidism].

Altogether 42 patients with hypothyrosis of different etiology (aged 17 to 57) were investigated. According to the results of oral glucose tolerance test (OGTT) all the patients were divided into 3 groups: normal OGTT, disturbed OGTT and a flat type of glycemic curves. High levels of cortisol and free fatty acids (FFA) were detected in persons with disturbed OGTT. A lowered reaction to insulin was found in 15 patients with high levels of cortisol and FFA. Persons with unchanged sensitivity to insulin demonstrated a normal type of OGTT and normal blood levels of cortisol and FFA, and among patients with a low reaction to insulin there were persons with disturbed OGTT and high blood levels of cortisol and OGTT. Positive correlation was found between OGTT disturbances, on the one hand, and lowered sensitivity to insulin, increased blood levels of cortisol and FFA, on the other hand. A conclusion has been made that one of the causes of GTT disturbance in patients with hypothyrosis is an increase in the blood levels of cortisol and FFA and a decrease of sensitivity to insulin.


[Surgical tactics in chronic autoimmune thyroiditis].

Analysis of surgical treatment of 76 patients with Hashimoto's disease has shown that focal forms of disease are an absolute indication for operation: cancer was diagnosed in 6.6. per cent of patients in intraoperative verification. Progressive thyrotoxicosis or neck compression served as an indication in a diffuse form of lesion.


[Status of the renin-angiotensin-aldosterone system in patients with a neuroendocrine-metabolic type of the hypothalamic syndrome].

The paper is concerned with the results of a radioimmunoassay of the state of the renin-angiotensin-aldosterone system in patients with a neuroendocrine-metabolic type of the hypothalamic syndrome. They received pathogenetic therapy with peritol (an antiserotonin drug) or parlodel (a dopaminergic drug) during three months and routine therapy. The latter was not enough to return to normal the basal blood levels of aldosterone, reaction of the glomerular zone of the adrenocortical substance and the juxtaglomerular apparatus of the kidneys. Peritol therapy normalized the blood concentration of aldosterone; reactions of the glomerular zone of the adrenocortical substance and the juxtaglomerular apparatus to insulin hypoglycemia and furosemide acute testing improved considerably. After a course of parlodel therapy blood concentration of aldosterone got to normal, and reaction of the glomerular zone of the adrenocortical substance and the juxtaglomerular apparatus to insulin hypoglycemia was unchanged whereas it improved after furosemide testing.


[Role of the liver in optimization of the thyroid status of rats in hypothyrosis caused by irradiation].

Experiments were made on 100 random bred rats of various age groups, controls and animals exposed to single external gamma-radiation at a dose of 1 Gy on the 35th day of life. Thyroxine and triiodothyronine concentrations were investigated in peripheral blood and separately in arterial blood, in thyroid, portal and hepatic venous blood. The activity of T4 conversion into T3 by 5'-deiodinating enzymes of the liver microsomal fractions and the activity of the liver mitochondrial enzymes--cytochrome of C-oxidase and alpha-glycerophosphate dehydrogenase were also investigated. A decrease in thyroid excretion of T4 and T3 and T4 blood concentration was noted in rats exposed to irradiation. 5'-thyroxine deiodinating activity of the microsomal enzymes was elevated in the liver of such rats; a T3 ratio in the blood outflowing from the liver was on the increase. A conclusion has been made that 5'-deiodination in the liver of rats with postradiation hypothyrosis is effected as a result of increased production of the most active hormone T3 from less active T4.


[Influence of novodrin and obsidan on the secretory activity of tissue basophils of the thyroid and parathyroid glands].

The task was to investigate secretory activity of sets of tissue basophils of the thyroid and parathyroids during administration of isoproterenol (novodrin) and propranolol (obsidan); 32 rats, divided into 2 groups, were given a single intraperitoneal injection of 20 mg of isoproterenol (the 1 st group) and 2.5. mg of propranolol (the 2nd group) with their subsequent decapitation with a 12-minute interval for 3 h. Six rats were controls. Increased tissue activity of tissue basophils was noted and interpreted as a result of elevated secretion of calcium regulating hormones developing under the influence of beta-adrenergic drugs.


[Functional morphology of the thyroid gland in primary immunodeficiency].

Morphological changes of the thyroid in non-inbred albino rats were analysed using a complex of histochemical methods. These data show the depression of functional activity against a background of primary immunodeficiency induced by neonatala thymectomy.


[Effect of prostaglandin E2 on ion regulating and acid excretory function of the kidneys].

Prostaglandin E2 action on ion regulating and acid excretory function of the kidneys was investigated in acute experiments on intact male rats whose angiotensin-converting enzyme (ACE) had been blocked by enalapril. It was shown that i.p. two-fold PGE2 injection (0.5 mg/kg) during water load decreased diuresis, glomerular filtration, excretion of potassium, titration acids, ammonium, and increased urine pH. Sodium excretion was detected only if ACE had been blocked. In both series of experiments, an increase in chloride excretion was found to be statistically significant. A conclusion has been made that PGE2 influences directly the inhibition of acid excretory function of the kidneys.


[Probability of an association between HLA- and DR-antigens in nuclear families of patients with insulin-dependent diabetes mellitus].

Insulin dependent diabetes mellitus (IDDM) is known to associate with various antigens and alleles of the HLA-system: DR3, DR4, and DQ-determinants. However penetration of the HLA-genes, predisposing to disease, is low, suggesting a possible role of additional genes outside the HLA-system in IDDM development. Among such genes there can be a group of heavy chain Ig genes (the Gm-system). The frequency of antigens of the Gm-system C1m(1) and C1m(2) and antigens of loci A, B, C and DR of the HLA-system was investigated in 92 Russians divided into 3 groups: 1 - IDDM patients from nuclear families (n = 35); 2 - their relatives of the 1st degree of kinship (n = 34); 3 - a random sampling (n = 23). The results obtained by A. A. Lopatenok and O. S. Budyakov (1973) were used as control data. No significant difference (p greater than 0.05) was found while comparing the frequency of Gm-phenotypes in IDDM patients from nuclear families with DR 4/X and in IDDM patients from nuclear families with another DR-phenotype, nor any significant difference was noted while comparing the frequency of Gm-phenotypes in IDDM patients from nuclear families and in patients from a random sampling with the HLA-phenotype DR 4/X. Thus the relationship of the Gm-system with IDDM through interrelationship with the HLA-DR-genes was undetectable. A conclusion was made that factors of the Gm-system played no significant role in predisposition to IDDM and could not be used as its genetic markers.


[Dynamics of disorders of cellular and humoral immunity parameters in patients with insulin-dependent diabetes mellitus].

Analysis of immunocompetent cell subsets in peripheral blood of patients with insulin dependent diabetes mellitus (IDDM) and the determination of sICA-autoantibodies in their sera were performed by flow rate cytometry and compared to healthy donors and patients with noninsulin-dependent diabetes mellitus (NIDDM). It was shown that newly diagnosed IDDM was characterized by predominant disturbances of humoral immunity, and disease progression was mainly accompanied by cellular immunity disturbances. Exogenous insulin was one of the causes of such disturbances. A tendency to normalization of cellular rather than humoral immunity was observed after the onset of human monocompetent therapy of IDDM patients. It is likely that the appearance in the peripheral blood of activated T-lymphocytes accompanied by sICA-autoantibodies and increased mature B-lymphocytes and NK-cells counts corresponds to increased ADCC against pancreatic beta cells in IDDM development.


[Relationship between glucose utilization by tissues and residual insulin secretion and their role in the genesis of hyperglycemia in type I diabetes mellitus].

Altogether 67 patients aged 16 to 50 suffering from insulin dependent diabetes mellitus (IDDM) of various duration were investigated to study the effect of peripheral sensitivity to insulin on genesis to hyperglycemia in type I diabetes mellitus. Residual beta-cell insulin secretory function was assessed by the level of C-peptide in a standard food test, and the rate of glucose utilization by tissues was studied by the clamp-method under the conditions of normoglycemia. The results obtained indicate the role of a decrease in peripheral sensitivity to insulin in genesis of hyperglycemia in diabetes mellitus, type I, and the presence of reciprocal interactions between glucose utilization and insulin secretion in IDDM patients and in controls.


[Echostructure of the pancreas. Comparison with exocrine secretory activity of the pancreas in patients with diabetes mellitus].

Qualitative disorders of an echopancreatogram are noted in half of patients with diabetes mellitus (both insulin dependent and noninsulin dependent). The most significant echopancreatographic quantitative and qualitative disorders were observed in diabetic patients with a maximal decrease in pancreatic enzyme excreting activity (on the basis of lipase and trypsin debit in a pancreozymin test, daily steatorrhea and chymotrypsin amount in daily feces). It has been assumed that a degree of ultrasound changes in the pancreas in diabetes depends on a degree of fibrosis of pancreatic exocrine tissue. Ultrasound investigations with quantitative and qualitative assessment of echopancreatograms is a valuable adjuvant diagnostic method in diabetes mellitus.


[Dermatoglyphics in children with constitutional exogenous obesity].

The results of investigation of dermatoglyphics were analyzed in 544 children suffering from constitutional exogenous adiposity. The results of population-based studies of a regional medicogenetic counselling service (1240 persons) were taken as control data. Dermatoglyphic changes included papillary patterns intensified at the expense of loops and twists. An increase in the atd angle value, a-b count in boys, the presence of additional triradii, abnormal endings of the main palm lines, a reduced C line, the absence of the C triradius in patients with constitutional exogenous adiposity as well in their relatives of the 1st degree of kinship were revealed.


[Clinical variants and symptomatic therapy of the climacteric syndrome].

The paper is concerned with the results of therapy of the climacteric syndrome: the 1st group--typical CS with predominant emotional-vegetative dystonia of vagoinsular nature, skin sensitivity to a certain fraction of estrogens was increased, the 2nd group--CS complicated by hypertension, skin reaction to progesterone; the 3rd group--CS with emotional-vegetative dystonia of mixed type, skin sensitivity to estrogens and progesterone. Intracutaneous administrations of fractions of estrogens (E) and progesterone (P) were at a ratio of E:P = 4:1 for the 1st group, E:P = 1:1 for the 2nd and 3rd groups, causing a complete convalescence of 77 of 94 patients and a partial convalescence of 17 patients. In case of a partial therapeutic effect diet- and balneotherapy was recommended.


[Impulse secretion of gonadotropins in patients with various forms of amenorrhea].

Circahoral variations of gonadotropin secretion were investigated in 5 healthy women in the follicular phase of the menstrual cycle, in 8 patients with normogonadotropic amenorrhea, in 6 patients with hyperprolactinemic amenorrhea, in 4 patients with hypogonadotropic amenorrhea, and in 10 patients with amenorrhea associated with body mass deficiency. The levels of LH, FSH, prolactin, estradiol and progesterone were determined by radioimmunoassay every 20 min for 4 hours. The results suggest that the blood levels of gonadotropins in different types of amenorrhea are determined mainly by an amplitude of their impulses.


[Features of the formation, expression and transmission of basic genetic and androgen programs of the level of unusual estrogen-binding protein in sexually mature female rat hepatocytes under experimental conditions].

Some features of the formation, expression and inheritance of basic genetic and androgen programs of the level of unusual estrogen-binding protein (UEBP) in mature female rat hepatocytes under experimental conditions were investigated. Liver regeneration after partial (2/3) hepatectomy of mature rats was used for generation of a new population of differentiated hepatocytes. The UEBP content was determined by radioligand technique in control liver and at 2, 4, 14 days of liver regeneration and related to the total DNA content as an indicator of cell proliferative activity. It was revealed that the basic genetic program of low UEBP level of hepatocytes of ovariectomized females was fully transferred to daughter cell during cell proliferation and characterized by a temporary elevation of its expression during initial steps of liver regeneration. It was shown that the androgen program of a high UEBP level was completely and stably formed after androgen action in hepatocytes of ovariectomized females and was fully transferred to daughter cells during hepatocyte proliferation. However experimentally formed androgen program of a high UEBP level in female hepatocytes was completely revealed only during early steps of liver regeneration (the 4th day), its expression was essentially declined after regeneration process was over.


[Thyroid morphofunctional changes in various types of experimental chronic stress].

Structural and functional parameters of the thyroid were studied in mature rabbits, inducing stress by stimulating the ventromedial nucleus of the hypothalamus or by exposing the animals to electrocutaneous irritations. Morphometric and radioimmunoassay results have revealed thyroid activation during the adaptation syndrome. Prolonged intensive stress was shown to cause a decrease in thyroid secretory activity, reflecting change of a stage of stable resistance by a phase of depletion of compensatory resources. However the nature of changes in the blood levels of thyroid and thyrotropic hormones in experimental animals have some characteristic features. A conclusion was made of the correlation between pathogenesis of the general adaptation syndrome and a methodological approach to simulation of a body tension reaction.


[Effect of psychotropic drugs on the structure and function of the adrenal glands of control and stressed animals].

The purpose of the experiment was to investigate the structure and function of the rat adrenal glands under chronic stress and its correction. Chronic stress is known to cause hypertrophy of the adrenals, enlargement of the area of nuclei and width of the cortical and medullary layers, a decrease in the content and pathological distribution of phospholipids, ascorbic acid and neutral lipids reflecting the function of these glands. Preventive courses of litonit, pikamilon and, to a lesser degree, piracetam and relanium weakened or removed characteristic pathomorphological changes in the adrenal structure. Complex analysis of the extracerebral mechanisms of each drug revealed the highest preventive activity of litonit which can be used to correct the adrenal glands under chronic stress.


[Liver nuclear phospholipids of rats with varying thyroid status].

Thin-layer chromatography was used for fractionation of rat liver nuclear phospholipids after in vivo administration of 14C-sodium acetate. The administration of T3 to thyroidectomized rats caused a sharp increase in the incorporation of the label in all phospholipids of the nuclear fraction. The action of sphingomyelin and sphingomyelase on RNA-polymerase of nuclei isolated from the liver of thyroidectomized rats was tested. Sphingomyelin was shown to cause stimulation of RNA nuclear synthesis; parallel incubation with sphingomyelinase eliminated a stimulating effect of this phospholipid.


[A model of diabetes mellitus in dogs: combination of pancreas resection with intra-arterial administration of alloxan].

A study was made of the indices of blood sugar on an empty stomach, GTT, blood insulin, body mass and the general status in 17 mongrels during one month after various types of resection of the pancreas: the 1st group--resection (80%), the 2nd group--resection (68%), the 3rd group--resection combined with intraarterial administration of alloxan. Insulin was determined using a standard kit RIO-INS-PG-125I by a radioimmunoassay. Alloxan was injected during operation at a dose of 250 mg (5% solution) in the upper pancreatoduodenal artery. Stable hyperglycemia, diabetogenic disturbances in GTT, a decrease in the blood level of insulin, and a clinical picture of diabetes mellitus were observed after operation in the 1st and 3rd groups. A new model of experimental diabetes mellitus in dogs (a combination of pancreas resection with intraarterial administration of alloxan) was recommended.


Familial pancreatic cancer: a family study.

The etiology of pancreatic cancer remains elusive. Recent attention has been given to host factors, as evidenced by the recognition of familial aggregations of this disease and its association with several hereditary cancer-prone disorders. We have investigated a remarkable family wherein pancreatic cancer has been documented through three generations, including progeny from two of the progenitor's three marriages. The protocol involved a search for documentation of cancer of all anatomic sites. We did not find any pattern of extrapancreatic cancer occurrences, and age at onset of pancreatic cancer corresponded to population expectations. The recognition of patients at high risk for pancreatic cancer should lead to research into potential environmental factors interacting with host susceptibility for elucidation of etiology and for earlier diagnosis.


Treatment of duct carcinoma of the pancreas with the LH-RH analogue buserelin.

Thirty-six patients (21 male, 15 female) with ductal pancreatic cancer were treated with the long-acting synthetic luteinizing hormone releasing hormone (LH-RH) analogue buserelin. All patients had advanced tumor stages (stage II: 7 patients; stage III: 11 patients; stage IV: 18 patients). A monthly follow-up including clinical status, computed tomography scan, or ultrasonography and the tumor markers carcinoembryonic antigen (CEA) and H carbohydrate antigen 19-9 (CA19-9) was carried out. There were no severe side effects apart from impotency in men and hot flashes and outbreaks of perspiration in three patients. No partial or complete remission was seen. Twenty-six patients showed tumor progression with a median survival time of 4 months (range 0.5-11 months). In 10 patients a "no change" evaluation with a median survival time of 10 months (range 8-17 months) was registered. In only two of these patients there was no increase in the serum tumor markers CA19-9 and CEA during this time. In conclusion, LH-RH analogue treatment cannot be recommended in this selected group of patients suffering from advanced tumor stages of pancreatic cancer.


[Neurons of cell populations of the solitary tract nuclei in rats of both sexes].

The paper is concerned with the results of karyometric and light optic investigation of neurons of different neuron sets of nuclei of the solitary tract in mature rats of different sex. Neurons of 7 out 17 male subnuclei were shown to demonstrate structural features of higher functional activity as compared to similar female neuron sets. The correlation of functional morphology and a stage of the estrous cycle was observed in neurons of these subnuclei in female animals. Neurons of other subnuclei either did not change their activity during the estrous cycle or demonstrated signs of a decrease in function in the proestrous stage.


Effect of taurocholate on CCK release and pancreatic secretion produced by two CCK-releasing peptides in conscious rats.

The role of luminal bile salts (taurocholate) in regulation of rat pancreatic secretion was examined by studies on the effects of luminal stimulants on the pancreas during infusion of various concentrations of taurocholate into the duodenum of conscious rats. Rats with external bile and pancreatic fistulae were used. For 24 h before the experiment, pancreatic juice was excluded from the intestine but bile was continuously returned to the duodenum. From the beginning of the experiment, 8-200 mM of taurocholate was infused at a rate of 1 ml/h instead of returning the bile. Pancreatic juice was collected for a 2-h period and then 2 micrograms of pancreatic secretory trypsin inhibitor-61 (PSTI-61) (= monitor peptide) or partially purified putative CCK-releasing peptide from rat intestine (intestinal CCK-RP) was injected into the duodenum (1 ml/min). Continuous infusion of taurocholate maintained a constant rate of pancreatic secretion, except at a concentration of 8 mM, which resulted in a slight increase in pancreatic secretion. Both PSTI-61 and intestinal CCK-RP significantly increased pancreatic secretions during infusion of 20 or 40 mM taurocholate, but had no significant effect during infusion of 80 or 200 mM taurocholate. Therefore, higher concentrations of taurocholate in the intestine prevented the stimulatory effects of luminal stimulants, probably by preventing the latter from reaching CCK cells.


The effect of pituitary adenylate cyclase activating polypeptide (PACAP) on exocrine pancreatic secretion in dogs.

The effect of new hypothalamic peptides, PACAP38 and PACAP27, on exocrine pancreatic secretion was studied in five conscious dogs each with a chronic gastric fistula and a Thomas duodenal fistula. The intravenous injections of PACAP38 and PACAP27 (2.5-100 pmol/kg) induced dose-related increases in pancreatic fluid, bicarbonate, and protein secretion. The potency of PACAP27 was equal to that of VIP but was only 1/100 that of secretin; PACAP38 was less active (less than 1/10) than PACAP27. PACAP38 and PACAP27, in contrast to secretin and VIP, stimulated protein secretion; the potency of the former was about 1/10 that of the latter. The peak response to PACAP27 was about 44% of the maximal response to CCK8. Pancreatic protein secretion, but not fluid and bicarbonate secretion, in response to PACAP38 and PACAP27 was significantly (p less than 0.05) reduced by atropine. It is concluded that PACAP has a VIP-like action on pancreatic fluid and bicarbonate secretion in conscious dogs, but differs from VIP in stimulating protein secretion via a cholinergic mechanism.


Experimental hybrid islet transplantation: application of polyvinyl alcohol membrane for entrapment of islets.

In this study, we first examined in vitro a polyvinyl alcohol membrane to be used to contain hybrid islet cells, and second we tested a bioartificial pancreas with entrapment of pancreatic islets in polyvinyl alcohol membrane in rats with experimentally induced diabetes. The permeability of the polyvinyl alcohol membrane to different substances was studied in a two-cell chamber system. Glucose, insulin, and nutrients passed through the membrane easily, whereas the passage of immunoglobulin G was completely prevented, indicating that this membrane could be effective in protecting the bioartificial pancreas from immunorejection. Approximately 2,000 islets collected from three Sprague-Dawley rats were enclosed in a mesh-reinforced polyvinyl alcohol tube and transplanted into the peritoneal cavity of six Wistar rats with streptozotocin-induced diabetes. Their nonfasting serum glucose levels were significantly decreased for at least 12 days. Six diabetic rats receiving intraperitoneal transplantation of free islets without the tube showed a slight but significant decrease in nonfasting serum glucose levels for only 3 days. One diabetic rat with transplantation of the bioartificial pancreas had a significant and sustained decrease in nonfasting glucose levels from pretransplanted levels of 440-500 mg/dl to a mean value of 162 +/- 13 mg/dl for over 3 months without immunosuppression. The bioartificial pancreas was then removed, and glucose levels gradually increased to over 500 mg/dl. The results of the present study suggest that a bioartificial pancreas with entrapment of islets in a polyvinyl alcohol membrane could be a promising therapeutic approach to diabetes mellitus.


Development of diabetic complications in a new diabetic strain of rat (WBN/Kob).

The development of ocular, renal, and neural lesions was examined in male diabetic WBN/Kob rats with endoexocrine pancreatic insufficiency. As for the ocular lesions, around 15 months of age, opacity of the lens began to appear. Opacity was first observed in the periphery of the lens, and then increased rapidly in severity, extending concentrically and centripetally, until total cataracts developed. The incidence of cataracts in male rats was gradually increased and reached almost 100% at 24 months of age. As for renal lesions, the 24-h urinary total protein began to increase at about 13 months of age and reached 50-300 mg/24 h at 13-28 month of age, which was significantly higher than in age-matched male Wistar rats (15-25 mg/24 h). Electrophoretic analysis revealed that the urinary protein was almost all albumin. Morphologically, an increased GBM thickness and glomeruli with segmental or global enlargement of mesangial areas were observed. As for neural lesions, a reduction in motor nerve conduction velocity was demonstrated electrophysiologically, and a marked decrease in density and diameter of myelinated fibers in the sciatic nerves were observed morphometrically. In conclusion, the WBN/Kob rat strain with slowly developing but severe lesions associated with pancreatopathy presents a suitable model for human diabetic complications.


Diabetes manifestation in BB rats is preceded by pan-pancreatic presence of activated inflammatory macrophages.

Pancreata of normoglycemic diabetes-prone (dp) and diabetes-resistant (dr) BB rats and normal Wistar rats were screened for macrophage infiltration by immunohistochemistry and by electron microscopy. Inflammatory macrophages were found in the endocrine as well as the exocrine part of the pancreata from dp BB rats. In the exocrine tissue they had a different phenotype (ED1+, ED2+, W3/25+, Ox17+) from that found in pancreata from dr BB and Wistar rats (predominantly ED1-, ED2+, W3/25+, Ox17-). The number of macrophages in exocrine portions of pancreata from the various rat strains were not different. By electron microscopy scattered macrophage-associated tissue lesions and phagocytosis of cell debris were found throughout the exocrine tissue and in islets of dp BB rats. Such lesions were low or absent in biopsies of animals that later did not develop diabetes. We conclude that macrophage-mediated cytotoxicity during the early phases of diabetes development in BB rats is not restricted to islets, but is a generalized, pan-pancreatic event.


Responsiveness and memory of the pancreatic B-cells to the insulin secretagogues D-glucose and L-arginine in prediabetic and diabetic rabbits.

Non-insulin-dependent diabetes was obtained in rabbits following pancreatic duct ligation. The insulin responses to D-glucose and to L-arginine were studied in the isolated perfused pancreas of control, prediabetic, and diabetic rabbits. In controls, D-glucose or L-arginine caused biphasic insulin release that was qualitatively and quantitatively altered in both prediabetic and diabetic animals. Most secretagogues influence the islet response to other secretagogues by modifying the B-cell memory. In perfused control pancreas, the priming effect of D-glucose resulted in a time-dependent potentiation (TDP) of insulin release during subsequent L-arginine stimulus, whereas L-arginine induced a time-dependent inhibition (TDI) of insulin release during subsequent D-glucose stimulus. As compared with the controls, the TDP effect obtained was emphasized in prediabetic and strongly diminished in diabetic animals. In some prediabetic and diabetic cases, the TDI remained unchanged compared with the controls, and in others it diminished in prediabetic and disappeared in diabetic animals where the effect became one of TDP. The effects of TDP and TDI seem to evolve independently of the modifications of the responsiveness to B-cell secretagogues.


Evidence for a direct inhibitory effect of PYY on insulin secretion in rats.

Peptide YY (PYY) has been shown to inhibit stimulated insulin secretion under in vivo conditions in the mouse, the rat, and the dog. In the present study, we investigated the effects of PYY on insulin secretion from the isolated perfused rat pancreas and isolated rat islets. In isolated pancreas perfused in presence of 8.3 mM glucose, PYY at 10(-10) and 10(-9) M, but not at 10(-8) M, inhibited insulin secretion. In the presence of 5.5 mM glucose, PYY (10(-9) M) did not modify basal insulin release but reduced the biphasic insulin response to arginine (10 mM). PYY also markedly reduced the pancreatic vascular flow rate; this effect was observed at all three concentrations tested in a dose-dependent manner. In isolated islets, glucose (15 mM)-stimulated insulin secretion was inhibited by PYY at 10(-7) M. We conclude that in the perfused rat pancreas, PYY inhibits insulin secretion and induces vasoconstriction without a causal relationship. In addition, our results on isolated islets suggest that the inhibitory action of PYY on insulin secretion is exerted through a direct islet action.


Adenocarcinoma of the pancreas with osteoclast-like giant cells: a case report with immunocytochemistry.

Histological examination of a tumor centered in the body of the pancreas of a 65-year-old Iranian man revealed it to have a substantial component in which osteoclast-like giant cells were set within a stroma of pleomorphic mononuclear cells though other areas were composed of conventional adenocarcinoma. Immunocytochemistry was used to investigate the differentiation of the various component cells of the tumor. The carcinoma cells of the usual type expressed epithelial antigens (EMA and cytokeratin). The giant cells expressed vimentin and showed membrane staining with anti-LCA, in common with examples of cells originating from the mononuclear phagocytic system, including normal osteoclasts. The accompanying stromal cells expressed vimentin only. This implies that the giant cells are likely to have their origin in the bone marrow, whereas the mononuclear stromal cells that separate them may represent tumor cells that have lost their epithelial phenotype. The giant cells are therefore an unusual tissue response to the presence of the carcinoma.


Incest: the family context. Understanding and detecting childhood sexual abuse.

The recorded incidence of child abuse is higher than many nurses might imagine, and adult incest survivors often suffer long-term psychological effects. An awareness of the characteristics marking families where abuse takes place can alert nurses to such cases--both past and present.


Non-invasive assessment of phrenic nerve function in infants following cardiac surgery.

PND occurs more frequently following cardiac surgery than was previously thought. Electrophysiological phrenic nerve testing is a reliable early test of the nerve's function. Phrenic nerve damage, particularly in children under 18 months of age, increases the risk of respiratory morbidity. Early diagnosis enables appropriate planning and treatment.


Promoting the motivation to change. The role of facilitative leadership in quality assurance.

Quality assurance initiatives depend on the motivation of committed clinically-based staff to succeed. A bottom-up approach encourages staff to identify priorities and goals in the knowledge that significant and valid changes can be made.


A team to ensure sensitive continuing care. Setting up a symptom control/support team.

The stress and responsibility associated with palliative care is demanding for patients and healthcare professionals. A symptom control/support team can act as a resource for all involved, offering advice on symptom control, counselling, education and bereavement follow-up.


First step towards a desired outcome. Preventing infection by risk recognition.

The need for effective infection control applies to all areas of patient care, but is often carried out on an ad hoc basis. Implementing infection control procedures as part of the nursing process will ensure this area of care is not overlooked.


An appetite for life. Assessing and meeting nutritional needs.

Admitting patients to hospital provides nurses with an excellent opportunity to assess nutritional needs and intake. It also presents them with a challenge to ensure patients accept the meals offered to them. Establishing an acceptable mealtime routine and helping patients to make menu choices can help them achieve this.


Objective assessment ensures improved diagnosis. Principles and techniques of urodynamics.

Nurses are playing an increasingly active role in urodynamic investigations, and need to understand the principles and techniques involved. This article offers an overview of the diagnostic function urodynamics play in urinary incontinence.


The ebb and flow of heart disease. Circadian rhythms and coronary heart disease.

Circadian rhythms have been shown to influence morbidity and mortality associated with heart disease, and most heart attacks occur in the early morning. An awareness of this link can motivate clients to comply with 24-hour medication.


Respiratory measurements. 2: Interpreting simple measurements of lung function.

1. When lung function is being measured, it is important that it is accurately interpreted and reported. 2. Clinical history and previously recorded values should be taken into account. 3. When correctly interpreted, measurements can provide useful information to aid diagnosis.


Information will enhance compliance. Informing clients about compression hosiery.

Clients are more likely to wear compression hosiery and look after it properly if they understand how it works. Community nurses can enhance their clients' compliance by educating them about the role compression hosiery plays in treating and preventing venous disease.


Extending the parental role. Involving parents in paediatric care.

Most children admitted to hospital would prefer to be cared for by their parents. Care by parent units enable parents to fulfil this role with the encouragement and support of paediatric nurses.


Emotional support can precipitate recovery. Setting up a counselling service for breast cancer patients.

Many women who are diagnosed with breast cancer do not receive the counselling and support they require. Nurse counsellors are well-equipped to take on this responsibility, and can help women consider their treatment options.


Understanding motor neurone disease.

Understanding of neurological disorders has improved in recent years, enhancing nursing involvement in this area of care The nurses' role as the key worker within a multidisciplinary team identifies their management skills. Nursing care of people with motor neurone disease centres upon


Writing for publication: part of your career development.

Nurses are increasingly being motivated to write for publication, and indeed this now plays an important part in career development. An understanding of the publishing procedure and an awareness of the need for a simple, clear writing style will equip nurses to take on this new and challenging role.


Attrition, attrition--we all fall down. Re-evaluating staff selection and retention.

Students who drop out of pre-registration nurse education not only represent a lost opportunity, but also a waste of time, effort and precious resources. The changes heralded by Project 2000 make this an ideal time to re-evaluate attitudes towards recruitment.


A moist, odour-free environment. A multicentred trial of a foamed gel and a hydrocolloid dressing.

Exuding wounds such as leg ulcers present special problems. A clinical trial of a new foamed gel dressing showed that it provides a moist healing environment without unacceptable odour, and improves the condition of the wound when compared to a hydrocolloid dressing.


Establishing the cost of comfort. Effectiveness of mattresses in pressure sore prevention.

The treatment of pressure sores exerts a significant drain on NHS resources. Identifying mattresses which help to prevent pressure sores can result in substantial long-term savings.


Creating educational opportunities to improve care. Management of the oedematous limb.

Lymphoedema was until recently accepted as a distressing condition which was difficult to manage. The development of new treatment strategies means this condition can now be controlled. Effective education initiatives are essential to ensure that these developments are widely implemented.


In touch with the world outside. Managing sensory changes in elderly people.

The inevitable deterioration of the senses associated with ageing can significantly affect older people's quality of life. Adapting daily routines and the home environment to cope with these changes can restore temporarily lost independence.


Reward summation and the effects of pimozide, clonidine, and amphetamine on fixed-interval responding for brain stimulation.

Two models of reward summation were examined in 16 rats lever pressing for intracranial stimulation under fixed-interval (FI) reinforcement. The first model examined rate-frequency functions and the second model traded off frequency and train duration. The second model was selected to assess the effects of three drugs on reward summation. Both clonidine and pimozide inhibited FI self-stimulation, but pimozide's effect could not be distinguished from a performance deficit. Two amphetamine isomers facilitated self-stimulation in a manner suggesting enhanced reinforcement. The dextro isomer was four times more effective than the levo isomer to facilitate self-stimulation. This study shows that the combination of the FI schedule with a reward-summation model is well suited for evaluating the effects of drugs on self-stimulation. The advantages of this model are that inter-reinforcement intervals are separated, which minimizes priming and stimulation aftereffects, and more responding does not increase stimulation availability, thus eliminating rate-dependency effects.


Antagonism of U-50,488H-induced antinociception by ginseng total saponins is dependent on serotonergic mechanisms.

Morphine-induced antinociception was prevented by pretreatment with ginseng total saponins in the tail-pinch and tail-flick tests carried out in mice. The antinociceptive effect of U-50,488H, a selective kappa-opioid receptor agonist, was prevented by naloxone, a nonselective opioid receptor antagonist, in the tail-pinch but not in the tail-flick test. However, U-50,488H-induced antinociception was prevented by ginseng total saponins in the tail-flick but not in the tail-pinch test. These results indicate that nonopioid mechanisms are involved in the antagonism of U-50,488H-induced antinociception by ginseng total saponins. In addition, the antagonism of U-50,488H-induced antinociception in mice pretreated with ginseng total saponins was abolished by pretreatment with a serotonin precursor, 5-hydroxytryptophan, but not by a noradrenaline precursor, L-dihydroxyphenylalanine, in the tail-flick test. Therefore, it appears that the antagonism of U-50,488H-induced antinociception by ginseng total saponins is dependent on serotonergic mechanisms.


Effects of Ginkgo biloba extract (EGb 761) on the guinea pig vestibular system.

Previous studies have demonstrated that the administration of Ginkgo biloba extract (EGb 761) improves the compensation of the vestibular syndrome induced by transection of the VIIIth nerve. To investigate the mechanisms at play, the vestibular nuclei of alert guinea pigs were perfused with EGb 761. This perfusion always induced a stereotyped reversible postural syndrome that was the mirror image of the syndrome provoked by the unilateral lesion of the otolithical receptors. This result supports the hypothesis that EGb 761 has a direct excitatory effect on the lateral vestibular nuclei (LVN) neurons. In a second step, we quantified the horizontal vestibuloocular reflex (HVOR) of the normal guinea pig following IP injection of EGb 761. In normal guinea pig, IP administration of EGb 761 led to a reversible, dose-dependent decrease of the HVOR gain without affecting the phase of the reflex. These data help to explain the therapeutic effects of EGb 761 during vestibular syndromes and strongly suggest an impact at the neuronal level.